I Hunt Medical Serial Killers. Ask Me Anything.

Do other medical professionals generally support you for weeding out murderers who abuse their profession or grief you for bringing their profession into disrepute?

Great question. It has been a mixed bag. Some are grateful and others unhappy that I have exposed the dark side of their profession. I continually preach that the overwhelming majority of health care professionals are honest, hardworking, dedicated individuals who perform miracles every day.

The doctors you've investigated, were their associates suspicious of them or were they oblivious to the fact that this was going on?

There are always one or two associates who become suspicious but the majority of coworkers don't want to believe that one off their own is intentionally murdering patients

How do you tell the difference between someone who is malicious vs someone who is just totally incompetent? What are the most telling data points that signal to you "this doctor is not normal"?

Are there any personality traits that you see show up in the medical professionals you catch?

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That a lot of really good questions. There are 26 red flags identified in my book but the short answer is the repeated administration of drugs to patients that were not prescribed these drugs. For instance epinephrine or insulin to a patient that had no medical necessity for these drugs.

Many of these killers suffer from Munchausen Syndrome by Proxy. They intentionally harm a patient to show the staff how well they respond to a medical emergency code

What motivated you to start this work? Thanks for doing this AMA.

The Swango case was thrusted upon me quite unexpectedly. After success with that, I began receiving unsolicited call for assistance

How was it thrusted upon you? Did you have a personal connection? Did you have a specific motivation that began this project &journey?

I got a call from the Chief of Psychiatry at the Northport VA that changed my life

Why did they call you in particular? Did you have experience in actual investigation beyond watching a lot of Colombo, like you mentioned elsewhere?

I served as the special agent in charge of the US Department of veteran affairs office of inspector general for the northeast. I was responsible for all major criminal investigations involving the VA from West Virginia to Maine. I have been an investigator since 1975

I have been an investigator since 1975

Did Doctor Jeffrey MacDonald (Captain, US Army) kill his family?

Couldn't say one way or the next

In your opinion, what are some of the most crazy stories of medical serial killers? (I'm sure all of them are crazy, but which ones are extra-crazy?)

They are similar in some respects and unique in others. I think the nurse in Italy who took a selfie with her and the patient she had just murdered is pretty crazy

How many medical serial killers exist, approximately? I hope this is really rare, because when you need a doctor you really need one. :-/

It is impossible to give an accurate number. Historically about 150 have been identified

Does that number include nurses or just physicians?

both

I'm assuming the number does not include the monsters from Nazi era-Germany?

I know that Dr, Mengele is included in that group

150 in how many years?

since these instances have been recorded

What’s the most interesting way someone was caught?

The autopsies, toxicology, and the science of forensics is always very interesting to read and study

Did most serial killers have a target victim? What about general practitioners, did they pick a certain type of victim?

Very sick patients in the intensive care units are usually the victims, but anyone could be a potential target

Do you think that they think they are 'culling the herd', or are they juust easy targets?

easy targets usually, sometimes they are angry at the patient for being annoying

Do you think there were more serial killers in the 70s and 80s or do you think there are just as many around today? I think about things like DNA technology, cell phones, cameras, and wonder how much easier it is to get caught today vs. back then.

None of those traditional forensic techniques will usually apply to medical serial killers who conduct their crimes in sterile healthcare settings

What was the most disturbing case you've come across?

They are all very disturbing. The case of Dr. Kornak in Albany was very disturbing because he was lying to veterans putting them into research projects he knew they were medically ineligible to be in

I live like five minutes from the Albany VA and never heard about this! Crazy!

you can google him or read the story in my book

They were all very disturbing. For some reason I was most disturbed about Swango poisoning his fiancé

Have you looked into the investigation of Dr Harold Shipman, anything to learn that would pick his like up sooner?

I met with detectives in England about this case and others online. there were many red flags missed on that case as well like him always denying the need for autopsies and the horrendous death rate of his patients

When would autopsies normally be done that the guy was unwilling to do? I would have assumed in most cases if a patient dies in hospital, it would be clearly identified what killed them and thus an autopsy wouldn't normally be done unless the doctor hadn't come to a confident diagnosis before they died. I thought autopsies were usually for people who died unexpectedly at home.

The cause of death is usually myocardial infarction or some heart related ailment. Don't confuse a hospital autopsy with a forensic autopsy

How did you get into this line of work?

Initially watching too many Columbo crime shows and saying I can do that. Never looked back

I was going to recommend watching Dexter... but maybe not after reading this!

I enjoyed that show very much

Have you been asked to look into the case of Dr. William Husel at Mt. Carmel Hospital in Columbus Ohio?

