Table Of ContentClinical and Forensic Perspectives
Edited by
Christopher P. Holstege, MD
Chief, Division of Medical Toxicology
Associate Professor, Departments of Emergency Medicine & Pediatrics
University of Virginia School of Medicine
Charlottesville, VA
Thomas M. Neer, SSA
FBI Supervisory Special Agent
National Center for the Analysis of Violent Crime
Critical Incident Response Group, Behavioral Analysis Unit
FBI Academy
Quantico, VA
Gregory B. Saathoff, MD
Associate Professor of Research
Departments of Psychiatry and Neurobehavioral Science & Emergency Medicine
University of Virginia School of Medicine
Charlottesville, VA
R. Brent Furbee, MD
Medical Director, Indiana Poison Center
Medical Toxicology, Methodist Hospital of Indiana
Indianapolis, IN
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Library of Congress Cataloging-in-Publication Data
Criminal poisoning : clinical and forensic perspectives / Christopher Holstege ... [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-4463-2
ISBN-10: 0-7637-4463-8
1. Poisoning. I. Holstege, Christopher P.
[DNLM: 1. Poisoning. 2. Crime. 3. Forensic Medicine--methods. 4. Poisons. QV 600 C929 2011]
HV6549.C737 2011
614’.13--dc22
2009041721
6048
Printed in the United States of America
14 13 12 11 10 10 9 8 7 6 5 4 3 2 1
Dedications
TO MY WIFE, Angela, for your love, grace, and ever-enduring fortitude;
to my six children (Erik, Elijah, Benjamin, Samual, Noah, and Annalee)
for infusing levity into daily life; and to both my parents, Henry and
Lois Holstege, for your selfless sacrifice in providing for my years of
valued education.
Christopher P. Holstege
TO MY WIFE, Tip, for your love, patience, and enduring support;
to Margaret MacDonald, for your friendship, encouragement, and
editing advice; to FBI Special Agent Jim McCarthy, for your insight,
humor, and years of partnership…it’s been a great run!
Thomas M. Neer
TO MY WIFE, Andrea, and to our children, Graham, Kathleen, and
Kenneth. I remain grateful for your love, patience, understanding, and
humor. You continue to provide me with what I value most in life.
Gregory B. Saathoff
TO MY WIFE, Esther, for your love, understanding, and assistance
in everything I try. You make my life so much better. To my partners
and coworkers: Mary, Dan, Louise, Kris, Blake, Jim, Maggie, and
the nurses and pharmacists of the Indiana Poison Center for sharing
in our vision and making it a reality. Work would just be work if not
for people like you. Many thanks.
R. Brent Furbee
Contents
About the Editors ix
Contributors xi
Foreword xiii
Preface xv
Acknowledgments xvii
section 1
Introduction to Poisoning
chapter 1 History of Criminal Poisoning 3
Bryan S. Judge
chapter 2
Poisoners and their Relationship
with Victims: The Need for an
Evidence-Based Understanding 13
Gregory B. Saathoff
chapter 3 Evaluating a Potential Criminal Poisoning 19
Thomas M. Neer
v
vi criminal poisoning: clinical and forensic perspectives
section 2
Agents Used by Past Poisoners
chapter 4 Acids and Alkalis 33
Matthew Salzman and Rika N. O’Malley
chapter 5 Animals 39
Blake A. Froberg
chapter 6 Arsenic 49
Ashley L. Harvin and Christopher P. Holstege
chapter 7 Botulism 55
William H. Richardson, III
chapter 8 Cyanide 63
Christopher P. Holstege and Paul M. Maniscalco
chapter 9 Dioxin 69
Christopher P. Holstege
chapter 10 Drugs of Abuse 75
Rachel Haroz and Susan Ney
chapter 11 Gamma-Hydroxybutyrate 83
Jenny J. Lu and Timothy B. Erickson
chapter 12 Hypoglycemics 91
Adam K. Rowden and Kelli D. O’Donnell
chapter 13 Neuromuscular Blocking Agents 97
R. Brent Furbee
chapter 14 Opioids 103
Ziad N. Kazzi and Kevin S. Barlotta
chapter 15 Organophosphates (Nerve Agents) 109
Christopher P. Holstege and Kahoko Taki
chapter 16 Plants and Herbals 115
R. Brent Furbee and Jou-Fang Deng
chapter 17 Potassium 129
R. Brent Furbee
contents vii
chapter 18 Quinuclidinyl Benzilate (QNB) 137
Christopher P. Holstege
chapter 19 Saxitoxin 141
Christopher P. Holstege
