The Death Shift

by Peter Elkind

  A dose of succinylcholine could produce an unimaginably horrible death. It left a person completely paralyzed yet conscious, unable to breathe yet totally alert. As the drug first took effect, a person’s hands would often twitch and his eyelids would flutter. An adult might gasp for help; a toddler unable to speak would take on a look of helpless panic. When completely under the drug, a person would be unable to cough or even to blink. So nightmarish were these sensations that doctors in the operating room first administered an anesthetic to dull their patients’ consciousness of the experience. Anyone who did not receive help breathing under succinylcholine would soon turn blue from lack of oxygen. A short time later, the victim’s heart would sputter and stop.

  Sutton felt certain that Chelsea McClellan had met such a fate. Holland’s patients had been given the drug, Sutton theorized, to induce arrests that would require rescue; the new pediatrician and her nurse would then appear to everyone as heroes. But in Chelsea McClellan’s case, something had gone awry; Chelsea had arrested a second time in the ambulance, and the rescue attempt had failed. Sutton wasn’t sure just whom to blame for the toddler’s death. Jones was the primary suspect, but how could the doctor not have known that something was going on?

  As he struggled to assemble a theory of the case, Sutton had yet to speak with either of the principal suspects. In early October, Dr. Holland had retained a lawyer and abruptly ceased cooperating. Genene Jones was less reticent. A few days after moving to San Angelo, Genene had phoned Texas Ranger Joe Davis to alert him to her new address and telephone number in Debbie Sultenfuss’s mobile home at the South Concho Trailer Park. She would be happy to answer any questions, anytime, Genene cheerfully announced. But Ron Sutton wasn’t ready to talk to Genene Jones. There was still too much he didn’t know.

  In early November, Sutton received the results of the autopsy on Chelsea McClellan. Because there had been no immediate suspicion of foul play, the autopsy arranged by Dr. Holland had been conducted not by a county medical examiner but by a private San Antonio pathologists’ group called Severance & Associates. On the day after Chelsea’s death, Severance had dispatched a junior physician, Dr. James Fletes, to Kerrville. Fletes had performed the autopsy in a back room at the Kerrville Funeral Home, and on opening Chelsea’s body, he had discovered nothing unusual. But the on-site examination was only the first part of the procedure. Fletes took samples from Chelsea’s major organs, removing some of them entirely, for further study back in the lab. On examining the tissues under a microscope, Fletes and his boss, Dr. James Galbreath, still could find nothing to explain the little girl’s death. They decided to send Chelsea’s brain to a neuropathologist, an expert in studying such tissue. Dr. Kathleen Kagen-Hallet, a faculty member at the UT medical school, was the only such civilian subspecialist in town. Her microscopic examination uncovered signs of gliosis—scarring—in Chelsea’s brain stem. Kagen-Hallet reported back that her findings were “subtle.” But the scarring provided the basis for her conclusion: Chelsea had died of SIDS, sudden infant death syndrome. With no other explanation at hand, Dr. Galbreath embraced Kagen-Hallet’s finding. In his final written report, he identified the cause of Chelsea’s death as an atypical form of SIDS.

  The autopsy presented Sutton with yet another thorny problem. How could he convict someone for murder when an autopsy of the victim attributed the death to natural causes? Sutton took stock of his prospects for successful prosecution. He had one dead baby and several more who had suffered. He had witnesses who described the children’s symptoms as consistent with the effects of succinylcholine. He even had a bottle of the drug that had been tampered with, and a second that remained missing. The evidence was chilling—but circumstantial. Sutton lacked an irrefutable link between the drug and the victims, someone who could swear she saw the children receive what she knew to be succinylcholine. Holland and Jones were the only possibilities. But such a statement from either one would amount to self-incrimination.

  Physical evidence was the only alternative. Sutton needed a laboratory test that could prove succinylcholine was in Chelsea’s body. But that prospect seemed impossible. Succinylcholine was chemically unstable; it broke down rapidly into substances found naturally in the human body. Medical wisdom held that the muscle relaxant was impossible to trace. This characteristic had earned it notoriety as the drug of choice for doctors who wanted to commit murder; it was the presumed instrument of death in the sensational 1967 trial of Florida anesthesiologist Carl Coppolino, convicted of murdering his wife. After the trial, Coppolino’s defense attorney, the renowned F. Lee Bailey, called succinylcholine “an ideal murder weapon.”

