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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The problem of Genene Jones was solved by recommending that the hospital administration replace all LVNs in the unit with RNs, on the grounds that most big-city pediatric ICUs had all-RN nursing staffs. There were six LVNs besides Genene, and one of them had been there since 1969. They would all have to go. “It was a case of having to use a huge stick because it was impossible to single out one,” says Dr. Arthur McFee, chairman of the surgery department. “If we had just gone out and fired her, we would have had a substantial suit.”
At about noon on March 2, 1982, Pat Belko passed the word that Virginia Mousseau, the hospital’s top nursing administrator, wanted to talk to the pediatric ICU nurses. The meeting was to begin at three o’clock. Agency nurses kept an eye on patients while the staff members from two shifts crowded into the ICU’s small back room. According to people who were at the meeting, Mousseau told the nurses that the ICU was good, but the hospital administration wanted to make it better. They were going to upgrade the unit. Dr. Conn had made a recommendation, and they were going to follow it and move to an all-RN nursing staff. The LVNs would all be offered other jobs in the hospital, Mousseau said, and would have until March 22 to leave the ICU.
The room exploded in tears and shouts. It wasn’t right, the nurses told Mousseau. She answered that the move was part of a trend; most ICUs had an all-RN staff. Finally Genene spoke up. “If you want a scapegoat, take me,” she said dramatically. “We know you just want to get rid of me. Let me go, and let the rest stay.” No, Mousseau assured her, the move wasn’t directed at any one person. The hospital administration planned to employ only registered nurses in all its ICUs; the pediatric unit just happened to be the first. The ICU would be scaled down to four beds, she added, so it could absorb the loss of the LVNs.
A few days later, Suzanna Maldonado found a note in her mailbox at the hospital. It was written on hospital scrap paper, and it said, “Your dead.” Maldonado turned the note over to Pat Belko. The next day another note arrived on a small white piece of paper, bearing a single word: “Soon.” This time Maldonado turned the note over to hospital security.
The hospital’s nursing administrators began individual meetings with the LVNs. They would all have the opportunity to take other jobs at Medical Center Hospital, they were told, and they would all get good recommendations. Genene was told that there were no pediatric positions available and was offered a place elsewhere in the hospital. But by then she had other options. She had accepted a job offer from Dr. Kathleen Holland, a third year pediatrics resident at Medical Center Hospital who was just getting ready to start her own practice in Kerrville.
THE NEW DOCTOR IN TOWN
Kathleen Mary Holland often told her friends that she was amazed she had ever become a doctor. Early in her life her ambitions didn’t reach much higher than the basement of the Albany, New York, public library, where she worked as a clerk-typist. She was the only child of two factory workers, and though her parents moved often, they never left their working-class neighborhood in North Albany.
Kathy quit high school after her father died in 1963, in the middle of her junior year, and when forced to return she misbehaved so badly that the principal wouldn’t let her go back for her senior year. She graduated instead from a black high school on Albany’s south side, and until she met and married a librarian named Larry Doyle, she hadn’t thought much about going to college. But Larry, twelve years older and extremely demanding wouldn’t let her settle down. She started taking science courses at the local community college, and when Larry found work in Tucson, she enrolled at the University of Arizona as a biology major. In 1971, after Larry got a job in New York at Cornell University, she enrolled there and completed her undergraduate degree. Kathy wanted to become a veterinarian, but after Cornell’s vet school turned her down twice, she and Larry moved to San Antonio, and she started thinking about studying human medicine. In July 1974 she enrolled at the University of Texas Health Science Center, working toward a medical degree and a Ph.D. in anatomy. Third-year rotations at Bexar County Hospital quickly helped her to decide to specialize in pediatrics. “Nobody seemed to be showing each other how much they knew,” she says. “Nobody was putting on airs. Nobody was arrogant. Everybody was just sort of people. Everybody walked into a room with pediatric patients and smiled and joked.”
Kathy and Larry and three cats had settled into a frame house in Bulverde, in Comal County, and she stayed an extra year at the medical school to try to finish her Ph.D. But problems developed with her research project—and, at the same time, with her marriage. Kathy and Larry’s divorce went through on July 27, 1979. By then she had moved in with Charleigh Appling, a retired Air Force colonel who was a campus police officer at the medical school.
