Niels Högel worked as an intensive care nurse at two hospitals in Lower Saxony, in northwestern Germany, from 1999 to 2005. During those years he gave patients medication that no doctor had ordered, mostly heart drugs, so that their hearts or circulation failed, and then he joined the team that tried to bring them back. He wanted the praise that came with a successful resuscitation, the court in Oldenburg found. In most cases the patients died.
On June 6, 2019, the Landgericht Oldenburg convicted him of 85 murders at the Klinikum Oldenburg and the hospital in nearby Delmenhorst, committed between 2000 and 2005, and sentenced him to life in prison. It acquitted him of 15 more for lack of evidence. He had already been convicted twice before, in 2008 and 2015, for crimes against six other patients. The Associated Press described him as believed to be modern Germany's most prolific serial killer. Investigators have said the true number of his victims may never be known, because many patients who died on his shifts were cremated before anyone suspected him.
The case also put the hospitals on trial. Colleagues in Oldenburg had noticed, years before his arrest, that patients deteriorated and died far more often when he was on duty. He was moved to another department, then encouraged to resign, and he left with a good written reference. He took that reference to Delmenhorst. Seven of his former superiors were tried for their part and were acquitted in October 2022.
Högel told the court in 2019 that he had a "protected" childhood without violence, according to the Associated Press. His grandmother and his father were nurses, and he said they were his role models in choosing the work. He described intensive care as stressful from the very start of his career, according to a report of his first day of testimony in Deutsches Ärzteblatt.
Psychiatrists later examined him. Psychological assessments described by AFP in 2018 found a severe narcissistic disorder and a paralyzing fear of his own death. Little else about his early life has been reliably reported.
Högel took a job at the Klinikum Oldenburg, the large hospital in the city of Oldenburg, in 1999, and worked there until 2002, according to the Associated Press. He worked first in the intensive care unit of the cardiac surgery department.
Staff there began to notice a pattern. In 2001 the unit kept a tally of the nurses on duty at resuscitations and deaths, a list later described in court. Högel's name had the most marks, 18, the taz reported in 2019. A handwritten note on the list said that endangering the department and the hospital was not acceptable, and that the suspicions were not enough to inform prosecutors. The list stayed inside the hospital. A later hospital manager had it from 2014 but did not hand it to investigators until 2016, according to the taz, and the hospital itself said in June 2016 that it had given the list to investigators that April. The hospital's management in 2016 said it could not understand why staff at the time had judged the list too weak to bring in the authorities.
According to the prosecutors who later charged his superiors, the people responsible had recognized the danger he posed by the end of October 2001 at the latest. Several meetings discussed calling in law enforcement, the indictment said, but the decision was made not to inform the police. Prosecutors alleged that the superiors kept quiet out of concern for their own reputations and for the reputation of the unit and the hospital.
Högel was moved to the anesthesia department. He drew attention there too. A former Oldenburg nurse testified in 2022 that resuscitation numbers in cardiac surgery fell after the move, and that Högel's best friend at the time had said things were now starting in anesthesia, Deutsches Ärzteblatt reported.
In 2002 the hospital's leadership acted, but not by going to the police. The managing director and the director of nursing arranged for Högel to be released from work for three months on full pay, according to the 2019 indictment of his superiors. The prosecutor who later argued their case said the managing director had asked the works council to persuade him to resign, and that Högel was given a choice between doing only patient transport and errands or leaving.
He left with a good reference. The taz described him as having been "praised away" with it. Prosecutors later called the reference false, because it concealed the danger he posed. With it, Högel applied for a job at the hospital in nearby Delmenhorst and was hired.
Högel worked in intensive care at the Delmenhorst hospital from 2003 to 2005, according to the AP and the police special commission. The indictment of his superiors placed the start of his work there in December 2002.
He continued to harm patients there. Police death statistics for the unit showed that its mortality rate nearly doubled in 2003 and 2004, the Weser-Kurier reported from testimony at the 2019 trial. One police investigator testified in 2019 that, when the figures were matched against duty rosters, Högel had been on duty for about 75 percent of all deaths on the ward: about 62 percent during his shift and 11 percent shortly after it ended, the Weser-Kurier reported. Orders for one heart drug that the ward rarely needed rose from 50 ampoules in 2002 to 225 in 2003 and 380 in 2004. Colleagues gave him a nickname that translates roughly as "resuscitation Rambo," the taz reported.
