Leonardo Cazzaniga was a senior doctor in the emergency department of the hospital at Saronno, in the province of Varese north of Milan. Between late 2010 and the summer of 2014 he gave a series of elderly and seriously ill patients intravenous overdoses of sedatives and anesthetics, given one after another in quick succession. He called the regime the "protocollo Cazzaniga," and colleagues said he referred to himself as the "angel of death." Outside the hospital, he took part with his lover, the emergency nurse Laura Taroni, in the deaths of her husband and her father-in-law.
The case reached the police because two nurses refused to accept what they saw. One of them filed a criminal complaint in June 2014, after a hospital commission had reviewed his work and taken no action. Cazzaniga and Taroni were arrested on November 29, 2016, in an inquiry the carabinieri called "Angeli e demoni" (Angels and Demons). Italian courts have since made final his convictions for 10 murders: eight patients and two members of Taroni's family. He has always denied any intent to kill, saying the drugs were meant only to relieve the suffering of people who were already dying. He is serving a life sentence.
Cazzaniga was 60 when he was arrested, according to Il Saronno and Il Post, which places his birth in 1955 or 1956. He lived in Rovellasca, in the province of Como, a few kilometers from Saronno; at his arrest he was described as separated, with no children. His elderly parents lived in Cusano Milanino, outside Milan.
He was trained as an anesthetist and had worked at Saronno hospital for decades, rising to deputy head of the emergency department. Il Saronno described him as the department's veteran doctor. Colleagues interviewed after his arrest called him unusual but brilliant, with courteous manners, and a competent doctor who could hold his own in technical discussions. His own defense lawyers later described him in court as highly prepared and empathetic, "by far the best" in the emergency room, while conceding that he was narcissistic and had misused benzodiazepines.
Other colleagues gave a harsher picture. Clelia Leto, the emergency nurse whose complaint started the criminal case, told the court in 2018 that he was admired for his experience but disliked for his behavior: arrogant, scornful of staff, especially nurses of foreign origin, and often vulgar. She said he regularly took large quantities of anxiety and psychiatric medicines from the ward cabinets at the start of his shifts and gave varying explanations when asked. Cazzaniga himself acknowledged under examination in March 2019 that he had conflicts with some colleagues and could be unpleasant at work.
In early 2016, about eight months before his arrest, he was moved from Saronno to the hospital at Angera, also in the province of Varese, where he did administrative office work with no clinical duties. Colleagues there did not know why he had been transferred.
Laura Taroni was a nurse in the same emergency department. She was 39 or 40 at the time of the arrests and lived in Lomazzo (Como), where her husband, Massimo Guerra, ran the family farm, which supplied a local milk dispenser. They had two sons. She and Cazzaniga met at work and began a relationship while she was still married. After early suspicions about her, she was moved to other wards.
According to the prosecution, the court rulings and the nurses who testified, Cazzaniga treated certain patients arriving in the emergency room, mostly elderly people with several illnesses or in the final stage of a disease, with combinations of intravenous drugs: the sedative midazolam, the anesthetic propofol, morphine, and the antipsychotics promazine and chlorpromazine. The doses were large and were given in rapid succession. Prosecutors argued that the amounts were three to eight times what guidelines allowed. Il Post reported that witnesses heard him call himself "god" and say that with a given patient he would spread his wings as the angel of death.
Nurses said the "protocol" was spoken of openly in the department. Leto told the court she first heard of it as gossip, then saw him prepare to use it on two elderly patients. She said he once told the son of a patient that his father was no longer a human being but an "organism," and told her that by trying to help a struggling patient she was being selfish and prolonging suffering. Radu Iliescu, another nurse, testified that he heard Cazzaniga tell the 118 emergency dispatch service that he would apply the protocol to incoming patients.
Cazzaniga's account never changed. He said in court in June 2018 that in his work as a doctor he had never meant to kill anyone, that the patients he treated arrived in agony or at the terminal stage, and that the drugs were meant to reduce suffering. He described himself as opposed to "accanimento terapeutico," the futile prolonging of treatment. His lawyers argued that the protocol was nurses' gossip, that the doses in the records varied patient by patient, and that his treatment was palliative care for people already dying. The courts rejected that defense. In its written reasons, the Busto Arsizio Court of Assize found that the victims were frail, cut off from their families and unable to resist, and it described his conduct as marked by "lucidity" and "lethality." Court-appointed experts, the reasons say, saw arrogance and presumption in him, not compassion.
