I recently watched the first season of the Netflix series “Mindhunter,” a fictionalized account of the 1995 book of the same title by John E. Douglas and Mark Olshaker. The subtitle of that book is “Inside the FBI’s Elite Serial Crime Unit,” and it details Douglas’ work over several decades in profiling mass and serial killers. Although the term “serial” killer is of recent origin, such murderers of three or more victims are now believed to have operated since ancient times. Jack the Ripper is often cited as the first modern, well-documented example of a serial killer. Like so many others, the murders remain unsolved.
The enormous press and public attention paid to the Ripper and similar cases continues to the present day, aided by endless novels, nonfiction works, films, documentaries, television shows and the internet. In addition to the FBI’s continuing efforts, numerous other researchers have examined these people and their murderous behaviors. The serial killer fictional and nonfictional universe is thus vast and ever expanding.
Thomas Neill Cream: Chloroform and Strychnine
Thomas Neill Cream can serve as an example of one type of health care serial killer. He was a physician with substantial medical training, but chose to use his skills to give him access to a vulnerable population, such as prostitutes. Possibly driven by both sadism and a desire for money, he used chloroform at first but changed to strychnine, a substance that would cause great suffering in his victims. Dr. Cream did not kill in a hospital, and thus, did not invite much scrutiny from his peers.
Although he was born in Glasgow, Scotland, in 1850, his family had moved to Canada by the time he was 4 years old. He grew up there and graduated from McGill College, in Montreal, in March 1876 with an MD and a CM (master of surgery). Dr. Cream lived well as a student—expensive clothing, jewelry, horse and carriages—on money provided by his father. During medical school he supposedly wrote an impressive essay on chloroform. He also apparently committed arson and insurance fraud, but managed to get away with the crime.
Dr. Cream did not get a license to practice medicine in Canada, but offered his services as an abortionist to a young lady—whose father discovered it and forced Dr. Cream to marry her in September 1876. Oddly enough, the next month he left Canada to continue his medical studies in London; he did not bother to bring his wife.
He attended lectures and worked as a temporary clerk in obstetrics at St. Thomas’ Hospital. By the spring of 1878, a year after his wife had died in Canada, Dr. Cream passed his exams and returned home to set up a practice in obstetrics. On May 3, 1879, the body of Kate Gardner, a young hotel maid, was found in the privy behind Dr. Cream’s office. She was pregnant and had been poisoned by chloroform. Dr. Cream denied paternity but was accused of murder and blackmail anyway. He promptly fled to the United States.
In Chicago he opened an office near the red light district to offer abortions to prostitutes there. At this point, he seems to have taken up strychnine as his murder weapon of choice. Two women soon died after abortions, one by strychnine, but Dr. Cream was not charged. However, a male patient died in July 1881 of such poisoning from Dr. Cream’s supposed treatment for his epilepsy. Dr. Cream was tried, convicted and sentenced to life but was released in 10 years. He left the United States for England in October 1881.
He settled in the Lambeth district of London where the impoverished population gave him easy access to prostitutes. After several of them died via strychnine, Dr. Cream was arrested and charged with four murders, an attempted murder and extortion. A jury took only 12 minutes to convict him, and in November 1892, he was hanged at Newgate Prison. According to a newspaper account quoting someone who had talked intimately with Dr. Cream, the doctor made his own aphrodisiacs by combining “strychnine, morphia and cocaine.” He seems to have been quite a connoisseur of drugs.
H.H. Holmes: Chloroform
Another physician whose practice ran to murder was Herman Webster Mudgett, better known to posterity as Henry Howard Holmes. Born in New Hampshire in 1860, Dr. Mudgett developed an attraction to dissection and surgery as a young man. At 18 he entered the University of Michigan Medical School, and then parlayed his skills into life insurance fraud. He purchased policies under fake names and then mutilated corpses to pretend they were the insured. He was eventually caught and quickly moved to a suburb of Chicago, changing his name.
There he began selling fake cures, and also married, robbed and murdered two women. When he had accumulated some funds, he built a hotel to service tourists coming to the city’s 1893 World’s Fair. The facility had features that allowed him to lock guests—especially young women—in their rooms, asphyxiate them with gas, and then easily move their bodies via chutes to the basement. Dr. Holmes thus procured skeletons to sell to medical schools.
Dr. Holmes left Chicago in July 1894, and eventually ended up in Philadelphia. He met Benjamin Pitezel and concocted a fraud scheme with him, but after a dispute chloroformed and killed him. He used the man’s body to defraud an insurance company of $10,000. This killing proved his undoing, and he was eventually arrested in Boston. Skeletons and bone fragments were discovered at the Chicago hotel, but not enough evidence to charge him there. He was tried in Philadelphia for the murder of Mr. Pitezel. (He had also killed Pitezel’s three children in Toronto.) Although he claimed innocence, Dr. Holmes was hanged on May 7, 1896. Estimates of the number of his victims range from the low 20s to 200.
A druggist in Chicago noted one of Dr. Holmes’ buying habits during the height of the hotel horrors. “He always wanted so much chloroform. … I sometimes sold him the drug nine or ten times a week and each time it was in large quantities.” A city detective later declared that the “devious paths of … Holmes bear the scent of chloroform.”
Genene Jones: Succinylcholine
In October 1982 and February 1983, two grand juries heard testimony relating to deaths and close calls at a Kerrville, Texas, pediatric clinic and nearby Bexar County Medical Center Hospital, in San Antonio. During Ms. Jones’ four years at Bexar, 47 suspicious deaths took place in the pediatric ICU on her rotations. At the clinic in Kerrville, several children suffered mysterious seizures, and a 15-month-old girl died on the way to the hospital while Ms. Jones was employed there.
