Andrzej N. worked as a paramedic for the emergency ambulance service in Łódź, Poland's third largest city. In January 2007 the Łódź Regional Court convicted him of murdering four patients by injecting them with Pavulon, a muscle relaxant, while they were being carried to hospital, and of helping a fellow paramedic murder a fifth. He was sentenced to life imprisonment. The verdict was upheld on appeal in June 2008 and became final in October 2009, when the Supreme Court dismissed the last defense appeals.
The killings came to light through a wider scandal. In January 2002 the daily Gazeta Wyborcza and Radio Łódź reported that staff of the Łódź ambulance service were selling information about patients' deaths to funeral firms, and that some patients might have been killed deliberately. The press named the affair after the slang the staff were said to use for a dead body, and it became known across Poland as the case of the "łowcy skór," the skin hunters.
According to the January 2002 reports, as later summarized by the Polish Press Agency and TVN24, information about deaths was being bought and sold inside the Łódź ambulance service, and there were signs that some patients had been given a muscle relaxant that in certain cases caused their deaths. When the case reached court, the judges found that the trade in information about deaths at the service had been going on since the 1990s.
The court described a commercial arrangement. Funeral homes paid ambulance staff for early word of a death, so that their representatives could reach a bereaved family first. Andrzej N. and the other defendants were convicted of taking money from funeral homes for such information. According to the Polish Press Agency's account of the verdict, the court found that the two paramedics had accepted 30,000 and 10,000 zloty from funeral homes, and the two doctors 16,000 and 13,000 zloty. All four were also convicted of forging prescriptions for Pavulon and of fraud against the families of dead patients, and the paramedics were found guilty of extorting money from those families.
Pavulon is a muscle relaxant used in hospitals. The appeal court later said that the defendants knew how it worked.
Only one of the victims is known in any detail. Wiesław S. was 72. He suffered from severe depression, and in January 2001 his condition grew worse. A doctor recommended that he be observed in a psychiatric hospital, and his family called an ambulance.
He rode in the back of the ambulance, in the medical compartment, with Andrzej N. sitting beside him. The ambulance doctor sat up front in the driver's cab, having judged that the patient was stable enough not to need a doctor at his side. As the ambulance neared the hospital, the paramedic reported that the patient had lost consciousness. The doctor began resuscitation, which went on at a Łódź hospital. After nearly an hour his circulation returned, but he had suffered severe brain damage, and he was moved to intensive care. He died at the end of February 2001. His death was put down to a stroke.
About two and a half years later, TVN24 reported, Andrzej N. told prosecutors that he had injected Wiesław S. with Pavulon during the journey. The murder of Wiesław S. was one of the four for which he was later sentenced to life.
Wiesław S. had drawn a pension and also earned money as a tailor, and he had been his family's main earner, a civil court later heard.
Andrzej N. was tried in the Łódź Regional Court with three other former employees of the ambulance service: a second paramedic, Karol B., and two doctors, Janusz K. and Paweł W. The two paramedics were charged with murdering five patients and faced life imprisonment. The doctors were charged with exposing 14 patients to a direct danger of losing their lives and with causing their deaths through negligence.
The trial lasted almost two years. Much of the evidence came from people who had worked with or near the defendants. In December 2005 a man who had shared a cell with the two paramedics for several months told the court that they had competed over which of them killed patients more effectively. He said Andrzej N. had talked to him about doctors involved in the scheme and their nicknames. Both paramedics denied having discussed any of this with him. RMF FM reported that another fellow inmate had given a similar account several weeks earlier.
In February 2006 a note that Andrzej N. had written in custody was presented in court. The prison service had intercepted it. According to RMF FM, he used the note to coach a fellow inmate who was to testify on his behalf, telling him not to let himself be tripped up because, as he put it, the prosecutor and the judge were sly operators. The doctors, unlike the paramedics, were not held in custody during the trial.
In January 2007 the court reopened the proceedings briefly after the defense lawyers had finished their closing speeches, to settle whether the charges against the doctors should be reclassified as negligent acts. Under Polish law such offenses are prosecuted only at the request of the injured parties or their families, and some of the families confirmed in court that they wanted the prosecution to go ahead.
In January 2007 the court convicted Andrzej N. of murdering four patients, whom it found he had injected with Pavulon during ambulance transport, and of aiding in the murder of a fifth. He was sentenced to life imprisonment. Karol B. was convicted of murdering one patient and aiding in four other murders, and was sentenced to 25 years. Janusz K., a 51-year-old doctor, received six years for endangering the lives of ten patients, and Paweł W., a 35-year-old doctor, received five years for directly endangering the lives of four. All four defendants were barred from their professions for ten years.
The charge of taking money for information about deaths was reclassified by the court as breach of professional confidentiality and fraud, and on those counts the defendants received two to three years.
The court considered it established that Pavulon had been given to patients of the ambulance service by paramedics. Its main evidence was the statements of Andrzej N., in which he described how he had given the drug. In its written reasoning the court said that in the ambulance the hope of patients and the trust of families had met ruthless and cynical "agentami ciemności," agents of the dark. The court also said that one of the doctors had shown so serious a lack of basic medical knowledge that it had probably caused the deaths of many people, and that neither doctor should have become a doctor, or should have left the profession after some time.
The court relied on a single expert opinion on the medical questions, from the anesthesiologist Professor Wojciech Gaszyński.