No, I just know what I have read in the media

What are your views on assisted suicide and euthanasia? (no, I am not stating that Dr. Michael Swango did that!)

I am a supported if done legally and ethically

Do you feel that credentialing departments in hospitals are catching more of these Dr.’s from practicing?

Yes! One of the great things to come from the Swango case is the improvement in medical credentialing. I am guardedly optimistic that he would not be allowed to practice today, even after changing his name and lying about his background

Is it easy for you to come home and just realx after a long day of work?

its sleeping sometimes that's a problem

I'm wondering if one of the things that keeps you awake is agonizing over killers who you haven't quite been able to nail. For all the ones you've caught, there must be a few who've eluded your grasp.

My book details the case of Richard Williams, indicted but never convicted. Suspected of killing about 60 veterans at the Harry S Truman medical center in Columbus Missouri

Do you have any medical experience yourself? If not, how did you prepare yourself for recognising the killers?

I had the great fortune of being tutored by Dr. Michael Baden, the world renowned forensic pathologist who worked on all my cases

I once had to get stitches removed from my finger. I went to a clinic and the nurse who did it refused to give me even a topical anesthetic. She pulled two out to my excruciating pain before I had to leave. As I screamed in pain between stitches, she comforted me in a way that made it seem as though she enjoyed it. I went to another doctor who gave me anesthesia and I felt nothing as he removed the last few stitches. That experience haunted me in a way no other exchange with a medical professional ever has. Do you think there are varying degrees of predation and sadism in the medical community? How likely are professionals with relatively harmless (causing no long term physical harm) sadistic habits to go on to killing?

Interesting question, I'm not sure I'm qualified to answer that

Hello,

Of the 26 red flags listed in your book, which were the most surprising to conceptualize or link?

How were these medical professionals as students? Their class ranking? Where they trouble makers before becoming professionals?

The fact that staff will refer to one of their workers as the angel of death and they still remain working without any administrative action taken against them until the media or law enforcement is involved

Can you please elaborate on this? What do you mean that they were referred to as angels of death?do you mean that one of their colleagues had identified that they were doing this? Or did they mean this in a positive sense? I just don't understand what the linkage is.

I mean that the talk amongst the staff is that this person is killing people and gets the nickname of angel of death but remains on duty. In the Richard williams case a patient heard that, rant out of the hospital and was returned only to die unexpectedly the next night after getting a visit from Williams

Are there any common themes to their motivations? I'd imagine much of it has to do with feeling powerful but surely there are a lot of factors.

Again, I have found that Munchausen Syndrome by Proxy surfaces in many, but not all of these cases

Have any of them seemed to be trying to provide a painless death to terminal patients?

I only had one physician who claimed that but the family and the investigators weren't buying his argument

My girlfriend talks about how there are cases where someone who is not dead but critically injured and is an organ donor will have their organs harvested by surgeons since they're in need and not many people would ask questions thinking their death was from the injury. Is this a thing that happens have you come across this? It's a scary thought.

I have heard about this mostly in Asian countries

Do you still go to the Doctor? How does someone in your line of work who’s “seen behind the curtain” not succumb to paranoia and such? What do you do?

Of course I still go to doctors and hospitals. You can read about bad lawyers and accountants but when you need their services you have to take a leap of faith. Again the odds of being a victim of theses people are extremely small

Is there anything in medical education that you believe could be changed to prevent some of these people from moving forward in their training?

Swango was known by his fellow medical students as "double O Swango, licensed to kill". So I would say yes!

How common do you think doctors are abusing their position? Why do you think they are killing patients?

Again, the overwhelming majority are terrific, honest caregivers. Some have issues from their youth, some have substance abuse issues, and others are just pure evil.

The ones you say who are pure evil, in their interrogations what details about their childhoods came up that were indicative of their development into monsters?

I recall speaking with the father of Nurse Kristen Gilbert who was convicted of killing patients at the VA hospital in Massachusetts. He was all about discipline and criticism of his daughter. Pretty telling interview

I didn't see this asked already but how did they become aware of the doctor's acts? Like did someone analyze the doctors trend levels and just notice that this person has an higher level of deaths or something?

It usually starts when a coworker notices that every time a particular nurse for physician is on duty the death rate goes up, he takes a week off and the death rate goes down

My husband and I just watched this last night.

Why do you think someone like Dr. Swango chose to kill the way he did? As a doctor, he must have known that they would certainly test for all kinds of chemicals and harmful substances he used to kill people and/or make them sick. Do you think he wanted to get caught and this was easiest way for him to get that satisfaction?

