Blood On The Table

by Colin Evans

  Clearly the hospital board was uncomfortable with Jascalevich’s story and also with his presence. In November 1966 they admonished him for endangering the hospital’s accreditation by failing to call meetings of the surgical department and for not providing adequate coverage at the hospital when it was considered necessary. As later events would demonstrate, Jascalevich always knew when to cut and run. In a surprise move, he tendered his resignation, on condition that no blame be attached to his conduct and that the inquiry be buried. The grateful hospital agreed, and in February 1967 Jascalevich duly resigned.

  At about the same time, Calissi and Galda completed their investigation and concluded that there was insufficient evidence to pursue a case against Jascalevich. Harris succeeded him as chief surgeon and the following year performed in excess of four hundred operations. There was not one suspicious death. With Jascalevich’s departure, the Riverdell “jinx” appeared to have vanished.

  Almost eight years passed. Memories of the dubious doctor began to fade. Until that letter was delivered to the New York Times.

  Although Farber had tracked down the hospital in question, the odds were still stacked against him. Loosening up tongues after so long a period of time was never going to be easy and for several months he became used to doors being slammed shut in his face and his phone calls going unanswered. Someone less diligent might have called it quits. But Farber refused to back off. And then he hit the journalistic jackpot: a source who had compiled a dossier contemporaneously with events at the hospital. What this dossier—labeled “Doctor X” by its author—had to say would change Farber’s life and the course of American journalism forever. It would also lead to the OCME performing some of its finest, most innovative work, as it battled to unravel one of the most complex and sensational cases in its long history.

  The dossier contained not just full details of the hospital’s accusations but copies of the DA’s investigation, the autopsy reports, and, critically, the name of the medical school where Jascalevich claimed to have done the illegal experiments on dogs. As Farber leafed through the paperwork he could scarcely believe his eyes. No one on the investigating team had bothered to corroborate Jascalevich’s story about the dog experiments at Seton Hall Medical School; they had just taken the doctor at his word. Farber set about remedying this lapse. Three staff members at the school agreed to talk. None could recall Jascalevich’s performing any alleged experiment on “dying dogs” left strapped down by other researchers who had completed their experiments. One attendant, Lee Henderson, swore that he had never received a tip from anyone in return for providing dogs “in any condition” at the school, nor did he know of anyone who had. Obviously, if true, this cast serious doubts on Jascalevich’s stated reason for having the curare.

  Farber continued digging and found that twenty-five patients had died at Riverdell during the time under review. Of these deaths, he wondered how many might reasonably be regarded as suspicious. Like most reporters who covered the medical beat in New York City, Farber had good contacts at the Office of the Chief Medical Examiner, and he called Dr. Michael Baden, at this time a deputy medical examiner. Baden agreed to look at the records. Eliminating those cases where the patient was obviously dying of a serious illness—such as cancer or heart disease—left him with thirteen deaths worthy of closer investigation. Of these, he isolated nine whose illnesses made it highly unlikely that they would have succumbed to sudden death. In the absence of any other indicator, to Baden’s way of thinking, the likeliest cause of death with these victims was poisoning.

  Baden was no fool. He knew that seeking to reopen a decade-old case would involve treading on a number of highly sensitive toes. Those doctors who had signed the original death certificates would want to defend their diagnoses; Calissi and Galda, both now elevated to the bench, would rebut any suggestion that they had taken their duties lightly; and it would also mean raising doubts about the original autopsies, performed by Dr. Edwin H. Albano, the New Jersey state medical examiner, and Dr. Lawrence Denson, Bergen County’s medical examiner. A new investigation would cast a cloud over all of them.

  Still, Baden decided to press ahead. Given the circumstances of the case, he felt that if the victims had been poisoned, then curare was most likely the agent of their destruction. But tempering this suspicion was the nagging realization that chances of finding curare in any body tissues after so long an interval of time were vanishingly small. Despite these reservations, Baden filed an affidavit with the Superior Court in Bergen County that, although notably light on any evidence that murder had been done, nonetheless did contain the consent for exhumations from family members of five alleged victims. A judge duly signed the order.

