Angels of Death: The Male NursesshareComments

Mercy or Power?

Charles CullenCharles Cullen, 43 and a male nurse, is among those healthcare professionals who apparently decided over the years that certain patients should die.� �When he was charged in two cases in December 2003, according to the Newark Star Ledger, he admitted that in the past 16 years in the 10 healthcare institutions in which he worked, he was responsible for taking the lives of 30 to 40 patients.� He was being merciful, he said, but their cases and his actions indicate otherwise.�

Although he has not yet specified the names of his victims as of this writing, in the past year he dispatched almost one patient per montha rate that raises questions about his motives.� �He also confessed in a way that indicated the murders were a source of empowerment for him.� He didnt have to confess, so why did he?� Was he trying to tell those with whom he has worked, See what I got away with all that time?

Reverend Florian GallCullen has been charged with the murder of Reverend Florian Gall at the Somerset�Medical Center in Somerville, New Jersey, and the attempted murder of cancer patient Jin Kyung Han, who was saved from his overdose by an antidote but who died months later from unrelated causes.� On both, Cullen is suspected of using a lethal dose of digoxin, a heart medication, which he procured through deceptive computer manipulation from hospital supplies.� After he was fired, he

was found to be the common denominator among six patients with abnormal test results.

In fact, Steven Marcus, a toxicologist and executive director of New Jersey Poison Information and Education System, had warned Somerset�Medical Center in July 2003 that they had a poisoner on their staff.� He spotted a cluster of at least four cases.� Hospital officials dismissed him, says the Newark Star Ledger, and had even complained about Marcus to the states health department, saying he had rushed to judgment and was pressuring them unduly.

Likewise in 2002, nurses at St. Lukes Hospital in Bethlehem, Pa., had warned the state nursing board, law enforcement, the county coroner, and even Cullens next employer that he could be a killer.� �They had seen a spike in Code Blues, reports the Morning Call, and had attempted to get a thorough investigation.� Nurses at two nearby facilities had also demanded that Cullen be dismissed and investigated.� However, hospital administrators had declined to pass the word along via a negative reference.� One nurse was even fired for her part in whistle-blowing.

Three days after his arrest, Cullen became a suspect in the unexpected deaths of two more patients in Pennsylvania�hospitals, and one woman was exhumed as part of the investigation.� Another already had a toxicology report of digoxin in the blood although he had not been prescribed this medication.� The results of both cases are pending.

In court at his arraignment, Cullen pleaded guilty to the charges and said he had no intention of fighting.� �He did not even want a lawyer, but in a quick turnabout accepted a public defender, who subsequently said Cullen might offer names in exchange for avoiding the death penalty.

A resident of Bethlehem, Pa., Cullen is the youngest of nine brothers and sisters.� �The New York Times reported that their father was a bus driver, their mother a home-maker.� Cullen grew up in a working-class neighborhood in New Jersey, in a strongly religious Catholic family.� His father died when he was an infant and his mother while he was in high school.� Two of his siblings have also died, and he cared for one of them during the process.�

In 1978, he enlisted in the Navy and when he got out, he attended a nursing school.� �By 1988, he was working at the first of many hospitals where he would stay only a short while.� He got married and had two daughters, but soon was divorced.� In 1998, says the Morning Call, he filed for bankruptcy and had a pile of debts and back payments due in child support to the tune of over $66,000.� He lost his dog to the animal protection agency, and though he seemed inconsiderate of others, he claimed he felt picked on.

In 1997, signs of a troubled mind surfaced.� �Cullen was taken to a hospital in New Jersey because he suffered from depression.� He refused to provide a blood sample and afterward filed a police report against the doctor.� Just over two years later, he lit coals in a bathtub and sealed off his apartment in a suicide attempt.� A neighbor called the police and when they took him in, they learned that this was not his first attempt.� An A&E broadcast in 2004 indicated that he had threatened a former girlfriend by breaking into her home to let her know how vulnerable she was.� He clearly was troubled.

As his debt mounted, he moved from one hospital to another, and at St. Lukes in Bethlehem, PA, he left to avoid an investigation into the deaths of 69 patients and into a mysterious box of heart medication found in a disposal bin.� �While the coroner determined at the time that there was no evidence of criminal conduct in any of the cases, many of those deaths will be reviewed again in light of Cullens confession.� There had been no toxicology reports on those patients and only one autopsy had been performed.� In short, it was a superficial investigation with no determination about the

medications present in the bodies.� The next step, if suspicions warrant it, would include exhumations.

Despite his spotty work record, Cullen never had trouble getting another job, probably due to the shortage of nurses.� �Yet he was fired outright in October 2003, amid questions concerning the death of Reverend Gall.� Now hes being investigated in seven counties across two states.

Representatives from the Somerset�Medical Center said they did not know that Cullen had been investigated elsewhere.� When they checked his credentials, according to a report in USA Today, they learned nothing that would have made them hesitate to hire him.� All they received were his dates of employment.� It was at this facility where Cullen may have done his deadliest work, admitting to killing between 12-15 patients in only 13 months.� Had concerns been passed along, things would have been different, and that upsets hospital officials.� Now theyre faced with a massive investigation and damage to their reputation.� Someone, they believe, should have warned them.

