Bellevue

by David Oshinsky

  The hospital responded that the document didn’t apply because Wirth had a “reasonable expectation of recovery” from the condition currently threatening his life. And several Bellevue doctors took the stand to insist that keeping an AIDS patient alive as long as possible made good sense in a world where medical research was rapidly advancing. “The treatment…changes every six months,” one of them stated. “Regularly, new therapies become available.”

  The court decided for the hospital. Accepting the claim that Wirth’s brain infection might not be fatal, Judge Jawn A. Sandifer found “no clear and compelling evidence” that the patient was “not without hope”—a tortured pronouncement, to be sure. “There is nothing more precious than human life,” the judge declared in ordering Bellevue to continue the treatment for toxoplasmosis, which it did. Wirth died the following month without regaining consciousness.

  Though Evans v. Bellevue wouldn’t rival the more spectacular right-to-die cases of that era, its impact was substantial. In 1985, Governor Cuomo had formed a task force on “Life and the Law” to help patients and hospitals find common ground. And two years later, in the weeks following Evans, the task force endorsed the concepts of the “living will” and the “designated proxy”—the first to provide “specific instructions” regarding life-sustaining treatment; the second to “protect the wishes and interests” of the incapacitated patient.

  The irony, of course, is that Wirth had little in common with the typical Bellevue AIDS patient. Well-educated and middle-class, he’d exhausted both his health insurance and his bank account, forcing him to “spend down” into poverty, where a public hospital bed awaited. Drug addicts didn’t normally plan ahead for medical emergencies, and gay patients of that era often hid their illness, refusing to be tested for AIDS or to tell their families for fear of being shunned. As a result, the great bulk of these end-of-life decisions fell to the hospital.

  At Bellevue, the general policy for comatose patients who hadn’t made their wishes known was to employ life-sustaining measures. Not wanting the ominous words “Code Blue” blaring over the loudspeakers all day, the hospital used a series of innocuous terms like “Airway Team” to alert staffers of an emergency without alarming other patients and visitors. Once in the room, the attending physician or resident took charge. In most cases, a serious attempt was made to keep the patient alive.

  But not always. Staffers cited examples of what is known today as the “slow code”—treating a hopelessly ill patient in cardiopulmonary failure at a pace that encourages death to naturally occur. Whether hesitating to put a tube down the throat, or to hook up the ventilator, or to put the paddles to the chest—the result is the same. A “Code Blue” is a supercharged and sometimes dangerous event. People are tense and packed together. It’s a time when the most needle sticks and careless accidents occur. “This wasn’t cowboy medicine. Nobody tried to play God,” a Bellevue doctor recalled. “These people were unbelievably sick, they had no chance of getting better, and they were going to keep suffering until the minute they died.”

  AIDS today no longer drives the debate over living wills, health care proxies, slow codes, or “Do Not Resuscitate” orders. And that alone is notable, marking its turn from a death sentence to a manageable condition. The vital work of identifying the Human Immunodeficiency Virus (HIV) that triggered AIDS took place in the laboratories of the National Cancer Institute in Rockville, Maryland, and the Pasteur Institute in Paris, while a group of academic medical centers, including NYU, played key roles in researching aspects of the disease. NYU focused on Kaposi’s sarcoma and other cancers, the maternal-fetal transmission of the virus, mathematical models for measuring HIV levels in the bloodstream, and human trials for new drug therapies.

  By 1990, NYU had two groups running independent trials: one at Bellevue led by Dr. Fred Valentine; the other at the Aaron Diamond AIDS Research Center directly across First Avenue headed by Dr. David Ho. Each group, working with different pharmaceutical houses, tested a multidrug therapy designed to suppress HIV in already infected patients. And both showed remarkable results. The viral loads of the subjects dropped to almost undetectable levels and stayed there as long as the routine was faithfully followed. The therapy produced some uncomfortable side effects. It was expensive and complicated, and had to go on indefinitely because the virus had not been fully eradicated—just kept in check. Still, a watershed had been reached in the containment of a once fatal disease.