  News of Baden’s intervention lit a fire under the investigation. Suddenly every media organization in the tristate area wanted a piece of the mysterious doctor in New Jersey. (One local paper in Bergen County reportedly assigned no fewer than ten journalists to the story.) All needed to tread carefully. Because Jascalevich was still practicing medicine locally—he had operating privileges at two hospitals in Jersey City—and had not been charged with any offense, fears of transgressing the laws of criminal libel kept his name out of the public domain. This actually proved to be an editorial godsend. Lurid headlines about a potentially murderous “Doctor X” put thousands on newspaper circulations in a way that no mere name could have achieved. Media clamor reached a fever pitch as Baden readied himself to supervise the first exhumation.

  The first body disinterred was that of Nancy Savino. The reasoning for this was quite calculated. Research has shown that curare tends to concentrate in the cartilage and in the soft tissues, both of which are among the earliest to decompose. Because Nancy had been embalmed, Baden felt there was a good chance the analysts would find something.

  Just after dawn on January 13, 1976, gravediggers at a cemetery in Bergen County shoveled away the snow and began hacking at the frozen topsoil. Early starts are standard procedure when it comes to exhumations. The main reason is economic. If the body can be dug up, examined, and returned to the ground the same day, it costs less. Also, the emotional wear and tear on family and friends is kept to a minimum.

  Two hours of backbreaking toil brought its reward; the cast-iron casket came into view. Some of Baden’s anxiety thawed ever so slightly when he saw that the casket had been encased in a cement vault. This would keep out any water and hopefully retard the level of decomposition. With as much dignity as was humanly possible, the gravediggers slowly exposed Nancy’s casket to the bleak January light. It was taken immediately to the OCME’s Decomposed Room, where Baden performed the autopsy.

  Every move he made came under the lynx-eyed scrutiny of Dr. Edwin H. Albano. When it comes to investigating crimes, the rivalry between New York and the Garden State has always been intense, and Albano was understandably miffed over a perception that he had been benched through incompetence. He was already smarting under thinly veiled press allegations that the New Jersey politico-legal machine had somehow whitewashed Jascalevich back in 1966; now he had to endure the humiliation of sitting on the sidelines while some out-of-towner reviewed his work. Albano’s resentment wasn’t wholly parochial. He had a serious ally in Manhattan.

  The biggest beast of all in the forensic science jungle, Milton Helpern, might have been retired for two years, since which time he’d been plagued by the long-term ill health that would kill him in 1977, but his presence still cast a long shadow over the entire medico-legal community. Privately, and not so privately at times, the former CME had continued his vendetta with Baden, still convinced that he had been railroaded out of office, and he now saw the Savino exhumation as his chance to get in some shots of his own. The way that Baden told it, Helpern grumbled to anyone who would listen that exhuming bodies after such a passage of time was a monumental waste of time and tax dollars. All they would find after ten years, he confidently predicted, were a few bones and an oozy putrescence, certainly nothing to offer the toxicologists
any hope. Helpern had firsthand experience of the difficulties in detecting obscure drug traces, when, back in the sixties, he had moved heaven and earth to prove that another doctor, Carl Coppolino, had used a curare-like poison to rid himself of a troublesome wife. A Florida jury had finally bought Helpern’s version of events, but it had been a struggle. On that occasion, Helpern had been dealing with a recently buried body. What Baden was attempting, he thought, bordered on the ridiculous.

  It was time to find out. A hush of anticipation hung in the air as the coffin lid was slowly raised. Then came a gasp. Nobody had expected this. Baden could scarcely believe the body’s quite remarkable state of preservation, far beyond anything he had dared hoped for. The pink crinoline dress that Nancy Savino had been buried in was so clean and crisp it might have just been laundered, and on her chest, exactly where her parents had placed them, lay a cross and a withered rose. The cement vault had excluded the air and allowed the already embalmed corpse to become almost mummified. When Baden studied the abdomen he saw, to his delight, that the sutures that had been inserted after the operation ten years earlier were still in place. In all likelihood, this meant that the organs and tissues could be analyzed. Which was just as well, because in the four hours that Baden spent examining the body he found no evidence of gross abnormality, nothing to contradict the findings of the first autopsy. Everything now rested in the hands of the toxicologists.