Healthcare Serial Killers

Shipman, Harvey & Angelo�

While Cullens stated motivemercy for seriously ill patients--may seem compassionate, other healthcare professionals convicted as killers have also made this claim, but a closer examination indicated otherwise.� �British physician Harold Shipman, who kindly made house calls, fed a sense of superiority as he dispatched at least 15 elderly women and maybe more than 200.� A forged will was found in his home.� Nurses aide Donald Harvey, who initially admitted to 80 mercy killings, seemed to enjoy the confessing as much as the killing.� Richard Angelo, a male nurse on Long Island convicted in four deaths, said he just wanted to feel more confident. (See more on Angelo and Harvey below.)

Harold ShipmanNurses who kill perceive how to exploit the atmosphere of trust in the healthcare community and how to hasten deaths that may go unnoticed in an already vulnerable arena.� �In the past 30 years, according to the Philadelphia Inquirer, there have been at least three dozen such cases in civilized societies, with more suspected.� Some

enter the profession as angels of death, while others transform into killers on the job.

Understandably, potential patients would like to know how to spot dangerous nurses before harm is done, but often these nurses seem like everyone else.� �They dont stand out.� Neighbors of Cullens just thought he was quiet.� Patients adored Dr. Shipman, even as he gently killed them.

While arguments have flown back and forth over the Cullen case in terms of ultimate responsibility, its clear that patients must depend on hospitals and clinics to spot the red flags and do something about them.� �Too often, these killers have been allowed to drift from one hospital to another, fired under a cloud of suspicion but rarely brought to justice until after incriminating evidence has reached shocking levels.�

Hospitals claim that if they pass on suspicions in a way that prevents someone from getting hired, they could be sued.� �But the hospitals where Cullen worked are discovering, says The Morning Call, that they may be sued for not doing so, and their insurance carriers are not going to cover them.� Intentional acts of murder are not considered part of professional practice, say the companies.� The hospitals, caught in a sort of Catch-22, are on their own.� If families move ahead on their threats to sue those facilities that did not voice suspicions when asked or did not warn other potential employers of Cullen, this case might become a real wake-up call.

In an article for Forensic Nurse, Kelly Pyrek indicates that since the mid-1970s, there have been 36 cases of serial murder among nurses and other healthcare workers in the�U.S. � A survey shows that the incidences appear to be increasing, with 14 during the 1990s and already five since 2000. (The article was written before Cullens atrocities came to light, so that makes at least six.)

Many experts speculate, says Pyrek, that healthcare has contributed more serial killers than all other professions combined and that the field attracts a disproportionately high number of people with a pathological interest in life and death.

This is partly due to denial, since many people refuse to believe that someone might enter the healthcare industry with anything but the purest motives.� �The most susceptible patients are very young children, who cant report suspicious activity, and the elderly or very ill, who are expected to die anyway.�

One of the first male nurses to come to the nations attention was Donald Harvey.

A Wake-up Call

Donald Harvey in courtBy the time he was 18, Donald Harvey was working in the medical profession as an orderly.� From May 1970 to March of the following year, he worked at Marymount hospital in London Kentucky.� He noticed people who seemed to be suffering, so, according to him in

interviews, he decided to do something about it.� His method was to smother.� He might use a pillow or he might use a near-empty oxygen tank.� Over the course of his stint there at the hospital, he killed at least a dozen people.� On a tape located by A&E Special reports for a 2004 broadcast, Angel of Death, he methodically describes in chilling detachment exactly how he worked.

Then Harvey�was arrested for burglary, for which he was fined, and he left that job for the Air Force.� After a year, he was discharged and soon he was committed to a hospital himself and placed in restraints.� He received numerous electroshock treatments and finally emerged to try to get work again.

Cincinnati VA Medical center�

He became a nurse's aid at Cardinal�Hill Hospital in Lexington, Kentucky and at Good Samaritan.� Then he moved on to the Cincinnati VA Medical center in Ohio.� This job he held onto for nearly ten years, working variously as a nursing assistant, housekeeper and autopsy assistant.� (One of his former lovers had been a mortuary assistant who enjoyed having sex after hours with corpses.)�

Sometimes Harvey�stole tissue samples and took them home.� Some say he practiced occult rituals with the human flesh.� Whatever he was doing, he certainly renewed his urge to kill, taking the lives of about 15 patients, but adding poison to his arsenal of death methods.� He even joked about it at time.

Charles SobhrajThen in 1985, he was caught with a pistol in the facility and forced to resign.� �At the time, he was reading a paperback biography of another serial killer, Charles Sobhraj, possibly to get ideas.� He went right to work as a nurse's aid in Drake Memorial Hospital.� There he killed at least 23 more patients by injecting them with different lethal substances like arsenic, cyanide, and petroleum-based cleansers

before his arrest in April 1987.� Some victims were chosen by occult means, as Harvey chanted over fingernails or hair that he placed on a homemade altar.�

Harvey�also poisoned people outside the hospital.� An argument with a neighbor inspired him to lace her drink and she nearly died.� He poisoned a lover, whom he then nursed back to health, but whose parents weren't so lucky.� The man's mother died by Harvey's hand, and the father became critically ill.

It was the death of a patient named John Powell that finally brought Harvey�down.� During his autopsy, the physician detected high levels of cyanide, and the death was ruled a homicide.� Harvey was arrested, but he pleaded not guilty by reason of insanity.� Then he confessed to killing 33 people, then 52, then more than 80.� He claimed that most were mercy killings

A psychiatrist who examined him said that not only was he was legally sane, he was a compulsive killer, murdering to relieve tension.

On August 18, 1987, in a Cincinnati�courtroom, Donald Harvey pled guilty to 24 counts of murder and four counts of attempted murder.� Then he added another murder plea, all of which got him a huge fine and four consecutive life sentences.

