by Peter Elkind
During the same period, Jones’s visits to the hospital and clinic for personal health complaints became more frequent. Between June and December of 1981, Genene sought medical treatment sixteen times. She was hospitalized four times. In August, she appeared in the emergency room, complaining of chest pains and dizziness, but left before being seen by a doctor. She returned two days later for stabbing pains she likened to a sharp needle in her chest. A doctor found no evidence of heart trouble and attributed her complaint to muscle spasm or depression. But Genene did not accept that conclusion; ICU nurses informed Belko that Genene was medicating herself with nitroglycerin. Three months later, she was admitted for constipation, cramping, and nausea. During four days in the hospital, she complained of several symptoms that doctors could not explain. Genene took herself off oxygen—“states she doesn’t need it anymore,” nurses noted—and refused to take the drugs her doctors had prescribed. She claimed she had vomited, but a ward nurse made a point of reporting that she saw no evidence. Genene spent much of her hospital stay smoking cigarettes and entertaining visitors from the ICU. Three weeks later, she was admitted again. Complaining of severe abdominal cramps and nausea—the textbook signs of a small-bowel obstruction—she went to the surgery service for observation. Genene underwent a battery of tests; she was wheeled into the x-ray room on a stretcher. When three days of studies revealed nothing, doctors discharged her, concluding that the problem had resolved itself.
During Genene’s seventeen days as a patient in Bexar County Hospital, not a single child died in the pediatric ICU.
After his initial visit from Robotham, Dr. Franks had heard complaints from other faculty about unexpected deaths in the pediatric ICU. Franks asked Robotham to determine the number of children who had died in recent months. J.R. reported back that there had been eleven since midsummer—all on the 3–11 shift. Franks ordered his secretary to pull the medical charts and asked Robotham to study them closely.
Despite the extraordinary bunching of deaths on a single shift, the acting chairman remained skeptical that anything criminal was going on. In private notes he began keeping in order to maintain a factual record, Franks detailed his personal doubts. “From the outset, and to the present time, I have no evidence—circumstantial or objective—that there is a ‘problem,’ i.e. negligence of omission or commission. However, because the concern was expressed and the possibilities existed, I have thought it prudent to proceed with an evaluation of the possibilities.” The nursing administrators had fretted that the entire stew was the product of personality conflict—that Genene Jones was being victimized by her enemies in the ICU. Franks echoed that concern, noting that he had directed Robotham to conduct his investigation “without appearance of a ‘witch-hunt.’”
All the same, Franks considered the matter too hot to handle himself. This wasn’t the sort of headache he had expected when he accepted the job as acting chairman. On November 10, 1981, Franks took the problem to B. H. Corum, the hospital district’s new top administrator.
Lieutenant Colonel Buford Hubert Corum, Jr., USAF (ret.), was the sort of man who believed in the power of fear. A short time after his appointment as executive director of the Bexar County Hospital District, Corum slipped into the hospital’s administrative suite through a back door. Discovering several employees laughing and joking at their desks, he marched up to them, face flushed and jaw set. “Do you know who I am?” he demanded. They did not. “By God,” Corum roared, “you’re going to find out.”
Corum had taken over the $58,000-a-year post in August, fresh from a quarter century of air force spit and polish. He grew up in small-town Alabama, attended college at Auburn, and enlisted at twenty-one. Degrees in pharmacy, hospital administration, and management propelled him into a career in the bureaucracy of military hospitals. Most recently, he had served as administrator of Wilford Hall Medical Center, a giant air force complex in San Antonio. Corum was six feet two and a swarthy 195 pounds. He wore a small mustache and metal glasses, and his shrinking allotment of hair stood in a tuft above his forehead. At forty-seven, he was married, the father of one daughter, and a deacon at his Baptist church. He smoked short cigars.
