The Death Shift

by Peter Elkind

  Kathy Holland—who had staunchly defended Jones only four days earlier—was now ruing her decision to employ the LVN. In the late afternoon, the pediatrician received a two-sentence letter notifying her that the executive committee of the Sid Peterson medical staff had suspended her privileges to treat patients in the hospital. She knew the move would cripple her medical practice. But that was the least of her problems. Holland was in the middle of a criminal investigation for murder.

  That afternoon, Joe Davis took Genene to Austin for her polygraph examination. Polygraph tests are inadmissible in court, and experts debate their accuracy. Nonetheless, the Rangers liked to use the lie detector as an investigative tool. John Maxwell, a Texas Department of Public Safety polygraph operator, hooked Jones up to the machine. According to a written report of the results, “the polygraph showed that Genene Jones was not being truthful when she stated that she had not injected the drug Anectine to any child within the past two months. It also showed she was being untruthful about having mixed, contaminated, or altered any medication given to a child in the past two months. It also showed she was being untruthful when she was asked if she had administered any other medication to a child that had not previously been authorized by Dr. Holland. It also showed she was being untruthful when she was asked, ‘Do you intend to answer each question about giving unauthorized or altered drugs to children at the Kerrville clinic truthfully?’” Genene later attributed the results to having taken the polygraph “on two hours of sleep and in the middle of an asthma attack. As far as I’m concerned,” she added, “I told the truth.”

  The next day, Joe Davis and a state police sergeant drove Kathy Holland to Austin for her turn on the polygraph. John Maxwell was once again the examiner. According to a written summary of the test, the polygraph indicated Holland had answered four questions untruthfully:

  “Do you intend to answer each question about giving inappropriate or altered drugs to children in Kerrville truthfully?”

  “Prior to Friday did you knowingly witness anyone on your staff at Kerrville administer succinylcholine chloride to a patient?”

  “Did you administer or order the administration of this drug to any patient in Kerrville?”

  “Have you mixed, altered or contaminated any medication given to a patient in Kerrville that caused breathing to stop?”

  After the exam, Maxwell asked Holland about the results. According to the written summary, Holland told Maxwell she had failed the test because “she was feeling a lot of guilt because she had obtained this nurse on her staff knowing that she was a prior suspect in San Antonio in similar incidents and also was feeling a lot of guilt about what had happened to her patients.” Holland said she had never given succinylcholine to a patient while in Kerrville. In all her answers, insisted Holland, she had told the complete truth. Davis drove Holland back to her office in Kerrville.

  By the time they arrived, Cathy Ferguson had stopped by to drop off Holland’s belongings from Nixon Lane. The doctor was unwilling to retrieve them herself as long as Genene was there. Holland planned to meet her husband, Charleigh, at a Kerrville hotel. She reached into an overnight bag to get some toothpaste; there was a letter inside—and two vials. “What’s that?” asked Joe Davis. Holland panicked. “This lady’s trying to frame me!” she said. The letter was another intimate message from Genene, written before Holland had gone to Austin for the polygraph.

  I have tried to convince myself that I should not regret the time we have spent together…and believe that the talk of family and love were sincere…All thru Bexar County Hospital accusations you were behind me, + now for whatever reasons, you’ve turned your back…

  …I’m writing this after coming back from Austin. I flunked three questions (all concerning) sucs [succinylcholine]…Believe me, you’ll flunk to, the way the questions are composed. But that probably won’t matter either. After today, nothing could change our relationship or the damage done to it…I certainly won’t ever be as free with my feelings of love + sharing…

  No matter what the outcome, I have never hurt a child, or given a child anything that might of hurt them. But if, as low man, I take the fall, I still don’t think I can hate you, even @ that point. If it protects you, I’ll do it. But believe me, I won’t go down alone. [This remark echoed almost precisely the defiant words Genene had used six months earlier, while battling her accusers at Medical Center Hospital.]

  Genene wrote that she had flunked because “nothing ever goes by the book in medicine.” Yes, she had altered medications to make them stronger or weaker. What nurse hadn’t? And she acknowledged giving benign medications without a doctor’s order in both Kerrville and San Antonio. As to whether she had administered succinylcholine: “You know,” wrote Genene, “after we talked about Misty, I truly don’t know if some was drawn up by someone and I used it…not knowing, anymore than you could know.”