They would not test for the chemicals he used routinely that is why he was not caught early on.

What was the most difficult to prove case and why?

The case of Richard Williams, indicted but never convicted in Missouri. The toxicology proved too unreliable for the prosecutor to continue the case

Do doctors take offense that you are accusing them of murder, negligence, or lack of knowledge in medicine?

You know, the 'I did all I can! How dare you say I screw up! You dare question my methods?' cards.

Of course, but we do not accuse without a substantial amount of evidence

How many medical professionals don't go to jail for this kind of thing? Has anyone somehow talked their way out of murder and just lost their accreditations?

Yes, there have been cases in both the US and Europe where just such a thing has happened

Can 'big data' catch many of these? How useful is looking for outliers in patient outcomes/morbidities across physicians?

It can certainly help. We use big data to catch hospital drug diverters all the time

At the risk of sounding like one of your subjects (I'm an engineer, not a medical professional fyi), how easy is it to be in the medical field and carry out these acts without getting caught?

No one wants to believe that a person who has taken an oath to save lives actually is intentionally taking lives. These people often demonstrate to their coworkers how well they react to codes and have saved some lives so people can't seem to believe that at the same time they are murdering some patients

Do you find that each one focuses on a specific illness or issue ? Or have there been any that will only kill if there are specific issues ? Do they think they are being merciful or are they enjoying it?

It has nothing to do with the patient, it only has to do with the thrill they receive from committing these acts

With long-term care facilities essentially locked down for several months now in the US due to covid, which limits the ability of family to make face to face contact with residents to verify their current health situation, and the statistical likelihood of negative outcomes for dementia patients who contract covid, is it probable that there are medical serial killers at work in long-term care now who will be undetectable so long as they don't get greedy or sloppy?

There are some dementia care units who are experiencing 30% mortality rates for residents due to covid ... isn't this an opportune time to literally hide the bodies?

We've already seen cases of 'bug chasers' in the health care field who knowingly contract covid, use medications to hide their symptoms, and continue to work in the health care field without properly using PPE in order to spread the virus. They've been seen so far as negligent and ignorant rather than malicious and criminal.

With state inspections limited due to the virus, are there particular red flags that would indicate intentional malicious medical practices rather than neglect due to overwork and limited staffing?

Wow, you are spot on in all your evaluations. 26 red flags are in my book in great detail

I've always thought it would be good to evaluate the relationship between provider specific mortality rate and provider-specific average patient CAN score. This would allow the identification of practitioners who have a mortality risk beyond that of their patients disease profile. Is this something that is currently in place?

If it is, it is very limited. Can't really say with certainty

I know we essentially have to take a leap of faith when we get medical treatment from someone, but are there any red flags we should look out for when seeing a doctor?

Do the best internet searches you can for malpractice and patient ratings before your first visit

I would imagine that there are enough people involved in patient care with enough medical knowledge that anything out of the ordinary should be noticed, especially similarities over time. What are the systemic problems that allow such prolific killings to happen?

Management, when confronted with these allegations is satisfied to have the target move on to another hospital rather than conduct a thorough inquiry that can harm the reputation of this facility

Do any of the ‘serial killers’ plead innocent? If so, do you believe any of the recorded people are innocent and just performed poorly due to incompetence?

Yes. Read about nurse Kristen Gilbert who was on trial for 6 months in Massachusetts for murder veterans. She was found guilty after trial

A lot of people are asking you questions specifically about doctors. Have you also looked at nurse serial killers like Charles Cullen?

Yes, a great case study of a nurse who traveled from hospital to hospital, always under suspicion but never referred to laws enforcement until the end of his killing spree

Do you know if any hospitals that have had a killer doctor on staff have have resisted your investigation, and if so could you give an example of such an obstruction?

Many hospital stories of management resisting an investigation all over the world. Read about the nurse williams case or the recent case of a nurse in Germany who murdered of 100 of his charges

What's a potential early red flag that a patient could spot? As patients in that environment I would imagine it's natural that most people just trust what their doctor is prescribing or doing, even if it may seem wrong/dangerous. After all, they're the experts not us. I know there is a history of medical practitioners in many fields using that fact to abuse and take advantage of their patients. Are there any consistent telltale signs in the actions/behaviours of these individuals that a layman could pick up on? And in your experience even if a patient were to pass on their concerns, how receptive are staff to complaints of that nature? I could see it being something that might not be taken seriously and just brushed off unless there was serious evidence.