Corum arrived at Bexar County Hospital determined to shape the place up, and he didn’t appear to mind bullying subordinates in order to do it. He inspected his command daily with a clipboard-carrying aide in tow, and when he found something amiss, he chewed out employees in public. Popping in at night, he startled lounging janitors with a sharp kick at their feet and sharper words of warning: “I write your check, you SOB!”
A man of towering ego, Corum once arranged to be introduced at a gathering of hospital administrators to the musical theme from Star Wars. He made it known he expected to be secretary of the U.S. Department of Health, Education, and Welfare within a decade. Corum labored to cut costs at the county hospital, but his efforts occasionally revealed a Queeg-like obsession with minutiae. At one meeting, he berated a group of deputies for failing to monitor the use of paper clips. Physicians chuckled at his fondness for being grandly addressed as “Doctor”—Corum had a Ph.D.—while making rounds in a short white lab coat, the sort worn by lowly interns. But employees bearing a grievance rarely found any humor in what Corum told many of them: “If you don’t like what I’m doing, hit the door!”
Within the hospital Corum’s hubris spawned legends. One widely circulated story concerned a meeting he was said to have held with Sister Angela Clare, the Catholic nun who ran the downtown Santa Rosa hospital. Sister Clare had called the session to warn that the number of indigent patients falling on Santa Rosa’s shoulders jeopardized the institution’s survival. “Sister,” Corum is said to have interrupted, “you mistake me for someone who gives a shit about Santa Rosa’s survival.”
Yet there were many who felt that B. H. Corum was just the man for the job, that a few swift kicks a day were precisely what the county hospital needed. The last permanent administrator had ended his eleven-year tenure in 1980, after presiding over cutbacks that set the UT doctors to revolt. So harsh were the reductions, so desperate the need for more staff and new equipment, that the medical school dean publicly branded the twelve-year-old hospital “inadequate.” Hoping to calm the doctors, the hospital board filled the vacancy with a popular figure from the medical school, Dr. Charles E. Gibbs, an obstetrician-gynecologist. Filling the post on an interim basis for eighteen months, Gibbs persuaded the county commissioners to raise hospital taxes for the first time in years and raised money through better debt collection. With a slight loosening of the purse strings, Gibbs started upgrading the hospital’s physical appearance and capital equipment; his mere presence boosted morale. But much remained undone. The board asked Gibbs to accept the job on a permanent basis, but he declined.
Corum was less reluctant. When the hospital announced its search for a permanent executive director, he appeared in Gibbs’s office, pressing for details about the job. Gibbs urged the board to pick a doctor; after all, the hospital’s basic task was patient care. But the board was unwilling to spend the extra $30,000 a physician-administrator would require. At the end of a six-month search, B. H. Corum got the nod. In his first public pronouncement, the new executive director made clear his intentions. He said he planned to run a tight ship and added: “I think I’m the man for the job.”
Corum knew money was the key to ensuring the happiness of the hospital’s three most sensitive constituencies: the UT doctors, hospital employees, and the Bexar County commissioners. If he couldn’t get enough public money to run the hospital properly, he would go after private funds—through private patients and private gifts. The problem with that idea was that which had dogged Bexar County Hospital since its opening: Those who could afford to do so almost always chose to go elsewhere.
Burdened by the image of his hospital as an underfunded, overutilized public institution for the poor—in short, burdened by reality—Corum was determined to refashion public perceptions. Attracting private money just requir
ed marketing—shedding the dismal charity-hospital rap, promoting the place instead as a bustling, world-class medical center. Corum decided to start by changing the hospital’s name; he was eager to banish the word “county,” with all its down-at-the-mouth connotations. After pondering such possibilities as Citizens Hospital and University Hospital, Corum in late October persuaded the board to rechristen the institution Medical Center Hospital. Corum also laid plans to open a private ward on the hospital’s twelfth floor, where paying patients could receive care without rubbing elbows with the unwashed. He started recruiting a special development board, led by wealthy businessmen, to raise funds. And he launched an aggressive public relations campaign, promoting all the changes under the slogan “New Horizons.”
