Irene B. was a nurse on the cardiac intensive care unit of the Charite, the large university hospital in Berlin. On June 29, 2007, the Landgericht Berlin sentenced her to life imprisonment for the murder of five patients who died there between June 2005 and October 2006. She had worked in nursing for more than 30 years, and doctors who testified described her as a capable nurse who took special care of the sickest patients. The court found that none of the five had asked her to end their lives, and that she had acted on her own view of which lives were no longer worth living.
The case also became a case about the hospital. A suspicion raised by one of her colleagues in August 2006 passed slowly through the ward, and three of the five deaths in the judgment came after it. The presiding judge criticized the Charite in open court, and the hospital appointed an outside commission to find out how the killings could go undetected for so long.
Little is on record about her life before the hospital. Her date of birth is not on record; her age at the time of the trial is given as 54 or 55. The newspaper taz, in a portrait written on the day of the closing arguments, described her as a lonely, withdrawn child who had a cold relationship with her mother and a strong attachment to her father, a man who returned from the war and taught her that strength counted above all.
Her professional life was spent on intensive care units. According to taz, she worked on the intensive care unit of a Jewish hospital in Berlin from 1975 to 1994, and colleagues there pushed her out of a leadership role. She then joined the cardiac intensive care unit of the Charite. The Bundesgerichtshof records that she worked as a nurse for more than 30 years, from 1994 in a cardiac intensive care unit at a Berlin university hospital; the medical journal Deutsches Ärzteblatt dates her start at the Charite to 1995.
Colleagues described her as an outsider on the ward. Deutsches Ärzteblatt reported that she was not well liked but was respected for her experience, and that doctors regarded her as skilled, while nurses and male nurses gave a more mixed picture. A senior physician who testified said she had never given him cause for complaint and that she was an outsider in the team because of her interests and quirks. At work, taz reported, she looked down on subordinates, and colleagues found her imperious. After the end of her marriage, the paper wrote, colleagues saw her as eccentric and unbalanced, and she rejected suggestions that she cut back her workload.
Witnesses at the trial described another side of her work. Deutsches Ärzteblatt reported testimony about rough physical treatment of patients, and that during the last two years she had become verbally aggressive. A younger colleague who saw one such incident reported it to the head nurse of the ward. The matter ended there, and nobody spoke to Irene B. about it.
The commission that the Charite later appointed reached the same finding in its report of July 10, 2007. It said she had shown physical roughness and verbal outbursts toward patients and relatives before the crimes came to light, that these incidents were passed up the chain of command and sometimes recorded, and that she was never confronted or disciplined.
The Bundesgerichtshof, in its order of April 3, 2008, dates the first of the five convicted cases to June 28, 2005; the others followed in 2005 and 2006. The patients were seriously ill or dying. Deutsches Ärzteblatt, reporting on the verdict, said the victims were four men and one woman, that they were unconscious or in a coma, and that the court found they did not visibly suffer. The court rejected any link to assisted dying. In the words of the presiding judge, Peter Faust, as the journal quoted him: "This case has absolutely nothing to do with assisted dying." Neither the patients nor their relatives had asked her for it.
One of the five was a 48-year-old woman. According to the court, as reported by the Irish Examiner and Deutsches Ärzteblatt, the woman had wanted to die at home, and the transport home had already been arranged when Irene B. ended her life.
Prosecutors had charged a larger number of deaths. The indictment named six patients, aged 48 to 77, who died on the unit between June 2005 and October 2006, and two further patients who were the subject of attempts. The Irish Examiner reported that investigators had looked at 15 deaths among patients in her care. The case against her rested on eight patients, and the court acquitted her on part of it.
In mid-August 2006, Deutsches Ärzteblatt reported, a male nurse on the unit became suspicious after seeing Irene B. at the bed of a 77-year-old patient for whom no further treatment was planned; the patient died minutes afterward. He did not go to a supervisor. He later said that suspecting a colleague of murder, in a profession devoted to saving lives, had seemed absurd to him.
Tagesspiegel reported that the nurse first confided only in a friendly colleague, who in late September 2006 told a senior physician. The nurse himself reported his suspicion to the doctor on the unit in early October 2006, after a vacation. In the meantime, three more patients in her care died. The senior physician, testifying at the trial, said he had considered the suspicion unfounded, because the colleague had not been an eyewitness, and that he saw no connection between Irene B.'s presence and the patient's decline. Looking back, he said, the matter had been treated as a rumor.
