Listener discretion is advised. This episode features discussions of murder, medical malpractice, mental health conditions and assault that may be upsetting. We advise extreme caution for listeners under 13.

The nursing staff is the lifeblood of a hospital, while doctors might decide on their patients treatments, is often a nurse responsible for executing that decision. They give injections, monitor life support equipment and keep meticulous records of each patient's condition. In some cases, the nursing staff decides which patient gets a bed first. And when medication is administered, one group of Australian nursing staff workers even ended up deciding who lived and who died.

This is Medical Matters, a Spotify original from podcast, every year, thousands of medical students take the Hippocratic Oath. It boils down to do no harm. But a closer look reveals a phrase much more interesting. I must not play at God. However, some doctors break that oath. They choose to play God with their patients, deciding who lives and who dies each week on medical murders.

We'll investigate these doctors, nurses and medical professionals. We'll explore the specifics of how medical killers operate not just on their patients but within their own minds, examining the psychology and neurology behind heartless medical killers. I'm Alastair Madden and I'm joined by Dr. David Kipa, M.D..

Hello, everyone. I'm Dr. Kipper, and looking forward to assisting Alischa with some medical insight about our next murder. A Story of the Lights Angels.

You can find episodes of medical murders and all other podcast shows for free on Spotify or wherever you listen to podcasts to stream medical murders for free on Spotify. Just open the app and type medical murders in the search bar. This episode we're discussing the lights, Angels of Death, a group of four nurses AIDS in 1980s Austria. Over the course of six years, the AIDS quietly murdered at least 20 patients in their care, but are suspected of killing dozens more.

And their method was brutal.

All this and more coming up. Stay with us. Waltraud Ragna always thought of herself as a caregiver, the young Austrian spent her early years taking care of her younger siblings on their rural farm while their mother worked watching them, feeding them and cleaning up after them. Then when she was 12, she was also tasked with taking care of her ailing grandmother, who couldn't walk due to open source on her legs. Those experiences stuck with her as she grew up.

Wagner knew she wanted to continue on the path of healing and become a nurse. But when she became an adult, she hit a wall. She enrolled in a nursing program but failed out before she was able to get her degree by nineteen eighty two. She had moved to Vienna, hoping to find more opportunities, unfortunately, without the proper education. Twenty two year old Wagner wasn't able to find a job as a nurse. However, she managed to get a job as a nurse's aide.

Despite the similarity in title, nurses and nurses aides have very different responsibilities in areas of expertise to become a nurse, someone must first complete a two to four year science based nursing program from an accredited school. It's a more difficult curriculum. There's obviously a deeper dive into the physiology and anatomy.

And because of that, the responsibilities are greater. Not only does this education prepare them for the medical aspects of nursing. It also emphasizes teamwork, communication, leadership and empathy. Once they have their degree and license, they enter a residency program that typically last six to 12 months on the job.

Nurses have responsibilities that include monitoring patient health, administering medications and treatments, performing diagnostic tests and operating medical equipment.

Nurse's aides are required to have a high school diploma and must complete a four to 12 week accredited nursing assistant program. Their job is to assist by alleviating a nurse's workload, and they do this by helping patients with daily activities like eating, using the bathroom and ambulating. The nurse's aide job offered Waltraud Wagner what she wanted most to take care of patients in a real hospital, even better for Wagner, her job was at one of the biggest and most respected hospitals in the city.

Lights, general hospital lights general had a sprawling state of the art campus in southwest Vienna. The hospital grounds were covered in manicured gardens and greenery. Its eight separate wings were charmingly called Pavilion's. Zarganar was assigned to Pavilion five, the section dedicated to the most difficult cases. Patients sent to Pavilion five were often elderly, terminally ill or suffered from mental health conditions requiring special attention from the nursing staff. Many hospital workers considered Pavilion five the worst assignment. Adeline's general and within Pavilion five, Ward D was the worst of the worst.