Dr. Kathleen Holland, the owner of the clinic, confronted Ms. Jones about discrepancies connected with the supply of succinylcholine. Dr. Holland then fired Ms. Jones when the nurse suggested they simply ignore that problem.
The 1982 grand jury heard evidence about the seizures and death at the clinic. The baby’s body was exhumed, and a test for the presence of succinylcholine was positive. However, Ms. Jones could not be tied specifically to that particular injection and was not indicted.
The following year the grand jury indicted Ms. Jones on two counts of murder and other charges related to injuries to six other children. In 1984 she was tried and convicted of murder for the clinic death. Her sentence was the 99-year maximum. In a second trial that same year, she was found guilty of child injury via heparin injection at Bexar and received another 60 years.
Ms. Jones, who became known as the “Angel of Death,” has been denied parole several times. Due to efforts to ease overcrowding in the Texas prison system, she came up for release in March 2018 when she reached the halfway mark of her concurrent sentences. Bexar County authorities charged her with five more murders on Dec. 7, 2017, in an effort to prevent her release. She is still incarcerated.
Mario Jascalevich: Curare
Thirteen patients died at a small osteopathic hospital in Oradell, N.J., between December 1965 and October 1966. Each person had routine surgical procedures and were doing fine postoperatively. Suspicions were raised a decade later when The New York Times received a letter claiming that 40 patients had been murdered at a hospital by its chief surgeon. No other details were given, but reporter M.A. Farber managed to trace the case to Riverdell Hospital, where Dr. Mario Jascalevich had been chief surgeon at the time.
The dead individuals had been patients of a new surgeon at the facility, who had convinced the hospital director to examine Dr. Jascalevich’s locker. Eighteen mostly empty vials of curare were found. Dr. Jascalevich claimed he was using the drug in experiments on dogs. At the time these facts were reported to the county prosecutor, who determined not enough evidence existed to pursue the case. Mr. Farber’s investigation led him to the prosecutor, who explained his frustrations at what he had believed were cases of murder. Mr. Farber also talked with the victims’ families. His article was published in January 1976, naming Dr. Jascalevich only as “Dr. X.”
As a result of the publicity, five of the deceased were exhumed, and autopsies found traces of curare. None of the patients had been given the drug during surgery. In May 1976, Dr. Jascalevich was indicted in five deaths; two of the charges were soon dismissed. The trial lasted 34 weeks. The defense called 21 experts, who testified that curare could not be identified in bodies that old. Dr. Jascalevich was found not guilty in October. He had surrendered his New Jersey license upon indictment, and that license was revoked for other reasons in 1980. He had been practicing in the Bronx with a New York state license, but eventually returned to his native Argentina and died in 1984.
Other Curare Derivative Cases
In the summer of 1975 at the Ann Arbor Veterans Administration Hospital, about 40 patients died from unexplained respiratory failure. The FBI determined that at least eight murders had occurred, and the weapon was Pavulon (pancuronium bromide, Organon). After months of further investigation, two nurses from the Philippines were charged. They had been on duty during the identified murders. Although witnesses had seen the nurses in some of the patients’ rooms, no other evidence tied them to the crimes, and they were acquitted. No one else was ever prosecuted.
In 1981, nursing home manager Arnfinn Nesset confessed to at least 27 murders using a preparation of suxamethonium chloride, under the brand name Curacit in his native Norway. Authorities developed a list of 62 possible murders, and Mr. Nesset was charged with 25 despite recanting his confession. He was tried, convicted of 22 killings and sentenced to 21 years, the longest allowed. He was released in 2004 and supposedly went to work for the Salvation Army.
In the late 1990s, Efren Saldivar worked as a respiratory therapist at Glendale Adventist Medical Center, in California. Several suspicious deaths during his shifts finally aroused attention. Eventually Mr. Saldivar confessed to dozens of murders at Glendale and elsewhere; he said he lost count after 60 or so. He was charged with and pled guilty to six murders in 2002, and received six consecutive life sentences. His drugs of choice were morphine, succinylcholine and pancuronium bromide.
In this article I’ve covered some of the best-known health care serial killers who have used gases or drugs typically associated with anesthesiologists. Have any actual anesthesiologists or nurse anesthetists ever committed such crimes? No such individuals I’ve found were true serial killers. John Kappler, MD, was an anesthesiologist and frequent psychiatric patient who used lidocaine and later his automobile in various murder attempts. He was finally sentenced to a mandatory life sentence in Massachusetts in 1990. Anesthesiologist Carl A. Coppolino, MD, was tried in New Jersey and Florida for the murders of a neighbor and then his own wife using succinylcholine. F. Lee Bailey defended him in the first case, and he was acquitted. He spent 12 years in prison in Florida for the murder of his wife.
What motivates health care serial killers, people trained and expected to promote healing and save lives? Some, like Genene Jones, seem to have a need to create situations in which they can appear either heroic and save a patient in crisis or incredibly sympathetic after a death. Efren Saldivar may have gotten bored on his long night shifts working alone. Mostly these people exhibit the personality traits carried to extremes of most serial killers—a sense of superiority, a desire to dominate and a lack of empathy for others. In the case of health care killers, they also have the knowledge about and access to the various drugs that can be lethal.
Psychiatrist Herbert G. Kinnell, who has long studied homicidal doctors and nurses, noted that medicine has produced far more serial killers than any other profession, with nursing a close second. They are intelligent, well-trained people, often working in an environment surrounded by co-workers who don’t want to acknowledge the signs of trouble.
- Iserson KV. Demon Doctors: Physicians as Serial Killers. Austerlitz, NY: Galen Press; 2002.
- Kinnell HG. Killer Carers. Athena; 2017.
- Ramsland K. Inside the Minds of Healthcare Serial Killers: Why They Kill. Westport, CT: Praeger; 2007.