Lucia de Berk, often called Lucia de B. or Lucy de B (born September 22, 1961 in The Hague

The Hague

The Hague is the capital city of the province of South Holland in the Netherlands. With a population of 500,000 inhabitants , it is the third largest city of the Netherlands, after Amsterdam and Rotterdam...

, Netherlands

Netherlands

The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

) is a Dutch licenced paediatric nurse

Child health nursing

Pediatric nursing or child health nursing is the specialty nursing care of infants, children and adolescents. A nurse who specialises in this area is usually referred to as a pediatric nurse, though there are many regional and sub-specialty variations in title...

, who was subject to a miscarriage of justice

Miscarriage of justice

A miscarriage of justice primarily is the conviction and punishment of a person for a crime they did not commit. The term can also apply to errors in the other direction—"errors of impunity", and to civil cases. Most criminal justice systems have some means to overturn, or "quash", a wrongful...

. She was sentenced to life imprisonment

Life imprisonment

Life imprisonment is a sentence of imprisonment for a serious crime under which the convicted person is to remain in jail for the rest of his or her life...

 in 2003 for four murders and three attempted murder

Attempted murder

Attempted murder is a crime in England and Wales and Northern Ireland.-Today:In English criminal law, attempted murder is the crime of more than merely preparing to commit unlawful killing and at the same time having a specific intention to cause the death of human being under the Queen's Peace...

s of patients in her care. After an appeal, she was convicted in 2004 of seven murders and three attempts. Her conviction was controversial in the media and amongst scientists, and was questioned by investigative reporter Peter R. de Vries

Peter R. de Vries

Peter Rudolf de Vries is a Dutch Investigative Journalist and crime reporter. His television program covers high profile cases and set a Dutch television viewing record. In 2005, he started his own political party which was disbanded soon after.-Early life and career:Peter Rudolf de Vries was born...

. In October 2008, the case was reopened by the Dutch supreme court

Hoge Raad der Nederlanden

The Supreme Court of the Netherlands is the highest court of the Netherlands, Curaçao, Sint Maarten and Aruba. The Court was established on 1 October 1838 and sits in The Hague, Netherlands....

, as new facts had been uncovered that undermined the previous verdicts. De Berk was freed, and her case was re-tried; she was exonerated in April 2010.

Charges

As a result of an unexpected death

Unnatural death

Unnatural death is a category used by coroners and vital statistics specialists for classifying all human deaths not properly describable as death by natural causes...

 of a baby (Amber) in the Juliana Kinderziekenhuis (Juliana Children's Hospital, JKZ) in The Hague on 4 September 2001, earlier deaths and cardiopulmonary resuscitation

Cardiopulmonary resuscitation

Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...

s were scrutinised. Between September 2000 and September 2001 there appeared to have been nine incidents, which earlier had all been thought unremarkable but now were considered medically suspicious. Lucia de Berk had been on duty at the time of those incidents, responsible for patient care and delivery of medication. The hospital decided to press charges against her.

Life sentence

On 24 March 2003, de Berk was sentenced by the court in The Hague to life imprisonment for the murder of four patients and the attempted murder of three others. The verdict depended in part on a statistical

Statistics

Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....

 calculation, according to which the probability was allegedly only 1 in 342 million that a nurse's shifts would coincide with so many of the deaths and resuscitations purely by chance. De Berk was however only sentenced in cases where, according to a medical expert, other evidence

Evidence (law)

The law of evidence encompasses the rules and legal principles that govern the proof of facts in a legal proceeding. These rules determine what evidence can be considered by the trier of fact in reaching its decision and, sometimes, the weight that may be given to that evidence...

 was present or in which, again according to a medical expert, no natural causes could explain the incident.

In the appeal on 18 June 2004, de Berk's conviction for the seven murders and three attempted murders was upheld. The crimes were supposed to have taken place in three hospitals in The Hague: the Juliana Child Hospital (JKZ), the Red Cross Hospital (RKZ) and the Leyenburg Hospital, where de Berk had worked earlier. 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 that they must have been caused by de Berk, who was present on all those occasions. The idea that only weaker evidence is needed for the subsequent murders after two have been proven beyond reasonable doubt has been dubbed chain-link proof by the prosecution and adopted by the court. At the 2004 trial, besides a life sentence, de Berk also received detention with coerced psychiatric treatment

Involuntary treatment

Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...