  Dr. Ho published first. The response was volcanic. Plucked from obscurity, he became an instant media star at thirty-six, a modern-day Jonas Salk. Time named him “Man of the Year,” and articles appeared predicting, prematurely, the end of the plague. But for the millions fortunate enough to receive these therapies, the nightmare had passed. “I have begun to believe that I will live a normal life,” wrote the critic Andrew Sullivan. “I don’t mean without complications. I take 23 pills a day—large, cold pills I keep in the refrigerator, pills that, until very recently, made me sick and tired in the late afternoon. But normal in the sense that mortality…doesn’t hold my face to the wall every day…that life is not immediately fragile; that if I push it, it will not break.”

  By the year 2000, Bellevue saw far more AIDS patients in its outpatient clinics than on its wards—patients with the same garden-variety illnesses as everyone else. And in 2012—with the disease no longer among the top ten killers of young men in New York City for the first time in thirty years—the hospital shuttered its AIDS (or Virology) Unit, a once unthinkable move. Looking back to a time when Bellevue was choked with bodies, “all dying, some rapidly, most slowly,” Fred Valentine called the move “astounding.” A momentous chapter in Bellevue’s history had closed—perhaps for good.

  18

  ROCK BOTTOM

  New York Hospital had long been a favored destination of celebrity patients seeking luxury, privacy, and top medical care. Relocated from lower Manhattan to the posh Upper East Side in the late 1920s with a $40 million gift from Payne Whitney, and modeled upon the Papal Palace at Avignon, it attracted the likes of Jacqueline Kennedy and the Shah of Iran. In the mid-1980s, however, New York Hospital suffered two devastating blows to its reputation, each involving the death of a patient under mysterious circumstances, and each raising doubts about the competence of senior physicians, nurses, and residents in training—in short, the entire medical staff.

  Libby Zion, the eighteen-year-old daughter of a prominent journalist, had come to New York Hospital’s emergency room in October 1984, with flulike symptoms compounded by emotional agitation. Eight hours later she was dead—the victim, a jury decided, of repeated errors by a poorly supervised and dangerously overworked house staff. Major reforms would follow, and a settlement be paid, but the bad news kept piling up. A series of high-profile malpractice suits would plague the hospital, followed by the death of pop artist Andy Warhol after routine gallbladder surgery in 1987, which officials blamed on cardiac failure compounded by indifferent nursing care. A withering exposé in the New York Times put it well: “A GREAT HOSPITAL IN CRISIS.”

  At Bellevue, meanwhile, an even darker tragedy was about to unfold. It, too, would involve a death, though not of a patient, and put the hospital in the crosshairs of the media. The main difference was that the events at Bellevue would seem more plausible to the average reader, more in line with its reputation, than the events at New York Hospital. Where one narrative drew its strength from the element of surprise, the other read like an accident waiting to happen.

  —

  Kathryn Hinnant loved New York City. The daughter of a South Carolina stockbroker and a nurse, Hinnant had first come to Manhattan for an internship in pathology at Lenox Hill Hospital. “She was tough,” her mentor recalled. “I have this vision of [a] young woman who looked like Audrey Hepburn, who weighed 100 pounds, doing autopsies, working in blood and intestines. Not only did she do it, but she was elected chief resident.”

  Following a brief stint at George Washington U
niversity Hospital, Dr. Hinnant returned to New York, lured by the museums, art galleries, and music venues she and her husband, a piano salesman, had come to adore. Specializing in cytopathology, the study of disease at the cellular level, she took a job on the NYU Medical School faculty as part of a research team developing a “thin needle biopsy” to reach “the deepest recesses of the body with great precision.” It was a plum assignment, given the connection between rare cancers and AIDS, and her career was rapidly advancing. Her tiny fourth-floor office at Bellevue, a few doors down from the pathology labs and autopsy rooms, seemed perfect for her needs.

  In the fall of 1988, Dr. Hinnant discovered she was pregnant. A decision loomed. Would she move back to South Carolina to raise a family and continue her research at a measured pace, or would she remain in the city, where daily life would be much more complicated than before? She and her husband agreed to put the question on hold.

