I am the retired special agent in charge of the US Department of Veterans Affairs OIG. There are a number of ongoing cases in the news about doctors and nurses who are accused of murdering their patient. I am the coauthor of Behind The Murder Curtain, the true story of medical professionals who murdered their patients at VA hospitals. Ask me anything.

photo verification . http://imgur.com/a/DapQDNK

Comments: 1276 • Responses: 93  • Date: 

DrHivesPHD2185 karma

What prompted you to take up this lifestyle and profession?

bts18112830 karma

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

sebinmichael446 karma

Why did they do it?

bts18111886 karma

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.

donteventextme1003 karma

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?

bts18111187 karma

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.

DriveGenie421 karma

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?

bts18111334 karma

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"

atseasheiscalm793 karma

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

bts18111335 karma

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

SantasDead387 karma

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

bts1811681 karma

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

black_flag_4ever571 karma

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

bts18111335 karma

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

vaultedk564 karma

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

bts1811728 karma

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

ThatShwaGuy424 karma

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

bts1811674 karma

1811 is the code for Federal criminal investigators

nad1984557 karma

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

bts1811885 karma

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

PapaBravoEcho89599 karma

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

bts1811763 karma

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

GroinShotz455 karma

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

bts1811436 karma

I agree completely

ramyunmori16 karma

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.

bts181118 karma

in these cases the communication is close

MrFrogy448 karma

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?

bts1811541 karma

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

Ken_Thomas393 karma

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?

bts1811847 karma

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

minecraftjahseh299 karma

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

bts1811442 karma

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

newnameEli291 karma

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)

bts1811539 karma

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

PhasmaFelis125 karma

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

bts1811215 karma

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

ChoseSinWon99 karma

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

bts1811169 karma

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

Shaggy__94269 karma

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

bts1811400 karma

Deny, deny, deny

phatlantis163 karma

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

bts1811337 karma

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

Mcsquizzy94 karma

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

bts1811196 karma

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

spr0798204 karma

What's your take on medical misdiagnosis?

bts1811311 karma

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

spr0798158 karma

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".

bts1811337 karma

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

Choo_Choo_Bitches126 karma

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

bts1811219 karma

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

localhost87105 karma

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.

bts1811165 karma

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

_haha_oh_wow_67 karma

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

bts1811104 karma

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

wouldyoulikesomemilk151 karma

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

bts1811247 karma

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

jaydezi143 karma

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

bts1811289 karma

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

Tenzu9140 karma

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

bts1811216 karma

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

DriveGenie85 karma

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?

bts1811137 karma

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

TwistedSync127 karma

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

bts1811174 karma

Interesting question. I'm not aware of any

xxxarkhamknightsxxx123 karma

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

bts1811179 karma

Michael Swango investigation was 7 years

Fink66539 karma

Did you write about this?

bts181195 karma

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

freckledfarkle122 karma

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?

bts1811167 karma

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

--Kitsune--121 karma

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

bts1811266 karma

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

kankenaiyo115 karma

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

bts1811214 karma

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

preachermanmedic104 karma

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?

bts1811103 karma

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

GB5102 karma

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

bts1811156 karma

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

tramadoc89 karma

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?

bts1811102 karma

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

unfazedmama62 karma

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?

bts1811104 karma

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

I_RAGE_AMA59 karma

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

bts181175 karma

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

Damncreative57 karma

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

bts181176 karma

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

heybingbong47 karma

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

bts181186 karma

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

HBScott196146 karma

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?


bts181176 karma

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.

Koumadin45 karma

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?


bts181142 karma

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

minnesotaris39 karma

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

bts181179 karma

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

SacredAfro38 karma

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!

bts181147 karma

Office of Inspector General

ShimmeringNothing37 karma

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?

bts181156 karma

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

inotamexican37 karma

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?

bts181178 karma

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

asadwit36 karma

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

bts181139 karma

Not to my knowledge

Leena5236 karma

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.

bts181140 karma

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

perpetuatinstupidity35 karma

Which hospital has had the most offenders?

bts181155 karma

No hospital has that dubious distinction

flyingboat50534 karma

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

bts181152 karma

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

Hedgehogz_Mom31 karma

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.

bts181132 karma

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

Jabahonki29 karma

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

bts181184 karma

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

jbcb525 karma

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

bts181140 karma

No, it was never really a concern

Abortivora24 karma

Is God Complex a thing among these doctors?

bts181138 karma

A few sadly yes

LiteBrite82021 karma

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.

bts181139 karma

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

coastercupcakeYT121 karma

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

bts181128 karma

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

lurks-a-lot20 karma

What is your opinion on the right to die?

bts181150 karma

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

classic72918 karma

Where can I buy your book?

bts181130 karma

Amazon, Barnes and Nobles, the usual places

gwanawayba18 karma

What motivates these doctors to kill their patients?

bts181136 karma

munchausen syndrome by proxy is the most common

gwanawayba23 karma

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?

bts181140 karma

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

Slade-QP17 karma

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?

bts181150 karma

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

SoVeryKerry16 karma

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?

bts181123 karma

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

atseasheiscalm16 karma

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

bts181128 karma

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

waldosan_of_the_deep13 karma

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?

bts181124 karma

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

ModestToTheTop13 karma

What's your view on assisted suicide?

bts181139 karma

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

GoneInSixtyFrames13 karma

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?

bts181151 karma

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

magicalmusic6612 karma

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?

bts181121 karma

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

preatorian9911 karma

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

bts181122 karma

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

MongolianMango10 karma

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

bts181111 karma

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

trulymadlybigly8 karma

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?

bts181117 karma

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

alienco6 karma

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

bts181120 karma

don't know until I'm asked

lavahot5 karma

Do you have a catchphrase when you catch these people?

bts18116 karma

MSKs medical serial killers

I_am_usually_a_dick5 karma

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.

bts181116 karma

I'm talking murder

-Ska-Is-Not-Dead-3 karma

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?

bts18113 karma

No worse than any other investigator involved with homicide cases

Koumadin3 karma

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

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

bts18119 karma

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

gumgum1 karma

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.

bts18115 karma

taking it upon yourself to euthanize a patient is murder

timetravelingboomer1 karma

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?

bts18111 karma

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

decidedaily1 karma

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)

bts18113 karma

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

HunterTwo20 karma

Are you friends with Bert Macklin?

bts18111 karma


Camabear0 karma

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?

bts18113 karma

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

MrDrProfRX-1 karma

How much does your editor hate you?

bts18112 karma

No idea

rilla573-3 karma

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

bts18113 karma

you will get caught, believe me

parkcamper-4 karma

Are you just trying to sell a book?

bts18116 karma

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.

hazeofthegreensmoke-6 karma

Have you watched Joker yet?

bts18112 karma

not yet