Killer Nurse (6 page)

For years Ms. Opal Few went up and down, changing sheets, cleaning and cooking meals for her family and boarders. Maybe it was all those trips up and down those stairs, the exercise Ms. Few did to make a living for her family, or just genetics; whatever the reason, Ms. Few reached the age of ninety-one in pretty good shape—a lot better than most of the other dialysis patients. Ms. Few had hip replacement surgery when she was eighty-eight years old, but the surgery was because her hip had simply worn out—not from a fall. She'd worked hard all her life. She eventually moved in with her daughter Linda, who said it was her mother's arthritis, not illness, that prompted the move.

When Ms. Few was eighty-seven years old, she went into the hospital very ill with a virus. She was admitted on a Monday, and on Wednesday, Linda said she got a call from a nurse. The nurse was whispering, and told her that she needed to get up there right away because her mom was dying. Linda learned that for three days the hospital had been giving her mother Lasix—a drug that treated fluid retention in patients. Linda recalls that the nurse said that the drug was shutting down her kidneys.

Linda James rushed to the hospital. Later, in explaining what had happened, the doctor told her that it was really hard when someone is older to know what is wrong with them. Ms. Few's life was saved, but the damage was done. When Ms. Few went into the hospital, she had 40 percent kidney function. When she came out, she had 10 percent.

Most people would have filed a lawsuit immediately, especially when the doctor admitted that he'd made a mistake, but Ms. Few said she knew it was an accident. They were trying to do what was best for her and the thought of a lawsuit never occurred to her. When it was brought up, she wouldn't hear of it.

The doctor's mistake was one of the chief causes she had to start dialysis to begin with. Ms. Few had wanted to stop dialysis and stay at home—she had things to do and didn't want to be tied to a chair for so long—but of course, her doctors and family told her she couldn't.

Right up until April 26, 2008, Ms. Few led a very independent life. She still did all her own cooking and cleaning, and took care of Linda's ten– and twelve-year-old kids after they got out of school while Linda worked. The ten-year-old was autistic and had to be monitored closely because of his special needs. Every day when the children got home, Ms. Few had pizza and a cold Dr Pepper waiting on them. She even babysat her two-year-old great-grandchild whose mother was attending the Academy of Hair Design, a beauty school.

On that “What if?” Saturday morning, Ms. Few answered the phone when DaVita called. She was glad to be able to get in for her treatment early and get it over with.

Ms. Few walked into DaVita that morning on her own with the use of a walker. Dr. Imran Nazeer, the DaVita director and Ms. Few's doctor, said that, as always, she was lively, full of energy and spirit. It wasn't just her doctor who said this; everyone described Ms. Few this way, but especially on the morning of April 26. Donnya Heartsfield, now an RN but an LVN in April 2008, said Ms. Few was just a sweet little lady; happy and cheerful, excited to be able to get in early.

After Ms. Few was called back to begin her treatment, Heartsfield hooked her to the machine. The older woman had no problems, her vitals were good, and she was progressing well with her treatment. The nurse made her rounds of the patients, and then checked on Ms. Few again and found her doing well. Before leaving to go on her break, Heartsfield asked her teammate to look after her patients until she returned.

Approximately thirty minutes later, the length of breaks at DaVita, Donnya Heartsfield returned to her patients. She found Ms. Few unresponsive and with no pulse. She yelled for help, and the staff attempted to save Ms. Few, but to no avail. She became the fifth patient in twenty-six days to die on the dialysis machine.

After Ms. Few was transported away from DaVita, Dr. Nazeer asked RN Sharon Smith what meds Ms. Few had been given. When Smith checked the computer, she didn't see where the meds were documented. Smith asked Saenz if she'd given Ms. Few her meds, and when Saenz said yes, Smith told her to document it. Saenz then went to the computer and put in a time she'd given the meds.

Just one week later, the syringe that Saenz had used to administer Ms. Few's meds would become a key piece of evidence in leading investigators to the true cause of so many unanswered what-ifs.

CHAPTER
6

IN PLAIN SIGHT

When Kimberly Clark Saenz awoke around 4
A.M.
on April 28, 2008, it was to a cool, windy Monday morning. Chances are that, like most of the other days she'd worked as a nurse for DaVita Lufkin, she didn't want to go in, but felt she didn't have a choice. They needed the money and she'd already missed a lot of days that month.

She probably had no inkling that by the end of the day she would become the subject of an investigation, or that news stories carrying her name would soon bounce all across the United States.

After dressing in regulation nursing scrubs and putting her hair in its usual ponytail, she would've made her way down the steps of her double-wide trailer (which sat next door to Saenz's parents, Bennie and Kent Fowler). A large sign in front of a huge pine tree at the edge of the road announced the family's affiliation with the Clawson Assembly of God Church.

Deep in the woods of East Texas, the early-morning darkness would be complete—no lights anywhere as Saenz eased her way through a heavy dew that blanketed the driveway. The moisture, combined with the layer of fine red dirt that accumulated on the windshield, meant that her wipers smeared across the glass before eventually clearing enough for her to see.

