ANGELS OF DEATH: THE FEMALE NURSESBY Katherine RamslandshareComments

The Malignant Hero

Every parent's worst nightmare is entrusting his or her child into the care of a person who intends it harm.� Few people would ever suspect that someone who enters the healing profession and swears on the nurse's oath would rather see children die than be healthy.� It took a lengthy investigation, breaking through walls of professional denial, and the near-destruction of a doctor's career before the truth about this malicious caregiver was discovered.

In 1982, Dr. Kathleen Holland opened a pediatrics clinic in Kerrville, Texas.� Needing help, she hired a licensed vocational nurse named Genene Ann Jones, who had recently resigned from the Bexar County Medical Center Hospital.� Many parents were happy to have this clinic available, but during a period of two months that first summer, seven different children succumbed to seizures while in Holland's office.� She transferred them by ambulance for treatment at Sid Peterson Hospital, never thinking the seizures were suspicious.� However, from the sheer numbers of children afflicted, the hospital staff thought something odd must be going on.�

They questioned Holland and she assured everyone that she was at a total loss as to why these children were suffering at her clinic.� At least they'd all recovered.� But then one of them, 15-month-old Chelsea McClellan, died while en route from the clinic to the hospital.� Dr. Holland was devastated, as were Chelsea's parents.� The child had not even been very ill.

Genene Jones 1968

Soon afterward, Genene Jones assured Dr. Holland that she had found a bottle of succinylcholine, a powerful muscle relaxant, that had been reported missing three weeks earlier.� Holland saw that the cap was missing and the rubber top punctured with needle marks, so she dismissed Jones from her employ.� She was later to learn that the near-full bottle had been filled with saline.� In other words, someone had been using this dangerous drug, which paralyzed people into a sort of hell on earth: they lay inert but aware and unable to get anyone's attention.

In February 1983, a grand jury was convened to look into 47 suspicious deaths of children at Bexar County Medical Center Hospital that had occurred over a period of four years---the time when Genene Jones had been a nurse there.� A second grand jury organized hearings on the children from Holland's clinic.� The body of Chelsea McClellan was exhumed and her tissues tested; her death appeared to have been caused by an injection of the muscle relaxant.� Jones was questioned by both grand juries, and, along with Holland, was named by Chelsea's parents in a wrongful death suit.

The grand jury indicted Jones on two counts of murder, and several charges of injury to six other children.� The various facilities where she had worked were appalled.

Problems Ignored

Yet anyone who knew Jones was not altogether surprised.� She could be inordinately aggressive, had betrayed many friends, and often resorted to lies to manipulate others.� While she'd wanted children all her life, the two she had she'd left in the care of her adoptive mother.�

Some believe that it was the accidental death of her fourteen-year-old brother that had worked on her when she was young; others that it was her adoptive father's death from cancer.� It may have been that she was ungainly, unattractive, and desperately needy, and had learned how to get attention by lying.� At any rate, she was reportedly voracious in her desire for the spotlight and for sexual liaisons, even if it cost her friends.� She had married young and was immediately unfaithful.

Jones had reserved her special ardor for doctors, seeing them as mysterious and powerful.� She wanted to get near them, so she eventually left her job as a beautician and trained for a year to become a vocational nurse. It looked like she would do very well, although she was not altogether happy about being on the bottom of the medical totem pole.

After only eight months after her first job, she was fired, in part because she made judgments in areas where she had no authority, and in part because she mistreated a patient, who subsequently complained.� She didn't last long in her next job, but soon she was hired in the intensive care section of the pediatric unit of Bexar County Medical Center Hospital.� It was here that she would leave her mark, and co-workers saw right away that Jones was unusual.

The first child she picked up had a fatal intestinal condition, and when he died shortly thereafter, she went berserk.� She brought a stool into the cubicle where the body lay and sat staring at it.�

It became clear to associates that Jones liked to feel needed and would often spend long hours on the ward, insisting it was important to a patient.� However, she skipped classes on the proper handling of drugs and made several medication errors.� While there were sufficient grounds for dismissal several times over, the head nurse protected her, which gave Jones a feeling of invincibility.� She never liked to admit to any mistakes, and now she had someone in power to back her up.� She tried to bully new nurses into looking to her for help.

Death Shift

By 1981, a year before she was finally stopped, Jones demanded to be put in charge of the sickest patients.� That placed her close to those that died more often.� She seemed to thrive on the excitement of an emergency, and even on grief when a child didn't make it.� She always wanted to take the corpse to the morgue.

It became clear to everyone that children were dying in this unit from problems that shouldn't have been fatal.� The need for resuscitation suddenly seemed constant---but only when Jones was around.� Those in the most critical condition were all under her care.� One child had a seizure three days in a row, but only on her shift. "They're going to start thinking I'm the Death Nurse," Jones quipped one day.� In fact, some of the staff called her duty hours the Death Shift.

