Last Dance, Last Chance

by Ann Rule

  Pat Finnerty and Chuck Craven were the “odd couple” of the D.A.’s office, but they worked so well together that they fit like a pair of gloves. Their only shared traits were that they were both Irish and had grown up in the same South Buffalo neighborhood.

  Buffalo is rife with nicknames, and Chuck Craven was called Chickie because the old-timers remembered that was his dad’s nickname when he was a sergeant in Homicide in the Buffalo Police Department. Chickie Senior cast a long shadow. He was a great detective and an athlete who played his last hockey game when he was sixty-nine.

  Craven had an Irish mug, but then so did Finnerty, who liked to say that he was a “potato-faced Irishman.” Craven’s hair was brown with a red cast, and Finnerty’s was gray with a reddish glow—or red with some gray, depending on how the light hit it. Craven’s easygoing grin belied the fact that he was a relentless and clever detective. Finnerty was taller and burlier, and he looked grumpy even when he wasn’t. He was also a merciless practical joker, enlisting Craven in his plots to catch the gullible unaware.

  “Pat liked to walk down the hall,” Craven said, “and pretend to walk into a doorjamb and bang his head. Then, if somebody laughed because he was clumsy, I had to whisper that he was blind in one eye because of an injury he suffered when he was in the Secret Service, and he couldn’t help it. Then, naturally, they were embarrassed—and he had them. But he’s probably the best investigator I’ve ever worked with. I’ve learned more from Pat than any detective I ever knew.”

  Pat Finnerty was once the Special Agent in Charge for the U.S. Secret Service office in Buffalo. Although one of its divisions guards the President of the United States, the Secret Service’s primary function is to protect the financial integrity of the country. Finnerty knew everything there was to know about the way money changes hands—for both legal and illegal uses. He could follow a paper trail like a bloodhound. He knew the many facets of white-collar crime; there was never a scam invented that fooled Pat Finnerty. He was a complete professional, and he distrusted anyone who was remotely connected to the media.

  But still, he could send victim’s advocate Sharon Simon and Chuck Craven into muffled laughter with the tricks he played on young prosecutors or detectives. Finnerty kept a fake “Wanted” poster of David Janssen as the Dr. Richard Kimball character on The Fugitive tacked to his office wall, convincing them that Kimball was still out there and needed to be caught.

  “They believed him,” Craven remembered, “and when he got on a crowded elevator and pretended he was having a panic attack because he forgot his ‘big pill’ that day, people who didn’t know him were squeezing against the wall. Pat is a very big guy.”

  Humor is vital in police departments and prosecutors’ offices. Without it, there is no relief from the tragedies that come through their doors day and night.

  Chuck Craven was born and raised in Buffalo, the only son in a flock of five sisters. He joined the U.S. Air Force and was sent to Clovis, New Mexico, where he met his future wife, Laurie. Six months later, he was ordered to Vietnam, where he fueled airplanes. After a stint in Thailand, he came back to New Mexico and reenlisted for three more years. He and Laurie moved to Peterson Air Force Base in Colorado Springs, where their daughter, Christine, was born. And then, probably genetically driven, Craven transferred into the Security Police.

  But Chuck Craven’s goal was to work in a civilian police department, and he joined the Clovis Police Department. At the same time, he finished college with an A.A. in Criminal Justice and a B.A. in Liberal Studies. The Cravens moved West, and Chuck joined the Scottsdale, Arizona, Police Department. He worked narcotics, one of the more dangerous units in any police department. He was usually unshaven and dressed like the people he hunted.

  He shrugs it off, but Craven was nearly killed when he was shot during a drug raid. Hit in the neck, he was very lucky that the bullet narrowly missed his carotid artery. Still, it would take a long time for him to recover—and his department told him he would never be cleared for full duty. He didn’t want a desk job; he wanted to be out in a squad car and, eventually, to be a detective.

  Instead, Craven was given a full retirement when he was only 36. He was not about to give up police work, although it would take more than a year of physical therapy to bring back the use of his arm. His physical therapists didn’t think he could do it, and they were amazed.