In the case of Swango, there were patients who survived his attempts and reported it to management. Their concerns were deemed to be examples of hospital delerium which is a patient imagining things happening that re not real. Staff does not want to believe one of their own is killing patients

Have you found that people enter the profession with the intention of committing murder on vulnerable people? Or have they been tempted having experienced the 'power' as a doctor and they literally want to play with someone's life?

This question is often asked of me. I feel that most killers do not enter the profession with the intent of killing but events in their personal lives and/or on the job change them. That's my opinion

I'm curious if you were involved in the case of Anthony Garcia, a doctor who murdered his division chief and the family of his program director because they failed/fired him as a resident for unprofessional behavior.

Giving a trainee a failing grade usually has repercussions for the educator. They often have to spend extra time writing letters justifying the failure, or they have to spend an extra year working with an incompetent resident, or they get subpoena'd in a lawsuit. There is no incentive to self-police, and then these problem doctors are unleashed to the public. Anthony Garcia is an extreme case, but I do think about the possibility of retaliation when considering failing a resident or student.

Why do you think physicians don't self-police?

I think things are improving in the self policing arena because the public is demanding it. Dr. Dennis Charney the Dean of Mount Sinai Medical School was shot by a researcher he fired for submitting fraudulent research. Luckily the dean survived and is back at work.

What did you make of Harold Shipman when the news of his murders surfaced through the media?

Incredible. He is the first doctor to be successfully criminally prosecuted for murdering his patients in the history of England....which in of itself shows you how hard it is to make these cases

I'm guessing you have heard about Dr. Macchiarini. Do think it's possible that he has munchausen by proxy? Or something similar? Or do you you think that he is just very very reckless?

You are referring to his research fraud. Very similar to Dr. Kornak in Albany. Don't know that much about his case but I will read up on it today

You mentioned that Swango's coworkers gave him nicknames that indicated that they had suspicions or knowledge of what was going on, do you think that in cases like this coworkers should be seen as complicit either by the law or by whoever can take away medical credentials?

The managers who are informed of these incidents and take no action are complicit as well as coworkers or say nothing. In Germany they are looking to prosecute some of the managers who were informed of these alleged killing and did nothing

I read a book about Charles Cullen, and the thing that struck me the most was how easily he got hired just because the hospitals were in dire need of nurses. Have you found this to be the case frequently? Where hospitals know something is not right but turn a blind eye simply because they need to hire?

Not true any more, for the most part....however, we are in the middle of a pandemic and there are nurses and physicians in great need for this front line fight....I had a case of a nurse who came up to NYC to help out but are real mission was to steal drugs to feed her habit

Are medical criminal thrillers accurate or realistic?(if you read them) and if so which one is the most realistic?

It varies from show to show. The Very Scary People episode, Dr Death is very accurate

Based on your experience what is the likelihood that Jack The Ripper was a doctor?

I took the Ripper tour in London. I always thought it could be a member of the Royal Family...but remember back then barbers did surgery as well

Have you ever encountered one with good intentions? I.E thinking that they are actually helping by saving patients from imminent pain, like angel of mercy.

I imagine there were many that have done this one way or another, but I wonder whether if there's a serial one.

I have encountered healthcare professionals who have acted like this on occasion, yes, but I don't classify them the same way

Hi I’m currently finishing my bachelors in psychology. Majority of my family are law enforcement and government agents, those areas never interested me. The human behavior aspect as well as their actions under pressure are simply amazing. My question is for the serial killers in the medical field do they have a “God Complex” in the sense of not bringing the victim back from death but in a sense of the victim for whatever reason they deem as they don’t deserve to live?

medical serial killer Donald Harvey said that after he kill the first 19 patients and no one questioned him he thought he was ordained by GOD to do these killings...no so illogical if you kill 19 patients and no one bats an eye...

What group is in charge of keeping tabs on the professional competence and due care of medical professionals and why do you think ethics is so easily abused in this profession?

The States have agencies and medical boards to watch out for bad performers. The ability to pull someone's license to practice is a great tool. But it is not so easy to use. I had a case of a pharmacist who confessed to stealing 200,000 dozes of oxycodone and the pharmacy board refused to even suspend his license until he pled guilty

Is there any hope for a data-driven approach to catching these people in the future? Would record centralization help at all with this?

I'm all for using data to track folks. We have made great strides in this area identifying individuals diverting hospital pharmaceuticals

Have you heard about what the uk is doing to the elderly in state funded care homes? Would this qualify in your opinion as medical murder?

Sorry, not familiar but will look into it, thanks for telling me about this

Have you ever wrongly convicted anyone? Or been part of such a case?

Thank goodness no. These cases take years to develop and consist of teams of people gathering a lot of evidence

Are you the only guy who does this?

Not too many of us who do this exclusively