  “Kathy, whatever the outcome, be a doc,” Genene continued. “Your to good not to be. Fight them, and don’t give up.

  “As for me, I’m thru with medicine. Nothing ever changes. It’s all bureaucratic bull-shit. It’s all dog-eat-dog to be top dog. I’ll find new dreams to think about + new goals to reach for.”

  Genene wrote Holland that only thoughts of her family had kept her “from going thru with suicide…in my insanity Monday, I just figured my way would solve everything. I wouldn’t have to fight and they could blame everything on me and you’d go on. But it can’t be that easy. I have to fight for my family and myself. Thank E.T. for giving me the strength to see that in time.”

  Genene said she hoped that someone would understand. She ended her letter: “God + E.T. be with you girl, and I do love ya! If you need me, E.T. will find us, + make it right. Love, Genene.”

  Genene kept trying to speak to Kathy Holland, as though a personal conversation could undo the entire mess. But Holland wasn’t about to have anything to do with her former nurse. She was afraid that Genene might try to kill her. When the doctor continued refusing her calls, Genene dispatched two more letters. The first, on a sentimental greeting card featuring a nature photo and a quotation from Wordsworth, was in an oddly familiar tone, as though nothing had come between them. It began “Dear Kathy” and ended “Love ya, Genene.” The second was formal and angry. Genene insisted Holland had agreed to make the monthly house payment—“in front of witnesses, by the way”—and informed the doctor she would be “out of your house by this weekend, and out of your life.”

  After her dismissal by Dr. Holland, Genene had called William Chenault, a San Antonio lawyer, who had handled her divorce eight years earlier. Chenault handled civil matters: domestic disputes, wills, small lawsuits, and real estate closings. By his own admission, he knew nothing about criminal law. But Genene trusted him—and it wasn’t a criminal case she was concerned about anyway. “She thought she’d been wrongfully fired,” recalled Chenault. “She wanted to know whether she could file a wrongful-discharge suit or something against Dr. Holland.” Chenault advised Jones not to worry about her dismissal; she was a suspect in a murder case. “I told her: ‘The one thing you don’t want to do is stay in Kerrville. Out of sight, out of mind. If you leave and go far enough, maybe it’ll go away.’” Chenault advised Genene to leave Texas—or relocate to its farthest outposts, perhaps Texarkana or El Paso. Genene decided instead to move to San Angelo, a West Texas City of 84,000, less than two hundred miles from Kerrville. She had selected San Angelo in response to a longstanding invitation from the parents of Chris Hogeda, the child whose death was the first considered suspicious in San Antonio.

  During the second week in October, Genene Jones moved out of the house on Nixon Lane. She left a note on the refrigerator, apologizing for leaving the place in such a mess. Debbie Sultenfuss was leaving town too. Quitting her job in the Sid Peterson intensive care unit, she submitted a letter saying that she had resigned because of the hospital’s “antiquated ideals.” Debbie moved her mobile home to a dusty trailer park on the southe
rn outskirts of San Angelo. Genene, her two children, and Cathy Ferguson moved in.

  Genene Jones had come to Kerrville full of hope that she would find more of the angels that she had known so well in San Antonio. She had indeed: Brandy Benites and Rolinda Ruff, the little girls who stopped breathing after coming to Dr. Holland’s clinic with diarrhea; Misty Reichenau, who had mouth sores; Jacob Evans and Anthony Winn, whose parents took them to the doctor because they cried too much; Chris Parker, who suffered one emergency after showing up at Holland’s office with raspy breathing, and a second, days later, after coming in for an ear infection. There was Jimmy Pearson, the sadly deformed seven-year-old whose heart stopped beating on the MAST helicopter. And there was Chelsea Ann McClellan, who stopped breathing on two visits, the last time forever. Petti and Reid McClellan would mark their daughter’s grave with the words: “Our Little Angel.”

