'Pattern' led to 'killer' nurse
A hospital nurse murdered three patients and poisoned 18 others by contaminating saline bags and ampoules with insulin, a court heard.
Victorino Chua, 49, also deliberately altered the dosages on prescription charts while working as a staff nurse at Stepping Hill Hospital in Stockport, Manchester Crown Court heard.
In all 21 patients suffered as a result of his "handiwork" with three of them murdered, Tracey Arden, 44, Arnold Lancaster, 71, and Derek Weaver, 83, jurors were told.
Chua, a Filipino who first came to the UK in 2002 and had worked at Stepping Hill since 2009, sat in the dock listening impassively as Peter Wright QC, began outlining the prosecution case against him.
Chua has pleaded not guilty to 36 charges in all, including the three alleged murders, one count of grievous bodily harm with intent, 23 counts of attempted grievous bodily harm, eight counts of attempting to cause a poison to be administered and one count of administering a poison.
All the offences are said to have happened between June 2011 and January 2012.
Mr Wright said following a massive police investigation a "pattern" began to emerge and the killer was identified.
He told the jury of 10 men and two women: "The pieces of the forensic jigsaw began to emerge.
"The person responsible for each of these matters became increasingly clear. It was, we say, Victorino Chua.
"As the investigation intensified, the common denominator, the defendant, was shown in sharper and sharper relief.
"Motive for this course of conduct, whomsoever is responsible, is difficult to determine with precision.
"Only the person responsible could ever know why they would embark on such conduct."
Mr Wright said it was the prosecution's job to prove Chua was responsible, not to say exactly why, or "what caused him to turn from a man who had dedicated his life to caring for others, to harming them".
Chua had worked on two wards, A1 and A3, at the hospital - but it was a "lottery" as to which patients were harmed, with the saline bags and ampoules contaminated with insulin by him to then be used by other unsuspecting doctors and nurses on innocent patients.
The prosecutor continued: "In the vast majority of cases, the poisoner seem to have contaminated products or altered prescription dosages completely at random.
"It was therefore a lottery as to who was treated with contaminated products and who was not."
Opening the case for the prosecution, Mr Wright continued: "In the summer of 2011, during the months of June and July, a poisoner was at work on two wards at Stepping Hill Hospital.
"Someone was deliberately contaminating healthcare products on these two particular wards.
"The products were typically saline bags and ampoules, known as flushes. These were used routinely in the treatment and care of patients on the wards.
"The poisoner was contaminating these products with insulin and was doing it in order to cause really serious harm to the unsuspecting patients subsequently treated with them.
"Twenty-one patients on wards A1 and A3 suffered in consequence of the poisoner's handywork.
"In three of these cases it resulted in their death, in another it caused serious brain injury."
Mr Wright said that after the spate of poisonings security measures were put in place and the poisoner changed his methods.
In January 2012 someone set out to deliberately alter the medical notes of patients to increase the dosage of various drugs - some of this was done "crudely", for example by changing a "30" to "80" and a "1" to a "7".
Seven patients had their prescriptions changed - but only one was given an increased dosage before the alterations were discovered.
The police were already engaged in a massive investigation into the earlier poisonings before the prescription changes were made, six months later.
Mr Wright said it became "increasingly obvious" that the poisonings were confined to wards A1 and A3, that the poisoner must have access to such wards and to the treatment rooms, and the only people with "unfettered" access were members of staff.
Chua was also on duty when the prescriptions were altered and a partial print of his palm was found on one of the medical notes involved.
He had also "inexplicably" tried to persuade another patient to take medication not prescribed to her and worked on ward A3 just before the first incident when a patient fell ill from poisoning.
Chua, the jury heard, had the opportunity to contaminate the products with insulin, then leave it "ticking away" on a ward to be used "wholly innocently" by "unsuspecting" members of staff on patients who would then suffer hypoglycemic episodes, when blood sugar levels drop dangerously low.
The jury heard that the "preponderance" of such incidents seemed to follow Chua around when he worked on either A1 or A3.
And he had also deliberately falsified the medical notes of two patients under his care to conceal that they were suffering from hypoglycemic episodes.
In one such case, a male patient, his real condition was only discovered after he had suffered brain injury.
Chua, who is married with two children, was born in the Philippines and left school at the age of 17, before graduating with a nursing degree in Manila in 1989, where he worked in the 1990s.
In February 2002 he came to the UK on a temporary two-year work permit, working in nursing homes.
He became a registered nurse in 2003 and a naturalised UK citizen in 2008.
In 2009 he began working as a staff nurse at Stepping Hill.
There was, Mr Wright said, "a most alarming coincidence" of hypoglycaemia in patients and the defendant's shift patterns.
As concern mounted, staff on ward A3 then discovered a number of contaminated ampoules of saline that had been injected with insulin using a hypodermic needle and left as "ticking time bombs".
The court heard the amount of insulin needed to poison a patient was very small.
At the hospital an "understandable degree of panic" was setting in and the police were called.
Security was increased, including CCTV and staff told to work in pairs as the police investigation continued - so the poisoner changed tack, it was alleged.
On the night shift of January 2 to 3 2012 Chua tried to give tablets to one patient, Gillian Millar, but she refused.
This was an effort to "stupefy" her because she was awake during the night - the same night he changed prescription charts for seven patients - one who was given the wrong dosage before the alterations were noticed by the day-shift nurses.
Mr Wright told the jury: "Mr Chua had the means and the knowhow. He also had the opportunity. So, it may be said, had many others.
"We say, keeping an open mind, as indeed you must and no doubt will, when you draw all the strands of this case together, the conclusion you are driven to reach is that the person responsible for each of these matters is the defendant."
Chua, formerly of Churchill Street, Stockport, was arrested on January 5 2012 and denied any wrongdoing.
He has pleaded not guilty to all charges.
The trial was adjourned until tomorrow morning.