He was deputy director of the
Sonnenstein Clinic from 1913 to 1918 and director of the institution from 1928 to 1939. In 1940, he became deputy director of the
Action T4 Medical Office (German:
Medizinische Abteilung) under
Werner Heyde, which had a
front organization called the Reich Cooperative for State Hospitals and Nursing Homes (German:
Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten) that handled the registration, evaluation, and selection of patients for adult euthanasia. As the T4 program's chief physician, Nitsche was responsible for corresponding with
mental health institutions about registering and transferring patients to be euthanized. He succeeded Heyde as head of the Medical Office in December 1941. ==Trial and execution==