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Justice systems are sometimes called upon to evaluate cases in whichhealth-care professionals are suspected of killing their patients illegally.These cases are difficult to evaluate because they involve at least two levelsof uncertainty. Commonly in a murder case it is clear that a homicide hasoccurred, and investigators must resolve uncertainty about who is responsible.In the cases we examine here there is also uncertainty about whether homicidehas occurred. Investigators need to consider whether the deaths that promptedthe investigation could plausibly have occurred for reasons other thanhomicide, in addition to considering whether, if homicide was indeed the cause,the person under suspicion is responsible. In this report, prepared under theauspices of the Royal Statistical Society, we provide advice and guidance onthe investigation and evaluation of such cases. Our work was prompted byconcerns about the statistical challenges such cases pose for the legal system.

Healthcare serial killer or coincidence? Statistical issues in investigation of suspected medical misconduct