One morning in October 1981, after finishing up the overnight nursing shift in the pediatric intensive care unit at Bexar County Hospital in San Antonio, Suzanna Maldonado stepped into the office of her boss. Pat Belko, the pediatric ICU’s head nurse, could not have been pleased to see Maldonado—the 25-year old registered nurse was not one of her favorites—and she was even less pleased when she found out what Maldonado had on her mind. Too many babies were dying in the ICU, she began—dying of problems that shouldn’t have been fatal. They were dying during a single nursing shift, the three-to-eleven evening shift. And they were dying, Maldonado said, under the care of a single nurse: Genene Jones.
Belko knew the ICU nurses had been trading such talk for weeks, maybe even months, but she considered it vicious gossip. Accusations like that, she scolded, shouldn’t be made lightly. But Maldonado wasn’t through. She had studied the ICU’s census book—the listing of patients and their condition during their stay in the unit. She had found out how many children had died during sudden emergencies and on which nursing shift the deaths had occurred. “It looks bad,” she told Belko.
Belko sent Maldonado from her office and walked down the long fifth-floor corridor—past the little boys and girls playing in the hall, past the open rooms of children who had busted a leg or lost an appendix, past the kids who would soon leave the pediatric ward, happy and healed. At the end of the hall, she walked through swinging double doors into the eight-bed pediatric intensive care unit. This was a different world. Here the children were mostly still and silent, asleep on their beds, hooked up to tubes and monitors. The pediatric ICU was where Bexar County sent its critically ill children who could not afford a private hospital: the infant girl whose raging father had cracked open her skull, the two-year-old who had nearly drowned, the seven-year-old who was struggling to survive a congenital heart defect.
Belko walked over to the nursing station, pulled out the big blue census book, and flipped through it. Maldonado had done her homework; her numbers were correct. Dr. James L. Robotham, the unit’s medical director, was in the ICU finishing up his seven-thirty rounds. Belko asked to speak with him, and the two of them walked back to her office. She told Robotham what she had learned, and they agreed that there would have to be an investigation.
A SHORT TIME LATER, BEXAR COUNTY Hospital, a public institution created to save lives, began the first of a series of extraordinary private searches to determine whether one of its nurses was killing children. In the meantime, children in the pediatric intensive care unit continued to suffer, and sometimes to die, from unexplained medical problems. Kids who seemed stable suddenly stopped breathing. They had seizures. Their hearts halted or started beating irregularly. Babies pricked with intravenous needles began oozing blood, their clotting mechanisms inexplicably gone haywire. Time and again, the problems developed on the three-to-eleven nursing shift. Time and again, it seemed, they developed when Genene Jones, licensed vocational nurse, was on duty. Around cafeteria tables and in hallways, a growing number of people who suspected that something was terribly wrong began calling Genene’s hours on duty the Death Shift.
Between May and December of 1981, the last of the hospital’s internal inquiries found, ten children in the ICU had died after “sudden and unexplained” complications. In all ten cases, Genene Jones was present at the child’s bedside during what the report gently terms “the final events.” The report concludes: “This association of Nurse Jones with the deaths of the ten children could be coincidental. However, negligence or wrongdoing cannot be excluded.”
But by the time that report was written, Genene Jones was long gone from Bexar County Hospital (which is now called Medical Center Hospital). Lacking definitive proof of wrongdoing, fearful of a lawsuit and bad publicity, the hospital administrators and the deans of the University of Texas Health Science Center in San Antonio, which trains its medical students in the hospital, were unwilling to fire Genene Jones, unwilling to call the police or tip off the district attorney. But the doctors who cared for patients in the pediatric ICU would not let her remain there—there was simply too much going on that medical science couldn’t explain. The administrators did not confront the problem directly; instead, they considered shutting down the ICU altogether. But they finally decided to move out all the licensed vocational nurses ( LVNs), Genene Jones among them, under the cover of upgrading the nursing staff to consist only of registered nurses, who have more training than LVNs. Genene Jones and the others were given good recommendations and offered jobs in other parts of the hospital. Jones turned down the offer, and on March 17, 1982, she quit working at Bexar County Hospital. The “unexplained events” stopped.
After leaving San Antonio, Jones took a job with a pediatrician, Dr. Kathleen Holland, in Kerrville; in a period of 31 days, seven of Holland Jones’ patients had eight separate medical emergencies.