Name some famous serial killers?

• Jack the Ripper

• Jeffrey Dahmer

• John Wayne Gacy

• Ted Bundy

Do You Know?

• Jack the Ripper (7)

• Jeffrey Dahmer (31)

• John Wayne Gacy (33)

• Ted Bundy (20+)

Harold Shipman, M.D.

Graph showing death rates by physicians

Why don’t we know these names?

• Harold Shipman, MD • Michael Swango, MD• Michel Pettiot, MD (63 murders in 1940’s)• John Adams, MD (40 murders in 1950’s)

• Orville Majors, Donald Harvey, Genene Jones,

First Exposure

• 22 y/o mother of 4 transferred after 19 days at another hospital

• Initially, 2 week N/V/D, cough, rash, weakness.• Was pancytopenic, pneumonia ascending

peripheral paralysis• Day#18 seizure and ventricular fibrillation

(“Torsades de pointe”)• Multiple episodes VF, +/- response to lidocaine

and Mg+2.• Neuropathy worse

Case continued

• Neuropathy worse, needs ventilator to breath

• D# 54, family priest comes in with story of confession about arsenic-laden OJ given to patient at party.

• Testing yielded normal urine but severely elevated hair levels in a pattern that suggested acute-on-chronic exposure

• 1984 - while a resident on Dr. Bauman’s cardiology rotation.

CHICAGO’S POISONING HISTORY• Johann Hoch - “The Stockyards Bluebeard”

– 1892-1905 murdered 12+ of 24 wives with arsenic. Collected assets. Hanged 2/23/1906

• HH Holmes– Dr Holmes built a drugstore empire based in

SouthSide of Chicago. Remains of > 200 people found in his castle. Spree lasted from 1893-1896. Considered the first sensational crime trial in American crime history

– “The devil and the White City”

• Tille Gburek– Chicago “psychic”, known for predicting exact date

of 5 husbands and 3 neighbors deaths - arsenic

MODERN CHICAGO• Tylenol murders

– 9/29-10/1/82, seven deaths from cyanide-laden Tylenol capsules

• Never solved, appears purely random act of poisoning

• After publicity of case, following month had 270 reports of product tampering, 36 were proven true in the U.S.

• Lead to development of two innovations– Dosage form?– Packaging?

CHICAGO Summer 2002• July- 12 y/o severe Cerebral palsy, non-diabetic,

found unresponsive by family member (no family member was diabetic, EMT found glucose = 0

• Multiple D50W’s and dextrose infusions over next 16 hours to maintain glucose of 40-60

• Blood insulin 400 (20 x nl), no c-peptide

• 9/9/02 – 67 ovarian cancer with mets, presents with A fib. Admitted to CICU. Digoxin 0.25 iv ordered, 2.5 mg given experienced RN – (?)

ILLINOIS HISTORY• Michael Swango (30+) “00-Swango”

– Born 1974 Quincy– Medical school at SIU didn’t graduate– 1984 Quincy paramedic - co-workers always got sick

when he brought doughnuts, soda, iced tea (Ant poison [Arsenic] found mixed with sugar in home. Charged and convicted aggravated battery 5 yrs prison.

– Lied about graduation and licensure, worked in hospitals in 5 states (inc Harvard) and Zimbabwe. Always large number of deaths noted during his duty

– “Blind Eye” by James B. Stewart

Toxicomaniacs

• Michael Swango• Helene Jegado 1800s (23+)

– arsenic to families she worked as maid for.

• Jane Toppan (31+)– Boston 1840s, private nurse with “special

cocktails” except too many died

• Graham Young– 1980s. 2 deaths, many poisonings, many

compounds.On arrest enough poison to kill> 300 in home

– “Young Poisoner’s Handbook” movie

Mercy Killers• Nurses– K Gilbert (4+) 96-7 NC epinephrine– Richard Diaz (12+) CA succinylcholine– Orville Majors (70-130) 1993-5 Indiana epi, KCL– Don Harvey (37-80+) 1970-1987,– Edson Guimares (5-131) Sao Paulo RN tech KCL, C Malevre (4-30

Paris 1997-8) Queen of euthanasia, W. Wagner gang Austria (45-200) 1983 MSO4/water

• Others– E Saldivar resp therapist (50+) Glendale 1989-1997pancuronuim,– A Nessitt nursing home administrator Norway 22+ curare– Midwife (36 women) gang, Hungary (80-300 men) 1914-1929 arsenic

U.S. Mercy Killers 1980-1990’s

• Nurses, alone or in groups, arrested for 172-240 suspicious deaths in 7 U.S. hospitals during 1980’s

• 4 Nurses arrested for 123-195 deaths in 1990’s in 4 U.S. hospitals

• Kevorkian? , Philip Nitschke? (Aussie), Christine Malevre (French)?

Mercy Killers 2000’s

• Hungarian Nurse (“Black Angel”) 30-40• Dutch nurse 14+ deaths mostly elderly or vry

young children, avidly read biographies on serial killers

• Japanese nurse 10+ deaths in his care, all children (vecuronium)

• Nurse, Texas arrested 7/2002 for 15 deaths 11 days – mivacurium

• West Palm Beach nurse used propofol, charged with 1 death. Investigating others

Extortion

• Usually isolated poisoning, product tampering with lawsuit against manufacturer desired result.

• Australia 1999 - Dennis Donald Fountain arrested for lacing strychnine into tampering OTC painkillers, three people hospitalized.

• Companies pulled product off shelves, est $72 M lost revenue

• Then threatened two manufacturers he would use their product next for $1 M in cash

Pharmacist Poisoners?

• No known current (at least to me)• Closest thing to it – “The non-Poison killer”,

Robert Courtney

• Kansas City MO, pharmacist caught by sales representative who was reviewing billing ordering records for chemotherapy

• He was diluting products Gemzar and Taxol

Nanjing China

• At least 40 dead (up to 100)• Breakfast shop – serving middle school kids

and migrant workers• Rival shop owner contaminated food with

tetramine (banned rodenticide since 1991)• At least 150 dead over past 12 months in

similar events

CURRY POISONINGS• 1998 - 4 deaths and 63 ill after eating food at

picnic. Arsenic found in curry.• Two years to find suspect• In interim over 40 copycat poisonings and

product tampering events in same year.– Cyanide laced Coke, disinfectant

• Repetitions (“poison pizza”) continue in Japan

Curry Poisoning (cont)

• Masumi Hayashi 37 y/o insurance saleswoman married to fumigator husband arrested.

• Had sold insurance policies to festival attendees, average $11 k.

• Tip was from visitor who got ill after signing policy in her home and being given drink and food that immediately made him ill

Current Food Poisoning (cont)• 3 arrested in Jerusalem September 2002 for

plotting to poison customers in Café where they worked, targeted pitchers of Coke

• 60+ grade school children Joliet Illinois hospitalized for food poisoning from eating chicken tenders– Ammonia spill in meat packing plant, product

already packaged, decided okay to still use but sprayed with pesticide first

Conclusions

• Malicious poisoning far more common and deadly than casual perception

• Healthcare professionals who poison are frequently identified by casual epidemiology or coworker concerns

• Unusual death rates and or discrepancies in stocks for KCL, paralytics, cardiac meds should be compared to deaths and work shifts

• Easiest to catch within the in-patient acute care

Harold Shipman, M.D.

Major internet sites

• Mayhem.net• Crimelibrary.com• Karisable.com• Cybersleuths.com

Now this is bioterrorism!

Paloucek@uic.edu