  Attuned to professional sensitivities and eager to stifle any possible subsequent accusations of bias, Baden opted to divide the tissue samples among four toxicology labs. The OCME’s resident chemists, Dr. Donald Hoffman and Dr. Lorenzo Galante, would handle the “home” analysis, while other samples were dispatched to laboratories in New Jersey, Long Island, and California. In selecting New Jersey, Baden wasn’t merely observing the proprieties, he was also firing another bullet in his ongoing feud with Helpern. The New Jersey chief toxicologist was none other than Dr. Richard Coumbis, formerly of the New York Office of the Chief Medical Examiner, and someone who had crossed swords with Helpern over the controversial Coppolino case. At that time the director of the OCME toxicology department was Dr. Charles Umberger, a close ally of Helpern’s, and Coumbis had never been happy with Umberger’s methodology for establishing the amount of succinylcholine in Carmela Coppolino’s body. Coumbis, who made no secret of his concerns, was asked to explain himself. Shortly thereafter, he, together with two fellow skeptics in the OCME chemistry department, paid a heavy price for their perceived revolt when Helpern fired them. (Helpern always insisted their dismissal was for an unrelated issue).

  When the scientists began their analysis of the Savino tissues, nothing in the medical literature told them if curare could be detected in decomposing bodies that had been buried for so long. Ordinarily, after an injection of curare, the body rids itself of about half of the drug within twenty-four hours and the rest thereafter. On the upside, there was the knowledge that curare was a relatively stable compound, one that might remain in body tissues long after death, though ten years was struggling in the dark. Although a test had recently been developed for finding curare in blood and urine, it had not previously been used on tissues, because isolating a fraction of tissue that might contain a drug such as curare was fiendishly difficult.

  One of the Long Island team, Dr. Leo Dal Cortivo, the Suffolk County toxicologist, had been wrestling with this very problem for some time. By modifying a method developed in 1963 by Dr. Ellis Cohen, a Stanford anesthesiologist, Dal Cortivo set up a series of experiments to determine if curare could be detected in tissues. Hopefully these would provide the answers to four questions:

  What happens biologically to tissue after being buried in the ground for ten years?

  If curare was present at death, would it still be present as curare, or might it have disintegrated into other compounds? If so, which ones?

  Even if curare was present, would modern technology be capable of analyzing such minute traces of the drug?

  What substances, if any, present in the earth or embalming fluid might chemically interfere with the tests and give false results, either positive or negative?

  Dal Cortivo began with the liver, because as the organ that breaks down most drugs, it was most likely to reveal the presence of the poison. He added water to slivers of tissue weighing less than five grams, homogenized the mixture in a blender, and then put the macerated tissue through a series of reactions with ether, methanol, dichloroethane, and a stream of nitrogen gas. He repeated this test on tissue from the kidney and the lung. Even then, Dal Cortivo didn’t know if Nancy’s tissue contained tubocurarine. To answer that question, he turned to thin-layer chromatography.

  Although nowadays regarded as a highly sophisticated laboratory tool, chromatography has its origins in much humbler surroundings. Early European dye makers were the first to adopt its principles, albeit in a rudimentary and unintended fashion. They found they could test their dye mixtures by dipping strings or pieces of cloth into a dye vat, then watching closely as capillary action drew the solution up the inserted material, the way that water moves up tissue paper in a glass. At various intervals, bands of differing colors appeared on the material, and by studying these the manufacturers could gauge the strength of their dyes.

  This phenomenon was further explored by chemists in nineteenth-century Germany, but it wasn’t put on a firm scientific footing until the Russian botanist Mikhail Tsvet began a series of experiments in 1906. Eager to find a method of separating plant pigments, he developed the basic principles that apply to this day.

