Thirty-three Unusual Deaths in Six Years at Psychiatric Services Aargau (Switzerland)

November 6, 2025

Nick strolls through the wintry park at Königsfelden Clinic with its tall trees and old fountain. He looks tired, but somehow also "confident", his father remembers. "Dad, now I really want to get out of this thing," his son told him on that walk in February 2023.

By "this thing", Nick means drugs. He was twenty-two years old at the time and had already tried many things. He started smoking weed in high school, later took various psychotropic drugs and finally snorted synthetic heroin on an irregular basis.

Now a controlled methadone program is supposed to help him. "It was a wonderful moment back then in the clinic park," says his father. "Nick had a great girlfriend and had just been admitted to the University of Zurich to study biomedicine after several semesters abroad. He was looking to the future and was determined to leave drugs behind him." Jane, his mother, also visits Nick that day. Before she leaves, they hold each other in their arms for a long time.

The next morning, Nick is dead. Deceased in the Königsfelden Clinic of the Psychiatric Services Aargau (PDAG).

PDAG is owned by the canton and is one of the largest psychiatric providers in Switzerland with around 6500 inpatients per year. People in serious personal crises receive treatment here. Among other things, around 1200 people with addiction problems are admitted each year. The main Königsfelden site is located in Windisch and, according to the website, offers customized treatment "that is individually tailored to those affected, their illness and life situation".

However, our research shows that not all patients receive optimal care. From 2018 to 2023, there were thirty-three "extraordinary deaths" at the PDAG.

Conversations with the bereaved show what dramas are hidden behind this figure. Over the past few months, we have met several families who have lost a young person at the Königsfelden Clinic. The relatives are only mentioned by their first names in order to protect their privacy. They kept quiet for a long time, but now they want to tell their stories and denounce abuses. "So that something finally changes," they say. "So that no more young people die." Their accounts, conversations with legal and medical experts and the analysis of documents reveal some disturbing conditions.

The clinic declined to speak to the editorial team. In writing, the PDAG stated, among other things: "Every patient death affects us and the treating teams." The thirty-three exceptional deaths should be seen in relation to the more than 34,000 inpatient cases in those years. In addition, an above-average number of serious cases were treated.

According to the PDAG, the thirty-three cases include around ten fatal incidents that are not suicides. These are said to be accidents or medical incidents. As far as is known, the Aargau public prosecutor's office has brought charges in one case and investigations are ongoing in two cases.

Nick's portrait in his parents' house in Aargau

Nick's parents are sitting at the dining table in their house in the canton of Aargau, and the deceased's girlfriend has also come to talk to them. "Many people are not interested in the deaths of mentally ill people or drug addicts. They imagine addicts who inject heroin, for example. But Nick wasn't like that," says Jane about her son.

A large photo of him hangs on the wall, framed in black. Nick looks at the viewer with shining eyes and a cautious smile on his soft features. "He was very lovable," says his girlfriend, "a good-natured person, helpful, with a great sense of humor."

Jane agrees. "Nick loved to make people laugh with little jokes." He often filmed them, the parents, and edited the footage into funny videos. However, the mother also describes her son as quiet and introverted. He was more the sensitive type, never one of the tough guys. This made him an easy victim at school. "He was bullied at elementary school because he was a bit chubby."

Nick starts smoking marijuana in the 8th grade. Over the years, he added alcohol, later also ecstasy and benzodiazepines, and finally, from time to time, pharmaceutical heroin called Diaphin. The drugs affected the young man's psyche. "He lost his drive over time," Jane recalls. "In his last year at school before his A-levels, it was clear that he was depressed. He didn't want to start university straight away. In 2019, he told me that he no longer saw any meaning in life."

It is a disturbing moment for the parents and Nick's sister, who has a close relationship with him. His father works in the finance industry and his mother Jane is a medical director in a pharmaceutical company. They say: "Maybe we were overambitious as parents and put too much pressure on him." At the time, they did not want to tolerate their son taking drugs. "We urged him to stop," says Jane. "That must have been very stressful for him because he thought he was always letting us down."