  On January 7, 1989—a bitterly cold Saturday—Hinnant went to her Bellevue office to prepare some slides for an upcoming lecture to medical students. The pathology wing, a building away from the patient areas, was completely deserted. “There ain’t nobody there, especially on weekends,” a housekeeper would remark. “You can holler as loud as you want; nobody can hear you.” Because her office had no window, Hinnant left the door ajar to catch a breeze. She turned on her slide projector, and got to work.

  —

  That same day, a homeless cocaine addict named Steven Smith was wandering Bellevue in search of someone to rob. Smith had been admitted a few weeks earlier for swallowing rat poison and muttering about suicide. Released against his wishes, he ingested even more poison, which got him readmitted. Though Smith now spoke of killing others as well as himself, the psychiatrist in charge could find no “psychosis or depression.” The patient was acting out, he thought, to get a warm bed and some personal attention.

  Others were less certain. A female intern recalled Smith as a “threatening” presence, and avoided him when she could. Held a few more days for medical observation because rat poison can cause serious internal bleeding, Smith, nicknamed “Ratman” by the staff, was released again because the psychiatric wards were full. Refusing to leave voluntarily, he was escorted from the hospital by uniformed guards.

  But not for long. Smith returned the following week by simply blending into the mass of homeless people—drug addicts, AIDS victims, psychiatric cases, emergency room arrivals—who poured into Bellevue as patients or who used the cavernous lobbies and rest rooms as part of their daily routine. But Smith went a step further: he moved into the hospital as a squatter, finding himself a machinery closet on Bellevue’s twenty-second floor.

  Dressed in stolen doctor’s scrubs with a stethoscope, a beeper, and a security badge, Smith had free run of the premises. “He took great joy moving around and fooling people, looking like part of the scenery,” the police commissioner recalled. That included taking some of his meals in the staff dining room and, according to Smith’s account, watching an operation in progress. A nurse did alert security after seeing Smith steal a clock and a hypodermic needle, for which he was arrested. But since no one bothered to run a name check—and petty theft by the homeless was quite common—he was released. Feeling more comfortable, even out of costume, Smith visited the emergency department seeking drugs for “back pain.” But the staff grew suspicious, and he retreated to his closet on the twenty-second floor.

  When Smith came upon Dr. Hinnant’s partly open office door on the afternoon of January 7, he peeked his head inside and said, as he later told police, “Can I talk to you for a minute?” He may not have seemed particularly threatening or out of place—a small man, five feet, six inches and 130 pounds, dressed in doctor’s garb (though Bellevue had very few African American physicians on staff). By ghoulish coincidence, Hinnant and Smith shared a common bond: both had grown up in Columbia, South Carolina, and both had returned there just a few months before—Hinnant to celebrate her parents’ wedding anniversary; Smith to track down and terrorize a former girlfriend, which had led to his arrest and a brief commitment to a mental hospital after he drank a bottle of liquid detergent. By his own estimate, Smith spent no more than twenty minutes in Hinnant’s office. In that time, he beat her unconscious, raped and sodomized her, and strangled her to death with an electrical cord.

  Dr. Hinnant’s husband had become frantic when she failed to show up that evening and didn’t answer her phone. Escorted to her office by a security guard, he found her battered, naked body on the floor. The slide projector was still running; her fur coat and pocketbook were gone.

  “On a typical day in 1989,” said the Daily News, “New Yorkers reported nine rapes, five murders, 255 robberies, and 194 aggravated assaults. Fear wasn’t a knee-jerk reaction, it was a matter of self-preservation.” Yet of all the homicides that record-breaking year, few grabbed the public’s attention quite like Kathryn Hinnant’s. Fifty police detectives were assigned to the case, which Mayor Edward Koch called “the number one [crime] to be solved.” Smith was arrested a few days later at a homeless shelter with Hinnant’s coat and credit cards in his possession. A search of Bellevue’s twenty-second floor turned up evidence of his encampment. The man the newspapers called “The Beast of Bellevue” had been caught.