Among the Delmenhorst patients was the grandfather of Christian Marbach, who later became the spokesman for the victims' families. He was admitted in 2003 for a routine operation, AFP reported. He died a few days later. Högel was convicted of his murder in 2015. "He tried twice to kill him," Marbach told AFP.
In June 2005 a colleague caught Högel giving a patient a drug that had not been prescribed. Even then he was not stopped at once. The head of the later police special commission said that staff had found in patients' blood a heart drug that no doctor had given, yet Högel went on working late shifts in intensive care until his vacation began, according to the Ärzte Zeitung. His last known killing came on June 24, 2005, two days after he had been caught in the act with another patient. The commission's head described those days as a symbol of the failure of the people responsible.
Högel himself testified in 2022 that his superiors had decided he should work two more shifts before his vacation. By that time, he said, he no longer tried to hide what he was doing and half hoped to be caught. Shortly afterward he was dismissed and then arrested, Deutsches Ärzteblatt reported.
The first case against Högel concerned the patient he had been caught with. Prosecutors charged him with attempted murder and dangerous bodily harm in that one case. In December 2006 the Landgericht Oldenburg convicted him of the lesser offense of attempted manslaughter with dangerous bodily harm and sentenced him to five years in prison, with a five year ban on working in his profession, according to the Weser-Kurier. The Bundesgerichtshof, Germany's Federal Court of Justice, overturned that verdict, a dpa chronology printed in the Ärzte Zeitung recorded.
At a retrial in the summer of 2008, the Oldenburg court convicted him of attempted murder and dangerous bodily harm and sentenced him to seven and a half years, with a lifetime ban on working in the profession. Sources differ slightly on this sentence: AFP and Al Jazeera reported it as seven years.
The court that sentenced him in 2015 said there had already been indications of further crimes in 2008. A police investigator testified in 2019 that he and a colleague had pressed for more exhumations at the very start of the investigation, and that the whole case could have been dealt with in 2006 or 2007. The police received the hospital's death figures only in 2006, because the hospital at first refused to name patients, citing data protection. The case then passed through the hands of several prosecutors. The Oldenburg prosecutor's office later apologized publicly for the delays, the Weser-Kurier reported.
The second case against Högel came after years of pressure from families who accused the prosecutors of dragging their feet. New charges were filed in January 2014, and the trial opened in September of that year, according to the dpa chronology.
The 2014 case covered five patients at the Delmenhorst hospital. In January 2015, during the trial, Högel unexpectedly told the court that he was responsible for about 90 acts in all, and that up to 30 of those patients had died. In November 2014, as the trial was under way, the Oldenburg police set up a special commission to examine more than 200 suspected cases at all his former workplaces.
On February 26, 2015, the Landgericht Oldenburg convicted Högel, then 38, of two murders, two attempted murders and dangerous bodily harm, all against patients at the Delmenhorst hospital, and sentenced him to life in prison, AFP reported in Deutsches Ärzteblatt. The court could rule only on the five cases charged. For three of the patients, it could not determine whether the medication or their poor health had caused their deaths.
The presiding judge, Sebastian Bührmann, found a particular gravity of guilt, which rules out the usual release on parole after 15 years. He said Högel had sought excitement and wanted to show colleagues how well he could resuscitate, and that the victims had been game pieces to him. "It was pure chance who survived and who died," he said. The defense had asked for convictions for two counts of manslaughter and three of dangerous bodily harm.
Judge Bührmann also apologized on behalf of the justice system for how slowly the case had moved. Years had passed between the first concrete suspicion and the trial, and he said, "That was not right." Prosecutors acknowledged mistakes and delays. Two former employees were under investigation on suspicion of obstruction of justice in office, the report said. Families who had joined the case as co-plaintiffs said they were relieved. Marbach said the family was satisfied, and one co-plaintiff wept.
With the 2008 case, six cases against Högel had now been decided in court, the Weser-Kurier noted.
