Killer Nurse (7 page)

What Saenz did next shocked the elderly patient. Ms. Hamilton saw Saenz kneel and place the bleach bucket on the floor. Ms. Hamilton asked herself, “What is she doing?” In her eight years of dialysis and all the time she'd worked in a medical setting, she'd never seen a medical professional place something used in patient treatment on the floor.

As Saenz poured the bleach, Ms. Hamilton could smell it. She witnessed the LVN draw bleach into four syringes and place them in her bosom, then look around again to see if anyone had noticed. She didn't spot Ms. Hamilton watching her.

Ms. Hamilton then watched in horror as Saenz injected both Ms. Rhone's and Ms. Risinger's dialysis lines with the syringes.

Ms. Hamilton wasn't the only one to have witnessed this macabre scene. In the chair next to Ms. Hamilton that day was Ms. Linda Hall, a sixty-eight-year-old black woman also from Angelina County, and also with a medical background. Ms. Hall had worked at Memorial Hospital in Lufkin as a nurse's assistant until her failing health caused her to quit. She'd been in dialysis for a year, and all of that with DaVita.

Ms. Hall had been reading on the morning of April 28, but as she glanced up from her book, she witnessed an event as scary as any horror story.

Ms. Hall watched Saenz open a drawer, remove a syringe, stick it in her shirt pocket, then look around very carefully as if she was checking to see if anyone had noticed her.

Moments later, Ms. Hall saw Saenz set a bleach pail, the kind they used to wipe the chairs and machines with, on the floor. Like Ms. Hamilton, this alarmed Ms. Hall, who had also never seen any medical personnel set anything on the floor. She continued to watch as Saenz looked around again, squatted beside the bleach pail, inserted the syringe, and filled it with the bleach.

Ms. Hall asked herself, “Lord, what is she fixing to do with that?”

Transfixed, Ms. Hall watched Saenz as she rose and walked back to the nurses' station, where the LVN stood for a couple of minutes, before walking over to Ms. Rhone's station. Saenz looked around again . . . and then injected one of the syringes into Ms. Rhones's saline port.

Ms. Hall asked herself, “Lord, did I see what I saw? Am I dreaming?”

Surely she was mistaken, Ms. Hall thought—something so unthinkable couldn't be occurring right in front of her. And the nightmare didn't stop there. Ms. Hall continued to watch as Saenz walked over and also made an injection into Ms. Risinger's lines.

Her book totally forgotten, Ms. Hall was at a loss for what to do. She knew what she'd seen, but didn't want to believe it. Not only had she just seen a nurse injecting patients with bleach—it was the same nurse taking care of
her
.

When PCT Angie Rodriguez returned from break at approximately 8:15, she found several unanticipated problems. Ms. Rhone's blood pressure had risen and her actions were unusual. She seemed agitated, and when Rodriguez asked her how she was, Ms. Rhone said she felt “uncomfortable.” Ms. Risinger was also complaining, of pressure in her chest and stomach pain. In a later interview with KTRE-TV, Ms. Risinger described the sensation: “It started out with a pressure on my chest,” she said. “It felt like somebody was pushing on me and then my stomach started a severe hurt.” That morning, she was left drifting in and out of consciousness. “It turned into a nightmare, and so many had died I thought, well, this is my turn.”

Dr. Nazeer, who had been at another dialysis center tending to other patients, made his way back to DaVita after learning of Ms. Risinger's chest pains. Before he arrived, though, Rodriguez and others were able to stabilize Ms. Rhone and Ms. Risinger. The women's mysterious and sudden symptoms passed almost as quickly as they'd arrived. But Ms. Risinger, at least, was still suffering some ill effects. When her husband, Jim, arrived to pick up his wife, DaVita employees said he demanded, “What's wrong with my wife? Who did something to my wife?”

Meanwhile, Ms. Hamilton, normally a quiet person, was not only scared but extremely agitated. She looked around for someone she felt she could trust, spotted Yazmin Santana, a PCT, and frantically waved her over. After telling Santana the story, Ms. Hamilton begged her not to let “Kim” touch her.

On the other side of the machine, Ms. Hall heard Ms. Hamilton tell Santana that she'd seen something. She spoke up. “Lord, I did, too!” Ms. Hall also begged a nurse who'd walked by not to let “Kim” touch her.

Santana now had two terrified patients, and she related that what Ms. Hamilton told her scared her, too. Santana had no idea what to do, so she went to Amy Clinton.