The commission described the sequence in its own words. The suspicion was discussed for a long time only in a small circle of colleagues; it was not raised with Irene B., with nursing or medical management, and no criminal complaint was filed. After several weeks, ward management was informed, and several more days passed before a response, which was indirect, through the chief physician. Deutsches Ärzteblatt reported that the clinic chief was not informed for another seven days, and that Irene B. was arrested on the same day he was told. The commission put the arrest in early October 2006. taz counted about six weeks between the first suspicion and her arrest.
She was arrested in October 2006 after the hospital alerted the prosecutors. According to the commission, she first confessed to two killings after her arrest and later to four. Deutsches Ärzteblatt reported that shortly after her arrest she said she would do it again, and that she described what she had done as a gentle way of restoring the patients' dignity.
The trial before the 22nd Grand Criminal Chamber of the Landgericht Berlin opened on April 18, 2007, with Peter Faust presiding. Irene B. was charged with six murders and two attempted murders. At the start, through her lawyer, she confessed to four of the killings and disputed the others. The statement read for her said that she regretted her actions and that she would have to answer for them. Her lawyer also stated that she had acted in accordance with the patients' wishes and for their benefit.
The court heard nine days of testimony from colleagues, supervisors and experts, taz wrote. As the trial went on, the defense described the acts as killing on request, an offense for which German law sets a maximum sentence of five years. taz reported that this claim was not borne out. Prosecutors asked for life imprisonment for murder.
A forensic psychiatrist, Alexander Böhle, described a narcissistic personality, taz reported. Deutsches Ärzteblatt added that the expert found her fully responsible for her actions and said she saw herself as a participant in a divine will. In her closing statement she called what she had done an absurd error; the journal described her as showing no deep remorse and appearing cold and distant in court.
On June 29, 2007, the Landgericht Berlin found her guilty of murder in five cases and sentenced her to life imprisonment. The Bundesgerichtshof's later order records that the court did not find a particular gravity of guilt, the finding that would have made an early release more difficult. It records that she was acquitted of further murder charges on factual grounds. The Irish Examiner reported at the time that she was acquitted in three of the cases brought against her, while the Bundesgerichtshof's order refers to five further murder charges; the two counts differ.
The Bundesgerichtshof's summary of the findings adds that none of the five patients had wished for help to die, that the court held her interventions had shortened each life, and that in one contested case the conviction rested on circumstantial evidence, which the Bundesgerichtshof found legally sound. In the case of the patient identified as S., she had not admitted the act, unlike the other cases.
The presiding judge said, as quoted by Deutsches Ärzteblatt, that the court did not know exactly why she had killed. He rejected the idea that some lives deserve less protection than others and said that there is no life that is "more or less worthy of protection". The court concluded that she acted when she believed the patients had to die at that moment, without pity and without being overwhelmed. The Irish Examiner reported that the court rejected the manslaughter argument. The writer Ulrike Baureithel, in a commentary in the weekly Der Freitag, noted that the court had found she acted without any commission from the patients and had set herself up as a ruler over life and death, and observed that the trial had not clarified her motives.
Judge Faust's oral reasons also addressed the Charite. Deutsches Ärzteblatt reported that he sharply criticized an administration that tolerates observed misconduct without consequences, saying it shared responsibility and might be criminally liable, and that those involved were unsuited to their roles. He also criticized colleagues who suspected murder and stayed silent, and said that fear of labor-law consequences or of a false accusation had no place when lives were at stake. The Irish Examiner reported his criticism of a lack of supervision and communication at the hospital, and the hospital's reply that it had already taken action.
taz reported that the hospital's former ward manager had been suspended for doing little after hearing, months earlier, of Irene B.'s aggressive behavior toward patients, and that three nurses were suspended for not passing on a suspicion they thought too vague.
