The Death Shift
When nurse Genene Jones was on duty in a San Antonio hospital, babies had mysterious emergencies and sometimes died. Then she moved to a Kerrville clinic, and the awful pattern began again.
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Before the nurse leaves the pediatric ICU, the security guard walks down the long fifth-floor hallway, clearing the corridor and closing patient’s doors so they will not see the procession. The guard then walks with the nurse to a staff elevator that takes them to the basement, and there he unlocks the morgue door. “Especially at night, it’s very eerie down there,” says Elizabeth Stauffer, a pediatric ICU nurse who left Bexar County Hospital in 1979. “A lot of times, there would be patients who died during the day. Sometimes their bodies wouldn’t be covered. You’d walk into the cold room, and you’d see blood dripping out of every possible opening. It’s a creepy feeling.”
The codes and trips to the cold room are the dark side of working in the pediatric ICU, the part of the job that makes a nurse, every few months, ponder whether she wants to find a less difficult job. But Genene Jones seemed attracted to the dark side. By early 1981 she had begun asking for assignment to the sickest children. Many experienced nurses like the challenge of a critical patient and seek it out from time to time. But Genene Jones did more. She demanded the sickest patients. “She pretty much made her own assignment,” says Cherlyn Pendergraft. “She was so strong she ran like a charge nurse. She was just an LVN. She had no authority or power to do it, but she did it anyway.” Even when other nurses’ patients had emergencies, Genene was involved. “Any time there was an arrest, Genene was there—in the middle and helpful,” says Dr. Debbie Rasch, a former resident now working in the ICU. “It was like she enjoyed the excitement. She was around, even if it wasn’t her patient.” When a child didn’t make it, Genene broke down and cried. Crying over a longtime ICU patient was common, but Jones seemed deeply affected by every death. “When the kids died, Genene really grieved,” says one resident. “She’d say, ‘Before you call the mom in, wait a bit.’ She’d hold the baby and rock him.”
“UNEXPECTED EVENTS”
The first of the deaths in the pediatric ICU that later struck investigators as peculiar was that of Christopher James Hogeda. Christopher died at 7:32 p.m. on May 21, 1981, at the age of fifteen months. He was very sick; he had been at Bexar County Hospital for almost six months. When he was admitted in early December 1980, he had a severe congenital heart defect, pneumonia, and diarrhea. In May he developed hepatitis, and infection spread throughout his body. Several times his heart began beating irregularly. He died of a cardiac arrest.
When Chris Hogeda died, Genene Jones erupted into tears. “He was my boy,” she says now; she had cared for the child for months. During that time, Genene had won the friendship of Chris’ parents, Diana and Crecencio Hogeda, Jr. (More than a year later, when Genene, in deep trouble, needed to leave Kerrville, the Hogedas suggested that she move to their hometown of San Angelo, and Genene accepted.) Now, with Chris gone, his parents had been summoned, and Diana Hogeda had asked Genene over the phone to wait in his room until they arrived. It was more than an hour. Genene had pulled the plastic tubes out of Chris’ body and washed him, crying and talking out loud all the while. “I would bathe the children, and I would sing to them while I bathed them,” Genene says. “If that sounds insane, tough shit. If you can’t die with dignity, why live with dignity?” She pauses. “We talked to them even after death. We’re not God. We don’t know when the spirit leaves the body.” Genene finished cleaning Chris Hogeda and wrapped his body in a blanket. She settled into a chair and held the corpse to her chest while she waited for his parents to arrive.
During 1981 nine more children died in the pediatric ICU after “unexpected events” (in the words of one internal report). But those deaths are merely landmarks—cases in which investigators, months later, found written evidence of something peculiar. Nurses and doctors who worked in the ICU recall many more unexpected emergencies—many of them nonfatal-in 1981 and early 1982. “It began to happen more frequently until it happened every day or two,” says Toni Grosshaupt. Patients would come into the unit, sick but suffering from problems children had been able to lick in the past, and die. Was there some mysterious germ in the air? The nurses wondered. A San Antonio version of legionnaires disease? As the summer of 1981 wore on, the problems became more frequent, and the nurses began to connect them to Genene. “I’d leave a patient I thought was stable,” says Grosshaupt. “She’d come on, and I’d find out the patient had a bad spell-had seizures or codes. That happened consistently.” Pat Alberti remembers several evenings when she arrived at 10:45 for work to learn that a child she cared for the previous night was dead. “I struggled with it for eight hours, and the kid was still alive,” she says. “Day shift had it for eight hours, and the kid was alive. [Genene] came in for three hours, and the kid was dead.”
