Expert comment Last updated 21 June 2018
Criminologists Professor Elizabeth Yardley, Professor David Wilson and Emma Kelly discuss the news that surfaced this week – a report has found that 450 patients died after being given powerful painkillers inappropriately at Gosport War Memorial Hospital.
Given that our most prolific British serial killer was a trusted, local GP working in Hyde in Manchester and a significant number of our other serial killers worked in hospital settings in various roles, it was inevitable that as criminologists we would become interested in the phenomenon of ‘Health Care Serial Murder’ as an individual phenomenon.
Yesterday, news broke that over 450 patients had died after being inappropriately prescribed painkillers at Gosport War Memorial Hospital and we were suddenly and dramatically made aware that the Hospital - as an institution - could act as a serial killer too.
These revelations emerged from a report by an independent panel, who suggested that the 450 deaths between 1989 and 2000 may well be an underestimate. Taking missing hospital records into account, another 200 patient deaths may be linked to these practices.
Prescribing within the hospital was overseen by Dr Jane Barton, who has not faced any criminal charges in relation to the deaths. She underwent a ‘disciplinary process’ during which she was found guilty in relation to the failings in care of 12 patients between 1996 and 1999 – representing only a fraction of the harm done. She was able to carry on practicing and chose to retire after the findings. She was allowed to make this choice and leave this behind her, something denied to the families of those who died.
Four years ago, we published our study on healthcare serial killers in the Journal of Investigative Psychology and Offender Profiling. Within that piece of research, we explored the phenomenon of nurses working in hospital settings who were convicted of killing their patients. Thankfully our study uncovered relatively few cases – just 16 killers across the world in the period between 1977 and 2009. However, what this small sample represented was that there were individuals prepared to abuse the sick and the vulnerable within institutions charged with their care.
Now we have to face an uncomfortable and obscene reality that perhaps those individuals were merely reflecting and then responding to broader, organisational cultures.
When we think of serial killers and multiple homicide, we tend to envisage lone predators and focus solely upon their individual psychopathology. We ask questions like ‘Why did they kill?’, ‘What turned them into a murderer?’ and sometimes ‘Could we have stopped them?’
But this is only part of the picture. To kill multiple people requires not just the presence of a determined killer but the absence of protectors and guardians. When no one is looking out for the interests of the vulnerable, the vulnerable become the victims. Within organisations, failed protectors and guardians find strength in each other, denying responsibility, eschewing accountability and playing ping-pong until (they hope) people will just go away and stop demanding answers.
The report of the independent panel stated that there was a disregard for human life at Gosport War Memorial Hospital where there was an “institutionalised regime” of administering dangerously high levels of medication.
Yet these people were not terminally ill; they were not in unbearable pain; they were not being ‘put out of their misery’ under the guise of compassion, or mercy. Instead they fell victim to a ‘one size fits all’, production-line style excuse masquerading as ‘care’. They entered the machine and never came out again as they were simply seen as problems to be dealt with and numbers to be crunched on the terminal care pathway.
The use of the word ‘care’ here is, obviously, wholly inappropriate. This wasn’t care; it was contempt.
It was also homicide.
The ring of the familiar for us as academics who study the phenomenon of serial murder wasn’t just limited to the setting where these murders took place. The victim group which was targeted was also something that we have become all too aware of through our research about serial murder. The group most likely to be targeted by serial killers in the UK are people over the age of 60 – and most likely women over the age of 60. Serial killers, in this respect are the perfect embodiment of a culture which all too often devalues the ‘elderly’ and their role in our society and which characterises them - wrongly - as a ‘drain’ on the state and even, most recently, as ‘responsible’ for Brexit.
For several years now, criminologists have been talking about the concept of corporate homicide, “a crime in which a person or people are killed as a result of corporate conduct – actions or omissions – which fall far below what can reasonably be expected of the corporation in the circumstances”. We discussed this very topic on our podcast last year. Examples often cited in this context are the Bhopal Disaster and Herald of Free Enterprise. These events are often described as tragedies or accidents, which conveniently distracts us from the fact that they came about because individuals made decisions - conscious choices - to put others in harms’ way. These deaths were wholly preventable.
So too at Gosport War Memorial Hospital, the actions and inactions of individuals created and maintained a culture and environment in which erasing - killing, the elderly became routine and normal.
When nurses voiced their concerns and when relatives complained to authority figures, the response was one of disinterest and detachment. Managers and bureaucrats hid behind procedures, processes and rules. They closed ranks, they engaged in interpretive denial – the facts were in front of them, they could see what they stacked up to, but they chose to interpret those facts in ways that justified not acting.
If we want to reduce the incidence of serial murder in the UK we can all do so by challenging the perverted social context which individual serial killers harness for their own, deadly ends. We need to challenge homophobia, have a grown up debate about sex work and begin to recognise and value the contribution that the ‘elderly’ have made and can continue to make to the development of our society. And, for us, that is also the hopeful message that emerges from this institutional scandal. In the same way that individuals deny, they can also acknowledge. The families of the victims of Gosport War Memorial Hospital did not give up. They fought. They challenged. They were tenacious and determined. We should be too.
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