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A disturbing number of serial killers are found in the medical profession, making victims of the very patients who entrust the twisted healers with their lives. The reasons for their choice of a career in medicine (and murder) are admittedly complex, but one advantage is the ready-made supply of victims - often weak and helpless, sometimes even comatose - who are presented daily to the medical professional. Those who select their victims from among the patients of a major hospital or nursing home and sheltered from suspicion by their Hippocratic oath and by the fact that death - particularly of the old and gravely ill - is taken more or less for granted. Only when a slayer grows too arrogant or careless, leaving telltale clues behind or killing too voraciously within a short time span, is he (or she) exposed.

Medical killers are found in the ranks of licensed physicians and dentists, of registered nurses, and of lower-ranked employees such as orderlies and nurse's aides. They are both male and female, black and white (although Caucasians dominate this group). As in their training, race, and gender, so they are diverse in motives, although certain major themes repeated themselves time after time.

One common motive in medical murder is the so-called mercy killing, wherein the slayer allegedly seeks to end the suffering of selected patients by ending their lives. The FBI Crime Classification Manual (1992) presents nurse's aide Donald Harvey as an example of a "mercy killer" in action, although his techniques smacked of sadism (and his selection of victims, at least in some cases, was achieved through satanic rituals).

A second type of medical killer is the would-be "hero," precipitating life-or-death emergencies with the intent of stepping in to save a patient at the penultimate moment, thus earning kudos from his peers or members of the victim's family. These operators - theoretically, at least - may not intend to kill at all but may instead fall short in their attempts to "rescue" patients they have driven to the brink of death. The FBI presents baby killer Genene Jones as an example of the "hero" type; identical motives have been ascribed to male nurse Richard Angelo in New York and to various others around the world.

Some medical slayers, of course, kill for profit. In the 1930's, Dr. Morris Bolber organized a murder-for-insurance ring in Philadelphia that claimed an estimated 50 lives. Most practitioners operate on a more modest scale, but some - like Connecticut's Amy Archer-Gilligan - open their own clinics or rest homes with murder in mind. Another profit-motivated killer, Missouri dentist Glennon Engelman, made no use of his medical skills when it came down to murder, preferring dynamite and firearms as his tools.

Finally, as some "healers" sexually abuse their patients, so we cannot rule out sexual or sadistic motives in some medical murders. Lesbian lovers Gwendolyn Graham and Catherine Wood made a brutal "game" of murder at a Michigan rest home, so excited by the death throes of their victims that they often had to find an empty room for hasty bouts of sex when they were finished smothering a patient in her bed. Likewise, it is undoubtedly significant that all three patients killed by Dr. Tony Protopappas in his dental chair with anesthetic overdose were attractive females under 35 years old.

The most frightening aspect of medical murder is the apparent ease with which some practitioners evade detection, sometimes forever, while running up prodigious body counts. A review of modern unsolved cases reveals seven hospitals - including five in the United States and one each in Canada and France - where unknown slayers claimed 320 victims with complete impunity. In one case where a killer on the ward was brought to book, a hospital administrator also pled guilty to destroying evidence illegally in a misguided effort to protect the hospital's "good name."