Other Complicating Factors
Another problem in bringing legitimate cases to prosecution is when providers are accused on trumped-up charges, which in Dr. Iserson’s view amounts to prosecutorial malpractice. Examples are cases post-Hurricane Katrina, when physicians and nurses were charged with patient deaths.
Internationally, an example is the case in Libya where the main defendants—a Palestinian doctor and five Bulgarian nurses—were charged with injecting 426 children with HIV in 1998, causing an epidemic at El-Fath Children’s Hospital in Benghazi. According to World Politics Watch, dozens of foreign medical professionals were arrested, with six eventually charged and forced to confess by Libyan authorities. Subsequent research published in the journal Nature indicated that viral strains present in the infected children were present at the hospital before 1998.
“This was a case of political blackmail,” says Dr. Iserson. These cases may not be clear-cut and may be open to negative interpretations that “make people skittish. That is why institutions are prone to say, ‘Gee, maybe it’s just one of those kinds of cases. We don’t want to make that kind of mistake.’ ”
Also problematic is the variable rate at which hospitals perform autopsies.
“Autopsy rates are down in many communities to 1% or 2% or even lower,” says Dr. Kizer. “When the data point to the possibility of a crime on a particular unit, the site needs to be treated as a crime scene. In most hospitals, when someone dies, you get them off the floor and you clean up as quickly as possible. That shouldn’t be the case if it is a suspected crime scene. Ideally there should be standardized processes or protocols whenever there is suspicion. And those protocols may be different than when a patient ordinarily dies.”
Seeking Solutions
Hospitalists and other professionals—especially nurses and ancillary personnel—have an obligation to be informed and astute regarding individual characteristics and signs of suspicious patient deaths. Appropriate epidemiological, toxicological, and psychological data must be collected and analyzed routinely.
“Data about this phenomenon need to be disseminated to heighten awareness that serial murder of patients is a significant concern that extends beyond a few shocking, isolated incidents,” write Drs. Yorker and Kizer and their co-authors.
Institutional hiring practices must be changed so balance is achieved between preventing wrongful discharge or denial-of-employment lawsuits and protecting patient safety. Existing state legislation and future federal legislation for institutional immunity is an important element of patient advocacy that hospitalists can support.
Ultimately, hospitalists must be informed, aware, and alert. “Most [suspicions] will not be anything,” says Dr. Iserson. “Just pay attention to it.” TH
Andrea Sattinger is a frequent contributor to The Hospitalist.
References
- Yorker BC, Kizer KW, Lampe P, et al. Serial murder by healthcare professionals. J Forensic Sci. 2006 Nov;51(6):1362-1371.
- Wolf BC, Lavezzi WA. Paths to destruction: the lives and crimes of two serial killers. J Forensic Sci. 2007 Jan;52(1):199-203.
- ASHRM. American Society for Healthcare Risk Management. A call for federal immunity to protect health care employers … and patients. Chicago: Monograph; April 1, 2005; www.ashrm.org/ashrm/resources/files/Monograph.Immunity.pdf.