She began her three-year pediatric residency at Bexar County Hospital in July 1979 and quickly impressed her fellow residents as a hardworking, capable—and aggressive—student. It took her just a few months to decide that after the residency she would go into private practice in Kerrville, sixty miles northwest of San Antonio, an affluent, pretty Hill Country town of 15,000, filled with retirees. There was a growing population of young families and just one pediatrician. The doctors there, all of them men, encouraged her move to town. Kerrville also had the largest general hospital in the area: the 120-bed Sid Peterson Memorial Hospital, a strong institution that was weak in pediatrics because Kerrville had for years been a town of old people. Here was a challenge, she though: to bring modern pediatric medicine to Kerrville.
The hospital’s lack of experience with pediatrics made Dr. Holland determined to find a nurse with good technical skills for her private practice. “The nurses of Sid Peterson really weren’t comfortable with starting pediatric IVs,” she says. “They really weren’t comfortable with drawing blood on kids younger than two…I wanted to take a nurse with me who had those skills, who had been through the codes. I wanted someone who would start IVs for me, who could draw meds for me. I was really worried about going into a whole new community where they did not have pediatric nursing skills at a level that I knew, and not having anyone to help me.”
Holland’s first choice was Pam Sturm, an RN. “You can’t afford me,” Sturm told her; she was making $8.35 an hour. “What you need to look for is an LVN.” An LVN would make about $5 an hour. Kathy Holland spoke to a handful of prospects. Then, she says, in the summer of 1981 she brought up the subject with Genene Jones.
Kathy Holland was one of the few residents Genene Jones admired. Unlike many of the young doctors, she didn’t seem to mind Genene’s constant questions; she respected her judgment. When Genene called to say something was wrong with a child, Kathy Holland came running. “If Genene says something’s going to go wrong,” Holland told another resident, “then it usually does.”
Genene says Dr. Holland didn’t talk to her about Kerrville until late 1981—and that her initial response was no. “I originally told her no because of all this stuff going on,” she says. “I told her no two or three times.” Finally, Genene says, when Holland arrived in the ICU with floor plans for her new office in Kerrville, she accepted. “She just sat there, already talking about the clinic,” says Genene. “The rumors were flying, and it sounded real good. It sounded peaceful and calm.” They agreed to begin in Kerrville in August.
Kathy Holland knew there were suspicions about Genene Jones. One day in early 1982, Holland’s best friend among the residents, a doctor named Jolene Bean, sat down with her and suggested that perhaps she should change her mind about hiring Genene. Yes, Holland told her friend, she had heard the gossip that Genene might be doing something to the children, but she had worked with Genene Jones. She didn’t believe it. “Nothing I ever saw fit that pattern,” she says now. “You show me a puppy that comes up to me and licks my hand. Somebody comes up to me and says, ‘That puppy just tore up my leg.’ You gotta show me.” Holland talked to Pat Belko, who backed Genene, warning only that she was an assertive person and that Holland would need to define clearly the limits of Genene’s responsibility. Wanting still more advice, Holland approached Dr. Victor German, a pediatrician who had assisted James Robotham in the ICU for the past several months. “This is a new office and a new community that really needs pediatrics,” she told him. “I’m not asking for you to disclose any absolute evidence. Just tell me: Is it a good decision to continue, or should I reconsider? Do you think there’s a possibility Genene could be doing something to hurt kids? ‘No, I cannot imagine that,’” Holland says German told her.
Later Holland ran into Robotham outside his laboratory in the medical school. He asked for a word with her, and she recalls that he said, “Hey, I hear you’re taking Genene to Kerrville. You better think twice. There’s a lot at stake up there.” Robotham mentioned the case of Rolando Santos, the child whose repeated bleeding had been documented as a heparin overdose. Holland said she’d heard that the tests on the child’s blood had been performed shortly after he had been given heparin to clear clots from an arterial line. Robotham told her he had other suspicions. She thought he seemed vague.
By June 30, 1982, the end of her residency, Holland had received several evaluations of the nurse she had hired, and most of them were favorable. The hospital had given Genene a good recommendation and offered her another job-hardly possible if administrators believed she was harming children, Holland thought. Robotham and some nurses had their suspicions, but their ill will toward Genene was clear. And besides, Holland knew Genene Jones. She would not withdraw her job offer. “How were you to think this was anything but personal when all these things were coming from people who hated her anyway?” she says. “I trusted her implicitly.”
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