The Mechthild Bach case is one of the most spectacular medical trials in recent history. Worn out by files, reports and accusations of murder, the cancer doctor took her own life on January 24, 2011.
by Stefanie Grossmann
The public history of the doctor Mechthild Bach begins in Langenhagen near Hanover. The doctor of internal medicine has been running a practice there since 1989, specializing in cancer medicine. She maintains beds in the nearby Paracelsus Clinic. As a senior physician in the hospital, she acquired her knowledge from, among others, the oncologist Hans Nieper, the head of the "Am Silbersee" clinic. He is considered a leader in alternative cancer medicine at the time. At that time, prominent patients such as Yul Brynner and Ronald Reagan were treated in Langenhagen.
Mother's cancer death left a lasting impression on Mechthild Bach
Originally, the daughter from a Christian family in Wuppertal did not want to become a doctor. Mechthild Bach first studied architecture and mathematics. When her mother fell ill with cancer, she switched to studying medicine - driven by the thought of helping. After his mother died of cancer, Bach dealt intensively with the subject of death and dying - at a time when patients in clinics were still often left to die, being dumped into the proverbial broom closet. Bach's goal is to find a humane way of dealing with death. For her, dying is part of life:it is important that it happens with dignity, without fear or pain, she said herself. According to the doctor in the NDR documentary "The Mechthild Bach case" from early November 2011.
Hanover is a "blank spot" when it comes to palliative care
For many incurable cancer patients, the Paracelsus Clinic was the last stop.In the 1990s, Germany was still a developing country in the field of palliative medicine. Other European countries such as Great Britain are much further along and have even created legal foundations. It was only in 2003 that the first chair for palliative medicine was established at the University of Aachen. There are no offers in Hanover and the surrounding area. Mechthild Bach in Langenhagen became the unofficial contact point for the terminally ill. Colleagues value the doctor for her empathy. One of them is Prof. Wolfhard Winkelmüller. The neurosurgeon and pioneer in pain therapy is happy to leave his patients to Bach, because it is not uncommon for incurable and exhausted cancer patients to be deported from clinic to clinic. "We were grateful that this clinic existed, that Doctor Bach took these patients from us," says the doctor in the documentary "Der Fall Mechthild Bach", for which the NDR spoke to numerous companions and those involved in the process shortly after Bach's death.
Companions confirm Bach's great commitment
Mechthild Bach is popular with her patients and employees. She took care of everyone, not just herself, says her former receptionist Petra Schoebel in the documentary. She admired Bach's commitment. The doctor devoted 14 to 16 hours a day to her patients, including the terminally ill. Back then, Bach tried to alleviate the suffering of her patients with a holistic approach. According to Schoebel, a patient lived for 17 years after Bach also treated her with mistletoe therapy, vitamins and trace elements.
Mechthild Bach is being targeted by the AOK Lower Saxony
For a long time, Mechthild Bach was denied the opportunity to comment on the allegations.But Mechthild Bach often argues with the insurance companies about taking over the costs. And so, from May 2003, the doctor's life got out of joint when the AOK Lower Saxony took a closer look at the clinic. The reason for this is the high number of deaths in connection with the use of morphine. The health insurance company uses an undercover investigator. In September, the medical service of the health insurance companies (MDK) filed criminal charges on suspicion of active euthanasia in 78 cases. The public prosecutor's office in Hanover then confiscated all patient files. The allegations hit Mechthild Bach out of nowhere. She doesn't get a chance to comment - instead she turns to the media. She explained that she had not been granted the right to be heard by the district government. The administrative court also refused an interview. In the meantime, the clinic is behind her and has repeatedly asked the MDK and the public prosecutor's office for a clarifying discussion - in vain.
Defender Waldraff criticizes human rights violations
"The way these proceedings against Mechthild Bach began, they continued with massive violations of European human rights and the constitution," says defense attorney Matthias Waldraff, looking back on the case a few years ago. "She couldn't defend herself against the massive allegations that rolled over her," continued the defense attorney. Bach loses her license to practice medicine. Nevertheless, she hopes to be able to return to work soon. But things are different.
Expert Schwartau brings "intoxication" into play
The MDK put the expert Manfred Schwartau on the case. The former cardiologist, who boasts of tracking down fraudulent doctors, provides a motive:greed. Mechthild Bach is said to have kept patients in the clinic longer than necessary to collect health insurance contributions. "False allocation" is what it is called in technical jargon. In order to avoid a false assignment test, Bach let patients die from "intoxication".