It was known as the death ward. It was where the most hopeless cases went. People who had suffered strokes were in comas or were bedridden and nearing the end. To make matters worse, Pavilion five was also the only internal medicine department that was not allowed to turn anyone away, even if it was full. Though there were only 29 beds in Ward, it often had to accommodate over 40 patients on top of the difficult patients and overcrowding. The ward was also perpetually understaffed.

The nurse's aides in particular were given the hardest and most demanding work from cleaning the patients nightly to wiping blood and other filth off the beds after a patient died, which was, unfortunately, often amid this chaos, Waltraud Vulcano was assigned the graveyard shift.

On these late night shifts, nurse's aides were often required to perform tasks that went beyond their normal responsibilities, including giving injections, the exhausted doctors on duty sometimes slept through their shift and were only awakened in cases of emergencies.

Wagner was quickly overwhelmed by her job, but she tried to make the best of her assignment and earned a reputation for being a hard worker. She was also well-liked among the other nurses and aides who described her as upbeat and charming. But the work and conditions in Wardah affected her significantly. Each morning, she would leave the hospital mentally and physically exhausted.

She was so affected by what she had experienced that she'd often vomit as soon as she got home. Working with terminal patients can cause some real emotional problems for nurses and other health care workers, seeing death and suffering is naturally distressing and the exposure to this is constant if you're working in a terminal ward.

As a result, professionals in these settings may develop depression, anxiety and PTSD or post-traumatic stress disorder. This can, in turn, lead to a host of resulting problems like insomnia, agitation and obsessive thoughts and rumination. It's also possible to develop compassion fatigue, which is when caretakers experience a burnout or diminished empathy towards their patients. Doctors and nurses in terminal wards who are experiencing any negative emotional backlash should seek therapy, talk about their issues with trusted friends or loved ones, and try to reframe what they're going through at work.

It's very hard for health care workers to know how they'll react to traumatic work environments until they've already suffered the consequences. So it's important for them to regularly keep tabs on their emotions and feelings.

Fogginess, own relationship to death and suffering was also permanently shifted by her work in Ward D, her responsibility to her patients likely began to feel like an exercise in futility with one inevitable outcome death. No matter how much care she gave her patients, they died. After all, that's why they were in that particular ward. Perhaps viognier began to see that death was a relief, both for the suffering patient and for herself. She understood her job was to simply wait for the sick to die.

So Virgona decided to expedite the process. In 1983, during her second year in the ward, Viognier was helping care for a 77 year old woman who was in terrible pain. The medication that the doctors had given her to help her sleep wasn't working, and her suffering lingered, allegedly.

The woman told Viognier she wanted to die. Although Vergano was desensitized to death, killing a patient, even at their request was crossing a major line, both legally and ethically. At the time, euthanasia was illegal in Austria, but it didn't stop Virgona from overdosing this patient with Rohypnol. Euthanasia is a hotly debated topic, and the first countries to legalize it were the Netherlands in 2001 and Belgium in 2002. There are a lot of people that, for whatever reason, don't want to continue living given their medical situation or the psychological impact that situation has on them or their family.

So it's a pretty wide landscape of why people choose this option. For this ending of life to be approved, a patient must be diagnosed with six months or less to live by a specialist. They also have to go through a long formal interview with a licensed physician who's willing to participate in this process. In addition, a second interview must be conducted a month later in order to confirm the decision. Understandably, some doctors don't support this kind of medical intervention, and this often stems from personal morality or religious beliefs.

Others don't support it because it directly violates the Hippocratic Oath, which explicitly prohibits euthanasia and the administration or assisted use of lethal medicine. However, in relation to our story, Valtierra definitely wasn't taking any of these things into account when she used a fatal amount of drugs to kill this woman.

As vile child, Varg now watch the woman slowly wither away from an overdose of Rohypnol, it would appear that she didn't feel sad or upset by what she'd done. Instead, she seemed to experience the opposite feeling a sudden rush of adrenaline. Killing her patient didn't make her feel guilty. It made her feel powerful.

For a brief moment, Child Wagner had command over the chaos of war. Maybe she loved the sensation of playing God, the ability to decide who lived and who died. Wagner justified her decision to kill because the patient had requested it. But wielding the power of death gave her a sense of control.