  Tsvet’s technique was simple and elegant. He packed a vertical glass column with an adsorptive material, such as alumina, silica, cellulose, or charcoal, and then added a solution of the plant pigments to the top of the column. Next, he washed the pigments through the column with an organic solvent. During the course of this migration, the pigments separated into a series of discrete colored bands on the column, divided by regions entirely free of pigments. Because Tsvet worked with colored substances, he called the method chromatography (from the Greek, meaning “color writing”). He discovered that these different bands were the result of various elements attaching themselves to the adsorbent. Because each compound has its own distinctive adsorption rate, this adherence takes place at different times, and by plotting these variances on a chart, then comparing that chart with a set of known reference values, the compound can be identified.

  This is the broad definition of chromatography. Modern improvements have refined the basics into many subdisciplines, of which thin-layer chromatography is much used. In this variation, a glass plate or plastic sheet is coated with a thin layer of a finely ground adsorbent, usually silica gel or alumina, that is mixed with a binder such as starch or plaster of Paris. The test sample is deposited at a spot near one end of the plate and a suitable solvent is allowed to rise up the plate by capillary action. The components of the sample become separated from one another because of their different degrees of attachment to the coating material on the plate or sheet. The solvent is then allowed to evaporate, and the location of the separated components is identified, usually by application of reagents that form colored compounds with the substances.

  When reviewing the Savino samples, Dal Cortivo put three drops—a drop of the solvent, a drop of the known tubocurarine, and a drop of the unknown sample from the exhumed tissues—on the baseline of a silica gel plate. During the next hour, each substance left a streak as it moved up the plate by capillary action. Next, he sprayed the plate with platinic iodide, which makes the known tubocurarine turn violet at a particular point. If the spot from the unknown sample turns the same shade of violet at about the same point on the plate, presumably that sample of exhumed tissue contains tubocurarine.

  This was world-class chemistry. Never before had the OCME—or any other forensic facility in the United States, for that matter—engaged in such an intensive and revolutionary bout of forensic testing. Even so, Baden wasn’t out of the wood
s yet. Because a diagnosis of curare poisoning based simply on a positive thin-layer chromatography was certain to be challenged by other scientists, he decided to push the parameters even further. He contacted experts at Columbia College of Physicians and Surgeons and a commercial lab in California and asked them to perform two other tests on the samples from Nancy Savino’s body: radioimmunoassay (RIA) and mass spectrometry.

  RIA is an extremely sensitive process, capable of detecting billionths of a gram of a substance. In the two decades since the RIA test was developed by Dr. Saul Berson and Dr. Rosalyn Yalow to detect insulin at the Bronx Veterans Administration Hospital, it had been applied to an ever-growing list of substances.* So far as Baden knew, no researcher had thus far used RIA to detect curare. Dr. Richard S. Matteo at Columbia agreed to run the tests.

  The test, in simplified terms, is based on a competitive reaction between “cold” (nonradioactive) curare—if any is present in a sample of exhumed tissue—and “hot” (radioactive) curare, and between curare antigens and the rabbit curare antibody. Tables tell the researcher how much hot curare will react with the rabbit antibody in the test tube. When cold and hot curare are added to the same test tube, a competitive reaction occurs. Both the cold and hot curare compete for the limited number of binding sites with the curare antibody. Any cold curare in the exhumed tissue would take up more binding sites, thus showing the presence of curare in the samples being tested.

  The final tool in Baden’s by now formidable forensic armory was the mass spectrometer. Hugely sophisticated, it can analyze an organic compound and reveal its constituent parts by bombarding the sample with electrons produced by a heated wire cathode. This breaks the sample’s molecules into fragments, each of which is electrically charged, then passed through an electric field, which accelerates them. A second magnetic field deflects them from their straight path into a circular one, with the heaviest fragments following a wide radius, while lighter fragments trace a path with a smaller radius.