  “We realized that the only grandparents our children had were in Buffalo, so we came home,” Craven recalled. “I got to play softball with my father. It was a good move.”

  Craven was hired by the Erie County D.A.’s office in1989. Until then, he had investigated accidents and narcotics, but now he would be tracking every kind of criminal there was. Craven also became a certified fingerprint examiner and an expert at drawing crime scenes to scale.

  Between them, Craven and Finnerty would handle everything from bunco to murder for hire. Each case they were assigned to had a different spin, but one or the other of them had the experience to winnow out the truth. Together, they were formidable. Now, they were about to learn a great deal about the practice of medicine.

  On September 3, 1997, Pat Finnerty and Chuck Craven knew only that Sarah Smith had died during what was allegedly a routine procedure in Dr. Anthony Pignataro’s office. They needed to interview all the office staff who had been present, as well as the paramedics and EMTs who had responded to the 911 call the morning of August 25.

  They found Janie Krauss first. A very pretty young woman, she was the very epitome of what blond jokes portray. She hadn’t mastered the correct terminology for techniques or medical instruments, and the two detectives exchanged dumbfounded looks while Janie struggled to explain what had happened.

  Janie said she had arrived late on that Monday morning, and that Sarah Smith was already in the basement surgery, conscious but drowsy from preoperative pills. She said that Sarah had been given 20 milligrams of Valium before her surgery. Janie’s assignment was to inject the anesthesia into a port in the tube to the patient’s arm. She had given sodium pentothal 6 cubic centimeters, and then Versed, 3 cubic centimeters. Janie wasn’t sure what those were for. She thought it was to control pain. Dr. Pignataro had then asked her to inject a second syringe of sodium pentothal, 7 cubic centimeters, into the port.

  Janie said she had been present for a dozen other operations like this one, although she couldn’t remember the name of this procedure. “He started with that sharp thing—I forget what it’s called…” Janie began.

  “A scalpel?” Finnerty asked.

  She nodded. “That’s it—and then he put this thing in and he was tunneling under her skin. It’s like a hockey stick…”

  “A hockey stick?” Finnerty echoed, amazed.

  They realized later that the expander Anthony had used to burrow under the patient’s skin was shaped like a hockey stick.

  Sarah Smith had said “Ouch” several times, and the doctor had told Janie to give her a third dose of sodium pentothal—7 cubic centimeters.

  The two D.A.’s investigators didn’t know much about anesthetic substances, and they nodded, unaware that this third injection was an excessive amount.

  Janie explained that Debbie Pignataro had been in the operating room, and that a boy from the Nichols School named Tom had been there, too. She didn’t know his last name.

  Within a few moments after the third injection, the pulseox on Sarah’s forefinger began to sound the way it did if the oxygen level fell too low, below 85. Janie said the blood pressure monitor went off, too. She had tried to read the blood pressure and gotten nothing, and then tried to get a manual blood pressure reading, but she couldn’t do that either.

  “What does it mean when the pulse-ox hits 85?” Craven asked.

  “I don’t know,” Janie said in a puzzled voice. “I just know that when it hits 85, it isn’t a good sign.”

  She remembered that they had all worked over the woman on the table, trying to get her to breathe again, but she didn’t kno
w for how long.

  Now Janie Krauss told them that the doctor had asked that the patient be hooked up to the electrocardiogram. “There was just a flat line. And he didn’t have a ‘Bamboo Bag.’”

  “What’s that?” Finnerty asked.

  “You know—that little masky thing you put over someone’s face when you want them to breathe?”

  “Like an oxygen mask?”

  “That’s it!” As Janie tried to explain it, the two detectives realized that she meant an Ambu-Bag, necessary to intubate the patient in an effort to give her oxygen. If it hadn’t been so tragic, her description might have been humorous. But it was all too clear that Anthony Pignataro not only hadn’t hired an anesthesiologist or a nurse-anesthetist, he was operating with an L.P.N. who had never had the proper training or experience to do the job he expected of her.

