by Peter Elkind
“Kathy, did you really hire Genene?” Montes asked.
“Yes, she’s very good,” responded Holland.
“Kathy, I’m not going to accept these admissions if Genene is with them. Please don’t send Genene with them!”
“They’ve already left.”
Montes climbed to the hospital’s rooftop landing pad to await the helicopter carrying Jimmy Pearson and Chris Parker. She soon got a call that they had made an emergency stop at Methodist. An emergency room doctor there told her Jimmy Pearson’s blood tests didn’t offer a clue to what had caused his arrest. When Genene Jones finally showed up, she greeted Montes. “Kathy’s getting arrests and real sick babies,” she told the young resident. “Never go into private practice. You don’t know how awful it is.”
After Monday’s trauma, Kathy Holland was grateful for the next few days’ routine. Business remained slow; she saw just a handful of patients a day. On Thursday, September 2, the pediatrician allowed Chelsea McClellan to leave Sid Peterson and go home. Brandy Benites and Chris Parker had already recovered and been dismissed from Santa Rosa. Things were finally settling down.
Friday, September 3
Misty Shayne Reichenau, twenty-one months old, was sick and fussy. She’d had mouth sores for four days, as well as fever and a cold. Misty was Kay and Larry Reichenau’s second child. Kay, thirty-one, was a housewife, Larry, thirty-two, a general contractor. Their daughter had been a healthy baby, without a major medical problem since birth. Earlier in the week, they’d taken Misty to her doctor, Duan Packard, a sixty-eight-year-old family practitioner in Kerrville. Dr. Packard had prescribed an antibiotic—ampicillin—for Misty’s throat and ear infections, and suggested hydrogen peroxide for her mouth. The antibiotic had cleared the infections, but the sores seemed to be getting worse. That morning, Misty had stopped eating and drinking and vomited twice. Kay Reichenau called Dr. Packard, who told her he was on his way out of town. He said there was a new pediatrician in Kerrville named Kathy Holland who could probably see Misty.
Mrs. Reichenau arrived at Dr. Holland’s office about 2 P.M. with her mother and daughter and was ushered into the treatment room. Misty cried while Genene took her rectal temperature; it was 101.8 degrees. Mrs. Reichenau held Misty in her lap as Dr. Holland examined the little girl’s neck, trying to bend her head down to her chest. Misty resisted, as though her neck were stiff. Holland and Genene looked at each other knowingly. “Dr. Holland said not to be excited, but it could possibly be meningitis,” recalled Mrs. Reichenau. Holland wanted to admit Misty to the hospital to test for the disease with a spinal tap. But first she wanted to start an IV; Misty seemed a bit dehydrated. Dr. Holland explained that she started IVs and drew blood at the clinic on all children she was sending to the hospital. Part of the reason for this unusual policy—such procedures were customarily performed in the hospital—was that the pediatrician wanted to get the IV treatments and blood tests going immediately. The other part of the reason was that Dr. Holland didn’t trust the nurses at Sid Peterson—at least not the way that she trusted Genene Jones.
Mrs. Reichenau volunteered to take Misty to the hospital herself—after all, it was less than a mile—but Dr. Holland insisted on calling EMS. While Holland left the room to summon an ambulance, Mrs. Reichenau stepped out to the waiting area to ask her mother to phone Larry. When she returned to the treatment room, Genene had prepared the IV and the fluids that were to flow through it into her daughter’s bloodstream. “You might want to step out in the hall, because it’s not easy on a mother to watch,” Genene told her. “She’s going to cry, and she’s going to scream.” Mrs. Reichenau said she didn’t need to leave. “I’m pretty stout; I can take it,” she said. Returning to the room, Dr. Holland helped hold Misty. The pediatrician and her nurse were struggling to start the IV. Misty was screaming and crying. And then the IV needle was in her arm—and she was silent. Misty stared at her mother with a strange, far-off look.
“There’s something wrong!” Mrs. Reichenau shouted.
“She’s just holding her breath,” said Genene. “She’s scared.” The nurse ordered Mrs. Reichenau out the door. Misty wasn’t breathing.
In tears, Mrs. Reichenau stumbled out to the waiting room, where her mother was sitting. Gwen came over to reassure them, but her words were of little comfort. “She said they were doing everything they could for Misty; that they weren’t going to let Misty die; that they had saved lots of babies,” Mrs. Reichenau recalled. “She said just last week they had saved a baby that quit breathing in her office. She said they could work miracles—that they did it every day.”