The deaths for which Cazzaniga stands convicted span almost four years. Italian courts and the local and national press have named the patients.
Pietro Oliva, 84, of Saronno, died on November 7, 2010, the earliest of the charged deaths. His grandson, Luca Rossoni, attended the opening of the trial in 2018 and said he hoped the responsibility of everyone involved, including those who had failed to check, would be established.
Federico Mascazzini, 75, also of Saronno, was one of two cases added to the charges in early 2018.
Antonietta Balzarotti died in 2011 at the age of 88. Her son, Bruno Devoti, was among the relatives in court on the first day of the trial.
Angelo Lauria was 69. He had cancer but was not terminally ill, and he was sent down from oncology to the emergency room on April 9, 2013, with worsening breathing problems. Iliescu testified that Cazzaniga prescribed two vials of morphine, which Iliescu gave, then took over the treatment himself; Iliescu later learned that the infusion contained propofol and midazolam. Lauria died within 30 to 40 minutes. When Iliescu asked why, Cazzaniga told him it was a question of medical ethics that he could not understand. Iliescu said Cazzaniga wrote Iliescu's name on the record of the drugs given and changed it to his own only when Iliescu objected. Lauria's death led both Iliescu and Leto to complain to management.
Mario Volontè, Pier Francesco Leone Ferrazzi and Luigia Lattuada were also among the patients whose deaths the courts attributed to him. Little has been reported about their lives. When the case first became public, Il Post described the four patients then in the charge sheet as a 69-year-old man with cancer, a 71-year-old man with advanced Parkinson's disease, a 77-year-old woman with cancer and a 93-year-old man admitted with a broken hip.
Domenico Brasca, 82, a retired man from Rovello Porro (Como), came to the Saronno emergency room on August 18, 2014, and died at home a few hours after he was discharged. His was the last death charged. After his body was exhumed in 2018, experts found midazolam, promazine and chlorpromazine, the drugs of the protocol.
Massimo Guerra, Laura Taroni's husband, was 45 or 46 years old. Prosecutors and the courts found that he was in good health. According to the charges and the first-instance judgment, Taroni convinced him that he had diabetes and heart trouble, and Cazzaniga supported the story with false certificates and prescriptions for the diabetes drug metformin. Over months, from about November 2012, he was given drugs he did not need. He suffered drooling, fainting, tremors and drowsiness and was admitted to hospital several times. Taroni told investigators he had sometimes been violent toward her, an account the defense used and the court weighed.
On June 30, 2013, he lay dying on the sofa at home in Lomazzo. Between 11:33 and 11:58 that morning Taroni exchanged text messages with Cazzaniga; she called the medical on-call service at 12:52, saying her husband had had a heart attack. His body was cremated. In an intercepted conversation after his death, Cazzaniga called the idea of cremation "brilliant," Il Post reported. At the 2021 appeal hearing, the deputy prosecutor general called his killing "a truly hateful crime."
Luciano Guerra, Massimo's father and Taroni's father-in-law, was 78 and had several illnesses. He was admitted to the internal medicine ward at Saronno on October 1, 2013, and died at about noon on October 20. The doctor who had admitted him told the court that he had last seen him at 10:20 that morning, drowsy but not in a coma, and that death had not seemed imminent.
Witnesses described Cazzaniga, who was not on duty there, visiting the ward, objecting to what he regarded as excessive treatment and interfering with the patient's care, to the point that he was informally barred. Leto testified that during the admission she saw him take a box of midazolam from a ward cabinet, draw a dose into a syringe and put it in his back pocket. The first-instance court found that he gave Taroni a syringe holding at least 5 cc of midazolam and told her, "Do what you think is right." When the body was exhumed on April 3, 2017, experts found significant amounts of midazolam in the liver and kidneys and traces in the brain. Prosecutors argued that there was no personal motive in this death and called it a clear application of the protocol.
Maria Rita Clerici, Taroni's mother, died on January 4, 2014, while staying at her daughter's home. Prosecutors said she had no serious illness beyond occasional migraines, that she was given an injection shortly before she collapsed, and that rescuers were kept from treating her. Prosecutors argued that both Clerici and Massimo Guerra died because they stood in the way of the relationship; Il Giorno reported that Clerici had openly opposed it.