When Santana told Clinton what the two women had claimed to see, Clinton couldn't believe it. She went over to talk to them herself. The witnesses' stories were almost identical. They also both said that after Saenz injected the bleach into the patients, she had dropped the syringes into two sharps containers, and they told Clinton exactly which containers the syringes were put in.

After hearing their stories in person, Clinton still had trouble believing them—the idea of a nurse injecting bleach into her own patients' lines just seemed too far-fetched, too inconceivable—but she knew she had to do something. First, she called Saenz off to the side and asked her if she'd put the bleach bucket on the floor, and something turned inside her when Saenz admitted that she had. Clinton shook her head and informed Saenz, “We don't do that.”

Clinton then asked her if she'd given Angie Rodriguez's patients any medication. Kim told her that she hadn't. All she'd done, she said, was give them saline because the patients' venous chambers were clotting. She also told Clinton that she'd charted what she'd done on the patients' flow charts.

Clinton was astonished when Saenz told her that she'd injected the patients with saline. DaVita Lufkin and all other dialysis facilities did indeed use saline to prevent the blood from clotting in the lines. However, at DaVita Lufkin, every dialysis machine had a bag of saline hanging from an IV rack attached to the machine. The saline bag had a clip attached to the line coming from the bag. If the patient needed saline, the care provider simply opened the clamp. Also on the line was a port for injections. This was where the care provider injected the patient's medicine. The oddity of Saenz's statement was that she'd need to inject the saline into the bag that already contained saline.

Clinton now had a huge dilemma on her hands. She didn't fully believe the story—the patients had to be mistaken somehow—but clearly
something
had happened, and she had two extremely upset patients on her hands who were scared to death. She had to do something to defuse the situation, and the only way she could think of at the time was to get Saenz out of the clinic. She hoped that her absence would calm down Ms. Hamilton and Ms. Hall enough to finish their treatments.

She told Saenz, “You've had a bad day. Go home, relax, and we'll start fresh in the morning.”

Saenz was upset but left, and Santana took over her patients.

With Saenz out of the building, the patients calmed down, but Clinton was left with an even bigger problem: what to do now? She began by checking Ms. Risinger's and Ms. Rhone's flow charts, a simple process, but became even more alarmed when she discovered that, despite her claim, Saenz had not, in fact, documented anything.

Clinton then went to Dr. Imran Nazeer, the clinic medical administrator. She told him what she'd learned, and like everyone else who heard this story, Dr. Nazeer was shocked. He'd never heard of anything like this. In a way, though, he was relieved—if the story was true, at least they finally had an explanation for what had been happening at the clinic over the past month, a cause for all the deaths and injuries to the patients.

The situation placed Dr. Nazeer in an unusual situation, one which later became very controversial. Since both patients who had allegedly been injected with the bleach were in the final stages of their treatments, and about ready to go home, Dr. Nazeer had opted to advise Ms. Rhone and Ms. Risinger to go to the hospital for blood work, but he didn't tell them why. When neither patient heeded his advice, however, he called them at home, told them about the possible bleach injections, and again asked them to go to the hospital for blood tests. This time they listened to him and went.

Dr. Nazeer's hesitation, though ill-advised, was understandable. There were no contingency plans for a scenario like this at DaVita Lufkin. Nothing like this had ever happened, not to them, or to anyone else for that matter.

Dr. Nazeer and Amy Clinton did two important things that morning after Saenz left, though: they took both sharps containers that the witnesses claimed Saenz had dropped the syringes in and saved them, and they also bagged Ms. Rhone's bloodlines to preserve as evidence.

However, for reasons unknown, they neglected one vital piece of evidence: they didn't preserve Ms. Risinger's bloodlines.

CHAPTER
7

THE INVESTIGATOR

Sergeant Stephen Abbott of the Lufkin Police Department had no idea that at about the same time he was walking into the back door of the Lufkin Police Department on Monday morning, April 28, 2008, two dialysis patients were in the process of telling a DaVita employee a horrifying story of something they'd witnessed.

He had no instinct warning him that by the time the day ended, he'd be involved in an investigation that placed him in a worldwide spotlight.

At six-four and around two hundred and fifty pounds, Sergeant Abbott was an imposing sight. With a Nordic appearance, short white hair that didn't quite make it to blond, and black-rimmed glasses that emphasized his milky coloring, he stood out in a crowd like a lumbering giant. He tended to move slowly, but was capable of moving very quickly if he had to.