Inside the crash room, Misty was having a seizure. Dr. Holland gave her oxygen and ordered a dose of Dilantin to prevent more convulsions. The doctor wanted to intubate Misty—to place a breathing tube down her throat—but the little girl’s teeth were clenched. Debbie Sultenfuss had dropped by Holland’s office for lunch. Now she appeared in the room with a bottle of the muscle relaxant Anectine, which she said Holland had asked for to keep Misty from struggling. Holland said later that she had never requested the drug and that when Debbie brought it in, she didn’t know the proper dosage and didn’t want to use it. She intubated Misty without the Anectine.
The ambulance arrived at Sid Peterson at 3:07 P.M., and Genene carried Misty in her arms directly up to the ICU. After a while, Holland came out and told the Reichenaus—Larry had arrived at the hospital by then—that she wanted to fly Misty to Medical Center Hospital for tests and observation. Genene told the Reichenaus they couldn’t fly in the MAST helicopter. The last time she’d flown in it, Genene explained, there had been a crisis, and they’d been forced to make an emergency landing in a field.
When Misty arrived in the pediatric ICU at Medical Center Hospital, doctors found her agitated, breathing on her own, and struggling against the breathing tube, which they took out. Dr. Holland had sent Misty to San Antonio with a tentative diagnosis of “partially treated meningitis.” But an assortment of tests revealed no evidence of the disease—and no explanation for the seizures. Doctors transferred Misty out of the ICU after one day and took her off the Dilantin Dr. Holland had prescribed. Misty’s San Antonio physicians told the Reichenaus they could find only what had sent her to Kathy Holland’s clinic in the first place: a nasty case of mouth ulcers. Misty was sent home five days after her arrival. Wrote a pediatrician in his discharge summary: “The patient’s hospital course was unremarkable.”
After Misty returned to Kerrville, her parents took her back to Dr. Holland for a follow-up visit. Holland asked if they wanted to use her as a pediatrician. The parents of Brandy Benites and Chelsea McClellan had kept their children under Holland’s care. But the Reichenaus declined. They told Kathy Holland they already had a family doctor.
Tuesday, September 7
After seeing a couple of children Saturday morning, Kathy Holland had closed her clinic for the long Labor Day weekend. Everyone was ready for the break. Dr. Holland had left Kerrville to spend the free time with her husband. Genene tried hard to relax. She had begun taking long walks to the top of a hill behind her house, where she would sit and meditate. She had grown fond of the summer hit movie E.T.; she referred to her visits to the hilltop as “going to talk to E.T.”
When the clinic reopened on Tuesday—four days after Misty Reichenau’s first office visit—Genene told Dr. Holland that she had completed an inventory of the office’s drugs and discovered a small vial of Anectine was missing. Presumably, this was the same vial that Debbie had brought to the crash room during Misty’s seizure. Holland told her nurse to search the office. If you can’t find it, she instructed Genene, log it as missing and order another bottle. A replacement vial was ordered from the Sid Peterson pharmacy later that day.
At night, the conversation on Nixon Lane inevitably turned to the subject of all the children arresting in the clinic. They had averaged less than three patients a day for two weeks, yet already they had sent four children to the hospital by ambulance. Ho
lland had tried to joke about how busy they were. But one night, in exhaustion, she had broken down in tears. This was worse than residency, Holland remarked. She had never seen so many sick kids.
Still Kathy Holland failed to connect what was going on with San Antonio, or Genene Jones. It was as though her decision to hire the nurse had erased all memory of the suspicions at Medical Center Hospital, as though there were no precedent for what was happening in her clinic. Genene’s exaggeration of minor symptoms was feeding Holland’s overaggressive approach. The pediatrician was interpreting each of her patients’ minor problems as a sign of serious illness—the sort of illness that would explain even seizures and respiratory arrest. To Kathy Holland, the one doctor in Kerrville with reason to know better, there was no pattern or common denominator. Each case was unique. The emergencies were a terrible coincidence.
Gwen Grantner offered her own contribution to the discourse. A woman of unusual ways, Gwen was an adherent of Eckankar, a religious cult that believed in reincarnation and rejected the notion that evil existed on earth. Gwen read books about mysticism. She confided to friends that she had the power to predict the future. One day at the clinic, Gwen began to scribble incomprehensibly on a piece of paper. Startled, she told Holland, “Something just made me write this.” They had to figure out what it meant.
