Hospitals, nursing homes, and other medical facilities are potential hotbeds for covert violence, if for no other reason than the fact that many, many people die there every year. After all, patients typically check into a hospital because of serious illness or injury, and nursing homes are intended for those who need round-the-clock care. Although most of the sick and injured who seek medical care in the United States and elsewhere are treated and then released on the road to recovery, many others die on the operating table or in their hospital bed. Death is very much part of life in healthcare facilities, which unfortunately also makes them places where a killer can operate unnoticed for long periods of time without being discovered.

According to the Centers for Disease Control and Prevention (CDC), diseases, illnesses, and other naturally occurring medical conditions account for more than 90 percent of U.S. deaths each year, with a large proportion of those occurring in medical facilities (although at lower rates than in the past, as greater awareness of palliative care and concern for patient preferences have resulted in more people dying in their own homes; see Shmerling [2018]). Add to that U.S. deaths from accidents (the third-highest cause of U.S. deaths), assaults, and complications of medical and surgical care—many of which also occur in medical facilities—and the death toll seems staggering. With nearly three million total U.S. deaths a year (Xu et al., 2021) and more than 700,000 people dying annually in hospitals (Shmerling, 2018), it seems reasonable to estimate that at least one million deaths collectively occur in U.S. healthcare facilities each year.

The lack of clear data related to medical deaths is an enormous obstacle preventing better understanding of the covert violence that occurs in these settings. The CDC recorded 5,329 U.S. deaths in 2019 that were caused by “complications of medical and surgical care” (Xu et al., 2021). This category includes deaths from medical devices, adverse effects related to incorrect doses of therapeutic medications, and difficulties that arose during surgical or medical care. However, deaths from accidental overdoses of a drug or from drugs administered in error are excluded here, even when they occurred in a healthcare setting and/or the drugs were administered by a doctor or other healthcare professional.