  On October 12, 1982—about the time Jones left town—District Attorney Ron Sutton convened a Kerr County grand jury to investigate what had befallen all the angels she had left behind.

  PART FOUR

  Judicious Silence

  …The committee, in general, recommends judicious silence…

  Minutes, Pediatric ICU Policy and

  Planning Committee, January 13, 1983

  Eighteen

  When Ron Sutton first heard about the death of Chelsea Ann McClellan, he was busy licking the wounds from the worst humiliation of his career. As prosecutor for the 198th Judicial District, a vast Central Texas territory, Sutton had tackled the Brady triple murder case—a horrible shotgun slaying of a mother, her daughter, and a family friend. Three times, Sutton had gone to court, intent on putting a murderer behind bars. Three times, he had come up empty. Sutton’s first suspect had won a mistrial, then was tried a second time and acquitted. Sutton eventually acknowledged he had prosecuted the wrong man, and he charged a second suspect with the murders. But after a grueling six-week trial, a jury returned a verdict of not guilty. Sutton had triumphed in hundreds of cases during his five years as district attorney. But for the moment, none of them mattered. He had lost the Big One.

  Ronald Leon Sutton wasn’t the sort of man to greet conspicuous defeat lightly. At thirty-eight, he had ambitions, dreams of statewide office. The Brady embarrassment might well have dashed them forever. But Sutton had little time to brood. His district sprawled over five rural Texas counties covering more than 5,300 square miles—an area four times the size of Rhode Island. There were dozens of cases to try, and no one else to take them to court; the 198th Judicial District had only one full-time prosecutor on its payroll. Sutton returned home and set himself to work.

  Home was Junction, Texas, population 2,593, the seat of Kimble County. Sixty miles west of Kerrville, twice that distance from San Antonio, Junction was typical of the little towns that dotted the Texas Hill Country. Most of its residents were ranchers, who raised sheep and goats and ran a few cattle. Many grew pecans and leased sections of their property during hunting season to city slickers who liked to shoot game. The only child of Baptist parents, Sutton had grown up in Junction. His father had owned a pecan and fur warehouse on the downtown square. Sutton’s law office was across the street.

  The DA carried his heritage into the courtroom, where he cultivated the image of a simple country lawyer. At the beginning of every jury trial, he introduced himself as Ronnie, then spoke for several minutes about his small-town roots. The prosecutor’s appearance buttressed the impression. Sutton was a burly man, with a round, ruddy face, short neck, and big gut. Shuffling about a courtroom, he looked ill at ease in his rumpled suit; he was quick to ask judges for permission to shed his jacket and yank loose his tie. Jurors could easily imagine the prosecutor more at home in blue jeans on his back porch, shooting the breeze with a few buddies and downing six-packs. In truth, there was much of the good ol’ boy in Ronnie Sutton. But there was also an undeniable element of calculation in the image. When Sutton appeared before a jury, there was no sign of the flashy diamond-rimmed Rolex that he usually wore on his left wrist. For trial, he carried his father’s gold pocket watch. Defense lawyers learned fast that Ron Sutton was no rube. The DA had a razor-sharp eye for detail, a gift for florid rhetoric, and fire in his belly for courtroom warfare.

  Sutton’s passion for legal drama took root early. As a child, his favorite television show was Perry Mason. His favorite theater was the Kimble County courthouse. Because the courthouse in Junction had no air-conditioning, trials often were held at night. Little Ronnie showed up regularly, joining standing-room-only crowds who turned out for the community’s liveliest evening entertainment. During high school, Sutton revealed his attraction to center stage. He worked as a disc jockey at the local radio station and played guitar in a hillbilly band.

  After graduating from college in 1966, Sutton enrolled at St. Mary’s Law School in San Antonio. Previously an uninspired student, Sutton flourished in law school, winning several academic prizes and graduating with high honors. The big Texas law firms began to court him, but Sutton put them off in favor of a one-year appointment as a briefing attorney for the Texas Supreme Court. Afterward, he joined a small law firm in San Antonio. By then, Sutton was married, with a toddler at home and a second child on the way. He was defending claims for giant insurance companies, working in the big city, on the fast track. His future and fortune seemed assured—until he abruptly reversed direction. After a year, Sutton quit his job, moved back to Junction, and hung out a shingle across the street from the Kimble County courthouse.

