Killer Nurse

by John Foxjohn

  After several minutes, Clinton was finally able to calm Saenz down enough to get her to return to work.

  On this day, Saenz had four patients to care for. Like all the other PCTs and LVNs at DaVita, the employees who cared for patients did so in teams of two. While one team member was on break or lunch, the other team member watched the other’s four patients, and vice versa.

  On April 28, Saenz’s team member was a PCT named Angie Rodriguez, who’d arrived at work that morning at 4 A.M. to get ready for patient arrival at 5:30. After clocking in, Rodriguez began her usual job of preparing everything for the patients’ arrivals. This included getting the “bleach buckets” (actually small pails) set up.

  Each patient care station had two of these buckets, which were approximately six inches deep, ten inches long, and six inches wide. In one of the buckets Rodriguez poured a 1:100 ratio of bleach to water. She measured the bleach using a small measuring cup. At each patient care station were boxes of one-use cleaning cloths. To clean a surface, the technician or nurse pulled out one of the cloths, dipped it in the bleach bucket, wrung it out, and wiped the patient chairs before and after use—simply a sanitation procedure.

  The procedure for the second bucket was the same, except the ratio of bleach to water was 1:10. The PCTs and LVNs used this solution to wipe up blood off the floor or any other surface. After the ten-hour shift was over, they were supposed to throw the solution out and draw a new one up for the next shift. These two buckets were enough to get them through an entire shift.

  When both bleach buckets were set up, the tech placed them on top of the dialysis machine to give the PCT or nurse easy access, but at the same time keeping them off the floor. In a sterilized health care facility, nothing involving patient care is ever placed on the floor.

  Like every other day, as patients arrived, Angie Rodriguez brought them in and weighed them. It was imperative to do this with each patient because their weight showed how much fluid they’d retained from the previous treatment and told the nurse how much fluid needed to be drained. The last thing the patient did before leaving when the treatments were over was to get weighed again.

  Next the patient was led to a sink to thoroughly wash the arm where their access port was. The patients waiting on Rodriguez had surgically implanted arterio/venous grafts inside their nondominant arm.

  After the washing, Rodriguez took the patients to the treatment station and began an in-depth but important process. It was critical for the employees who treated patients to keep accurate records of the patients’ vital signs and all procedures that took place. Nursing schools hammered it into the students’ heads, it was on their licensing test to become a nurse, and each medical facility emphasized it—especially DaVita.

  First Rodriguez took the patient’s standing blood pressure, followed by the patient’s sitting blood pressure. After she recorded her findings on the flow chart, she checked all of the vital signs—pulse, temperature, lungs, heart rate—and recorded those on the chart, too.

  Next, Rodriguez placed two large, IV-type needles through the patient’s skin and into both ports. Each needle had a tube connected to it; one tube took the patient’s blood out and through a filter in the machine that acted as the kidney, and the other tube brought the filtered blood back into the patient’s body.

  Rodriguez’s patients sat on the opposite side of the bay from her teammate that day: Kimberly Clark Saenz. Two of the four patients under Rodriguez’s care were Ms. Carolyn Risinger and Ms. Marva Rhone.

  Rodriguez hooked Ms. Rhone up at 5:52 A.M. Records indicate that her blood pressure dropped that morning, but it wasn’t anything to be worried about. Rodriguez kept a careful check on all of her patients, including Ms. Rhone, and they were all okay when she told Saenz that she was going on break at about 8:00.

  Rodriguez had no way of knowing that during the approximately fifteen minutes that she was away, the unspeakable would occur.

  One of Kim Saenz’s own patients that morning was Ms. Lurlene Hamilton, a sixty-two-year-old black woman who was a veteran of the dialysis process—by 2008, she had been undergoing dialysis for eight years, the last three at the DaVita Lufkin Dialysis Center. Ms. Hamilton had been born and raised in Chireno, Texas, a small community in Nacogdoches County just north of Angelina County, though in April 2008, she lived in Zavalla, a small community in Angelina County. Before she became ill, Ms. Hamilton had worked at a nursing home and at the Mental Health Mental Retardation Center, taking care of the elderly.