Taroni was convicted of her mother's murder. Cazzaniga was charged with it too, but the Busto Arsizio court acquitted him of this death "for not having committed the act." When the Court of Cassation later confirmed Taroni's sentence, it explained that the different results turned on how much weight each court gave to Taroni's own statements, not on a different account of what happened.
In a few months the two boys lost their father, grandfather and grandmother. Leto's complaint expressed concern for them as well, and after the arrests a juvenile court placed them in a protected facility.
Clelia Leto arrived in the Saronno emergency room in 2012, when Cazzaniga was already an established figure there. In April 2013, according to her complaint, he wanted to give an elderly woman in agony intravenous propofol and midazolam while another, conscious patient was in the room. Leto objected that morphine and oxygen could ease her suffering. He reacted angrily and threatened her, she said, and when she said she would report him he asked whether she would report him over the drugs; she said yes. She later testified that he told her she was finished at work and that he would kill her, which she understood as a professional threat, and that on one occasion he followed her by car.
Radu Iliescu, a nurse of Moldovan origin who worked in the Saronno emergency department from September 2012 to September 2015, reported Lauria's death to the nursing coordinator, who asked him for a written account. He testified that the report went to the hospital's medical director but that nobody came back to him. When he challenged Cazzaniga, he said, the doctor called him a traitor and said he would send him to Siberia.
The two nurses' reports led hospital management to set up an internal commission in 2013 to examine Cazzaniga's cases. It was created by the health director of the Busto Arsizio hospital authority, which then ran Saronno, and coordinated by Saronno's medical director; its members included the head of the emergency department and a forensic doctor. According to ANSA reports quoted by Quotidiano Sanità, the commission's own report observed that his combination of opioid painkillers, benzodiazepines and hypnotics had no equivalent among other emergency doctors and that the doses appeared clearly to exceed guideline values. It nevertheless ruled out criminal responsibility. Iliescu recalled being thanked for raising his doubts. Leto told the court that management knew of the problem because she had told them several times, and that it was tolerated and played down. The inquiry ended without disciplinary action.
On June 20, 2014, with the help of a lawyer, Leto filed a criminal complaint with the Busto Arsizio prosecutors. She had already gone to the Saronno carabinieri that month after the threats. Asked at the trial's opening in April 2018 whether she would do it again, she said she would.
The Saronno carabinieri, under Captain (later Major) Giuseppe Regina, spent about two years on the case. Investigators went through the hospital's history of admissions and deaths, had medical records examined by experts from outside Lombardy, questioned more than 150 people and placed the couple under electronic surveillance.
The wiretaps became central. In a conversation in a car on June 19, 2016, Cazzaniga said he had performed euthanasia. Taroni corrected him: euthanasia, she said, is when a lucid patient asks to die. He then corrected himself, calling the acts "voluntary homicides." Prosecutors, in their arrest request, wrote that the pair discussed killing as a way of solving problems "with disarming calm." His defense later pointed to another intercepted conversation, from June 2016, in which he said he was convinced he had sedated the patients, not killed them.
On the morning of November 29, 2016, carabinieri arrested Cazzaniga and Taroni and searched the hospital. Reports differ on where he was taken: SaronnoNews said at the Angera hospital, Il Saronno at his home in Rovellasca. He did not resist and appeared calm, and he asked to bring a philosophy book with him; Il Giorno later reported that he took a four-volume collection of Greek tragedies into prison. He was held in the prison at Busto Arsizio. Taroni was arrested at the family farm in Lomazzo and held at the Bassone prison in Como.
At the arrest, the warrant named four patient deaths, dated between February 2012 and April 2013, and the death of Massimo Guerra. Fourteen other people, almost all hospital staff, were placed under investigation for failures connected to the case, not for the killings. Investigators seized about 80 patient files from the emergency room. The regional health councilor, Giulio Gallera, said the Lombardy region was dismayed and announced a separate regional inquiry. A judge refused Cazzaniga's request for house arrest in early December 2016.
On February 2, 2017, after a two-day interrogation of Taroni at the Como prison, prosecutors formally placed both suspects under investigation for the deaths of Luciano Guerra and Maria Rita Clerici. Luciano Guerra's body was exhumed in April 2017. In June 2017 prosecutors asked for the couple and 12 others to be sent for trial; a review of the seized files had added four new suspicious patient deaths.
