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Serial Killer Nurse 039Blood Money039 Death of Rural Hospitals

Welcome to the latest edition of Investigative Roundup, gathering some of the best investigative reporting on healthcare each week.

Serial Killer Nurse

A nurse in Germany who confessed to killing 43 people -- and stands accused of killing hundreds more -- is, according to the New York Times, "the most prolific serial killer in the history of peacetime Germany, and perhaps in the world." Niels Högel's murder spree lasted five years, the investigation of his acts took more than a decade, spanned countries, and led to the exhumation of 130 suspected victims. He is serving life in prison for the murder of two patients and having a hand in the killing of four; he's currently on trial for killing 100 others.

Högel's method was injecting patients with lethal doses of medication. Sometimes, he would then race to save the patient. Coworkers gave him the nickname "Resuscitation Rambo." Colleagues who noticed how many patients needed resuscitation during Högel's shifts and became suspicious either didn't say anything or there was no real follow-up once they reported. One hospital essentially dismissed him, but still provided him with a glowing letter of reference that let him find work elsewhere.

It wasn't until another nurse caught Högel red-handed -- life support system off and empty vials of unprescribed medicine in the trash -- in 2005, that the net began to close. Even after that patient died, Högel was allowed to finish his shift, during which another, final victim died.

The sheer volume of his crimes and the silence leads to the question: How did this happen? Some believe there's a reluctance to speaking truth to the hierarchical structures in German healthcare -- what one former colleague called "a culture of looking away and keeping your head down."

'Blood Money'

With an aging population and an increase in blood-clotting disorders, human plasma is a billion-dollar global business. For many in the U.S., selling plasma provides a few hundred dollars a month that helps fill in financial gaps. The Pittsburgh Post-Gazette looks at the flourishing pay-for-plasma business in which clinics like CSL Plasma serve as a "regular stop" for working men and women. Some use the extra money to buy necessities such as teeth cleaning, and others spend the extra cash on a nice dinner. It can also be the difference between making the monthly rent and eviction. One expert calls it a "financial coping mechanism for families to meet essential expenses."

Plasma centers often take advantage of this and set up shop in impoverished neighborhoods or near universities along public transit routes. Centers also entice donors with cash bonuses to visit frequently. To many living paycheck to paycheck, the incentive to make more money is already there. And it's relatively easy money."There's nothing hard if you're not scared of needles," one client told the newspaper.

While donating plasma shouldn't cause any long-term problems, the World Health Organization suggests that blood and plasma should only come from unpaid donors who volunteer. The U.S. joins China and Russia in ignoring the guideline.

Death of Rural Hospitals

The Washington Post paints a grim picture of the state of rural hospitals in the U.S. One such case is the Fairfax Community Hospital in Oklahoma that was fighting for its life despite dwindling funds and morale.

In this community hospital, there was no working x-ray machine or appropriately sized sutures, and the administration struggled to pay bills, including payroll. It wasn't always clear in the morning that the hospital could remain open in the afternoon. Some staff worked unpaid while others quit when paychecks became irregular.

Fairfax was once a thriving hospital that state officials called one of the best rural health facilities. Now, after unsuccessful corporate takeovers and bankruptcies, the fate of this community hospital -- an essential first-line of treatment for many patients -- hangs in the balance.

Fairfax is just one among hundreds of rural hospitals across the country that have suffered from Medicaid and Medicare rate cuts, increased emergency visits, and a higher percentage of uninsured patients. According to the Post, 46% of rural hospitals lost money last year, and 400 are at "high risk of imminent failure."

Trouble at Western State Psych Hospital

Although legislators in Washington state recently signed laws that would help bolster the state's mental healthcare system, the AP reports that Western State Hospital, the state's largest psychiatric hospital, continues to grapple with wide-ranging problems.

According to the AP, a therapist had part of her thumb bitten off by a patient, the sewage system flooded after patients flushed "non-disposable items" down the toilets, and the staff was working on extreme overtime. What's more, there were cases of chicken pox at the facility. Dozens of workers were sent home without pay.

Although the Department of Social and Health Services says one chickenpox patient was moved around and exposed a pregnant worker, a spokesperson for the agency praised Western State Hospital's quick response to the outbreak. Hospital nurses, however, called the reaction "haphazard."

Source: https://www.medpagetoday.com/publichealthpolicy/ethics/79852

Death, serial, killing, nurse




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