The Death Shift

by Peter Elkind

  Yet Holmstedt had published nothing on testing human tissue, and only his own collaborators had replicated his results. In a hearing outside the jurors’ presence, which consumed an afternoon, Brookshire ripped into Holmstedt, branding the distinguished Swedish doctor a “salesman” for his procedure. Arguing that the technique flunked the “general acceptance” standard, Brookshire said it had “emerged from a twilight zone of scientific theory.” Why, the test had been developed on rats! Rising from his seat, Nick Rothe noted wryly that there were not many opportunities to test for succinylcholine in the embalmed body tissue of humans. How much testing was enough? Rothe demanded. “How many people have to die…how many exhumed bodies and embalmed bodies of individuals who have been murdered by the use of succinylcholine have to go into the ground…before a court sitting in a county in Texas can admit the testimony?” By day’s end, the judge had decided: He would permit the jury to hear the evidence.

  Ron Sutton was worried that Holmstedt’s testimony would confuse the jurors. They were about to enter a world of molecular weights, gas chromatography, ion-pair extraction, and nanograms. Sutton feared the Swedish doctor might even alienate the jurors by speaking over their heads. But when Holmstedt took the stand, the DA relaxed. Holmstedt was a balding, white-haired man who spoke in thickly accented English. He instructed the jury about his craft as gently as a grandfather teaching an eight-year-old arithmetic. On cross, Brookshire challenged the doctor’s methods, but Holmstedt was unassailable; he brushed off the attack with wit and gentlemanly charm. Holmstedt focused on the history and technique of his test. Dr. Rieders, the Philadelphia toxicologist who carried the frozen tissue from Texas to Stockholm, disclosed the results. While arcane details were quickly forgotten, the damning message of the two experts stuck: There were traces of succinylcholine in the body of Chelsea McClellan.

  By the second week of testimony, the crowds seeking admission to the courtroom had started to get surly. When the doors opened every morning, spectators shoved and elbowed one another for seats. During a brief recess one day, three elderly women accosted a bailiff for being unable to find them a place. At lunchtime each day, Carter ordered his staff to clear and lock the courtroom to protect evidence. Regular trial-watchers, many of them elderly women, assured themselves a seat for the afternoon session by bringing sack lunches in brown paper bags and camping out on the floor outside the courtroom. The judge had made matters worse by setting aside two rows for local high school students whose teachers thought the Jones trial would make an excellent lesson in civics. “Hey, these people are taxpayers,” Carter told complaining reporters. Finally, the judge relented and reserved a handful of seats for the press.

  Ron Sutton’s relations with the media were more cordial. Each day after trial, he held an impromptu press conference outside the courtroom, where he commented on the proceedings, in casual defiance of the judge’s gag order. Then the DA and his colleagues retired to the Georgetown Inn to unwind. Gathering in their large conference room, they popped a few cold ones from the refrigerator, held court with reporters, and waited to see how their day’s work played on the six o’clock news. After dinner, Sutton stayed up late, hashing over the day and preparing for the next.

  Sutton’s legal assistant had noticed that amid the crush of spectators, the courtroom seats reserved for Genene’s family and friends were almost always empty. Not even her children made an appearance. Crystal was with Gladys Jones, who lacked the strength or inclination to travel regularly to her daughter’s trial. The Texas Department of Human Services had assumed legal custody of Edward.

  In addition to losing her children, Genene faced the permanent loss of her career. The Texas Board of Vocational Nurse Examiners was considering suspension of her license. Worst of all, she stood to lose her freedom. Yet Genene was oddly blasé toward her plight. During jury selection, she had cried briefly while Brookshire made opening remarks, and once bolted from the courtroom, complaining of a stomach ailment. Returning with a filled carafe of milk, she had begun sipping it at the defense table, explaining that it would soothe her ulcer. But since testimony began, Genene had remained impassive, appearing bored with the proceedings. She doodled on pads and wrote letters and gobbled candy while court was in session. One day, she wanted to bring a book into the courtroom. And not just any book, but a copy of Pet Sematary, a best-selling horror tale by Stephen King. Genene was persuaded that courtroom reading would be unwise. But her lawyers couldn’t get her to behave in a manner that showed she realized this was serious. “She acts like she’s on trial for jaywalking,” said Laura Little.

