Besançon. Péchier Trial: Discover in detail the 30 cases of poisoning of which the anesthesiologist is suspected

Frédéric Péchier, 53, is accused of poisoning thirty patients, twelve of them fatally, at two clinics in Besançon. The anesthesiologist fiercely denies committing these crimes.

The vast majority of victims, aged 4 to 89, suffered unexpected cardiac arrests during minor surgical procedures, with no medical consensus on the causes of each of these serious adverse events (SAEs). The opening of an extraordinary police investigation in early 2017 reshuffled the deck by considering the possibility of malicious intent.

After eight years of investigations , the investigating judges considered that the charges against Dr. Péchier were sufficiently serious or consistent for the Doubs Assize Court to take up the matter. The trial of the former block leader will begin on September 8 in Besançon.

Here, in chronological order, are the detailed circumstances of the thirty cases of alleged poisoning which will be examined during these four months of hearings.

The disturbing EIGs are being relocated to the Polyclinic, where Frédéric Péchier has been working for several weeks.

Arriving for a simple gallbladder operation, 41-year-old Bénédicte B. is the first patient of the day. About ten minutes after falling asleep, she develops bradycardia. Her anesthesiologist, Dr. Pignard, is working urgently, supported by Dr. Péchier, among others. Adrenaline, cardiac massage, electric shocks: Bénédicte B. is "recovered," then admitted to the university hospital for monitoring, out of danger.

His case remains incomprehensible and subject to debate. Complicated by the absence of material seized at the time, the analysis of this EIG, carried out in 2023 by two medical experts, opens the door to massive poisoning from a local anesthetic.

Michel V., 48, is admitted to the Polyclinic for an aortic bypass. Like Madame Boussard's, his heart fails shortly after the induction of anesthetic, supervised by the same Dr. Pignard. This time, resuscitation is carried out in Frédéric Péchier's absence. Entrusted to Minjoz Hospital, Michel V. is out of danger.

As was the case three weeks earlier, no immediate toxicological analysis was conducted, which obscured understanding of the problem. The university hospital detected stenosis of a coronary artery in the heart, requiring stent placement. In light of the patient's clinical picture, a recent medical second opinion nevertheless suggested potentially lethal poisoning from a local anesthetic or potassium.

At the Polyclinic, Nicole D.'s case definitely arouses suspicion. This 65-year-old woman is about to be put to sleep for a routine cholecystectomy when she feels a violent pain in her arm and chest. "Help, I'm going to die," she screams, before falling into her artificial sleep. Simple stress, the medical team imagines. But as soon as she is intubated, serious cardiac problems appear. Dr. Péchier has been absent from the premises for a week, and for good reason: in a financial dispute with the institution, he is preparing to return to work at the Saint-Vincent clinic.

After several days in a coma, Nicole D. wakes up. Unable to determine the definitive causes of her EIG, a defibrillator is fitted, transforming the rest of her life into a tunnel of anxiety: the sixty-year-old fears that another cardiac arrest will occur. Dr. Pignard orders the analysis of all medical equipment. In addition to an excessively high dose of potassium, the inexplicable presence of adrenaline in an IV bag leaves one speechless. For the first time, the theory of malice is emerging . The prosecutor is notified, the police are involved and interviews are conducted, without a suspect being identified... Until the indictment, in 2017, of Dr. Péchier.

Back at the Saint-Vincent Clinic. This minor urology operation is just a hiccup for Eric G., a 49-year-old accomplished athlete. Fifty minutes after his induction, however, the patient goes into cardiac arrest requiring the intervention of several doctors, including Dr. Péchier, who is in an adjoining room.

Eric G. survived this strange EIG. The controversial diagnosis of Tako Tsubo was made at the time, but analysis of the sequestrations in 2018 outlined another scenario: a large quantity of lidocaine was detected in a bag supposed to contain only saline solution. Syringes also showed traces of lidocaine, one of which was found, and bupivacacaine, another local anesthetic that was not included in the protocol for this operation.

