Killer Nurse (3 page)

With a young son and a baby on the way, Kimberly Clark Fowler Hopper Saenz quit Fleetwood Transportation on June 23, 2000, less than two weeks after marrying Kevin Saenz. She'd held the job for almost three years, and when she left, they would have hired her back. As things turned out, this distinction made them unique among Kim's employers.

Saenz gave birth to a daughter, Madison Grace, on December 22, 2000, and for the next year and a half, life seemed to have quieted down for the Saenzes.

On July 24, 2002, Kimberly Saenz's parents paid $14,000 to Angelina Savings Bank in Lufkin to pay off the loan on their property. The property then played Ping-Pong. They sold it to Kimberly Saenz for a $20 token fee. However, less than a month later, Kimberly Saenz sold them back that same property for the same fee.

Then one month and three days after paying the loan off, Saenz's family used that same property to borrow $24,225 from the same bank. That loan coincided with their daughter's start at Angelina Community College in the nursing program.

Saenz graduated in December 2004 as an LVN (licensed vocational nurse) in Texas. Naturally her parents and other members of the family were proud of her. In an E! Program interview, her father, Kent, talked about how hard she'd worked to become a nurse. He said, “It was a full-time job just to become a nurse.” He also said his daughter hadn't pursued nursing for the money. “It was about helping people,” he said. “She just liked to help people.”

Her son, Jacob Hopper, told the same program, “I always got to go to school knowing my mom was out there saving lives.”

Fate, however, had other plans.

The same month she graduated from nursing school, Saenz went to work for Memorial Hospital, one of the two hospitals in Lufkin, but she worked there only five months. Exactly one month after leaving Memorial, Saenz went to work for Woodland Heights, the other hospital in Lufkin. There's no official indication as to why she left Memorial Hospital, but in August 2005, two months after going to work for Woodland Heights, she was fired for stealing Demerol—a highly controlled narcotic. Records also indicated that she supposedly gave Demerol to patients who were not in pain.

As the whirlpool swirled around her and with a bad work record for the two nursing jobs she'd held in less than a year since earning her degree, complete with the charges against her at the last one, one might assume that Saenz would not get another nursing job anytime soon. However, federal employment laws only allow employers to disclose if they would hire that person back or not. Although Saenz had a serious charge against her nursing license, the Texas State Board of Nursing only lists the allegation against a nurse's license after they have investigated the charges. At that point, the board hadn't yet investigated the Woodland Heights charges about the stolen Demerol. At the time Saenz was looking for another job after Woodland Heights, potential employers only had a clear nursing record to look at. Despite her two no-rehires, nurses were hard to find and in high demand.

Saenz's next job was at Wright Choice Home Health. She worked for them under two months. Employees said that, in the beginning, she was pleasant and on time, and seemed to enjoy the job. However, her mood and work record quickly changed drastically. She became morose when she was there, and often arrived late. Finally, Wright Choice let her go because she was constantly late and didn't call in—and sometimes just simply didn't show up for work.

Kevin Saenz told people at this point that his wife was so depressed that she couldn't get out of bed and he was taking her to Brentwood Hospital in Shreveport, Louisiana, for treatment. She was, in fact, admitted there for depression and suicidal thoughts. While there, she also complained about how Kevin treated her.

After the Brentwood stay, Kimberly applied for employment with the Lufkin State School, a state-supported living facility for people with developmental and mental disabilities. She began work there on October 1, 2006, as a probationary employee. Thirty days later on October 31, 2006, they terminated her employment because she was not suited for her assigned position.

At this point, she'd been a nurse for less than a year and had been fired from four nursing jobs—and had four no-rehires on her record. Then before she celebrated her first year as a nurse, she got her fifth job. On November 27, 2006, she went to work for the Children's Clinic of Lufkin.

The fact was, Kimberly Saenz was having some real problems in her life—problems that people she'd gone to school with, gone to church with, or who knew her socially had no idea about. In addition to her depression, she and Kevin were experiencing serious financial difficulties, which was putting incredible strain on the marriage and surely exacerbating her depression.

The family got some welcome good news when Kevin found a job as an appraiser with the Angelina County Appraisal District, a job that paid well for the area. Whether or not they knew about his criminal history and time in prison is unknown. As an indicator of what he might have made in 2005, in 2012, Chief Appraiser Tim Chambers asked the appraisal board for permission to hire two additional appraisers. The two new employees would cost the county approximately $130,000, which included salary, benefits, equipment, and car allowance. That's roughly $65,000 a year apiece. Considering that a policeman earns in the low $30,000s, and a teacher with a college degree begins in the mid-$30,000 range, $65,000 is a good salary, especially for Angelina County.

