There is one kind of serial killer who is not driven by lust or pathological hatred, who does not murder in frenzy, who is unusually cool, calm and – as the force of law and order worldwide have discovered – is the most elusive of all to convict. These killers are in a venerated position of trust as members of the medical profession. It is almost inconceivable that anyone who devotes his or her life to saving life should turn that ethic on its head and begin instead to take life away. But the proof that it happens is all too clear. The fact that it probably happens far more than we are aware is an eerie afterthought.

There are an alarming and seemingly growing number of nursing staff who have put paid to their vulnerable patients. And sadly, even when alarm bells start ringing, it has often taken literally years for action to be initiated to halt these false ‘Angels of Mercy’.

A classic but utterly shameful case is that of Genene Jones, a Texas pediatric nurse whose records were shredded by the hospital where she worked, thereby disguising the true extent of her crimes and the hospital’s inaction in tackling them. Jones got a thrill from putting children in mortal peril and thrusting herself into the role of heroine when they pulled through. Sadly, many did not. She is feared to have lethally injected up to forty-seven infants and children in her care over a four-year span in clinics around San Antonio in the early 1980s.

The warning signs had always been there. Born in 1950, Jones was rejected by her real parents and given up for adoption. She remained close to her brother and was distraught when he died young. She was similarly affected when her other brother and father also died of cancer. It was clear that she joined the nursing profession because she ‘needed to be needed’. That wasn’t easy, because most of her nursing colleagues found her to be a very strange character. She was forced to quit a number of her early nursing positions because of her difficult and sometimes aggressive behavior. Despite this, she landed a job in the intensive care section of the pediatric unit of Bexar County Medical Center Hospital. There, fellow nurses described her as an attention-seeker, a braggart and someone who could not easily take orders.

Hospital staff found it remarkable that when a baby died, Jones would be grief-stricken as if it were her own child. If allowed, she would sit by the body for hours and insist on taking it to the morgue herself. Despite her peculiar behavior, she had the support of her head nurse, who liked and protected her. She was subsequently granted authority to oversee the hospital’s sickest children, giving her access to a cabinet of medications, of which she made free use.

In 1981, it was noted that an unusual number of babies were dying on her shifts, at one point as many as seven in a fortnight. The infants had been admitted with common childhood symptoms such as fevers, vomiting or diarrhea but, while in Jones’s care, they developed unexplained seizures and suffered cardiac arrest. A typical tiny patient was month-old Rolando Santos, who was being treated for pneumonia but whose unexplained heart problems, extensive hemorrhaging and finally coma all occurred or intensified on Jones’s shifts. The baby recovered only when he was placed under 24-hour surveillance.

Fellow staff labelled Jones’s on-duty hours ‘the Death Shift’. The head of the pediatric unit, Dr James Robotham, made a formal complaint about her after an autopsy on one of the babies in her care revealed traces of Herapin, a drug that causes the heart to stop. Tragically, hospital administrators failed to launch a thorough investigation, fearing the bad publicity for their hospital, and instead simply requested that the drug’s use be carefully monitored.

Infant deaths continued but, with Herapin restricted, toxic amounts of another drug, Dilantin, began to arise in laboratory tests. When investigators failed to pin the deaths on just one nurse, a staff restructure was ordered and Jones was moved from the pediatric unit. As a consequence, she resigned. That should have been the end of Jones’s career. Yet in 1982 the killer joined a newly-opened pediatric clinic, in Kerrville, Texas. Within a two-month period, seven children there succumbed to seizures, culminating in the death of a 15-month-old infant, Chelsea Ann McClellan, who had come in for a routine check-up but had been treated by Jones. As with all the other babies who had suffered unexpected seizures, Chelsea had immediately been transferred to Kerr County’s Sid Peterson Hospital. Staff there were more alert to the dangers, their suspicions aroused by the sheer volume of children admitted and the fact that, once in their care, the babies speedily recovered. An investigation into the sudden ‘epidemic’ of infant ailments produced the shock discovery that a similar spate of emergencies had occurred at Bexar County Medical Center Hospital, where Jones had previously worked.

