Wednesday, March 23, 2011

Killer Clinicians

The thought that the helping hand of a doctor can turn into the claws of a monster preying on patients is uniquely terrifying, Dr Stephen J Cina, forensic pathologist and co-author of a recent book about murderous medics, tells Eimear Vize.

Herman Webster Mudgett is not a name that inspires terror. But then doctors should be a source of comfort rather than a cause for alarm. This particular medical man, however, who changed his name to Dr Henry Holmes after graduating medical school, designed and built the proverbial house of horrors where he terrorised, tortured and slaughtered hundreds of victims.

A crew of 800 workers laboured for two years to construct his very impressive three-story ‘castle’, complete with turrets, battlements and 105 rooms. Some of its more disturbing features included soundproof asbestos-lined vaults, quicklime pits, trap doors, chemical labs, a glass-bending furnace and a nine-room basement hooked up to the city’s gas mains.

It was late 19th century Chicago and Dr Holmes, with his thriving clinical practice and charming nature, was the paragon of polite society. But when his Horror Castle was finished, he embarked on a relentless killing spree. Over a period of three years, the handsome doctor selected his victims from among his employees, lovers, and at least 50 paying hotel guests. They were mostly women, but men and children too. The victims’ bodies went by secret chute to the basement where many were meticulously stripped of flesh, crafted into skeleton models and then sold to medical schools. 
Dr Holmes dissected some of the bodies, performed chemical experiments on a few and saved pieces of several corpses in his vaults.

The number of this murderous medic’s victims has been conservatively estimated between 30 and 100, though his total may have been as high as 230. On May 7 1896, Dr Holmes was hanged in Philadelphia. One of his last requests was to be buried in cement so that no one could ever dig him back up.

Dr Henry Holmes
“Who would?” remarks Dr Stephen J Cina, a forensic pathologist working as the Deputy Chief Medical Examiner in Fort Lauderdale, Florida. His humorous quips, frequent and dry, belie the grim reality of his chosen field. A recognised leader in forensic pathology in the US and internationally, Dr Cina has spent several years in the US Air Force as a Regional Medical Examiner, flying around the world to investigate homicides and suspicious deaths.

Who better, then, to co-author a book about homicidal physicians? He and his collaborator Dr Joshua Perper have a combined medical expertise spanning 60 years. As forensic pathologists, they witness death daily and have investigated hundreds of murders. They accept that most doctors are a force for good, but their recently published book – When Doctors Kill: Who, Why, and How – contains accounts of horrible atrocities and features descriptions of graphic murders committed by ‘healers’, such as Dr Henry Holmes, America’s first serial killer.

Dr Cina explains that he was initially approach by Dr Perper, the Chief Medical Examiner and his boss, to collaborate on the book. “We had teamed up before on various projects. We have written several scientific papers together and occasionally give joint lectures. We make a good team,” he says.

“I don't believe doctors as a general rule focus on death as much as forensic pathologists do, and rightly so. Physicians who kill are not a widespread problem. When you think about it, we looked at all doctors involved in killing going back hundreds of year and we were able to cover the topic in a few hundred pages. That says a lot. That being said, when a doctor does ‘go bad’ it is usually a sensational story since people put so much trust in their physicians.”

They capsulate this point in their book with the comment: “If you kill one person, you may make the local news. If you kill five, you will probably end up on national television for a week, maybe longer if nothing else is going on in the world. If you are a physician-murderer, you will probably get a juicy book contract and have your life immortalised in a made-for-TV movie.”

Of course, doctors have the same genetic library of both endearing qualities and character defects as the rest of us but their vocation places them in a position to intimately interject themselves into the lives of other people. The vast majority, fortunately, work to ease pain and save lives rather than killing patients.

Dr Stephen J Cina
Well researched, colourfully descriptive and often humorous, When Doctors Kill explores frightening cases of doctors who cross the line from healing to murder. The book covers a wide span, beginning with the dawn of medicine and reaching into the 21st century. And it appears that history is replete with “good doctors gone bad”.

These killer physicians have murdered thousands in the name of advancing science and medicine. They have been recruited by despots who twist their life-saving skills into tools of control, intimidation, and unspeakable horror. Some doctors have focused their intellect on ruling countries with an iron fist instead of a comforting touch. They have even been active participants in terrorism, holding key roles in al-Qaeda and several Palestinian organisations. Simply put, when the Hippocratic oath states “above all do no harm to anyone,” these doctors have claimed an exemption.

In their book, Drs Cina and Perper present riveting profiles of serial killer physicians, as well as mass-murdering doctors. And they stress that there is a significant difference between these two categories. Murderers of multiple people are classified in three major groups: Spree killers murder multiple victims over a short period of time in an outburst of rage. But, we are assured that there are no reported cases of spree killing doctors.

