The Death Shift

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The Death Shift Page 13

by Peter Elkind


  …I will not + can not tolerate being persecuted any more. I’m also tired of talking to people, thinking problems will be solved + having them rubbed in your face time + time again.

  It’s obvious to me now, after tonight…that my credi[bility] in’t worth a damn.

  As I have told you in previous conversation, I won’t leave without a bang. I feel it is only fair that I have a shot a[t] persecuting people to[o].

  “Call tonight a breaking point,” Genene wrote; she said she was tired of fighting a losing battle. “You people have succeeded in doing + making me something I never thought I’d be. A quitter. It’s all yours Pat. I don’t feel that I can return to this unit today or even tomorrow…I do hope someone continues to fight for the kids. Their worth it.”

  Despite the letter, Genene decided to stay. Rapidly shifting gears, she told other nurses that she welcomed the investigation—that she was eager to blow the whistle on how the doctors were screwing up. It was about time something was done, Genene Jones declared. After all, babies were dying.

  Eleven

  Alan Conn’s investigators began work at 8 A.M. sharp on Monday, February 15. The Canadian doctor had assembled a high-powered team of six specialists: the medical directors and head nurses of pediatric intensive care units at three famous big-city hospitals. Jim Robotham and Pat Belko led them through a tour of the pediatric ICU. Then they adjourned to a conference room at the medical school, a comforting distance from the turmoil, and began ushering in witnesses.

  Thirty-two people had been summoned, including all the critical players in the conflict: Suzanna Maldonado, the nurse who started it all; Larry Hooghuis, the pediatrics resident who caught Genene Jones about to give a heparin overdose; Bob Franks, the anguished acting chairman of pediatrics; Kent Trinkle, the temperamental chest surgeon; Ken Copeland, the pediatrician who rescued Rolando Santos. Jim Robotham and Pat Belko were each to sit through two sessions. Genene Jones was to have thirty minutes to speak her piece.

  After seeing the committee agenda, Belko fretted that the list of doctors was stacked against Genene. The head nurse mentioned her fear to a third-year resident in pediatrics who thought highly of the LVN, and Kathy Holland agreed to volunteer to make an appearance before the committee. It was but the first of many occasions when Dr. Holland was to rise in Genene Jones’s defense.

  The investigators conducted three days of interviews, and they got an earful. Almost everyone was angry at someone, and most were willing to speak their mind. Pat Alberti, the LVN whose complaint to her psychiatrist had rattled Dr. Franks, bluntly informed the committee, “Genene’s killing off the kids.” Although Dr. Robotham offered a more complex account of what was wrong, the outline he prepared for his testimony ends with a similar conclusion: “Bottom line issue centers around one nurse.”

  But when it came time to analyze the situation, the committee members decided to view the complaints about Genene Jones merely as a symptom of a broader malady. Privately, even before setting foot in the ICU, Alan Conn had virtually dismissed the notion that a nurse was deliberately harming children. His own hospital in Toronto was in the final throes of a remarkably similar ordeal; a cardiac ward nurse had been charged with murdering four babies with a heart drug. The whole business had destroyed careers, divided the staff, and soiled the hospital’s name. To Conn’s mind, nothing good had come of the matter (the scant evidence against the nurse eventually would prompt a judge to dismiss the charges). He saw no need to encourage such a debacle in San Antonio.

  On the subject of the ICU’s operations, however, Conn and his committee were scathing. The ICU’s “growing pains,” their confidential written report began, had reached “an acute stage.” Staff attitudes and morale were “poor.” Robotham and Belko were failing to provide “effective” leadership. The medical director had no authority to change anything. The pediatrics department offered little support. The quality of the residents was mixed, and the shortage of well-trained nurses was “critical.” Nursing errors weren’t being documented. Doctors and nurses at all levels had an adversary relationship, and their communication was ineffective, “even at critical times.” Conn urged the extraordinary step of shutting down the unit for an overhaul—to include the replacement of both Jim Robotham and Pat Belko.