Justice and media pounce on Mechthild Bach
The public prosecutor's office and the media jumped at the Mechthild Bach case. The inconspicuous-looking doctor soon got the stamp of the "angel of death" or the "scandal doctor" from the tabloids, but also from serious newspapers. "I did terminal care and nothing else," Bach countered the allegations in the "Neue Presse". You haven't killed anyone. But her attempts at an explanation don't help her:her name is associated with death - and the fear of unauthorized euthanasia.
Doctor Bach experiences bullying in prison
Bach's arrest met with a lack of understanding among patients:they demonstrated in front of the Hanover prison and took part in protest marches, as shown here.On a February morning in 2004, police officers came to Bach's door and arrested her. Because of the suspicion of manslaughter, the doctor is held in custody in the Hanover penal institution. "She ended up in a four-bed cell, with petty criminals and prostitutes who chain smoked and made malicious remarks when 'Frau Doctor' tried to read files and write to her lawyer," write former HAZ journalists Gabi Stief and Hans-Peter Wiechers in the book "The Murder Suspicion". In prison, she experiences "the worst time of her life", Mechthild Bach later. After 22 days, she is released on bail of 40,000 euros, the arrest warrant remains in place, and she has to report to the police station once a week.
Justice scandals accompany the first trial against Bach
The experiences change the people of Mechthild Bach. The formerly tough doctor is slowly breaking up inside, as colleagues and friends notice. She is not allowed to work and has no income, so she has to sell her practice. In February 2008, four years after the end of the pre-trial detention, proceedings for eight counts of manslaughter were opened. Also because the public prosecutor's expert, Prof. Michael Zenz, needed more than five years for his report - from October 2003 to May 2008, when he finally presented his last report. Witnesses to this are now deceased. But Mechthild Bach still harbors the hope of finally being able to explain himself. After only six months, however, the process collapses because a judge fell ill and the court failed to name a replacement.
But that's not the only point where the judiciary doesn't cover itself in glory. Another judge is considered biased:"As it became known during the course of the trial, one of the three judges had already confided in his ex-wife on the phone before the trial began that he considered the accused to be one hundred percent guilty of intentionally injecting patients to death. He had Mechthild Bach hasn't seen him once, but he was familiar with the first reports," write Stief and Wiechers.
Second procedure "is carried out with great aggressiveness"
A year and a half later, in October 2009, the proceedings at the Hanover Regional Court begin again. The accused are now charged with 13 cases of manslaughter. The trial under judge Wolfgang Rosenbusch "is being conducted with great aggressiveness," says Hans-Ludwig Schreiber later. The former judge and consultant in the Lower Saxony Ministry of Justice is a medical ethicist on euthanasia and is closely monitoring the process. It seems to him that the basic topic of euthanasia should be thoroughly worked up on the basis of this case, according to Schreiber in the NDR documentation.
Lukas Radbruch from the University of Aachen attests Mechthild Bach's professional competence - and that she did not administer excessive doses. However, their documentation has gaps:There are no declarations of consent or pain records from patients.
The battle of the experts in court
Mechthild Bach and her defense attorney Matthias Waldraff had to watch as the experts dominated the process.The errors in the documentation are Mechthild Bach's undoing:expert Schwartau assumes in his report that she acted secretly, even perfidiously and cruelly. The court relies on this report - Manfred Schwartau is not undisputed as an expert. Doctors had repeatedly lost their livelihoods after his assessments. The Winsen methadone doctor Hans-Jürgen Quathamer committed suicide at the end of 2009 after being charged, having his license revoked and having his fees reimbursed in the amount of 660,000 euros.
Bach's lawyers apply for bias - but the judges refuse. Instead the experts Schwartau and Zenz take up more and more space, observers see them as dominating the process. To the defense attorney Waldraff, the public prosecutor's office in the proceedings only seems like an accessory of the experts:"You have actually taken on the role of the chief prosecutor in the courtroom." The prominent pain doctor Rafael Dudziak acts as a counter-expert. He is to investigate whether the doses of morphine administered by Mechthild Bach were fatal. His result:negative. The doctor didn't want to kill anyone. But the reserved, little eloquent Dudziak cannot score against the eloquent Zenz. The court does not appreciate any of his arguments.