Then in Kentucky, he admitted to twelve more murders, but entered a guilty plea on only nine of them.� �There he got eight life terms, plus twenty years.

Yet he wasn't finished.� �In Cincinnati again, he confessed to three more killings and three attempts to murder.� That amounted to 37 official murder victims in total, which gave him the U. S. record to that date (and still holding, pending the Cullen investigation) as having the most confirmed victims of any healthcare serial killer in America.

It wasnt long before another homicidal male nurse popped up.

Defending Harvey

The odd thing about William Whalen's new book describing his relationship with killer nurse Donald Harvey is that while he's ambivalent about the way Harvey has long fed on publicity, he's also giving him this chance to "tell his story."� Actually, Defending Donald Harvey (Emmis Books) is largely Whalen's story.� He was Harvey's defense attorney, and one might easily question the ethics of some of his decisions.� For example, after the first murder came to light, he urged a suspicious reporter to "keep digging" and decided that since Harvey had confessed to him a number of hospital murders, he needed to protect society rather than attempt to get his client off.� He justifies that, hoping to get readers to sympathize with his difficult position, and many will.� Nevertheless, there are several situations throughout this case in which Whalen seems less concerned with the demands of our justice system than with his personal issues.� And, surprisingly, he remained friends with Harvey after his part was done.� It's difficult to know, when all is said and done, what he really thinks about Harvey: Sometimes this serial killer is a monster, sometimes merely a pathetic human being.

The story is familiar to anyone who knows about healthcare serial killers, so there's not much new here.� Even the reporter, Pat Minarcin, who broke the story and who adds an "Afterword," merely repeats most of what Whalen says.� Since there has been no other book on Harvey, this is a good addition to the extant literature on serial killers, but otherwise there seems little justification for retelling Harvey's story at this time.

Harvey was caught when an autopsy revealed a toxin in the body of a male patient, John Powell, and at the time, no one put much effort into considering that he may have caused other deaths as well.� It was Harvey himself who started the momentum by confessing to his public defender, who then urged Minarcin to find a way to dig up evidence.� Harvey told Whalen that he had lost count of how many people he'd killed (including people outside the hospital), but that it had not been more then seventy.� In the end, says Whalen, he was convicted of thirty-six murders and one charge of manslaughter, although beyond the official tally there were clearly many more victims.

No Mercy Killer

Harvey continues to insist that he was a mercy-killer, but the facts indicate otherwise.� Over the course of eighteen years in several different institutions, he killed for petty reasons as well as mercy.� One man he just didn't like; another he killed out of revenge.� And then there were the acquaintances he poisoned with arsenic who just happened to have annoyed him.� There seems little doubt that he was engaged in occult practices when he chose some of his victims, and the opening scene of this book has him lighting candles that stand for specific people and deciding from a candle's flicker that the person symbolized by that candle should die.� He supposedly believed he was receiving commands from some spirit named Duncan.� Even so, Whalen wants to accept the idea that Harvey's acts were somehow the result of projecting his own depression onto his patients (although he also sometimes rejects this explanation).

While Whalen attempts to set Harvey apart by comparing him against a description from a book that stereotypes serial killers, he fails to make comparisons against studies of healthcare serial killers, aside from a passing glance at Charles Cullen (whom Harvey believes may have actually corresponded with him for a short time).� Despite himself, Whalen makes it clear that like many serial killers, Harvey was cold-blooded about this business but was a complete coward when it came to his own death.� He also loves attention, inflating his victim count to 87 when he was not getting enough, and he appears to be a callous narcissist.� In other words, among serial killers, he's not that unique.

But there's a more important issue at stake.� It's clear that Harvey should never have gotten the jobs he did, and since Cullen's story is sadly similar, we can see from this account that not much has changed since 1987 when Harvey was caught.� Indeed, hospital administrations still protect their institutions and letters of warning to others still fail to get sent.� In addition, the idea of an "internal investigation" by administrators who ignore whistleblowers is as much an empty gesture today as it was back then.

Yet Harvey offers a solution. He likes to "help" by describing his methods and telling hospitals what they did wrong in creating situations that allowed him to kill unhampered.� In other words, he revels in his acts, blames others, and deflects responsibility from himself.� So what else is new?� There will always be ways for determined predators to kill, no matter what safeguards are put into place.� The bottom line is, short of psychosis, they choose to exploit the trust engendered in healthcare communities and to take the lives of vulnerable people.� There's not much here about Harvey to feel sympathy for.

Murder for Self-Esteem

Richard Angelo, arrest photoOperating around the same time at Good Samaritan Hospital on Long Island�in New York was Richard Angelo, 26, from Lindenhurst.� He was a former Eagle Scout and volunteer fireman.� Unlike Harvey, he said that he was motivated more by the idea of saving people than killing them.� He just wasn't very good at it.

He had put himself into situations where he could be a hero.� �Since he worked as an emergency medical technician and Charge Nurse, he saw plenty of opportunities, so he decided to take a chance.� Injecting something into the IV tube of a patient named John Fisher, Angelo created an emergency.� The man was soon in critical condition, but before Angelo could save him, he died.� That one was a failure, but Angelo tried again.�

"I wanted to create a situation," he later said in a taped confession, "where I would cause the patient to have some respiratory distress or some problem, and through my intervention or suggested intervention or whatever, come out looking like I knew what I was doing.� �I had no confidence in myself.� I felt very inadequate."