Kevin Saenz's annual salary was likely more than many families in Angelina County lived on per year. However, the couple was supporting their eight-year-old daughter as well as Saenz's teenage son, Jacob, from her previous marriage, for whom she hadn't received financial help until on January 23, 2006, when the Texas Attorney General filed a motion to make Chris D. Hopper pay child support.

However, the extra income didn't seem to help. On Friday, December 15, 2006, Green Tree Servicing and Conseco Finance Corporation filed a lawsuit in Angelina County against the accounts, contracts, and notes of one Kim C. Hopper; in other words, she was being sued for nonpayment. With all of these financial strains in play, the family had a hard time making it, even with Kevin's relatively generous paycheck.

And just when Saenz really needed job stability, she wouldn't find it at the Children's Clinic. On March 20, 2007, the clinic reprimanded her for missing eight and a half days of work without calling in. But the reprimand didn't help, and after working there for six months, her last day there was May 29, 2007.

That wouldn't be the last the Children's Clinic heard from Kimberly Saenz. After they fired her for basically not showing up for work, she filed for unemployment compensation. Some people said she was actually surprised when it was denied.

At this point in Kimberly Saenz's life, the question was not if she'd go down, but how far, and the trip continued. Whether financial troubles were the tipping point or not, on June 7, 2007, Kevin and Kimberly Saenz split up. This in itself wasn't all that unusual, but the police don't usually get involved when a couple separates.

Lufkin police officer Sterling Glawson responded to a disturbance call on Tulane Drive in Lufkin. When he arrived, he was told that an argument had begun between Kimberly and Kevin Saenz at their home in Pollok. Kevin had fled from the home to his mother's boyfriend's home on Tulane Drive, but Kimberly had followed him. In a scuffle, he was injured.

Glawson arrested Kimberly Saenz for assault causing bodily injury and issued her a criminal trespass citation. She spent the night in jail and was released the next day on a $1,500 attorney bond, but once out, she discovered that her husband had gotten an Emergency Magistrate's Protective Order against her. Between June and August 2007, Kim and Kevin worked things out, temporarily at least.

With her employment record as a nurse in Angelina County showing that her longest stint was the six months at the Children's Clinic—and showing her five no-rehires—it seemed a long shot that anyone would hire her again. However, the State Board of Nursing still hadn't investigated that charge from Woodland Heights in Lufkin. A check of Saenz's nursing license didn't show those charges.

Against the odds, Saenz was hired in August 2007 as an LVN, or licensed vocational nurse, working for the DaVita Lufkin Dialysis Center. Kevin Saenz told the E! Program, “She was ecstatic and excited to go to work for DaVita. . . . Her exact words were, ‘This job has to be a Godsend.'”

But as events would play out, the “Godsend” turned out to be anything but.

CHAPTER
3

DAVITA

Upon entering the DaVita Lufkin Dialysis Center, visitors and patients alike sat in a waiting room dominated by a “wall of fame” board that covered most of the wall. The board consisted of photos of patients in the middle of a red heart. Large words next to the pictures proclaimed, “Concentrating on compassionate care the DaVita way.” The wall of fame board, a point of pride for DaVita, was where patients and staff shared a little about their lives outside of the clinic. DaVita was so proud of this board that each of their 1,300 clinics had to have one.

On most days, the center was full of mature to elderly people waiting to begin their treatments. The patients' ages, physical characteristics, and backgrounds varied, but all had one thing in common: they were there because their kidneys were failing them. Human kidneys help sustain life in many ways. The kidneys maintain blood pressure, convert vitamin D to calcitriol, a form of vitamin D that treats and prevents low levels of calcium in the blood. They also regulate calcium, and secrete the hormone erythropoietin, which triggers red blood cell production. They also act as a filtering system to get rid of impurities in the blood and discharge waste through the urinary tract. People with renal failure need dialysis because the treatment does what the kidneys no longer can. Without dialysis, the patients would die.

Inside the treatment area, the DaVita Lufkin Center had an atmosphere of cleanliness and, like most medical facilities, an antiseptic feeling. In addition, a hint of bleach lingered in the air. Bleach was the predominant disinfectant and sterilizer at DaVita, and other dialysis clinics. In April 2008, the staff at DaVita ran a bleach solution through all the dialysis machines once a week, on Thursdays. After they did that, they then rinsed all the bleach out of the machines. They also used bleach on the floor, where occasionally nurses or PCTs spilled blood. After every patient left a chair where treatments took place, the caregiver wiped the chair, machine, and area down with a bleach solution.