It should be noted that Eric G.'s anesthesiologist, Dr. Jeangirard, was opposed to Frédéric Péchier's return to the Saint-Vincent clinic. No cardiac ESIs had been reported in the first half of 2009, when Dr. Péchier was practicing at the Polyclinic.

Fate struck again two weeks later. About to undergo surgery for varicose veins, Sylvie G., 41, experienced severe chest pains before fainting. Dr. Péchier, who was in a neighboring room, assisted his colleague, Dr. Humbert, with resuscitation. The patient woke up after three days in a coma at the university hospital, with persistent vision loss and regular migraines.

The hypothesis of Tako Tsubo is favored, although the patient did not appear to experience any anxiety characteristic of this phenomenon. No medical equipment was preserved, but the latest counter-expertise leans towards adrenaline poisoning.

Ulysse B., 61, was only supposed to make a brief visit to Saint-Vincent, as his elbow surgery was minor. However, his heart failed at the end of the procedure, just after a paracetamol bag was inserted and Acupan, a painkiller, was induced. Frédéric Péchier had specifically asked Dr. Arbez to perform this anesthesia. His colleague was taken by surprise by the cardiac arrest, but Dr. Péchier and other practitioners took matters into their own hands and saved the patient. He remained in a coma for four days and suffered psychological after-effects in the form of anxiety disorders.

What happened? In the summer of 2011, no one had a rational explanation. More recent analysis of the sequestrations from this SIG highlights the unexpected presence of lidocaine, in trace amounts in a syringe. This disturbing detail corroborates the hypothesis of the experts called upon by the investigating judge, who favor the illicit injection of a local anesthetic boosted with adrenaline.

Anesthesiologist Arbez is struck by her third SAE: Christian P., who came to remove cancerous liver metastases, loses his footing a few minutes after the first incision. Working in the neighboring operating room, Frédéric Péchier bursts into the room and recommends intralipids, an effective antidote to an overdose of local anesthetics. The 63-year-old patient's heart starts beating again. Ten days of hospitalization later, he is recovered, despite chronic abdominal weakness.

Could the ropivacaine injection via an epidural have caused this SAE? A priori no, the level measured in Christian P.'s blood was normal. Despite the absence of seizure of the bag placed just before the tachycardia, experts are betting on local anesthetic poisoning... Dr. Arbez, affected by this new blow, long regretted not having listened to Frédéric Péchier, who had advised her the day before not to come to work that morning.

Dr. Arbez found himself confronted with a new abnormal situation ten days later when Micheline G.'s heart raced immediately upon induction. This 52-year-old patient, considered fragile, also showed signs of cyanosis. Her resuscitation, which was assisted by Dr. Péchier, who was present in a neighboring operating room, was fortunately a success. With one drawback: the insertion of a catheter in her urethra, which was supposed to resolve her kidney stone problems, could not be performed.

The possibility of a curare allergy was favored, but all the test results came back negative. This case raised questions for the medical community. In 2018, an examination of the fragmentary sequestrations revealed nothing conclusive, with the notable exception of traces of lidocaine in a syringe, even though this local anesthetic was not supposed to have been used. The most recent medical counter-expertise nevertheless opted for adrenaline poisoning.

The time has come for Denise M., 80, to replace her hip prosthesis. The first to be admitted to the orthopedic operating room in the morning, the octogenarian loses a significant amount of blood. Her troubles are only just beginning, since once in the recovery room, a large hematoma catches the nurses' attention... An emergency return to the operating room to resolve a problem that, this time, isn't cardiac.

Although no wound is detected, Denise M.'s abnormally fluid blood continues to flow. It is analyzed: her clotting rate is strangely low. It is decided to administer protamine, an antidote known to regulate the effects of the anticoagulant heparin. It works. But questions perplex the medical team: how could such a dose of heparin, capable of causing serious hemorrhaging, have contaminated Denis M.'s veins? Medical error seems to have been ruled out by the investigations. One alternative remains: malicious intent.

