He exhibits many of the traits of serial killers. I suspect that his psychological profile would probably indicate that he aroused by his decisions that are directly responsible for the deaths of people.
He believes he is more intelligent than everyone and exhibits a godlike complex. There are many examples of doctors with this same personality type that were serial murderers.
He hides his murderous lust behind the bureaucratic protection of his role in government where he can carry out his form of killing while believing he is immune from prosecution by the cattle he believes he can so easily kill.
His modus operandi is quite literally using and abusing his bureaucratic authority to make decisions that determine if people live or die. He's able to kill and gratify himself without being caught.
Check out the "you're killing us" protests aimed at him in the 80s. This isn't his first massacre
Yes, not his first rodeo indeed. I suspect he has a history of abuse, probably something in his youth that fostered his psychopathy. He probably got his first taste of murderous gratification as a young resident where he was finally able to unleash his god complex and satisfy his own growing twisted curiosity and blood lust. He probably was highly aroused by his first kill, perhaps an "undesirable" that he didn't believe was worthy of life, where he quietly prescribed the wrong medicine, misdiagnosed a deadly but curable disease, and was able to hide his crime within the protection of the medical bureaucracy.
That's actually a good idea. Look for "angel of death" patterns everywhere he worked, it will be there. Psychos often get caught killing patients they think they can hide as "natural" - it's what attracted them to medicine
I wonder if he had connections to Dr Kavorkian?