Then a baby named Jose Antonio Flores, six months old, went into cardiac arrest while in Jones's care.� He was revived, but went into arrest again the next day during her shift and died from bleeding, the cause of which was unknown.� While treating the father for a heart attack, she allowed

the brother to carry the corpse.� Then she grabbed it and ran down the hospital corridors with the dead baby in her arms.� No one could figure out what her behavior meant, but blood testing on the corpse indicated an overdose of a drug called Heparin, an anticoagulant.� No one had ordered it.�

Another disturbing mystery.

Then Rolando Santos, being treated for pneumonia, was having seizures, cardiac arrest, and extensive unexplained bleeding.� All of his troubles developed or intensified on Jones's shift.� Finally one doctor stepped forward and told the hospital staff that she was killing children. They needed to do an investigation.� Yet the nurses continued to protect their own, especially those in charge.� Since the hospital did not want bad publicity, they accepted whatever the head nurses said.

Another child was sent to the pediatrics unit to recover from open-heart surgery.� At first, he progressed well, but on Jones's shift, he became lethargic.� Then his condition deteriorated and he soon died.� In view of others, Jones grabbed a syringe and squirted fluid over the child in the sign of a cross, and then repeated it on herself.

Finally, three months after the initial suspicions, a committee was formed to look into the problem.� They decided to replace the LVNs with RNs on the unit, and Jones promptly resigned.� To their mind, that took care of the problem.

Death Spree Ends

All it did was let her know she could get away with medical abuse, and she moved on to the Kerrville clinic.� Despite the risk of exposure in such a small place to inject children to the point of seizure, she didn't stop.

Although Dr. Holland was warned in veiled tones not to hire Genene Jones, she went ahead and did it, viewing Jones as a victim of the male-dominated patriarchy but a competent nurse.� She had no idea that by teaming up with this woman, she was about to kill her own career, her marriage, and one of her young charges.

While awaiting trial, Jones told someone, "I always cry when babies die.� You can almost explain away an adult death.� When you look at an adult die, you can say they've had a full life.� When a baby dies, they've been cheated."

Prosecutors presented Jones as having a hero complex: She needed to take the children to the edge of death and then bring them back so that she could be acclaimed their savior.� One of her former colleagues reported that she wanted to get more sick children into the intensive care unit.� "They're out there," she supposedly said.� "All you have to do is find them."

Yet her actions may actually have been inspired by a more mundane motive: She liked the excitement and the attention it brought her.� The children couldn't tell on her; they were at her mercy.� So she was free to recreate emergencies over and over.

In a statistical report presented at the second trial, an investigator stated that children were 25% more likely to have a cardiac arrest when Jones was in charge, and 10% more likely to die.� A psychiatric exam failed to give her the testimony she would need for an insanity defense.

Bexar County Court

On February 15, Jones was convicted of murder.� Later that year, she was found guilty of injuring another child by injection.� The two sentences totaled 159 years, but she's eligible for parole after twenty.

Although she was suspected in the deaths of other children, the staff at the Bexar County Medical Center Hospital shredded numerous records, thus destroying potential evidence.� Most of those personnel who had protected her resigned, and the hospital settled a legal suit brought by the McClellans.

Despite that, Chelsea's mother will never forget something she witnessed shortly after her baby was buried.� Going to the cemetery, she spotted Genene Jones kneeling at the foot of Chelsea's grave, sobbing and wailing the child's name.� Confronted, Jones walked away without a word, but took with her a bow from Chelsea's grave.

As bizarre as it is to imagine a nurse putting babies at risk to the point of death, it may be easier to explain than the next strange story.

Murder By Proxy

A map of Hungary, showing Budapest

Nagyrev is a farming village on the River Tisza in Hungary, about sixty miles southeast of Budapest, near another town called Tiszakurt.� For a time, a community of killers flourished in these two places... thanks to the midwives.� Known as the "wise women", they inspired and assisted in the murders of an estimated three hundred people over a span of fifteen years.

It started during World War I, and since there was no hospital in Nagyrev, the prominent midwife, Julius Fazekas, took care of people's medical needs.� She'd only been in town for three years, but in that time had gained a reputation for helping women get rid of unwanted babies.� Her cohort in crime, reputed to be a witch, was Susanna Olah, a.k.a., "Auntie Susi".

Most of the men had gone to war in 1914, but soon there were other men around---the Allied prisoners of war in camps outside town.� They apparently had limited freedoms, because a number of women got involved with these men, and when spouses returned, the wives were unhappy.� They'd gotten

used to their sexual freedom, it seems, and did not wish to have it curtailed.� Talk got back to the midwives about the general discontent.� Apparently they saw a way to capitalize.

Fazekas and Olah began boiling arsenic off strips of flypaper to sell to these women.� They dispensed poison to whoever wanted it, and there were plenty of takers.� It's estimated that around fifty poisoners went into action, calling themselves "The Angel Makers of Nagyrev," and because of the high death rate, the area eventually became known as "The Murder District".