Nick undergoes various therapies with psychologists. He now receives psychotropic drugs for his depression and anxiety practically all the time. He also obtains Oxycodone, Valium and Temesta on the street. Despite this, he began studying biomedicine in Scotland, met his girlfriend in Zurich in 2021 and discovered a new passion in producing electronic music.

"Of course I noticed that he still took drugs from time to time," says his girlfriend, "but it became less frequent as our relationship progressed." At first, Nick used drugs regularly, but then he managed to stay completely abstinent for several months. Until an incident occurred shortly before Christmas 2022.

Nick travels to St. Moritz with friends for a few days. They consume hard drugs together. One of the young men has to be admitted to hospital as an emergency because he almost dies from an overdose. "It was a wake-up call for Nick," says his father.

After the New Year, the student therefore wants to get off drugs. He visits the Zurich Center for Addiction Medicine Arud, a renowned institution for the treatment of addicts, especially when it comes to opioids such as painkillers or heroin.

Here, Nick wants to undergo opioid agonist therapy (OAT), in which the addictive substances are replaced with medicinal opioids such as methadone or morphine, which are then administered in a controlled setting and, in the best case, slowly discontinued. "The aim is to reduce the patient's craving for opioids and the pressure of addiction," says Professor Philip Bruggmann, Co-Head Physician at Arud, who did not treat Nick himself. Professional dispensing is intended to stabilize those affected and prevent fatal overdoses and infectious diseases caused by street drugs.

Treatment with methadone can save lives

It is a successful concept. According to the Swiss Coordination and Specialist Office for Addiction, around 16,000 people across the country are in an OAT. "It is a harm-reducing measure that has already saved an enormous number of lives," says Bruggmann, adding an important "but": "Of course, there is also a risk of a fatal overdose with methadone. If you are not used to opioids and take too much, it can lead to respiratory arrest." Particular caution is required if drugs such as benzodiazepines are taken at the same time, as these also have a respiratory depressant effect. And not every addicted patient is suitable for therapy.

Nick is therefore thoroughly examined at Arud. If you want to start treatment with methadone, you should already be used to opioids. Experts also speak of tolerance. Opioids break down relatively quickly in the body, so anyone who has not consumed any for a week or longer is no longer used to them. If you were to start treatment with the usual methadone doses in such a case, it could be life-threatening.

There is a simple remedy for this risk: a urine test that proves whether the patient has a tolerance for opioids or not. The Swiss Society for Addiction Medicine therefore requires a corresponding analysis before every OAT. And this is exactly what happens at Arud.

Help with suicidal thoughts

"A urine test is mandatory for us," says Professor Bruggmann. But Nick's analysis came back negative. His last use was too long ago, he has no opioids in his urine, so his body no longer shows any tolerance. The psychiatrist responsible for him at Arud rejects methadone therapy because of the negative urine test.

The twenty-two-year-old is devastated. He wanted to get off drugs with this therapy, but now he is being denied it. Nick has suicidal thoughts - and is taken to Zurich University Hospital due to intoxication, and the following evening to Triemli City Hospital. He is desperate. In Triemli, he rips the infusion out of his arm, his nightgown is full of blood. He wants to get out of the hospital.

But after midnight, he is taken by ambulance to the Königsfelden Clinic in Windisch, where he is placed under compulsory care. There was no room at another clinic in the Zurich area that Nick and his parents would have preferred.

The PDAG serves as a "teaching hospital" for the university

The PDAG's main building from the late 19th century is located in a spacious park and was considered the "most beautiful and best-equipped institution in Switzerland" when it was inaugurated in 1872. Light-flooded corridors instead of barracks-style wards. Today, the Königsfelden Clinic is still one of the largest and most modern psychiatric clinics in the country and serves as a "teaching hospital" for the medical faculty of the University of Zurich, among other things, according to its website.

Nick is given a single room. He feels restless on admission to the clinic and is given a drug that is actually an antipsychotic and is normally used to treat schizophrenia. He is also given Valium. Nick tells his girlfriend that he feels terrible every time he receives the yellowish liquid.

