They murdered their patients - I tracked them down, Special Agent Bruce Sackman retired, ask me anything

What prompted you to take up this lifestyle and profession?

I got thrusted into an investigation of a physician named Michael Swango who was working at the Northport VA hospital. He was eventually convicted of murdering three veterans at that facility

Why did they do it?

It can range from having a God complex all the way down to something as trivial as the patient was hitting the buzzer too much and annoying them.

Are the medical professionals who commit these crimes usually caught and prosecuted? Or would is it difficult to find enough evidence to support prosecution in most of these cases?

Great question. We only hear about the ones that have been identified. Out of those most are convicted but some have been acquitted because of the difficulty in proving these cases.

You've mentioned Munchausen by Proxy a couple times already. Do you believe there may be a personality type common among doctors that lead them to that profession and also seems to exhibit itself in that disorder?

Alternatively, do you think a God Complex is more common among doctors and people who pursue that field because of its nature?

I'm not a psychologist but let me relate to you what medical serial killer Donald Harvey once said..."After I didn't get caught for the first 15, I thought it was my right. I appointed myself judge, prosecutor and jury. So I played god"

Is/was it harder to investigate because it's Military?

No, the fact that the VA has an inspector general with access to everything in the hospital in some ways makes it easier than in the private sector

This is probably an obvious question for you, but do HIPAA laws not apply to military?

They do, but the VAOIG is part of the VA. An outside agency like the FBI would require subpoenas

Did any of these murderers pick their victims based on who would miss them?

SOme murders seek out patients with no family to question the deaths, other killers actually like speaking with the family after the death to relive the experience by telling the family about the patients last hours

How do other 1811’s feel about you publishing this book?

Very supportive, no negative feedback whatsoever. In fact the book was highlighted in the 1811 magazine

For those coming from r/all, and are out of the loop, what, or who, are 1811's?

1811 is the code for Federal criminal investigators

Did you find yourself having to deal with coverups and justifications by higher-ups, or were administrators more transparent and neutral?

Absolutely! No manager wants to announce that they have a serial killer employed at their facility. Its much easier to get this person to quietly move on to the next hospital

Do you then prosecute these higher ups for passing along the problem?

Seems to me they are just as guilty by kicking the can down the road and further enabling these serial killer doctors

Wow, now that's a great question. The answer is no one I'm aware off has ever been prosecuted to that, but I would like to see it

I would find this akin to an accomplice of the murders... Involved in covering up a murder... At the least misprision of felony.

I agree completely

After the OIG is done investigating, the matter is usually referred to the US Attorneys Office for prosecution. From there it can take a couple of years to go to trial. Sometimes the defendant takes a plea agreement, but I don’t know how well the USAG communicates with OIG about case disposition.

in these cases the communication is close

Do these type of people move employment from place to place, to avoid being detected? What is the line between munchausen by proxy and serial killer?

The most famous case of moving from hospital to hospital is nurse Charles Cullen, check it out. Munchausen by proxy is just one of the motives for these killings but not the only one

How often do you find that the murderer's co-workers suspected something was wrong?
How many of your investigations were triggered by a co-worker's report?

for every bad medical professional there are many outstanding professionals who are brave enough to come forward and express their concerns, without them we would never know

What other kinds of professionals do you work with? What are the most interesting specialists you've worked with/brought in?

I work with toxicologist, medical examiners, and forensic nurses. My favorite is Dr. Michael Baden, the forensic pathologist

Did they “murder” for gain? Fun? Boredom? Or they didn’t do their jobs to the standard of care, had a bad outcome and accused of murder? (Haven’t read about any specific cases, so examples would help me understand)

Many of them suffer from Munchausen Syndrome by Proxy, they intentionally harm a patient and then show the staff that they are heroes by trying to save them. Not true for every killer, but for many of them

So they're not technically trying to kill people, but they are maliciously harming them in a way that is often fatal?

That is true for some of them. Its not about the patient, its what the experience does for the killer

Does this happen in normal hospitals?
Also is their signs that someone my have Munchausen before they kill?

There are a series of red flags that are published in the book and in an article titled When The ICU Becomes A Crimes Scene

How do the suspects react when they realize they or the hospital are being investigated?

Deny, deny, deny

How many of them eventually confess and explain their motives (or something close to that)?