In fact, some women decided to be rid of more than just an inconvenient spouse and began to poison other annoying relatives and even their own children.� Occasionally they poisoned one another.� Marie Kardos murdered her husband, her lover, and her twenty-three-year-old son.� Just before he died, she got him to sing for her.� Knowing he was poisoned, she listened to his sweet voice.� In the midst of his song, he clutched his stomach and was soon dead.� Giving testimony years later, she seemed to think this event rather delightful.� Maria Varga killed seven members of her family, considering the death of her husband in particular a Christmas present to herself.

Because Fazekas' cousin filed the death certificates, when officials poked their noses in to check on the sudden rise in the death rate, she showed them that everything was in order.� This one was a drowning (a poisoned woman tossed in the river), and that one was an illness.� There were no doctors around to make examinations, so who was to say differently?�

The first death was Peter Hegedus in 1914, and by some accounts, the poisonings stopped in 1929 only after a medical student from another town found high levels of arsenic in a body washed up on the riverbanks.� This event inspired officials to exhume two other bodies in the Nagyrev cemetery, and finding poison, arrested suspects.

By another account, the killings stopped because one woman, Mrs. Szabo, who was acting as a nurse, got caught poisoning a man's wine.� Then another patient complained of the same thing.� Under questioning, Szabo implicated a friend, who admitted that she'd poisoned her mother.� She also told on the midwife, and Fazekas was brought in for questioning.

She denied it and said they could prove nothing.� However, the authorities set a trap.� They let her go and she went about warning her customers that their game was over.� Her arsenic factory was closing down, and no one had better tell.� However, as she went from house to house, she all but pointed out to the police who the poisoners were.�

That day, they made thirty-eight arrests, with more to follow, and twenty-six women actually went to trial.� Eight received the death sentence, seven got life, and the others spent some time in jail.� Among those who died was "Auntie Susi," because it was she who had gone about town distributing the poison to various customers.� Her sister was also sentenced to death.� One account says that Fazekas was one of those hanged, but another describes her suicide by poison in her own home, surrounded by pots of boiled flypaper.� At any rate, the woman who'd come in to offer her "medical" services had inspired a shocking murder spree, and the final tally will never be known.

Authorities considered that theses women had been gripped by madness for fifteen years, brought on by their promiscuity.� They were at a loss to otherwise explain it.

Yet this isn't the only place where female caretakers have teamed up to kill people.

A Sisterhood

Medical thriller writer Michael Palmer's first novel was The Sisterhood.� It featured a group of nurses who start an underground organization to help people to die in hospitals around the country. "Nurses

bound together in mercy," the jacket reads, "pledged to end human suffering."� However, within the organization, some "mercy-killers" take things too far and patients who should have survived end up dead.� What began as a benign act of compassion became a wellspring of evil.

This story is fiction.� What follows is not.

Map of Austria, with Vienna marked

It was a nurse's aide in Vienna, Austria, who started the murder spree at Lainz General Hospital.� Most of the people who go there are elderly, many of them with terminal illnesses.� It's not difficult to hide a murder or two among people who are already at death's door.� Even so, it wasn't as if Waltraud Wagner wanted to kill not at first, anyway.

It started in 1983 and by the time officials began to look into the suspicious deaths some six years later, the death toll stood at 42.� However, an unofficial count was in the hundreds.

Wagner, 23, had a 77-year-old patient who one day asked the girl to "end her suffering."� Wagner hesitatingly obliged by overdosing the woman with morphine.� It was then that she discovered she enjoyed this kind of power, and it didn't take much to recruit accomplices from the night shift.� Maria Gruber, 19, was happy to join.� So was Ilene Leidolf, 21.� The third recruit was a grandmother, 43-year-old Stephanija Mayer.

Wagner was the "death pavilion" leader, and they planned the murders as a group.� She taught the others how to give lethal injections, and she added some fatal mechanisms of her own creation.� The "water cure" involved holding a patient's nose while forcing him or her to drink.� That was an agonizing death that filled the lungs, but undiscoverable as outright murder.� Many elderly patients had fluid in their lungs.

Moving from compassion to sadism, the women took out patients who merely annoyed them by soiling sheets or asking for help too often.� Such people were issued their "tickets to God."

At first, these nurses killed sporadically, but by 1987, they were escalating.� Rumors began to spread that there was a killer on Pavilion 5.�������

It was their own carelessness that finally stopped them.� Over drinks one day, they relived one of their latest cases, laughing over the patient's distress and the fact that she deserved her fate.� At a table nearby sat a doctor.� What he overheard sent him scurrying to the police station, and they quickly launched an investigation.� It took six weeks, but all four women were arrested on April 7, 1989.� The doctor in charge of their ward was suspended.

Collectively they confessed to 49 murders, and Wagner took credit for giving a "free bed with the good Lord" to 39 of them.� She had decided that their deaths were long overdue, and she reveled in the fact that the power over their lives rested with her.� However, one of her accomplices believed that Wagner's death count was closer to 200 in just the past two years.