chapter 20 Sedative-Hypnotics 145
Laura K. Bechtel
chapter 21 Sodium Monofluoroacetate 155
Christopher P. Holstege
chapter 22 Strychnine 159
Gerald F. O’Malley and Kelli D. O’Donnell
chapter 23 Thallium 165
Daniel E. Rusyniak
chapter 24 Toxalbumins 171
Ayrn D. O’Connor
chapter 25 Trichothecene Mycotoxins 179
Stephen W. Borron and Juan C. Arias
section 3
Specific Classes of Poisoners
chapter 26 Medical Serial Killers 189
Thomas M. Neer, James McCarthy, Bernard Postles, and
R. Brent Furbee
chapter 27 Munchausen by Proxy 213
David L. Eldridge
chapter 28 Drug-Facilitated Sexual Assault 229
Laura K. Bechtel
Glossary 235
Index 237
About the Editors
Christopher P. Holstege at Butterworth Hospital (Grand Rapids, Michi-
Christopher P. Holstege, MD, is an associate pro- gan) and his fellowship training in medical
fessor of emergency medicine and pediatrics at toxicology at Indiana University (Indianapolis,
the University of Virginia’s School of Medicine Indiana). He is a diplomate of both the Ameri-
and chief of the University of Virginia’s Division can Board of Emergency Medicine and the
of Medical Toxicology. His clinical practice is American Board of Medical Toxicology.
associated with the University of Virginia’s Cen-
Thomas M. Neer
ter of Clinical Toxicology. He has published ex-
tensively in the medical literature with over 100 Supervisory Special Agent (SSA) Thomas Neer
publications in medical journals, periodicals, is a 25-year veteran of the FBI with extensive
and books. Dr. Holstege speaks extensively on experience in complex criminal and counter-
various topics in the field of medical toxicology, terrorism investigations. Since 1995, he has
with a focus on areas such as criminal poisoners been assigned to the FBI’s Behavioral Analysis
and chemical weapons of mass destruction. He Unit in Quantico, Virginia where he provides
has been integrally involved in the diagnosis and FBI field offices and state, local, and foreign
management of a number of high profile crimi- police with behavioral assessments on cases in-
nal poisonings, including the dioxin poisoning volving unusual circumstances or serial offend-
of the Ukrainian President Viktor Yushchenko. ers. Among his many cases, SSA Neer served
In appreciation of his work in both educa- as the FBI’s principal behavioral advisor during
tion and clinical service, Dr. Holstege received the investigation of Michael Swango, a medical
the Dean’s Award for Clinical Excellence from doctor who was convicted of murdering several
the University of Virginia, the National Faculty patients in hospitals.
Teaching Award from the American College Prior to his career with the FBI, SSA Neer
of Emergency Physicians, and the Attending was employed by the Naval Criminal Investiga-
Teacher of the Year Award from the Univer- tive Service and the Federal Bureau of Prisons.
sity of Virginia’s Department of Emergency SSA Neer’s diverse law enforcement career in-
Medicine. He currently serves on the Board of cludes extensive operational travel to Europe,
Trustees of the American Academy of Clini- Asia, Africa, and the Middle East.
cal Toxicology and on the Steering Committee A 1976 graduate of the University of Florida,
of the University of Virginia’s Critical Incident SSA Neer pursued graduate studies in 1977 at
Analysis Group (CIAG). He is a consultant to the Southern Illinois University’s Center for the
the Federal Bureau of Investigation (FBI). Study of Crime Delinquency and Corrections.
Dr. Holstege received his bachelor of sci- A 2001 graduate of the Police Staff College
ence degree in chemistry from Calvin College in Bramshill, England, SSA Neer is currently
(Grand Rapids, Michigan) and his doctor of a candidate for a master of arts degree at the
medicine from Wayne State University School Fletcher School of Law and Diplomacy, Tufts
of Medicine (Detroit, Michigan); he completed University.
his residency training in emergency medicine
ix