Many do not confess. When they do they usually try and argue that they were ending the patients suffering...not true,

what is the next step in showing people the truth once they deny? evidence i imagine? but a lot of people believe liars/deniers

Its very tough to convince people that someone who has taken an oath to save lives is actually taking lives

What's your take on medical misdiagnosis?

That's complicated. My world relates to medical professionals who intentionally misdiagnose for a variety of nefarious reasons

How do you think we'd be able to distinguish these cases from actual medical errors? The doctors don't really leave behind a trail of evidence, do they. At least, not if they've done the deed "well".

The cases usually begin when the death rate on a particular ward increase every time a particular nurse or physician is on duty. When that nurse is not working, the death rate declines

How do you attribute the death rate increase to malicious intent and not just incompetence?

The patients should not have expired when they did. There deaths were totally unexpected by staff and family

What about cases where death doesn't occur during a shift?

For example, if my patient is suffering from sepsis and I withhold treatment, the patient will die sometime over the next few days, not the next 8 hours.

Do you measure the correlation? This would have a weaker correlation and would be very difficult to catch.

Your right, and that's what makes these cases so difficult to prove. And that's why the numbers are so high before they are prosecuted

That's kind of scary to think about, how many of these people do you think there are?

No way of telling except every couple of weeks a new story breaks somewhere in the world with increasing frequency

Which case of doctors and nurses who are accused of murdering their patients,you found the most disturbing?

They are all incredibly disturbing, particularly for the families of the victims.

Anything that the average person can look out for to protect ourselves and others?

My advice is to always have an advocate with you to politely and respectfully ask questions and record whats going on. This is a situation a killer would try to avoid

Did they all go to prison for murder or did some get lighter sentences? and can the hospitals be held liable for their actions?

Those that are convicted usually wind up getting life sentences. The hospitals sometimes settle with the family depending on the facts. In one case in Missouri, the family won the civil suit against the hospital but charges were dropped against the nurse for insufficient evidence

Were there any instances you found where it appeared doctors may have killed on the request of a patient, like euthanasia, or did any doctors or families of victims claim that was the case ever?

SOme killers make that claim but I don't buy it

Has there ever been a case where multiple doctors/nurses worked together to kill one victim?

Interesting question. I'm not aware of any

What’s the hardest or most exhausting case you’ve had to solve?

Michael Swango investigation was 7 years

Did you write about this?

Yes. It is in my book, Behind the Murder Curtain.

As a nurse when I read these stories it makes me sick. I know there is good n bad in every profession but in medicine people trust us with their lives. Have any of the good staff helped with investigations ? How do they react knowing this happen to their patients at the hands of a coworker?

The staffs are usually terrific help to us. They want the murderer prosecuted and removed from healthcare as soon as possible

Whats the most surreal or Odd case have you ever taken?

The case of a doctor on Albany that altered medical records to place patients into studies they were not medically eligible for and resulted in their deaths. Dr. Kornak

You make me scared of hospitals. Is there anything a layperson can do to prevent himself from becoming a victim of mad healthcare professionals?

Don't go it alone, bring a calm advocate with you.

So I used to work for a transfer EMS service 10 years ago. We had one medic, Marty, who had intubation rates on routine transfers around 50 times higher than her co-workers. She’d have a patient that she intubated while en route to the hospital literally every other week. We all assumed she was just a turbo and overly excitable, resulting in her performing excessive and unnecessary interventions on a regular basis on elderly patients who generally weren’t able to tell their side of what happened, but reading all of this and hearing the phrase Munchausen by Proxy for the time, I’m starting to wonder if that’s what was going on. I just looked her license up, and it looks like she’s still working... do I need to report this?

If you feel like it's something you need to do.

Is the rate of murder by health care professionals higher at the VA then other hospital systems?

The VA tends to keep inpatients longer than the private sector but there is no data to show that the VA is any worse in this regard than the private sector

As a vet, thank you for what you do for those of us who need the VA. 22 vets a day commit suicide and mental health through the VA is very important. #mission22 I’m a retired medic. What is the initial process that begins investigations?

It starts with a nurse coming forth to management with his/her suspicions.

Did the medical staff seem to have a "type" like most serial killers? Besides access and I'm sure patients with limited family involvement, did they seek out patients with specific features or diagnoses?

Almost all of these cases occur in the Intensive Care Unit where death is a more common ocurence

What prompted investigation of these individuals? Who picked up on the increased death rates when these doctors/nurses were on service?

It various from situation to situation. Sometimes it the nurses, other times its physicians.