At last the finger of suspicion was pointed at the ‘Death Shift’ nurse. Chelsea’s body was exhumed in October 1982 and it was found that a powerful muscle relaxant, succinylcholine, had been injected. In February 1983, a grand jury was convened in San Antonio to look into a total of forty-seven suspicious deaths of children at Bexar County Medical Center Hospital over a four-year period when Jones had been working there.

It had taken a scandalously inordinate length of time and many unnecessary infant deaths before Jones was finally taken out of circulation. Even then, she was charged only with poisoning one child, Chelsea McClellan, and went on trial for that single murder in January 1984. She was sentenced to ninety-nine years in prison and earned another sixty years in a second trial the same year when she was found guilty of injuring Rolando Santos by injection.

A further scandal was to be revealed during the court cases. Officials at Bexar County Medical Center Hospital had shredded the records of Jones’s employment and activities, destroying crucial evidence that was under subpoena. Thus, the ‘Death Shift’ nurse’s final murder count may never be known though police sources have speculated that Jones may have murdered almost fifty helpless infants since the start of her ill-fated nursing career in 1977.

As can be seen from the case of Genene Jones, it is notoriously difficult to apportion blame for hospital killings. According to leading forensic scientist Henry Lee, murders by nursing staff are the most difficult serial killings to detect and on which to obtain a conviction. ‘You have to figure out who the victims were long after they were buried,’ he said. ‘Then you have to link them to the suspect. Prepare to fail.’

Lee made his comments after another particularly horrifying case that of Texas-born Efren Saldivar who, like other nurses similarly accused, became labelled by the media as an ‘Angel of Death’. Saldivar confessed to murdering no fewer than fifty patients while working as a respiratory therapist in a Los Angeles hospital.

Saldivar had taken a brief course at North Hollywood medical college in 1988 to qualify for his job at the Glendale Adventist Medical Center, where he worked the night shift, when he was more likely to be able to operate alone. Over a period of ten years, he killed his patients by injecting a paralytic drug which led to respiratory or cardiac arrest.

Police put an end to his silent slaughter in 1998 after authorities, acting on a tip-off from another member of staff found phials of a muscle relaxant in his locker. Then aged 32, he made a full confession, admitting that he had killed his first patient when he was 19 and fresh out of training. The victim, an elderly woman terminally ill with cancer, had been suffering, so Saldivar suffocated her. His next victims died when lethal drugs were fed into their intravenous drips. Much later, in 1997, he became bolder, injecting lethal doses directly into elderly patients. By way of partially excusing his actions, he said he picked only those who were under the standard order: ‘Do not resuscitate.’ He also said that he had dispatched his victims because his department was so understaffed that not all of them could be adequately cared for.

Saldivar’s conviction seemed a foregone conclusion until the killer suddenly recanted his confession. To gain adequate evidence against him, twenty of the most recently buried patients had to be exhumed – and six of those bodies contained large amounts of a muscle relaxant drug called Pavulon, which is derived from a South American poison. Presented with the findings, Saldivar confessed all and was brought to court in March 2002, when he pleaded guilty to six counts of murder.

His confession allowed him to avoid the death penalty: instead, he was given six consecutive life sentences. The six murders to which he had pleaded guilty were no more than a token charge, however. Even his confession to fifty killings was considered an underestimate, some authorities putting his tally at over 100.

Forensic scientist Henry Lee’s comments relating to the Saldivar case – that, by their very nature, it is notoriously difficult to apportion blame for hospital killings – was again proven in the case of a spate of mysterious deaths at a Michigan hospital in 1975. Within just six weeks, no fewer than fifty-six patients died at the Ann Arbor Veterans’ Administration Hospital. There were eight deaths on one night alone in only three hours.

The muscle relaxant drug Pavulon, as used two decades later by Efren Saldivar, was revealed as the cause. It was said that large doses had probably been given intravenously, causing patients to cease breathing. The FBI was called in but the deaths of yet another eight patients while investigations were taking place virtually closed the hospital.