  A defense lawyer’s “ideal murder weapon” was a prosecutor’s nightmare. Now Sutton had a doctor who wouldn’t talk, victims who couldn’t, a murder drug he was unable to trace, and an autopsy that concluded the victim wasn’t murdered at all. He began to wonder if he was dealing with an unwinnable criminal case.

  Nineteen

  Although it was unfolding behind closed doors, Ron Sutton’s grand jury investigation was producing considerable consternation sixty miles away in San Antonio. In sending Genene Jones off, the doctors and administrators at Medical Center Hospital had expected never to hear from her again. They had granted the nurse a full reprieve for whatever mischief she had committed in the pediatric ICU. Any rational person would be grateful and live out her life in anonymity. The possibility that she would start up again simply wasn’t part of their calculation.

  The distressing news had filtered down from Kerrville even before the formal investigation began. In checking on Jones’s background in September, Joe Vinas had spoken to Dr. Arthur McFee, the surgeon at the UT medical school who had been appointed to chair the new committee supervising the pediatric ICU. Even though his area of expertise was far from lofty—McFee specialized in gastro-intestinal surgery—he was the medical school’s resident aristocrat. A short, balding man of forty-nine, McFee collected fine wines, frequented the local symphony, and exuded erudition. Proud of his Harvard pedigree, he kept a captain’s chair with the Crimson seal in his office. McFee had been recruited to the medical school at its inception, after two years in the navy. In the fifteen years since, he had become one of the most influential members of the faculty. Impressed with McFee’s work overseeing the surgical ICU, the Conn committee had recommended that he preside over the reorganization of its troubled pediatric counterpart.

  On October 21—nine days after the Kerr County grand jury began its investigation—McFee convened a meeting of his Pediatric ICU Policy and Planning Committee. Deputy hospital district administrator John Guest, nursing administrator Virginia Mousseau, pediatric ICU head nurse Pat Belko, and the new pediatrics chairman, Dr. John Mangos, were among those present. Hospital district executive director B. H. Corum and medical school dean Marvin Dunn received the meeting’s minutes. “Considerable discussion was given to PICU concerns transcending the Hospital District and with specific reference to a current situation arising in Kerrville involving individuals hitherto employed at MCH,” according to the committee minutes, compiled by McFee. “Dr. Corum has expressed to the chairman that the view of the committee will be the official view of the hospital district. The committee feels that the hospital should cooperate in every way possible when asked to do so in the course of a legitimate investigation.” This cooperation, however, was to have limits. The minutes state: “The committee does not feel that the hospital district should volunteer any information regarding prior employees under any circumstances at all.” Officials of two public institutions—the county hospital and the UT medical school—possessed information that was surely relevant to a criminal investigation of murder. Yet they were setting out a policy of saying nothing unless asked.

  The two institutions’ top officials would cling to this strategy, even as they received new evidence linking Genene Jones to suspicious deaths. In January 1983, they received the report of the most detailed internal investigation of the strange deaths in
the ICU. This was the study recommended by the Conn committee, which in March 1982 had urged an “immediate” review of “several isolated untoward events.” But the inquiry had not begun for six months, until September 17—coincidentally, the date of Chelsea McClellan’s death. The responsibility had fallen to a three-member panel led by the new pediatrics chairman, John Mangos, who had relieved Dr. Franks of his interim duties. Its other members were John Guest and Jean Foster, a mid-level nursing administrator.

  The Mangos committee’s report focuses on the cases of thirteen children treated in the ICU during 1981 and early 1982 who experienced “sudden and unexplained problems”—arrests, seizures, or bleeding episodes. Ten of the thirteen died. In all ten cases, Genene Jones was present at the child’s bedside during what the report gently terms “the final events.” There are three possible explanations for Genene Jones’s presence “during events leading to the death of children and infants in the PICU,” the study says. “This presence could be: 1) coincidental; 2) Because Nurse G. Jones volunteered the care of very sick infants and children; 3) Due to negligence or wrongful doings by Nurse G. Jones resulting in the sudden deterioration and death of patients.” 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.”