  The only other people in that surgical suite were a 17-year-old boy and Debbie Pignataro. Until now, the investigators hadn’t realized they were there.

  Janie said that Dr. Pignataro had sent Tom scurrying to find an Ambu-Bag, but all he could find was one for a child. Then the doctor had tried to use a flat piece of metal to open an airway, and finally had screamed for a coat hanger.

  The detectives winced. They weren’t medically oriented, but they could see that Pignataro hadn’t been at all prepared for an emergency. They wondered if indeed he had caused the emergency.

  Finally, Janie said, he had given up and told Tom to call for help. Once Tom called 911, Janie thought that the rescue workers had arrived in about five minutes.

  Finnerty and Craven thought it would be a good idea for Janie Krauss to talk directly to the assistant district attorneys on the case, and she went with them willingly. On the way, she became animated as she told them about her exciting weekend.

  “She told us that she went to a concert and she got to go backstage and meet Mick Jagger,” Chuck Craven said. “There’s a young mother with two little kids dead, and she’s excited about Mick Jagger…”

  Debbie Pignataro was considerably more affected by Sarah Smith’s death. She looked at Lauren and Ralph and thought how she would feel if anything happened to her and they were left without a mother. She went over the operation again and again in her mind.

  Her only assignment had been to keep an eye on the pulse-ox device and the blood pressure cuff, but she always watched the patient, too, whenever Anthony asked her to help him during operations. She wasn’t familiar with the dosage of anesthetics. She had worked in the pharmacy so many years ago, and there they filled prescriptions—not doses of anesthesia.

  “But I was watching her face,” Debbie would say a long time later. “And I could see that her skin was getting gray. I tried to tell Anthony, but he was too busy with what he was doing. When the pulse-ox started to sound, he told me to take her fingernail polish off, so I could see the nail bed better. And he said to jiggle the pulse-ox because it was probably just some loose wires.”

  Debbie had become more and more concerned, but Anthony ignored her until the other alarm went off—the blood pressure alarm. Only then did he look up at his patient. And, at that point, he realized that she was comatose. But Debbie realized to her horror that he had made no preparation whatsoever to have the instruments needed present in his “surgical suite.”

  On September 9, Chuck Craven and Pat Finnerty met with representatives of the New York State Department of Health, the Vigilant Fire Company in West Seneca, and attorneys from the Erie County District Attorney’s Office. Other than Pignataro’s staff and his wife, the fire department’s rescue squad personnel were the only people in Anthony Pignataro’s office on the day Sarah Smith stopped breathing. They were able to reconstruct the scene of panic they encountered when they answered the 911 call.

  Dave Koehler, the first assistant chief, had been the first to respond. He drove to the fire station to pick up the Life-Pak that would trace the heart’s rhythm and send it to a doctor in the ER, and could also be used to shock a heart into beating. When Koehler arrived at the Center Street office, he was met by a young man, who pointed toward the basement steps.

  Koehler told them that he knew the doctor socially and recognized him. He knew Debbie Pignataro, too. She was wearing surgical scrubs but was standing off to one side as Pignataro tried to open an airway and a young woman was doing closed chest compressions.

  “She just went out,” Pignataro had gasped. “She had no history of medical trouble.” He asked Koehler if he had a stylet for an intubation tube. He seemed to be having a great deal of trouble getting a breathing tube down the patient’s throat.

  At the time Koehler arrived, he saw three leads hooked up to an electrocardiogram in the room, but the screen was blank. He himself attached two pads from the Life-Pak to try to obtain any sign of heart activity. The only response he got was a slight reaction to the closed chest compressions. He heard Pignataro shouting for a clothes hanger.

  Koehler recalled that Pignataro was begging to no one in particular, “We can’t lose this one!”

