Syndrome that feeds on a desire for attention: Mary Braid reports on serial killings in the US which have similarities with the Allitt case

IN BEXAR County Hospital, San Antonio, Texas, Nurse Genene Jones's 3-11pm shift was nicknamed the death shift by colleagues.

'Blue code' emergencies multiplied when she worked in paediatric intensive care. And when a child collapsed or stopped breathing, Nurse Jones was always in the thick of it. It was some time before staff suspected that Jones was a heroine in dramas of her own creation.

In 1984, she was sentenced to 99 years for the murder of Chelsea McClellan, a year-old patient who died after a lethal injection. But investigators believe her to be responsible for as many as 15 other deaths.

Jones's story is remarkably similar to that of Beverly Allitt. It also appeared to start a trend. There have been at least seven investigations into serial killings in US hospitals since.

Psychiatrists believe Jones suffered from Munchausen Syndrome by Proxy where sufferers harm children in a perverted desire for attention. It is a variation on Munchausen's Syndrome where sufferers imagine symptoms, deliberately harm themselves and even convince medical staff they need unnecessary surgery.

Recently the definition of Munchausen's syndrome by proxy has been expanded to apply to individuals who fabricate and induce medical problems in children under their care.

Jones certainly appears to fit the syndrome profile. In his book The Death Shift, American journalist Peter Elkind describes her as a rather inadequate character who had felt neglected since childhood. She exaggerated her son's medical problems and when she became a nurse she pestered senior staff for the most 'at risk' patients.

Eventually she began injecting children with paint thinner and powerful drugs, sparking emergencies in her ward.

On blue code, Jones' workmates remember her extraordinary excitement. They said she became sweaty and seemed in a state of almost sexual 'euphoria'.

Donald Harvey, a former nursing aide, is perhaps the most infamous medical serial killer after Jones. In August 1987 he pleaded guilty to killing 24 people, attempting to kill four others and assaulting another by administering poison. All but one of his murdered victims were patients at Daniel Drake Memorial Hospital in Cincinnati, Ohio, where he worked or a year.

The former morgue attendant poisoned his victims with arsenic, rat poison and hepatitis serum. Nicknamed 'the Angel of death' by colleagues because of the number of patients lost in his care, he was caught only because a mandatory autopsy was performed on a road accident victim. Cyanide was discovered in the stomach.

After Harvey's conviction lawsuits worth more than dollars 71m ( pounds 46m) were filed against the hospital by families.

Hospital security companies are taking the growth in medical serial killings seriously. They advise thorough background checks on all hospital employees, reviews of the patterns of deaths and strict control over access to poisons.

Louis Gasbarro, president of the International Association for Health Care, Security and Safety Officers, says protecting the public from psychopathic health workers who 'run amok' is very difficult.

In the Death Shift, Elkind condems the hospital for failing to expose Jones. Despite evidence that she was harming children, administrators did not fire her, fearing litigation and scandal. Instead, they gave her a letter of recommendation for her next job.

It was in that post, when the pattern of emergencies were re-established and Chelsea McClellan died, that Jones was finally arrested.

In 1991 four Austrian nurses were found guilty of killing more than 40 elderly patients in a Vienna hospital.