  On the morning of April 28, Saenz hooked Ms. Hamilton up to the machine. As she progressed through her treatment, Ms. Hamilton—an especially observant patient, and with medical training besides—saw Saenz across the bay with Rodriguez’s patients. This in itself wasn’t unusual; the veteran dialysis patient had seen this scenario carried out a thousand times. What drew Ms. Hamilton’s attention on this occasion, however, was that Saenz wasn’t acting normal. As she later said, “Saenz was just looking around at her coworkers like, ‘Do anyone see me?’”

  What Saenz did next shocked the elderly patient. Ms. Hamilton saw Saenz kneel and place the bleach bucket on the floor. Ms. Hamilton asked herself, “What is she doing?” In her eight years of dialysis and all the time she’d worked in a medical setting, she’d never seen a medical professional place something used in patient treatment on the floor.

  As Saenz poured the bleach, Ms. Hamilton could smell it. She witnessed the LVN draw bleach into four syringes and place them in her bosom, then look around again to see if anyone had noticed. She didn’t spot Ms. Hamilton watching her.

  Ms. Hamilton then watched in horror as Saenz injected both Ms. Rhone’s and Ms. Risinger’s dialysis lines with the syringes.

  Ms. Hamilton wasn’t the only one to have witnessed this macabre scene. In the chair next to Ms. Hamilton that day was Ms. Linda Hall, a sixty-eight-year-old black woman also from Angelina County, and also with a medical background. Ms. Hall had worked at Memorial Hospital in Lufkin as a nurse’s assistant until her failing health caused her to quit. She’d been in dialysis for a year, and all of that with DaVita.

  Ms. Hall had been reading on the morning of April 28, but as she glanced up from her book, she witnessed an event as scary as any horror story.

  Ms. Hall watched Saenz open a drawer, remove a syringe, stick it in her shirt pocket, then look around very carefully as if she was checking to see if anyone had noticed her.

  Moments later, Ms. Hall saw Saenz set a bleach pail, the kind they used to wipe the chairs and machines with, on the floor. Like Ms. Hamilton, this alarmed Ms. Hall, who had also never seen any medical personnel set anything on the floor. She continued to watch as Saenz looked around again, squatted beside the bleach pail, inserted the syringe, and filled it with the bleach.

  Ms. Hall asked herself, “Lord, what is she fixing to do with that?”

  Transfixed, Ms. Hall watched Saenz as she rose and walked back to the nurses’ station, where the LVN stood for a couple of minutes, before walking over to Ms. Rhone’s station. Saenz looked around again . . . and then injected one of the syringes into Ms. Rhones’s saline port.

  Ms. Hall asked herself, “Lord, did I see what I saw? Am I dreaming?”

  Surely she was mistaken, Ms. Hall thought—something so unthinkable couldn’t be occurring right in front of her. And the nightmare didn’t stop there. Ms. Hall continued to watch as Saenz walked over and also made an injection into Ms. Risinger’s lines.

  Her book totally forgotten, Ms. Hall was at a loss for what to do. She knew what she’d seen, but didn’t want to believe it. Not only had she just seen a nurse injecting patients with bleach—it was the same nurse taking care of her.

  When PCT Angie Rodriguez returned from break at approximately 8:15, she found several unanticipated problems. Ms. Rhone’s blood pressure had risen and her actions were unusual. She seemed agitated, and when Rodriguez asked her how she was, Ms.
Rhone said she felt “uncomfortable.” Ms. Risinger was also complaining, of pressure in her chest and stomach pain. In a later interview with KTRE-TV, Ms. Risinger described the sensation: “It started out with a pressure on my chest,” she said. “It felt like somebody was pushing on me and then my stomach started a severe hurt.” That morning, she was left drifting in and out of consciousness. “It turned into a nightmare, and so many had died I thought, well, this is my turn.”

  Dr. Nazeer, who had been at another dialysis center tending to other patients, made his way back to DaVita after learning of Ms. Risinger’s chest pains. Before he arrived, though, Rodriguez and others were able to stabilize Ms. Rhone and Ms. Risinger. The women’s mysterious and sudden symptoms passed almost as quickly as they’d arrived. But Ms. Risinger, at least, was still suffering some ill effects. When her husband, Jim, arrived to pick up his wife, DaVita employees said he demanded, “What’s wrong with my wife? Who did something to my wife?”

