French anaesthetist accused of fatally poisoning patients

The prosecutor in the eastern French city of Besançon on Friday appealed against a judge’s decision to free Frédéric Péchier, a 47-year-old anaesthetist who is accused of deliberately poisoning at least 24 patients, nine of whom died, between 2008 and 2017.

Dr Péchier wept in the arms of his daughter and mother when he was granted conditional liberty at 3am on Friday, after two days in custody. He will stay at his parents' home in the west of France, is required to check in with gendarmes and is barred from practising medicine or contacting former colleagues.

On Thursday, the anaesthetist was formally placed under investigation for 17 acts of poisoning that led to seven deaths. He was initially placed under investigation in 2017, for seven other cases that resulted in two deaths.

The two dozen victims were hospitalised for routine surgery and ranged in age from four to 80. "Dr Péchier is the common denominator," Etienne Manteaux, the Besançon prosecutor, told a press conference on Thursday.

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Péchier worked at Saint-Vincent, a 250-bed private clinic in Besançon that employs 80 doctors and carries out 20,000 operations each year. The anaesthetist drew up work schedules for 10 colleagues.

Cardiac arrests

Péchier first came under suspicion in January 2017 when Sandra Simard, a healthy 37 year old, suffered repeated cardiac arrests during back surgery. "As usual when there was a problem, Frédéric Péchier showed up to help his fellow anaesthetist, and immediately declared she was suffering from hyperkalemia," Frédéric Berna, Ms Simard's lawyer, told Le Parisien newspaper.

Hyperkalemia is a higher-than-normal level of potassium, which agitates the heart and can stop it. Péchier is accused of injecting potassium or the local anaesthesia lidocaine into intravenous pouches.

Simard was transferred to the local university hospital, where a doctor who was surprised by Péchier’s accurate diagnosis told the clinic to seize the IV pouches. They were found to contain 100 times the lethal doze of potassium. Saint-Vincent notified local authorities.

Over two years, a deputy prosecutor investigated 66 other cases of “grave undesirable events”. She interviewed all survivors, and all medical personnel who had been in contact with them.

Last December, the remains of four patients who died of unexplained heart attacks during surgery were disinterred for postmortem examinations. Two showed high levels of local anaesthesia, which was not supposed to have been used in their operations.

The 17 additional poisonings attributed to Péchier on Thursday were the result of the investigation.

The parents of Teddy, who nearly died during a tonsillectomy in 2016 when he was four, filed a lawsuit against Péchier this week. The anaesthetist’s alleged youngest victim “had two inexplicable heart attacks before he was reanimated by Dr Péchier, who was called in and who arrived in less than a minute”, said Jean-Michel Vernier, the family’s lawyer.

Contaminated pouches

Contaminated intravenous fluids “flowed drop by drop and provoked cardiac arrest”, Manteaux, the prosecutor, told the press conference. “This method was particularly clever, because in the event of cardiac arrest one looks for organic causes, or perhaps human error, but no one at Saint-Vincent imagined the pouches had been contaminated.” For that reason, the pouches were not kept.

Investigators long compared Péchier to the proverbial pyromaniac fireman. They believed he poisoned patients so that he could then bring them back to life, God-like.

Manteaux suggested a different possible motivation when he spoke of “intense conflict” between Péchier and certain colleagues. According to this theory, the anaesthetist hoped the competence of his enemies in the anaesthesiology department would be questioned. Manteaux emphasised that victims were always the patients of other doctors, never Péchier’s.

“Why would I do such a thing?” Péchier asked in an interview with L’Est Républicain newspaper in 2017. “I would amuse myself injecting toxic substances so I could reanimate people? That’s completely mad.”

In detention this week, Péchier reportedly claimed that a colleague whose name he did not divulge poisoned the patients. "Someone poisoned them, but it wasn't him," his lawyer, Randall Schwerdorffer said.

If Manteaux’s accusations are confirmed in court, Frédéric Douchez, the lawyer for Saint-Vincent told Le Monde, Péchier’s acts would amount to “medical terrorism”.

Péchier is likely to receive a life sentence if convicted of the poisonings and resulting fatalities.