Angels of Death: The Male Nurses

Paula Lampe in the Netherlands, author of The Mother Teresa Syndrome, has collected information about healthcare serial killers, male and female, for years. Since 1970 in the Netherlands, she counts four male and five female such killers, while around the world she has counted 81 cases, 31 of which are male. This does not include physicians who kill, but only those people in position to act as a nurse.

Her own findings indicate that what motivates many of these people are what she terms "feelings of transparency," by which she means lack of self esteem or feelings of unworthiness. They are killing to enhance their own sense of value and of power. Most of her detailed work has been done on cases of female healthcare serial killers, but some of her findings seem to apply to males as well.

A number of experts around the world are attempting to devise a way to spot these killers earlier in their careers in order to make the administrators of hospitals and nursing homes take complaints about them more seriously. Lucy and Aitken in Scotland have written about the use of statistical evidence, Karl Beine in Germany has called attention to the problem, and Beatrice Crofts Yorker, associate professor of psychiatric mental health at Georgia State University in the U.S., has been quite outspoken about the constellation of warning signs that could be useful.

Male nurses are disproportionately represented among caretakers who harm patients. While there are many more cases, quantitatively, of females who indulge in this behavior, Beatrice Yorker, Director of the School of Nursing at San Francisco State University, cites a striking statistic: the 146,000 male registered nurses represent five to seven percent of all nurses yet are responsible for more than one-third who have killed patients in the U.S. since 1975. In an article for The New York Times, Jerry Lucas is quoted as saying that large numbers are unhappy, facing rampant sexism, stereotyping and belittlement. Some leave while the rare nurse who kills may be seeking empowerment, as well as venting some anger.

Utah State Prison

Al Carlisle, a psychologist who worked with inmates at Utah State Prison, describes serial killers as having divided souls, or a compartmentalized self. They offer a public persona that appears to be "good," while nurturing a darker side that allows their murderous fantasies free reign. Because they have painful memories, they have learned to use fantasy to escape. Such fantasies can turn violent and demand an avenue of release. Situations that bear some similarity to the fantasy, such as feeling powerful over the bedridden, may trigger acting it out. Then when he derives satisfaction from that, he feels compelled to do it again.

In other words, the expression of unacceptable impulses and desires eventually becomes an equal part with the "good" persona, and then becomes a dominating part. Via rehearsal and opportunity, the person feeds his fantasy until he becomes an unquenchable habit.

Among the red flags for spotting male healthcare serial killers, then, are:

• a person who likes to "predict" when someone will die
• a person on whose shift a higher incidence of Code Blues or deaths occur
• a person who seems inordinately enthused about his or her skills, and likes to arrive early or stay late on a shift
• a person whom others have seen inside a patient's room shortly before that person's health unexpectedly deteriorated
• a person who likes to talk about death with colleagues or shows odd behaviors related to the death (excitement, ownership, undue curiosity)
• a person who keeps to him- or herself, and prefers shifts where fewer colleagues are around
• the person is given macabre nicknames by others on staff
• there are several incidences associated with this person at different institutions
• some of the suspect substance was found in the person's home
• there are inconsistencies in their statements when asked about the incidences
• the person has been involved on other criminal activities
• the person appears to exhibit surreptitious behavior
• the person makes colleagues anxious or suspicious
• the person seems to crave attention
• the person tries to prevent others from checking on patients
• the person hangs around during the immediate death investigation

While none of these is sufficient to place someone under a cloud of suspicion, a number of them occurring together should be taken seriously.

With this in mind, let's look at more cases. Not all of the people involved are proven serial killers, and not all have been convicted. Even those that are have been suspected in many more deaths. A few have killed outside the professional arena.