Again there were emergency procedures in the examination room; the ambulance run to Sid Peterson Hospital. In the emergency room Chelsea’s color, breathing, and heart rate began to return to normal. Kathleen Holland decided to transfer Chelsea to San Antonio and called the MAST unit. They were busy, so instead she scheduled her transfer in an ambulance by ground rather than wait for the MAST helicopter to become available. As before, Genene would go along in the ambulance while Kathleen Holland would follow in the car. While Dr. Holland was phoning the hospital in San Antonio, one of the nurses at the hospital drove Petti back to the clinic where she had left Cameron and her car. Genene asked for a ride back with them to the clinic to get her and Dr. Holland’s purses, she said.
As Petti explained to Cameron that his grandmother was going to pick him up while she went to San Antonio, she saw Genene rushing about the clinic packing medical supplies into her bag. Genene returned to the hospital and boarded the ambulance transporting Chelsea to San Antonio. Holland followed in her car, and Petti, who was by now joined by her husband, Reid, brought up the rear in their vehicle.
In the back of the ambulance, paramedic Tommy James pumped the respiratory bag to assist Chelsea with her breathing, while Genene monitored the child’s blood pressure and heartbeat through an electronic monitor. Ten minutes into the drive, the monitor began to give an alarm—Chelsea was having a heart attack.
The ambulance stopped and Holland rushed into the cabin to find the paramedic bagging Chelsea while Genene was performing CPR. “She’s flatlined!” Genene shouted, meaning that the cardio-monitor was showing a flat green line on the scope—no heartbeat.
Dr. Holland stopped everyone for a minute and listened for a heartbeat. There wasn’t any. She ordered Genene to begin emergency drug injections. Genene pulled out a number of syringes from her bag and injected Chelsea with epinephrine, calcium chloride, and sodium bicarbonate. There was no response in Chelsea.
Holland ordered the ambulance to proceed to the nearest available hospital. This was Comfort Community Hospital about ten minutes away. The ambulance radioed for them to prepare for a Code Blue arrival. They arrived at 1:05 and quickly wheeled Chelsea into the emergency room. There Kathleen Holland and the hospital doctor, assisted by the paramedic, Genene, and the hospital nurses, attempted to revive Chelsea with rounds of injections of various cardiotonic drugs. The only thing left to do was to attempt to give her an electric shock, but the paddles were too large for the size of the child’s body. At 1:20 p.m., Chelsea was pronounced dead.
Although Kathleen Holland said she was in a state of shock and did not remember this, others recall that Genene Jones emerged with the dead child wrapped in a blanket and handed her to Petti, who broke down weeping.
Later, Genene took Chelsea’s corpse into her own arms, and cradling the dead child to her breast, rode sobbing in the ambulance all the way back to the hospital in Kerrville, where she logged the body into the morgue.
When Genene returned to the clinic that afternoon, she wrote in big, bold letters in the office log:
…CPR DISCONTINUED. PARENTS INFORMED OF DEATH BY DR. HOLLAND. BABY TRANSPORTED FROM COMFORT TO SID PETERSON HOSPITAL BY EMS AND MYSELF, AND TAKEN TO MORGUE. I WOULD HAVE GIVEN MY LIFE FOR HER. GOOD-BYE, CHELSEA
Genene then turned to 19-year-old Lydia Evans, who was sitting in the waiting room with her 5-month-old son Jacob. She had scheduled an appointment earlier for Dr. Holland to have a look at her baby, who had been cranky and irritable all week. The appointment was cancelled when Dr. Holland left on the emergency run to San Antonio with Chelsea, but when she died and Holland was scheduled to return to the clinic, the receptionist phoned Lydia and told her the appointment was “uncancelled.” She could come in if she still wanted to. Dr. Holland would be arriving shortly, she was told.
Lydia said she arrived at the clinic with her mother, father, and Jacob between 3:15 and 3:30 p.m. She testified that the receptionist told her Dr. Holland still had not returned, but the clinic nurse would see them for now.