Suspicions fell upon two Filipino nurses, 30-year-old Filipina Narcissco and 31-year-old Leonora Perez. Both had always been on duty when the deaths occurred. Despite concerns about another hospital worker who committed suicide in 1976, Narcissco and Perez went on trial the following year charged with eight murders, poisoning and conspiracy. However, the case collapsed when it was revealed that, although patients had stopped dying in large numbers once the nurses had been removed from duty, no one had actually seen them adding anything to the intravenous drips. Perez was discharged on instructions of the judge and Narcissco was found not guilty of murder.

Both nurses were convicted of poisoning and conspiracy, but those convictions were also set aside when an appeal was lodged. Awaiting a retrial, the two women underwent psychiatric testing but were pronounced sane and normal. All charges against them were dismissed at a second trial in February 1978. What exactly happened at the Ann Arbor Veterans’ Administration Hospital was to remain a mystery.

Why does an ‘Angel of Mercy’ become an ‘Angel of Death’? In an interview at the Warren Correctional Institution in Lebanon, Ohio, in 1991, former male nurse Donald Harvey, serving several life sentences for murdering dozens of his patients, said: ‘People controlled me for eighteen years, and then I controlled my own destiny. I controlled other people’s lives, whether they lived or died. I had that power to control. After I didn’t get caught for the first fifteen, I thought it was my right. I appointed myself judge, prosecutor and jury. So I played God.’

How Harvey ever got a job working in hospitals is in itself a condemnation of the system. Born in 1952 and raised in the Appalachian Mountains, he was a shy homosexual who dabbled in the occult but was also obsessed with all things medical. At the age of 18, he took a part-time post as a junior orderly at Marymount Hospital in London, Kentucky, where, he was later to confess, he killed twelve patients in ten months by suffocation or removing their oxygen supply. His reason: ‘I wanted to ease their suffering.’

At the age of 20, Harvey joined the US Air Force but was discharged less than a year later and was committed with mental disorders to the Veterans’ Administration Medical Center in Lexington. The state of his health does not seem to have been improved by attempts to treat him by the application of electroshock therapy. Upon his discharge from hospital, Harvey disguised his recent medical history and got part-time jobs as a nursing assistant and as a clerk at three Kentucky hospitals, before moving to Ohio in 1975 to work at the Cincinnati Veterans’ Association Medical Center in jobs that included nursing aide, laboratory technician and mortuary assistant. There, he literally got away with murder for ten years.

How easy it was to avoid detection or conviction was proved when a routine search by security guards in 1985 revealed on Harvey’s person an array of hypodermic needles, cocaine-snorting equipment and a .38 caliber pistol. He was fired – but went straight into the next job, as a nursing aide at Cincinnati’s Drake Memorial Hospital.

Harvey must have felt invulnerable. He began killing his patients in ever increasing numbers by poisoning them with arsenic, cyanide, insulin, morphine or fluid tainted with hepatitis B and/or HIV. He would also sprinkle rat poison on their food, inject air into their veins, stab them with a coat hanger pushed through a catheter, disconnect their life support machines or suffocate them with plastic bags and wet towels.

Harvey kept a diary of his crimes, which eventually helped convict him. But even though his colleagues openly referred to him as the ‘Angel of Death’, it took an autopsy on one of his Victims in 1987 to reveal him as a poisoner. The diary catalogued his killings: fifteen patients in ten years at the Cincinnati Veterans’ Association Medical Center, twenty-three in thirteen months at Drake Memorial. Not all his Victims were elderly patients. After a lovers’ tiff, he tried to poison his gay partner Carl Heeler, who ended up in hospital but survived. He also administered poison to Heeler’s mother and father; she survived but he was admitted to hospital – where Harvey laced his food and where he died in May 1983.

When he was finally arrested, Harvey feigned insanity, at first confessing to thirty-three murders, then fifty, then eighty-plus. His mental state made it difficult to sift fact from fiction, though the Cincinnati prosecutor’s office was clear in its assertion when Harvey was brought to court in August 1987 that ‘this man is sane and competent but is a compulsive killer’. In three separate trials, in Ohio and Kentucky, he was convicted of forty murders and was given fifteen life terms in prison. The true tally of his murders, however, may never be known.

