Se­rial killers that few pur­sue

There’s a strange re­luc­tance to study mur­der by nurse

Calgary Herald - - NP - ChriStie BlatChford

It was a cheer­ful Lisa Cor­rente who stepped to the mi­cro­phone Wed­nes­day to be­gin her cross-ex­am­i­na­tion of the woman who is prob­a­bly the world ex­pert on HCSK, the un­of­fi­cial acro­nym for Health Care Se­rial Killers.

She was tes­ti­fy­ing at the pub­lic in­quiry into the safety and se­cu­rity of res­i­dents in long-term care, aka the El­iz­a­beth Wet­t­laufer in­quiry, which has moved to Toronto for a few days of ex­pert and tech­ni­cal ev­i­dence.

The ex­pert is Beatrice Yorker, an Amer­i­can nurs­ing pro­fes­sor who while in law school in Ge­or­gia, saw on TV a story about a nurse who had been caught in­ject­ing pa­tients with potas­sium chlo­ride, to lethal ef­fect.

Law stu­dent Yorker was cu­ri­ous. She did a search for ‘nurses charged with mur­der’ on le­gal data bases, and “to my hor­ror, nine cases popped up.”

That was in the 1980s, and led to her odd spe­cialty.

In any case, Cor­rente rep­re­sents Meadow Park Long Term Care in Lon­don, Ont., the care home where the Canadian HCSK Wet­t­laufer killed the last of her eight el­derly vic­tims, 75-year-old Ar­pad Horvath.

By that time, Wet­t­laufer was freshly fired for a string of med­i­ca­tion er­rors from the Ca­res­sant Care home in Wood­stock, but no one knew it, be­cause her union (the On­tario Nurses As­so­ci­a­tion) grieved the fir­ing and suc­cess­fully ne­go­ti­ated a set­tle­ment that saw Ca­res­sant pay Wet­t­laufer $2,000 for dar­ing to try to fire her and agree to pro­vide a neu­tral ref­er­ence.

Cor­rente went over the num­bers that Yorker has found over the years, 131 cases world­wide since 1970 where health-care providers have been pros­e­cuted for mur­der or as­sault. Most HCSK are nurs­ing staff.

Only two of those cases are Canadian.

One was the se­ries of pe­di­atric deaths on a car­diac ward at Toronto’s Hospi­tal for Sick Chil­dren in the early 1980s, where one nurse was wrongly ac­cused (and ex­on­er­ated af­ter a pre­lim­i­nary in­quiry and a for­mal in­quiry) and an­other sus­pect was never pros­e­cuted.

The other, of course, is Wet­t­laufer, who wreaked her havoc over the course of al­most a decade of work, mostly in care homes in south­ern On­tario.

She was caught — though that’s clearly the wrong word — only af­ter she con­ve­niently con­fessed her crimes to a psy­chi­a­trist and so­cial worker at the Cen­tre for Ad­dic­tion and Men­tal Health in Toronto.

She later pleaded guilty to eight counts of first-de­gree mur­der, four of at­tempted mur­der and two of ag­gra­vated as­sault, all in re­la­tion to vul­ner­a­ble aged pa­tients un­der her care at three care homes and one who was still liv­ing at home.

Wet­t­laufer was sen­tenced last sum­mer to life in prison with no chance of pa­role for 25 years.

“So,” said Cor­rente, “of 131 pros­e­cu­tions glob­ally since the 1970s, only two were in Canada?”

“Yes,” Yorker replied. “Are you aware of any ear­lier ones in Canada?” Cor­rente asked.

“No,” said Yorker.

The lawyer pressed mer­rily ahead: “So, one hospi­tal case and only one case in long-term care?”

“Yes,” said Yorker. “That’s less than half of one per cent?” Cor­rente said. “Given our pop­u­la­tion, that’s a very low in­ci­dence rate?” “Very low,” said Yorker. “So would you con­sider (Wet­t­laufer) an iso­lated case? An anom­aly?”

“I don’t know if I’d go that far,” Yorker said, “be­cause we know it does hap­pen, so prob­a­bly there aren’t enough mech­a­nisms to de­tect it in long-term care.”

One of Yorker’s key points is that too lit­tle is known about health-care pro­fes­sion­als who de­lib­er­ately try to harm pa­tients, and that, with few ex­cep­tions, reg­u­la­tory and pro­fes­sional groups have demon­strated re­mark­ably lit­tle ap­petite to study the phe­nom­e­non.

Yorker’s ground-break­ing 2006 study on HCSK, writ­ten with five oth­ers from around the world, was re­jected for pub­li­ca­tion by a num­ber of lead­ing jour­nals, fi­nally land­ing only in the mag­a­zine of the Amer­i­can Academy of Foren­sic Sci­ences.

As Yorker put it once, shark at­tacks and dog bites — now, those things get at­ten­tion. But HCSK? Not so much.

Yorker wouldn’t know this, but if the rest of the first world isn’t ter­ri­bly good at re­search­ing and study­ing HCSK, Canada, with its dis­mal track record at this sort of thing, is bound to be even worse.

Not all HCSK can be pre­vented, Yorker said, but that’s no rea­son not to try to get bet­ter data, bet­ter in­for­ma­tion, about them, and to im­prove ways of do­ing busi­ness.

“There are still peo­ple so clever and so de­ter­mined they will evade the sys­tems in place, just like ter­ror­ists,” she told the in­quiry.

She sug­gested a few tweaks: There needs to be bet­ter med­i­ca­tion track­ing, for in­stance, so where pos­si­ble nurses could be linked to pa­tients, though that’s tricky with in­sulin, Wet­t­laufer’s weapon of choice and a pop­u­lar one, be­cause doses vary so greatly.

Health-care work­ers should be bet­ter ed­u­cated about what ex­actly is an un­ex­pected death, espe­cially in a care home, where death is hardly a stranger. Staffing ra­tios mat­ter.

And the whole health-care cul­ture needs to move away from blame, she said, where staff may be re­luc­tant to re­port er­rors or suspicions for fear of be­ing dis­ci­plined, to one where “if you see some­thing, say some­thing” is the ethos.

Af­ter all, though the chances of be­ing killed by a health-care pro­fes­sional are low, the lucky among us will grow old, and may end up at a care home.

In fact, such homes are the new growth area. Since Yorker did her 2006 study, there have been 41 new cases of HCSK.

And where in 2006, 70 per cent of HCSK took place in hospi­tals and only 20 per cent in LTC and nurs­ing homes, in the new cases of the last dozen years, that per­cent­age has risen to 36 per cent.

As Yorker said once, this in re­ply to a lawyer’s ques­tion about the wide­spread re­luc­tance to look sus­pi­ciously upon some­one like a kindly nurse or a pleas­ant nurse’s aide, “There are re­ally bad peo­ple out there who can trick you.”

PETER J THOMP­SON / NA­TIONAL POST

Beatrice Yorker, an Amer­i­can nurs­ing pro­fes­sor, is an ex­pert on HCSK — or Health Care Se­rial Killers.

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