When his mother visits him, she sees that her son has symptoms of paralysis, a rare but severe reaction to the antipsychotic. The doctor in charge gives him an antidote, but it doesn't seem to work and his condition worsens. His sister, who is currently studying abroad, sends him a WhatsApp message that day. "God and a higher power have shown you and me and everyone around you that you will heal and continue to be here on earth with us," she writes, "because you have lived through hell and yet you are still alive. And have learned to laugh despite the pain. And are able to show love and are loved."

The father is shocked when he sees his son the next day. "His head was crooked, he looked like a zombie." As a reaction to the antipsychotic, Nick can no longer walk independently, has difficulty breathing and can't swallow properly.

At some point, the father insists that his son be taken by ambulance to Aarau Cantonal Hospital. There, his condition stabilized within a few hours. A urine test is also carried out at the hospital in Aarau, and again it is negative for opioids. Nick has now not taken any such substances for at least a week.

Because the twenty-two-year-old recovers quickly, he is able to return to Königsfelden the day after next, a Wednesday. But he doesn't really want to stay there. He tells his girlfriend that he is bored and complains that there are hardly any conversations with psychologists.

The parents actually wanted to get to the bottom of the problem and, in addition to treating the drug addiction, to clarify what has been causing Nick psychological stress for so long. The deputy senior physician responsible for him prescribes him a neuroleptic, which is actually used to treat bipolar disorders or schizophrenia, and high doses of the benzodiazepine Temesta, between 5 and 7.5 milligrams per day, due to sleep problems and inner restlessness. Both drugs have a strong sedative effect.

Nick does not want to stay at the Königsfelden clinic

He wants to go home, he doesn't feel any withdrawal symptoms and is determined not to take any more drugs, Nick tells a nurse on Friday. The clinic then convenes a meeting between Nick, his parents, the attending senior physician, a junior doctor and the head nurse. They convince the patient to stay. They offer him the opportunity to start methadone on the same day.

Jane, as a pharmaceutical specialist, asks questions during the conversation, according to her. She is also said to have pointed out that methadone therapy had been rejected by Arud. However, the doctor prescribed a therapy start with a daily dose of 30 milligrams and an additional three reserve doses of 10 milligrams, depending on the patient's condition. This corresponds to the opioid agonist therapy that Nick had previously been refused.

The senior physician does not order a urine test. At the clinic, urine samples can be sent to the laboratory from Monday to Friday, and it takes a few hours for the results to come back. Maybe it was too late on Friday afternoon to get the results. Maybe the doctors didn't think it was necessary. Maybe it was simply forgotten.

At 5.30 pm on this Friday, Nick receives his first methadone dose of 30 milligrams. At around 10 p.m., the nursing staff give him another 10 milligrams from the reserve. He also swallows two and a half tablets of Temesta (6.25 milligrams in total) throughout the day, which have a strong dampening effect.

Everything still seems to be fine with Nick. Unlike other opioids, methadone is broken down slowly and accumulates in the patient's body. If doses are too high or administered frequently, it becomes dangerous from the second day onwards, according to specialist literature and the experts consulted.

The next day, which is Saturday, there is no doctor on the ward who is responsible for Nick. A senior doctor is on background duty. In the morning, Nick is again given 10 milligrams of methadone, Temesta again and another sedative drug. The medical records state: "Always seems asleep on all follow-up rounds afterwards." At 10.47 a.m. it is noted: "Appears calm and adjusted."

At lunchtime, as described at the beginning, the father visits his son. Afterwards, Jane comes for a few hours, they have a good conversation and end up hugging each other tightly. Everything looks like a new beginning. Later that afternoon, Nick is given another 30 milligrams of methadone and half a tablet of Temesta for the second time since midday.

Later, he is allowed to leave the clinic briefly and goes into town with his girlfriend. At first he was more talkative than usual, she says. Nick ordered a lemonade, not alcohol as usual. They told each other how much they loved each other. But then he quickly got tired and wanted to go back to the clinic.

After 9 pm, Nick is given another 10 milligrams of methadone and this time a whole tablet of Temesta (a total of 5 milligrams throughout the day).

He exchanges voice and text messages with his girlfriend on Whatsapp. Nick seems increasingly befuddled.