As she sat in prison awaiting trial, Wagner scaled her culpability back to ten murders, all of them for reasons of mercy.

The jury didn't buy it.� Ultimately, Wagner was convicted of 15 murders, 17 attempts, and two counts of assault.� She was sentenced to life in prison.� Leidolf got life as well, on conviction of five murders, while the other two drew fifteen years for manslaughter and attempted murder charges.

As the state attorney put it, "It's a small step from killing the terminally ill to the killing of insolent, burdensome patients, and from there to that which was known under the Third Reich as euthanasia.� It is a door that must never be opened again."

And yet it has been opened again and again.� And not all the nurses are female.

Hospital Phantoms

Map of Michigan

The Veteran's Administration Hospital in Ann Arbor, Michigan was the scene of a high death rate during the summer of 1975.� Up to forty patients had died from an inexplicable respiratory failure.� Since the hospital was a government facility, the FBI stepped in, and by August, they confirmed that eight men had definitely died from unnatural causes.� Declaring a killer was at large who was using Pavulon, they warned that until they identified this person, any patient was vulnerable.

Pavulon is a muscle relaxant derived from curare, a drug that can paralyze.� It has to be delivered carefully and when not in use is kept locked up.

The investigation continued for months, with suspicion centering on two nurses from the Philippines, Lenora Perez, 31, and Filipina Narciso, 30.� They were the two who were on duty each time the patients in question were stricken. Soon they were both charged with murder.� Several relatives of the deceased were called as witnesses during their trials, stating that the nurses had been seen in the vicinity of the patients, and even in their rooms, during the fatal seizures.

However, coincidence and sparse circumstantial evidence made up the prosecutor's entire case, and that wasn't sufficient for convictions.� No one had actually seen them administer a drug and no one could link them to the Pavulon.� The judge even vacated the murder charge against Perez.

Even so, the trial for Narciso took thirteen weeks, with all the guns the FBI could bring to bear.� Finally, she was acquitted, although both nurses were convicted of conspiracy and poisoning.� Yet the convictions were appealed and the appeals court set them aside.� At a second trial, the charges were dismissed and the murders remain unsolved.

Toronto skyline

The same thing happened at the Hospital for Sick Children in Toronto.� From June 1980 until March the following year, there was a significant rise in infant deaths in the cardiac ward.� In fact, it was alarming.� Somewhere between 21 and 43 deaths occurred, which was an increase for that facility of over 600%.� Most of them were suspicious.

After twenty deaths, several nurses expressed their concern.� The resulting investigation did not deter whoever was behind these crimes.� An autopsy on one tiny victim showed that an elevated level of digoxin, a drug for regulated heart rhythm, was in the tissues.� The baby was only 27 days old.� Similar deaths occurred over the next few days, and there seemed to be no way to end this spree, so the hospital called an emergency session.�

The result of that was to suspend the cardiac ward nurses for three days to search their lockers and look over their work schedules.� Then another baby died on the ward from digoxin overdose.� None of those nurses was there.

Yet based on other nurses claiming that she made odd remarks and facial expressions, Susan Nelles was arrested and charged with four counts of murder.� Twenty-four of the suspicious deaths had occurred during her shift.� She was placed on leave until her trial came up.

That action didn't stop odd things from occurring back at the hospital.� One nurse found propanolol capsules in her salad and another caught some on her soupspoon.� That seemed to imply that Nelles was not the culprit and the "maniac" still stalked the hospital.� Yet now he or she was going after the nurses.�

When Nelles went to trial, sixteen more murders were cited that followed the same pattern of the four with which she was accused.� However, there was no evidence, and ultimately the charges were dismissed.� The judge even went out of his way to insist that Nelles was an excellent nurse.

Results from examinations of thirty-six of the infant cases were sent to Atlanta, Georgia, to the Center for Disease Control.� They noted that 18 were suspicious, and others were consistent with poisoning.

Then another baby died.� Gary Murphy was six months old, and his tissues showed elevated digoxin levels.� Nurses came forward to accuse Phyllis Trayner, who denied the charges.� No one pursued the matter, one nurse resigned, and the final official reports left the many unsolved murders "open."

From individuals to groups, both male and female, caregivers are harming their patients.� What makes someone do such things?

Motives

It is unfortunately a fact of bureaucracy that administrators will inevitably hide whatever makes their agency or company look bad to the public in order to keep the revenue flowing in.� The paramount issue with hospitals is trust: If patients don't feel safe going to a particular facility, they'll choose another, and that is to be avoided at all cost.�

The fact is, one bad apple doesn't make the entire facility unsafe, but public perception can exaggerate the situation, especially with the media's help.� The typical manner of dealing with suspicious caretakers is to move them into jobs where their contact with patients is minimal, or pressure them to leave, but that's just not sufficient to stop them.� Numerous physicians and nurses have been protected by administrators, and because of that, their compulsion to harm or kill continues.