Serial killers, with their high IQ and so-called “mask of sanity” have cooling periods between attacks when they act in an apparently normal fashion. They are more calculating and may hone their sadistic fantasies for decades. Most of the high-profile physician killers fall into this category.

Unfortunately, a number of doctors have also assisted, either willingly or under duress, in mass murders, the third category. The role of physicians in Nazi concentration camps is a case in point. Forty-five percent of German doctors became members of the Nazi party and, as officers in the SS, were active participants in the killing of the “unfit” and "undesirable racial pollutants".

Dr Cina confides that he finds the involvement of doctors in war atrocities most disturbing: “The ‘scientific experiments’ performed on people by the Nazis, Japanese in World War II and American physicians are revolting. I have served in the US Air Force and understand following orders, but doctors answer to a higher calling and cannot subjugate their morality to unethical military directives.”

He explains that doctors take lives for a variety of reasons, many of which are shared by other members of society. They may kill for financial gain or out of jealousy. They may maim or dismember in search of sexual gratification. They may torture to impose their will on another helpless human being simply because they have the opportunity to do so. They may kill just to prove they can get away with it. Or they may just become addicted to death and pain.

Physician killers, however, have also been involved in murder for reasons not shared by the average Joe. Sometimes doctors have killed out of real or perceived "Acts of Mercy”. The detection of doctors committing clinicide (intentional murder in the setting of providing care) is very difficult. Crafty medical serial murderers are usually those who use poisons or medications with lethal consequences on patients who are expected to die and whose death will not arouse suspicion. “These killers likely will never come to trial,” Dr Cina adds, ominously.

Dr Harold Frederick Shipman
A prominent example of this class of killer doctor is Dr Harold Frederick Shipman, who was the most prolific serial killer in recorded history. This British doctor has 218 murders positively ascribed to him (mostly elderly women) although the real number is likely to be higher than this. It was only through forging the will of one of his wealthy elderly victims, whose daughter was a solicitor, that he was caught and the entire houses of cards fell on him. If this hasn’t happened, his murderous ways may have continued unchecked for many more years.

“We look up to the doctor as a figure of wisdom and compassion. The thought that this helping hand can turn into the claws of a monster preying on patients is truly terrifying. Nevertheless, such monsters have existed and likely still practice in the medical profession,” the authors warn.

Another timely topic addressed in the book is the potentially unhealthy, master/pet relationships characteristic of celebrities and their personal physicians. The authors highlight a number of doctors who have treated high-profile celebrities, including Judy Garland, Elvis Presley, and Anna Nicole Smith, and whose treatment may have led to their deaths. The role that doctors played in Michael Jackson’s drug abuse and demise also receives an in-depth discussion and exploration.

The authors offer their insights into the ethical conflicts inherent in modern medicine, including the prospect of the first genetic homicide – murder by means of chromosomal manipulation.

They also pour over the controversial issue of assisted suicide and euthanasia - “the grey zone between comfort measures and homicide”.  They suggest that a distinction should be made between assisting in suicide and enabling suicide. Enablement is a passive process, such as forgoing life-saving treatment or prescribing powerful medication that may be abused by the patient, whereas assisted suicide requires action. The difference between assisted suicide and euthanasia is that the patient is not an active participant in euthanasia, except that they have expressed a wish to die.

While researching this chapter, the authors decided not to seek the opinions of colleagues. “We attempted to gather objective evidence and present a fair and balanced discussion of this tricky issue,” says Dr Cina. The reader is left to ponder whether, in certain circumstances, euthanasia is ethical and, if so, how does it differ from the philosophy promulgated by the Nazi regime?

As forensic pathologists, Dr Cina witnesses death daily and has investigated hundreds of murders but, thankfully, he says he has never encountered a case where the perpetrator was a member of the medical profession. 

“Evil doctors are a rarity, thank God!” he exclaims. “It is possible, though, that some apparently natural deaths have been victims of caregivers. It has been said that the easiest people to kill are those who are expected to die, such as the elderly or infirm.

“People should remember that their doctor is trying to do the best job possible for you despite working in an environment of increasing governmental regulation, diminishing reimbursement, a constant fear of lawsuits, and leaving school hundreds of thousands of dollars in debt. But doctors are people just like the rest of us - we are not perfect. We do make mistakes, and rare doctors do some terrible things-once again, just like the rest of us.”


  1. Regarding Euthanasia,I think a living will and or end of life instructions should be available on every persons medical data. Here in BC, elderly and/or infirmed patients are encouraged to have a vial (pill box container) with essential medical information and end of life instructions in the egg box or top right hand shelf in their fridge.