It may appear from these cases that the ‘Angels of Death’ syndrome is a particularly American trait. Two classic cases show this not to be the case – the better-known being that of Beverley Allitt, a plain, overweight, frumpy English girl of whom nobody in the Lincolnshire town of Corby Glen took much notice but who was always relied on to be sensible, caring and diligent.

Allitt reputedly suffered from Munchausen’s Disease by Proxy, a rare disorder which produces phantom ailments and, in extreme cases, can cause sufferers to harm others deliberately so that they can ‘make them better’ later. At 17, Allitt took a nursing course which qualified her for her first job: as a trainee nurse at the local Grantham and Kesteven General Hospital. She was placed on the pediatric ward – the most dangerous place anyone with Munchausen’s could possibly be.

It was this undiscovered syndrome which led Allitt to become a hospital serial killer. In May 1993, she also entered criminal history as the worst British female serial killer of modern times when she was found guilty at Nottingham Crown Court of murdering four children and attacking nine others. All had been on Ward 4 of the hospital. Her first victim, a 7-week-old boy, died of a massive heart attack in February 1991, just two days after being admitted with a chest infection. A mentally and physically handicapped 11-year-old boy was killed within three hours of being admitted following an epileptic fit. A 2-month-old girl died after suffering convulsions at home hours after being released from hospital following an insulin overdose. Allitt’s last victim, 15-month-old Claire Peck, died on 22 April after being admitted with asthma.

Police were called in only after Claire’s death, although nine other children’s conditions had become dramatically life-threatening during the period. But once blood tests had been carried out on other victims, a simple check of staff rotas showed that the common factor was Beverley Allitt. She had administered to the children lethal and near-lethal overdoses of both insulin and potassium chloride. She had also tried to suffocate some of them.

At her trial, Allitt’s twisted logic became apparent; she believed she was doing no wrong in killing without mercy. The 24-year-old nurse showed no emotion as she was given four life sentences.

The undue delays in the authorities waking up to the fact that they have a killer in their midst is also apparent in the extra-ordinary case of a string of hospital killings in Austria, which that country’s Chancellor, Franz Vranitzky, described in 1991 as ‘the most brutal and gruesome crime in our nation’s history’.

The perpetrators – for, extraordinarily, there was more than a single killer – were only unmasked when a group of nursing aides at Vienna’s Lainz General Hospital, which specialized in geriatric cases, were overheard laughing and joking in a bar about speeding the death of one of their patients. A horrified doctor at an adjoining table reported the conversation to police and an investigation was launched that, at one stage, put the total body count at an astonishing 300 elderly people.

The group’s ringleader, Waltraud Wagner, had been 23 when, in 1983, she claimed her first victim, disposing of a patient with an overdose of morphine. She later recruited into this unusual criminal gang three other members of the hospital nursing staff: Maria Gruber, 19, Irene Leidolf, 21, and Stephanija Mayer, 43.

These ‘Angels of Death’, who usually worked the night shift, devised their own method of murder. One would hold the elderly victim’s head and nose, while another would pour water into the person’s mouth, causing drowning. The attacks went undetected because elderly patients were frequently found to have fluid in their lungs.

The killings went on for six years, until their loud voices during the 1989 bar-room drinking session gave them away. Under arrest, Wagner confessed to causing thirty-nine deaths a total she later reduced to only ten cases of ‘mercy killing’. She said: ‘The ones who got on my nerves were dispatched to a free bed with the good Lord. They sometimes resisted but we were stronger. We could decide whether the old fools lived or died. Their ticket to God was long overdue anyway.’

In March 1991, she was sentenced to life for fifteen murders and seventeen attempted murders. Irene Leidolf got a life sentence for five murders, Stephanija Mayer fifteen years for manslaughter and seven attempted murders, and Maria Gruber fifteen years for two attempted murders. When the case was closed, the body count officially stood at forty-two, but many put the final tally at between 200 and 300 victims.

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