At 20:58 she writes: «Yeah Baby â�¤ï¸�, loooved seeing you»

He replies with a voice message. He loves her and thanks her for the visit. Some of his words are barely understandable, the sentences sound slurred, he speaks sluggishly, quietly, monotonously.

20:59 She writes: «R u ok? U sound a bit drugged up»

21:02 He: «Yeah, doing fine»

22:41 She: «Gn baby â�¤ï¸�»

22:48 He: «Gn bby â�¤ï¸�â�¤ï¸�»

The next day, a nurse walks through the corridors. It is February 5, 2023, early in the morning. Her job is to check whether the patients at the Center for Addictive Disorders are doing well. In Nick's case, she reports a room check at 7.30 am. The nursing journal states that he was "seen sleeping". It also says that a nurse administered ten milligrams of a neuroleptic drug to him at around eight o'clock. And at 10 a.m., according to the entry, there was another check-up. "His breathing seemed calm and normal," noted a member of staff.

Nick's girlfriend wakes up around this time. She writes to him at 10:11: «Gm â�¤ï¸�â�¤ï¸�»

No answer.

At 11:28 she writes again: «What should we do today?â�¤ï¸�»

No answer.

Jane also writes to her son. But the Whatsapp message doesn't arrive, it remains with a single gray checkmark.

She called the clinic, asked about Nick, but received no information, the mother recalls. So she asked the staff to look in his room because he wasn't answering.

When a nurse enters his room at 12.25 p.m., she finds Nick lifeless in bed. The resuscitation that was immediately initiated was quickly discontinued. He has been dead for hours. A doctor fills out the death certificate and notes: "unnatural death".

After the death, the police are asked to investigate

Jane stares in horror at the police officers who ring her doorbell a little later and tell her that Nick has died. Her husband is standing next to her, white as a sheet. How is this possible? A moment ago they were hugging their son and talking to him about plans for the future. And now he is dead.

The public prosecutor's office in Aargau ordered an autopsy of the body and in the following weeks commissioned the police to carry out an investigation.

Jane and her family are stunned and sad. "Above all, I was ashamed," she tells us in conversation. "I blamed myself for not protecting him." What drove her son into drugs? Did his parents put him under pressure as a teenager with excessive expectations? Were they both working full-time and not there enough for Nick?

In the weeks that followed, they received vague verbal information from the public prosecutor that it was possible that their son had died of a methadone overdose.

Time now passes slowly. Jane sometimes cries for hours. Three months after the death, she and her husband are sitting in the studio of stone sculptor Vittorio Fontanive. There are sculptures everywhere: metal angel figures, stone cats, Jesus on a wooden cross. The parents have the unbearable task of choosing a gravestone for their deceased son. "He would probably have liked a stone with a large angel's wing best," says the mother. "The manager was very empathetic and at one point asked why our son had died so young."

Jane can't answer. She is not prepared to share her son's story with a stranger. Instead, her husband now tells the sculptor that it happened during drug withdrawal at the Königsfelden clinic.

Stone sculptor Fontanive is confronted with death every day. "It's part of life," he says later in conversation with us. "But when it comes to children who have died, it affects me too."

The name Königsfelden makes Fontanive prick up his ears. He remembers that not so long ago, he made a gravestone for another family whose son had also died after a stay in hospital. "That really got to me at the time."

The sculptor sees Jane and her husband's despair. "I suspected that not everything had gone normally with the death." He saw the woman's distress, he says, "it seemed to me that she had a lot of pressure on her chest" and that they felt alone with the pain. "So I told them about the other family affected. And asked if I should make contact."

 And so Jane meets Theo's mother in the summer of 2023. She lost her son in January 2021, after treatment in Königsfelden. He was just eighteen years old.

Theo had an autism spectrum disorder. He was admitted to the clinic because he suffered from obsessive-compulsive disorder. In Königsfelden, he was kept in an isolation room for weeks. As the NZZ am Sonntag later reported, Theo repeatedly threw his head on the floor during his stay. The staff noticed the falls and reported them. But they only reacted when Theo was already unconscious. Shortly afterwards, he died of a severe traumatic brain injury.

