Friends of the Forensic Science Club, this week we present the paper “Serial murder in medical clinics and care homes”, by Beine, K. H. (2022), in which the author compiles information about serial murders in nursing homes and hospitals carried out by nurses in the Germany, Austria and Switzerland context. 

We have seen in recent years a number of murders in clinics and nursing homes coming to light in courts around the world. 

Due to the darkness and lack of knowledge surrounding these types of crimes, we should take a look at the trials for the cases already uncovered and see if they yield clues to help in the prevention of the phenomenon, avoiding future cases. 

In addition, early identification, by co-workers, of those at risk of committing these crimes is crucial for patient safety. However, it appears that this detection is often blocked by the fact that colleagues and managers consider it “impossible” for such behavior to take place in their institutions.

In German-speaking countries (Germany, Austria and Switzerland), a total of 12 such serial murders have been prosecuted. Worldwide, 57 have been documented

This study was limited to murders committed in Germany, Austria and Switzerland until February 2022. The author examined victim characteristics, crime scenes, types of murder, perpetrators and their motivations, among other points of interest. 

There were a total of 205 confirmed victims ranging in age from 31 to 96 years. 

In some cases of homicides in residences and hospitals it is not possible to confirm that some victims were murdered. This happens because there are long periods of time between the crime and the investigation. Therefore, it is possible that the actual number of victims is much higher. 

Only in a few cases the victims were in a process of irreversible death. On the other hand, there were others who were recovering and were even about to be discharged. 

In 8 crime scenes, important negligent handling of drugs was discovered. In most cases drugs considered lethal agents were used, such as insulin, sedatives and muscle relaxants, anesthetics, antiarrhythmics or potassium chloride, among others.

It is important to know that post-mortem examinations were not performed thoroughly or competently at these crime scenes, so it is possible that the reckless use of drugs occurred more frequently than could be proven. 

In addition, in several cases extensive bruising and visible puncture marks went overlooked. 

In all serial murders it was clear that co-workers had noticed strange behavior on the part of the accused. This behavior was even reported to bosses and managers.

The 17 perpetrators convicted in the 12 cases were 53% women. The remaining 47% were men. Their average age was between 33 and 34 years. All of them were nursing professionals. Most of them lived alone and 5 of them were prohibited from practicing their profession.

In terms of psychological characteristics, they were introverted persons, with a development of distant and cold interpersonal relationships, a reserved and tense personality, existence of denigrating comments and harsh language, as well as aggressive outbursts

Murderers were found to have higher than average insecurity and narcissistic personality traits. They perceived insecurity as a weakness incompatible with their image and, therefore, concealed and repressed it. 

In all cases there was no single determining motive for committing the crime, but rather unique combinations. For example: the quest for power, wanting attention from others or a supposed compassion for the victims. 

Due to the complexity of these types of cases, a thorough investigation is required to increase the effectiveness of prevention. 

In addition, there is a need for more reciprocal attention among coworkers, detailed information about each patient, teamwork and good communication.

Efforts to improve prevention efforts are imperative precisely because we know so little about the dark undercurrents of homicides in hospitals and nursing homes. 

In short, the author urgently calls for experts in the mind of the killer to get to work to curb the spread of this criminal phenomenon.

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