The experts in the Mechthild Bach case
Three experts determine the procedure in the Mechthild Bach case. But other experts also appear in court.
For the medical service of the health insurance companies (MDK), among other things, the cash examiner Manfred Schwartau determined. But the former cardiologist is controversial because he has no experience in substitution therapy. The working group on legal certainty questioned Schwartau's competence in an open letter to the Lower Saxony Medical Association, and the MDK dispelled the doubts. Schwartau accuses the accused of murder out of greed, among other things. Overall, the MDK employs nine experts in the case.
The public prosecutor's office in Hanover appoints Prof. Michael Zenz as an expert. He is a full professor at the Ruhr University in Bochum. In October 2003 he was commissioned to prepare an expert opinion. It takes him more than five years to do this - he only presented his last expertise in May 2008. His reason:work overload. He criticizes Mechthild Bach in an unusually sharp manner, accusing her of breaking off medically necessary therapies and not having properly informed the patients . There he is director of the clinic for intensive care medicine and pain therapy. In his report from April 2004 he tries to refute the allegations against the defendant. The morphine doses were said to be too low to be able to die from it.
Forensic pathologist Achim Schmoldt from Hamburg also appeared in the trial as a private expert for the AOK Lower Saxony. In the eyes of the defense, his report is in no way objective.
In addition, Lukas Radbruch from the University of Aachen has his say in the proceedings. He holds the first chair for palliative medicine in Germany and has prepared an expert opinion on behalf of the Paracelsus Clinic in Langenhagen. He concludes that Bach's medical treatment is impeccable and finds no evidence of active euthanasia. However, he criticizes gaps in the documentation and the lack of declarations of consent from the patients.
Interim report of the court:conviction for murder?
The trial of Mechthild Bach is dragging on. Friends, acquaintances and even politicians are therefore making serious allegations against the judiciary. According to the then President of the Lower Saxony state parliament, Jürgen Gansäuer, the duration of the proceedings was inhumane. "Pretty much everything that could have gone wrong went wrong here," sums up Germany's leading medical lawyer Professor Dr. Hans-Ludwig Schreiber 2011 in the NDR documentary. On January 18, 2011, the Criminal Court drew up a so-called interim balance and found the allegations against the doctor to be confirmed in all cases dealt with. And:In two cases, the court even considers a conviction for malicious murder to be possible. These two patients did not know they were going to die, according to Judge Wolfgang Rosenbusch. A murder conviction would mean a life sentence for Bach.
Mechthild Bach loses hope and courage to face life
The prospect of never being able to work as a doctor again robbed Mechthild Bach of all courage.Mechthild Bach could no longer stand being "publicly dissected," as her lawyer Waldraff later called it. The cancer doctor only wanted to take the pain away from her patients, she had repeatedly asserted in the process. And asks why the legal principle "in case of doubt for the accused" does not apply to them. Towards the end of the process, the doctor is physically and mentally ruined, her life crushed by files, expert opinions and the mammoth trial. "It's gotten so cold out of this world," she wrote in an email. In farewell letters to her friends, she sums it up:"I'm leaving with a clear conscience." A few days after the judicial interim report, the 61-year-old took her own life in her home in Bad Salzdetfurth. More than 500 companions, friends and patients say goodbye to her in Langenhagen. Her friends said she died of an overdose of justice. More than 70 days of trial and eight years of indictment lay behind her. She completed the "Bach" process in her own way.
Bach case intensifies discussion about euthanasia
After the death of Mechthild Bach, the files are closed and many questions remain unanswered. The relatives of the deceased patients also lack certainty as to why their family members died, as lawyer Martina Zerling-Andersen reported to the epd after Bach's suicide. She had represented two joint plaintiffs in the proceedings.
But the case has advanced the discussion about end-of-life care and euthanasia. Palliative medicine is no longer in its infancy; today there are special wards in clinics, outpatient palliative care by general practitioners and hospices. Back in Bach's day, painkillers were administered very sparingly. The targeted administration of opioids such as morphine is now part of the routine in pain therapy, also because it relieves the patient's shortness of breath during the dying process. However, it is discussed openly and decisions are made within the team, also in order to protect oneself legally. A lot has happened.