We have also spoken to Theo's mother. She does not wish to comment publicly at this time. The canton of Aargau writes in a press release: "Based on a psychiatric expert opinion obtained, the public prosecutor's office assumes that close supervision would have been absolutely necessary in this case." The criminal authorities have brought charges against two doctors at Königsfelden on suspicion of intentional and negligent homicide by omission. Among other things, it is demanding a prison sentence of six years. The trial is due to take place in January. The accused are presumed innocent.

The PDAG did not comment specifically on Theo's case when asked. This is not possible for legal reasons, especially as proceedings are ongoing: "Such proceedings belong in the constitutional framework of court proceedings, where the facts and legal issues can be examined objectively and independently - not in the media public sphere, which makes it difficult to make an objective assessment." According to PDAG's statement, it is assumed that the upcoming court proceedings "will also bring up issues that should somewhat correct the very one-sided picture that has been painted so far".

Nick died of methadone poisoning. Could he still be alive?

A year after Nick's death, Jane and her husband's self-reproach turns to horror and anger. They gain access to the files of the public prosecutor's office. Included is an autopsy report that describes in detail how and why Nick died. The report from the Aargau Institute of Forensic Medicine arouses the parents' suspicion that their son could still be alive.

The coroners state that Nick died without a doubt from methadone poisoning. They put the time of death between 00.50 and 06.25 in the morning. At 7.30 a.m. at the latest. "However, it can be ruled out that Nicholas was still alive at 10.00 a.m.," they write in the autopsy report. The deceased had also suffered a prolonged agony before his death. In other words: Nick fought for his life for an extended period of time in the early hours of the morning until the latest possible time of death at 7.30am.

It can therefore be ruled out that he slept peacefully at 7 a.m., took a drug at around 8 a.m. and was still breathing at 10 a.m., as staff on the ward wrote in the nursing journal. He was dead in bed from at least 7.30 am to 12.25 am, perhaps much longer, without the hospital noticing. Nick didn't eat breakfast or lunch - nobody reacted. And this despite the fact that people who start methadone therapy need to be monitored closely in order to check their condition regularly.

The family also learns from the report about the doses of methadone and benzodiazepines that Nick received at the clinic. The forensic scientists also found a quantity of Valium in his blood that was inexplicable - and a surprisingly high quantity of methadone in relation to the dose administered. They speculate that Nick may have secretly consumed additional methadone, but "a treatment error as a result of a methadone overdose by the doctors treating him" is also "fundamentally possible".

The parents bring in one of the best specialists in this field as a private expert. Zurich doctor André Seidenberg (74) is regarded as a pioneer of Swiss drug policy. In the 1980s, he won the legal and political battle against the cantonal authorities in Zurich over the distribution of syringes to drug addicts. At the time, he was also on Zurich's Platzspitz to provide medical help. In the 1990s, he was co-founder and head doctor of Arud and developed low-threshold methadone treatment and heroin distribution.

Seidenberg analyzed Nick's years of medical history, the nursing journal and the autopsy report. His expert opinion contains three central findings:

Nick was not addicted to opioids at all. Apart from the two negative urine tests in the weeks prior to his stay in the PDAG, there was no evidence of opioid-specific withdrawal symptoms such as sweating, trembling, freezing, wide pupils, motor restlessness and others in the records of previous visits to the doctor and the clinic. According to the nursing report, the patient slept through two nights after his return from Aarau Cantonal Hospital, "which would have been impossible under opioid withdrawal", writes the expert. This should have been readily apparent to "trained and experienced doctors and nursing staff". Although Nick had complained of anxiety and restlessness in the clinic, these were withdrawal symptoms from benzodiazepines and alcohol. Long-term, dependent consumption was recorded in the files for both. "It is possible and, on reading the medical records, seems likely that both the doctors and the nursing staff misinterpreted 'restlessness' as an opioid withdrawal symptom."

