Lucia de Berk case
The Lucia de Berk case was a
Her conviction was controversial in the media and among scientists, and it was questioned by the investigative reporter
Suspicions and investigation
Colleagues started to notice that patients often died under de Berk's watch. Suspicions were raised when a five-month-old baby turned blue and died unexpectedly, only an hour after doctors had said that her condition was improving.
Police investigators looked into all the deaths that had occurred between 1997 and 2001 while de Berk was working at three hospitals in
Lucia de Berk was charged with killing thirteen patients and attempting to kill five others by injecting them with
Trial
De Berk's trial began in September 2002. Amongst the other evidence used against her were diary entries that the prosecution asserted showed that she was "obsessed by death".
The prosecution argued that she had killed or attempted to kill patients by unnecessarily increasing dosages of medicines, or giving large doses of drugs that are difficult to detect. One of the trial judges noted that the cases in question seemed to follow a particular pattern, saying: "Lucia says she believes she sees a problem and starts to alert colleagues and soon enough a crisis occurs, did you perhaps raise the alarm first so that you could then introduce death?".[6]
De Berk denied the charges, blaming the deaths and near-deaths on other staff in the hospitals or the quality of medical equipment.
During the trial, proceedings were adjourned as de Berk was sent by the court for psychiatric tests at the Netherlands forensic psychiatric assessment centre, where she was found to have a personality disorder but to be completely responsible for her actions.[11] De Berk had previously refused requests to undergo psychiatric tests.[10] When a psychologist testified at the trial that de Berk was "theatrical, narcissistic, aggressive and suffering from a personality disorder", de Berk replied: "that sounds like me".[7]
In March 2003 de Berk was found guilty of the murder of four of the individuals and the attempted murder of three others.[12] In every one of the cases de Berk was responsible for their care and medication, or was the last person present before they died or declined.[11] Of those that died it was concluded that they had been given an overdose of either potassium or morphine, and in each of the cases de Berk was the last person to be at the patients' bedside.[12] In all seven cases where she was found guilty there was no possible medical explanation.[11]
In two cases, the court concluded that there was proof that de Berk had poisoned the patients. Concerning the other cases the judges considered that they could not be explained medically and must have been caused by de Berk, who was present on all of those occasions. The idea that only weaker evidence was needed for the subsequent murders after two had been proven beyond reasonable doubt, dubbed chain-link proof by the prosecution, was accepted by the court.[13]: §7
The very high digoxin levels in autopsy blood from one child were key to the argument. Digoxin had previously been administered to the child, but the treatment had been discontinued some time before and doctors argued there should be none remaining. There was a brief period when the child had been disconnected from monitors approximately an hour before death, which would have been the time when a lethal overdose of the drug would have needed to be administered. This, the prosecution argued, gave means and opportunity to murder the child.[13]: §7
De Berk was jailed for life. Her lawyer quickly said that she would appeal, claiming that her conviction had been based only on circumstantial evidence.[12] The media reported her diary entries as being the key evidence in her conviction.[14][12]
Further convictions and appeals
In 2004, de Berk's first appeal failed[15] when the Court of Appeal upheld her conviction, and then convicted her of three additional murders.[16][17] At the 2004 trial, besides a life sentence, de Berk also received detention with coerced psychiatric treatment, despite the state criminal psychological observation unit finding no evidence of mental illness.[13] A second appeal also failed when the Dutch Supreme Court upheld her conviction in 2006.[17][15]
Doubts
One of the various pieces of evidence against de Berk at the original trial had been the testimony of a statistician, who said that the odds that it was a coincidence that all the incidents occurred when she was on duty were 342 million to one.[17] Doubts were raised about de Berk's conviction when this claim was criticised.[18] However, the appeals court still upheld the conviction on this and the other evidence.[18]
The
The prosecution initially charged de Berk with causing 13 deaths or medical emergencies. In court, the defence showed that de Berk could not have been involved at all in several of the cases. For instance, she had been away for several days, but administrative errors had caused her absence on those days to be overlooked. Also, all the deaths except the last had been registered as
Statistical arguments
Hospital and ward |
Juliana Children's Hospital |
Red Cross Hospital, ward 41 |
Red Cross Hospital, ward 42 |
---|---|---|---|
Total shifts | 1029 | 336 | 339 |