And now she wanted more.

After the patient died, Varona reported it to the doctors, none of them batted an eye, a death on board was business as usual. There was no need to examine the woman or check her blood for fatal levels of medication. Virgona had gotten away with murder and she was already thinking about how to experience that rush of power. Once more, she wanted to kill again and as soon as possible. Coming up, Volkskrant child Wagner tries a new method of murder and finds accomplices to help her.

Now back to the story.

In 1983, 23 year old nurse's aide Waltraud Wagner gave a fatal overdose of medication to a terminally ill patient at Lyness General Hospital in Vienna.

After this first murder, Wagner discovered just how much she enjoyed being the arbiter of death in her ward.

Wagner seemed to love the power that she felt as she watched her patient die.

And she wanted to experience that sensation again, but she didn't want to do it alone.

Over the next few years, Wagner recruited three of her closest friends on the ward to join her murderous crusade. All of them were nurses aides. But 19 year old nursing school dropouts Maria Gruber and 21 year old Irene laid off came from large families similar to Wagner's, and they were burned out by their time in Ward.

Wagner's third accomplice, 43 year old Stephanie Amaia was a Yugoslavian immigrant who is eager to make friends with the younger AIDS when she discovered what Wagner and her friends were doing. She joined in to be a part of the group in addition to their stressful work environment.

Each of the aides had their own issues at home. Stephanie Amaia was a recent divorcee. Maria Gruber was a single mother working strenuous hours. Irene laid off, was stuck in a potentially abusive marriage, and she avoided going home as much as possible. All of them felt trapped and powerless by their brutal jobs and their difficult home lives. Wagner offered them a way to exercise what little power they had at work and take control of their otherwise chaotic lives.

Wagner was persuasive.

She argued that euthanizing ill patients who were in great pain was a merciful act. She convinced them that it was the right thing to do. Of course, it also helped that fewer patients would also make their work in wards easier. A new balance of power and lighter workload intrigued all three women. After all, they'd also spent years working in wards and struggling with difficult patients and stressful overcrowding. So Gruber laid off and Meyer agreed to kill. Now, Viognier had a team and she was their leader.

Virginia gave her new accomplices a tutorial in euthenasia, showing them how to inject patients with Rohypnol, morphine, insulin and tranquilizers.

They used drugs that wouldn't cause any extremely unusual symptoms.

As we've learned from previous episodes, an insulin overdose could result in death caused by severely low blood sugar. We also know that morphine is a very strong opiate and can cause death by shutting down heart and respiratory function. This leaves us with Rohypnol, a medication we haven't yet discussed. Rohypnol is a benzodiazepine or benzo, which is a type of tranquilizer. Tranquilizers are central nervous system depressants and like opiates, they activate the parasympathetic nervous system, which slows everything down in the body.

If taken at a high enough dose, tranquilizers stop heart function and respiration, which is fatal without immediate intervention. Keep in mind these were all terminal cases on this ward, and depending on a patient's specific ailment, any one of these medications could have induced a natural looking death. It's not surprising that these murders didn't attract suspicion.

The method that was used was quick, simple and effective. She and her accomplices were able to kill as many patients as they wanted using drug injections, and the doctors and hospital administrators were none the wiser. After all, the drugs were normal medications, albeit in fatal doses. And nobody blinked at patients dying in the notorious death ward after their first murders. Varner's accomplices also understood just how empowering it felt to end their patients lives. Perhaps the act of killing let them reclaim some small amount of authority inside Wardi.

Their actions could lead one to believe that the three other AIDS also came to love the feeling of power in deciding a patient's fate. So they began to take interest in more and more patients care. But the treatments they often administered was death.

The nurse's aides told themselves that they were motivated by mercy, but that reasoning became weaker and weaker over time.

Soon, they were no longer pretending to have their patients best interests at heart. Instead, it appears they began killing any patients who caused problems or made their lives difficult in any minor way.

If a patient buzzed the nurses station too many times during the night, Zarganar would turn to her accomplices and according to court testimony, tell them that it was time for the patient to get a ticket to God. According to some reports, she would put the patient's name on a to do list to be taken care of the very next night. Among themselves, they allegedly referred to this as termination.