  Unwilling to accept the prospect that criminal conduct was at the heart of the ICU’s problems, Conn’s committee embraced the more benign explanation of personality conflict and recommended the removal of combatants on both sides—without distinguishing between right and wrong. Thus the committee blamed Robotham as much as Belko, even though the medical director had done more than anyone else to try to stop Genene Jones. Looking for a graceful way to ease him out, the committee suggested a new title for Robotham: director of critical care research. After Dunn and Corum privately approved the medical director’s sacking—bypassing pediatrics chairman Franks entirely—Conn summoned his former protégé to breakfast to break the news.

  As he arrived for the meeting with Alan Conn, J.R. was expecting a briefing on the review panel’s secret findings. Good things would result from this, Robotham was thinking. The hospital and the medical school had been ignoring his complaints about the pediatric ICU for months. The support of Conn’s committee would force the bureaucrats to act, make them cough up the money and staff he needed to straighten out the ICU. Most of all, Robotham figured, it would offer the administrators the excuse they needed to fire Genene Jones.

  But that wasn’t what Al Conn was telling him. Speaking in fatherly tones, Conn counseled Robotham that he was suffering from burnout. This move would give him a chance to break out of the grueling ICU grind; he could concentrate on his research, spend more time with his family. But Robotham didn’t buy it. Conn was telling him he was fired—ousted from his job in the ICU. He told friends he’d been screwed. His old mentor had betrayed him.

  Genene Jones’s foremost advocate was more fortunate. Dr. Franks had joined the Conn committee in urging Pat Belko’s dismissal. According to the minutes of a meeting where the matter was discussed, Franks said the pediatrics department believed Belko had failed to recognize the ICU’s problems and “did not have the courage or capability to deal with them.” Both faculty and house staff, he concluded, gave Belko “a vote of no confidence.” But Virginia Mousseau protested vigorously. Whatever the doctors thought about her performance, they couldn’t fire Belko, she declared. They didn’t have the paperwork in her personnel file to justify her removal. Belko was placed under close watch for a six-month unofficial probationary period, and when it was over, she kept her job.

  The ICU’s fate was resolved more quickly. Dr. Conn had urged that the unit be closed for reorganization, with its patients transferred to another ICU in the hospital, under the supervision of another medical department. The implication was clear: The pediatricians had let things get out of control, and they no longer could be trusted to run the unit themselves. B. H. Corum, suddenly alarmed after months of passivity, backed this extreme solution. The ICU’s problems were so grave, he felt there was no choice. But the medical school’s doctors balked. Moving the ICU’s patients, they argued, would just create problems elsewhere. After a round of high-level meetings, a deal was struck to keep the unit open. A young female anesthesiologist was named to replace Robotham, and control of the unit was handed to a newly formed Pediatric ICU Committee, chaired—to the pediatricians’ consternation—by a surgeon, Dr. Arthur McFee.

  The thorniest problem, of course, was that of Genene Jones. On February 17, after Conn and his committee completed their interviews, they met privately with B. H. Corum and Marvin Dunn. Despite Conn’s personal skepticism that anyone had harmed children deliberately, in this select group the panel acknowledged the possibility. Dunn took notes of the investigators’ informal remarks: “Majority events attributable to med & nursing inadeq but not all. Response inadeq at every level; Nurses—either malignant intent or gross neglect.” Genene Jones was identified as the “center of storm.”<
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  In a secret preliminary draft of its report, the committee—without explanation—urged the “immediate removal” of both Jones and Pat Alberti. Like Robotham, Alberti had been targeted for contributing to the turmoil; her primary offense was agitating loudly for Jones’s removal. But the specific reference to the two LVNs was not to see the light of day. Conn deleted it from his final report, in favor of a solution that eased the administrators’ fears of litigation.

  Instead of firing Genene Jones outright, they would replace all the LVNs in the unit with registered nurses, employing the excuse that most big-city pediatric ICUs had all-RN nursing staffs. There were six LVNs besides Genene, and one of them had worked in the ICU since 1969. They would all have to go. “It was a case of having to use a huge stick because it was impossible to single out one,” Dr. McFee, the surgeon, explained later. “If we had just gone out and fired her, we would have had a substantial suit.”

