Jeremy Laurance: The dangerous power of healing hands

Medical life

Who are the biggest serial killers in history? Doctors first, nurses second. Richard Smith, the former editor of the British Medical Journal, tweeted this insight at the weekend. The deaths at Stepping Hill Hospital, Stockport, have revived interest in the issue and sparked memories of other incidents where patients have died in suspicious circumstances. Some cases are better known than others.

Everyone remembers Beverley Allitt, the nurse jailed for life in 1993 for the murder of four children, whom she poisoned at a hospital in Lincolnshire.

Less familiar are more recent incidents such as that of nurse Colin Norris, 32, who was jailed for 30 years in 2008 for killing four elderly patients at two hospitals in Leeds, and nurse Anne Grigg-Booth, 51, who was charged in 2005 with the murder of three elderly patients at a hospital in Yorkshire but died of an overdose before the case came to trial. Nurse Benjamin Green, 25, was convicted in 2006 of murdering two patients and harming 15 others at Horton General, Oxfordshire.

Why is Allitt remembered but Norris, Grigg-Booth and Green are not? Probably because her victims were children.

In 2008, John Field, a lawyer and former nurse with 30 years experience, studied 48 cases from around the world where nurses had killed patients. His conclusion? The murder of patients was "independent of the quality of care provided" and "could occur in any healthcare facility".

Equally unreassuring was the review by Herbert Kinnell published in the BMJ in 2000 of serial homicide by doctors in the wake of the Harold Shipman murders. He wrote that the medical profession "attracts some people with a pathological interest in the power of life and death," and concluded his survey with the warning: "History does tend to repeat itself."

It is hard to see what hospitals can do to make patients safer. Medical care depends on trust. We allow doctors and nurses to do things to us that in another context would constitute physical assault. All that protects us is the shared belief that what they do is intended to deliver more benefit than harm.

Following Shipman's conviction for the murder of 15 patients in 2000, tighter restrictions were placed on the availability of morphine, the drug he used to dispatch his victims. Result – more terminal patients died in agony, denied the medicine that could have eased their suffering.

Field says that of the 48 cases he studied, 38 were serial killers about whom collegues had harboured suspicions for some time but had not reported them. When they did, hospital managers were slow to react and "on a number of occasions encouraged the nurse to move on".

Ah yes – the classic manager's response. We have seen this gambit adopted with dodgy doctors in the past. Surely someone in the NHS can at least reassure us that this is not happening now.