Thus, when Dr. Franks phoned Corum on November 10, raising the possibility that someone was killing children in his hospital, the administrator might have thought about how such a situation—if it was true—threatened more tiny lives every day. But B. H. Corum would likely have thought about other considerations too: about how calling the police or the district attorney would doubtless make the whole matter public, about the unprecedented scandal that would produce, and about how such a tempest would jeopardize everything he wanted to accomplish.
After receiving Franks’s call, Corum summoned his young deputy, associate executive director John Guest, and his top nursing administrator, Virginia Mousseau. Guest wrote personal notes one day later, summarizing the meeting: “Dr. Corum indicated a call from Dr. Bob Franks that day. Dr. Franks concerned with # of deaths in PICU particularly on 3–11 shift…Ms. Mousseau indicated one LVN is suspected of some involvement. Discussed concerns about Robotham getting out of hand with suspicions and emotions. Discussed control of those who know about problem. Potential need for outside investigation.”
After exploring what was known about the possibility that a nurse was harming children, after hashing over the suggestion that the ICU’s medical director was overreacting, B. H. Corum decided that the situation required no special action on his part. If Franks wasn’t sure there was a problem, why should he assume there was one? Corum delegated Guest to keep informed about the pediatricians’ investigation. The executive director was preoccupied with other matters. His hospital had a new image to establish.
Nine
Jim Robotham was beginning to wonder if everyone thought he was crazy. Franks seemed to be humoring him, nursing thought he was on a witch hunt, and the hospital administration wouldn’t get involved. Robotham’s scrutiny of the ICU’s medical charts had left him deeply unsettled. He had discovered a worrisome number of episodes where something had happened that he couldn’t explain—and a nagging correlation between such events and the presence of Genene Jones.
In a confidential five-page memo to Franks, Robotham reviewed nine individual cases, documenting emergencies that were either unexpected or inconsistent with a child’s illness. Several patients had experienced bleeding or other problems only under Jones’s care. The special lab tests Robotham had ordered gave him more cause for alarm. A staff hematologist who tested the blood of Jose Flores—the child whose body Genene had carried on the madcap chase through the hospital—“felt the most likely diagnosis, though one which could not be confirmed to explain the bleeding, was an overdose of heparin,” Robotham noted. In another case, the blood expert considered too much heparin “the most likely possibility.”
Even after reading Robotham’s report, Dr. Franks remained skeptical of his suspicions. “Although there are recurrent, pointed references to a particular nurse, I do not perceive a constant ‘thread’ which suggests misadventure,” reported Franks on December 3, in another note for his private files. “I have previously discussed with Jim my concern that he has without basis prospectively identified a culprit; the report, in my view, contains conscious or subconscious expression of that view. I do not believe it substantiated by the attached.” Franks informed John Guest that the chart review had turned up nothing. “This is the end of it,” Franks declared.
But Robotham wouldn’t give up. He had searched for other answers—and ruled them out, one by one. Could the drug company have made the heparin too strong? Robotham had sent unopened samples down to the lab; they were normal. Was there something contaminating the medical equipment? Robotham had sent intravenous bottles and tubing to be tested for bacteria; nothing was in them. Could the heparin problems result from honest nursing mistakes? Robotham knew medication errors were common in hospitals, but he had issued countless directives about the use of heparin. More mistakes seemed unlikely.
Still the awful pattern went on. Children in the pediatric ICU continued to suffer—and sometimes to die—from unexplained medical problems. Robotham’s chairman and the nursing administrators—Belko, Harris, and Mousseau—were all demanding that he produce proof. They would take no action without it. But there was no proof of anything. Night after night, Robotham would go home to his family and lie awake in bed, wondering.