Some of the patients survived, some died.� �It's estimated that he managed to kill ten people in his desire to be important.�

Then one patient, Gerolamo Kucich, caught him.� �Kucich saw a bearded man put something into his IV, and he managed to reach for his call button before he succumbed.� That action saved his life.� He then told some nurses about the man and they linked the description to Angelo.� Kucich's nurse took a urine sample and had it analyzed.� It came back testing positive for the paralyzing drugs, Pavulon and Anectine, which had not been prescribed for this patient.

A search of Angelo's apartment turned up vials of both drugs, so he was arrested.� �He confessed that he'd murdered several patients.� Ten bodies were exhumed and the paralyzing drug was found in their system.� Angelo was soon nicknamed Long Island's "Angel of Death."

Richard Angelo in courtCharged with multiple counts of second-degree murder, which meant murder with depraved indifference, Angelo pleaded at his 1989 trial that he suffered from a mental disorder that precluded him from understanding the nature of his offenses.� �In short, he pleaded a form of temporary insanity at the time of each death.�

Two psychologists testified that he suffered from a personality disorder called dissociative identity disorder, formerly known as multiple personality disorder.� �They said that he had not recognized the risks to these patients, and after he'd injected them, he'd moved into a dissociative state that made him unaware of what he'd just done.� He felt inadequate and sought to create situations in which he could feel powerful and heroic.� The psychologist rested his findings on the fact that Angelo had been wired to a polygraph during questioning and had proved truthful about his state of mind during the murders.� However, the judge would not allow him to talk about that in court.

Countering this, the state had two mental health experts agree that Angelo suffered from a personality disorder but not one that precluded him from appreciating whether his actions were right or wrong, or even just risky.� �He knew what he was doing while he was doing it.

The jury convicted Angelo of two counts of second-degree murder, one count of second-degree manslaughter, one count of criminally negligent homicide, and six counts of assault.� He was sentenced to 61 years to life.

Troubled Caretaker

Orville Lynn MajorsSome people don't learn from the examples of others.� �Before Orville Lynn Majors, LPN, joined the nursing staff at Vermillion County Hospital in Clinton, Indiana, in 1993, only around twenty-six people died there per year in the intensive care unit.� It was a small facility with only 56 beds.

Then a larger percentage of people began to die.� �It's true that they were mostly elderly, yet it still seemed astonishing that in 1994, the deaths there rose to 101, with 67 of them in the last half of the year (and 63 of them during Majors' shifts).� In only 22 months of his service there, 147 people died, most while he was working.� Majors seemed oblivious that someone would eventually grow concerned.� A nursing supervisor started asking questions.

Majors' license was suspended in 1995 and the death rate returned to normal.� �Clearly something was amiss, and a $1.5 million investigation that covered 160 deaths between May 1993 and February 1995 revealed that Majors sometimes took his own initiative in "treating" patients, something for which he had no authority.� Investigators exhumed 15 bodies to examine tissues, finding that at least six deaths were consistent with the administration of epinephrine and potassium chloride.� Most had experienced a rise in blood pressure before their hearts had stopped.� Police searched Majors'

residence, where they found a stash of suspicious syringes and needles, along with the two drugs.� They also found potassium chloride in vials in a van owned by Majors' parents and driven by him.

It wasn't long before Majors was suspected in up to 130 deaths.� �In December 1997, he was arrested and charged with six counts of murder.� An independent statistical report run on all of the deaths indicated that patients were 43% more likely to die at the hospital if Majors was working.

Orville Lynn Majors going to courtSeventy-nine witnesses were paraded through his trial, some of whom had witnessed him injecting the patients who later had died (and in his position, he was not authorized to give any injections).� �Others claimed that he was callous toward patients, saying things like, "Let them die."� One witness, a former roommate, stated that Majors had said that senior citizens should be gassed.�

Majors claimed to be innocent and attributed the high percentage of deaths during his shift to his long working hours and overtime.� �It was a weak defense at best.

On October 17, 1999, Majors was convicted of six counts of murder, for which he received a sentence of life in prison.

There are others, such as Robert Diaz, convicted in 1984 in California�of killing 12 elderly patients with a lethal dose of heart medication, and Brian Rosenfeld in Florida whose death toll may run to 23.� And in some places, the murders in which male nurses were suspected were never solved.

Red Flags

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 5 to 7 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 patients room shortly

before that persons 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 persons 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, lets 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.

Code Blue Junkie

Nurse Joseph Dewey Akin, 35, who worked at Cooper�Green Hospital in Birmingham, Alabama, was tried in September 1992 for killing Robert J. Price, 32, a quadriplegic, with a lethal dose of lidocaine.� Investigators suspected Akin in over one hundred deaths in the area over the past decade in twenty different facilities where he worked.� However, many of those facilities had thwarted investigations.

Akin had long been suspected of causing many Code Blue medical emergencies, both in Alabama�and in hospitals around the metro Atlanta area.� The number of such emergencies at one hospital in Georgia was unusually high when Akin was working there, and colleagues noticed that at least four types of heart drugs had been stolen.

In the incident in which Akin was arrested, the amount of lidocaine found in Prices body was twice the lethal dose and four times the therapeutic dose.� �While defense experts attempted to explain it as something other than murder, prosecution experts had a ready counter-explanation.

At Akins trial, Marion Albright, Prices assigned nurse, testified that when she came back from a lunch break she saw Akin walking out of Prices room.� �She attempted to enter it to check on her patient but he had tried to prevent her from doing so.�

Akins defense lawyer stipulated that the initial cardiac arrest was caused by a blocked ventilation tube, and that the amount of lidocaine found in his body was given to Price when the emergency team was trying to save his life.� �The defense also pointed out inconsistencies in nurses testimony and in hospital records, as well as the fact that the hospital had originally billed the Price family for the lidocaine, indicating that it had been ordered for him (and if not, they had billed falsely).

