Rogue practitioners: What motivates them, and what can be done to protect patients?

Last month, it emerged that a German male nurse, currently serving a life sentence for the murder of two patients, is being investigated for 84 other suspected murder cases. If confirmed, this would make him Germany’s worst post-war serial killer.

The nurse, known only as Niels H under German privacy rules, was previously convicted of attempted murder in 2006 and of actual murder in 2015. He gave his victims lethal drug doses leading to heart failure or collapse of circulatory systems.

One aspect that makes his particular case stand out is that it seems he didn’t actually intend to kill his victims. According to the judge at his original trial, Niels H was motivated by the desire to win approval and recognition, by successfully resuscitating from coma the very same patients he had previously secretly overdosed.

Willis Re’s research on multi-patient injuries can shed some useful light for healthcare risk managers and their insurers

What underlies this sort of behaviour, just how unusual is it and what can be done to protect patients? These are all questions where Willis Re’s research on multi-patient injuries can shed some useful light for healthcare risk managers and their insurers alike.

Previous blogs have touched upon other rogue healthcare practitioners, such as the surgeon Ian Paterson, who was responsible for hundreds of patient injuries. Sadly the examples of Niels H and Paterson, while extreme, are far from unique.

To give just a few examples: Poggiali, an Italian nurse, is thought to have killed around 93 patients in the space of a year, after injecting her patients with abnormally high levels of potassium chloride. In Australia, Dr. Patel was found guilty of manslaughter, leading to the death of 13 patients during his tenure as surgeon at Queensland’s Bundaberg base. Japanese police are still on the lookout for an angel of death who may have caused the deaths of 48 patients at a hospital by poisoning their intravenous drips. And in Spain, Dr. Maeso infected 275 patients with hepatitis C, injecting himself with morphine before using the same syringe to inject his patients.

What motivates the behaviour?

Our data suggests that these rogue practitioner cases generally fall into at least one of the following categories:

  • Repetitive poor outcomes, where no particular motive is apparent or alleged, which might therefore be put down to serial incompetence or recklessness, rather than any premeditated desire to harm.
  • Financially motivated, such as deliberate misdiagnosis leading to unnecessary but financially lucrative surgical procedures.
  • So-called “angels of mercy” or “angels of death,” where healthcare providers, often in a relatively junior capacity—meaning they’re not usually authorised to prescribe drugs — take it upon themselves to relieve suffering.
  • Deliberate attention seekers, where the healthcare provider exaggerates or even causes a medical problem, in order to then be in a position to come to the rescue.
  • Deliberate and malicious acts, with examples ranging from knowingly putting patients at unnecessary risk of contracting HIV, to abuse, mutilation and sometimes even murder.

What can it mean for healthcare organizations, insurers?

The implications are profound. Last week, Spire Healthcare, the U.K.’s second largest private hospital provider with 39 hospitals, saw first-half profits slashed by 75% and its share price fall 18% after it had to set aside some £27.6m to settle claims from patients of Ian Paterson, money presumably not covered under its regular insurances.

It was also reported that Paterson’s own insurer had paid out £10m, so the amounts involved are far from negligible. To address such threats Willis Re works closely with our clients and reinsurers to design, develop and build capacity to support practical and robust reinsurance solutions. The good news is that improvements in hospital risk management and evolution of insurance protections will no doubt follow.

About John Haydon

John Haydon is an Executive Vice President in Willis Re's London office specialising in Financial & Professiona…
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