Overusing the call button wasn't the only reason a patient could end up on Varner's termination list. She also targeted patients who soiled their bed, failed to take their medications, snore too loud, complain too often, or simply annoyed the nursing staff. Of course, nearly all the patients sent to Ward fit those criteria at some point. So Varg now always had a long termination list. At one point, the AIDS might have been killing a patient every few weeks.

But as the years passed and her body count increased to double digits, Waltraud Viognier began to get bored with her own murderous methods.

Like an adrenaline junkie needing a new fix, injecting patients with lethal doses of drugs was beginning to lose its excitement. She wanted to find a new way to kill.

So in the mid 1980s, after a few years and maybe a dozen victims, Wagner and her accomplices created a new technique for killing patients, one that was more elaborate and more painful for their victims. The method required three nurse's aides working together, one would pinch the nose of the patient, one would hold down the patient's tongue, and the last would pour water down the patient's throat until they drowned. They called it the water cure. This method was difficult to detect in terminal patients after they died, Waterkeeper torture has been around for centuries and could cause death by drowning or water poisoning, also known as over hydration, as large quantities of water are poured down someone's throat.

The victim has to keep swallowing in order to avoid drowning. In other words, they need to keep gulping down water to avoid inhaling it over. Hydration alone can also be deadly. As such, a large water intake in a condensed time frame can fatally imbalanced electrolyte levels in the body, causing brain and heart functioning to cease. This can be a relatively quick or drawn out method of killing someone depending on the physical health of the victim and the amount of water poured to time ratio.

In this case, the victims were all experiencing health complications, and the four nurse's aides most likely worked as quickly as possible to avoid being caught. Given these factors, it's likely that each killing took less than 30 minutes, these deaths would also have been relatively easy to cover up. And this is because the victims inevitably ended up inhaling some water into their lungs. This would have looked like pulmonary edema or a buildup of fluid in the lungs, which is pretty common in elderly people with underlying heart conditions.

Because of this, these deaths would have probably look normal to licensed general doctors at the time.

Over time, Waltraud Varner and her accomplices perfected their water cure method and likely killed dozens of patients in Ward over the next few years when they held down a patient and watched them die. The AIDS experienced a far greater rush than injecting patients with an overdose. The water cure became the AIDS primary method for killing.

To the other doctors and nurses, the higher mortality rate of Wardi was noticeable, but not surprising, though the death rates also fluctuated wildly between shifts. The supervisors of the hospital didn't examine the deaths for any patterns. Nobody noticed that there were many more deaths when certain staff members were on duty, specifically Ragna and fellow killers.

For five years, the four women were able to kill patients without anyone noticing, and according to some estimates, it's possible they accumulated nearly 50 victims.

But by 1988, as their murder spree was entering its sixth year, the high death rate finally attracted some attention. Other workers in the hospital questioned the sheer number of bodies being wheeled out of war dead and rumors began to circulate about possible foul play, but no one inside the hospital was willing to look any closer until another nurse's aide voiced her concerns to a doctor in Pavillion five at some point. The police also became aware of the rumors and attempted to begin an investigation.

But the administration at Licensed General Hospital didn't take kindly to the accusations of medical malpractice. The department's head doctor stonewalled the police and refused to let them investigate, assuring them that there was nothing abnormal happening on his watch. The investigation soon fizzled out and likely left the four women feeling even more powerful than before. It seems they were impervious to suspicion. They were confident that nobody would ever bother searching the death ward for a killer.

But this belief made them reckless. In February of 1989, the four women went to a pub near the hospital after their shift ended after a few drinks. The four nurses aides loudly discuss the events of their shift. The most memorable moments of the day, of course, was the termination of another patient, an elderly woman named Julia, droppable after six years of getting away with murder.

The aides felt invincible since the thwarted investigation. They'd allegedly killed as many as 22 more patients drunk on power. They didn't bother being discreet. They knew they would never be caught. So why not talk about their power and deadly achievements?