At the start of the trial the Charite appointed a commission on patient safety. Its four members were Klaus Bepler, a presiding judge at the Federal Labour Court; Ricarda Klein, nursing director at the Hamburg-Eppendorf university hospital; Jens Reich, an emeritus professor of medicine in Berlin; and Peter M. Suter, an emeritus professor of intensive care in Geneva. The hospital board convened it on April 25, 2007, and it reported on July 10, 2007. It did not rule on the crimes themselves; it examined organizational, communication and structural failures.
Its findings were direct. Staff showed strong deference to authority, especially in conflicts, and passed responsibility upward instead of acting on it. Cooperation between nurses and doctors at the bedside worked, but communication at the leadership level did not. Round-the-clock medical cover was unstable: outside doctors were sometimes added at night and gave uncoordinated orders, and at times the only doctor on duty left the ward. Training in ethics and team discussion of end-of-life questions were insufficient, and patients' rooms were hard to see into, with curtains and doors often closed. The ward also handled both heart disease and multiple organ failure, and it was unclear whether its expertise matched that range.
The recommendations included a stronger critical incident reporting system, with ward-level groups that excluded managers; daily joint bedside rounds of doctors and nurses and weekly case and ethics conferences with outside experts; structured ethics training for all ward staff; and a reorganization of intensive care into larger units with stable staffing. Deutsches Ärzteblatt reported in the summer of 2007 that the Charite would merge its intensive care units into larger, interdisciplinary units, introduce the anonymous incident reporting system on the cardiac unit, and increase staff exchange. The hospital's medical director, Ulrich Frei, and Suter said the restructuring was controversial and that similar weaknesses would probably turn up at other German university hospitals. A neurosurgeon, writing to the journal, argued that larger units would not detect crimes more quickly.
Irene B. appealed on points of law. On April 3, 2008, the 5th Criminal Senate of the Bundesgerichtshof, under case number 5 StR 525/07, rejected her revision as unfounded. It changed the verdict itself, however: she stood convicted of murder in three cases and of manslaughter in two, not murder in five. The order records individual sentences of five years for the two manslaughter counts and life imprisonment as the aggregate sentence. The life sentence as an individual sentence therefore fell away in two cases.
The court upheld the finding of murder in three cases on the ground that the victims were defenseless and that the people who could have protected them, the doctors who were resuscitating the patients and a relative, did not know of the danger. She exploited that trust. The court rejected the lower court's finding of base motives. Its reasoning was that the motive came from her conviction that life in the patients' dying state was no longer worth living, and that this conviction, shaped by her self-image, made the acts manslaughter and, in three cases, murder, but not murder out of base motives. It also said that the lower court's speculation about a search for intense experiences or a compulsive perfectionism could not be used because it was not reliably established. The two cases that remained as manslaughter were those in which no further findings could support the murder characteristic.
The Bundesgerichtshof's order of April 3, 2008 ended her appeal. Later developments in her imprisonment are not on record.
Her motive was never settled. She told the court she acted for the patients' good; the court rejected that and found she acted without any request from them. The psychiatric expert described a narcissistic personality but not a condition that reduced her responsibility.
The number of patients varies in the record. Reports in April 2007 gave six murder charges and two attempted murders, the Irish Examiner noted that investigators had examined 15 deaths among her patients, and the Bundesgerichtshof's order refers to five further murder charges on which she was acquitted. Only the five convictions are findings of the courts. Her age is given as 54 or 55, and her start at the Charite as 1994 or 1995.
1975 to 1994: according to taz, works on an intensive care unit at a Jewish hospital in Berlin.
1994 or 1995: joins the cardiac intensive care unit of the Charite.
June 28, 2005: the first of the five convicted cases.
Mid-August 2006: a male nurse becomes suspicious; he tells only a friendly colleague.
Late September 2006: a senior physician is told.
Early October 2006: the nurse reports to the station doctor; ward and clinic management are informed; Irene B. is arrested.
April 18, 2007: trial opens at the Landgericht Berlin; she confesses to four killings.
April 25, 2007: the Charite convenes a commission on patient safety.
June 28, 2007: closing arguments; prosecutors ask for life imprisonment.
June 29, 2007: sentenced to life imprisonment for murder in five cases; no particular gravity of guilt found.
July 10, 2007: the commission delivers its report.
April 3, 2008: the Bundesgerichtshof rejects her revision and changes the verdict to murder in three cases and manslaughter in two.