To Patricia Alberti, there was no question: Genene Jones was killing kids. A thirty-nine-year-old former army medic, Alberti was an LVN on the night shift, with seven years of experience in pediatric ICUs. Alberti had listened for weeks as the terrified young nurses on the 3–11 shift spoke of the increasing number of codes. Like Suzanna Maldonado, she had made a point of caring for Genene’s patients. She had come to know the frustration of arriving for work to discover that her patient’s bed was empty. “I struggled with it for eight hours, and the kid was still alive. Day shift had it for eight hours, and the kid was alive. [Genene] came in for three hours, and the kid was dead.”
A native of North Carolina, Alberti was a tall, lean woman who voiced her convictions bluntly and clung to them with tenacity. Belko’s threats of discipline were not about to shut her up. On two occasions, parents had informed Alberti that Genene claimed to have taken their critically ill children off a respirator—something only doctors may do. Alberti had reported the remarks to Belko, but the head nurse attributed them to misunderstandings. To the nurses, nothing they said about Genene seemed to make a difference. They felt as though they were watching a disaster unfold—and were helpless to do anything about it. While Robotham continued his search for answers, some nurses contemplated tipping off a local newspaper columnist. Pat Alberti would turn to her psychiatrist, a doctor from the UT medical school. A nurse was killing babies with drugs, she declared, and nothing was being done.
On December 8, Joshua Sawyer arrived in the pediatric ICU. Eleven months old, Joshua was suffering from severe smoke inhalation after being rescued from a fire at his family’s home. He came to the ICU in a coma and covered with soot; transferred from another hospital, he had already experienced seizures and one arrest. Doctors in the ICU ordered sedative drugs—Dilantin and phenobarbital—to prevent any more seizures. Joshua’s condition was critical, but a scan of his skull revealed brain activity, an encouraging sign. “Given the patient’s age and early signs of brain’s general recovery,” a pediatric neurologist observed, “prognosis for further neurologic recovery, though guarded, probably warrants aggressive treatment.”
By December 11, Joshua had started to improve. Although he remained in a coma, his seizures had stopped, and he was breathing without a respirator. Genene Jones took over his treatment at 3 P.M. that day. At 7 P.M., the baby’s heart began beating too rapidly, a condition known as tachycardia. Doctors pulled him out of the emergency. Arriving for the overnight shift, Pat Alberti overheard Genene telling Joshua’s parents that their son would have permanent brain damage if he survived. Their baby would have to be institutionalized, Genene declared; he would be better off dead. The next day—again under the care of Genene Jones—Joshua Sawyer died at 9:22 P.M.
The baby’s sudden downward spiral had surprised his doctors. Joshua had suffered two arrests on the night of his death. His heart had begun contracting erratically at 7:55 P.M.; electrical shock and drugs had brought it back to a normal rhythm by 8:20 P.M. Thirty minutes later, h
is blood pressure started to drop, and then his heart failed a final time. During the brief period between the two arrests, doctors had sent a blood sample down to the lab to check the level of Dilantin in Joshua’s body. The result did not arrive before his demise, and in the chaotic aftermath—coming too late to make a difference, with parents to inform and paperwork to complete—the lab study was ignored. But it told a story that would have been difficult to attribute to mere misunderstanding, even for those who previously felt certain that nothing was wrong in the pediatric ICU.
Joshua’s blood sample had gone to the hospital’s third-floor pathology lab, where technician George Farinacci filled out a form identifying it as sample #3463. Farinacci took the test tube of blood and fed it into a large, complex machine called an Automated Chemical Analyzer. The normal range for Dilantin was between 10 and 20. But the number that registered was more than double that: 55.5, bumping the equipment’s upper limit the way boiling water would overheat a body thermometer. To get a precise reading, Farinacci carefully diluted the sample’s concentration by half, recalibrated for the dilution, and ran it through again. This time, the Automated Chemical Analyzer showed 59.6—a toxic level of Dilantin, more than enough to throw a baby’s heart into cardiac arrest. Farinacci entered the result into the hospital’s computer, which printed it out for Joshua’s bulky medical chart, where the evidence that the child had received a massive overdose of Dilantin would go unnoticed for more than a year.