, though the state criminal psychological observation unit did not find any evidence of mental illness.

Important evidence at the appeal was to be the statement of a detainee in the Pieter Baan Center

Pieter Baan Center

The Pieter Baan Centre is a forensic psychiatric observation clinic in Utrecht, Netherlands, operated by the Ministry of Security and Justice, where suspects of crimes in the Netherlands are observed to ascertain whether they can be held wholy responsible for their suspected crimes...

, a criminal psychological observation unit

Forensic psychiatry

Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...

, at the same time as Lucia de Berk, that she had said during outdoor exercise: "I released these 13 people from their suffering". However, during the appeal, the man withdrew his statement, saying that he had made it up. The news service of the Dutch Broadcasting Foundation (NOS

Nederlandse Omroep Stichting

The Nederlandse Omroep Stichting , English: Netherlands Broadcasting Foundation, is one of the broadcasters in the Netherlands Public Broadcasting system...

) and other media that followed the process considered the withdrawal of this evidence to be a huge setback for Public Prosecution Service (OM). A series of articles appeared over the following years in several newspapers, including Vrij Nederland

Vrij Nederland

Vrij Nederland is a Dutch magazine which was established during the German occupation of the Netherlands in World War II as an underground newspaper but has since grown into a magazine. The weekly magazine is generally considered to be intellectually left-wing...

and the Volkskrant, raising doubts about the conviction.

The case was next brought to the Netherlands Supreme Court

Hoge Raad der Nederlanden

The Supreme Court of the Netherlands is the highest court of the Netherlands, Curaçao, Sint Maarten and Aruba. The Court was established on 1 October 1838 and sits in The Hague, Netherlands....

, which ruled on 14 March 2006 that it was incorrect to combine life imprisonment with subsequent psychiatric detention. Other complaints were not taken into consideration, and the evidence from a re-analysis by a Strasbourg

Strasbourg

Strasbourg is the capital and principal city of the Alsace region in eastern France and is the official seat of the European Parliament. Located close to the border with Germany, it is the capital of the Bas-Rhin département. The city and the region of Alsace are historically German-speaking,...

 laboratory was not considered relevant. The Supreme Court gave the matter back to the Court in Amsterdam to pass judgement again, on the basis of the same factual conclusions as had been made before. Some days after the ruling of the Supreme Court, de Berk suffered a stroke and was admitted to the hospital of Scheveningen prison. On July 13, 2006, de Berk was sentenced by the Court of Appeal in Amsterdam to life imprisonment, with no subsequent detention in psychiatric care.

Doubts

A committee of support for Lucia de Berk was formed that continued to express doubts about her conviction. Philosopher of science

Philosophy of science

The philosophy of science is concerned with the assumptions, foundations, methods and implications of science. It is also concerned with the use and merit of science and sometimes overlaps metaphysics and epistemology by exploring whether scientific results are actually a study of truth...

 Ton Derksen, aided by his sister, geriatrician Metta de Noo-Derksen, wrote the Dutch language book Lucia de B: Reconstruction of a Miscarriage of Justice. They doubted the reasoning used by the court and the medical and statistical evidence that was presented. See also the English-language article Derksen and Meijsing (2009).

Chain-link proof

Of the seven murders and three attempted murders finally attributed to de Berk by the court, the court considered two proven by medical evidence. According to the court, de Berk had poisoned these two patients. The court then applied a so-called chaining-evidence argument. This means that if the several attempted or actual murders have already been established beyond reasonable doubt, then much weaker evidence than normal is sufficient to establish that a subsequent eight “suspicious incidents” are murders or attempted murders carried out by the same defendant.