  Genene insisted that her casual manner was merely evidence of a positive attitude, that she was dead certain she would win acquittal. Her lawyers saw it as proof that their client was living in a realm of her own, a world apart from reality. Nothing about the trial seemed to capture Genene’s attention—until Kathy Holland took the witness stand.

  Twenty-Nine

  Ron Sutton had wanted to keep the timing of Kathy Holland’s testimony a surprise. He subscribed to one of the rules of courtroom warfare: Never alert the enemy. But word had leaked out after Holland wrote a prescription for a member of the prosecution staff who had the flu. From a local drugstore, the rumor that the doctor was going to take the stand spread through Georgetown like a brushfire. After several days of numbing medical evidence, Kathy Holland’s appearance promised the trial’s most dramatic moments—unless, of course, the nurse testified, and whether that would happen was anyone’s guess. On Thursday, January 26, it was standing room only once again.

  No one was looking forward to Holland’s testimony with greater anticipation than the defendant. The doctor was a prosecution witness, but Genene knew Kathy wouldn’t say anything to harm her. They had shared not just a house and a workplace but a life together in Kerrville. They had spoken of loyalty and of friendship, of family and of love. A lot had come between them since. But the nurse still felt certain: Kathy was going to vindicate her. With Valentine’s Day three weeks off, Genene had acquired a package of candy hearts with little messages stamped on them. She showed her lawyers the one she wanted to put on the witness stand for Kathy. It read: “Be True.”

  Since the trouble broke in Kerrville, Kathy Holland had experienced a hellish fifteen months. She had suffered financial devastation, public scandal, and the breakup of her second marriage. Charleigh had finally gone his own way, after standing by Kathy for several months after their divorce. Holland had been forced to moonlight at Santa Rosa Hospital to try to pay her bills. She had struggled to rebuild her practice in Kerrville, but the unending publicity had thwarted her efforts. It didn’t help that the Sid Peterson medical staff still refused to restore her privileges. Desperate for a place to see patients after hours, Holland had finally applied for privileges at the tiny hospital in Comfort, where Chelsea McClellan had died. Her application was tabled indefinitely; Holland would later claim in legal documents that the Sid Peterson chief of staff had told his Comfort counterpart she was a lesbian.

  Holland hoped her testimony in Genene’s trial would erase all the black marks against her. Since receiving the assurance that she would not be prosecuted, she had spent hours helping investigators in both Kerrville and San Antonio. Sutton and Rothe had worked on Holland’s testimony in the San Antonio office of her lawyer; Jack Leon had even helped them coach her. The problem was that the pediatrician recounted events with a detached, clinical effect; it made her seem cold and abrasive. “She would be a better witness,” observed Leon, “if she spoke as a woman rather than as a doctor.” The lawyers urged Holland to loosen up and express emotion, maybe even shed a few tears on the stand. For trial, they told her to dress feminine, as part of the effort to soften her appearance; it also would repudiate the unsubstantiated rumors that she was a dyke who had consorted with Genene. In Kerrville, the doctor usually wore slacks and little makeup or jewelry. Holland showed up in Georgetown wearing a dress, earrings, stockings, and a visible coat of makeup.
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  Genene was at rapt attention and chipper as her former boss climbed the witness stand. Here, seated before her in this den of snakes, was a friend. Genene believed that this woman she loved would help her win her freedom. Holland was there, of course, to do just the opposite.

  Avoiding Genene’s gaze, the pediatrician quickly served up a string of damaging revelations. Sutton led Holland through Chelsea’s first respiratory arrest on August 24. The doctor testified that the child had suffered a period of slow heartbeat, or bradycardia. The jury had already heard testimony that bradycardia was a side effect of succinylcholine. The DA moved on to the day of Chelsea’s death. Holland said she had ordered routine immunizations after Genene had told her that the child’s temperature was a flat 100 degrees; pediatricians considered up to 100.4 degrees within the range of normal. But when she later checked Chelsea’s medical chart, the doctor testified, she discovered that Genene had recorded Chelsea’s temperature as 100.6 degrees.

