New Poisoning Charges for French Anaesthetist

Marine Cygler

June 12, 2019

Besançon, France – A French anaesthetist has been indicted over 24 suspected poisonings that led to nine deaths.

It is an extraordinary case with corroborating evidence but no firm proof.

Overwhelming Evidence, Lacking Proof

After being taken into custody in mid-May, the anaesthetist Frédéric Péchier was indicted for "poisoning vulnerable persons" "with premeditation". Described by the French press as a brilliant resuscitator and admired by his colleagues from the two clinics where he practised in Besançon, he is accused of poisoning 24 patients who had presented for low-risk surgical procedures, and who had one or more cardiac arrests on the operating table.

Nine of them could not be resuscitated. Released under judicial supervision, Dr Péchier, who is suspended from practise, denies being responsible for the alleged poisonings.

He faces a life sentence. However, even if all the evidence disclosed by the investigators is overwhelming, there is a lack of concrete proof.

The Besançon Court of Appeal is due to consider an appeal by the prosecution against a decision to release Dr Frédéric Péchier under judicial supervision.

Indictment

In February 2017, the Regional Health Agency (Agence Régionale de Santé, ARS) of Bourgogne Franche-Comté referred the case to court, alerted by the management of the Saint-Vincent clinic in Besançon where two patients had just been diagnosed with serious adverse events in the operating theatre in less than a week.

Accidents relating to anaesthesia are very rare in France: 1 death for 15,000 patients. The ARS investigation shows that both patients received lethal doses of potassium and anaesthetics, and highlights other cases of suspected heart attacks during surgical procedures.

From the beginning of March 2017, Dr Frédéric Péchier - a planning manager responsible for the 10 anaesthesiologists at the Saint-Vincent clinic (250 beds) - was indicted over seven premeditated poisonings between 2008 and 2017, including two deaths.

Parallel to the investigation launched for the first seven poisonings, a preliminary investigation was opened relating to dozens of other suspicious deaths. Conducted over 2 years, it has led to the new indictment of Dr Péchier. This time, he's suspected of 17 new cases of poisoning. He's now accused of a total of 24 poisonings, including nine fatal cases.

Routine Operations

What do the 24 victims have in common? Not much. Only that their surgical procedures should not have presented any particular difficulties. And that they were carried out either at the Saint-Vincent clinic or, for three patients, at the Franche-Comté polyclinic.

By reviewing the personnel of the two clinics as well as their schedules, the investigators came across Dr Péchier, the only common link in all these serious adverse events.

At a news conference, the public prosecutor Etienne Manteaux explained that even if the 47-year-old anaesthetist had never been caught in the act, there was an "array of corroborating evidence" against him.

He described the modus operandi in detail which consisted of "contaminating the bags of rehydration solution, or bags of paracetamol, with local anaesthetics or potassium". Given the potentially lethal doses found, the investigators rejected the hypothesis of a medical accident, they had no doubt that these were deliberate acts of crime.

Thrill of Resuscitation? Revenge?

What motivated the poisoner? Why would anyone deliberately provoke a cardiac arrest? At first, it was the "thrill of resuscitation" according to the favoured theory: to resuscitate a patient in cardiac arrest means being the saviour. This has been compared to the firefighters who commit arson then help put the blaze out.

However, the prosecution seems to be moving towards another direction - revenge. Apparently, these serious adverse events had occurred during a period of conflict between Dr Péchier and his colleagues. A psycho-criminological report was written by two psychology profiling experts who had never met Frédéric Péchier. Their report, which was handed over to the courts at the end of April before the second indictment, supports this hypothesis.

After gaining exclusive access to this report, L'Est Républicain said experts are clearly apportioning blame to Frédéric Péchier: "Many personality traits and life events legitimately contribute to the suspicion regarding his possible guilt." In the words of the report,  the regional newspaper describes Frederic Pechier as "the mystery poisoner" and "an informed criminal" whose modus operandi reveals "an emotional coldness", feeding on a desire for revenge against his colleagues. "Anaesthetists and their skills are perceived as a danger that needs to be eliminated ... and the patients are utilitarian victims."

Released Under Judicial Supervision

The fact remains that, at the end of his interrogation, the judge at the High Court of Besançon decided to release Dr Péchier under judicial supervision. This has now been the case for 2 years.

The prosecutor, who is seeking pre-trial detention, has appealed against that decision.

The former anaesthetist continues to maintain his innocence.

Translated from Medscape French Edition.

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