  At about noon on March 2, 1982, Pat Belko passed the word that Virginia Mousseau wanted to talk to the pediatric ICU nurses. The meeting was to begin at 3 P.M. Agency nurses kept an eye on the patients while the staff members from two shifts crowded into the ICU’s small back room. The ICU was good, Mousseau told the nurses, but the hospital administration wanted to make it better. They were going to upgrade the unit. Following a recommendation from Dr. Conn, they were going to move to an all-RN nursing staff. The LVNs would all be offered other jobs in the hospital; their pediatric ICU positions would be eliminated as of March 22.

  The room exploded in tears and shouts. It wasn’t right, the nurses told Mousseau. She answered that the move was part of a trend; most ICUs had an all-RN staff. Finally, Genene spoke up. This was the sort of thing that happened in Communist countries. “If you want a scapegoat, take me!” she declared. “We know you just want to get rid of me. Let me go, and let the rest stay.” No, Mousseau assured her, the move wasn’t directed at any one person. The hospital administration planned to employ only registered nurses in all its ICUs; the pediatric unit just happened to be first. The ICU would be scaled down to four beds, she added, so it could absorb the loss of the LVNs.

  Pat Alberti heard the news when she arrived for work at 10:30 P.M. The word has come down, someone told her; the LVNs have to be gone within three weeks. “This is bullshit,” Alberti snapped. She walked out of the ICU and never returned.

  The hospital’s nursing administrators soon began individual meetings with the six remaining LVNs, who were advised that they could all have other jobs at Medical Center Hospital. Genene was informed that there were no pediatric floor positions available, but she could apply for a place on another ward. She submitted her resignation instead, effective March 17.

  On hearing the news, Virginia Mousseau informed the new committee overseeing the pediatric ICU that “both LVNs regarded as most sensitive in the functioning of the unit either have or will depart the unit and the hospital.” The doctors and administrators were pleased. Their circuitous plan had worked; they had washed their hands of Genene Jones.

  During the five months since her first complaint about Genene Jones, a time of internal investigations and review committees and far too many sick children, Suzanna Maldonado had continued to work nights in the pediatric ICU, where she crossed paths daily with the woman she believed was a baby-killer. In bedside conversations with other nurses, Genene Jones seemed to reserve her harshest venom for Maldonado. She made it known that she blamed Suzanna for the vile suspicions that cost her her job—the lies that were going to take her away from the kids she so dearly loved.

  It was about 2 A.M. on March 16—during the final week of Genene Jones’s career at Medical Center Hospital—when Maldonado noticed, above her name on the nursing assignment sheet at work, the notation “✓ your box.” In her ICU mailbox, Maldonado discovered a note scrawled in block letters on hospital scrap paper. It read: “YOUR DEAD.” Maldonado turned the note over to Pat Belko in the morning after her shift. Belko agreed that the handwriting on the two messages was probably that of Genene Jones. She told Maldonado she would take care of the matter. Then she blackened over the entry on the nursing assignment sheet.

  When Genene arrived for work that day, Belko asked her whether she had left the note. Jones denied doing so. Convinced that Belko was taking no further action, Maldonado informed hospital security about the death threat before beginning work that night. When she arrived in the ICU, she found another slip of paper in her mailbox. It bore a single word: “SOON.” This time Maldonado turned the note over to security, whose officers interviewed Suzanna but considered the case closed after Genene Jones left the employment of Medical Center Hospital.

  This sentiment—that Jones’s departure closed the books on the pediatric ICU’s problems—also prevailed among those who ran the hospital and the medical school. Alan Conn’s committee, while making no reference to criminal behavior in its report (the final version of the document contains not a single mention of Jones’s name), had heard too many horror stories to ignore the possibility entirely. In a brief appendix that served to protect it from a charge of whitewash, the committee, which had been recruited to find out why babies were mysteriously dying, urged the appointment of another committee to do the job. “Based upon uncertain explanation of several isolated untoward events in the care of patients, this committee recommends an immediate review by a committee of clinical care within the PICU over the past twelve months.” Despite the panel’s emphasis on haste, Corum and Dunn, with the troublesome LVN gone, acted with no sense of dispatch. The last internal investigation of the ICU would not begin for six more months.

