The COVID-19 Murders

A senior physician administers lethal injections to COVID-19 patients.

Posted Nov 22, 2020

Did the pain and suffering of two COVID-19 patients justify terminating their lives? It has been reported in the media this week that a senior physician at the Essen University Medical Center in Germany took it upon himself to end the lives of two patients suffering from COVID-19 on their intensive care unit (ICU) by administration of a lethal injection. He was promptly arrested and charged with their deaths. Did the families give their written permission for this to occur? Were the policies and procedures of the medical center regarding end of life for terminally ill patients followed or did this physician simply take it upon himself to play God?

Has the current pandemic and its large influx of very ill patients enabled healthcare providers to circumvent both the law as well as medical center policy and procedure to end life? Is this situation in Germany a one-time unique occurrence or is this more common today than ever before?

In my career as a criminal investigator, I have run into this situation before. 

A patient at a large medical center in New England had been placed on what is known as “comfort measures only (CMO).” This pertains to patients that have terminal illnesses and a “Do Not Resuscitate Order” (DNR) has been given. The comfort of the patient is the primary goal as he or she glides down the pathway to death. Assisting someone in this regard clearly does not mean accelerating the patient’s demise for any reason. Yet, a physician took it upon himself to do just that and brag about it to his staff. 

Dr. X was the Chief Surgical Resident at a New England Medical Center the evening of March 7, 1997. A terminally ill patient was treated in the ICU until March 9, 1997 when he was transferred to Dr. X’s unit.

On the following morning, Dr. X administered a dose of morphine in excess of 75mg after requesting a nurse to perform this act, which she refused. This was administered by flushing the contents of an intravenous storage bag through an infusion pump that was attached to the patient. The patient died immediately thereafter.

Dr. X actually acknowledged to members of his unit that morning that he had administered that dose of morphine to the patient, he knew the quantity was large, and that he wanted the patient to die. Dr. X had also stated that the patient had been CMO since Friday, that the family wanted the patient to die, and that he was to put the patient’s wife out of her misery. Dr. X further stated that the patient was going to die anyway, that he hastened it along, and he (Dr. X) took full responsibility, according to witnesses. To the credit of the management of this medical center, the prosecutor’s office was promptly notified and an investigation began.

It didn’t take long for the news media in both Rhode Island as well as Massachusetts to pick up on the story. By June 4, 1999, it was widely reported in the news media that the widow of the patient was suing the Medical Center and Dr. X for $20 million. If the family wanted the patient to die as claimed by Dr. X, they sure had a funny way of expressing their appreciation.

Investigators sent the morphine infusion pump to the manufacturer for testing. It was found to be functioning properly. Raw data collected from the pump event history log showed that the pump flow setting had been increased several times to allow the content of the intravenous bag to flow freely through the pump. This obviously reflects the actions of someone determined to kill.

The medical examiner for the state performed the autopsy. The report listed the cause of death as “acute morphine overdose”; the manner of death as homicide, and the circumstances of death as, “Administration of morphine in excess of 'comfort measures only' advanced directives.” This meant that the patient died not from his natural disease processes, but from the administration of an overdose of morphine.

A medical ethicist from Harvard University was asked to review the facts of this case and concurred that Dr. X’s actions were illegal and unethical. 

Armed with this evidence, I thought the prosecutor’s office would pursue the matter.  I was dead wrong. After all, I had witnesses who saw Dr. X administer the morphine, a nurse that declined to follow his order to do the same, and several individuals ready to testify that he admitted to what he had done. That coupled with the family stating that they never asked Dr. X to end the patient’s life.  

In spite of these facts, the chief prosecutor was of the opinion that the patient was near death, was about to expire anyway, and that it would be too difficult to prove a criminal charge against Dr. X especially a homicide charge (or any other charge we recommended). They rejected the medical examiner’s opinion as being based on a legal standard less than their own for prosecutive decisions. The prosecutor wrote to me in a letter that, “as you may be aware, the legal standard for the medical examiner’s finding is probable cause. The same standard applies to a grand jury’s determination that criminal charges ought to be filed. Our prosecutive decisions, however, are guided by a much higher standard.” 

The legal standard for the medical examiner’s findings is not probable cause. The standard is a reasonable degree of medical and scientific certainty. What the prosecutor was stating to me was that if not convinced she could unquestionably win a conviction; she would decline the case. In my opinion, her arguments were ill-conceived and quite frankly her decision to decline prosecution cowardly. I felt strongly that Dr. X did not simply ease a patient into a peaceful death but had decided to play God and end the life of the patient at his own time and choosing.   

What eventually happened to the lawsuit filed against the hospital by the family of the patient? The lawsuit against the medical center was settled for $750,000. When an individual works for the government as a physician, that individual is covered for all malpractice issues provided he was working within the scope of his employment. The government refused to certify that Dr. X was acting within the scope of his employment when he intentionally caused the patient’s death and Dr. X did not appeal the denial of certification. The family then for some unknown reason, dropped their suit against this physician. He is currently practicing medicine in the New England area.

This brings us to 2020 and the deaths of almost 1.5 million people worldwide from COVID-19.  With hospitals overwhelmed with large numbers of patients and their intensive care units filled to capacity, decisions regarding life and death are an everyday occurrence. The law as well as policy and procedures must be followed when addressing the issue of end of life care, whether we are in the middle of a pandemic or not. In my book, Behind The Murder Curtain, I address the topic of medical serial killers (MSKs). I’m often asked if the current crisis has enabled these killers to murder patients under the cover of a pandemic. I have not seen any evidence of this yet but quite frankly it is too early to say. It’s simply too early to say what the post mortem on the care and treatment of COVID-19 will be, but I have a strong feeling the German case will not be the only hospital situation to result in a criminal prosecution.