A week later, the scenario repeated itself… Admitted for kidney removal, orchestrated by Dr. Lecuyer under the watchful eye of anesthesiologist Sylvain Serri, Pascal B. returned to the recovery room around 10:50 a.m. His bandage gradually soaked up a significant amount of blood. The alarm was raised in the afternoon. Urgently mobilized, the laboratory quickly concluded: heparin overdose, which must be treated as quickly as possible.

Pascal B. underwent surgery the next day to remove the 1200 ml bag that had appeared in his body. No one understood this case: not the surgeon, the anesthesiologist, or the nurses. Suspecting poisoning, Pascal Bobert finally filed a complaint in March 2017. Six years later, a second medical assessment confirmed the likelihood that he had been injected with a fraudulently contaminated container of heparin.

Monique C., 62, fell asleep at 8:57 a.m. and didn't have time to operate on her scoliosis. While the surgeon was cleaning the area to be incised, her heart stopped working. Without any warning signs. Her anesthesiologist, Dr. Arbez, insisted on continuing a seemingly hopeless 45-minute resuscitation program, which also included Frédéric Péchier, who was in the next room. A winning persistence: transferred to the university hospital, Monique C. survived.

This SAE divided the doctors tasked with finding a cause. The counter-expertise carried out in 2023 identified as the probable cause "an exogenous administration" of potassium and/or local anesthetics, possibly carried by one of the infusion bags used on the patient.

Odile L., 43, lying on her stretcher, waits to be taken to the operating room for uterine removal. But when only an IV bag is inserted, she starts shaking and complaining of chest tightness. Heart problems are assailing her for no reason. Her anesthesiologist, Dr. Biyick, takes matters in hand and stabilizes the situation. Based on the cardiac ultrasound ordered that same day, the rare Tako Tsubo syndrome is suggested. This diagnosis does not at all convince the medical experts contacted in 2023 by the investigating judge, who are leaning toward the administration—out of protocol—of an adrenaline anesthetic.

Questioned by the police in 2019, Odile L. also claims to remember that on January 8, 2015, while she was lying in the reception room, a man in a white coat placed medical equipment at her feet, sliding down with a smile: "that's good stuff." The patient insists it was Dr. Frédéric Péchier. He fiercely denies this.

Even before the incision in his leg, which was suffering from vascular problems, Christian D. suffered a double cardiac arrest seven minutes apart. Prior to the operation and given a complicated schedule, Dr. Péchier had volunteered to sedate this potentially fragile patient, but Dr. Humbert had wanted to remain in control. When everything went off the rails, Frédéric Péchier and others went to Christian D.'s bedside to manage his successful resuscitation. Transferred to the university hospital, the 66-year-old man remained in a coma for a week.

The cause of his SAE remains unclear, although his blue tongue suggests, according to some caregivers, an "adrenaline bolus." The experts at the University Hospital, for their part, do not rule out the possibility of Tako Tsubo, while another considers hypoxic cardiac arrest (due to a lack of oxygen). A medical expert report from 2023 is more affirmative, retaining the scenario of adrenaline intoxication, the only one "that can explain the entire clinical scene."

Wilhem B., only 16 years old, is going to undergo knee arthroscopy. A simple procedure to perform for Dr. Forterre, an experienced surgeon. Shortly after the teenager's anesthetic induction, orchestrated by Dr. Cherreau, high blood pressure, major tachycardia, and dilated pupils appear. His heart problems will eventually subside, despite headaches and vomiting upon waking. The reassuring tests performed while still in the heat of the moment reveal no cardiac abnormalities.

When questioned about this disturbing SAE, her anesthesiologist did not rule out an excess of adrenaline, generated "either naturally or artificially." This is also the opinion of the medical experts mobilized in 2023. According to them, a high dose of adrenaline could have been administered to Wilhem B., notably via his first IV bag or via the initial syringes of Propofol or Sufentanil.