  Meanwhile, Ms. Hamilton, normally a quiet person, was not only scared but extremely agitated. She looked around for someone she felt she could trust, spotted Yazmin Santana, a PCT, and frantically waved her over. After telling Santana the story, Ms. Hamilton begged her not to let “Kim” touch her.

  On the other side of the machine, Ms. Hall heard Ms. Hamilton tell Santana that she’d seen something. She spoke up. “Lord, I did, too!” Ms. Hall also begged a nurse who’d walked by not to let “Kim” touch her.

  Santana now had two terrified patients, and she related that what Ms. Hamilton told her scared her, too. Santana had no idea what to do, so she went to Amy Clinton.

  When Santana told Clinton what the two women had claimed to see, Clinton couldn’t believe it. She went over to talk to them herself. The witnesses’ stories were almost identical. They also both said that after Saenz injected the bleach into the patients, she had dropped the syringes into two sharps containers, and they told Clinton exactly which containers the syringes were put in.

  After hearing their stories in person, Clinton still had trouble believing them—the idea of a nurse injecting bleach into her own patients’ lines just seemed too far-fetched, too inconceivable—but she knew she had to do something. First, she called Saenz off to the side and asked her if she’d put the bleach bucket on the floor, and something turned inside her when Saenz admitted that she had. Clinton shook her head and informed Saenz, “We don’t do that.”

  Clinton then asked her if she’d given Angie Rodriguez’s patients any medication. Kim told her that she hadn’t. All she’d done, she said, was give them saline because the patients’ venous chambers were clotting. She also told Clinton that she’d charted what she’d done on the patients’ flow charts.

  Clinton was astonished when Saenz told her that she’d injected the patients with saline. DaVita Lufkin and all other dialysis facilities did indeed use saline to prevent the blood from clotting in the lines. However, at DaVita Lufkin, every dialysis machine had a bag of saline hanging from an IV rack attached to the machine. The saline bag had a clip attached to the line coming from the bag. If the patient needed saline, the care provider simply opened the clamp. Also on the line was a port for injections. This was where the care provider injected the patient’s medicine. The oddity of Saenz’s statement was that she’d need to inject the saline into the bag that already contained saline.

  Clinton now had a huge dilemma on her hands. She didn’t fully believe the story—the patients had to be mistaken somehow—but clearly something had happened, and she had two extremely upset patients on her hands who were scared to death. She had to do something to defuse the situation, and the only way she could think of at the time was to get Saenz out of the clinic. She hoped that her absence would calm down Ms. Hamilton and Ms. Hall enough to finish their treatments.

  She told Saenz, “You’ve had a bad day. Go home, relax, and we’ll start fresh in the morning.”

  Saenz was upset but left, and Santana took over her patients.

  With Saenz out of the building, the patients calmed down, but Clinton was left with an even bigger problem: what to do now? She began by checking Ms. Risinger’s and Ms. Rhone’s flow charts, a simple process, but became even more alarmed when she discovered that, despite her claim, Saenz had not, in fact, documented anything.

  Clinton then went to Dr. Imran Nazeer, the clinic medical administrator. She told him what she’d learned, and like everyone else who heard this story, Dr. Nazeer was shocked. He’d never heard of anything like this. In a way, though, he was relieved—if the story was true, at least they finally had an explanation for what had been happening at the clinic over the past month, a cause for all the deaths and injuries to the patients.

  The situation placed Dr. Nazeer in an unusual situation, one which later became very controversial. Since both patients who had allegedly been injected with the bleach were in the final stages of their treatments, and about ready to go home, Dr. Nazeer had opted to advise Ms. Rhone and Ms. Risinger to go to the hospital for blood work, but he didn’t tell them why. When neither patient heeded his advice, however, he called them at home, told them about the possible bleach injections, and again asked them to go to the hospital for blood tests. This time they listened to him and went.