  After four months of study, Mangos’s committee had documented the extraordinary pattern that Jim Robotham, Suzanna Maldonado, and Pat Alberti, among others, had flagged more than a year earlier. But instead of being alarmed at the prospect that they had harbored a murderer, the doctors and administrators took solace in the report’s failure to uncover proof of wrongdoing. On January 13, the Pediatric ICU Committee convened in a hospital meeting room over lunch. At the end of the session, the discussion again turned to Kerrville. “In general, the apprehension of the committee is that an investigation is proceeding in Kerrville under the auspices of the grand jury,” note McFee’s minutes. “…A review of charts of all patients seen in the PICU in December, 1981, and January and February of 1982, has revealed absolutely nothing for which the hospital district could be held liable in the opinion of Dr. Mangos…The committee, in general, recommends judicious silence on the issue.”

  Kathy Holland believed she was a victim of judicious silence. After discovering the opened bottle of succinylcholine, she had turned to members of the medical school faculty for aid and counsel. Eight of them wrote letters on her behalf to Dr. Packard in Kerrville, in support of Holland’s campaign to win restoration of her privileges to practice at Sid Peterson Hospital. But as Holland’s predicament deepened, she grew bitter at her former teachers for failing to save her from herself. In a visit to Dr. Mangos a few weeks after the grand jury investigation began, she explained how her dreams of a thriving practice had collapsed. Holland knew Mangos was investigating what had happened in San Antonio. Why hadn’t someone done more to stop her from hiring Genene?

  The fifty-year-old Mangos, lured to San Antonio from the University of Florida medical school, was an eminent academic physician, nationally known for his research into cystic fibrosis. But now, speaking to Kathy Holland, he donned a different hat—that of an ordained Greek Orthodox priest, a title that prompted the pediatric residents to dub him “Father John.” Mangos told Holland that he realized she was going through a tough time but assured the former resident that the pediatrics faculty was behind her; everyone knew she was a caring person and a good doctor. Mangos advised Holland that his review of the ICU records had revealed absolutely nothing that suggested she was guilty of wrongdoing in San Antonio. Sensing her anger at the medical school, Mangos told Holland that he, too, had been victimized by the errors and omissions of others. He could have sued—but he had decided not to do so, Mangos explained, because he knew litigation would just disrupt more lives. Mangos urged Holland to follow his example. It was best not to harbor vengeance, he counseled; the Lord would take care of things.

  Kathy Holland was inclined to give providence some direction. In the first days after her discovery of the tainted bottle of succinylcholine, the doctor had spoken freely to Texas Ranger Joe Davis. On October 1, she retained a hard-nosed San Antonio criminal lawyer named Jack Paul Leon, who promptly phoned Ron Sutton to ask if his new client was a target of the DA’s criminal investigation. When Sutton told Leon she was, Leon instructed the doctor to say nothing more to the authorities.

  When Holland first contacted Leon, she wanted to sue the Sid Peterson executive committee for its refusal to restore her hospital privileges. Why couldn’t the other doctors see that she had done nothing wrong? By refusing to let her treat patients in the hospital, they were ruining any chance she had of rebuilding her practice. Leon cautioned Holland to slow down; they first needed to make sure she didn’t go to prison. An intense man with an impressive record of defending against charges of white-collar crime, Leon contemplated the worst-case scenario. Sutton was convinced that Genene Jones had harmed children. And he appeared to believe that Holland had known what was going on—or at least that she should have. If Holland was charged with the death of Chelsea McClellan, was there any danger of conviction? Leon concluded there was not. In turning over the opened bottle of succinylcholine, Holland had provided the prosecution with its most important piece of evidence—unlikely behavior for a co-conspirator to murder. Besides, what motive could Holland have to deliberately harm her patients? She had a bright career ahead of her, everything to lose.

