Warning! Some drugs diverted for murders

A 35-year-old nurse practitioner was convicted for the murder of her husband. She became a murder suspect after investigators discovered she had lied about an extramarital affair and had surreptitiously left the hospital and driven to her house shortly before the house was discovered on fire with her husband inside.

Test results of the deceased husband showed rocuronium concentrations of 4.9 mcg/ml in the blood and 14.4 in the liver. Review of the burned house materials revealed a charred needle cap, similar to those used in the hospital where the nurse practitioner worked.

In another case, the wife of an anesthesiologist died suddenly and unexpectedly. Although the initial death certificate did not list homicide, the father of the wife suspected foul play. An investigation was launched. An anesthesiologist reviewing information about this case learned that the husband anesthesiologist had previously been tried for murder, and found not guilty. This previous trial followed the sudden and unexpected death of the husband of a woman with whom he had allegedly been having an affair. The district attorney and consultant anesthesiologist theorized that the anesthesiologist had injected the buttocks of the first victim with succinylcholine while he slept.

The body was exhumed and, on detailed examination, was discovered to have a fractured hyoid bone. It then was speculated that an injected dose of succinylcholine had produced apnea but begun to wear off before death, so the victim was strangled. A second autopsy of the deceased wife found a high concentration of choline in her buttocks. The husband anesthesiologist was tried for the murder of the second wife, found guilty, and sent to jail.

In a recently published study, a group of anesthesiologists recount these cases in which drugs stolen from healthcare facilities were used to kill and clinicians were convicted of murder.1 The anesthesiologists are warning that, in addition to the perennial problem of drugs being diverted for personal use or resale, some powerful drugs are stolen from providers to be used as murder weapons.

They note that anesthetic drugs, opioids, and muscle relaxants can depress breathing and other vital processes enough to kill, and these drugs have thus been used for euthanasia, suicides, and state executions. Criminals also have recognized the lethal capabilities of anesthetic drugs, and during recent years they have committed homicides using hypnotics, inhalational general anesthetics, opioids, and muscle relaxants, they say.

An analysis of 523 homicidal poisonings occurring between 1999 and 2005 found their rate increasing and that 65% involved medicines, according to the study. An increasing recognition of the use of muscle relaxants and anesthetic drugs for homicides means anesthesiologists are likely to be involved in more homicide investigations and prosecutions, sometimes as an expert witness, but sometimes as the defendant, says Robert E. Johnstone, MD, in the Department of Anesthesiology at West Virginia University in Morgantown and one of the authors of the study.

"Anesthetic drugs can be used for harm as well as healing. That's really new information for a lot of people," Johnstone says. "This was a revelation for me, and I think it will be for many anesthesiologists. We think of using these drugs carefully with our patients and protecting them from diversion for abuse, but the idea of preventing their use for criminal purposes is really a new thing."

Johnstone advises managers to consider the potential criminal exploitation of anesthetic drugs when addressing drug security and diversion. "The drugs have been diverted primarily from hospitals, and of course we live in a very litigious society," he says. "We're seeing evidence that this is becoming more common, and I think it's probably only a matter of time before we see a hospital dragged into an ugly murder case with allegations that the hospital bears responsibility for not preventing their theft and use in a crime."

Reference

  1. Johnstone RE, Katz RL, Stanley TH. Homicides using muscle relaxants, opioids, and anesthetic drugs: anesthesiologist assistance in their investigation and prosecution. Anesthesiology 2011; 114:713-716.