Morgue (19 page)

The local newspapers covered the bickering among the egotistical justices of the peace, and citizens finally came awake. At its next meeting, the Bexar county commissioners established Texas's first medical examiner's office. For $14,000 a year, the commission hired Dr. Robert Hausman, a Dutch-born forensic pathologist who was then the lab director at an Atlanta hospital. Coincidentally, before he started the job, Hausman spent a month alongside my father, getting a quick forensic refresher under New York's Chief Medical Examiner, Dr. Milton Helpern. I was only fourteen years old at the time and certainly couldn't have imagined that someday I'd lead the office Hausman founded in San Antonio.

Death didn't dawdle. Two hours after Texas's first ME was sworn in on July 2, 1956, his first case—a suicide—arrived. He had only one assistant and a secretary, but he inaugurated a new era in Texas forensics when he was called to a ninth-floor suite in a downtown San Antonio hotel where a forty-eight-year-old white male had shot himself through the heart with a Spanish-made, .32-caliber semiautomatic handgun.

Case No. 1 (as it was officially labeled) was simple enough from a forensic perspective—the room had been locked from the inside and the single gunshot was heard as a bellboy knocked on the door at eleven a.m. But from a human perspective, it was much more complex: The dead man was Joseph Cromwell, the only son of a pioneering Oklahoma oil wildcatter and heir to his late father's vast fortune. A ninth-generation descendant of English Lord Protector Oliver Cromwell, he lived on the sprawling family ranch in nearby San Marcos. As a young man, he had graduated from a prestigious military college and Hoover's secretary of war, a family friend, had personally commissioned him as a second lieutenant. Parties at the family's sprawling ranch were legendary, and the last ten years of Joe's hedonistic life were boozy, gluttonous, and aimless. By the end, the money was almost all gone.

Joe Cromwell checked into the hotel a week before with only a couple of changes of clothes and no valuables. Police found him lying on his bed in his undershirt, boxers, and blue-gray socks, his face unshaven for a few days. He'd left detailed instructions for the hotel manager, police, and his son in a series of suicide notes on the nightstand.

Was it merely a coincidence that the first casualty on Hausman's first day wasn't an ordinary death? Well, no death is ordinary if you're the one who's dying. And I've found that most “ordinary” people have a few extraordinary stories somewhere in the book of their lives.

A medical examiner's job is to determine cause and manner of death (in this case a single bullet through the heart in a suicide), but a sentient human wants to know what is sometimes unknowable, the deeper why. The real reason Joseph Cromwell took his own life was never discussed by his family and is now forgotten, if it was ever known at all, but I know Dr. Hausman kept the suicide notes on his desk for a couple of days. Nevertheless, with an endless parade of suspicious or unattended deaths starting on that historic first day, he had to let the husk of Joe Cromwell go.

We all do.

When I first came to San Antonio, nobody from the ME's office went to death scenes. I changed all that when I started sending my own investigators—who had taken all their reports by phone—to the actual places where people died. I worried at first that the cops might chafe, feeling as if I didn't trust them to do their jobs. That wasn't the case; forensic investigators are simply looking for different clues than policemen. Luckily, most of my investigators had police backgrounds and my chief investigator was a retired San Antonio detective known to reporters as Mr. Homicide. As I write this, his nephew, also a former homicide detective, is the Bexar County ME's chief investigator, too.

Being at the scene was important. The more information we can gather in the earliest moments after an unexplained death, the better chance we have to explain it. I wanted my investigators and forensic pathologists to examine as many deaths as possible, even when the cause seemed apparent. Why? Because what is apparent isn't always true.

In those days, as now, local police routinely reported suspicious deaths, but hospitals weren't always quick or eager to call the medical examiner. The law didn't require hospitals to report the deaths of patients directly under a doctor's care if the doctor could certify without doubt why his patient died, but a wide spectrum of questionable deaths fell in the law's gray area. Hospitals naturally want to avoid bad reputations, lawsuits, and even uncomfortable questions, so they too often pretend that any death in their hospital beds was completely natural. Attending doctors, not wanting any second-guessers, often sign death certificates without the certainty the law requires.

