The trial of Frédéric Péchier, a French anesthesiologist accused of poisoning 30 patients, opened Monday, September 8, in the eastern city of Besançon, France.

Is Péchier a serial killer in a white coat, or has he for more than 8 years been the victim of a grave miscarriage of justice? That is the question before the Assize Court of Besançon, regional criminal court that tries the country’s most serious offenses, where three professional judges and six jurors will hear the case through mid-December. The 53-year-old physician is accused of poisoning 30 patients, 12 of them fatally.

Origins of the Case

The case began on January 11, 2017, when a 36-year-old woman underwent routine back surgery at Saint Vincent Clinic in Besançon. She went into cardiac arrest on the operating table but was resuscitated by Péchier with calcium gluconate. An analysis of fluid bags revealed that one contained potassium at 100 times the normal concentration. Investigators concluded the bag had been tampered with, and a criminal inquiry began.

Investigators soon discovered that Saint Vincent Clinic had an unusually high rate of serious adverse events (SAEs). Between 2008 and 2017, its SAE rate was twice the national norm. In total, police linked 30 suspicious cases to possible poisoning: 27 at Saint-Vincent and three at the nearby Franche-Comté Polyclinic. Victims ranged in age from 4 to 89; 12 died. In each case, magistrates said that the “common denominator” was Péchier.

Circumstantial Evidence

The prosecution acknowledges there is no direct physical evidence against Péchier, who had been regarded as a skilled and conscientious anesthesiologist. There are no confessions, eyewitnesses, or recordings — only a body of circumstantial evidence and what investigators call a “statistical doubt.” Péchier was frequently present during these events, often reviving patients at the critical moment. In some cases, he quickly identified both the cause of cardiac arrest and the treatment required, a speed that judges suggested reflected prior knowledge.

In only one of the 30 cases, Péchier was the designated anesthesiologist. The incident occurred on January 20, 2017, when a 70-year-old man suffered cardiac arrest just 4 days after the earlier case. Investigators allege Péchier deliberately provoked the event to divert suspicion. Prosecutors point out he told a colleague the patient had been poisoned with mepivacaine 15 days before laboratory confirmation.

Péchier’s Defense

Prosecutors argue Péchier’s motives were twofold. First, he allegedly wanted to showcase his skills as a resuscitator and appear a hero. “What came up a lot was this propensity to always be there [and] to boast about being the best,” noted the lawyer for one victim. But, the lawyer admitted, such a trait does not in itself make him a murderer. Second, Péchier allegedly targeted patients of colleagues with whom he had conflicts in order to discredit them. One anesthesiologist with whom he clashed reportedly saw seven SAEs among her patients between 2008 and 2014, three of them fatal, before she left Saint Vincent Clinic.

Péchier, however, has consistently denied the allegations, citing the lack of material evidence and describing himself as the target of a plot by colleagues. His defense team argues most of the adverse events stemmed from medical error rather than malicious acts. His attorney, Randall Schwerdorffer, has promised a detailed challenge to expert testimony during the proceedings.

Since the inquiry began, Péchier has been banned from practicing medicine and has twice attempted suicide, saying he wished to “die innocent.”

In a rare step for such a high-profile criminal case in France, Péchier is being tried while free. Speaking to RTL, a major French news radio station, he said, “It’s necessary to lay all the cards on the table.” While he acknowledged feeling anxious about the months ahead, he maintains he has “strong arguments” in his defense. He expressed understanding of the victims’ distress but insists he is not responsible.

The trial is expected to last more than 3 months, with a verdict due Friday, December 19. If convicted, Péchier will face life imprisonment.

This story was translated from JIM.