Doctors call for more postmortems after murders at German hospital

German forensic pathologists are demanding higher standards in the investigation of unexplained cases of death after a nurse was found to have committed at least 12 murders in a hospital in the small Bavarian town of Sonthofen before anyone suspected.

The 25 year old nurse, named only as Stefan L, has admitted that in the last one and a half years he had killed seven female and five male patients aged between 60 and 89 years. A further 70 deaths that occurred while he worked in the hospital are currently being investigated, as well as deaths at his former workplace, a hospital in Ludwigsburg, Baden-Württemberg.

He was not suspected until July 2004, when it was noticed that drugs that can cause respiratory arrest and complete muscle relaxation (midazolam, etomidate, and suxamethonium) were missing from the ward he worked on. Police found the drugs, which in combination can be lethal, in his flat and arrested him. He confessed to the murder of 10 patients, claiming that he wanted to relieve them of their suffering. The investigation showed that the nurse chose his victims after picking up doctors' information on their health status.

Professor Wolfgang Eisenmenger from Munich University, president of the German Society for Forensic Medicine, estimates that between 1200 and 2400 murders in Germany have not been registered because postmortem examinations are done in just 5% of cases of suspicious death. This is exacerbated by fears of additional costs among the police and prosecuting attorneys. His colleague Professor Klaus Püschel from Hamburg University supported his views and asked for more postmortem examinations by pathologists who are independent of the hospital where the patient has died.

Professor Karl-Heinz Beine, a psychiatrist from Hamm, near Dortmund, who has published papers on hospital staff who kill, says that most of them kill to try to diminish their own fears of suffering and death. Although unstable, they are mostly inconspicuous and are often valued as reliable but introverted colleagues, but their initial motivations of healing and helping have been overcome by aggressive fantasy and obsession. Suspicions are rarely raised, and the murders often pass unnoticed in a place where unexpected death is common.

The nurse has been charged with murder, but the trial has not started.