The police special commission was named "Kardio." In late August 2017, after almost three years of work, it presented its findings at a press conference. It said Högel may have killed 84 more patients between 2003 and 2005 at the intensive care units in Oldenburg and Delmenhorst, the Ärzte Zeitung reported.
The figures were without precedent in Germany, the commission's head, Arne Schmidt, said. Investigators had exhumed 134 former patients from 67 cemeteries: 35 who had died at the Klinikum Oldenburg and 99 who had died at Delmenhorst during Högel's shifts. They evaluated about 500 patient files and nearly 300 expert reports. New laboratory methods had to be developed, and the tests found heart drugs and other medications that the patients should not have received.
Schmidt said that more than 130 other patients had died at the two hospitals during Högel's shifts but had been cremated, so that the causes of their deaths could hardly be proved. He said he had no doubt that some of Högel's victims were among them. He also questioned Högel's own explanation that he wanted to show off his skill at resuscitation, asking why someone who wanted to succeed would choose patients who were already in critical condition. He criticized the doctors and nurses responsible at Delmenhorst, saying suspicion should have been raised much earlier.
The commission's work also reached the Oldenburg hospital. In June 2016 the police and prosecutors had held a joint press conference, and the Klinikum Oldenburg said in a statement that day that investigators had so far proved six deaths at the hospital caused by another person's act. In 2014 the hospital had commissioned an outside medical expert to review deaths during Högel's time there, and he found strong signs of unnatural death in 16 patients, the hospital said. A dpa chronology recorded that by June 2016 investigators held Högel responsible for at least 33 deaths at Delmenhorst and that he had confessed to killing patients in Oldenburg too.
Some possible victims had been buried in Turkey. Prosecutors requested several exhumations there, and in one case the Hannover Medical School confirmed that a man had received a heart drug that was not medically necessary, dpa reported in October 2018. Earlier that year three requests for legal assistance to Turkey were still open, epd reported.
In January 2018 the Oldenburg prosecutors charged Högel with 97 more murders: 62 at Delmenhorst and 35 at Oldenburg, epd reported on January 22. Three further suspected cases in Germany were dropped because experts could not rule out that the drug traces found had come from legitimate treatment. More than 130 suspected cases could not be pursued because the patients had been cremated.
In September 2018 the count rose by one, to 99. In October 2018, during psychiatric interviews before the trial, Högel recalled another case that had earlier been dropped, and the prosecutors added it, dpa reported. The trial would cover 100 counts of murder.
The trial opened on October 30, 2018, before the Landgericht Oldenburg, with Judge Bührmann presiding again, as he had over the earlier trials, Deutsches Ärzteblatt reported. Because of the number of co-plaintiffs and the public interest, the court sat in the Weser-Ems-Hallen, a conference center in Oldenburg converted into a courtroom. About 126 relatives joined the case as co-plaintiffs, AFP reported, supported by victim counselors from the Weisser Ring charity.
The reading of the indictment took more than an hour. Chief prosecutor Daniela Schiereck-Bohlmann said Högel had killed from base motives and by treachery, out of a wish to show off his resuscitation skills to colleagues and superiors, and to fight boredom. The victims were aged 34 to 96.
Asked whether the accusations were true, Högel answered "Yes." He said he had put patients into life threatening states with medication and then revived them, to win his colleagues' respect, and that he had done it for the "positive feedback." Marbach said the confession could be a big step forward. "Today he looks like a small, vulnerable mass murderer," he said. Judge Bührmann told the relatives that the whole truth might not be found. "But we will search for it, I promise," he said.
As the trial went on, Högel's account narrowed. He came to say that he had committed 43 of the murders, that he could not remember whether he had harmed the patients in 52 other cases, and that he had not been involved in five, according to the AP and Al Jazeera.
Many former colleagues testified. In Oldenburg, the head of the ward linked to the 2001 tally list declined to testify and was himself under investigation, the taz reported, and his deputy said he knew nothing of the list. Judge Bührmann doubted parts of the testimony. Eight witnesses were sworn in, and perjury investigations followed against them and false statement investigations against two others. In February 2019 the Klinikum suspended staff involved who still worked there. The hospital had paid for lawyers for all its witnesses, and some witnesses felt this was meant to keep them in line, the taz reported.