What are your thoughts on the WV VA hospital suspicious deaths being uncovered right now?

I think they are on to something. We will watch it closely

What were some of the first clues that these murders had occurred?

Death rates in a particular ward when a particular employee is on duty

Any comment on the current activities at Louis A. Johnson VA Medical Center in Clarksburg, West Virginia, that have drawn the scrutiny of investigators with the FBI and the VA Office of Inspector General?

https://www.usatoday.com/story/news/nation/2019/08/28/va-deaths-another-death-w-va-veterans-hospital-ruled-homicide/2135368001/

Yes! There have been other medical murder cases using insulin injections. However, insulin dissipates quickly and can be difficult to prove. I have confidence in the OIG/FBI that they will be successful in this case.

Are you familiar with the case of Christopher Duntsch the spine surgeon in Texas?

This is still being debated whether he intentionally maimed and killed (he had witnesses - he really didn’t try to cover it up) vs gross incompetence (with no insight into his lack of skill)

Any thoughts about this case?

https://www.texasobserver.org/anatomy-tragedy/

I am familiar with it but I don't feel I know enough to comment

Can you please talk more about nurses and the differences of motive compared to physicians, if any?

The motives can be the same. Some killer simply have a fascination with death. Others crave the power of life and death over and individual. They crave having the power to decide who should live and who should die

Silly question, but what does OIG stand for? This is all new to me, so I will check out your book. What a very wild concept, murdering patients at a VA hopsital. Thanks for the ama!

Office of Inspector General

Do killers tend to have certain seemingly-innocent personality traits in common (e.g. being introverts, or willingness to take risks, etc), or are their characters as diverse as any other random collection of unique individuals might be?

I don't claim to be from the silence of the lambs group, but from what I 've seen there are some similarities like needing attention

How rampant is this? When you hear about this type of thing you think it's a one of. Is it more pervasive than that?

Its difficult to say. The fact that most medical serial killers aren't identified until there are multiple deaths is terrifying

Just wondering out loud - as per your knowledge, has anyone been falsely accused of this?

Not to my knowledge

Do you think there are more measures that could be implemented in hospitals and care facilities that could make these types of murders less prone to choose to kill in facilities?

Having worked I the medical field for 40 years I have utilized extreme risk management tools/systems and have had good results. I have always believed any organization should recognize small signs that can lead to catastrophic events and prevent them from occurring. We have become either complacent or ignorant to monitoring and utilizing our instinctual clues IMHO.

I applaud your work btw. Book has been ordered.

You are absolutely correct! It can begin with an admission that these things happen and we will work to prevent it

Which hospital has had the most offenders?

No hospital has that dubious distinction

What can hospitals do to prevent situations like these from happening in the first place?

The red flags protocol in the book and the article can help

I have the medical records as proof my father was overdosed into heart failure in a VA hospital in 1975. Do i have any recourse.

You'd have to seek out a competent medical malpractice attorney

Are you ever curious you’ll stumble upon some of the biggest serial killers the US has ever seen with this type of investigation?

The numbers are horrific. Swango was accused of killing about 60 patients. The problem is they kill so many patients they can't remember themselves how many they killed. A recent nurse in Germany was convicted of killing 100 patients and suspected of killing 300

Are you ever worried about retaliation from the people you were investigating?

No, it was never really a concern

Is God Complex a thing among these doctors?

A few sadly yes

Have you ever had to encounter the families of the physicians convicted of murdering their patients? Did you have to face any backlash or hate from people who truly thought they were innocent? I respect your line of work; it's not an easy job to wake up to on a daily considering there's not much down time being in the FBI. Thank you so much for your service to the common people and including doing this AMA.

My heart goes out to all the families involved. They were always terrific to us. Yes there was backlash, particularly to the whistle blowers who brought all the negative attention to the hospital

Sorry if this question is too general - what goes into the process of tracking an operation like this down? How long does it take?

ALmost every case takes years from the time the allegation surfaces to the time it is proven. It takes a team of people to do this

What is your opinion on the right to die?

If the patient and the family confer with the doctors and other medical professionals and they are all in concurrence I have no problem

Where can I buy your book?

Amazon, Barnes and Nobles, the usual places

What motivates these doctors to kill their patients?

munchausen syndrome by proxy is the most common

That's fascinating. Would these people show signs in childhood like serial killers killing animals and things like that? Are there other psychological traits common with these people such as personality disorders or other mental illnesses?