At a preliminary hearing in July 2017, Cazzaniga's lawyers, Ennio Buffoli and Andrea Pezzangora of Brescia, asked for the case to be moved away from Busto Arsizio because of "too much hatred" and hostile media coverage. The request did not succeed. The charges kept growing: by early 2018 Cazzaniga faced nine patient deaths in the main case, two more (Oliva and Mascazzini) added on an immediate-trial request, and the three family deaths. In May 2018 a judge ordered the exhumation of Domenico Brasca, whose death became the twelfth patient count.
Taroni chose an abbreviated trial, which reduces a sentence by one third. On February 23, 2018, the preliminary hearing judge in Busto Arsizio, Sara Cipolla, sentenced her to 30 years for the murders of her husband and her mother and acquitted her of the death of her father-in-law. In the same proceedings several hospital doctors charged with lesser offenses, such as false certificates about Massimo Guerra's illness or failure to report, accepted plea deals or received suspended sentences.
The Milan Court of Assize of Appeal confirmed her 30 years on July 3, 2019. On appeal to the Court of Cassation, her lawyers argued that the appeal court had ignored their challenge to her mental capacity, and in autumn 2020 the Cassation annulled the sentence and ordered a new appeal. A new psychiatric report found that she had a fascination with death but was of sound mind and able to understand and will her actions. On February 12, 2021, a second Milan appeal court again imposed 30 years. It dropped the aggravating circumstance of premeditation for her mother's murder but kept the sentence, because the aggravating factors of killing a parent and using poisonous substances remained. The Court of Cassation rejected her final appeal in 2022, and its written reasons were reported in February 2023. Her conviction for the murders of Massimo Guerra and Maria Rita Clerici, with a 30-year sentence, is final. No later news of her has been reported.
Cazzaniga chose an ordinary trial before the Corte d'Assise of Busto Arsizio, where professional and lay judges sit together. It opened on April 13, 2018, under presiding judge Renata Peragallo, with the chief prosecutor of Busto Arsizio, Gian Luigi Fontana, and prosecutor Maria Cristina Ria. Four of the commission members were tried alongside him for aiding him and failing to report, and an oncologist for failing to report one death. The Milan medical association joined as a civil party. Some 160 witnesses were listed, and the trial ran to more than 60 hearings.
Leto testified for more than three hours in June 2018. Iliescu flew in from Bristol, England, where he was working in intensive care, and testified at the end of the same month. Immediately afterward Cazzaniga made his first statement: "In my work as a doctor I never intended to kill anyone." In September 2018 the court heard witnesses about Luciano Guerra's last days on the medicine ward. In March 2019 Cazzaniga was examined for more than six hours and denied all 12 patient deaths. While in custody he was reported to be writing a philosophical book on life, death and transcendence based on the Book of Genesis.
In September 2019 the court allowed him to move to house arrest with an electronic tag at his parents' home in Cusano Milanino. The prosecutors appealed, a Milan review court restored prison custody, and after the Court of Cassation rejected the defense's appeal, carabinieri took him back to the Busto Arsizio prison on January 23, 2020.
In their closing in November 2019, the prosecutors portrayed a doctor who believed he could decide over other people's lives, who scorned the colleagues who had treated a patient before him as too passive, and whose patients fared differently once they passed into his care. The defense spoke for almost 20 hours in January 2020. It called the case a witch hunt, argued there was no scientific proof that the doses were lethal, and asked for acquittal or, at most, a conviction for manslaughter. On the day of the verdict Cazzaniga read a 15-page handwritten statement in capital letters. He insisted he had never acted as Lady Macbeth urged her husband.
On January 27, 2020, after about seven hours of deliberation, the court sentenced Cazzaniga to life imprisonment with three years of daytime isolation, a permanent ban from public office and a ban from practicing medicine. It convicted him on 12 of the 15 counts: ten patients (Oliva, Mascazzini, Volontè, Moneta, Borghi, Balzarotti, Ferrazzi, Vergani, Lattuada and Lauria) and Massimo and Luciano Guerra. It acquitted him of three: the patient Antonino Isgrò, who had died on April 30, 2012, because the court's expert found no clear link between the drugs and the death; Domenico Brasca; and Maria Rita Clerici.