But the women didn't realise they were seated only a few feet away from a doctor who worked at Licensed General Hospital. The doctor listened in shock as the nurses aides recounted exactly how they'd killed Julia Drupal with the water cure. They described holding her down and pouring water down her throat and laughed about the expression on Japan's face as she died. After he'd heard enough, the doctor shakily left the pub and went right to the police.

He told them they had gotten it wrong. Those months before there wasn't a murderer inside Ward. There were four of them. Coming up, the lines angels of death are brought to justice. Now back to the story.

By nineteen eighty nine, the four killer nurses aides of General Hospital, 30 year old Waltraud Bogner, 27 year old Irene laid off 25 year old Maria Gruber and 50 year old Stephanie Amaia was certain that their crimes would never be discovered. The nurse's aides had been killing any patient they chose for six years and had never faced any real scrutiny. They were so confident that they had no problem with going to a local bar and loudly discussing their most recent murder.

They believed they were untouchable and they were dead wrong after the doctor overheard their inadvertent confessions to murder. The police spent two months gathering evidence of murders in Ward D. Then on April 7th, 1989, the police arrested all four women at the police station. The four accused murderers were split up and interrogated separately. The investigators had the statement by the doctor, but much of their evidence was circumstantial. To convict the women, they needed confessions. The police confronted each woman with names and pictures of patients who died under their watch over the past six years.

After a few days of questioning, the women began to confess. One by one, Mayer gave the police a description of their water cure method. Gruber and laid off confessed to killing patients with injections of Rohypnol and morphine, and all three of them pointed to Waltraud Wagner as their ringleader. When faced with the confessions of the others, Wagner didn't try to claim innocence. She calmly admitted what she'd done. The police presented Wagner with a list of all patient deaths in Ward over the previous two years and asked her to identify each of her victims.

Faulkner was quick to identify 39 patients as her victims. In each case, Wagner was allegedly able to recount the exact method she used to terminate each patient.

The investigators were startled by Wagner's precise memory and the strange, remorseless demeanor she displayed while describing how she murdered dozens of people. When asked why she kept killing, she shrugged and said that it became a habit. One of the investigators asked Wagner how she could remember each of her killings in such detail. Wagner winked and replied, You'd remember something like this.

When asked why she killed so many of her own patients, Wagner candidly replied that the ones who got on her nerves were given a free bed with the good Lord.

The news of the nurse's AIDS arrests and subsequent confessions sparked massive outrage in Austria lines, General Hospital faced intense scrutiny. The supervisor of Pavilion five who prevented the investigation the previous year was suspended. Days after the arrests, the police blamed Lights General Hospital for putting up a wall of silence that prevented a full investigation in 1988. If that investigation had been allowed to continue. Local media reported it could have saved the lives of 22 patients who died at the nurse's AIDS hands in the last year.

When investigators looked into Wardi, they found numerous red flags that the hospital had ignored. The death rate spiked to five or six times the normal rate when Waltraud Wagner was working shifts. Wagner's floor also administered nearly 20 500 ampules of the drug Rohypnol. Between 1983 and 1987, the normal usage was less than 300 ampules. The true number of murders committed by the four women remains a mystery. After the arrests, they initially confessed to a combined 49 killings.

But it's suspected by some that the real death toll could be as high as 300.

The trial of Voltron, Bogner and the other three nurses aides began in 1991, it was one of the highest profile trials in the history of modern Australia. Given the confessions, the only real question was how many they had murdered and who was the most responsible. The focus landed solely on Waltraud Varno.

The other three nurses aides blamed Varona for pressuring them into murder, using her domineering and intimidating personality. Stephanie Amaia added that Varner's nickname in Wardi was the witch.

Bogner tried to fight back, accusing the others of being just as involved in the killings as she was, she hit back at Miah, testifying that Meyer appeared to enjoy holding down the patients as they died. Faulkner also withdrew her initial confession, taking responsibility for only nine deaths rather than the 39 she initially claimed. But it was too little, too late. The image of her as the evil ringleader stuc.

At trial, each of the nurse's aides defended themselves with the same argument, they were motivated by mercy. They claimed that each of their victims was suffering and they simply provided the ultimate form of care by killing them.