For the two murders found proven by the court in The Hague, many experts do not exclude a natural cause of death. In the case where digoxin

Digoxin

Digoxin INN , also known as digitalis, is a purified cardiac glycoside and extracted from the foxglove plant, Digitalis lanata. Its corresponding aglycone is digoxigenin, and its acetyl derivative is acetyldigoxin...

 poisoning was alleged, and supposedly detected by independent measurements in two Dutch laboratories, the method used in those laboratories did not exclude that the substance found was actually a related substance naturally produced in the human body. The Strasbourg laboratory used a new method, a test of high specificity and sensitivity, and did not support the digoxin overdose hypothesis. In the second case, the intoxication could have been an overdose caused by a faulty prescription

Medical error

A medical error may be defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.-Definitions:As a general...

. For both children, it was not clear how and when de Berk was able to administer the poison. Regarding the digoxin case, the prosecution gave a detailed reconstruction of the timing. However, other parts of the evidence discarded by the prosecution showed by the time-stamp on a certain monitor that at the alleged moment of poisoning de Berk was not with the patient at all, and that the specialist and his assistant were with the patient at that time.

The prosecution initially charged de Berk of causing thirteen deaths or medical emergencies. In court, the defence was able to show definitively that de Berk could not have been involved at all in several of these cases. For instance, she had been away for several days; the idea that she was there was due to administrative errors. Furthermore, all deaths had been registered as natural, with the exception of the last event. Even that last event was initially thought to be a death by natural causes

Death by natural causes

A death by natural causes, as recorded by coroners and on death certificates and associated documents, is one that is primarily attributed to natural agents: usually an illness or an internal malfunction of the body. For example, a person dying from complications from influenza or a heart attack ...

 by the doctors responsible for the child, but within a day, on being connected by other hospital authorities with de Berk and her repeated presence at recent incidents, it became classified as an unnatural death.

Statistical proof

The court made heavy use of statistical calculations to achieve its conviction. In a 2003 TV special of NOVA, Dutch professor of Criminal Law Theo de Roos stated: "In the Lucia de B. case statistical evidence has been of enormous importance. I do not see how one could have come to a conviction without it". The law psychologist Henk Elffers, who was used by the courts as expert witness on statistics both in the original case and on appeal, was also interviewed on the programme and stated that the chance of a nurse working at the three hospitals being present at the scene of so many unexplained deaths and resuscitations is one in 342 million.

This value was wrongly calculated. If one wishes to combine p-value

P-value

In statistical significance testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true. One often "rejects the null hypothesis" when the p-value is less than the significance level α ,...

s (right tail probabilities) of the statistical tests based on data from three separate wards, one must introduce a correction according to the number of tests

Fisher's Method

In statistics, Fisher's method, also known as Fisher's combined probability test, is a technique for data fusion or "meta-analysis" . It was developed by and named for Ronald Fisher...

, as a result of which the chance becomes one in a million.

Biased reporting meant that this lower figure was invalid. Events were attributed to de Berk once suspicions began to fall on her, which could not have had anything to do with her in reality. The statisticians Richard D. Gill and Piet Groeneboom calculated a chance of one in twenty-five that a nurse could experience a sequence of events of the same type as Lucia de Berk.

Philip Dawid

Philip Dawid

Alexander Philip Dawid is Professor of Statistics in the Statistical Laboratory, University of Cambridge, and Fellow of Darwin College, Cambridge...

, Professor of Statistics at the University of Cambridge

University of Cambridge

The University of Cambridge is a public research university located in Cambridge, United Kingdom. It is the second-oldest university in both the United Kingdom and the English-speaking world , and the seventh-oldest globally...

 (UK), stated that Elffers “made very big mistakes. He was not sufficiently professional to ask where the data came from and how accurate the data were. Even granted the data were accurate, he did some statistical calculations of a very simplistic nature, based on very simple and unrealistic assumptions. Even granted these assumptions, he had no idea how to interpret the numbers he got”. Professor DasGupta, a toxicologist from the University of Houston

University of Houston

The University of Houston is a state research university, and is the flagship institution of the University of Houston System. Founded in 1927, it is Texas's third-largest university with nearly 40,000 students. Its campus spans 667 acres in southeast Houston, and was known as University of...