With her lights on bright, she would be able to see some of the wildlife that flourished in the dense forest that lined the edges of the rough, pothole-laden blacktop. The twisting road mostly held dense trees and underbrush, but was occasionally interrupted with pockets of human habitation—from run-down trailers, to wood and brick houses, and even a scattering of mansions sitting off the road on hilltops.

Because of the darkness and the rough condition of the road, it took Saenz almost fifteen minutes to travel the four miles from her home to Highway 69, the main thoroughfare through Pollok, an unincorporated community in the northwest corner of Angelina County.

After turning right on the highway, she could speed up, passing Central High School on the left and a couple of churches on the right—one of them her own. Her quick trek took her past a Polk Pick-It-Up, a convenience store and meat market. At that hour everything was closed except the convenience store.

Minutes after turning on the highway, she came to the loop around Lufkin. She turned right, traveled through two traffic lights, and arrived at the DaVita Lufkin Dialysis Center. A fellow DaVita employee said she saw Saenz sitting in her car with her eyes closed and her head back for several minutes. She said she was about to go back and check on Saenz, when her coworker's car door finally opened.

The atmosphere Saenz encountered at DaVita on April 28 was extremely tense, as it had been for some time. All throughout April 2008, the clinic had existed in what is called a comorbid state. There were simply too many unexplained patient deaths at DaVita Lufkin and too many patients suffering serious health complications.

From April 1 to April 28, the facility had had to transport thirty-four patients by ambulance to hospital emergency rooms. This number was three times the amount of patients taken to the hospital in March. Even more disturbing to DaVita officials were the nineteen patients who'd died in a five-month span from December 2007 to April 2008.

This was the atmosphere of the clinic that Kimberly Clark Saenz walked into on the twenty-eighth of April 2008. Anxiety was already high, and things began to go wrong immediately. One of the patient care technicians had to call in sick, so Amy Clinton, the head investigator who had taken over the operations of the clinic, called an off-duty RN by the name of Dale Stockwell to come to work.

Clinton never thought calling Stockwell in would cause any problems. But looking back, it may have only highlighted a problem that already existed.

* * *

Amy Clinton was a professional, smart, and vivacious woman in her early thirties, with a classic beauty. Not the beauty queen type of looks, but the kind that proclaims breeding and class—the type that makes men look twice, and then a wistful third time.

Clinton earned her bachelor of science degree at Stephen F. Austin State University in Nacogdoches, Texas (pronounced Nak-uh-DOE-chez), and became a registered nurse. She worked in a busy hospital emergency room for a year before starting to work as a dialysis nurse in 1997.

Owing to her intelligence, hard work, and ability to lead and interact with her coworkers and subordinates, she soon climbed the corporate ladder. People who worked with and under Clinton were quick to point out that she knew how to listen—even to the people under her—and was receptive to implementing advice if it made sense and fit what was best for the patients.

People who talked about Amy Clinton described her as kind and caring. Nursing wasn't an occupation to her, but a calling. She honestly cared about the patients, their suffering, and their problems. Several commented that it wasn't only her aptitude and professionalism, but her compassion that was much of the reason behind her quick ascent in the company.

When Clinton arrived at the DaVita Lufkin Dialysis Clinic, she didn't know that location's employees, their specific problems or issues, but she knew how DaVita was structured and how each clinic was supposed to be run. DaVita basically had three tiers of employees who dealt with patients. The lowest tier was the patient care technicians (PCTs). These employees weren't nurses, but people hired and trained to care for patients as they underwent the dialysis process.

The second tier of employees were the licensed vocational nurses (LVNs) like Kimberly Clark Saenz. Unlike the techs, the LVNs were nurses who went to two years of college to earn their licenses. For the most part, LVNs and PCTs performed the exact same job; despite the extra education, the only practical difference between the two at DaVita was that the LVNs could give shots but the techs couldn't.

The top tier of employees were the RNs—registered nurses. Like Clinton, RNs had attended four years of college and had progressed beyond LVNs. These nurses held supervisory roles, responsible for all the other employees caring for patients. In most circumstances, DaVita Lufkin had three RNs on duty per shift. One acted as the med nurse, responsible for drawing up and administering the meds to the patients, and the other two as charge nurses, one for each of the two bays of patients in the facility.

Except in emergencies or when there was a shortage of people to work on a given day, the RN usually didn't have direct involvement with patient care. This job fell to the techs and the LVNs. Because she was new to the facility and didn't know the staff, Clinton was unaware that this was a huge point of contention with Kimberly Saenz. Saenz constantly voiced her displeasure to other DaVita employees about caring for patients. She thought patient care was beneath her as a nurse. The only job she cared about doing was that of med nurse.

Because of illness, vacation, time off, and other such issues, there wasn't always an RN available to do the med job, and even when there was, the staff sometimes got behind and the LVNs had to act as med nurses and pull their own meds.

On the morning of April 28, when Amy Clinton had to find a replacement for the PCT who'd called in, she didn't think anything about it when Dale Stockwell agreed to come in. However, Stockwell was an RN, so Clinton had to change the schedule around. Stockwell became the med nurse for that day, and the LVN scheduled to do that job was relegated back to patient care. With most that wouldn't have been a problem, but on that day, Kimberly Saenz was scheduled to be the med nurse.