That Monday morning he was second in command of the department's criminal investigation division (CID). Like most police departments the size of Lufkin, which had a population of around 28,000 in 2008, they didn't have specialized investigative divisions; the detectives basically handled whatever came their way. Sergeant Abbott usually supervised the eight detectives on staff, but as in most small departments, he also had several other jobs to oversee—namely, he was in charge of the evidence room and the crime scene unit, both vital parts of any criminal investigation.

Born and raised in Huntington, a small community nine miles east of Lufkin, Sergeant Abbott went into the Army after high school, and became a military policeman. Little if any information is available of his high school or Army days mainly because he wouldn't tell anyone. All he'd tell a person in a soft voice that never seemed to rise or fall was that he was a private person and he wished to stay that way.

Although Abbott declined to speak much of his days in the Army, it's known that he was assigned to a military police unit attached to Fort Dix in the mid– to late eighties, and that that unit was deployed to Nicaragua in Central America during the infamous Iran-Contra affair. More than that is a mystery. The sergeant also didn't tell war stories.

After being honorably discharged in 1988, Sergeant Abbott returned home to East Texas and attended Angelina Community College, a local community college. He worked as a security guard at a chicken processing plant and at a pizza place to help pay his way through school.

In 1993, he was hired by the Lufkin Police Department. After graduating from the police academy, he did a long stint in patrol, broken up with some time in the drug enforcement unit.

By 2008, Sergeant Abbott had been with the department for fifteen years, and the fact that he rose to the rank of sergeant in that time, with little investigative experience, spoke to the kind of officer he was and to the higher-ups' belief in his abilities. His fellow officers described Abbott as extremely intelligent, honest, and as dedicated to his job as anyone, though never willing to take credit for anything. He always attempted to deflect credit to others.

Almost all police investigative units have someone with the ability to go into any situation and deal with any sort of person or problem—be it a board meeting with suits, politicians with an agenda, or a ditch digger in ripped jeans—and be able to relate to the people and handle whatever situation comes up. In April 2008, Sergeant Abbott was that person in the Lufkin CID whom higher-ups sought out to handle delicate or unusual cases.

Around four thirty that Monday afternoon, Sergeant Abbott was sitting in his office—a room with bare white walls except for two prints that were there when he moved in, and a wooden plaque in the shape of a military police badge with the words “Military Police” on it—getting ready to leave for the day when his two bosses sought him out. They had what they thought might become a sensitive situation. In other words, the proverbial mess had hit the fan, and Sergeant Abbott was going to have to clean it up.

Initially, all Sergeant Abbott was told was that there was an issue that might involve possible tampering with medicine at the DaVita Lufkin Dialysis Center, and he needed to go there and find out what was going on. This in itself issued a major challenge. He had no background whatsoever in the medical field, had never investigated anything in the medical field, and didn't know anyone who had.

Since he didn't have a clue as to what he was about to walk into, Sergeant Abbott went looking for another detective to take with him. By that time of day, most of the detectives were out of the office, but as luck would have it, he found Corporal Mike Shurley, another supervisor. Like Sergeant Abbott, Corporal Shurley also had additional duties other than investigations; he'd spent the day at SWAT practice and was still in his SWAT uniform. He'd just dropped by the office for a moment to check his messages when Sergeant Abbott stuck his head in and asked him to come along to DaVita.

On the five-minute drive from the police department to DaVita, Sergeant Abbott filled Corporal Shurley in on what he knew, which wasn't much. Shurley wasn't as large as Abbott, but he looked imposing in his SWAT uniform. As the two detectives walked into the dialysis center (still full of patients) that evening, they still had no real idea why they were there.

Jerry McNeill, DaVita divisional vice president, met the detectives and explained the horrific situation to them. McNeill told them that two patients had claimed to see a DaVita nurse purposefully inject bleach into the lines of two other patients and then dispose of the syringes in two sharps containers. He told them that after Saenz was dismissed for the day, Amy Clinton and Giselle Frenette, another RN whom Clinton had brought in to help her monitor DaVita, went into the reuse room and used a screwdriver to pry the lids off the two sharps containers. They dumped all of the syringes from one container on a piece of paper and from the other container on a different piece of paper to ensure that they didn't get the contents of one container mixed with the other.

Now Clinton used the same test strips they used on the dialysis machines to check the syringes.

Clinton soon found a syringe that wasn't labeled but appeared to have a little clear liquid inside. She pulled the syringe apart and used the strip to test the inside of the syringe. When the strip turned purple—an indicator of bleach, her heart sank. “Oh, my goodness,” Clinton said.