, (Texas, US) commented on the complete lack of toxicological evidence with regard to the claimed digoxin intoxication.

The use of probability arguments in the de Berk case was discussed in a 2007 Nature

Nature (journal)

Nature, first published on 4 November 1869, is ranked the world's most cited interdisciplinary scientific journal by the Science Edition of the 2010 Journal Citation Reports...

article by Mark Buchanan. He wrote:
At the initiative of Richard D. Gill, a petition for a reopening of the Lucia de Berk case was started. On 2 November 2007 the signatures were presented to the Minister of Justice, Ernst Hirsch Ballin

Ernst Hirsch Ballin

Ernst Maurits Henricus Hirsch Ballin is a Dutch politician of the Christian Democratic Appeal . He served as Minister of Justice and Minister for Suriname and Netherlands Antilles Affairs from November 7, 1989 until May 27, 1994 in the Cabinet Lubbers III...

, and the State Secretary of Justice, Nebahat Albayrak

Nebahat Albayrak

Nebahat Albayrak is a Turkish-Dutch politician and former civil servant. As a member of the Dutch Labour Party she is a former State Secretary for Justice in the Netherlands. Since May 12, 2010 she has been an MP. From April till August 2011 she was on maternity leave...

. Over 1300 people signed the petition.

Diary

Lucia de Berk's diary also played a role in her conviction. On the day of death of one of her patients (an elderly lady in a terminal stage of cancer) she wrote that she had 'given in to her compulsion'. She wrote on other occasions that she had a 'very great secret' and that she was concerned about 'her tendency to give in to her compulsion'. De Berk has stated that these were references to her passion for reading tarot cards, which she explains she did secretly because she did not believe it appropriate to the clinical setting of a hospital. However, the court decided they were evidence that she had euthanised

Euthanasia

Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....

 the patients. According to the court, the reading of cards does not accord with a 'compulsion' nor with 'perhaps an expression of fatigue', as she described it at the time. De Berk's daughter Fabiënne explained in an interview on the television program Pauw & Witteman that some of her mother's notes in the diaries are 'pure fiction' which she intended to use in writing a thriller.

Dutch Forensic Institute report

After the appeal proceedings were closed, but before the judges delivered their verdict, the Public Prosecution Service received, via the Netherlands Forensic Institute

Netherlands Forensic Institute

The Netherlands Forensic Institute, is the national forensics institute of the Netherlands, located in the Ypenburg quarter of The Hague....

 (NFI), a report from a forensic laboratory in Strasbourg on the evidence for digoxin poisoning. The report subsequently lay in a drawer of the NFI for two years, but it did turn up in time for the final evaluation of the case before the Supreme Court. According to the Public Prosecution, the report contained no new facts, but according to de Berk's defence the report proved that there was not a lethal concentration of digoxin in the first case. The Supreme Court accepts the facts reported by the judges at the appeal court, and is concerned only with jurisprudence and correctness of the sentence, given those facts. The report therefore was not admitted into the final considerations of the sentence given to de Berk.

Posthumus II Commission

In general, in the Dutch legal system

Law of the Netherlands

The Netherlands is a civil law country. Its laws are written and the application of customary law is exceptional. The role of case law is small in theory, although in practice it is impossible to understand the law in many fields without also taking into account the relevant case law...

, cases are not re-opened unless a new fact, called a novum, is found. New interpretations by experts of old facts and data are generally not considered a novum.

In spite of this, Ton Derksen submitted his and Metta de Noo's research on the case to the Posthumus II Commission. This ad hoc, non-permanent commission examines selected closed cases and looks for evidence of errors in the police investigation indicating "tunnel vision" and misunderstanding of scientific evidence. Derksen pointed out that the medical experts who had ruled out the possibility of death by natural causes had not been given all relevant information, that the hypothesis of digoxin poisoning was disproven, in particular by the Strasbourg analysis, and that the statistical data were biased and the analysis incorrect, and the conclusions drawn from it invalid. The commission announced on 19 October 2006 that this was one of the few cases it would consider in detail. Three wise men, recruited by the Public Prosecution service from the full Posthumus II committee, considered the following matters, having been instructed to focus on possible blemishes in the criminal investigation:

• Whether there were also unexplained deaths when Lucia de Berk was not present, unknown to the public prosecutor.
• Whether the expert witnesses were given all relevant available information.
• Whether scientific knowledge now threw a different light on the digoxin question.