  “If you would have known that Chelsea McClellan had 100.6 temperature,” asked Sutton, “would you have directed Genene Jones to give immunization shots?”

  “No,” said Holland.

  “Why, Doctor?”

  “I don’t give immunizations to a child with a temperature that is clearly within the febrile area, the fever zone.”

  Holland said Genene came to her on September 20, the day of Chelsea’s funeral, asking for permission to restock several medications used in the clinic’s emergencies. Sutton handed Holland a pharmacy invoice showing the purchase of a vial of succinylcholine on that date. He asked the doctor if she had authorized the purchase. Holland said she had not. She testified that her nurse had also ordered a vial of atropine without permission. Atropine was a drug often given with succinylcholine to counteract bradycardia. The jury would soon hear that one bottle of each substance turned up missing and had never been found. The implication was clear: Jones had obtained a private stash of drugs to work her mischief.

  Then there was the matter of another bottle of succinylcholine—the one Genene claimed had been lost, then rediscovered. Holland had ordered that vial before she opened her clinic. Jones informed her it was missing on September 7. On September 11, complaining of a bleeding ulcer, Genene had entered Sid Peterson Hospital for six days. Chelsea died on the day she returned to work. Holland informed Jones of the hospital committee’s inquiries about succinylcholine on Friday, September 24. Before the weekend was out, the nurse told her boss that she had located the missing bottle.

  But Holland suggested that Genene had told two important lies. Jones reported that she had discovered the bottle in a drawer of the examining table in the clinic’s crash room. Mary Mahoney—the nurse who had filled in while Genene was hospitalized—had already testified that she had gone through the drawers and discovered no medications. Genene also claimed that the rubber seal on the bottle of succinylcholine remained inviolate; Holland had discovered needle holes in the top. The doctor then described confronting Genene to demand an explanation for the holes. She ended her day on the stand by testifying that Genene had suggested they just throw the bottle away.

  “She’s lying! She’s lying!” hissed Genene to her attorneys, as tears streamed down her face. Why was Kathy betraying her? The lawyers told her to shut up and wait; they’d have a crack at Holland on cross-examination. But Genene wanted to speak to Kathy herself. If only they could talk, maybe everything would be all right. Brookshire wouldn’t allow it. When the doctor finished her testimony and left the courtroom, Genene broke down. For the first time, she was reluctant to run the gauntlet of press outside the courthouse. As she was led in handcuffs to a sheriff’s cruiser for the trip back to jail, Genene hid her teary face from the cameras. Brookshire’s legal assistant, Patty Jones, visited the nurse in her cell that night. She found her looking broken. “I can’t believe Kathy did that to me,” Genene moaned.

  For the defendant, it would get worse. The next day, Holland described Genene’s halfhearted suicide attempt, the events that prompted the nurse’s firing, and her discovery of Jones’s suicide note, with its semiconfessional reference to “the seven people, whose life I have altered.” Holland had turned the opened bottle of succinylcholine over to authorities. State police chemists would inform the jurors that most of its contents were missing and had been replaced with salt water.

  Sutton worked hard to end each day’s testimony with a bang—to feed the jurors a damning chunk of evidence to chew on overnight. On this Friday, as the close of testimony neared, he asked Holland to read Genene’s final notes in Chelsea McClellan’s medical chart: “Fifteen minutes into transport child noted to be mottled with eyes deviated upward. No response to pain. Cardiac monitor shows asystole. CPR begun. Dr. Holland in EMS unit. Five milliquivalents bicarb IV push; .8 cc’s epinephrine IV push and 2.5 cc’s calcium gluconate IV push without response. Meds repeated without response. Code eight to Comfort to Comfort Hospital. CPR continued. Meds repeated times six at Comfort Hospital without response. Pupils fixed. CPR discontinued. Parents informed of death by Dr. Holland. Post consent obtained. Baby transported from Comfort to Sid Peterson Memorial Hospital by EMS and myself and taken to morgue. I would have given my life for hers. Goodbye, Chelsea. Jones LVN.”

