A French doctor has been arrested on suspicion of poisoning over 50 patients in order to impress his colleagues by stepping in at the last moment to “save” them, according to prosecutors who likened him to a “pyromaniac fireman.”

Anesthesiologist Frederic Pechier has been taken into custody in connection with 42 “serious adverse events,” including 20 deaths that happened on his watch during the 17 years he worked at clinics and hospitals in Besancon, eastern France. He was already indicted in seven other cases, two of which involved fatalities, in 2017.

Prosecutors claim Pechier tampered with anesthesia pouches used by colleagues for otherwise routine operations. This caused patients to have cardiac arrests, giving the doctor a chance to swoop in at the last minute and rescue them, gaining him the respect of his fellow doctors and the admiration of his victims, it is alleged. If true, the scheme appears to have worked – his peers reportedly considered him a “brilliant” anesthesiologist.

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Pechier was placed under “judicial supervision” after the initial charges were brought against him in May 2017. He was accused of poisoning seven patients between 2008 and 2017 at two different clinics. Investigators said two of the dead patients had potassium levels five times the lethal dose in their blood.

The scope of the investigation was since expanded and some 50 similar cases were identified, the prosecution told the French media. At least four patients who died at a clinic where Pechier worked had similar traces of potassium, an exhumation of their bodies found in December. Pechier was detained for questioning about these new allegations on Tuesday.

“If these cases of poisoning are proven, he would be one of the biggest serial killers in the history of France,” said Me Berna, lawyer for several of the victims.

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The anesthesiologist insists that he is innocent, saying that he was called for consultation in difficult cases because of his talent and skill, and is now being vilified for it. His defense team argue that the forensic evidence against Pechier is questionable, since potassium levels can rise naturally in a dead body.

The doctor was banned from practicing medicine after the 2017 indictment, with a petition to allow him to work as a consultant rejected by the judge. This put him on the verge of bankruptcy, his lawyers say, effectively punishing him for a crime that has yet to stand the test of a trial.

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