Ten proceedings against witnesses were opened in all, epd reported in 2021. Nine were dropped in 2020, after prosecutors found that the witnesses' statements that they had noticed nothing could not be shown to be false. In June 2021 prosecutors charged one former Oldenburg nurse with perjury over testimony he gave in February 2019. The outcome of that charge has not been reported.
The psychiatrist Henning Saß testified in late April 2019. Högel refused to speak with him, so Saß relied on earlier reports, the testimony at trial and his own observations, dpa reported. Saß found a combined personality disorder, emotional instability and strong mood swings, but said these were less marked than in mentally ill people, and that Högel was criminally responsible for his acts.
Saß said Högel lacked shame, guilt, remorse and empathy. He described a strong need for importance and recognition and a rivalry with doctors, whom Högel at times regarded as incompetent and arrogant. As master over life and death, Saß said, size, importance and power had mattered to him. In Högel's eyes, the "good" patients were those who could be treated purely as objects, and patients who talked bothered him.
The prosecution argued that 97 murders had been proved and that the evidence fell short in only three cases. Prosecutor Schiereck-Bohlmann asked for life imprisonment with a finding of particular gravity of guilt. The defense accepted that murder had been proved in 55 cases, argued for attempted murder in 14 and asked for acquittal on the remaining 31, according to dpa and the taz. Neither side asked for preventive detention.
A lawyer for more than 100 relatives, Gaby Lübben, showed photographs of the victims during her closing argument, and the courtroom applauded when she finished, the taz reported. In his last words on June 5, 2019, Högel apologized to the families and said he felt remorse and shame. "I am really sorry," he said, according to the AP, and he said he wanted to give every relative an answer.
On June 6, 2019, the court convicted Högel of 85 murders and acquitted him of 15. It sentenced him to life imprisonment, found a particular gravity of guilt, and banned him for life from working in nursing, elder care or rescue services. The written judgment ran to 149 pages, epd reported.
The court found that Högel had given patients drugs that were not medically indicated, causing cardiac arrest or circulatory collapse, mainly so that he could then revive them. He hoped for recognition from colleagues, doctors and the patients he "saved," and he accepted that the resuscitations might fail and the patients die. In the cases tried, the resuscitations failed and the patients died soon after. The court found that he acted from base motives and, in most cases, by treachery, because he exploited the patients' unsuspecting state.
"Your guilt is incomprehensible," Judge Bührmann told him. The case and the crimes went beyond every limit, he said, and he described himself as "an accountant of death." He said the court regretted that it had been unable to clear up all of the cases, and that he knew this was hard for the families in the room. To show the scale, he noted that under an American system of adding sentences, 85 murders at 15 years each would amount to 1,275 years, beck-aktuell reported. German law does not impose consecutive sentences, so the court passed a single life term.
Including his earlier convictions, 91 killings had now been proved against Högel, the Landgericht said in 2022, according to epd.
Högel appealed, and so did one co-plaintiff, a relative who challenged an acquittal in a case where the court could not be sure a killing had taken place. The Bundesgerichtshof rejected both appeals on September 1, 2020, and announced the decision on September 11. It found no legal errors in the judgment or the proceedings, and the conviction became final, epd and the AP reported.
Few of the patients have been named publicly. They were men and women in intensive care and anesthesia, aged 34 to 96. AFP reported that they appear to have been chosen at random, and that Högel did not target people with incurable illnesses or claim pity as a motive. Prosecutors said many were not terminally ill but recovering, the AP reported.
For the families, the investigation reopened deaths they had long accepted as natural. Petra Klein of the Weisser Ring in Oldenburg told AFP that police had visited families to tell them their relatives might have been victims, and that the news had come as an incredible shock. The son of one patient whose death was suspected but never confirmed told NPR in 2019 that he had "gone through hell."
Marbach welcomed the 2019 verdict but said it could not fully satisfy the families, and that families would sue the two hospitals, Al Jazeera reported. Before the verdict he had called Högel a liar who admitted only what could be proved against him, dpa reported.