  That left unresolved the central question: Had Genene Jones been murdering children? But the doctors and hospital administrators felt no urgency to get to the bottom of things. Ignoring altogether the need to stop a possible baby-killer, they were content at having arranged a surgical solution to their own problem: the extraction of Jones from the ICU without scandal or litigation.

  But the procedure produced complications. In the department of pediatrics, the handling of the crisis sparked impotent fuming and rebellion. After being cut out of the decision to remove Robotham from the job of medical director, Bob Franks briefly resigned his post as acting pediatrics chairman in protest. The decision to hand control of the ICU to a committee—particularly one headed by a surgeon—had also incensed the house staff. The pediatric residents contemplated going on strike. Instead, twenty-six of them signed a petition, complaining about the treatment of Robotham, the abrupt removal of the LVNs, and the absence of any explanation for the changes. The residents asked to see the Conn report—whose contents remained confidential—and demanded a meeting with Dunn and Corum. But the administrators never even responded.

  Robotham himself had steamed in private for several days. Then, in two bitter letters to Dunn, he complained that his abrupt removal had damaged his reputation in the medical community. Why was he being made the scapegoat? He had been fired after struggling for months to do something about Genene Jones. Yet the nursing administrators who protected her had gone unpunished. Why, even Jones was still employed a month after his own removal! “The manner in which this situation has been handled,” Robotham wrote, “would appear to warrant an investigation in itself.”

  The ousted medical director’s references to his damaged reputation made the dean nervous. Dunn started to worry that Robotham might file a lawsuit—or perhaps resign. In early April, the dean met privately with the angry doctor to try to calm him. Dunn told Robotham that no one questioned his integrity or dedication; he had worked exhaustively under difficult circumstances and made great improvements in the unit. He had been replaced, Dunn explained, because the pediatric ICU needed a full-time medical director. The medical school continued to value his contributions in teaching and research.

  Robotham agreed, for the moment, to stay in San Antonio. He remained worried, however, about what Genene Jones might do. Even after Rolando Santos’s bleeding had placed the entire IC
U on notice—indeed, virtually until the day she left the hospital—Jones’s association with mysterious emergencies had continued. In late February, while the administrators were concocting their elaborate plan to get rid of the LVNs, one child had died after four arrests on three consecutive days—all of them on the 3–11 shift, all of them under Genene’s care. Paul Green, the hospital’s malpractice attorney, had hinted back in January that he might tip off the district attorney. Although Robotham believed the DA had been alerted—in fact, Green had decided to say nothing—there was no sign that anything had come of it. On April 26, six weeks after Jones had left, Robotham wrote Virginia Mousseau, Medical Center Hospital’s top nursing administrator, a letter that would prove prescient.

  As the cloud of dust which has surrounded the future of the PICU begins to settle, I am concerned that one serious issue has not been addressed to my knowledge. Ms. [Genene] Jones was, as you are aware, the outstanding nurse in the PICU when I first began working there two years ago. As multiple family, personal and job related difficulties mushroomed, I spoke to you on a few occasions and on multiple occasions to both Ms. Harris and Ms. Belko during the last year. I did arrange over one year ago for Ms. Jones, through Pat Holden in Psychiatry, to obtain family counseling. We spoke with regard to trying to arrange a shift change in her job to allow her more time with her children. I also referred her for a medical consultation within the University for some of her physical complaints, and quietly looked on during her numerous ER visits and inpatient admissions. The stress placed on this nurse was awesome and yet she unfortunately knowingly or unwittingly clearly contributed to the overall problem existing for both her personally and the PICU as a whole.

  During the fall she twice requested that I place a written recommendation in her record, but under the circumstances at that time, I told her that as director of the Unit it would be better to wait until I could write a completely unqualified endorsement. The evolution of events did not allow that to occur. Although I have no official administrative responsibility for Ms. Jones, I do feel that there should be adequate documentation in her records of the stresses she experienced so that she will be properly protected and judiciously supervised at any future place of employment.

 

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