In fact, protection by superiors supplies the first motive mentioned on the list below.� While there's no one reason why these men and women take advantage of their patients the way they do, most fall into the following categories.

1. Testing feelings of invincibility.�Genene Jones certainly felt protected, and when she added in her ability to generate attention and the fact that she managed to get away with murder for several years, you have a person developing a serious sense of megalomania.� She had power over her patients and she seemed to feel she had power over those with whom she worked.� She could charm them into siding with her, which left her free to do what she wanted.

2. Attention.In some cases, nurses who kill are seeking attention, and they may have developed a personality disorder known as Munchausen by proxy syndrome. Often, they return to a healthcare facility many times, making people in their care sick so they can hang out with doctors and get their attention. The more hopeless the case appears, the more they revel in it while feigning concern.� They mostly just seek attention and care, although a small percentage of them secretly hope to baffle a physician.� If the medical staff at one place suspects fakery, the patient is likely to notice the change in attitudes and move on to another. They may repeat the same scene in each place or come up with new symptoms altogether.� Some even inject their charges with a toxin to simulate an organic disease. Most Munchausen by proxy patients are female.� They know how to lie in great detail and to disguise what they're doing.� What happens to their charges is not their concern; they're in it for the attention. Not all of them are nurses, but some of the nurses in charge of children may have this disorder.

3. DisdainPsychologist David Canter says that the way people treat the objects of their violence speaks to how they feel about people in general, and about themselves.� A number of nurses who've been caught exhibit poor self-esteem.� While motives attributed to them are often about gaining power over vulnerable people, it may go deeper than that.� They may feel so inadequate that harming others or setting up a risky situation is the only way they can place themselves in terms of worth over other people.� Their disdain for the patient mirrors their disdain for themselves.� This could come from abuse as a child or the

failure to be accepted by peers.� Whatever the case, they act out what they feel for themselves.

4. Compassion.Several nurses have claimed that their fatal injection or asphyxiation of patients was done out of a sense of mercy.� A 24-year-old nurse in Budapest, "Timea F," who is also known as the Black Angel because she always wears black, is suspected in the deaths of forty patients over the span of a year.� The motive she offered in her confession was that she hoped to "ease her terminally ill patients into death."� The patients were ill and in pain, with no hope of recovery, and it seemed best to help them.� However, "mercy-killing" has often been a cover for some other dark motive, so it's not necessarily to be trusted.� Nor is it a justification.

5. PsychopathyA large percentage of the nurses appeared to show no feelings of remorse for what they had done, or to have any concern about the people they killed.� There were no apologies to families of the deceased.� In fact, many psychopaths roam free in society, and for those who feel compelled to kill, what better place to do it without discovery than a facility where people die anyway?� They're generally good at charming themselves into a position and at hiding what they're up to.� It's easy for their colleagues to miss the signs.� Many psychopaths are driven by anger and take it out on the most vulnerable people within reach.� Some kill just for the physical charge it gives them, which may derive from a depressed autonomic system.� About the only way to stop them is better vigilance in the hospital system.�

6. The malignant heroAs with doctors, there have been nurses who set up risky situations in order to create an emergency where they can emerge as heroes.� It matters little to them that the patients might die, and in fact that's been the case with those who were caught.�

7. Financial gainA few of the caregivers see a way to enrich themselves by conning vulnerable people or stealing from them.� Some use a "wallet-opening smile" while others just find a way to take what they can.��

Let's take a look at a couple of cases like that.

Benign Exploitation

Several nurses have viewed the field of patient care as a way to con people out of their money and enrich themselves.� One of the most clever was Amy Archer-Gilligan.�

Map of Connecticut with Newington marked

Although she had no qualifications, Archer-Gilligan billed herself as a nurse in 1901 and opened a nursing home for the elderly in Newington, Connecticut.� Her devoted patients called her Sister Amy.� Six years later, she moved to Windsor, ten miles away, and opened another elderly care facility, the Archer Home for the Elderly and Infirm.� It was here that she came up with a scheme.

Sister Amy persuaded some of her patients to pay an insurance premium of $1000, for which she promised them lifetime care, no matter how long they lived.� It seemed too good to be true, and it was.� Many of her patients turned over the money, and once she had it in her possession, she made sure they took up no more of her resources.� Smothering or poisoning them, she explained their deaths to the local physician who signed the death certificates as old age.

Dr. Howard King apparently saw no reason to be suspicious, despite the rising death toll at Sister Amy's 14-bed facility, and he continued to sign off on each fatality.� Between 1911 and 1916, there were 48 deaths, and in fact, both of Sister Amy's successive spouses had died, too, one of them within a year of marrying her.

By 1914, authorities started to get suspicious.� An undercover officer signed himself into Sister Amy's nursing home.� He listened to her spiel and collected evidence of fraud and foul play, and then took his findings to his colleagues.� They exhumed the bodies of Amy's second husband and some of her former patients.� Finding high doses of arsenic in the body tissues, they charged Amy Archer-Gilligan with six counts of murder.� Consulting with physicians, they discovered that an average death toll in such a small place would be eight to ten, not forty-eight.� How could Dr.�King not have noticed?

