Remember the t-shirt ‘Join the British Army: go to interesting places, meet interesting people, and kill them‘? Well it is kind of similar but a bit more sinister. You are not going to join the army. Nope, you are going to join the nursing profession.

1. Become a nurse
Make sure you are not quite the usual run-of-the-mill nurse. It doesn’t matter in what way you are different as long as it’s noticeable – or example, you are a guy or a bit better educated than most other nurses. Or you came to nursing after a previous career preferably in something a bit fishy. Have a big mouth, get a reputation for standing up for yourself and kindly pointing out when other people seem to be making big mistakes, even if they are (God forbid) doctors.

2. Now sit back and wait
Sooner or later you are on a ward where people often die. They do have such wards in hospitals, you know. Wait a bit longer. Wait for an unexplained cluster of cases.

Actually, as any statistician can tell you, unexpected clusters of cases are exactly what you should expect when events are completely random and completely independent of one another. Remember those three airliners crashing in three days, just a few weeks ago?

Statisticians will also explain that when things are slowly changing in hospital environments – the seasons, new staff with new habits regarding how to classify events on NHS forms, new policy (for example, close down one ward to save money and get a new kind of patients on old wards) etc – the phenomenon of big gaps and tight clusters is strengthened. Psychologists and neuro-scientists will tell you about cognitive biases. The events are not actually independent. One event triggers more being noticed and registered.

3. Now we need the trigger: an unexplained death and a paranoid doctor
This is like, spark and gunpowder.

Let’s look at the gunpowder first.

The key doctor. Well, in a stressful situation, everyone is paranoid, right? It’s another of those damned cognitive biases. Just because I’m paranoid doesn’t mean they’re not all out to get me. So let’s not use the word ‘paranoid’. Let’s say, stressed or suggestible.

Now the spark.

The key event. We also need an event to trigger the doctor’s thinking – the spark which causes the gunpowder to explode. This should be a notable unexpected occurrence which is associated with that equally notable nurse we were previously talking about – the odd one who always seemed to be there when there was some kind of upset. The one with the big mouth and the odd background. This is easy.

What we also need is an unexpected death. That is easy too. Why unexpected? Because people had made the wrong diagnosis or were not aware of the full facts even if they were right there in the patient’s dossier (had no time to go through that stack of paper yet). Notice, if someone is critically ill and about to die, they are going to die, today or tomorrow or the next day but typically the exact moment of the next crisis is not predictable. Well, in hindsight yes, but not in advance.

Doctors may have said things to family (for example, ‘… he/ she is doing well, should go home next week’) when they really meant: ‘… this is close to the end, nothing more we can do, better to die at home’. That can even be hospital policy.

Not everyone has full information. In fact, almost nobody does. There is no full information. Everyone has snippets, often out of context, often wrong.

Now everything has clicked in someone’s mind and the link is made between the scary nurse, the disturbing event … and we had a lot more cases like that recently (for example, the ‘seasonal bump’ in respiratory arrests: seven this month but usually it’s just one or two.

4. The hurried trawling expedition
The spectre of a serial killer has now taken possession of the mind of the first doctor who got alarmed and he or she rapidly spreads the virus to his close colleagues. They talk together and agree to do some work. They start looking at other seemingly similar recent cases and they let their minds fall back to other odd things which happened in recent months and stuck in their minds. The scary nurse had also stuck in their minds, 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. Hindsight, right? On the other hand if he was on a week’s vacation then obviously everything must have been OK and the case is forgotten.

5. The hurried medical conference
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 knew something about the screw-ups and mistakes says nothing about them but confirms the fears of the others.

Medical collegiality. 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 (a culture of lying, the covering up of mistakes). Anyway a lot of the information in the dossiers is wrong, corrupted; misclassifications galore, important documents are lost, important forms never got filled in properly. Medical care is not an exact science. According to recent NHS statistics many men are in NHS hospitals because of pregnancy – their own pregnancy see here.

6. The police
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 PR department, the management, the legal department, are all working full throttle in this damage control exercise. 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. In the case of Ben Geen it was the syringe. It was alleged that between December 2003 and February 2004, at least 17 patients suffered respiratory arrests for unknown reasons, and Geen was on duty during these incidents. He was arrested in 2004 and an empty syringe found in his pocket. He had a perfectly good innocent explanation for why the syringe was there, which moreover corresponds to what was actually in it, but you won’t find that reported in the media. Instead you will find statements that it contained a toxic combination of drugs … pure fantasy.

This is what Wendy Hesketh (she’s a lawyer, 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 seem 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 wants 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.’

Is this fiction? No it is real life. Truth is stranger than fiction.

This is the true story of Lucia de Berk, Ben Geen, Colin Norris, and Susan Nelles. This can happen to another innocent nurse, somewhere in the world, today. And when I say in the world I mean: in England, Scotland, or Wales; in Canada, Germany, France; in Norway or Denmark … Perhaps even in America (they seem to have more real serial killers there, but perhaps that is because they ahve the death penalty).

And here’s the bad news: because of medical collegiality no medic is ever going to speak up about this. There will not be a legal ‘new fact’. There is no reason whatever for the legal system to review the case. You’re sunk mate, up shit creek without a paddle. Better to admit guilt and get the horror over with bit sooner.