The four commission members (Saronno's former general director, Paolo Valentini; the former health director of the Busto Arsizio hospital authority, Roberto Cosentina; the former head of the emergency department, Nicola Scoppetta; and a forensic doctor) were each sentenced to two years and six months for aiding him. The court found they could not have failed to assess his conduct competently and had not done their duty to act on it. The oncologist was acquitted because "the fact does not exist."
Gabriella Guerra, Massimo's sister, said she felt no relief, because no sentence could ease the family's pain.
The appeal opened in Milan in February 2021. The deputy prosecutor general, Nunzia Ciaravolo, asked for the life sentence to be confirmed and for Cazzaniga to be convicted for Brasca's death as well. Speaking by video link without notes, Cazzaniga told the court he had not watched people suffer and then killed them; he had tried to prevent suffering, and he had no need to kill patients who were already dying. Asked about remorse, he said he had nothing to repent of, "because repentance presupposes an admission of guilt. I have not killed anyone."
On April 13, 2021, the Milan Court of Assize of Appeal confirmed the life sentence and the three years of daytime isolation. It acquitted him of the deaths of Giuseppe Pancrazio Vergani, Virginia Moneta and Giacomo Borghi under the provision of Italian procedure that applies when proof is insufficient or contradictory. It overturned his acquittal for Domenico Brasca and convicted him of that death. The total stood at 10: eight patients and the two Guerra men. The court held the health authority, ASST Valle Olona, civilly liable, writing that hospital leaders should have set up a system of checks to protect their patients. For the four commission members, the court declared that the charges were time-barred under the statute of limitations, so the case against them ended without a final verdict on the merits.
The defense appealed to the Court of Cassation, arguing in particular that the Milan court had convicted him for Brasca without re-hearing the witnesses whose evidence had led to his acquittal. In September 2022 the Cassation's First Criminal Section confirmed the life sentence and made the convictions for nine murders final. It also rejected an appeal by the prosecutor general. On the Brasca count alone it annulled the conviction and sent the case back to Milan, on the procedural ground that the decisive witnesses had not been heard again.
The retrial before a second Milan appeal court began in April 2023 and heard, among others, Gaetano Iapichino, a former professor of anesthesia and intensive care who was one of the experts who examined Brasca's exhumed body, the emergency doctor who received him, a radiologist and a defense consultant. On June 27, 2023, the court again convicted Cazzaniga of Brasca's murder and confirmed life imprisonment with daytime isolation. Fanpage reported that Brasca's relatives were awarded 200,000 euros in moral damages. The defense argued that Brasca had been terminally ill with signs of a heart attack, that the drugs matched guidelines, and that he died two hours after discharge, long after they were given. On February 23, 2024, the Court of Cassation's Fifth Criminal Section rejected that appeal, and the tenth conviction became final. As the newspapers noted, it changed nothing in practice: he was already serving life.
Cazzaniga was held at Busto Arsizio from his arrest until his brief period of house arrest in 2019 and again after January 2020. By late 2021 he had been moved from the prison at Monza to Opera, near Milan, where Il Giorno placed him in February 2023. By December 2023 he was in the prison at Alessandria, in Piedmont. Il Giorno reported then that he had enrolled in a degree course in letters (humanities), a long-standing interest.
In April 2026, according to a TGCOM24 article of April 12, Cazzaniga was held in Alessandria prison, serving his life sentence. No later court ruling or news report about him had appeared by October 18, 2026. His convictions are final. His eligibility for any form of release has not been reported.
The arrests led the national news bulletins and front pages in November 2016, and the trial was then followed hearing by hearing by Il Giorno, SaronnoNews and Il Saronno. The patients came from Saronno and nearby towns. Relatives of patients joined as civil parties, and the health authority was named civilly liable on appeal. In 2018 the authority declined to join the trial as a civil party, saying it would pursue its own damages claim through the Corte dei Conti, Italy's audit court.
The case was told for television in a Crime Investigation documentary and, in September 2024, in "Amore malato: Gli angeli della morte," broadcast on the Nove channel, which included relatives of patients and a former colleague.
