An open letter

To whom it may concern,

I’m wondering if you can do anything to help Ben Geen. Write an article, blog about it? There are important issues which need to be made known to the public. There is a lot of false information and it needs to be countered.

There is in fact an international epidemic of falsely accused health care serial killers;

In Netherlands: Lucia de Berk
In the UK: Colin Norris, Ben Geen
In Canada: Susan Nelles

We have felt compelled to start this “action committee” because yet again the media has totally poisoned the climate against the victim and this needs to be redressed.

In the UK Colin Norris and Ben Geen are serving 30 year sentences and it is absolutely clear that they are completely innocent. Since no one was murdered there never will be a confession by the true murderer. Because there were no murders there won’t ever be new evidence pointing in a different direction. There will never be a new fact so the system will never allow the cases to be reviewed. Since the medical profession was complicit in putting these guys away no medical doctor will ever say a word to compromise his esteemed colleagues.

In NL we had Lucia de Berk.

Canada had Susan Nelles.

I am sure there are lots of US cases.

What is going on? Why this international epidemic of falsely accused “health care serial killers”?

Answer: in the UK: the scare which followed Shipman triggered increased paranoia in the National Health Service. Already stressed, overburdened, underfunded … managers, nurses, specialists all with different interests, under one roof in a hospital … different social classes, lack of communication

So here are the ingredients for a Lucia/Ben/Colin:

(1) A disfunctional hospital (chaos, stress, short-cuts being taken).

(2) A nurse who is different from the other nurses. Stands up in the crowd. Different sex or age or class. More than average intelligence. Outspoken, critical.

(3) Something goes wrong. Someone dies and everyone is surprised. (Why surprised: because of wrong diagnosis, disinformation, ….).

(4) Something clicks in someone’s mind (a paranoid doctor) and the link is made between the scary nurse and the event.

(5) Something else clicks in … we had a lot more cases like that recently (eg. the seasonal bump in respiratory arrests. 7 this month but usually 0, 1 or 2).

(6) The spectre of a serial killer has now taken possession of the minds of the first doctor who got alarmed and he or she rapidly spreads the virus to his close colleagues. They start looking at the other recent cases and letting their minds fall back to other odd things which happened in recent months and stuck in their minds. The scary nurse also stuck in their mind and they connect the two. They go trawling and soon they have 20 or 30 “incidents” which are now bothering them. They check each one for any sign of involvement of the scary nurse and if he’s involved the incident quickly takes on a very sinister look. On the other hand if he was on a week’s vacation then obviously everything must have been OK and the case is forgotten.

(7) Another conference, gather some dossiers – half a dozen very suspicious cases to report to the police to begin with. The process of “retelling” the medical history of these “star cases” has already started. Everyone who was involved and know something about the screw-ups and mistakes says nothing about them but confirms the fears of the others. That’s a relief – there was a killer around, it wasn’t my prescription mistake or an oversight of some complicating condition. The dossiers which will go to the police (and importantly, the layman’s summary, written by the coordinating doctor) does contain “truth” but not the “whole truth”. And there is even more truth outside the hospital dossiers (culture of lying, of covering up for mistakes).

(8) The police are called in, an arrest is made, there is of course an announcement inside the hospital and there has to be an announcement to the press. Now of course the director of the hospital is in control – probably misinformed by his doctors, obviously having to show his “damage control” capacities and to minimize any bad PR for his hospital. The whole thing explodes out of control and the media feeding frenzy starts. A witch hunt, followed by a witch trial.

Then of course there is also the bad luck. The syringe, in Ben’s case, which confirms his guilt to anyone who does a quick Google search today.

This is what Wendy Hesketh (she’s writing a book on the topic) wrote:

“I agree with your view on the “politics” behind incidences of death in the medical arena; that there is a culture endorsing collective lying”

“Inquries into medico-crime or medical malpractice in the UK see to have been commandeered for political purposes too: rather than investigate the scale of the actual problem at hand; or learn lessons on how to avoid it in future, the inquiries seem designed only to push through current health policy”

“the “Establishment” want the public to believe that, since the Shipman case, it is now easier to detect when a health professional kills (or sexually assaults) a patient. It’s good if the public think there will never be “another Shipman” and Ben Geen and Colin Norris being jailed for 30 years apiece sent out that message; as has the string of doctors convicted of sexual assault but statistics have shown that a GP would have to have a killing rate to rival Shipman’s in order to have any chance of coming to the attention of the criminal justice system. In fact, the case of Northumberland GP, Dr. David Moor, who openly admitted in the media to killing (sorry, “helping to die”) around 300 patients in the media (he wasn’t “caught”) reflects this. I argue in my book that it is not easier to detect a medico-killer now since Shipman, but it is much more difficult for an innocent person to defend themselves once accused of medico-murder.”