That night, Kathy, Genene, and Gwen met on Nixon Lane. They sent Genene’s children off with Cathy Ferguson, lit candles on the counter, turned out the lights, and gathered around a Ouija board. Starting out seated at the kitchen table, they soon moved to the living room floor. Gwen asked the Ouija board: What did the message mean? Then Genene piped in: Did it have anything to do with the kids in the office? Was it bad? The answers weren’t clear. Several days later, Debbie Sultenfuss joined them for a second session, this time with tarot cards. Gwen laid out four cards, recalled Holland. The meaning of one was uncertain. The second was “about crucifixion, about someone being unjustly accused,” the doctor recalled. The third suggested the new battling the old. The fourth warned of financial ruin and bankruptcy.
Jones and Holland both said later that the mystical meetings were nothing more than fun and games, and that no individual patients were discussed. “Now they’re trying to accuse us of witchcraft,” complained Genene. “Shit, I don’t talk to spirits. The only spirit I talk to is the Lord Himself.”
Fifteen
On Saturday, September 11, Genene Jones returned to the emergency room at Sid Peterson Hospital—this time as a patient. She arrived shortly after 1 A.M., complaining of violent cramps in her abdomen and waves of nausea that made her vomit blood. Doctors admitted her to the sixth floor for treatment of a suspected bleeding ulcer. Lisa drove Gladys Jones up from San Antonio to visit. On their first trip to Kerrville since Genene had moved, they stopped by Nixon Lane to see Crystal and Edward, who were temporarily under the care of Debbie Sultenfuss and Cathy Ferguson. Gladys Jones was careful to hold her tongue throughout the day. She had never understood why her daughter collected such an odd assortment of friends.
Genene was to remain in the hospital until the evening of September 16. For the four workdays her nurse was gone, Dr. Holland arranged for an RN from Austin, Mary Mahoney, to fill in. The clinic had never been quieter. Only one or two patients came in each day, and none required hospitalization or emergency treatment. Mahoney busied herself filing charts and checking supplies. The nurse liked her temporary employer but was surprised when Dr. Holland told her that four children had arrested in the clinic since it opened. Mahoney had never heard of so many emergencies occurring in a doctor’s office during so brief a time. When Brandy Benites came in for a checkup, appearing healthy as could be, Mahoney was amazed to learn that the baby had suffered one of the arrests. Whatever caused her emergency had disappeared without a trace.
Friday, September 17
On the morning Genene returned to work, Petti McClellan arrived at the clinic for the first appointment of the day. Petti later said she had called Dr. Holland’s office on Thursday to set it up—not for Chelsea, but for her son, Cameron, who had the flu. According to Petti, her daughter had been well since her first traumatic visit to the pediatrician, twenty-four days earlier. But when she called, said Petti, Dr. Holland asked her to bring Chelsea in for a quick checkup.
Genene Jones recalled it differently: Petti “had called in and told Gwen [that Chelsea] was having increased blue spells. She also stated she’d had two seizures that lasted three minutes each that day. She felt the blue spells were getting worse.”
Chelsea and Cameron arrived with their mother at about 10:30 A.M. Gwen sent them back to the clinic’s staff lounge, where Petti could talk with Dr. Holland and smoke a cigarette. Genene Jones appeared first, scooping up Chelsea to measure her height (twenty nine and one quarter inches) and weight (eighteen pounds, twelve ounces). Then Dr. Holland came in. While she and Petti spoke, Chelsea ran up and down the hallway and played. Cameron, feeling miserable, just sat. Dr. Holland briefly examined Chelsea on the carpet in the lounge, then told Petti she wanted Genene to give the little girl her inoculations. Holland ordered two: a diphtheria-tetanus injection and a measles-mumps-rubella shot. Genene suggested that Petti not watch, but Petti said she wanted to hold Chelsea to keep her from getting upset. Holland returned to her office to record her notes on Chelsea’s chart, while Petti walked to the crash room with her daughter.
Genene had already filled the syringes. They were lying on a counter. Chelsea, wearing a dress and matching bonnet of red-and-white gingham and lace, sat down on Petti’s lap, facing her mother and holding her hands. Genene took the first needle and pushed it into the top of Chelsea’s chubby left thigh. Moments later, Chelsea began to have trouble breathing. A whimper stuck in her throat, as though she were trying to cry “Momma” but couldn’t get it out.
“Stop!” shrieked Petti. “Do something! She’s having another seizure!”