In October 2007, the commission released its report and recommended that the case be re-opened. They concluded that the case had been seriously marred from the start by tunnel vision. In particular, the same persons, chosen from close circles of the hospital authorities rather than on the basis of recognised relevant expertise, had first helped the hospital in its internal investigations, then had advised the police, and finally had appeared before the courts as independent scientific experts. They noted that there was strong disagreement concerning whether or not baby Amber had died of digoxin poisoning. On 2 April 2008, de Berk was released for three months because after re-examination of the death of the last "victim", a natural death could no longer be ruled out.

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, acknowledging that new facts uncovered by Knigge substantially undermined earlier evidence. In particular, an independent team of medical researchers with access to all available medical information had reported to Advocate-General Knigge that the death which sparked the case appears to have been a natural death. The key toxicologist of the earlier trials had agreed with the new medical findings, pointing out that at the time of the trial, the court had only given him partial information about the medical state of the child. De Berk's statements about her doings on the night of that child's death had also been shown to be correct; indeed, during the period in which the courts had earlier concluded that she must have administered poison, the baby was actually being treated by a medical specialist and his assistant.

Lucia de Berk was allowed to wait in freedom for a retrial at the Court of Arnhem

Arnhem

Arnhem is a city and municipality, situated in the eastern part of the Netherlands. It is the capital of the province of Gelderland and located near the river Nederrijn as well as near the St. Jansbeek, which was the source of the city's development. Arnhem has 146,095 residents as one of the...

, which first adjourned while further investigations were made. The public prosecution had asked for extensive new forensic investigations, but this request was turned down by the court. Instead it commissioned further independent medical investigations into the cases of two more of the children, again allowing a multidisciplinary medical team access to all possible medical data concerning the children. At a session on 9 December 2009, the court stated that new integral medical investigations of the last nine months had confirmed that the cases of Amber, Achmed and Achraf were all natural deaths/incidents. These were the only cases where there was previously claimed proof of de Berk's culpability.)

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, sometimes caused by wrong treatment or bad hospital management, and sometimes unexpected because of 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, saving lives on several occasions. The Public Prosecution capitulated, formally requesting the court to deliver a not guilty verdict. On 14 April 2010, the court delivered the not guilty verdict.

Compensation

On 12 November 2010, it was revealed that Lucia had received an undisclosed amount of compensation from the Ministry of Justice. The news was first broadcast by a local TV station in the West of the Netherlands. It was later confirmed by the ministry to the Dutch news agency ANP

Algemeen Nederlands Persbureau

The Algemeen Nederlands Persbureau is the largest news agency in the Netherlands. ANP was founded on December 11, 1934 by the association of Dutch newspapers NDP...

.

See also

• Miscarriages of justice in the Netherlands
• Sally Clark
  Sally Clark
  Sally Clark was a British solicitor who became the victim of an infamous miscarriage of justice when she was wrongly convicted of the murder of two of her sons in 1999...
  
  
• Prosecutor's fallacy
  Prosecutor's fallacy
  The prosecutor's fallacy is a fallacy of statistical reasoning made in law where the context in which the accused has been brought to court is falsely assumed to be irrelevant to judging how confident a jury can be in evidence against them with a statistical measure of doubt...
  
  

External links

1. Site on statistical aspects of case, by Richard D. Gill, Professor of Mathematical Statistics at Leiden University.
2. English summary of site of Dutch committee for Lucia de B. by Metta de Noo and Ton Derksen
3. Three reasoning instincts and the fabrication of facts: the case Lucia de B., by Ton Derksen