Murder by Poison
Most people who die from poisoning do so accidentally. As a mode of criminal homicide, poisoning, compared to guns, knives, blunt objects, and ligatures, is rare. According to FBI statistics, out of the 187,000 criminal homicides committed from 1990 to 2000, only 346 involved poison. During the period 2001 to 2006 the figure rose to 523. But forensic toxicologists, the experts educated and trained to detect and identify substances harmful to the human body, believe that homicidal poisoning is more common than crime statistics suggest. For example, in 2002, 26,435 people died of poisoning. While only 63 of these deaths were ruled as murder, 3,336 were listed under manner of death as "undetermined." In other words, forensic pathologists considered these poisoning deaths as suspicious.
Nobody knows how many people are being murdered by poison because most of these deaths are classified as naturally caused fatalities. In most of these cases, there are no outward signs of homicide. There are no bullet holes, stab wounds, cuts, bruises, or marks around the neck that signify that these deaths were not natural. In most instances, because these deaths are not outwardly suspicious, no autopsies are conducted. These victims are embalmed, buried, or cremated. End of story. Occasionally, suspicions may arise when, say, an estranged spouse receives a large life insurance payment, and a week later, remarries. Money and sex are common motives for murder, but motive is not evidence. The evidence of a homicidal poisoning is the poison. If the toxic substance is not detected and identified in the course of an autopsy, the killer will get away with murder. Exhumations are rare.
Poisons are seldom detected where clinical (rather than criminal) autopsies are performed by regular hospital pathologists. This is because the pathologist is not thinking homicide, or looking for poison. Unless a specific poison is suspected, the chance of random discovery is unlikely. Arsenic, because it is readily available, tasteless, and can be administered in a series of small doses that causes a period of illness before death, is the weapon of choice among those who murder by poison. Within 24 hours of ingestion, arsenic moves from the blood into the victim's liver, kidneys, spleen, lungs and GI tract. In two to four weeks traces can be found in the victim's hair, nails, and skin. From there, traces of the poison settle in the bone. Thirty minutes after ingesting a small dose of arsenic, the victim will experience a metallic taste, garlic smelling breath, headaches, muscle cramping, vertigo, vomiting, abdominal pain, and diarrhea. If the victim doesn't die within a few hours from shock the poisoned person may die a few days later from kidney problems. If the victim survives two to four weeks, in addition to horrible suffering, he will start losing his hair. When death finally comes, the likely cause will be identified as renal failure. Other common poisons used in the commission of homicide include strychnine (rat poison), morphine, and Demerol. Antifreeze (ethyzene glycol) has become a relatively popular weapon in murder-by-poison cases.
Angel of Death Cases
Deaths by homicidal poisonings that commonly do not raise suspicion, and are therefore misdiagnosed as natural fatalities, involve hospital patients who are elderly, or already ill. The death of an old or gravely ill patient, almost by definition, is a natural death. This is why physicians, nurses, and other healthcare workers who kill--so-called "angels of death"--have gotten away will murdering so many people.
Normally, homicide by poison is not an impulsive crime. But in the hospital, or home for the elderly, it is a crime of opportunity. The angel of death has easy access to the poison and to the victim. There is no need for extensive preparation and planning. Moreover, there is no apparent or obvious motive for the homicide because these killers do not receive any direct personal gain out of the crime. The homicidal motives associated with angels of death are therefore pathological, and hidden. This type of serial killer is difficult to spot because angels of death are not manifestly insane. They possess personality disorders that compel them to murder out of generalized rage, boredom, or the impulse to play God.
As murderers, angels of death are cold-blooded, careful, and vain. This makes them hard to catch. Quite often in their employment histories they have been terminated from previous healthcare jobs. When too many patients die on a nurse's or orderly's watch, and the employee comes under suspicion, he or she is fired. Healthcare workers suspected of murdering patients often quit, and get a similar job somewhere else. The tendency, among healthcare administrators, is to deny the obvious, and pass the problem on to the next employer. Over the years, dozens of angels of death have been caught but only after large numbers of patients have been murdered. Given the nature of the crime and the limited role forensic science plays in these cases, it is reasonable to assume that the small number of angel of death convictions represents the mere tip of a rather large homicidal iceberg.
Angel of Death Donald Harvey
In 1975, after working briefly as a hospital orderly in London, Kentucky, 23-year-old Donald Harvey took a job with the Veteran's Hospital in Cincinnati, Ohio. As the years passed, a pattern emerged. When Harvey was on duty, patients died. Finally, after ten years, and the deaths of more than 100 patients on his watch, the orderly was fired. He was terminated because several hospital workers suspected he was poisoning his patients. After Harvey left the facility, the death rate plummeted. Terminating Donald Harvey turned out to be good medicine, at least at the VA hospital.
Shortly after his firing, Harvey was hired across town at Drake Memorial Hospital where the death rate began to soar. As he had done at the VA facility, Harvey was murdering patients by either lacing their food with arsenic, or injecting cyanide into their gastric tubes. The deaths at Drake, like those at the VA hospital, were ruled as naturally caused fatalities. While suspicions were aroused it was hard to imagine that this friendly, helpful little man who was so charming and popular with members of his victims' families, could be a stone-cold serial killer.
As clever and careful as Harvey was, he made a mistake when he poisoned John Powell, a patient recovering from a motorcycle accident. Under Ohio law, victims of fatal traffic accidents must be autopsied. At Powell's autopsy, an assistant detected the odor of almonds, the telltale sign of cyanide. This was fortunate because most people are unable to detect this scent. The forensic pathologist ordered toxicological tests that revealed that John Powell had died from a lethal dose of cyanide. Harvey had been the last person to see Mr. Powell alive, and John Powell would be the last person he would kill.
The Cincinnati police arrested Harvey, and searched his apartment where they found jars filled with arsenic and cyanide, and books on poisoning. However, the Hamilton County prosecutor believed that without a confession, there might not be enough evidence to convince a jury of Harvey's guilt. The suspect, on the other hand, was worried that if convicted, he would be sentenced to death. So Harvey and the prosecutor struck a deal. In return for a life sentence, Donald Harvey would confess to all of the murders he could remember. Over a period of several days, he confessed to killing, in Kentucky and Ohio, 130 patients. When asked why he had killed all of those helpless victims, the best answer Harvey could muster was that he must have a "screw loose." Forensic pathologists familiar with the case speculated that the murders had given Harvey, an otherwise ordinary and insignificant person, a sense of power over the lives of others. Harvey pleaded guilty to several murders and was sentenced to life in prison.
The old saying that "murder will out" does not always apply when the weapon of choice is poison.