The nurse told Petti that Chelsea was just reacting to the pain of the injection. According to Genene, the child looked better after a few moments, so she gave her the second shot, this one in the top of Chelsea’s right thigh. By the time Genene pulled the syringe out, Chelsea wasn’t breathing at all. She turned blue and began having a seizure. The little girl was trying to breathe but couldn’t; her body was jerking uncontrollably. Then she went limp. Petti had never seen anything so horrible.
The ambulance arrived at the office at 10:58 A.M., and Chelsea was in the Sid Peterson emergency room nine minutes later. She arrived in Genene Jones’s arms, with an IV already started and a breathing tube down her throat. The emergency room staff stripped off her clothes and hooked her up to a heart monitor. Chelsea soon began struggling to pull out the breathing tube. Holland removed the tube, and Chelsea began crying. The baby was breathing on her own; the tube didn’t seem necessary. But Holland explained that she was worried Chelsea would suffer another respiratory arrest. While nurses pinned her arms, the doctor replaced the first breathing tube with a larger one and ordered a dose of Valium. The drug made Chelsea sleepy. Genene taped the tube tightly in place, sealing the little girl’s mouth. Doctors, nurses, and respiratory technicians hovered around the treatment table. Genene, assisting her boss at the toddler’s bedside, looked up at the commotion all around her. “And they said there wouldn’t be any excitement when we came to Kerrville,” she remarked.
Chelsea’s color had returned soon after her arrival in the ER. She was bright pink, noted Holland; she was looking very good. Nonetheless, the pediatrician wasn’t willing to let Chelsea remain at Sid Peterson. Something had to have caused the seizures. The doctor wanted to find out what, and felt Sid Peterson wasn’t the place to do that. “I didn’t want her just hanging around there,” Holland said. “She had already done things that were unexpected. I was wondering what was going on in her head. I felt sure something neurological was going on that we were missing.”
Dr. Holland told the McClellans she wanted to transfer Chelsea to a San Antonio hospital im
mediately. Her plan was to fly the child to Medical Center, but the MAST helicopter was unavailable and the county hospital’s ICU beds were full. She settled instead for sending Chelsea by ambulance to Santa Rosa. While Dr. Holland made the necessary arrangements, Genene and Petti recruited a hospital employee to drive them back to the clinic; Petti had left Cameron there, and Genene needed her bag of supplies for the trip. Walking out to the car, they noticed a large black hearse parked in the hospital driveway. Genene held a hand in front of Petti’s eyes to block her view. “That doesn’t bother me,” said Petti. “Chelsea’s not going to die.”
The ambulance set out from Sid Peterson at 12:36 P.M. Chelsea, Genene, and paramedic Tommy James were in the back. Another paramedic, Steve Brown, was the driver. Dr. Holland followed the ambulance in her white Datsun, while Petti and Reid McClellan followed her in their own car. Chelsea was on a heart monitor and was receiving fluids through an IV. She was breathing through a tube attached to a respiratory bag. Genene and Tommy James took turns pumping oxygen into her lungs. They were cruising along at code two—a step away from a full emergency. Everything seemed stable. Eight miles down the highway, the peaks and valleys on the heart monitor fell into a flat line. Chelsea was arresting. The paramedic worked the respiratory bag faster. “Pull this son of a bitch over!” screamed Genene, and they skidded to a halt on the shoulder.
Holland jumped into the ambulance. “She’s flat-lined!” shouted Genene, who was performing chest compressions. Holland checked Chelsea’s heart with a stethoscope and heard nothing. She climbed onto the stretcher, straddled Chelsea, and took over the heart massage, while ordering Genene to draw up a round of resuscitative drugs: epinephrine, calcium gluconate, sodium bicarbonate. No response. She ordered another round. “Get me to a hospital—quick!” Holland ordered. The ambulance pulled onto the highway and took the second exit. They arrived at the Comfort Community Hospital—a tiny one-story building where the doctors’ parking area is marked by a rusty sign nailed to a tree—at 1:05 P.M. and rushed Chelsea into the small emergency room. They had radioed ahead, and the hospital staff was waiting. Dr. Holland ordered up several more rounds of drugs and took turns with Genene and Steve Brown at CPR while Tommy James worked the respiratory bag. Chelsea’s heart flickered on briefly, then stopped, then beat weakly again. Then stopped. After twenty minutes, Chelsea’s pupils stopped responding to light, indicating severe brain damage from lack of oxygen. “That is all we can do,” said Holland. Chelsea Ann McClellan, fifteen months old, was dead.