In many cases, yes. They have been suspected of starting fires, lying and mistreating others, etc.

Wow, this is like a real life Bones episode. I can't imagine the logistics and coordination required for such an endeavor. I hope retirement has been good to you and someone took up the torch after you.

That being said, are there better vetting processes in place now for the safety of patients? Are there any sort of measures out there to detect these events before they become a pattern?

One of the best things to come out of the Michael Swango case was that hospital spend much more time and resources vetting their staff. Swango spent time in prison for poisoning his coworkers only to come out and work as a physician at VA hospitals

I closely followed the case of nurse Orville Lynn Majors who got 350+ years for killing several of his patients in a Brazil, IN hospital. There has to be a pay off- what is it? What do these people enjoy (?) by killing their patients?

The experience gives them a sense of power, excitement and G-d like power they could never experience anywhere else

You look extremely familiar. Have you spoken on any TV shows before?

I've done a lot of public speaking and have been on some shows in the past

Is intentional malpractice a symptom of the VA healthcare system or does it exist everywhere and it's just more noticeable in the VA system?

I don't think the VA hospital system has an exclusive on any wrongdoings

What's your view on assisted suicide?

I'm not opposed to it if it is probably staffed and discussed

Is there a conspiracy if X number of people don't make it past (time frame, next fiscal year, ect) we (VA Gov) could save X dollars. Or have the murders/neglect for proper treatment been proven mostly personal?

The closest thing I've seen to that can be found in a story about a hospice CFO in Texas who ordered staff to execute patients by giving them an overdose of their meds because they were living past their reimbursement dates

It sounds like you didnt intentionally plan this field, what were you originally planning on doing? And are you glad you ended up doing this instead?

I always wanted to do investigations, never thought it would be involving medical serial killers though

What legal tools did your office have to compel witnesses to speak to you?

We always have the grand jury, but like I said, the overwhelming majority of healthcare providers are wonderful honest folks who want to help

What kind of statistics are red flags in your investigations? And how dig do you have to deep to find them?

There is no set number, just an unexplained increase in the death rate on a particular ward

What do you think of the current lawsuit going on in Columbus Ohio with Dr William Husel? At least 25 people he killed with overdoses of fentanyl! How at fault are the nurses in this?

This is a case we have to watch carefully. There are many questions for nurses and pharmacy. Need to know some more info before I comment

what’s one thing you can’t talk about?

don't know until I'm asked

Do you have a catchphrase when you catch these people?

MSKs medical serial killers

when you say 'murder' are you talking about euthanasia or legit killing someone against their will? I live in OR and we have death with dignity so it is a fine line.

I'm talking murder

How has this work taken a toll on you and your family? What things do you do to keep yourself sane while investigating these cases?

No worse than any other investigator involved with homicide cases

Any updates on Michael Swango’s life in prison in Colorado?

Has he been a disciplinary problem? Does he have visitors ?

I saw a show on TV where a woman was corresponding with him so I guess he's ok. I do not wish him well

How can you accuse doctors and nurses of murder when all they are doing is euthanizing patients?

Yes I'm being deliberately provocative because some people are all gung-ho about legalizing euthanasia without thinking it through properly.

taking it upon yourself to euthanize a patient is murder

Is this an undertaking that is close to your heart due to someone close to you having suffered this, or were you just moved by these things occurring and felt compelled to do what you could?

Thank goodness nothing family related, but unlike other serial murders who have roamed high crime areas in the evening, we all have to go to a hospital at sometime

What avenues for reporting suspicions are in place for concerned staff?

(Like you said, management may be inclined to deny a problem rather than admit they’ve employed a serial killer)

Hospitals have compliance and other departments they can reach out to. Many times they will go to law enforcement directly

Are you friends with Bert Macklin?

no

Prior to writing this book, what did you consider as the potential unintentional repercussions that this book could have? For example, as this is an exceptionally rare occurrence, did you consider how reading this book could bias a person negatively against the medical profession?

Lastly, how do you address these concerns in your book?

I make it clear that the overwhelming majority of healthcare providers are honest dedicated people who perform miracles every day. Its because of this environment that killers are able to get away with murder

How much does your editor hate you?

No idea

What is the easiest way to murder your patients without getting caught? /s

you will get caught, believe me

Are you just trying to sell a book?

I already sold a lot of books in the part year. I'm just commenting about cases that are in the news just about every other week.

Have you watched Joker yet?

not yet