Letters

Murder in the NHS: Grantham consultants support scapegoat doctors

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6926.477 (Published 12 February 1994) Cite this as: BMJ 1994;308:477
  1. C R Birch,
  2. J E Carty,
  3. D Valerio,
  4. B L Kathel,
  5. A D Al-Asadi,
  6. U D Wijayawardhana,
  7. S M O'Riordan,
  8. J L Breckenridge,
  9. C Onugha,
  10. G Batchelor,
  11. D Clarke,
  12. S Voght,
  13. R M Spencer-Gregson,
  14. R Husemeyer,
  15. V Trinham,
  16. S Bradley,
  17. P Gibson,
  18. C E Cory
  1. Grantham and Kesteven General Hospital, Grantham, Lincolnshire NG31 8DG
  2. Department of Public Health, Paisley PA2 7BN.

    EDITOR, - We were encouraged to read W J Appleyard's editorial in support of the paediatricians at Grantham and Kesteven General Hospital who were made redundant in the wake of the murders committed by Beverly Allitt.1 We wish to reiterate our support for our colleagues, Dr Nelson Porter and Dr Charith Nanayakkara. We have previously conveyed our concern that they were being made scapegoats in letters to the regional medical officer, the district general manager, our member of parliament, and the Times (which did not publish our letter). We believe that Drs Porter and Nanayakkara have suffered a grevious injustice without proper opportunity to defend themselves.

    References

    Audit critical incidents in patients at risk

    1. C Stark,
    2. D Sloan
    1. Grantham and Kesteven General Hospital, Grantham, Lincolnshire NG31 8DG
    2. Department of Public Health, Paisley PA2 7BN.

      EDITOR, - W J Appleyard describes the efforts of the consultant paediatricians at Grantham and Kesteven Hospital to uncover the cause of the unusual deaths on their ward.1 Similar episodes have occurred elsewhere and have proved equally difficult to identify. One series of health care murders continued for 15 months.2 In two other cases the available evidence did not secure successful prosecutions, leaving the possibility of repetition.3,4

      For any particular patient it may be impossible to identify the unusual nature of the death,2 and so patterns of deaths become important. The main difficulties affecting clinicians are the rarity of the event, which results in a low index of suspicion, and the difficulty in identifying a true increase in mortality.3 In deciding whether an increase in unexplained deaths has occurred the possibility of random fluctuation must be considered. There may be no increase in overall hospital mortality during the “epidemic” period even when a health care murderer is subsequently identified. Cause specific death rates may also not show a problem. Random fluctuations can be even more extreme in small units. One possible solution is to look at critical incidents rather than mortality alone2: they may best be monitored with graphic representations of the rates of incidents.3 Even if an unexplained increase is apparent other possibilities, such as errors of medication, must be considered.5

      Once a problem has been identified epidemiological techniques can further delineate its nature by looking at the time and place of occurrence and association with particular hospital staff. Such investigations can show only association and not a causal relation. Retrospective epidemiological investigations have not always resulted in prosecutions, showing the importance of epidemiologists and clinicians working in tandem, and with police forces when appropriate.4

      Despite their rarity, health care murders merit attention because of their extraordinary potential for harm. Previous work suggests that elderly and very young patients and those in intensive care units are particularly at risk. Clinicians working in such environments may benefit from remaining alert, as the paediatricians in Grantham did, to the possibility of such events. A system of audit that examines critical incidents and can identify and correct more common problems, as well as criminal actions, should be encouraged.

      References

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