  While Leon felt certain he could win at trial, he knew a criminal indictment would shadow Holland for the rest of her life. Grand juries were notorious for following a prosecutor’s inclinations. If Sutton wanted to go after Holland, reasoned Leon, he could surely indict her for something. Leon turned his attention to avoiding the doctor’s indictment in the first place. That meant just one thing: convincing the DA that Kathy Holland was innocent.

  Sutton had already moved to turn up the heat on the beleaguered pediatrician. On October 12, on Leon’s advice, Holland had appeared before the grand jury and refused to testify, citing her Fifth Amendment rights against self-incrimination. When the doctor also refused to comply with a grand jury subpoena for her office medical records, Sutton asked a district judge to hold her in contempt of court. At the contempt hearing on November 5, Leon agreed to hand over Holland’s records. But the far more critical issue was the lady doctor’s testimony. At an informal session with the prosecutor after the hearing, the defense attorney made his pitch. As long as she faced criminal indictment, Leon stated, his client would continue to take the Fifth. Leon knew Sutton had a tough circumstantial case. If you go after Holland, he told the DA, you won’t convict anybody. There’s no case against Holland, he argued, and an indictment against the doctor would keep her from testifying against the real culprit, Genene Jones. You need Holland’s testimony, insisted Leon. And Sutton could have it—if only he would pledge not to seek the doctor’s prosecution. “My client should be on your team,” Leon argued, “and you should be on hers.”

  Sutton listened quietly. Leon was a sharp lawyer—a fellow alumnus of St. Mary’s Law School—and correct in his assessment of the difficulty of Sutton’s case. But the DA from Junction was far from ready to abort his investigation of Dr. Holland, unwilling to accept that she had known nothing about the unlikely events unfolding literally under her nose. Sutton would consider what Leon said, but he was not yet ready to make a deal.

  Shortly after moving to San Angelo, Genene Jones had phoned her mother to explain that there might be trouble. Gladys Jones did not doubt it; Genene was always in some kind of pickle. After their hurried relocation, Genene and Debbie Sultenfuss had both found nursing work at the state school for mentally retarded adults. Edward and Crystal enrolled in the local public school system. Cathy Ferguson, who had discovered during her stay in Kerrville that she was pregnant, watched Genene’s children when the other adults were away. The manager of the South Concho Trailer Park was surprised to see so many people living
in the fourteen-by-sixty mobile home. But she thought Genene Jones and her crowd were friendly—just normal, everyday folks. The manager did not notice the law-enforcement officers who cruised by Debbie’s trailer from time to time, following Ron Sutton’s instructions to keep an eye on its occupants.

  On December 15, intent on removing an obstacle to punishing anyone for Chelsea McClellan’s murder, Ron Sutton drove to San Antonio with Ranger Joe Davis. Sutton had arranged a meeting with Dr. Kagen-Hallet, the medical school neuropathologist who had ruled that Chelsea died of SIDS. Kagen-Hallet worked in a cramped, third-floor office at the Veterans Administration Hospital, connected by a walkway to Medical Center Hospital. Pathologists as a group were a macabre lot, brimming with anecdotes about some flesh-mangling injury or especially ravaging disease. When the two burly lawmen located Kagen-Hallet’s office, they discovered a pale, thin-faced woman of forty, who wore her graying hair in a tight bun behind her head. Plastic jars filled the doctor’s bookshelves. Each contained a human brain, floating in fixative. In discussing individual cases, Kagen-Hallet occasionally gestured toward one of the jars, remarking enthusiastically, “I’ve got his brain over there,” as though speaking of a prize coin she’d placed on display.

  Sutton spoke to the pathologist about Chelsea McClellan. A doctor and her nurse were under investigation in the child’s death, the DA explained. He had reason to believe the toddler had received a shot of succinylcholine. Would the knowledge of such an injection alter her certainty that Chelsea had died of SIDS? Kagen-Hallet said it would. The brain-stem scarring she found in Chelsea might have damaged the baby’s normal breathing-regulatory mechanism. Such a child whose breathing was interrupted—by a shot of succinylcholine, for example—might have trouble resuming respiration. Kagen-Hallet agreed to research the subject and write an addendum to her findings—an addendum that would acknowledge the possibility that succinylcholine had caused Chelsea’s death.