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The suspected serial poisoning at a hospital in Yokohama, in which two elderly patients died over just a few days in late September after they received intravenous drips allegedly laced with disinfectant, highlights the need to beef up security at medical and welfare facilities — which, according to people familiar with the situation, are generally vulnerable to deliberate acts to harm people, including patients.

Security systems in hospitals and care facilities are often said to be based on a positive view of human nature — that people, including staff and visitors, are not out to commit malicious acts against others. Hospital safety measures focus instead on prevention of medical accidents and errors. But in reality, many incidents have taken place where vulnerable patients have been exposed to harm — and in some cases lost their lives — in these supposedly safe places. There may be limits to how much security can be brought to bear at these institutions, including staffing levels. But that can’t be an excuse for not doing what can be done.

Many of the inpatients at Oguchi Hospital in Yokohama are reportedly in the terminal stage of their illnesses, with most either bedridden or having trouble walking on their own. The two male victims — both 88 years old — were among such patients, treated in the same eight-bed room on the institution’s fourth floor. One of them died in the early morning of Sept. 20, just hours after he was administered an IV drip. A chemical contained in a disinfectant stored at the nurses station on the floor — which is used to disinfect surgical instruments — was found in his body as well as in his IV drip bag. A subsequent autopsy of the other victim, whose death three days earlier was initially diagnosed as due to his illness, found the same chemical component in his body. It is suspected that somebody injected the chemical by piercing small holes in the rubber plug that connects the IV bag and tube.

A subsequent probe exposed alarmingly lax security at the hospital, which stations nurses on each floor at night and in principle bans the entry of outsiders after 9 p.m. But there were no surveillance cameras in the wards, and only one dummy camera installed near the guard room on the first floor. IV drip bags are stored in a locked room and hospital staff carried the bags to each floor for the day’s use. But the bags were kept in cardboard boxes and placed on nurses’ desks, leaving them accessible to anybody when nobody was watching.

For the holiday weekend that started Sept. 17, however, all three days’ worth of drip bags for all inpatients were distributed to the nurses stations on each floor on the first day. An examination of about 50 unused IV drip bags after the death of the second victim showed that similar small holes had been made to the seals that covered the rubber plugs on about 10 of them — suggesting an attempt to indiscriminately poison patients.

Even prior to the two deaths, the hospital had experienced a series of troubling incidents since April — including a case in which a nurse’s apron was found slashed, as well as a staff member suffering blistered lips after drinking a beverage apparently laced with bleach — but never reported them to the police. The Yokohama Municipal Government was informed of such incidents in an email, and during an inspection in early September city officials urged the hospital management to consult the police. But the hospital reportedly did not talk to the police, thinking that it should resolve the problems on its own.

A variety of people have cause to enter hospitals, including the families of inpatients. Security can be tightened against outsiders, but perhaps only up to a certain limit depending on how much each institution can invest in staffing and systems. The risk of wrongdoing may rise if it involves people who are familiar with a hospital’s inner practices.

Regrettably, there have been criminal cases in which staff at medical and care facilities have harmed their patients or care recipients. In 2000, an assistant nurse at a clinic in Sendai was charged with murdering one patient and injuring four others by mixing a muscle relaxant in their IV drips. The man pleaded not guilty but was ultimately sentenced in 2008 to life in prison for committing the crime out of a sense of frustration with the head of the clinic.

A former care worker at a nursing care facility in Kawasaki who is under indictment for allegedly killing three elderly residents by throwing them off their room verandas in 2014 has been quoted as telling investigators that the victims gave him too much trouble. The alleged perpetrator of the massacre of 19 people at a care home for people with disabilities in Sagamihara, Kanagawa Prefecture, in July was a former care worker at the facility who was reportedly driven by a distorted view that severely disabled people should be subjected to mercy killing.

It’s not yet clear what was behind the events at the Yokohama hospital, but the suspected murders strongly suggest there is a need to tighten security at medical and care facilities — based on the regrettable understanding that acts of malicious intent are always possible.

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