How many murders did you have in your hospital last year? Did they involve sporadic or serial killers?

What? You don’t know? You really haven’t thought that much about it?

I’m not surprised.

Chances are you might have had some murders but they were not discovered. I’m not only talking about the angry patient or family member who brings a gun to the ER or a patient room to seek revenge for a bad outcome. Or, bad guys whose assaults just happen to be carried out in hospitals. These are usually obvious, recognized, and widely reported.

Ken Kizer and Beatrice Yorker recently have published a paper in a Joint Commission journal discussing the sometimes overlooked patient safety aspects of what the authors term HealthCare Serial Murder (HCSM).

Since 1975, at least 35 American healthcare workers have been formally charged with serial murder of patients, marking healthcare workers as an overrepresented occupational group among known serial killers.

Some of the worst serial killers of all time have been physicians. Physicians, of course, occupy the uniquely powerful position of enjoying the total trust of patients and their families, easy access to lethal drugs and devices, and the unquestioned authority to sign death certificates.

These authors draw distinctions between healthcare serial murder and euthanasia, assisted suicide, politically motivated assaults, or crimes of passion. Of course, the actual numbers of serial killings are unknown, but more than 1,000 suspicious deaths have been linked to persons charged with HCSM.

Let’s face it. We in healthcare education or practice may select people to work with patients without knowing a great deal about their potential to become killers.

Kizer and Yorker make several proposals of how the healthcare community might do a better job of recognizing and preventing HCSM, naming IOM, NQF, and AHRQ as organizations that could review the subject and recommend good processes.

Meanwhile, in your own setting, I suggest that you raise your institution’s alertness to the potential of healthcare murders as a patient safety issue. One good place to start would be to look at in-hospital deaths.

There is a classic way to do this … it’s called … frequent autopsies.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more hospital news.