In September 2019 the Oldenburg prosecutors charged five former superiors at the Klinikum Oldenburg with manslaughter by omission: the long serving managing director, the former director of nursing, the former head of cardiac surgery, the head of anesthesia and a ward manager. The charges covered up to 63 cases each. Three of them were accused over the reference, and through it over 60 murders and attempted murders at Delmenhorst between December 2002 and June 2005, epd reported.
The court narrowed the case. It admitted charges only for three deaths at Oldenburg and rejected the 60 Delmenhorst cases, and in July 2021 the Oberlandesgericht (higher regional court) Oldenburg upheld that decision, rejecting complaints from the prosecutors and the co-plaintiffs. The Oldenburg staff had no legal duty toward patients in Delmenhorst, the higher court said. Leaving the suspicions out of the reference was an omission, and an omission is punishable only when it is equivalent to an active act, a high standard it found was not met here.
Separately, four former Delmenhorst staff were charged with manslaughter by omission. Before the trial opened, the nursing head of one Delmenhorst intensive care unit fell seriously ill, and his case was separated, to be continued when he was fit to stand trial, epd reported in February 2022. What became of his case was not reported.
The trial of seven former superiors opened on February 17, 2022, again in the Weser-Ems-Hallen and again under Judge Bührmann. Four came from Oldenburg: the former managing director, the former director of nursing, and the former medical head and nursing head of the cardiac surgery intensive care unit. Three came from Delmenhorst: two senior doctors and the deputy nursing head of the intensive care unit. The Oldenburg defendants were charged with aiding manslaughter by omission, the Delmenhorst defendants with manslaughter by omission, in eight cases together: three deaths at Oldenburg and five at Delmenhorst.
Högel testified as a witness in March 2022. He could not recall the three Oldenburg deaths of November 2001 that were before the court, and he gave no statement on four of the five Delmenhorst deaths, epd reported. Defense lawyers questioned whether anything he said could be relied on. In June 2022 the prosecutor, Gesa Weiß, said she doubted that one of the Oldenburg deaths had been a killing by Högel.
In July 2022 the court gave a preliminary view that the evidence did not show the four Oldenburg defendants had acted with intent with the certainty a conviction required, dpa reported. In September it gave a further preliminary view that the evidence did not show intentional action with sufficient certainty, epd reported.
On October 12, 2022, prosecutor Weiß asked the court to acquit all seven. There had been irregularities and suspicions, she said, and the handling of them had been a series of serious mistakes, but intentional help by omission, or knowingly accepting further harm to patients, could not be proved. She compared the managing director's decision to pass the problem on to the handling of abuse cases in the Catholic Church. The co-plaintiffs supported her position.
On October 13, 2022, after 29 hearing days, the court acquitted all seven defendants, following the requests of both the prosecution and the defense. Judge Bührmann said this was not an acquittal for lack of evidence: the court had positively found that there had been no intentional wrongdoing. He called it a question of legal justice, epd reported. Reports do not say whether the acquittals were appealed.
The case shaped new rules for hospitals in Lower Saxony. In October 2018 the state passed an amendment to its hospital law, in force from January 1, 2019. Every hospital must run an error reporting system that accepts anonymous reports, hold regular conferences, ideally monthly, to review deaths and unusual courses of illness, form a drug commission, and by January 1, 2022, provide ward pharmacists to advise doctors and nurses on medication. Lower Saxony was the first German state to make ward pharmacists compulsory, and the law responded in part to the killings in Oldenburg and Delmenhorst, dpa reported in 2022.
The Klinikum Oldenburg said in 2016 that it had carried out most of a catalog of patient safety measures drawn up in 2014, and had presented them to a special committee of the state parliament. Eugen Brysch of the German Foundation for Patient Protection called for a national alarm system, anonymous whistleblower points, tight electronic control of drug dispensing and independent examinations of the dead, epd and Deutsches Ärzteblatt reported.
Under German law a life sentence can be suspended on parole after 15 years, but a finding of particular gravity of guilt allows a court to require longer. Högel applied to have his minimum term set. On March 17, 2026, the sentence enforcement chamber of the Landgericht Oldenburg set it at 28 years, as the prosecutors had asked, and refused to suspend the sentence after 15 years, epd and beck-aktuell reported.