Lydia testified, “Ms. Jones came out from the back of the office then and introduced herself, and said that we could go ahead and do the preliminary work on Jacob. Dr. Holland was due back any moment.”
The examination appeared to be routine, with Genene weighing and measuring the baby and asking Lydia about the infant’s history. Except for one thing, recalled Lydia, in her courtroom testimony
I remember that she kept coming back to his eyes—looking into his eyes—and feeling his head, she did that a lot. She seemed concerned and mentioned something about his left eye not responding to light properly, that the pupil was sluggish, or something like that, though the right eye, she said, seemed to been all right. I’d never noticed any problems with Jacob’s eyes, and I really didn’t see any problem then either—but I wasn’t really “double-checking” her.
Genene told Lydia and her mother that she detected a type of eye movement that was symptomatic of seizurelike activity and that she thought it would be best to transfer Jacob to the hospital in Kerrville to run some tests. She left the room for a few minutes and then returned and told the family that Dr. Holland had authorized her to take some blood samples and put Jacob on an IV line in preparation for the transfer.
As soon as Lydia heard that Jacob was going to be put on an IV she became concerned: Why? Is this serious?
Genene assured her it was routine, but “with the kinds of tests they’ll be running, you can’t always be sure how a baby will react.”
Lydia began to have second thoughts about the “tests”—maybe they should wait and think about it. Genene reassured her that Jacob would be fine and began ushering both Lydia and her mother out of the examining room, saying, “Now, ladies, I need to get him ready for the hospital. I’m a mother, too, and I know how it is to watch your child when he’s unhappy. I think it’d be better if you waited out in the lobby.”
Lydia’s mother spoke up and said that Lydia could leave but she’d be glad to stay and help with Jacob. Genene was insistent that it was against the rules to have a relative in the room when performing a “delicate procedure.”
As Lydia and her parents sat in the waiting room, they heard Jacob screaming in a way they had never heard before. “It was not the normal crying of a baby,” his grandmother would testify. “It was a scream. It was a terrified cry. He screamed several times, and then, in mid-scream—as though it were just cut off—there was nothing, just dead silence.”
Kathleen Holland was at Sid Peterson doing paperwork connected with Chelsea’s death when she heard from her secretary that Lydia Evans would be coming in to the clinic. Exhausted and drained by Chelsea’s death, she told her to tell Genene to immediately send the family to the hospital—she would examine the infant there. She completed the paperwork and was preparing for the presumed arrival of Lydia with her infant son, when the hospital operator stopped her and told her there was an emergency at her clinic—she was needed there immediately.
By the time Holland arrived at her office, an ambulance was parked at the door and Jacob had already been loaded in. The doctor next-door had performed emergency procedures on the child, who had had respiratory arrest. Holland got into the ambulance with Genene and asked her what had happened.
Genene explained, “He had a seizure. I had to call the doctor and nurse from next-door. He ordered 180 milligrams of Dilantin.” Genene then coughed and rolled her eyes, according to Holland, and said, “I knew that was too much, so I only gave him 80.”
Jacob was stabilized at the hospital and after six days of examinations, they still could not determine what caused the respiratory arrest.
“You’ve Got a Baby Killer on Your Hands.”
Unlike the San Antonio hospitals, Sid Peterson was a small facility in which everybody knew each other and everything that went on in the town of Kerrville. Five emergency seizures in a month at the newly opened clinic did not go unnoticed. One of the doctors commented, “There was just too much smoke. I’ve
been in practice forty-three years and never had one. To the best of my knowledge, we’ve never had one in Kerrville. Something had to be wrong.”
Disturbing also was the fact that the patients would recover within an hour or so after their crisis—unless Genene accompanied them for transfer to San Antonio, where inevitably on the way there they would have another seizure.
On Wednesday, September 22, the medical management team at the hospital decided to schedule an interview with Dr. Holland for the next day to discuss the issue. It was decided also that the next time there was an emergency case brought in from Holland’s clinic, the hospital doctors would attend and observe carefully what was going on. They did not have long to wait.
