100 Murder Cases

German Serial Killer Leaves as Many Questions as Victims

OLDENBURG, Germany — The new nurse arrived at the intensive-care unit of Delmenhorst hospital with a solid letter of reference, describing him as someone who worked "independently and conscientiously." In a crisis, it said, he reacted "with consideration" and was "technically correct."

It gave no indication that officials at his former hospital in Oldenburg, Germany, had grown deeply suspicious about the number of deaths while the nurse, Niels Högel, was on duty. Or that they had barred him from contact with patients and effectively pushed him out.

Before long, similar suspicions arose at Delmenhorst. Within four months, a patient, Brigitte A., died under his care. Others, Hans S., Christoph K. and Josef Z., followed. All were identified with only a last initial under German privacy laws.

Today, Mr. Högel, 42, is considered the most prolific serial killer in the history of peacetime Germany, and perhaps in the world. Officials suspect that as many as 300 patients may have died by his hand over five years starting in 2000.

Still, it took more than a decade for a full investigation by the authorities, who exhumed over 130 bodies in Germany, Poland and Turkey as they struggled to define the scope of his crimes. Mr. Högel has admitted to killing 43 people, has not ruled out killing 52 others and denied killing five.

The number of killings and the amount of time it took for suspicions surrounding his actions to come to light have raised uncomfortable questions for Germany, including whether the same deference to hierarchy and predilection for procedure that once facilitated Nazi-era crimes allowed Mr. Högel to kill uninterrupted for so long.

"If it is possible that in Germany more than 300 deaths over 15 years can be swept under the carpet, what else is possible?" said Christian Marbach, whose grandfather was a victim of Mr. Högel. "What does it take for people in Germany to stand up and pay attention?"

Mr. Marbach now speaks at nursing schools about the moral questions raised by Mr. Högel's case.

According to Frank Lauxtermann, the only former colleague who testified openly about working alongside Mr. Högel, "A culture of looking away and keeping your head down" ultimately shielded the suspect.

Mr. Högel is serving a life sentence for murdering two patients and playing a role in the killing of four others. The current trial is his third since 2006.

This time, he faces charges of killing 100 more patients — 36 at the main clinic in Oldenburg, a tidy city that prides itself on its university and 17th-century palace, and 64 others after he transferred to Delmenhorst, a suburb of Bremen, about 20 miles away.

The presiding judge, Sebastian Bührmann, has ordered eight of Mr. Högel's former colleagues to be investigated on perjury because of suspicion that they lied to the court or withheld evidence in the current trial to cover up lapses.

Revelations of apparent negligence by the hospital authorities have already led to other criminal investigations. Two doctors and two head nurses from the Delmenhorst hospital were charged with manslaughter. Mr. Högel is expected to testify at their trial after the court reaches a verdict in his case, expected in June.

Former colleagues from Mr. Högel's early days as a nurse said he had quickly made a name for himself as someone who could handle the pressure of life-or-death situations.

In reality, prosecutors say, he created situations in which life and death rested in his own hands.

He administered overdoses of drugs that caused cardiac arrest so that he could rush back and try to revive patients heroically. His colleagues called him "Resuscitation Rambo" and rewarded his skill with a necklace made of injection tubes, which he wore with pride.