And that's not how we should treat death.

In my first year as the chief in San Antonio, my frustration grew with stubborn hospitals that refused to report all questionable deaths—especially at the Bexar County Hospital, a county facility used as a teaching center for the University of Texas Health Science Center at San Antonio. By the fall of 1982, I was not so quietly stewing. I knew some unexplainable deaths were not being reported to the ME, so I rattled as many cages as I could to force hospitals to be more responsible. I even resigned from the faculty at the Health Science Center in protest, but nobody listened. I totally alienated the University of Texas bosses, who did nothing. It was a fool's errand to bang on the gates of a fortified culture that was arrogant, greedy, and opaque.

And whether by providence or accident, that's when the tragic case of little Chelsea McClellan materialized for me, literally on a whisper.

In January 1983, after a speech to San Antonio pathologists, my assistant medical examiner Corrie May struck up a conversation with an old friend from the local medical school. The doctor, a neuropathologist, mentioned that the Kerrville DA was looking into the unexplained death of a little girl. The DA, she confided, suspected a doctor and a nurse who had both recently worked at the Bexar County Hospital.

And, she whispered, there had been some suspicious baby deaths at the medical center, too. The hospital had been quietly investigating on its own for a few years, she said.

When Corrie May told me, I was shocked and angry. I had been beating the drums about unreported deaths at the hospital for months, and now here was evidence that my suspicions were valid. But I had no idea the reality might be even worse than I imagined.

The next morning I walked into the DA's office to deliver the frightful rumor: Somebody might be killing babies at the county hospital.

*   *   *

Indeed, the Bexar County Hospital was worried. At least one nurse had come forward earlier with suspicions. At least one doctor expressed qualms about a baby death he couldn't explain. The death rate in the pediatric ICU was higher than it should be. And whether this was anomalous or deliberate, it would all be an enormous embarrassment if it got out.

Two internal inquiries yielded no firm conclusions, but a common thread surfaced: Nurse Genene Jones's name kept coming up. A dark portrait began to emerge.

Genene Jones was born in San Antonio on July 13, 1950, and was immediately given up for adoption. She grew up short and chubby, felt ugly, and had few friends because she was a drama queen who lied chronically, yelled a lot, and was unpleasant to be around. Throughout her life, she occasionally told stories of sexual and physical abuse as a child, although the stories were always a little fuzzy, and after an endless string of lies, nobody took her seriously anyway. She also began to feign sickness as a way to get attention.

At sixteen, her younger brother was killed when a homemade pipe bomb exploded in his face. A year later, her slightly shady father died of cancer. Acquaintances say she was devastated, even though Genene was fond of saying she grew up unwanted and unloved. Her adoptive mother became her sole supporter.

After high school, Genene reportedly pretended to be pregnant to force her slacker boyfriend to marry her. But within a few months, he joined the Navy, and between affairs with a string of married men, Genene took beauty school classes.

When her husband returned from the Navy, they had a child, but they divorced after only four years of marriage. Soon she was genuinely pregnant, so she began to look for a better job that would pay more than she was making as a beautician (and would salve her unnatural fear of getting cancer from hair chemicals).

She'd once worked in a hospital beauty salon, and she'd developed a special attraction to doctors. A lightbulb switched on. Genene dumped her son on her mother and enrolled in classes to become a licensed vocational nurse. Shortly after graduation in 1977, she had another child, who also was dumped in her mother's care, and Genene began her new career.

Surprisingly, Genene proved to be a pretty good nurse, although she hated being just one cut above a candy striper. She believed deeply she should be in charge. She became obsessed with diagnosing people, even though it wasn't her job.

Now twenty-seven, she lost her first job at San Antonio's Methodist Hospital after only eight months when she was fired for being too bossy, too rough, and too eager to make decisions that were well above her pay grade. Her next job, at the small, private Community Hospital in San Antonio, was also brief.