All four defendants appealed. The prosecutor did not. At the hearing before the Łódź Court of Appeal, which ended on June 2, 2008, the defense lawyers asked for acquittals or for a retrial.
Andrzej N.'s lawyer argued that the trial court had been wrong to treat only his client's first statements as true, and that he could not be convicted of murder on his own statements alone. If the court did rely on those statements, the lawyer said, his client deserved an extraordinary reduction of sentence, because he was the one who had described the trade in information and the deaths of patients. Karol B.'s lawyer argued that the case rested on circumstantial evidence, that the chain of that evidence was not closed, and that his client had never admitted killing anyone. He said the expert evidence did not clearly show that patients had been killed. The doctors' lawyers argued that the patients had been in a life-threatening condition and that most of them were elderly. One said his client had been convicted of acts not in the indictment and had been the target of a media campaign. The lawyers acting for the victims' families as subsidiary prosecutors asked the court to reject all the appeals.
On June 9, 2008 the Court of Appeal upheld the sentences. Judge Marian Baliński said the expert opinions were not the only evidence of guilt: the court also had the defendants' statements before trial, the testimony of witnesses and a large body of documents. The findings of the first court, the appeal court said, showed something "unimaginable for a being that calls itself homo sapiens." The judges considered the paramedics' sentences fair, though severe. They thought the doctors' sentences rather lenient, but they could not increase them because only the defense had appealed.
The defense lawyers for the two former paramedics and one of the doctors filed cassation appeals with the Supreme Court. They asked for the verdicts to be overturned and the case sent back to Łódź, arguing that the appeal judgments were incomplete and unclear and that the judges in Łódź had made serious errors. On October 27, 2009 the Supreme Court dismissed the appeals. RMF FM reported that Andrzej N. would serve his life sentence, that Karol B. had 25 years to serve and that Janusz K., who had intentionally exposed ten patients to death, had six years. No further appeal was possible.
The family of Wiesław S. also went to the civil courts. His widow sued the regional ambulance station, the service that had carried her husband, for 100,000 zloty. In December 2006 a district court ruled that the station was not liable for the injection itself but was liable for a poor resuscitation. An expert listed several errors by the ambulance doctor: using air instead of oxygen, failing to give the proper drugs, and riding beside the driver rather than beside the patient. The court set compensation at 38,000 zloty, taking into account that the widow had a small pension and that her husband had been the family's main earner.
Both sides and the station's insurer, PZU, appealed. In November 2007 the appeal court raised the award to 50,000 zloty, to be paid by the station and its insurer. Judge Małgorzata Dzięciołowska said the station's disorganization had given the paramedic unrestricted access to Pavulon, because there were no rules governing how the drug was handled, and that the resuscitation had lacked due care. A doctor sitting beside the patient, she said, might have prevented the injection or started resuscitation sooner. The court raised the award after a psychologist's report showed that the widow had developed severe depression after her husband's death and had needed help with daily life for months. "Although six years have passed, she still has not returned to normal," the judge said. TVN24 reported that several similar claims were pending.
Gazeta Wyborcza reported in June 2010, in an account relayed by the legal portal e-prawnik.pl, that Andrzej N. was serving his life sentence and had sued over the judge's phrase "agentami ciemności," which he considered a public insult to his personal dignity. He first sought 80,000 zloty and reduced the claim to 3,000 zloty at the hearing. The Łódź Regional Court dismissed the suit, holding that the judge had been entitled to use the term because the crime of which he was convicted was exceptionally reprehensible.
The number of victims proved in court is five, four of them murders by Andrzej N. and one in which he was found to have aided Karol B. Some reports summarize the outcome less precisely: TVN24, in June 2008, described his life sentence as being for killing five patients. The convictions, as reported by RMF FM, the Polish Press Agency and Gazeta Wyborcza, were for four murders and aiding a fifth.
The doctors were not convicted of murder. They were found to have endangered the lives of 14 patients who died, ten in one doctor's case and four in the other's.
A fellow inmate's courtroom account of competition between the paramedics, and his claims about the doctors' nicknames, were denied by both paramedics. They stand as testimony, not as findings of the court.
1990s: the court later found that the trade in information about deaths at the Łódź ambulance service dated from this decade.
January 2001: Wiesław S., 72, collapses during an ambulance transport with Andrzej N. beside him.
End of February 2001: Wiesław S. dies in hospital; the death is attributed to a stroke.
January 2002: Gazeta Wyborcza and Radio Łódź report on the sale of information about deaths by ambulance staff and on suspicions that patients were killed.
About two and a half years after the death of Wiesław S.: Andrzej N. tells prosecutors that he injected him with Pavulon.
December 1, 2005: a former cellmate testifies at the trial in the Łódź Regional Court.
February 6, 2006: an intercepted note from Andrzej N. to a fellow inmate is presented in court.
December 2006: a district court awards the widow of Wiesław S. 38,000 zloty from the ambulance station.
January 2007: the Łódź Regional Court convicts Andrzej N. of four murders and aiding a fifth and sentences him to life; Karol B. receives 25 years, the doctors six and five years.
November 2007: the appeal court raises the widow's award to 50,000 zloty.
June 2, 2008: the appeal hearing ends in the Łódź Court of Appeal.
June 9, 2008: the Court of Appeal upholds the verdicts.
October 27, 2009: the Supreme Court dismisses the cassation appeals; the verdicts are final.
June 2010: the Łódź Regional Court dismisses his suit over the phrase "agentami ciemności."