A Cluster of Unexplained Cardiac Arrests in a Surgical Intensive Care Unit

Munchausen Syndrome by Proxy in health care workers

“…A review of 72 papers concerning Munchausen Syndrome by Proxy published internationally since 1977 in nursing, medical and legal journals demonstrated the considerable physical and emotional harm that can be caused when a person persistently fabricates symptoms on behalf of another and thus causes that person to be regarded as ill The majority of cases mvolve a mother who falsifies illness or induces sjmiptoms m her child, although one case of a father (Maker & Squier 1990) and another of a babysitter (Richardson 1987) being the perpetrators of this kind of abuse have been reported A diagnosis of MSP has also been given to a man who fabricated illness m his two adult partners (Sigal et al 1986) This extensive literature did not, however, yield any reference to health care workers having a diagnosis of MSP Although the more recent papers have made specific reference to Beverly Allitt as a means of introducing an article on MSP (Mitchels 1983, Cole 1993 Darbyshire 1986, Franks & Adele 1987, Creighton 1988, Sacks et al 1988, Naish 1989) revealed that smce 1975 at least 14 nurses have been charged with murder This is not an exact figure because of the lack of cnminal statistics which classify the relationship hetween a victim eind the occupation of his/her killer, and nursing records of this information have not been collated Again, there was no reference to MSP as a possible explanation for their behaviour, even m an academic analysis of the possible rationale for the actions of nine of these nurses (Yorker 1988), although Yorker has since wntten extensively on MSP (Yorker & Kahan 1990, 1991 In contrast, UK and US newspaper reporters appear to have latched on to the sensational nature of MSP analysmg It thoroughly in relation to Beverly Allitt's behaviour (The Guardian 1993a,b, The Independent 1993a retrospectively relating it to the very similar case of a nurse m Texas in 1982 [The Independent 1993b) and describing its use m the case of a foster mother with MSP in California accused of murder m 1992 [San Francisco Chronicle 1992) Several of the key features of MSP can also be identified in the reports of two further cases of nurses who murdered patients m their care This review therefore examines the chjiractenstic presentation of MSP and considers selected case studies of health care workers who have harmed people m their care, to demonstrate the similarities and differences between cases where parents and nurses have been the perpetrators of harm and to consider the implications…”

“…At least 14 cnminal tnals have occurred between 1975 and 1993 in which health care providers were associated with epidemics of adverse patient outcomes In four of these cases -occumng m Michigan (Stross et al 1976), Texas (Beuhlerefa/ 1985), Toronto (Istreef ay 1985) and Georgia (Franks & Adele 1987) -epidemiologicai euid toxicological studies have led to convictions In the other cases, however, the tnals have been complex and lengthy, often not leading to conviction or with convictions subsequently being dropped Difficulties encountered include the problem of recognizmg and establishing the occurrence of clusters of adverse outcomes, the prevalence of temporary or agency staff making it difficult to identify a relationship between events and the staff on duty, a lack of sophisticated forensic toxicological input, a general and understandable reluctance on the part of health care professionals to suspect another health ceu"e professional, and the need to obtain evidence before making an accusation…”