These serial cardiac EIGs spare no age group. Tedy H., 4 years old, is a sad example. Put to sleep for tonsil removal, the little boy quickly develops a sudden ventricular fibrillation… His little heart stops beating. In the pediatric operating room, it's all hands on deck. Dr. Péchier and Dr. Balon-Dole rush to help their colleague, Dr. Cherreau.

Tedy's condition is stable, but fragile. He is sent to the university hospital, where he remains in a coma for two days. This resuscitation is a bittersweet success, as no one is able to explain to his family the origin of the SAE. A civil expert suggests a faulty intubation maneuver. Others wonder if the EMLA patches (local anesthetic) placed on the child could have caused poisoning. Nothing convincing. Traces of lidocaine found in a syringe raise some eyebrows. According to several medical experts, Tedy's clinical picture suggests a massive overdose of potassium or local anesthetic .

The astonishing setbacks of Dr. Serri follow one another. Kévin B., 26 years old, distinguished sportsman, must go through the “clinical” box for a knee ligamentoplasty performed by Dr. Forterre. Ropivacaine is injected locally at the end of the procedure, without any major reaction. Once in the recovery room, and while a Ringer's bag and a Perfalgan bag are placed on him, Kevin B. plunges into the abyss: hypertension, tachycardia, severe heart failure. Dr Serri, reinforced by his colleagues including Dr Péchier, does not understand what is happening.

Kevin B. is holding on despite his 13 days in a coma. He will then remain followed by a cardiologist, as no one can establish the origin of his SAE. The case of young Bardot calls out to the medical community of the Saint-Vincent clinic and the Minjoz University Hospital. A default diagnosis is made: Tako Tsubo syndrome. Rather, everything points to a massive and exogenous intake of adrenaline, although Kevin B.'s treatment protocol makes no mention of it.

On the legal front, everything changed at the beginning of 2017, following Sandra Simard's lumbar arthrodesis operation. As the intervention comes to an end, this 36-year-old mother suffers a cardiac arrest. His anesthesiologist, Dr Balon-Dole, benefits from the express advice of Dr Péchier, who recommends calcium gluconate. A paid choice. Sandra Simard remains between life and death. She will only be out of the woods after five days of coma, at the cost of persistent after-effects: memory problems, concentration problems, chronic fatigue, etc.

Dr. Balon-Dole wants to understand. Encouraged by the University Hospital, she insisted on sequestering all the medical equipment used, Ringer bags included. One of them reveals the macabre key to the enigma: potassium is found in astronomical quantities in the solute, a hundred times the normal dose. The prosecutor is notified by the Regional Health Agency. A police investigation is opened, guided by a new direction: malevolence. Only Dr. Péchier, once suspected, refutes this idea, accusing his colleague, Dr. Balon-Dole, of having tampered with this pocket to hide a hypothetical medical error.

This latest SAE - the only one which directly concerns a patient of Dr Péchier - occurs in a climate weighed down by ongoing suspicions. The Saint-Vincent clinic is under surveillance. Jean-Claude Gandon , 70, underwent surgery for prostate cancer. While no surgery has yet taken place, a nurse spots a pierced infusion bag on the anesthesia cart. Dr. Péchier, feverish, rummages through the drawers and points out two other damaged pockets. Shortly after, Jean-Claude Gandon's heart suddenly gave out. His resuscitation, to which other practitioners contribute, is difficult, but punctuated with success.

Poisoning with local anesthetics was immediately suspected. And extensive analyzes confirm it: high doses of mepivacaine are found in the blood, as well as in a bag of the patient's paracetamol. This local anesthetic was also detected in two syringes thrown into the rubbish bin. The existence of poisoning, first denounced by Frédéric Péchier himself, is beyond doubt. The practitioner claims that someone tried to kill his patient. The police believe, conversely, that Dr Péchier, cornered by the investigation, hastily improvised an “alibi EIG”.