  Ron Sutton remained in Georgetown over the weekend to review medical records with his star witness. He was pleased with the way things were going. Holland hadn’t taken all their coaching to heart; she was still too detached and methodical. But the doctor had answered his questions with confidence, and there was still plenty of opportunity for her to show the jurors some emotion.

  Genene spent the weekend quietly licking her wounds in jail. She received a visit from her friends at the New Life Ministries, a group of born-again Christians who did missionary work with prisoners. Genene had been studying the Bible with them and had pledged her commitment to Jesus Christ as her savior; proclaiming Jones’s innocence, they had appeared in court regularly to offer the accused baby-killer support. On Monday, Genene finished a letter to her old San Antonio friend Keith Martin.

  Addressing her note “Hi Babe,” Genene wrote that it had been “quite painful to hear people I thought of as friends + family lie so blatantly. It seems I’m crying a lot these days.” Genene expressed optimism about her acquittal, telling Martin that he would have to treat her to dinner when the trial was over. She noted that she was “again free of the marital bonds,” and said her children were receiving counseling. Genene added: “Guess I’ll need it when this is over.”

  It was not until Kathy Holland’s third day on the witness stand that the defense had a chance to cross-examine her before the jury. Holland’s testimony was clearly damaging, but the defense attorneys felt they could make the jury doubt her credibility. Kathy Holland was walking a tightrope. She faced a $7 million civil suit filed by the McClellans, which asserted her negligence. In her sworn deposition for the lawsuit, she flatly declared she saw nothing to indicate that any of her patients had been given succinylcholine. But now Holland and the McClellans were on the same side. To buttress the prosecution, the doctor was suddenly recalling symptoms consistent with succinylcholine—symptoms that weren’t documented anywhere. She was trying to have it both ways; the attorneys for the defense didn’t intend to let her get away with it.

  Burt Carnes shuffled to his feet to handle the interrogation. After Chelsea’s first arrest, he pointed out, Holland had diagnosed the problem as a seizure disorder and placed the child on Dilantin, an anticonvulsant. How could she now attribute the problems to succinylcholine, a paralyzing drug?

  Holland said her diagnosis had originated with Genene’s initial statement that Chelsea had suffered a seizure. In the days that followed, Holland testified, Genene’s report prompted her to interpret behaviors that she would otherwise consider normal as subtle signs of seizures.

  Carnes worked to remind the jury that it was the doctor, not the nurse, who bore the ultimate responsibility for patient care. He drummed the message home
. “You were the doctor, you were there,” he told Holland. If the jurors would blame the pediatrician, they might not blame his client.

  “To what degree did you rely on your LVN to make your diagnosis of seizure activity?” Carnes asked.

  “I didn’t rely on Genene to make the diagnosis of seizure activity, but every doctor relies on a nurse to report what they see as having happened, and uses that information appropriately.”

  Carnes read Holland excerpts of her medical records, where she had described personally observing signs of seizures by Chelsea—both in the clinic and in the hospital. For September 17, too, Holland’s own notes reflected that Chelsea had suffered “tonic-clonic” seizures—characterized by rhythmic jerking of the arms and legs—during her clinic arrest.

  “Would you say that was a tonic-clonic seizure activity that you observed?” asked Carnes.

  “That was my impression at the time,” said Holland.

  “What is your impression today, Doctor?”

  “My impression is that there could be other things that could have been happening.”

  “What is that, Doctor?”

  “Based on what I now know about the possibility of succinylcholine having been used, it is possible that that could have been the result of succinylcholine being administered.”

  “And you are going to tell this jury that what you observed was momentary limpness, followed by…tonic-clonic seizure movement. You are saying that was succinylcholine?”

  “Mr. Carnes, I am saying that in retrospect now, the movements that I saw and the sequence of events that I observed are consistent with an administration of succinylcholine. Looking at them at the time, in the context of the moment of their happening, my initial impression was that these were seizure-like movements.”