DaVita Lufkin had two bays for patients. Each bay had a nursing station that overlooked the open end of a large horseshoe-shaped arrangement around three walls of the bay, and in the center of the horseshoe, two rows of patient stations that sat back to back.

With the computers at the nursing station, the nurse could monitor how well the dialysis machines were functioning, the time patients had remaining to receive treatment, and when they needed to have their vitals checked again. DaVita required patients' vitals to be checked every thirty minutes.

Dialysis is a lengthy process—taking hours at a time—because the body's entire blood system must be pumped through the dialyzer, filtered and cleaned, and returned to the body. Most patients spent between three and four hours a day, three days a week doing the treatments. They were confined to sitting in the chair as their blood was drained from their body, cleansed of impurities, and put back. The comfortable patient chairs were padded and had white laminate butterfly trays on both sides that could be flipped up or down. Nurses and technicians used the trays to help hold the medicine vials, syringes, and other equipment, and they also doubled as patient armrests.

The patients passed the time differently. Some watched TV, other patients listened to music. Some talked on cell phones, while others balanced checkbooks or read, things the patients could do with one hand.

Because the same people spent the same three days a week with one another at the clinic for the same three to five hours a day, many of them became extremely astute observers of what was going on with their own treatment as well as others'. These patients often discussed their treatment with one another and noticed any variations in protocol, such as a change in medication. In many instances, some even gave one another medical advice.

Some patients didn't care which nurse or technician administered their treatments; they'd take whoever was available. But others asked for or even demanded to have their favorite nurses and technicians hook them up to the machine. They had a preferred time and favorite chair, too, much like they probably did at home. Although some patients could be difficult, irritable, and unpleasant to be around, most were easy to get along with, friendly, and trusted their care providers.

Ms. Clara Strange and Ms. Thelma Metcalf were two of those friendly, trusting patients. They both had appointments at DaVita Lufkin on Tuesday, April 1, 2008. With light winds, a seventy-one-degree temperature, and no rain, it was a typical spring day in East Texas. April Fools' jokes played out in Lufkin as they would all over the world.

But unlike those who could look forward to pranks and practical jokes, Ms. Strange and Ms. Metcalf would be spending about half of their April Fools' Day hooked up to dialysis machines. One of the nurses on duty was Kimberly Saenz.

Ms. Clara Strange was born Clara Jones on November 6, 1930, in nearby Pollok, Texas, the same place as Kimberly Saenz. Although she grew up in the country, she didn't have to worry about company—her five sisters and four brothers along with her parents provided plenty. Later, she married A. C. Strange, and they settled down and raised a family of their own.

Eventually, Ms. Strange went to work for the Lufkin State School, and she worked there until her retirement. Not that Ms. Strange sat back and took it easy—when her daughter Betty Fernandez died, Ms. Strange also raised her grandchildren.

On that Tuesday morning, Ms. Strange was put on the dialysis machine at 11:34 by patient care technician (PCT) Werlan Guillory. She had some shortness of breath when she was hooked up, but as the treatments progressed, she improved quite a bit. That afternoon when Guillory went on break, Ms. Strange was tolerating treatments well, and her blood flow rate was set at 400 cc/min as prescribed by her doctor. When Guillory returned approximately thirty minutes later, however, he was shocked to discover Ms. Strange unconscious, unresponsive, and without a heartbeat. Her blood flow rate had been changed to 300 without doctor approval or any documented reason to turn it down. Blood flow rate (BFR) is an important component of dialysis, and the nephrologist calculates the rate based on each individual patient, his or her health, as well as other factors. Basically it is the rate that the patient's blood is removed and put back in the body. A normal slowdown of the rate might, depending on the patient, be from 400 cc/min to 390 cc/min. Normally, even when the blood flow rate is turned down, it is done in small increments because this rate affects the patient's blood pressure.

After yelling for help, Guillory said he asked Saenz, “Kim, what is going on?” But she didn't answer or even seem to care, he later reported.

Although the clinic wasn't an emergency room and not equipped as such, they did have nurses and doctors there as well as a crash cart, and they constantly monitored the patients' vital signs. Besides that, they were only a minute away from both Lufkin hospitals. Seldom did life-threatening medical situations develop without any symptoms. Nurses and doctors converged on Ms. Strange, and a PCT by the name of Cory Smith rushed the crash cart out in an attempt to save her. But nothing helped. Ms. Clara Strange died while attached to the dialysis machine at DaVita.

Ms. Strange's death affected most of the DaVita employees deeply because she was well liked—one of those patients who was kindhearted and affable, and not a bother or trouble to the staff. They sincerely enjoyed treating her. However, they didn't have time to grieve at that moment.

Ms. Thelma Metcalf, another of the well-liked patients who happened to be in the same patient bay as Ms. Strange, was also in trouble.