The next day, Thursday, September 23, Clarabelle Ruff brought in her 5-month-old baby girl, Rolinda, to the clinic, suffering from diarrhea and dehydration. After examining the child, Dr. Holland told her she wanted to check her into the hospital for observation. She ran the IV line herself, but asked Genene to prepare the medicine she was going to inject into the line. When she was ready, she asked Genene to hand her the syringe and injected its contents into the IV line. Soon the baby went into respiratory arrest and an ambulance was called to take her over to Sid Peterson.
When the word got out that yet another Code Blue patient was on the way from Kathleen Holland’s clinic, almost the entire staff of doctors from the hospital crowded into the room to observe.
As before, the child appeared to be recovering from the respiratory arrest. As the baby convulsed and fought the incubation tube being forced down her breathing passage, one of the doctors, an anesthesiologist immediately recognized what was happening: The child was recovering from the effects of a particular type of anesthetic. Anectine—succinylcholine, or “succs” in medical slang—was a synthetic curare used as a muscle relaxant in delicate surgery. While not affecting consciousness, it paralyzes every muscle in the body, including the diaphragm, and if given in a larger dose, the heart.
The day was not over yet. When Ruff had brought in her girl to the clinic, another mother was in the waiting room with her child—Mary Ann Parker, whose baby boy Chris three weeks earlier had been the other infant on the medevac helicopter and had escaped Genene’s attention during that flight. Chris, who had since returned home from the hospital, was now suffering from diarrhea and an ear infection and Parker brought her son back to the clinic. As Holland and Genene rushed off to the hospital with the Ruff child, Genene told Parker to take her child to the hospital emergency room and that Dr. Holland would see her there. Less than an hour later, Genene Jones entered the hospital waiting room and took Mary Parker’s son away to an emergency examining room. She placed the child on a bed that was being prepared for an emergency cardiac patient coming in by ambulance. When an emergency room nurse asked that Genene move the child, who was there for a routine examination to free the bed for the incoming emergency, Genene snapped at her, “Well, I hope to hell this baby doesn’t go into cardiac arrest.”
A few minutes later, Genene called a Code Blue for Chris Parker, who had stopped breathing. The ER doctors quickly responded, stabilizing the child, and soon Kathleen Holland arrived. Remarkably, Holland found a half-filled syringe lying in Chris Parker’s bed. Asking Genene and the nurses what it was, nobody knew. According to court testimony, Holland squirted the syringe empty onto the floor and told the nurses to get rid of it.
At the end of the day, as the exhausted Kathleen Holland and Genene walked out of the hospital’s intensive care unit and paused before the commemorative plaque at the entrance, Genene wistfully said, “Maybe someday this will be the Chelsea Ann McClellan Memorial Pediatric Intensive Care Unit.”
That same day the hospital doctors were meeting to discuss what they had observed in the emergency room and the suspicions the anesthesiologist had about the presence of succinylcholine. The medical community is a tight one and the doctors decided to call their various colleagues at Bexar County Hospital in San Antonio to find out all they could about Dr. Kathleen Holland, the recently graduated pediatrics resident. One of the doctors talking with a resident he knew at Bexar County was told by him that indeed there was a problem in the PICU in San Antonio—an unusually high death rate that nobody could explain and that the common denominator was a PICU nurse. The resident could not remember her name.
Was it Genene Jones?
The resident said he would check and call back shortly.
Five minutes later the phone rang. The resident said, “You’ve got a baby killer on your hands.”
On Friday, September 24, Kathleen Holland was called into a meeting at the hospital. There were eleven doctors seated at a board table, one of them a psychiatrist. They began to quietly pose questions to Holland, carefully listening to her responses and observing her body language. A lot of children seemed to be getting sick in her clinic. Why did she think this was happening?
Kathleen explained that every child was a separate medical situation with its own explanation. She had reviewed each case. She appeared to the doctors to be tense but professional and sincere. They asked her a battery of questions about her methods, techniques, instruments, medications, and her approach to pediatrics.