Oddly, he sided with the killer, claiming that the poison had been planted in those bodies to frame her.�

Nevertheless, Archer-Gilligan stood trial, and her defense amounted to this: She was a good Christian, which prohibited her from doing such things.� Although she was only convicted of the most recent murder, she was given a life sentence.� She ended up serving it in an institution for the insane.

Another nurse, Anna Marie Hahn, had a similar idea, but she pursued it more like a grifter.� She came to America from Germany in 1929 and settled in Cincinnati, Ohio.� There she began to administer health care to several elderly men, ingratiating herself into their wills.� Most of them were wealthy, and she was soon showing off their "gifts" of appreciation.� By the mid-1930s, she had acquired one estate and was taking what she could from the homes of two other patients who had died.� Since the final hours of these men had not been easy, word came to the police that there was something suspicious going on.� The latest victim was exhumed.

It turned out that the "nurse" had used arsenic and a strong purgative to dispatch her charges.� A search of Hahn's home revealed a cabinet full of poisons, which led to the exhumation of her other patients.

At her trial, Hahn's own husband turned on her, telling the court that she had tried to persuade him to insure his life for a large amount of money.� He refused and then suffered from severe stomach cramps soon thereafter.

While Hahn admitted to swindling and theft, she claimed to be innocent of the three murders.� Yet the jury convicted her and she had the honor of being Ohio's first female executed in the electric chair.

Killing for money is a mundane motive, but it makes more sense than those nurses who promise to nurture and heal, and then kill for excitement.

Just For the Fun of It

In the past century, only two women have been executed for federal crimes.� Both took place in 1953.� In Massachusetts, where the Salem witch trials still leave a haunting residue, no woman has been executed since 1789, and most residents are against the death penalty.� Yet in March, 2001, there was some concern that, despite how they felt, the citizens of Massachusetts might have to honor a federal mandate from the District Court in Springfield to turn over one of their own to death row.� Even worse, this woman was a nurse.

Kristen Gilbert

Kristen Gilbert, 33, worked on Ward C of the Veteran's Affairs Medical Center in Northampton, Massachusetts.� When she was there, it seemed that too many patients died from cardiac arrest.� In 1996, three nurses came forward to report their fear that there was a killer among them.� Their concerns inspired an investigation.

Gilbert is the divorced mother of two sons, 7 and 10.� To her coworkers, she seemed normal enough, but under her care, four patients were dead and three others had succumbed mysteriously to near-fatal heart failure.� Added to that was the inexplicable shortage of epinephrine (synthetic adrenaline), a drug that stimulates the heart.� More notably, Gilbert seemed to love the excitement of an emergency when some patient's heart raced out of control.

To look into this matter, investigators exhumed the bodies.� Just as the nurses feared, a toxicology analysis found epinephrine in the tissues.� Since that drug had not been prescribed for these men, there was no reason for it to be in their bodies.

Then someone phoned a bomb threat into the hospital, and Gilbert was arrested, tried, and convicted for this apparent attempt to divert the investigation.� She served fifteen months.� She was also treated for psychiatric problems.

Digging around, the prosecutor, Assistant U.S. Attorney William M. Welch II came up with a theory: Gilbert was having an affair with a member of the hospital security, James Perrault.� Whenever there was an emergency call, he came rushing to respond.� That meant Gilbert could see him and do a little flirting.� Welch even accused her of killing one patient so she could leave early for a date.

With their affair long over, Perrault testified against her.� He said that Gilbert had actually admitted to him one day that she'd killed the patients by injection.� Added to his testimony were frightening things that the nurse said.�

Nurse Kathy Rix, suspecting something was wrong, counted the epinephrine bottles one afternoon.� There were three.� Then there was a cardiac emergency, and when she went back to see if the bottles were still there, she found none, but there were three broken containers in the needle disposal bucket.

One nurse said that she'd heard the first man who'd died cry out, "Stop! Stop! You're killing me!"� At the time, Gilbert was in his room.

Bonnie Bledsoe, another nurse, claimed that Gilbert had offered her some adrenaline when she said she suffered from asthma.� Gilbert pulled it right out of her pocket.

David P. Hoose for the defense claimed that no one had witnessed his client injecting epinephrine into the patients, and since all of them were ill, how could anyone point the finger at her?� People die in hospitals all the time.� Perrault had turned on her because of trouble they were having, not because she'd actually confessed.� In fact, she'd just been angry at him and was trying to be provocative.� He'd made more of her words than she'd intended.� As for the missing epinephrine, he blamed other nurses with drug problems, and said that the toxicology analysis on the bodies was shoddy science.� He even accused the federal prosecutor of going after his client, a white woman, to balance out the high percentage of minority men on death row.