Nick was given a dangerous mix of drugs at the clinic. Seidenberg writes that it is not appropriate to speculate about Nick's possible secret consumption because of the post-mortem high methadone level and the Valium found, as was done in the autopsy report. Methadone accumulates strongly in the fatty nerve tissue of the brain in living people. When the nerve cells die, the methadone molecules return to the blood. This so-called redistribution explains the high methadone level of the deceased at his autopsy. In addition, the medically prescribed Temesta slowed down the breakdown and "directly increased the respiratory depressant and sedative effect of methadone". The same applied to another drug that Nick was given. Such interactions are part of the basic knowledge when prescribing such substances, writes Seidenberg. "Every drug prescription system (in a clinic's computer, editor's note) lights up red flags when the substances mentioned are prescribed in combination." Why no warnings appeared in Königsfelden needs to be clarified.

The dose was incorrectly calculated. According to Seidenberg, doctors in a methadone program prescribe a fixed daily dose and additional reserve doses in case the patient shows withdrawal symptoms before the next daily dose. Nick also received such reserves. Seidenberg writes: "The prescription was medically incorrect in this case. Even the first dose of 30 mg is borderline high for an opioid-abstinent person. The prescription of methadone reserves is inadmissible from the outset if withdrawal symptoms are not expected." In addition, there is no reference to the patient's written consent to the treatment actually being carried out (informed consent), according to Seidenberg.

PDAG does not comment on these assessments when asked. The specific case is also not commented on in general, for the same reasons as with Theo. They are bound by patient confidentiality, duties of care under labor law and legal requirements due to pending criminal proceedings.

The parents realize from the private report at the latest that there are serious problems at the clinic. Nick's relatives wonder whether there are other people affected and launch an appeal on Facebook. They are looking for people who have experienced something similar at Königsfelden. Only a few hours passed before Barbara got in touch.

Dominik also wants to get off drugs at the Königsfelden clinic

"When I read the Facebook entry, I only had one thought," says Barbara. "Not again."

She then goes into the attic and opens a wooden chest that has been locked for years. Inside are clothes, pictures and valuables from her late son Dominik. "After his death in November 2017, I put all the memories in the chest to find some kind of closure," she says at a meeting. Jane and Theo's mother are also sitting at the table.

"When I took Dominik's things out of the chest, everything came up again," says Barbara. There is also a blue folder full of files in the wooden box. They document how her son died of a methadone overdose in the Königsfelden clinic at the age of twenty-five. And how his case never came to court despite shortcomings in psychiatry.

Dömu, as everyone called him, was a gifted pupil, his mother recalls. He completed his apprenticeship as a heating engineer with top marks. "At the same time, he messed up a lot as a teenager," says Barbara. "He tried everything: Weed, alcohol, ecstasy, cocaine." He was in a clique for a long time and there was a lot of peer pressure. "We sat together with other parents, tried to influence our children and get them off drugs. But it didn't help."

Dömu's little brother is his closest confidant. He describes him as his protector. "He always intervened when someone wanted to do something bad to me as a child." As young men, the two lived together in a shared flat for a long time and were inseparable. Dömu had phases in which he managed without addictive substances, but always relapsed. "Of course that led to discussions between us," recalls his brother. "I saw that the drugs were harming him. So at some point I told him to go to Königsfelden for rehab. I was afraid for him and didn't want to lose him at some point after an overdose."

Dömu agrees. In November 2017, when he was twenty-five years old, he entered the Königsfelden Clinic.

In contrast to Nick, a urine sample is taken from him, which tests positive for opiates. The doctors start methadone therapy and at the same time give the patient neuroleptics and an antidepressant. And the benzodiazepine Valium.

On the first day of treatment, Dömu receives 50 milligrams of methadone. On the second day, 70 milligrams. On the third, 90.

How is he doing with it? Opinions differ widely on this. According to the caregivers' entries, the patient repeatedly shows withdrawal symptoms, but is "friendly in contact" and appears to be "adapted" - he seems to "have fun" playing UNO. However, a fellow patient, who was later questioned by the Aargau public prosecutor's office, stated that Dömu had "clearly overdosed" on methadone. "He kept nodding off," the witness reports, "he also said that he was high because of the methadone."