In the end, after just over an hour of deliberation and only two votes, the jury decided that the circumstances warranted a conviction. When the verdict was read, Akin put his hand to his face.

One juror, when interviewed for the Atlanta Journal and Constitution, said, Too many people all placed him at the scene of the crime, and nothing he said to explain it made sense.

On appeal, Akin's conviction was overturned, yet when he was tried again, the jury was unable to reach a verdict.� Another retrial was scheduled for March 1998, but two months before it was to begin, Akin pled guilty to manslaughter.� He received a sentence of fifteen years.

Extracurricular Murder

Some nurses kill while on the job; others wait until theyre on their free time.� �The New York Post, Daily News, and Newark Star Ledger carried the stories on this suspect, as did many New York-based gay newspapers and Web sites.

Along the rural East Coast during the early 1990s, the remains of five middle-aged men were found dumped along some roadway.� �Found variously in Pennsylvania, New Jersey, and New York, they had been murdered, dismembered, and wrapped tightly in several layers of plastic bags.� From the method of cutting with a saw and a knife, wrapping and disposal, it seemed to be the work of a single perpetrator, and he was soon dubbed the Last Call Killer.� There were also similarities in the way the victims were bound and in ligature marks on the wrists.� Many leads were followed, but all of them went cold.

Then a new technique for getting fingerprints off plastic bags was developed.� �Called vacuum metal deposition (VMD), it involved an expensive high-tech machine that coats evidence with gold and zinc to develop the latent prints into near-picture quality.� The oils from the prints absorb the gold, and the zinc bonds with it to reveal each place where the gold stuck except where it was absorbed.� The prints then stand out like a developing photograph, giving a reverse image of them.

When New Jersey�investigators learned about the VMD technique, they sent gloves believed to have belonged to the Last Call Killer, found on a body, and two dozen of the bags that had been collected from the bodies for analysis.� Scientists in Toronto managed to lift some prints, which the NJ police ran through AFIS in all fifty states.� They got a match in Maine named Richard Rogers.� Sixteen prints from nine of his fingers were identified.� He was a fifty-year-old registered nurse from Staten Island, having worked for the past twenty years at Mount Sinai Hospital in Manhattan.

It turned out that Rogers�had a history.� He had bludgeoned an acquaintance to death, wrapped the body in a tent, and dumped it on the side of a road.� When he was charged with manslaughter, he claimed self-defense and was acquitted.

The MO was just too coincidental.

On May 27, 2001, Rogers�was arrested and charged with the murder and dismemberment of two of the victims found in New Jersey: the July 1992 murder of Thomas Mulcahy, 57, a business executive from Sudbury, Massachusetts, and the May 1993 killing of Anthony Marrero, 44, a hustler at the Port Authority Bus Terminal in Manhattan.� Police have both fingerprints from the bags, carpet fibers that are similar to those found in Rogers home, and bite mark evidence for the Mulcahy murder.� He was also the one with whom the gloves bearing Rogers fingerprints were found, and those gloves had been purchased on Staten Island.� There were two fingerprints and a palm print matching Rogers on the bags wrapping Marreros parts.

He remains a suspect in the other three, with new evidence announced in January 2004 about two of them: Peter S. Anderson 54, an investment banker who was found in 1991 on the Pennsylvania

Turnpike showed 18 of Rogers fingerprints on the bags that wrapped his remains; Michael Sakara, 55, a New York law journal typesetter found in 1993 on a rural highway was last seen at a gay bar and was seen with Rogers.� �In addition, another man, Matthew Pierro, who was last seen in 1982 in a bar in Orlando, Fla. and was found murdered had bite mark impressions on his chest that appear to be a match for Rogers (who had attended college in Florida and who was placed in Florida at the time the victim disappeared).� One other murder that shares a similar MO is that of Guillermo Mendez, 50, a Cuban refugee who was not known to be gay but who was found in 1992, dismembered, drained of blood, and scattered around Schenectady, New York.

On January 21, 2003, Rogers�was indicted by a grand jury in New Jersey on two counts of murder and two counts of hindering apprehension.� One of the murders occurred in Ocean County and the other in Burlington.� The body parts of Thomas Mulcahy were found by state workers who were emptying trash cans.� Both victims, found a year apart, had been repeatedly stabbed.� Apparently Rogers was barely acquainted with them, having just met them before they were last seen alive.

Rogers trial is pending, as are further charges.� �At issue will be the fingerprint method, as well as the New Jersey prosecutors jurisdiction, since the murders may not have occurred in New Jersey.� If experts affirm its reliability, Rogers will have a difficult time with a defense.� Nevertheless, he denies involvement in any of them.

The U.S. is not alone in unwittingly providing killing grounds for unstable male nurses.

Universal "Care"takers

Around the world, examples can be found of males in the position of nurses who have caused deaths.�

Kevin CobbKevin Cobb, a 38-year-old nurse who worked in the casualty department at St. Peters Hospital in Chertsey, Surrey, England, was convicted in May 2000 of one count of manslaughter, two counts of rape, and four counts of drugging women with intent to rape.� Cobb injected patients with midazolam, a powerful sedative, which causes short-term memory loss.� It also resulted in the death of fellow nurse, Susan Annis.� Cobb had slipped the drug into her cider while they were eating, intending to rape her after the drug took effect.� Instead, Ms. Annis, who had a minor heart problem, collapsed and died. Cobb portrayed himself as a hero, claiming he tried to revive her, and was seen crying at her funeral.� He might have gotten away with it, but then Janine Cuddington, a patient, complained that she lost consciousness on a hospital gurney and awoke to find herself being raped. She immediately went

to the police, who did tests and found traces of midazolam in her blood. Her immediate action was a key factor, as midazolam cannot be detected after 8 hours.�� After the police had been notified, two more victims came forward.� Cobb received seven life sentences, but remains a suspect in half a dozen more such rapes.