Indeed, the rate of serial killers in the UK’s National Health Service must be tiny and if there are good ones around they won’t even be noticed.
Yet it is so so easy in a failing health care organization for the suspicion to arise that there is one around. And once the circumstances have aligned and the triggering event has occurred there is no going back. The thing snowballs. The “victim” has no chance.

Chance events are clustered! Pure chance gives little bunches of tightly clustered events with big gaps between them. When chances fluctuate (e.g. seasonal variation, new hospital policy) then the phenomenon is even stronger!

Take, for example, the three airliners that crashed within a couple of days this week!
How unusual is a cluster of such cases? Well by the law of *small* numbers (Poisson and even super-Poisson variation – Poisson means pure chance .. super-Poisson means pure chance but with the “chance per day” slowly varying in time. Poisson is not a fish but a French mathematician from 200 years ago) “short intervals between crashes are more likely than long ones”. (actually – very short, and very long, intervals, are both common. Pure chance means that accidents are *not* uniformly spread out in time. They are clustered. Big gap, cluster, biggish gap, smallish cluster… that’s pure randomness!)

Then there is the Baader-Meinhof phenomenon
“Baader-Meinhof is the phenomenon where one happens upon some obscure piece of information – often an unfamiliar word or name – and soon afterwards encounters the same subject again, often repeatedly. Anytime the phrase “That’s so weird, I just heard about that the other day” would be appropriate, the utterer is hip-deep in Baader-Meinhof.”

Another name for this is *observer bias*. You (a medical doctor having to fill in a diagnosis for a patient in a standard form, which is totally inadequate for the complexity of medicine) saw one case for which they had to give a rather unusual label, and in the following weeks, that “unusual diagnosis” will suddenly come up several times.

Well, Professor Jane Hutton wrote all these things in her expert report for the appeal 6 years ago but the judge said that such kind of statistical evidence “is barely more than common sense” so refused a request for her to present this common sense in court.


One Comment Add yours

  1. Richard Gill says:

    About the syringe: here is Ben’s story, corroborated by his (ex) girlfriend who is also a nurse, getting married to another guy this October. A very very nice girl, indeed. As are Ben’s parents. I did not yet meet Ben.

    By the way, she is convinced of his complete innocence and she’s (been) heartbroken. Because she’s a nurse and because of their break-up and up-coming marriage she doesn’t dare talk about the case. Nor does Ben’s mother – who is also a nurse – she would lose her job and her licence.

    The syringe (without a needle) which (on doctor’s orders) is used to inject muscle-relaxant into a drip of someone who’s going into an operation so you can get the pipes down their throat etc etc ended up after a more than average hectic Friday (understatement) in Emergency in his coat pocket. His girlfriend, doing the weekend washing (looking for dirty handkerchiefs?), found it and said he should take it back to dispose of properly. It was of course against the rules to have it. I guess it was half full or half empty or something… Now Ben had been getting funny looks from the doctors and other authorities the last few days, and expected to be in trouble. He had a big mouth, he was smart, he was a *guy* (the only one, probably), he had been in the army. His dad was a paratrooper, his mum a nurse. When he saw the police when he arrived at his work on Monday he panicked and he instinctively pressed the syringe empty. Not smart. Pure instinct.

    *On* his coat were found minute traces of everything a nurse gets to use in a hospital including anaesthetic. So, there was no “fatal lethal mixture” of anaesthetic and muscle-relaxant in the syringe. Even if the newspapers say there was. This is pure imagination of the journalists. No doubt encouraged by police and prosecution and hospital authorities.

    Incidentally the nurses were being told to do things by the doctors that really they weren’t allowed to do, and record keeping was also not quite up to scratch (more understatement). As other nurses have testified.

    So the syringe is not the clincher to his guilt but on the contrary a quite heartbreaking tragedy.


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