Unlike the 1980s, passive euthanasia is legal in Austria today, though under very strict regulations and only allowed under certain circumstances. Passive euthanasia refers to stopping any treatment necessary to keep a patient alive. These four nurses aides certainly weren't withholding any treatment to stop their patients suffering. Conversely, they were actively ending lives with medications and other twisted novel methods like their so-called water cure. Some of these killing techniques were probably even more agonizing and horrendous than the pain their victims were already experiencing.

In contrast to passive euthanasia, active euthanasia relates to the administration and use of a lethal agent or medication.

However, these women were not engaged in this either, as euthanasia itself, passive or active, is only legal and legitimate in very particular situations. These four were really nothing more than cold blooded killers. If they were truly motivated to ease the anguish of their patients, they should have brought their concerns to the supervising nurses.

Nurses aides aren't qualified to make decisions regarding a patient's treatment or well-being anyway.

The right thing to do here would have been to turn to a more qualified health care professional for help.

Their collective claim of being motivated by mercy really doesn't make any sense. These murders were not in any way ethical or defensible acts.

The nurse's aides claims of mercy killing didn't convince the court full around. Volgin was convicted of 15 murders and sentenced to life in prison. Irene laid off, was convicted of five murders and also received life in prison. Stephanie Meyer had successfully convinced the court that she was intimidated by Faulkner and was convicted of lesser charges, accessory to attempted murder and manslaughter. She was sentenced to 20 years in prison. Maria Gruber judged less harshly due to her young age when the crimes began, was ultimately sentenced to 15 years in prison.

In the Austrian justice system, a sentence of life in prison doesn't really mean what it claims. After 15 years, if the courts determine the prisoner poses no danger to others, they can be released on parole. Maria Gruber and Stephanie OMYA were released in 2003 after 12 years in prison. Voltron, Virgona and Irene Leidel were both released in 2008 after just under 18. The release of the four nurses aides caused widespread anger in Austria. Many questioned the wisdom of a prison system that only held convicted mass murderers for 15 years.

The nurses say it's ironically benefited from a merciful Austrian justice system on a very basic level. This is another case that illustrates the problems associated with hospital overcrowding. If licensed general had more staff and resource to accommodate the overabundance of patients in Ward D.

Nurses probably wouldn't be burnt out to the point that they were having nurse's aides give injections and other duties beyond their level of training. More resource and more manageable workload also increase hospital staff morale and decreases personal stress. Who knows, maybe these nurse's aides would have thought twice before joining foreigners game if working conditions weren't as taxing, although their behavior was completely inexcusable. This story illustrates how medical workers like the lights angels lost all sense of right and wrong in an extreme environment like Ward D and how a flawed health care system enabled their sinister activity after their release from prison.

Waltraud Child Ragna, Irene Leidel, Maria Gruber and Stephanie Amaia were all given new identities by the Austrian government, allowing them to live quiet, anonymous lives. Today, somewhere in Austria, each of the four former nurse's aides likely have neighbors, friends and co-workers who have no idea that the friendly woman they know was once an angel of death. Thanks for listening to medical matters and thanks again to Dr. Kipa for joining me today. Thanks so much.

You can find all episodes of medical murders and all other PARCA shows for free on Spotify, not only to Spotify. Already have all of your favorite music, but now Spotify is making it easy for you to enjoy all of your favorite podcast shows like Medical Murders for Free from your phone, desktop or Smart Speaker to stream medical matters on Spotify. Just open the app and type medical murders in the search bar. We'll see you next time. Medical Murders is a Spotify original from podcast.

It is executive produced by Max Cutler, Sound Design by Trent Williamson with production assistance by Ron Shapiro, Carly Madden, Kristen Acevedo, Jonathan Cohen, Alexandra Trick Delta and Bruce Kaktovik. This episode of Medical Matters was written by Ryan Lee with Writing Assistants by Maggie Admi, Fact Checking by Bennett Logan and research by Chelsea Wood. Medical murder stars Dr. David Kipa and Alastair Murden.