On the morning of the fourth day of therapy, the patient is given another 50 milligrams of methadone. Too much for the twenty-five-year-old. A fellow patient alerts the nursing staff in the morning. They find Dömu "hanging over the edge of the bed with his upper body and struggling to breathe", as it says in a report. "Facial color meandered between gray and blue," the employees note. Paramedics had to give the young man artificial respiration and took him by ambulance to Baden Cantonal Hospital (KSB) in a "comatose state".

Dömu is successfully stabilized. He admits to having secretly taken cocaine the previous evening, but no additional opioids. He stays at KSB for less than ten hours before returning to the Königsfelden clinic. According to a roommate, Dömu is not really feeling any better. "I thought he looked like he did when he first came to the hospital," the fellow patient later told the public prosecutor. After midnight, he said, he heard Dömu say: "I don't like it anymore, I don't like it anymore."

Around seven, Dömu is dead - because of too much methadone

The planned methadone dose for the next day is reduced. The doctor in charge also orders regular checks on the patient. But there are no frequent checks. A nurse, who takes over the night shift after Dömus returns from hospital, checks his vital functions at around 1.30 am that night. According to the records, the next visual check in the room did not take place until 5.09 a.m. - the patient appeared to be asleep, the nurse noted.

Around 7 o'clock, Dömu lies dead in his bed.

Barbara is just about to go to the clinic to visit her son when two police officers arrive at the front door "to deliver some sad news", as the mother says.

A doctor inspects the lifeless body at the clinic and reports that "it is almost certain that the cause of death was natural". However, the forensic medical examination came to a different conclusion: according to it, the death was a "consequence of methadone intoxication". The blood levels are high. The chosen treatment regimen for methadone "clearly deviates from the recommendations of the Swiss Society for Addiction Medicine". A breach of the doctor's duty of care could "neither be confirmed nor ruled out with certainty."

The authorities commission an expert report. According to the expert from the University Psychiatric Clinics Basel, "the overdose of methadone appears to be the cause of death". The expert speculates that Dömu may have secretly consumed additional methadone. But it is also possible that the clinic administered even more methadone than was documented in the system.

The expert judged the 90 milligrams of methadone on the third day, which was properly reported, to be "risky" but not a gross professional error. However, it would have been imperative to ensure close monitoring of the patient. "He should not be alone."

A nurse who was responsible at the time stated in a later interrogation: "The hourly checks are not done to the minute." He continued: "We don't have an alarm clock." In fact, Dömu lay in his room for hours without being monitored by carers, as the files show.

The public prosecutor's office orders another expert opinion, this time directly from Aarau Cantonal Hospital, which is closely networked with the PDAG. They say that the patient could perhaps have been saved in time if his vital signs had been monitored continuously and he had been spoken to regularly. "However, this requires appropriate equipment and trained personnel."

It must also be assumed that Dömu "took methadone independently and without consulting a doctor shortly before his death and suffered a fatal overdose as a result", it is now suddenly stated. Not the clinic, but the patient is said to be to blame.

The public prosecutor closed the case in January 2019. He describes the checks on the ward as "inadequate", but not as the cause of death.

The public prosecutor wants to talk to Königsfelden

For the mother, the decision is hard to take because she does not believe that Dömu secretly took additional methadone. But she doesn't want to contest the decision. "We had no money for it. We were exhausted and didn't want to fight anymore."

So the family put their memories of Dömu in a chest and left them there for years.

Back then, in 2019, Barbara had only one hope: after the case was dropped, the public prosecutor wrote a letter, which is available to this editorial team. In it, he announced that he would talk to the clinic. Because he "considered the methadone dose administered to be too high" and because it was "incomprehensible that the staff allegedly did not carry out the prescribed night checks due to a lack of time".

Dömus' mother has long hoped that such a conversation with the clinic would lead to improvements. But now she is sitting at the table with Jane, who has lost her son Nick, and with Theo's mother, who has suffered the same fate. Because it happened again. Because Nick was again prescribed high doses of methadone, at least according to the accusation, and the monitoring of the patient was inadequate.

According to the PDAG, the conversation took place with the public prosecutor. "As the medical specialists involved at the time have no longer been employed by PDAG for some time, we are unable to go into detail about the medical aspects," they said on request. "However, we can state that PDAG complies with the internationally and nationally applicable guidelines and recommendations and that processes are adapted accordingly where necessary." PDAG did not answer any further questions about Dömu's case.