de Berk's shifts | 142 | 1 * | 58 |
Incidents | 8 | 5 | 14 |
Incidents during de Berk's shift(s) |
8 | 1 | 5 |
Statistics in report presented at trial[21] * Later found to be 3 [22] |
In a 2003 television special of
Statistician
The use of probability arguments in the de Berk case was discussed in a 2007 Nature article by Mark Buchanan. He wrote:
The court needs to weigh up two different explanations: murder or coincidence. The argument that the deaths were unlikely to have occurred by chance (whether 1 in 48 or 1 in 342 million) is not that meaningful on its own — for instance, the probability that ten murders would occur in the same hospital might be even more unlikely. What matters is the relative likelihood of the two explanations. However, the court was given an estimate for only the first scenario.[25]
In addition to errors in the analysis, concerns were raised about the data provided by one of the hospitals, which appeared to show that De Berk was present at every single significant incident where reanimation (successful or not) was required. As a certain number of such cases are expected in all hospitals, there was reason to doubt the data provided, and later analysis after De Berk's acquittal showed that indeed, not all incidents were reported, and some cases attributed to her occurred when she was not present, had already left or was absent due to illness.[26]: 128
At the initiative of Gill, a petition for a reopening of the de Berk case was started. On 2 November 2007, the signatures were presented to the Minister of Justice, Ernst Hirsch Ballin, and the State Secretary of Justice, Nebahat Albayrak. Over 1300 people signed the petition.[27]
Case reopened
On 17 June 2008, the Advocate-General of the Supreme Court, G. Knigge, made a request for the Supreme Court to reopen the case. On 7 October 2008, the court acceded to his request by acknowledging that new facts uncovered by Knigge substantially undermined the earlier evidence.[28]
In addition to the statistical arguments, at the third appeal hearing doubt was cast on the evidence about high digoxin levels in one child's blood, which had played a major role in de Berk's second conviction and life sentence for murder at the 2004 appeal hearings. Digoxin levels in autopsy blood should be expected to be much higher than those in a living patient. Living heart cells extract digoxin from the blood and concentrate it, but heart cells die within minutes after death and so digoxin can then diffuse into the blood in the heart and in the surrounding large blood vessels, the sites from which blood is extracted by pathologists for blood chemistry analysis. Additionally, the blood taken from the child for analysis did not originate from a proper sample but was squeezed out of a piece of gauze left inside the body after two autopsies had disturbed all of the organs. Digoxin levels increase with the evaporation of liquid. The measurement of digoxin was also complicated by the presence of digoxin-like immunoreactive substances (DLIS), which occur naturally particularly in infants. The tests used to determine the presence of digoxin were not able to distinguish between digoxin and DLIS. A laboratory in Strasbourg, with the facility to distinguish between digoxin and DLIS, analysed the samples and found 7 milligrams of digoxin per litre, a level below the threshold that would indicate poisoning. Other medical findings also failed to show any evidence of poisoning, such as the non-contraction of the heart.[13]: §7
It was also shown that the evidence of opportunity to poison the child with digoxin was flawed. The monitor had been disconnected at 1:20 for 28 minutes, but a doctor's examination was recorded at 1:00. Analysis of the log sheet of examinations showed that they were always recorded on the hour or the half hour. A reconstruction of events showed that the disconnection would therefore have been for the examination itself, logged at 1:00 but taking place shortly after the hour. Digoxin kills within an hour, and so would have needed to be administered during that examination.[13]: §7
In December 2009, with new statistical analysis and medical evidence having been presented, the court accepted that the deaths had all been entirely natural.[13]: §7 The appeal hearing ended on 17 March 2010. Witnesses heard on the final day stated that the deaths at the Juliana Children's Hospital were natural and were sometimes caused by wrong treatment or bad hospital management and sometimes resulted from faulty medical diagnosis. The behaviour of the nurses, including de Berk, during a couple of medical crises turned out to have been swift and effective and to have saved lives on several occasions. The Public Prosecution capitulated by formally requesting the court to deliver a not guilty verdict, which occurred on 14 April 2010.[13]: §7
See also
- Miscarriages of justice in the Netherlands
- Sally Clark
- Prosecutor's fallacy
- Accused (2014 film), a 2014 Dutch film
References
- ^ More Dutch prisoners serving life without parole Archived 25 September 2015 at the Wayback Machine, Barbara Rijlaarsdam, NRC Handelsblad, 22 November 2009
- ^ a b "Unlucky Numbers: Richard Gill is fighting the shoddy statistics that put nurses in prison for serial murder". Science. 19 January 2023. Retrieved 1 October 2023.