As the two RNs continued to test, they found four syringes in the two containers that tested positive for bleach. That just happened to be the exact number of syringes the two witnesses claimed Kim had used and put in the containers.

Frenette said that she was shocked when the syringes tested positive—so much so that she uttered a “bad word,” which was something she just didn't do.

Even with the test results now in front of them, both detectives were still doubtful. Sergeant Abbott said later, “I was skeptical. Witnesses don't always know what they saw.” Corporal Shurley echoed those thoughts.

In truth, no one really wanted to believe that a medical professional would do something to deliberately harm patients. As Jessica Cooley,
The Lufkin News
crime reporter, later told E!, “It seemed like such a wild accusation. A nurse would inject someone with something that was used for cleaning. It just didn't make any sense.”

Despite his doubts, however, Sergeant Abbott called for the crime scene unit to come to DaVita, while McNeill filled the two detectives in on some back story. He gave them a list of patients who had died while on the dialysis machines, but stressed that it was extremely rare for patients to die suddenly on the machines while doing dialysis—however, as April 2008 drew to a close, the DaVita Lufkin Dialysis Center had experienced an unusually large number of deaths and injuries to patients, totally perplexing the company. After a thorough investigation that had focused on four areas—the water, the machines, the policies and procedures, and the patients themselves, all of which had come back clean—the company had been left as confused as ever. DaVita's investigators simply could not find anything to explain what was causing the fatal issues, yet clearly, the deaths and injuries had continued.

But, McNeill told them, two patients had come forward that very day with disturbing information. Both claimed to have seen Kimberly Clark Saenz, a nurse, fill a syringe with bleach from a container used to sterilize the equipment and inject the fluid into the IV port of Carolyn Risinger, and then Marva Rhone. Thankfully those patients had both survived, but now DaVita had a full-blown criminal investigation on its hands.

Sergeant Abbott said later that DaVita had only one request: to let the rest of the patients finish their treatments and leave the clinic before the police began the main part of their investigation. Although defense attorney Ryan Deaton later claimed that DaVita had its hooks into everyone, including the police department, Sergeant Abbott said, “In my experience, there was never any interference in the investigation from DaVita or their attorneys.” He added, “Besides that, I'm not the type to allow interference in my investigations.” Coming from Sergeant Abbott, it was a simple statement of truth.

As the detectives waited for the crime scene unit to arrive and the patients to leave, DaVita gave them a crash course on how dialysis worked, and the procedures that the PCTs and nurses had to follow. Like most police officers, other than basic lifesaving skills—CPR and things like that—Abbott and Shurley knew little about medical procedures, and absolutely nothing about the dialysis process.

As the nurses took the detectives through the medical procedures and patient care, Sergeant Abbott asked questions and had them go through things again and again. As a colleague said of Abbott, “He always goes the extra mile to prepare himself for the investigation.” That proved to be an understatement.

Once the crime scene unit arrived, they were directed to the reuse room to examine the evidence that Amy Clinton and Giselle Frenette had found. In the room were two sharps containers in biohazard bags, and Corporal Shurley, still dressed for battle, guarded the door to make sure no one could tamper with any evidence as the crime scene techs began to do their jobs.

Although the DaVita inquiry later turned into a murder investigation—the first one Sergeant Abbott had ever headed—that night, all they were looking at was the injection of two patients with bleach. Since both patients had lived, the most anyone could be charged with in Texas was aggravated assault with a deadly weapon—bleach, if it proved true—and at that point, both detectives had entertained some healthy skepticism about what the witnesses had said.

One important thing the detectives learned was that DaVita had been keeping all the bloodlines used for the patients who suffered cardiac arrests while undergoing treatment on a dialysis machine. They kept the individual lines in marked biohazard bags in a freezer. Sergeant Abbott didn't have a clue what to do with the bloodlines, but he instructed CSU to collect all of them and take them in as evidence. These later became the most important evidence in the entire case.

In addition to the two sharps containers from the reuse room that Corporal Shurley was guarding, the two investigators also confiscated
every
sharps container in the clinic as evidence. Sergeant Abbott had the crime scene unit number and label every container based on the patient station numbers that were on the walls. They also made a chart of where each container had been before they took it into custody. Corporal Shurley said later that this was hugely important in the long run and defused a defense theory that DaVita was merely trying to cover up their own negligence by blaming a single employee. There was no way DaVita could have known in advance that the investigators would take all of the sharps containers.

Next to the bloodlines, these sharps containers proved the most important evidence collected. They didn't point to aggravated assault. They pointed to murder.