Adrian Schuler from the public prosecutor's office in Aargau states: "All allegations and issues were comprehensively clarified in the proceedings at the time." The discontinuation of the proceedings was not contested. "Against this background, we do not consider it expedient to reopen the questions that have already been answered in criminal proceedings that have become legally binding." Possible responsibility on the part of employees has been investigated. "There were no grounds for suspicion in this regard," says Schuler.

Dömu's helpless family is left behind. His relatives are still wondering where the evidence is that he secretly consumed additional methadone in the clinic. The deceased's brother still reproaches himself years after the death. "I had advised him to go to rehab in Königsfelden so that he wouldn't die of an overdose," he says. But the thought that this is exactly what happened there is almost unbearable. "He was always there for me. His death broke something inside me forever."

For Barbara, too, it is extremely upsetting every time the memories come up. "When I talk about Dömu, I sometimes can't sleep for days. But now I want to talk," she says to the other two mothers at the table. "So that the clinic finally admits its mistakes and improves."

Thirty-three extraordinary deaths in six years.

The canton of Aargau, i.e. the owner of PDAG, is aware of this figure, but apparently does not consider itself responsible. The general care situation for patients in the PDAG is "considered to be good overall", according to the government council's response to an interpellation. "The hospitals themselves are primarily responsible for ensuring quality; the same applies accordingly to the Aargau Psychiatric Services."

On request, PDAG wrote: "Our employees give their best every day for the benefit of our patients. Nevertheless, we are aware that not everything is always satisfactory in day-to-day treatment. But we take all feedback very seriously." This is why PDAG is constantly developing in terms of organization, processes and personnel. Specific measures have been taken in recent years, such as a concept for dealing with self-harm as well as self-harm and endangerment of others. "As a treatment team, we also have an interest in learning from what has happened and implementing any improvement measures."

The investigation into Nick's case continues. Research shows that the deputy senior physician, who did not have a urine test done and prescribed the various sedating drugs, did not have a diploma that could be recognized in Switzerland. The doctor had come to Königsfelden from Kosovo soon after completing her studies. After three and a half years as a junior doctor, she was promoted to deputy senior physician.

She is currently a defendant in the investigation by the Aargau public prosecutor's office on suspicion of involuntary manslaughter. She is presumed innocent. She has so far refused to make a statement to the criminal authorities. Her lawyer told this editorial team that his client acted conscientiously and carefully at all times. "We are convinced that the investigation against her will either be dropped or end with an acquittal in court."

All that remains for the bereaved are mementos, like this cap from Nick with his pin collection.

Jane and her husband appear as private plaintiffs in the criminal proceedings. They are questioned by a constable from the Aargau police on behalf of the public prosecutor's office. They want answers, but they don't get them.

The nurses who were responsible for Nick did not comment during the interrogation or said that others had carried out the check-ups. However, the head doctor at the Center for Addictive Disorders in Königsfelden did provide information. The constable questioned her for nine hours in his office in Baden in September 2024. She is not responsible, says the head physician, as responsibility for the patients lies with the senior doctors and nursing staff. She only visits the ward once a month. She did not comment to this editorial team.

The parents follow with excitement as the constable continues to ask questions. He wants information about the morning Nick died. He wants to know why there were entries about check-ups in the care report even though the patient had long since died. The chief physician replies that she can't explain this either.

"That made me really angry," says Jane. She was even angrier that the head doctor answered "no" to the police officer's question as to whether any conclusions had been drawn within the hospital about the death.

It was this moment that prompted the parents of the deceased to go public. "This statement shocked me," says Jane, "because it shows that the clinic is carrying on in exactly the same way. If we keep quiet, it could happen again."

Source: Catherine Boss, Roland Gamp, “Death in psychiatry: He lay lifeless in the hospital bed all morning - and nobody noticed,” Das Magazin, October 18, 2025 (translated from original German language article: https://www.tagesanzeiger.ch/pdag-koenigsfelden-tod-nach-methadon-therapie-im-aargau-920659249815)