When Healers Become Killers: Why Some Nurses and Other Medical Workers Murder Their Patients

As a nurse, Niels Hoegel was entrusted with helping save patients' lives. Instead, he is suspected of killing more than 100 patients at two hospitals in Germany from 1999 to 2005.  (Editor's Note: As of May 10, 2019, authorities suspect Hoegel of more than 300 murders.)

Hoegel, 41, had already been convicted of two murders when new counts were announced January 22, 2018, charging him in the deaths of 97 additional patients. Hoegel told authorities he injected patients with drugs to cause heart failure or circulatory problems and then attempted to revive them so he could be seen as a hero.

We spoke with Beatrice Yorker, professor emerita of nursing and criminal justice at California State University, Los Angeles, and author of scholarly works on serial killings in health arenas. She explained how these killers get away with the crime, why craving attention can be deadly and how an unlikely group of hospital employees can unwittingly solve crimes.

What motivations might be behind these types of serial killings?

These people are attention seekers. They have underlying hostility and rage, and it's a way to express power and control where they may otherwise feel fairly helpless in their lives.

How are serial killers in health-care settings different from typical serial killers?

The biggest difference is covert versus overt violence and aggression. Murder in the health-care setting is a more feminine form of violence. Even the male nurses are choosing to engage in a feminine form of violence, which is killing with kindness. That's things like smothering, poisoning and injecting in the context of caregiving.

Masculine forms of violence are gunshots, strangulation, battering, drowning, beating. Very physically aggressive, assaultive types of violence.

So they find this easier to accomplish?

Prior to our 2006 [scholarly] article ("Serial Murder by Healthcare Professionals"), it was almost too easy to cause a cardiac arrest or death in a patient just by adding a couple of extra drops into a syringe injected into IV tubing. It doesn't even prick their skin. Although that has changed in the United States because there are [now] a lot more safeguards in place.

Hoegel claims he acted out of boredom.

It is definitely a motivation that has come up in other cases. They like to create critical incidents; they're just enlivened by it. It's an addiction. It's a buzz. It's an extreme form of being a drama queen or a drama king. They're happy in a crisis.

Hoegel also said he liked feeling euphoric when he was able to resuscitate the patients. Does that tell you anything about his mental state?

They're not mentally ill, but many of them do have personality problems or disorders.

Seeking that intense feeling of happiness is a disorder?

It can be an addiction. It can drive compulsive behavior. It's associated with using alcohol to excess, drugs to excess, hurting animals, cutting your wrists. There are lots of instances when seeking euphoria can become problematic. Look at extreme thrill seekers—they can end up dying.

Could feelings about his appearance or low self-esteem spur these killings?

Not necessarily. Our study looked at 90 people who were prosecuted for murder of their patients. They fit the whole gamut. It's not a determining factor.

Is Hoegel's M.O. similar to those with Munchausen syndrome by proxy, when people intentionally harm others to get attention for themselves?

I see many parallels. The biggest is that they use medical crisis to get attention.

Do these medical serial killers give off any signs?

They always seem to have some kind of crisis in their personal lives and they are pathological liars. Once they've been identified, [colleagues] will say, 'Oh my gosh, I should have suspected. I knew something was off. I knew if I left the unit, my patients would go into a code.'

There have been similar killings by health-care workers such as Genene Jones in Texas,  Elizabeth Wettlaufer in Canada and Charles Cullen in New Jersey. Are medical professionals one of the larger subsets of the serial-killer population?

Yes. It takes quite a bit of planning and determination to abduct somebody, tie them up and do the things that people like Ted Bundy have done. On the other hand, people go into the hospital because they're on the verge of dying. It takes a lot less effort to just inject a few extra concentrated drops of medication into them. And then when the patient dies, it's much less suspicious than finding a body on the street or having a missing-person report.

They're predominantly nurses.

Eighty-six percent in our study were in the nursing profession, 12 percent were physicians and 2 percent were allied-health professionals like med-tech and respiratory therapists.

Do they see themselves as an ‘angel of mercy,’ someone who can end a patient's suffering?

Several of them have said, 'I was only trying to help the patient.' But when we looked at the actual patient records, that was not the case. Some patients came in for a biopsy that turned out to be normal. No one asked for this. Not a single patient of a health care-serial killer ever consented to be euthanized.

Deaths wouldn't be unusual in health-care settings. Does that make detecting these killers more difficult?

Absolutely. You don't routinely do autopsies when people die in hospitals. You're not looking for a crime.

The way many of the serial health-care killers got caught is by a statistical analysis of death. Someone in the data department called up and said, 'We've had a 50 percent increase in the number of deaths in the ICU in the past few months.' The numbers crunchers are often the ones who say, 'We've got a problem here.'