Known to her many friends as Fran, Ms. Metcalf had lived the majority of her life in Zavalla, a small town in Angelina County twenty miles east of Lufkin. Though she was born in Houston, after marrying Walter Metcalf, the couple eventually settled deep in the piney woods of East Texas. There Ms. Metcalf went about raising her family. She was a loving, caring mother who'd instilled discipline in her four children, provided support to her husband, and made time for friends and her church.

In the latter part of 2007, her health began to fail and she was admitted to Memorial Hospital in Lufkin with renal problems. In August, with her condition improving, Ms. Metcalf was released from the hospital and began outpatient kidney dialysis treatments at DaVita Lufkin Dialysis Center. However, within a few days of beginning treatments, Ms. Metcalf's condition worsened and she was unable to walk. After an interview with Mr. Metcalf,
The Lufkin News
reported, “Her condition not only shocked her husband of forty-eight years, but also her family doctor. He told the family that he didn't understand why she went downhill so fast.”

Although the sixty-eight-year-old Ms. Metcalf was a type 2 diabetic, not in good health, and had to be helped out of her wheelchair for treatment, on that April morning she was in a good mood, talkative, and her vital signs were great. Then she began her dialysis treatment.

Ms. Metcalf's blood pressure dropped from 105/82 to 93/68 in thirty-one minutes. At 3:05 in the afternoon, just like Ms. Strange, she became unresponsive and her heart stopped beating.

Cory Smith, the PCT who had rushed the crash cart to Ms. Strange in that unsuccessful attempt to save her, had not even gotten it put away before Ms. Metcalf coded. After grabbing another breathing device—he'd just used the one on the cart on Ms. Strange—he rushed the crash cart back to try to help Ms. Metcalf.

He handed Saenz the breathing device and she placed the mask on Ms. Metcalf and started operating the breathing pump while another nurse did chest compressions. As they did CPR, Smith noticed that there was no rise and fall of Ms. Metcalf's chest, which indicated that no oxygen was getting into her lungs.

Smith told Saenz that she had to open Ms. Metcalf's airway, but Saenz didn't respond.

He told her two or three more times, but Guillory said Saenz not only never responded, but never even acknowledged that he was talking to her. Finally, Smith said, “Let me do it.” He took the breathing bag from Saenz and attempted to clear Ms. Metcalf's airway and then put the mask back on, but it didn't do any good. Ms. Metcalf was rushed to the hospital, where EMTs administered three doses of epinephrine, a drug used with cardiac arrest patients to attempt to revive them, but it was too late.

Ms. Metcalf became the second patient to die on the dialysis machine at DaVita Lufkin—and within five minutes of Ms. Strange.

After Ms. Metcalf was rushed to the hospital, employees discovered that her blood flow rate had also been turned down from 300 to 200, and again without doctor approval.

The correct blood flow rate is crucial for every dialysis patient. Obviously, too much blood cannot be removed from the body at once, so usually no more than a pint of blood is outside the patient's body at one time. An alarm system is triggered if the blood flow rate falls too low.

An air detector also triggers an alarm in the event that air enters the bloodlines, which can be deadly. Yet another alarm system checks for foreign substances that shouldn't get into the patients' bloodlines and be brought into the body. If these or any other problems occur with the machine, the alarm is set to go off and stop the blood flow of that patient—therefore eliminating the harmful things from entering the patient's blood.

However, if a foreign substance were introduced into the lines in any way, slowing the blood flow rate gave that substance time to be diluted with the blood, and therefore reduced the chance of the alarm going off. If the alarm didn't go off, the blood continued to flow, carrying the substance throughout the patient, and the staff would not be alerted to the problem.

Neither Ms. Strange nor Ms. Metcalf's alarm systems went off that day—and both were found with lowered blood flow rates.

Dr. Imran Nazeer, a nephrologist and the medical administrator of DaVita Lufkin, later said that in all of his twenty-three years as a kidney doctor, he'd never before seen a patient die of a heart attack while receiving dialysis, and he'd only ever even heard of two such cases. The chances of one patient dying of cardiac arrest while on a dialysis machine are something in the neighborhood of 7 in 100,000. The odds of two patients at the same facility dying of cardiac arrest within five minutes of each other while on a dialysis machine are beyond astronomical. What's more, neither Ms. Strange nor Ms. Metcalf had exhibited any sign of heart problems before they suddenly both died of cardiac arrest.

Ms. Metcalf's family had her cremated. After a service in Zavalla, they took her ashes to a creek in Arkansas where she'd played as a child and spread them there. Seldom does a cremation play a vital role in a trial, but four years later, this cremation did.