Niels Högel, a former nurse in Germany, has confessed to killing 43 patients at two hospitals in Germany, but authorities suspect he killed up to 300 patients between 2000 and 2005—but it took five years for him to get caught, Melissa Eddy writes for the New York Times.

About Högel

Högel grew up in Wilhelmshaven, Germany, and decided to become a nurse, like his father.

Högel began his career at a hospital in Oldenburg and eventually transferred to another in Delmenhorst, about an hour's drive away.

During his time as a nurse, Högel made a name for himself as someone who could handle intense, life-or-death situations. His colleagues called him "Resuscitation Rambo," for his ability to swoop in and save the day.

A troubling pattern

But at some point, Eddy writes, Högel's colleagues began to notice that, when he was on duty, it was more common for patients to suddenly need to be resuscitated. Högel's colleagues said people often die in intensive-care wards, but not so many and so quickly.

A former colleague at Delmenhorst identified only as Susanna K., testified in court, "In the beginning, you just think it is fate. But at some point you grow distrustful."

Prosecutors said Högel was creating these life or death situations by administering overdoses of drugs. The drugs would cause a cardiac arrest, allowing Högel's to rush in and try to revive the patients he'd overdosed.

Prosecutors believe Högel's actions potentially led to hundreds of deaths, Eddy reports. According to records from the Delmenhorst hospital, of the 411 deaths that occurred during Högel's time at Delmenhorst, 321 occurred during or just after his shifts. Authorities still aren't sure exactly how many patients he killed.

Högel is currently serving a life sentence for murdering two patients and for playing a role in the death of four others. He's confessed to killing 43 people, has not ruled out killing 52 others, and has denied killing five. Högel faces charges for the deaths of another 100 patients at both the Oldenburg and Delmenhorst hospitals.

Catching a killer

According to Susanna, before Högel's crimes were confirmed, some of his colleagues at Oldenburg had talked about his suspicious record. However, Susanna explained that colleagues were circumspect about saying anything to their superiors, either out of fear of being reprimanded or because they didn't believe it was their business. In at least one case, a nurse in Delmenhorst had expressed her concerns about Högel to her superior, but no action was taken and no one followed up with her, Eddy writes.

In June 2005, five years after Högel started killing patients in 2000, someone caught onto him and collected evidence to prove Högel's actions.

That person was a fellow nurse at Delmenhorst identified as Renate T. In June 2005, she found Högel standing over a lung cancer patient named Dieter Maass. Maass' life support system had been turned off, and in the trash can were four empty vials of a medication not prescribed to him, Eddy writes. Renate immediately took a blood sample from Maass and sent it off for tests. The next day, Maass died.

Renate's test results showed Maass had received a dangerously high dosage of a heart medication, which led to a discussion between the doctor and nurse in charge. However, while this was going on, Högel was allowed to finish his shift, and in that time, "Renate Röper, 67, became his final victim," Eddy writes.

Arne Schmidt, who is currently the police chief in Cuxhaven and led a special investigation into Högel from 2014 to 2017, said, "The course of events that took place on June 24 are symbolic of the failure of those responsible for their completely erroneous assessment of actual facts and the tragic results that ensued for the patients."

Karl-Heinz Beine, a neurologist and head doctor of psychiatry at St. Marien Hospital, said Högel appeared to be driven by narcissism and the need to fill a lack of self-worth.

At his latest trial, Högel said he felt "shame" when reading over the medical records of the dead patients. "Every single case, even just reading them. I am endlessly sorry," he said.

The important role hospital culture plays in protecting patients

Some have speculated how the institutional culture in the places where Högel worked may have contributed to his ability to continue for so long. Only one of Högel's former colleagues testified openly about working with him.

That colleague, Frank Lauxtermann, testified that "[a] culture of looking away and keeping your head down" ultimately allowed Högel to continue killing patients.

Beine said that he hopes the current trial will raise awareness about the need to report suspicious activity and break through hierarchical structures within hospitals and other institutions in Germany. "As a health care worker, you have to know that your responsibility is for your patients, not the hospital's image," he said (Eddy, New York Times, 5/10).