Pat Belko, the head nurse, knew there were whispers about Genene. She says she didn’t think twice about it. “It was real hard to think that somebody who seemed to care so much about patients and get along so well with families would be doing something of this nature,” she says. “The two of them just didn’t seem to fit together.” She knew that the nurses who were talking the most didn’t like Genene. And she knew they had no proof. Belko told them to either document their suspicions or knock it off.
Genene herself seemed devastated by the rash of deaths and near-deaths in the ICU. In September another of her patients died, and Genene fell into a chair in the corner of the ICU and broke into tears. Debbie Rasch walked over to comfort her, and Genene looked up, her eyes red and puffy. “Why do babies always die when I’m around?” she asked.
Suzanna Maldonado began working in the pediatric ICU in 1980, less than a year after getting her RN degree. She was on the eleven-to-seven shift—the one following Genene’s—and friction soon developed between the two women. Genene thought she knew more than Maldonado and considered her a spoiled child; Maldonado thought of Genene as an aggressive LVN who tried to make people think she knew more than she really did. When children began having more and more unexpected problems during the summer of 1981, Maldonado was among the first to notice—and to make the connection to Genene Jones. “I thought, ‘All these children died in the same period of time, and it just so happened that Genene was taking care of them,’” she says. “If the kid was sick, why didn’t he die on me? Why didn’t he die on somebody else?” She began making a point of reviewing what Genene had done. She started thinking about the number of children who had died. By October she was ready to go to Pat Belko—ready for the confrontation that convinced Belko that she should take the suspicions about Genene to Dr. Robotham and persuade him to launch investigation.
October 10, 1981: Jose Antonio Flores, six months and three days old, died in the ICU at 5:22 p.m. Admitted on October 6 for fever, vomiting, diarrhea, and dehydration, he developed seizures during his third day in the pediatric ward and was taken to the hospital basement for a brain scan. While there, he went into cardiac arrest. Doctors revived him and brought him to the pediatric ICU, where they noticed he was bleeding uncontrollably. He arrested a second time, and doctors tried for 52 minutes to revive him, but they failed. The child’s death certificate says the bleeding caused the fatal cardiac arrest. The cause of bleeding, it says, is unknown; there was no autopsy. Handwriting on Jose Antonio Flores’ medical records, says an internal report, indicates that Genene Jones was present during the brain scan.
BLOOD THINNER
From the beginning, Dr. Robotham had worried about heparin. Several children, like Jose Antonio Flores, had developed bleeding problems in the ICU. Blood would leak from old needle punctures, ooze out of suture sites, their mouths, even their rectums, until finally their blood pressure would drop, putting sever strain on the heart. Doctors had been diagnosing the bleeding as symptomatic of disseminated intravascular coagulation (DIC), a relatively rare condition often caused by severe infection, which can set off a reaction that keeps blood from clotting. But there seemed to be too many cases. The problem had never cropped up with such frequency before. There was one other possibility: heparin, an anti-coagulant that doctors and nurses used every day in the pediatric ICU; a small amount kept intravenous lines from clotting with blood. Was someone giving the children too much? Or could there be a more innocent—though equally deadly—reason, such as a faulty batch of heparin? Was someone giving children overdoses of other drugs as well?
Robotham told Pat Belko that he wanted the heparin handled more carefully. Each nurse was told that she had to have a second nurse watch whenever she drew heparin from its container. Both nurses would have to initial the bottle to show who had conducted and witnessed the procedure. In early November Robotham briefed Dr. Robert Franks, acting chairman of the pediatrics department at UT, and Franks asked him to review all deaths in the ICU over the past several months and report back in writing. In the meantime they decided to begin a full-scale effort to separate true DIC cases from possible heparin overdoses. Establishing an overdose of heparin or some other drug, they knew, would require extensive laboratory tests. Robotham met with the pediatric residents and ordered them to draw and send to the lab an extra blood sample whenever a child developed unexpected problems. Franks filled in the Bexar County Hospital District’s executive director, B.H. Corum, who then asked Franks to keep John Guest, the hospital’s administrator, informed.
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