In 1978, she was hired to work in the pediatric intensive care unit at Bexar County Hospital, a fairly new facility that largely served the poorest citizens in America's fifteenth largest city at the time. But the job didn't start well. Genene's tendency to boss people around—even though she was the lowest on the totem pole in rank and experience—chafed. Besides being her abrasive self, she habitually second-guessed and overruled doctors' orders. She also liked to brag about her sexual conquests, which she'd often describe in lurid detail. To make matters worse, she was brassy and openly libidinous around male physicians.

Early on, she imploded over the first child who died in her care, perplexing other nurses with an excessive and bizarre kind of public grief. She dragged a stool into the dead baby's cubby and stared at the body for a long time. At other times, she'd insist on escorting the bodies of dead babies to the hospital morgue, singing to them on their way … but she also participated in a kind of “dead pool,” in which she'd bet on the next child to go.

Although her job was normally to provide basic bedside care, Genene developed a talent for inserting needles. She also seemed extraordinarily interested in various drugs and their effects. It all seemed natural, even praiseworthy, for a caregiver to want to know these things.

Just after Christmas in 1981, four-week-old Rolando Santos arrived at the ICU with pneumonia and was immediately placed on a respirator. Three days later, he started having unexplained seizures. Two days after that, his heart stopped as he bled from several needle punctures on his body. When the bleeding restarted a few days later, a test showed he'd been injected with heparin, an anticoagulant drug for heart patients.

When the bleeding started yet again, it was stanched with a drug designed to reverse heparin's effects, and Rolando's suspicious doctor immediately transferred Rolando out of the ICU, even though he was still too sick. The ICU was apparently just too dangerous for the child.

Within four days, Rolando Santos had recovered enough to go home.

Armed with solid evidence that somebody had administered an overdose of heparin to a child who didn't need the drug, a hospital official described the “purposeful nursing misadventure” in a memo to the dean of the medical school. He promised to keep an eye on the ICU's dark and disturbing trend in unexplained deaths and near-fatal episodes.

Genene Jones worried some people in the ICU, but she wasn't immediately suspected in Rolando Santos's case, or in any of the other questionable cases that were piling up. In her four years on the ICU floor, she proved to be a divisive figure but was never fired, even though some of her colleagues sent up several red flags about the number of inexplicable tragedies.

And those numbers didn't look good. During Jones's time in the hospital's pediatric ward, forty-two babies died. Thirty-four of them—four out of every five of the hospital's dead babies—died while Jones was on duty. Other nurses began calling Jones's three-to-eleven tour the “death shift.” Jones herself worried out loud that she'd be known as the “death nurse.” And maybe for good reason: Overall, the hospital's infant mortality rate almost tripled during her tenure there.

Yet despite the hospital's growing concern, nobody ever reported any questionable deaths to me, the county medical examiner whose job it was to determine how and why people die.

By 1982, unable to prove anything and unwilling to set off a public spectacle, the hospital literally cut its losses in a brilliant PR stroke. It announced a plan to “upgrade” its pediatric ICU staff with more experienced registered nurses and quietly let two nurses go: licensed vocational nurse Genene Jones and the nurse who voiced suspicions that Jones was killing babies.

Armed with good recommendations from her bosses, Genene was quickly recruited by Dr. Kathy Holland, who'd just finished her residency at Bexar County Hospital, to work at a new pediatrics clinic in Kerrville, Texas,

Thus it was that a few months later, one of the San Antonio hospital's former nurses (and, at the moment, one of the doctors it trained) was embroiled in a death investigation in Kerrville, the San Antonio DA was snooping around about other deaths, and I was bringing pressure on the hospital's administration to be more transparent. A destructive perfect storm was about to break.

But even after Chelsea McClellan died, children continued to have unexplained and frightening episodes of seizures, respiratory failure, and unconsciousness at Dr. Holland's Kerrville clinic. Incredibly, in the afternoon after Chelsea's death, another child lapsed into a similar spell after an injection by Jones, who was staffing the clinic alone while Dr. Holland was busy arranging for Chelsea's autopsy.