In the end, Gilbert was convicted of three counts of first-degree murder, one count of second-degree murder, and two counts of attempted murder.

Since these crimes were committed on federal territory, the government could put her to death.� The prosecutor was certainly asking for that, with the aggravating circumstance that her victims were highly vulnerable and her attitude had been cruel and heartless.�

However, when her sentence was announced, Kristen Gilbert got life in prison.

A Sexual Game

Gilbert's idea of excitement pales in comparison to the next team of caregivers. It was in Walker, Michigan in 1987 where a pair of lesbians made death a sexual game.� Gwedolyn Gail Graham, 23, and Catherine May Wood, 24, worked together at the Alpine Manor Nursing Home.� Graham was a nurse's aide and Wood was her immediate superior.� Wood had divorced and gained an enormous amount of weight, so she was hungry for a friend.� When she met Graham, they immediately hit it off and soon became lovers.

It was Graham who first broached the subject of murder.� They practiced sexual asphyxia to achieve greater orgasms, so Wood later claimed she thought Graham was kidding.� Yet the linked pain and pleasure of their sexual games became threaded with the idea of cruelty.� Just talking about murder got them both excited.

They started killing patients in January and continued for three months, picking patients to kill whose initials would end up spelling "murder."� Graham called this "the Murder Game."� Posting Wood as sentry, she started with several elderly women, but they struggled so hard, she had to back off.� Yet they did not register a complaint, and in fact, most of the patients liked these two women.

Then Graham went into the room of a woman suffering from Alzheimer's who would not be able to fight her off.� She smothered the woman with a washcloth.� In the weeks that followed, she moved

on to another, and then another.� There were times when the act of killing so excited her that she and Wood went to an unoccupied room for sex.� Graham even took items off the victims---jewelry or dentures---to help her to relive what she had just done, and she found enormous emotional release in murder.

When they washed the bodies down as part of the postmortem routine, they grew even more excited.

Then they got bolder.� They told colleagues what they were doing, because even the confessions added to their heightened sexual drive, but their accounts were dismissed as sick jokes.� Graham showed three aides her shelf of souvenirs, and still no one stopped them.

Then Graham wanted Wood to take a more active role.� To prove her love, she would have to kill one of the patients herself.� Wood wasn't ready for this, so she got transferred to another shift.

Graham took up with another woman and then left Michigan to go work at a hospital in Texas taking care of infants.� A terrified Wood confessed everything to her former husband, but it took him over a year to take action.� Finally he called the police.

Of the forty patients who had died in that three-month period, eight seemed suspicious enough for further investigation.� Then they settled on five, and arrested both women.� Wood turned state's witness against her former lover for a sentence of 20 to 40 years.� She told them she'd come forward because of Graham's claim to her that she wanted to "take one of the babies and smash it up against a window."

To offer a mitigating circumstance, Graham said that her father had molested her, but this charge was never proven.� Her lawyer also claimed that Wood came forward with lies just to get even with a lover who had left her.� This was a set up.

The jury believed Wood.� Graham was convicted on five counts of first-degree murder and one count of conspiracy to commit murder (although Wood had claimed that she'd tried to smother five more patients.)� She got six life sentences, with no possibility of parole.

People, both male and female, who take advantage of vulnerable patients to feed their own needs are in some way depraved.� They defy society's code of trust, and some of them are obviously sadistic.� Whether it's because something terrible was once done to them or because they just needed to feel more powerful, they make people everywhere wary entrusting themselves to the healthcare system.� Thus their damage is more profound than whatever they do to their victims.� In a real way, society itself becomes their ultimate victim.

Despite Media, It Doesnt Stop

Healthcare serial killers (now referred to as HCSKs or SHCKs) have become prominent in the media over the past decade, and yet around the world nurses are still killing patients:

Vickie Dawn Jackson In July 2002, Vickie Dawn Jackson, 36, was indicted in Texas for

four counts of murder at Nocona General Hospital.� Prosecutors believe that she injected lethal doses of mivacurium chloride, a muscle relaxant that temporarily stops a person from breathing, into elderly patients to end their lives. � Several vials of that drug turned up missing.� Ten bodies were exhumed to run tests and early in 2004, Jackson was indicted on three more counts of capital murder, one count of attempted murder, and one count of injury to a disabled person.� She is suspected in as many as twenty-five deaths, according to Associated Press reports.� Her trial is scheduled for October 2004.

Christine Mal�vre

Christine Mal�vre was charged with the murder of seven patients in 1997 and 1998 at a lung hospital in Mantes-la-Jolie, France.� She confessed and said that she had wanted to help them to die out of compassion.� In fact, according to Reuters, she said that she had assisted around thirty patients to die, but then she reduced that number to two and claimed she had done it at their request.� Two others, she said, had been accidents.� She had written a book about her acts, called My Confessions, apparently in an attempt to bring attention to the need for euthanasia for incurable and painful diseases.� Families of her victims denied that those people had made any such request to have help ending their lives.� Mal�vre was sentenced in January 2003 for six of the deaths to a prison term of ten years.� She is also permanently banned in France from working as a nurse.

