With insulin killings, the murder weapon often is hiding in plain sight

When a lifesaving drug — insulin — is used as a murder weapon, medical professionals are likely unprepared to consider that the difficult-to-detect medication was used to commit a crime, according to a forensic pathologist who worked on the recent case of a West Virginia pharmacist convicted of fatally dosing her husband.

When a lifesaving drug — insulin — is used as a murder weapon, medical professionals are likely unprepared to consider that the difficult-to-detect medication was used to commit a crime, according to a forensic pathologist who worked on the recent case of a West Virginia pharmacist convicted of fatally dosing her husband.

Dr. Paul Uribe, a former military medical examiner who consults as a pathologist across the United States and helped solve a string of insulin murders at a West Virginia veterans hospital, told NBC News that there appear to be few protocols showing pathologists and emergency room doctors how to best handle the cases.

“You’re not going to stumble across an insulin homicide,” Uribe said. “You have to have a suspect and you have to look for it, because if you’re not looking for it, you’re not going to find it.”

While such crimes are rare, Uribe said, some recent cases in the U.S. have had a staggering number of victims. In Pennsylvania, a nurse confessed to trying to kill 19 people with insulin at five facilities between 2020 and 2023. Seventeen of her patients died. At the West Virginia veterans hospital, a nurse admitted in 2021 to killing seven elderly patients with insulin.

Uribe said he knows of no protocols promoted by organizations for ER doctors or medical examiners and knows of only one state — West Virginia — where lawmakers have sought to reckon with this apparent lack of awareness. A bill introduced this year in the state Legislature seeks to require emergency rooms to test patients for insulin when they’re admitted with possible symptoms of insulin poisoning.