- ^ "Nurse Lucia de Berk finally found not guilty of murdering seven patients". 14 April 2010. Archived from the original on 24 July 2011.
- ^ "Apology for nurse jailed for murdering seven patients", AP, The Independent 14 April 2010.
- ^ a b c "Dutch nurse denies patient murders". BBC News. 17 September 2002. Retrieved 1 October 2023.
- ^ a b c d e f g h i "Court to Rule on Dutch Nurse Accused in 13 Deaths". New York Times. 8 October 2002. Retrieved 1 October 2023.
- ^ a b c Sage, Adam (25 March 2003). "Life for nurse who murdered babies". The Times.
- ^ a b c d e "Dutch nurse denies killing 13 patients in 'angel of death' case". The Independent. 18 September 2002. Retrieved 1 October 2023.
- ^ "Dutch nurse accused of 14 murders". BBC News. 8 May 2002. Retrieved 1 October 2023.
- ^ a b c "New inquiry into Dutch 'killer' nurse". BBC News. 8 October 2002. Retrieved 1 October 2023.
- ^ PMID 12663401.
- ^ a b c d "Dutch nurse gets life for murdering four patients". The Guardian. 25 March 2003. Retrieved 1 October 2023.
- ^ ISBN 9780465032921.
- ^ "Life sentence for hospital killer damned by her diary". Sydney Morning Herald. 26 March 2003. Retrieved 1 October 2023.
- ^ a b "Justice Flunks Math". New York Times. 26 March 2013. Retrieved 2 October 2023.
- ^ Jeffrey S., Rosenthal (2015). "Probability, Justice, and the Risk of Wrongful Conviction". The Mathematics Enthusiast. 12 (1).
- ^ a b c "Dutch nurse Lucy De Berk acquitted of patient murders". BBC News. 14 April 2010. Retrieved 1 October 2023.
- ^ a b "Court clears Dutch nurse jailed for murdering patients". The Guardian. 14 April 2010. Retrieved 1 October 2023.
- ISBN 90-8571-048-0. Archived from the originalon 4 October 2008.
- ISBN 978-0-7546-7620-1
- ^ S2CID 5245768.
- .
- ^ Statistiek in het strafproces Archived 9 April 2008 at the Wayback Machine NOVA/Den Haag Vandaag, 4 November 2003
- ^ "Expert on the most important proof in the Lucia de B. case: 'This baby has not been poisoned'". Archived 4 October 2008 at the Wayback Machine NOVA. 29 September 2007.
- PMID 17230166.
- ISBN 978-1-108-42827-9.
- ^ Persbericht CWI Archived 8 April 2008 at the Wayback Machine Petitie 2 November 2007
- ^ NRC "New trial for nurse convicted of seven killings" 7 October 2008
Sources
- doi:10.1038/445254a; Published online 17 January 2007
- ISBN 978-0-465-03292-1. (Seventh chapter: "Math error number 7: the incredible coincidence. The case of Lucia de Berk: carer or killer?").
External links
- Site of Dutch committee for Lucia de B. Site of Dutch committee for Lucia de B. by Metta de Noo and Ton Derksen (contains also English language pages)
- Three reasoning instincts and the fabrication of facts: the case Lucia de B., by Ton Derksen