Martha U was chronicled in Paula Lampes book, The Mother Teresa Syndrome, after being convicted in 1996 of murder in the deaths of four elderly patients.� (Lampe is also detailing the de Berk case above in another book, and she offered her study for this article.)� Martha U was suspected of killing nine�patients.� She had worked for twenty years in a geriatric nursing home and had used insulin to overdose the patients.� In two cases, the patients

apparently had angered her, one by showing anger himself and the other by throwing food at her.� Nevertheless, she insisted that she had killed to end the patients suffering.� Yet she had murdered patients who were not as ill as others in the same room.� If anything, Martha U was clearly inconsistent.� She had made statements, according to Lampe, to the effect that she could not stand people dying, and she had resuscitated one patient who could have died peacefully.� Lampe viewed her as having narcissistic personality disorder and a hero complex.� None of the patients who died were considered to have been terminally ill.� Martha U was a loner but also a compulsive helper.� Immediately upon her arrest, she confessed.

Lampe, living in the Netherlands, used Martha Us case to discuss the fine line between aggression and the desire to be needed.� Those caregivers with self-esteem issues and other personal needs may go over the line.� Lampe, a former nurse, said in the book that Martha U did not murder to help others but to end her own unbearable feelings of transparency.� In other words, she was satisfying her own needs rather than the needs of her patients.� The helping aspect was actually a compulsion, and that kind of addiction can lead to murder.� Referring to an FBI theory, Lampe indicated in a news report that killing gives psychopaths who have such a low self-esteem a sense of power.� That fact that they carry a secret, namely I have killed someone and nobody knows, also gives them power.

Several professionals are now attempting to devise what could be termed a prospective profile of HCSKs, hoping to devise a constellation of red flags that colleagues can become aware of and use effectively.� Lampe suggests that those nurses who seem compulsive, secretive, and consistently in the area of emergencies or Code Blues ought to be the focus of more scrutiny.� Beatrice Crofts Yorker, associate professor of psychiatric mental health nursing at Georgia State University, has collected numerous cases and noted that many involved injection of non-controlled medicationsperhaps an area of concern for hospitals.� She, along with others in law enforcement, indicate that the following signals should be taken quite seriously:

Statistically, there is a higher death rate when the suspected person is on shift

The suspect deaths were unexpected The death symptoms were also not expected, given the patients

illness or procedure The suspected person is always available to help He or she is often the last one seen with the victim The suspected person has moved around from one facility to

another Other staff members give that person nicknames like death

angel The person is overly interested in the death

Other patients have complained about the persons treatment of them

The person is secretive or has a difficult time with personal relationships

The person has a history of some form of mental instability or depression

Identifying such people as soon as possible requires documenting patterns of behavior and finding physical evidence that links the suspected individual to the crimes.� �Unfortunately, intentional killers, as well as people who become addicted to killing as the result of a mercy killing or two, have the perfect arena in which to get away with murder for long periods of time.� Hospitals are places of trust and the means to kill patients are readily available.� In addition, medical murders are not easily detected.� Stopping this phenomenon requires a sharp eye, an awareness that any care facility is vulnerable, and a desire to ensure that suspicious people be taken seriously.

Bibliography

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French Nurse Jailed in Six Deaths, Reuters, Feb 1, 2003.

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"Hospital Killings Spark Health Reform," Budapest Dispatch, March 21, 2001.

Jones, Richard Glynn.� Poison!� Secaucus, NJ: Lyle Stuart, Inc., 1987.

Lampe, Paula.� The Mother Teresa Syndrome, Holland: Nelissen, 2002.

Lane, Brian and Wilfred Gregg.� The Encyclopedia of Serial Killers.� New York: Berkeley, 1995.

Lucy, David and Colin Aitken.� �A Review of the Role of Roster data and Evidence of Attendence in cases of Suspected Excess Deaths in a Medical Context, Law, Probability and Risk (2002) 1, 141-160.

Newton, Michael.� The Encyclopedia of Serial Killers, New York: Checkmark Books, 2000.

Nurse Accused of Killing Patients says Shes Innocent as Trial Begins, Canadian Press, September 24, 2002.

Nurse Indicted on Additional Counts in Texas Hospital Deaths, .kron4.com, 2004.

Nurses in Missouri and Texas Charged with Killing Patients, Reuters, July 18, 2002.

Pyrek, Kelly.� �Healthcare Serial Killers: Recognizing Red Flags, Forensic Nurse, September/October 2003.

Schlesinger, Louis., ed.� Serial Offenders: Current Thought, Recent Findings.� Boca Raton, FL: CRC Press, 2000.

Scott, Gini Graham.� Homicide: One Hundred Years of Murder in America.� Los Angeles, CA: Roxbury Park, 1998.

Tynan, Trudy.� "Nurse's Case has Few Precedents," Southcoast Today, March 18, 2001.