  Sutton was happier in a small pond, but he wanted to be a big fish. He won a seat on the county hospital board. He joined the Junction Rotary Club, the Junction Jaycees, and the Junction Chamber of Commerce. He won election as county attorney, a job that involved prosecuting misdemeanor crimes and giving legal advice to county officials. He served as chairman of the Junction Rodeo Association and president of the Hill Country Fair. The public activities offered a relief from the boredom of rural legal practice. A small-town lawyer accepts any job he can get, no matter how insignificant; he can’t afford to specialize. Ron Sutton’s private practice included the work older local lawyers didn’t want: divorces and child custody cases, workmen’s compensation and personal injury work. Politics was more fun—and top elected positions paid more than most Hill Country attorneys could make from the practice of law.

  In 1976, at the tender age of thirty-two, Sutton reached for the top elected position in sight—a state district judgeship. He won the Democratic party nomination, but a Republican from Kerrville, the district’s biggest town, beat him in the general election. Opportunity knocked just one year later, when the sitting district attorney resigned to accept another judgeship. Prodded by a state legislator friendly to the Junction lawyer, the governor named Sutton to the vacancy in September 1977.

  The DA’s weekly routine in the 198th Judicial District was far from glamorous. There were hearings, grand juries, and trials to attend in five different counties. Sutton spent much of his time driving from courthouse to courthouse in his battered station wagon. The vast majority of cases he handled were small stuff: vandalism, bad checks, burglaries, and thefts. Every now and then, a drunk Mexican or drifter would stab someone in a bar. And unlike his big-city counterparts, who had dozens of investigators and lawyers to aid them, Sutton had to do almost all his own legwork. His staff included only a secretary, a legal assistant, and one part-time lawyer.

  The job exacted a price. Sutton’s marriage broke up just a year after he became DA. And when a convicted felon threatened his life, he began making a habit of stashing a 9-millimeter pistol in his car. But he won far more cases than he lost—even sending one man to Death Row—and voters seemed to like him; in two elections, no serious opponent took him on. After four years in the job, Sutton began to think about the old Texas tradition of electing small-town boys to statewide office. Until the Brady triple murder case, that is. Then he began to worry about someone running against him for DA.


  Beaten and battered, Sutton was far from excited when Texas Ranger Joe Davis called with the story of a baby-killing nurse in Kerrville. He figured it was just angry parents looking to blame somebody for their daughter’s natural death. But when Davis relayed details of his nascent investigation, Ron Sutton realized this was a case that could dwarf anything he had ever touched.

  On October 12, Sutton drove sixty miles east on the interstate to Kerrville, where he convened a Kerr County grand jury to investigate the death of Chelsea McClellan. As Sutton began to gather information, he was struck by the complexity of the case. Eight different children had experienced apparent emergencies under the care of the pediatrician or her nurse. While most of the episodes had taken place in Holland’s clinic, children had also developed problems in the Sid Peterson ER, in ambulances en route to San Antonio, and on a MAST helicopter. There were dozens of people to interview. This case was a giant jigsaw puzzle, and Sutton wasn’t even sure he knew where to find the pieces.

  The state police crime lab offered a start. Its chemists had analyzed the bottle of succinylcholine with the needle marks in the top. While the vial was almost full, the lab reported that its contents were only one sixth the normal concentration. Whoever had withdrawn the drug had replaced its volume with saline solution. Accustomed to dealing with death by handgun, shotgun, or switchblade, Sutton soon realized a syringe filled with succinylcholine made an equally lethal weapon.

  Succinylcholine chloride was a man-made compound that resembled the jungle drug curare, which South American Indians used to tip poisonous darts. Known among doctors as “sux,” it worked as a neuromuscular blocking agent, intercepting the transmission of nerve impulses to the muscles. Doctors began using succinylcholine regularly during the 1950s, chiefly to paralyze patients receiving breathing tubes in the operating room. Because the drug was so powerful, it was administered almost exclusively by anesthesiologists.