On January 14, 2004, a 34-year-old Swiss man identified as Roger Andermatt was arrested for the murder of 24 patients. He was also charged with the attempted murder of 3 patients, and another three deaths were classified as assisted suicide. � �He confessed to them all.� The murders all occurred between September of 1995 and June of 2001, and they took place in nursing homes in and around Lucerne, Switzerland.� The victims, aged 66-95 were suffering from Alzheimers disease or in need of high levels of care.� Nine patients were killed with lethal doses of medication, eight patients were smothered with a plastic bag or a cloth, and 10 patients were killed using a combination of drugs and smothering.� Andermatt claimed to have killed out of pity, although he added that he and his nursing team, felt totally overworked by the volume of care they had to provide to their patients. Forensic expert Rudolph Hauri describes the crime as, The largest case of euthanasia ever seen in Switzerland.� The trial will take place at the end of 2004 or the beginning of 2005.� If found guilty, Andermatt could face up to 10 years in prison for his crimes.�

Ted MaherIn France, an American male nurse, Ted Maher, in prison for manslaughter in the case of a multi-billionaire banker, escaped in 2003 but was caught again.

Farther East

Daisuke MoriIn 2001 in Japan, Daisuke Mori, 32, was arrested and charged with the murder of Yukiko Shimoyama, 89. � �He was also charged with four counts of attempted murder of a 1-year-old girl, an 11-year-old girl, a 4-year-old boy, and a 45-year-old man.� Mori was a nurse in the Hokuryo Clinic in Izumi Ward, Sendai, and the victims were his patients.� Prosecutors say he

administered a muscle relaxant to his victims through an intravenous drip, implying that he replaced a bag that was prepared by other nurses with one that contained the lethal doses. The alleged attacks occurred between February and November 2000, yet Mori pleaded not guilty to the charges.� There were no witnesses to the alleged acts.

The Clinic became suspicious when some of Moris patients conditions suddenly deteriorated.� �Two days after the police began investigations, Mori was fired. When he attempted to leave with his belongings he also tried to take empty ampoules from the clinic.� These ampoules were tested, and traces of vecuronium, the primary ingredient of muscle relaxant, were detected.

Sketch: Daisuke Mori in courtProsecutors say Mori wanted to attract attention by bringing his victims close to death and then performing emergency resuscitation on them.� �They also say he had complained about his working conditions and the doctors at the clinic.

Mori originally confessed to the crimes, but then recanted, saying he was forced to confess.� �He also insisted that the clinic invented the charges in a bid to cover up medical blunders.� His lawyers claim that whatever happened to the patients was due to side effects from medication.

Prosecutors took an unprecedented three days to make their final arguments.� They demanded life imprisonment.� As of this writing, the disposition of this case has not been decided.

The Dabbler

Hu Wanlin is a Sichuan�native of China.� He received only a primary school education, and then led a troubled life.� While serving a sentence in jail for intentional homicide, swindling, and abducting and trafficking in women, Hu decided to try something different.� In 1993, while still in jail, he opened a medical practice.� Four years later Hu was released from prison, and although he had no legal certification, he continued to practice medicine in the Shaanxi and Henan provinces.

Hu called himself a miracle-worker who could diagnose patients with only a cursory examination that might last only five seconds.� �He worked in the traditional practice of qigong, which requires the healer to emit qi from his body. The qi would have curative powers, without physical contact being necessary.� There were thousands of such practitioners in China, with eager followers.� Hu himself became a public figure, having his medical practice and medical miracles described by a well-known Chinese novelist, Ke Yunlu. � Yet scientists denounced him.

And there were problems.� �Hu sold home-made herbal medicines, which were mixed with the mineral salt mirabilite.� These medicines contained lethal amounts of sodium sulfate.� He didnt

save his patients; in fact, some died.� Three deaths were clearly attributed to his illegal and unsafe practices.

Hu was arrested in January 1999 at the age of 50, suspected in causing the deaths of nearly 150 patients.� �He was charged with illegally practicing medicine and was found guilty and sentenced to 15 years in prison. � As part of his punishment, he no longer has the right to vote for five years and he had to pay a fine 150,000 Yuan.�

According to reports in the Xinhua News Agency, this case helped bring attention to the problems China has had with unauthorized medical practice, and China has now set up a medical licensing system under which only licensed doctors are allowed to treat patients.� In 1999, 300,000 Chinese passed a national medical examination and became Chinas first group of licensed doctors.

Killer Shaman

Ahmad Suraji was an Indonesian shaman, or sorcerer, who was locally respected for his powers of supernatural healing and granting wishes.� �In 1997, the 45-year-old shaman was arrested after an investigation turned up the bodies of several missing women on Surajis sugar cane plantation. � Police officers found twenty-six skeletons of females which they believed were the remains of some of Surajis victims.

The victims were mainly prostitutes who came to the shaman with wishes to be made more beautiful.� �Although they had not been patients, they had been vulnerable to his exploitation of their belief that Suraji had powers of healing and enhancement.� In fact, the eldest of his three wives, Tumimi, was convicted as well, charged with being his accomplice.