Final convictions: the murders of eight patients (Oliva, Mascazzini, Volontè, Balzarotti, Ferrazzi, Lattuada, Lauria and Brasca) and of Massimo Guerra and Luciano Guerra. Ten in all.
Acquitted, and therefore not counted as murders: the deaths of Antonino Isgrò and of Maria Rita Clerici (acquitted in 2020), and of Giuseppe Pancrazio Vergani, Virginia Moneta and Giacomo Borghi (convicted in 2020, acquitted on appeal in 2021). Taroni, separately, stands convicted of her mother's murder.
The count. Several reports give nine rather than ten. In September 2022 nine convictions became final while Brasca's was retried, and some reports of the 2023 and 2024 rulings described Brasca's death as the ninth. Il Giorno's reports of the appeal and the Cassation rulings give the breakdown that adds up to ten: seven patients confirmed on appeal, Brasca, and the two Guerra deaths.
Never charged: investigators reviewed about 80 other patient files from the emergency department. Beyond the cases that went to trial, no further charges are reported.
The hospital commission: its members were convicted at first instance of aiding Cazzaniga, but on appeal the charges were declared time-barred. That is neither a conviction nor an acquittal.
Cazzaniga's own claim that he gave the drugs only to ease the suffering of the dying was rejected by every court that heard the case.
1955 or 1956: Leonardo Cazzaniga is born (aged 60 at his arrest in November 2016).
November 7, 2010: Pietro Oliva, 84, dies at Saronno, the earliest death for which Cazzaniga is convicted.
2011: Antonietta Balzarotti, 88, dies.
April 30, 2012: Antonino Isgrò dies (Cazzaniga later acquitted).
2012: Clelia Leto joins the Saronno emergency room; Radu Iliescu arrives in September.
From about November 2012: Massimo Guerra is given drugs after being told falsely that he is diabetic.
April 9, 2013: Angelo Lauria, 69, dies in the emergency room; Iliescu and Leto complain to management.
2013: an internal hospital commission reviews Cazzaniga's cases and finds no grounds to report him.
June 30, 2013: Massimo Guerra dies at home in Lomazzo.
October 20, 2013: Luciano Guerra, 78, dies on the medicine ward at Saronno.
January 4, 2014: Maria Rita Clerici dies at her daughter's home.
June 2014: Leto goes to the carabinieri; on June 20 she files a criminal complaint with the Busto Arsizio prosecutors.
August 18, 2014: Domenico Brasca, 82, dies at home in Rovello Porro hours after leaving the Saronno emergency room.
Early 2016: Cazzaniga is transferred to office work at Angera.
June 19, 2016: an intercepted conversation in which he first calls his actions euthanasia, then voluntary homicides.
November 29, 2016: Cazzaniga and Taroni are arrested; 14 others are investigated.
February 2, 2017: both are placed under investigation for the deaths of Luciano Guerra and Clerici.
April 3, 2017: Luciano Guerra's body is exhumed; midazolam is found.
February 23, 2018: Taroni sentenced to 30 years (abbreviated trial) for the murders of her husband and mother; acquitted of her father-in-law's death.
April 13, 2018: Cazzaniga's trial opens at the Busto Arsizio Court of Assize.
May 2018: exhumation of Domenico Brasca ordered.
June 2018: Leto and Iliescu testify.
July 3, 2019: Taroni's sentence confirmed on appeal.
September 13, 2019: Cazzaniga moved to house arrest; returned to prison January 23, 2020.
January 27, 2020: life imprisonment for 12 of 15 counts; commission members sentenced to two years and six months.
Autumn 2020: Cassation annuls Taroni's appeal ruling over her mental capacity.
February 12, 2021: Taroni again sentenced to 30 years on retrial.
April 13, 2021: Milan Court of Assize of Appeal confirms life for 10 murders; three acquittals; commission charges time-barred.
2022: Cassation makes Taroni's sentence final.
September 2022: Cassation makes nine of Cazzaniga's convictions final and sends the Brasca count back.
June 27, 2023: second Milan appeal court convicts him again for Brasca.
December 2023: reported in Alessandria prison, studying for a humanities degree.
February 23, 2024: Cassation rejects his last appeal; 10 convictions final.
September 7, 2024: Nove broadcasts "Amore malato: Gli angeli della morte."
April 12, 2026: reported held in Alessandria prison.
October 18, 2026: no later ruling or news reported.