  Dr. Nazeer’s hesitation, though ill-advised, was understandable. There were no contingency plans for a scenario like this at DaVita Lufkin. Nothing like this had ever happened, not to them, or to anyone else for that matter.

  Dr. Nazeer and Amy Clinton did two important things that morning after Saenz left, though: they took both sharps containers that the witnesses claimed Saenz had dropped the syringes in and saved them, and they also bagged Ms. Rhone’s bloodlines to preserve as evidence.

  However, for reasons unknown, they neglected one vital piece of evidence: they didn’t preserve Ms. Risinger’s bloodlines.

  CHAPTER 7

  THE INVESTIGATOR

  Sergeant Stephen Abbott of the Lufkin Police Department had no idea that at about the same time he was walking into the back door of the Lufkin Police Department on Monday morning, April 28, 2008, two dialysis patients were in the process of telling a DaVita employee a horrifying story of something they’d witnessed.

  He had no instinct warning him that by the time the day ended, he’d be involved in an investigation that placed him in a worldwide spotlight.

  At six-four and around two hundred and fifty pounds, Sergeant Abbott was an imposing sight. With a Nordic appearance, short white hair that didn’t quite make it to blond, and black-rimmed glasses that emphasized his milky coloring, he stood out in a crowd like a lumbering giant. He tended to move slowly, but was capable of moving very quickly if he had to.

  That Monday morning he was second in command of the department’s criminal investigation division (CID). Like most police departments the size of Lufkin, which had a population of around 28,000 in 2008, they didn’t have specialized investigative divisions; the detectives basically handled whatever came their way. Sergeant Abbott usually supervised the eight detectives on staff, but as in most small departments, he also had several other jobs to oversee—namely, he was in charge of the evidence room and the crime scene unit, both vital parts of any criminal investigation.

  Born and raised in Huntington, a small community nine miles east of Lufkin, Sergeant Abbott went into the Army after high school, and became a military policeman. Little if any information is available of his high school or Army days mainly because he wouldn’t tell anyone. All he’d tell a person in a soft voice that never seemed to rise or fall was that he was a private person and he wished to stay that way.

  Although Abbott declined to speak much of his days in the Army, it’s known that he was assigned to a military police unit attached to Fort Dix in the mid– to late eighties, and that that unit was deployed to Nicaragua in Central America during the infamous Iran-Contra affair. More than that is a mystery. The sergeant also didn’t tell war stori
es.

  After being honorably discharged in 1988, Sergeant Abbott returned home to East Texas and attended Angelina Community College, a local community college. He worked as a security guard at a chicken processing plant and at a pizza place to help pay his way through school.

  In 1993, he was hired by the Lufkin Police Department. After graduating from the police academy, he did a long stint in patrol, broken up with some time in the drug enforcement unit.

  By 2008, Sergeant Abbott had been with the department for fifteen years, and the fact that he rose to the rank of sergeant in that time, with little investigative experience, spoke to the kind of officer he was and to the higher-ups’ belief in his abilities. His fellow officers described Abbott as extremely intelligent, honest, and as dedicated to his job as anyone, though never willing to take credit for anything. He always attempted to deflect credit to others.

  Almost all police investigative units have someone with the ability to go into any situation and deal with any sort of person or problem—be it a board meeting with suits, politicians with an agenda, or a ditch digger in ripped jeans—and be able to relate to the people and handle whatever situation comes up. In April 2008, Sergeant Abbott was that person in the Lufkin CID whom higher-ups sought out to handle delicate or unusual cases.

  Around four thirty that Monday afternoon, Sergeant Abbott was sitting in his office—a room with bare white walls except for two prints that were there when he moved in, and a wooden plaque in the shape of a military police badge with the words “Military Police” on it—getting ready to leave for the day when his two bosses sought him out. They had what they thought might become a sensitive situation. In other words, the proverbial mess had hit the fan, and Sergeant Abbott was going to have to clean it up.

  Initially, all Sergeant Abbott was told was that there was an issue that might involve possible tampering with medicine at the DaVita Lufkin Dialysis Center, and he needed to go there and find out what was going on. This in itself issued a major challenge. He had no background whatsoever in the medical field, had never investigated anything in the medical field, and didn’t know anyone who had.