Suraji confessed to the 42 murders, saying that he had actually planned to kill even more--72 in all. � �He claimed that in 1986 his late father, from whom he believed he had inherited his supernatural powers, had contacted him during a dream and ordered him to do so as part of a black magic ritual. � In order to improve his shamanic skills, he admitted that after strangling the women, he drank their saliva.

He showed no remorse for his actions throughout the trial.� On April 28, 1998, a judge found Suraji guilty of all the murders and ordered him to be put to death.� His wife was sentenced to death as well, by firing squad.

Ahmad Suraji�was executed is Djakarta�on July 9, 2008.

Other Technicians

It's not clear when the suspicious deaths began in the Glendale�Adventist Medical Center near the Ventura Freeway in southern California, because the elderly frequently die of natural causes.� When they're poor or have few relatives, they may die unnoticed.

Reporter Paul Lieberman for The Los Angeles Times�describes the respiratory failure of a 75-year-old woman in 1996.� Her name was Salbi Asatryan and she was an Armenian immigrant.� She was taken to the hospital for extreme difficulty with breathing, so she went right into critical care, accompanied by her worried daughters, and was stabilized.� Several respiratory therapists worked with her and felt sure that she would pull through.� They expected her to soon go home.� She was even breathing on her own and feeding herself.� That's why everyone was surprised when three days after she'd begun to look better, she was found dead in her bed.

Efren Saldivar, 1998There had already been talk around the hospital about the night shift and the "magic syringe."� �A few workers had their suspicions about a certain respiratory therapist who was playing God.� Efren Saldivar became a hospital therapist, Lieberman points out, because he "liked the uniform."� The healthcare career was just something to do, and when it got burdensome, he figured out a way to lighten his load.

Saldivar had no life goals to speak of.� �He might go to college or enlist in the military.� His plans were vague, with no real sense of direction.� He didn't want to start a business or work for himself and he did not want to work around other people.� As soon as he did get a job, which was in a supermarket, he acted irresponsibly.� It was just a menial job with no future, but he'd steal things from the store for other guys.

The cases had been under investigation since February 1998. In March, Salvidar confessed to murdering 50 patients for humanitarian reasons. � �He claimed he started killing in 1989 but stopped in 1997 because a colleague noticed morphine in his locker.� At first he said that he only killed patients who looked ready to die, but his story would eventually change.� When no corroborating evidence turned up, he was released.� He then recanted, saying he was not a murderer, but only a liar.��

During the investigation, twenty bodies were exhumed and tissue samples were taken by the Los Angeles County Coroners Office.� �Toxicological tests were done and the drug Pavulon was found in the remains.� Of the six, five had not received Pavulon as part of their legitimate medical treatment prior to their deaths.�

Efren SaldivarWhen Saldivar was arrested a few years later in 2001, he confessed a second time. � �He admitted, according to Lieberman, that he often killed just to lighten the workload during shifts that were understaffed.�

When he was at his wit's end, he would look at the board that listed patient names and decide, "Who do we have to get rid of?"

He admitted that he'd killed patients at other hospitals, too, where he'd worked part-time.� After sixty victims, he'd lost count.� He figured it was over one hundred.� It had just been a gradual thing, an act that had bothered him a little at first but then he'd grown used to it and let it all slip from his mind.� "You don't plan it," he said to the investigators.� "After that, you don't think about it for the rest of the day, or ever."

He pleaded guilty to the six murders and he is serving a life sentence in prison.�

Still Being Decided

Richard WilliamsSome cases get as far as arrest, indictment, and even a trial, without being resolved.� �In Columbia, Missouri, according to Associated Press reports, Richard Williams was indicted in 2002 for killing 10 patients 10 years earlier.� He is a former veterans hospital nurse and was charged with administering the paralyzing drug, succinlycholine, a derivative of curare, killing nine men and one woman in his care.� Their ages ranged from 58 to 85.� The charges were made possible by new technology that detects the drug in peoples tissues in a way that was previously impossible.� The prosecutors also had over one hundred witnesses.

But then charges were dismissed when problems with the test arose.� �Williams, who had maintained his innocence despite almost two dozen deaths during his shift being classified as moderately suspicious, was surprised but pleased.� Nearly on trial for his life, he was suddenly a free man.

Similarly apprehended was John Bardgett, a 25-year-old nurse who worked at Harborside-Northwood Nursing Home in Bedford, New Hampshire.� �He was arrested in September 2001 on second-degree assault charges. In April 2002, those charges were changed to two charges of second-degree murder and four counts of first-degree assault for giving two elderly women unauthorized doses of morphine. The trial, starting in January 2003, ended with an acquittal for eight charges, including second-degree murder, negligent homicide, first-degree assault, and manslaughter. The jury was deadlocked on one count of negligent homicide and on three counts of first-degree assault. The state must now decide if they will retry Bardgett on those four counts.�

The state alleges that Bardgett intravenously injected two patients, Dorothy Koch, 91, and Clara Hamm, 92, with lethal doses of morphine.� �Both were terminally ill, as Koch was suffering from

end-stage liver cancer, while Hamm was being treated as a hospice patient. They both died within an hour on September 9, 2001, of receiving the injections of acute opiate intoxication, and they both died within seven hours of each other.