When Clinton informed Saenz that she'd been switched, Saenz got teary-eyed and upset, which surprised Clinton. She didn't understand what the problem was. After all, nurses were supposed to take care of patients. That's why most went into the field, and that's why most stayed with it. After talking to her for a few minutes, Clinton thought Saenz would be okay.

It wasn't until later, when another employee came to Clinton and told her that she needed to talk to Saenz, that Clinton realized that the LVN hadn't gotten over it. Clinton found Saenz not at her station but out back on the loading dock smoking a cigarette and still very upset about the assignment change.

After several minutes, Clinton was finally able to calm Saenz down enough to get her to return to work.

On this day, Saenz had four patients to care for. Like all the other PCTs and LVNs at DaVita, the employees who cared for patients did so in teams of two. While one team member was on break or lunch, the other team member watched the other's four patients, and vice versa.

On April 28, Saenz's team member was a PCT named Angie Rodriguez, who'd arrived at work that morning at 4
A.M.
to get ready for patient arrival at 5:30. After clocking in, Rodriguez began her usual job of preparing everything for the patients' arrivals. This included getting the “bleach buckets” (actually small pails) set up.

Each patient care station had two of these buckets, which were approximately six inches deep, ten inches long, and six inches wide. In one of the buckets Rodriguez poured a 1:100 ratio of bleach to water. She measured the bleach using a small measuring cup. At each patient care station were boxes of one-use cleaning cloths. To clean a surface, the technician or nurse pulled out one of the cloths, dipped it in the bleach bucket, wrung it out, and wiped the patient chairs before and after use—simply a sanitation procedure.

The procedure for the second bucket was the same, except the ratio of bleach to water was 1:10. The PCTs and LVNs used this solution to wipe up blood off the floor or any other surface. After the ten-hour shift was over, they were supposed to throw the solution out and draw a new one up for the next shift. These two buckets were enough to get them through an entire shift.

When both bleach buckets were set up, the tech placed them on top of the dialysis machine to give the PCT or nurse easy access, but at the same time keeping them off the floor. In a sterilized health care facility, nothing involving patient care is ever placed on the floor.

Like every other day, as patients arrived, Angie Rodriguez brought them in and weighed them. It was imperative to do this with each patient because their weight showed how much fluid they'd retained from the previous treatment and told the nurse how much fluid needed to be drained. The last thing the patient did before leaving when the treatments were over was to get weighed again.

Next the patient was led to a sink to thoroughly wash the arm where their access port was. The patients waiting on Rodriguez had surgically implanted arterio/venous grafts inside their nondominant arm.

After the washing, Rodriguez took the patients to the treatment station and began an in-depth but important process. It was critical for the employees who treated patients to keep accurate records of the patients' vital signs and all procedures that took place. Nursing schools hammered it into the students' heads, it was on their licensing test to become a nurse, and each medical facility emphasized it—especially DaVita.

First Rodriguez took the patient's standing blood pressure, followed by the patient's sitting blood pressure. After she recorded her findings on the flow chart, she checked all of the vital signs—pulse, temperature, lungs, heart rate—and recorded those on the chart, too.

Next, Rodriguez placed two large, IV-type needles through the patient's skin and into both ports. Each needle had a tube connected to it; one tube took the patient's blood out and through a filter in the machine that acted as the kidney, and the other tube brought the filtered blood back into the patient's body.

Rodriguez's patients sat on the opposite side of the bay from her teammate that day: Kimberly Clark Saenz. Two of the four patients under Rodriguez's care were Ms. Carolyn Risinger and Ms. Marva Rhone.

Rodriguez hooked Ms. Rhone up at 5:52
A.M.
Records indicate that her blood pressure dropped that morning, but it wasn't anything to be worried about. Rodriguez kept a careful check on all of her patients, including Ms. Rhone, and they were all okay when she told Saenz that she was going on break at about 8:00.

Rodriguez had no way of knowing that during the approximately fifteen minutes that she was away, the unspeakable would occur.

One of Kim Saenz's own patients that morning was Ms. Lurlene Hamilton, a sixty-two-year-old black woman who was a veteran of the dialysis process—by 2008, she had been undergoing dialysis for eight years, the last three at the DaVita Lufkin Dialysis Center. Ms. Hamilton had been born and raised in Chireno, Texas, a small community in Nacogdoches County just north of Angelina County, though in April 2008, she lived in Zavalla, a small community in Angelina County. Before she became ill, Ms. Hamilton had worked at a nursing home and at the Mental Health Mental Retardation Center, taking care of the elderly.

On the morning of April 28, Saenz hooked Ms. Hamilton up to the machine. As she progressed through her treatment, Ms. Hamilton—an especially observant patient, and with medical training besides—saw Saenz across the bay with Rodriguez's patients. This in itself wasn't unusual; the veteran dialysis patient had seen this scenario carried out a thousand times. What drew Ms. Hamilton's attention on this occasion, however, was that Saenz wasn't acting normal. As she later said, “Saenz was just looking around at her coworkers like, ‘Do anyone see me?'”