  Firefighters Lou Gimbrone, Rich Cramer, and Paul Bernardi rushed in, followed by David Willman, the second assistant fire chief. When the Rural/Metro Team arrived a few minutes later, Koehler heard the doctor ask them for their intubation equipment. Koehler looked to see if there was a crash cart in the surgery and saw none. What he saw was Pignataro and Janie trying to work the yellow wire clothes hanger into the victim’s throat so he could get an oxygen tube into her lungs.

  Jim Cavanaugh had been the last paramedic to arrive. The emergency medical personnel were attempting to get oxygen into the silent woman on the operating table. Like the rest of them, Cavanaugh was shocked to see that she was so young. They had expected an older person.

  Pignataro was frantic, and he was getting in their way more than helping them. However, he left the room once “to get a cup of coffee,” and then returned and pointed at his EKG machine. “Look at my EKG,” he shouted. “Mine’s better. Can’t you guys shock her? We’ve got to save this one!”

  Anthony Pignataro had then grabbed the Rural/Metro team’s defibrillator and moved toward his patient as if he were going to use it, but the paramedics stopped him. Whatever his reason, he hadn’t used his own defibrillator. They didn’t know if it even worked.

  Paul Bernardi wished mightily that someone would get Pignataro out of the operating room. He was so out of control that he wasn’t helping the patient. He was hindering the rescue workers, attempting to remove some tube from the woman’s chest area, fighting clumsily to intubate her airway. Bernardi and the other emergency medics carried Sarah Smith on a gurney to the rescue rig, where they were able to get oxygen going and shock her heart into beating. As they prepared to race to Buffalo Mercy Hospital, Pignataro attempted to jump into the back of the rig.

  He was too agitated for them to deal with, and Dave Koehler volunteered to drive Pignataro in his vehicle and follow the ambulance.

  It had been nineteen or twenty minutes since Sarah Smith received any oxygen—far too long for a human brain to survive without profound damage.

  Debbie was left behind. It would be up to her to explain to Dan Smith why he couldn’t pick his wife up and take her home for the few days of rest that Anthony had assured Sarah was all she would need to recover from his miraculous surgical procedure.

  And, of course, there had been no easy way to tell Dan Smith that his beloved wife was in such critical condition. His loss was something that would come to him in a series of searing revelations over the next seven days—and indeed for the rest of his life.

  A postmortem examination of Sarah Smith’s body was performed at 9:45 on September 7, 1997, by Dr. Fazlollah Loghmanee, associate chief of the Erie County Medical Examiner’s Office. If, as Anthony claimed, Sarah had a preexisting medical condition that had killed her, Dr. Loghmanee would find that out.

  The term “autopsy,” roughly translated, means “to see for one’s self.”

  Dr. Loghmanee dictated into a tape recorde
r at the beginning of the postmortem examination. Sarah was five feet, five and a half inches tall and weighed 124 pounds. She had very little fatty tissue on her body. Her breasts were small.

  The forensic pathologist could see the beginning of an operation: the semicircular incision around her navel and an odd “tunnel” above her muscles but through the soft tissue from her navel to her right breast. A bag containing less than 20 cubic centimeters of blood-tinged fluid rested within the breast. The left breast was normal; her surgery had stopped before the second half had begun.

  All the signs in the organs of her body were normal. She had a sound heart, lungs, kidneys, arteries, liver; all were normal save for changes that had occurred after she was deprived of oxygen for twenty minutes. The only trauma had come from the breast augmentation surgery.

  Dr. Loghmanee’s final notation read: Cause of Death: Asphyxia due to Inadequate Ventilation Under Anesthesia.

  As always, it would take several weeks before the results of a toxicology screen were available. When the results came in, Sarah Smith’s blood and urine had tested positive for lidocaine, codeine, diazepam, midazolam, and thiopental—all drugs administered by Anthony Pignataro.

  Chuck Craven and Pat Finnerty began learning everything they could about anesthesia. The advent of the Internet had made it possible to find out anything about anything, and they punched in their questions and rapidly got up to speed. As soon as they learned the basics, the two investigators began to interview doctors who specialized in anesthesia.