  It would be hard to imagine a more chilling scenario: a young doctor, five months pregnant, brutalized in her office by a deranged man roaming a public hospital at will. Not only had the assailant been arrested and released a few days before, he’d apparently been declared harmless by the psychiatrist who examined him. Furthermore, a look at Bellevue’s security log for the month before the murder showed “at least three reports of unauthorized persons living in the fourth floor locker room and at least five reports of persons sleeping in other common areas and in stairways around the hospital.” Squatting at Bellevue, it appeared, was hardly an aberration.

  —

  To make matters worse, the murder had occurred at an institution well known for security lapses. Ever since the infamous Nellie Bly exposé a century before, the press had kept a running tally of Bellevue’s blunders, some becoming the stuff of legend. In 1919, Captain Fritz Duquesne, a top German spy, had fled Bellevue’s prison ward by sawing through the bars and scaling an eight-foot fence with “menacing spikes” on top. The incident became a global sensation—partly because of Duquesne’s notorious exploits during World War I, and partly because he’d tricked Bellevue’s medical staff into believing he was a “hopeless paralytic” with an incurable disease. Though New York’s district attorney was certain Duquesne had bribed his way to freedom, no one at Bellevue was ever charged, and the elusive Duquesne went on to spy again, for the Nazis during World War II.

  When Bellevue’s massive psychiatric building opened in the early 1930s, space was provided for two secure prison wards—one for men, the other for women—each with fifty beds. But the wards filled up so quickly that male prisoners with medical problems were moved back to the main hospital, while those with psychiatric issues remained. Both buildings contained a courtroom to process the various cases, where the psychiatric staff assessed the suspect’s competence to stand trial. And, as with Fritz Duquesne, the doctors had the unenviable task of distinguishing between a legitimate illness and the false symptoms of those hoping to cheat justice. Some cases proved easier than others; in 1941, for example, a prison psychiatrist recorded the intentionally bizarre behavior of two murder suspects “remanded to Bellevue for observation”—one “taking a banana, peeling it, throwing away the fruit, and eating the peel,” the other “pouring out his soup, putting the bowl on his head, and wearing it.” The suspects weren’t insane, the psychiatrist testified; they were fakers clumsily trying to avoid the electric chair, which soon became their fate.

  But such cases paled in comparison to the events surrounding William Morales, a leader of the FALN, a domestic terror group demanding independence for Puerto Rico, that had planted dozens of homemade bombs throughout New York Ci
ty in the 1970s, including one that killed four people at historic Fraunces Tavern near Wall Street. While plying his deadly craft, Morales had accidently blown off his fingers and blinded himself in one eye. Tried and sentenced to eighty-nine years, he was moved to Bellevue’s third-floor prison ward—D-2—for physical rehabilitation. Once there, he sued the police department for “illegally confiscating” his fingers as evidence rather than sending them to the hospital for “possible reattachment.” Then he disappeared.

  To this day, the breakout remains shrouded in mystery. Using a pair of fourteen-inch wire cutters, along with rolls of elastic bandage tied to his bedpost, Morales somehow removed the window grate and grabbed his makeshift rope, which quickly snapped under his weight, sending him tumbling down to a grassy patch below. Fortunately for Morales, a window air-conditioner broke his fall. He was met by fellow gang members, who whisked him to a safe house in New Jersey.

  The New York Post broke the story in three perfectly scripted words: “HANDLESS TERRORIST ESCAPES.” How, exactly, had a one-eyed man missing all ten fingers been able to pull it off? The Bellevue prison ward had armed corrections officers. Visitors were supposed to be searched. Who gave Morales the bandages and the wire cutters? Why had no one spotted a car full of strangers on the street below?

  There were no answers, only theories. Investigators suspected that a member of Morales’s legal team and a sympathetic doctor had provided the escape tools, while security personnel had been either complicit or astonishingly inept. Several officers were fired, followed by the city’s corrections commissioner and key members of his staff. Meanwhile, Morales fled to Mexico and then to Castro’s Cuba, where he was given asylum—and remains to this day.