Bardgett was allegedly heard bragging to nurses about the deaths, saying such things as, I killed another.� �I just killed Clara.� He also referred to himself as Angel of Death or Angel of Mercy.� One person said that he had bragged about killing three patients, but the body of one had been cremated before it could be investigated for traces of morphine.� He was also seen by several witnesses acting arrogantly and happy after the deaths, and a funeral director called his behavior, Unusual ...almost as if he was on a natural high.�

Bardgetts attorney defends the comments and the nickname of Angel of Death.� �According to reports in The Boston Globe, he stated that Bardgett was only referring to the fact that he had encountered many deaths while working as an emergency medical technician. Bardgetts statement, I killed this patient, was also dismissed as meaningless--- just the remarks of a cocky man who made inappropriate comments.

Doctors had instructed nurses to administer morphine to these patients, but under the skin not intravenously. Bardgett gave both of the women morphine intravenously.

Since Bardgett was arrested, he has been forbidden to enter a medical facility unless he has an appointment or an emergency need for treatment. This order still stands until the state decides whether or not to have a retrial. Bardgett said he would eventually like to get back into the medical profession.

Killing Spree

Sonthofen hospital clinic

The tabloids called him the "Death Nurse" and "Angel of Death," as Stephan Letter admitted early in 2005 to killing sixteen patients at the Sonthofen hospital clinic in the Bavarian Alps (some sources say he admitted to twelve). He'd been arrested in July 2004, after a high death toll among elderly patients alerted clinic staff to missing medicine and Letter's presence during the deaths; some of the medication was found in Letter's home an amount sufficient to kill ten people. He said he had wanted to "liberate" the souls of people he knew were suffering.

But for investigators, a confession wasn't good enough, as Letter could always recant (and had done so the day after his initial confession). He'd also admitted under interrogation that he didn't actually know how many people he had killed; it could have been more. To prove the details of Letter's confession about mixing a muscle relaxant with the respiratory drug Lysthenon to administer fatal injections, authorities exhumed forty-two bodies as they considering bringing even more charges against the twenty-six-year-old nurse. However, at least six suspected victims had already been cremated, and possibly many more.

Stephan Letter

While Letter claimed he was killing people to end their misery, prosecutors believed otherwise. Eventually, thirteen more charges were added, according to Bavarian news sources, bringing the total to twenty-nine. Initially, six charges were for murder and twenty-two for manslaughter (including one attempt), while one case was viewed as "killing on demand" a patient had requested it. The charges were eventually changed to sixteen counts of murder, twelve of manslaughter, and one of killing on demand. Letter was also charged with the theft of some of the patients' belongings. His victims had ranged in age from forty to ninety-five.

Chief prosecutor Herbert Pollert cited proof from the autopsies that the fatal medication had been administered. While the drug mixture was difficult to detect in bodies buried more than a year earlier, at least they knew what they were looking for. With sophisticated analysis, pathologists were able to determine that, just before a patient's death, the drugs had been administered in high doses. Criminal investigation Chief Albert Muller indicated that the work done on this case to prove the MO had "broken new ground," scientifically.

Shockingly, it had not taken Letter long to start killing. He'd been hired at the clinic in January 2003; he apparently gave the first injection only a month later. He stole the drugs to inject, and the mostly-elderly patients died within five minutes. However, two women in their forties were subjected to Letter's special form of "mercy" as well, and at least six patients were in no danger of dying. They'd even been lively and cheerful rather than the suffering victims that Letter had described. One seventy-three-year-old woman had even made plans for when she was to be released. Instead, he killed her. A few had died soon after admission, before being fully examined.

Letter was given psychological assessments to try to determine if he really believed his motives or was just using them as a way to mitigate what he had done. As his trial approached, he stood by his story.

Liberator?

The murder trial began in Kempten, Germany, in July 2006. News sources considered Letter's acts to be the "worst killing spree in postwar German history," according to the BBC and dw-world.com, and an attorney for relatives of the deceased said the murders had been random and "aimless." As the proceedings opened, Letter read a statement accepting his guilt and claiming he'd only wanted to help, but he did not formally testify at any time during the trial on his own behalf. Instead, he listened as others argued over what he had done and what he'd intended.

The prosecutor used the fact that some of the patients had not been seriously ill or dying to prove murder, and in a few cases, it seemed that Letter had had little contact with them. His defense attorneys argued that he was only guilty of thirteen manslaughters and two mercy killings, saying that these patients had lost their will to live. He also believed that Letter had been inexperienced and perhaps emotionally unstable, thinking he was doing the right thing. However, the presiding judge, Harry Rechner, stated, "None of the patients was expecting an attack on their lives." He rejected claims that Letter had no evil motive, stating that the defendant had shown only superficial interest in the patients, not genuine concern. The prosecutor's closing statement compared Letter's spate of killing to an assembly line.

Judge Harry Rechner

On November 20, 2006, Stephan Letter was found guilty on twenty-eight counts - twelve murder, fifteen manslaughter, and one mercy-killing - and sentenced to life in prison. Judge Rechner added a rider that would deny him automatic parole after fifteen years and said that, in any event, he must never be allowed to practice as a nurse again.

Letter listened to the verdict and sentence, and some sources state he showed little reaction, but others describe him as choking back tears. The Australian reported that he "seemed to mouth four words: 'Es tut mir leid' (I'm sorry)."

In light of this case, the clinic had to review and revise its procedures, since the stolen drugs should not have been so easily accessible. They were generally used only in intensive care units and supposedly were carefully controlled. Yet no one apparently noticed that someone was pilfering significant amounts across a period of time until many people were dead. The German Hospice Foundation called for Germany to introduce uniform checks, with medically qualified coroners viewing every patient who died in hospitals and homes for the elderly.

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Written with the research assistance of Jamie DiPasquo.