The court cited the extraordinary number of crimes, most committed with two of the legal features of murder, treachery and base motives; his drive for recognition; and his abuse of power over sick, defenseless patients, which had badly damaged public trust in health care. It also weighed his personality and his development in prison since 2019. A court spokesperson said the 28 years did not mean automatic release; before any release, a psychiatric expert would have to assess whether he was still dangerous. Neither Högel nor the prosecutors appealed, and the order became final, dpa reported on April 17, 2026.
Högel has been in custody without a break since May 2009, epd reported in March 2026. He has served his sentence at the JVA Oldenburg prison, according to dpa in 2019 and epd in 2022. As of April 17, 2026, he remained in prison under the life sentence, with a minimum term of 28 years and no release possible without a new assessment of whether he is still dangerous.
The number of victims. The courts have found 85 murders in 2019 and, with the earlier verdicts, 91 killings in all. Högel was acquitted of 15 further counts. Investigators said in 2018 that the full toll could exceed 200, AFP reported, but more than 130 patients who died on his shifts were cremated, and those deaths cannot be examined.
His confessions. Högel at first admitted all 100 counts in the 2018 trial, then narrowed his account to 43 murders, 52 cases he could not remember and five he denied. The prosecution called 97 cases proved; the defense, 55. An expert at the 2019 trial described him as a "competent liar," the taz reported.
His motive. Högel said he wanted the praise that followed a successful resuscitation, and both courts accepted that he sought recognition. The head of the police commission doubted this account in 2017, noting that he often chose patients already in critical condition. The 2015 court spoke of a search for excitement, and the 2026 court of a craving for recognition.
The period of the crimes. The 2019 charges ran from February 2000 to June 2005, and most reports of the verdict give 2000 to 2005. Some agency reports of the 2020 appeal ruling give 2002 as the start.
The superiors. Prosecutors alleged that superiors in Oldenburg recognized the danger by late 2001 and stayed silent to protect their reputations. The courts found that intent could not be proved, and that the Oldenburg staff had no legal duty toward patients in Delmenhorst. All seven defendants in the 2022 trial were acquitted.
1999: Högel starts work at the Klinikum Oldenburg, first in cardiac surgery intensive care.
February 2000: start of the period covered by the 2018 murder charges.
2001: a tally on the Oldenburg unit shows him present at more resuscitations and deaths than any other nurse; by late October 2001, prosecutors later alleged, superiors recognized the danger.
2002: moved to anesthesia, then released on full pay for three months and given a good reference; leaves Oldenburg.
December 2002 or 2003: starts work in intensive care at the Delmenhorst hospital.
2003 to 2004: the Delmenhorst unit's death rate roughly doubles; use of heart drugs rises sharply.
June 2005: caught by a colleague giving a patient an unprescribed drug; last known killing on June 24; dismissed and arrested.
December 2006: five years for attempted manslaughter; later overturned by the Bundesgerichtshof.
Summer 2008: at retrial, seven and a half years for attempted murder and a lifetime professional ban.
May 2009: in custody without a break from this point.
January 2014: new charges; trial opens in September.
November 2014: police set up the Kardio special commission.
January 2015: in court, Högel admits about 90 acts, with up to 30 deaths.
February 26, 2015: life sentence with particular gravity of guilt for two murders, two attempted murders and dangerous bodily harm.
June 22, 2016: police and prosecutors announce findings; the Klinikum Oldenburg confirms six proven deaths there.
August 2017: the Kardio commission reports 134 exhumations from 67 cemeteries and 84 further suspected murders.
January 2018: charged with 97 more murders; the count later rises to 100.
October 30, 2018: trial opens in the Weser-Ems-Hallen; he admits the charges.
April 2019: psychiatrist Henning Saß testifies.
June 6, 2019: convicted of 85 murders, acquitted of 15; life with particular gravity of guilt and a lifetime ban.
September 26, 2019: five former Oldenburg superiors charged with manslaughter by omission.
September 1, 2020: the Bundesgerichtshof rejects his appeal (announced September 11).
July 2021: the Oberlandesgericht Oldenburg upholds the narrowing of the charges against the superiors.
February 17, 2022: trial of seven former superiors opens.
October 13, 2022: all seven acquitted.
March 17, 2026: minimum term set at 28 years; final by April 17, 2026.