At one point they asked if she used succinylcholine at the clinic. Kathleen told her she had some but had never used it.
They questioned her about Genene Jones. According to their testimony, Kathleen defended her, saying that Genene had actually taught her a thing or two about resuscitating children. She had been an LVN in the PICU in San Antonio, but was moved out after the unit upgraded the nursing staff to RNs. All had been offered jobs elsewhere in the hospital and she had been graded “eligible for re-employment.”
The meeting ended when Kathleen’s beeper went off. Jimmy Pearson, the boy who arrested on the MAST flight to San Antonio and who had been returned to Sid Peterson, was arresting and Code Blue was called. It was not a good omen.
After Holland left, the doctors decided to call the Texas Board of Vocational Nurses and explained their concerns to an investigator there, Ferris Aldridge. After hearing out the doctors, Aldridge told them this was not a board matter, but that he would put the proper authorities onto the problem. This was how the Texas Rangers at the Department of Public Safety got involved, the first time in two years of death and suspicion that anybody got law enforcement authorities involved. This was the beginning of the end of Genene Jones’s killing career.
When Kathleen Holland returned to the clinic she told Genene about the meeting and what had been asked. She mentioned that they had asked if they had used succinylcholine on any of the patients in the clinic. She also told Genene that they expressed their concern over her aggressiveness and asked her if she had trusted her clinic staff.
“At that point, she became upset,” Holland later testified. “She said, ‘Somebody’s starting rumors,’ or something to that effect.”
Over the weekend, Kathleen Holland went away, but returned to the house she shared with Genene on Sunday evening. During idle conversation, just before retiring for the night, Genene suddenly said to her, in an offhanded manner, “Oh, by the way, I found that missing vial of succs.”
This was news to Holland: “What missing succs?”
Genene went on to remind her of the day she had told her about the missing vial of succinylcholine. The only problem was that Kathleen could not remember having any such conversation with her.
“So where was it found?” Holland asked.
“In the lower drawer of the crash room’s table, under the paper lining,” replied Genene.
Holland became uneasy. Strange that the very medication that was brought up in the meeting on Friday was now the one that apparently Genene was claiming was lost at the clinic. Holland recalled that Genene suddenly began to volunteer other information. As she spoke, Genene could not look at her but kept staring down at the table.
“There is one problem,” Genene continued, “the cap has been popped.”
Holland’s
heart froze.
Genene could not explain how that had happened, other than to say they had a lot of people in and out of the office. That did not satisfy Holland. She remembered once hearing that when people begin to volunteer all sorts of unsolicited information, it usually means something.
The next thing to come out of Genene’s mouth, was “Oh, yeah, I checked, and there are no holes in the stopper. I checked it against the replacement vial and all 10 cc’s are there. If somebody wants to draw it up, they can draw it up. It’s all there.”
Kathleen had a hard time sleeping that night. She could hear Genene moving about in her part of the house. The next morning, after doing her rounds at the hospital, she returned to her clinic about the time Genene was going out to lunch. Dr. Holland went straight to the refrigerator where the drugs were kept. She pulled out the two vials of succinylcholine and held them up to the light. She immediately noticed that there was a very slight, subtle difference in the meniscus—the dip in the fluid—in one of the vials. She tipped the vials and looked at their tops. One was still sealed with a cap, but the other vial was missing its cap, and Kathleen could distinctly make out two needle puncture holes in its red rubber stopper.
When Genene returned from lunch she was in good spirits and told Dr. Holland that she had just visited Chelsea. Petti would later testify that she saw Genene that day at her daughter’s graveside, rocking back and forth and sobbing, calling out Chelsea’s name over and over.
Kathleen called the office staff together and attempted to find out how the two puncture marks could have occurred in the succinylcholine vial stopper. Nobody could come up with a satisfactory answer. Genene kept saying that there were a lot of people coming into the clinic.
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