Perfect Poison (13 page)

World War Two veteran Angelo Vella had lived in Westfield, Massachusetts, his entire adult life. At sixty-eight, he had been retired from the Marine Corps for decades, yet still kept in touch with the boys down at the local VFW. Vella was a respected volunteer firefighter, but earned his living operating a concession stand in town, serving fried dough, baked potatoes, pasta and antipasto. Whatever Angelo Vella's customers wanted, he was happy to deliver.

Like a lot of veterans his age, Vella suffered from COPD, and had spent many years in and out of area hospitals.

Treating his COPD, Vella had gone to the VAMC numerous times. Gilbert, like a lot of the nurses on Ward C, had gotten close to Vella's family throughout the years because he had spent so much time up on the ward. According to Vella's daughter, Mary Vella, Gilbert was the “friendly nurse with the short blond hair and colorful smocks with different-color cartoon characters . . . on them.”

Mary Vella and her family liked Kristen Gilbert.

On February 4, 1996, at 7:00
A.M.
, Vella was admitted to Ward C. Because he had been complaining of “shortness of breath,” Vella was given a room on Ward C right next to the nurse's station. Based on his condition upon admission, Vella's doctors thought it was the best room for him. He could be monitored more closely.

Originally from Northern Ireland, Mary O'Hanlon was the traditional motherly type of nurse. A short, petite woman, she had a very noticeable Irish accent.

O'Hanlon conducted an “admission assessment”—a routine form filled out when patients are admitted to the ward—of Vella after he was admitted. She recorded all of his vital signs, applied oxygen, and checked his skin for abrasions. Vella had been involved in an auto accident back in 1959 and had multiple scars on his lower legs. “His skin was dry . . . tattoo on right arm. His admission weight: one hundred and ninety-three pounds,” O'Hanlon wrote.

Most of the information had come from Vella himself, who was, O'Hanlon noted, “alert and stable.”

Vella was well educated about his disease. He had been involved in the Chronic Lung Disease Support Group and Pulmonary Rehab program the VAMC offered. The program taught patients to gain control, through education, of their disease. Vella worked hard. He wanted to learn about his condition and help the nurses wherever he could.

But one of his chief medical problems was out of his control. Edema, or the “swelling of soft tissue as a result of excess water retention,” had plagued Vella for years. O'Hanlon, along with his doctors, were keeping a close eye on it, and he was responding well to a treatment of Lasix, a diuretic designed to fight the onset of edema.

By the end of O'Hanlon's shift, it was obvious that the Lasix had worked—because Vella's edema had begun to subside.

For quick IV access, his arm was fitted with a hep-lock. When O'Hanlon checked it before she left, it was “patent”—free from any obstruction—and “showed no redness, no swelling or tenderness,” she wrote.

Gilbert, who had just come on duty as the medicine nurse, took over for O'Hanlon at around four o'clock. Being a Team Leader that day, before O'Hanlon left, she was obliged to tape-record a report of Vella:

“He is in no distress. He seems comfortable and alert . . . good color, and his vital signs are stable.”

At five, Lisa Baronas, who was just down the hall from Vella's room, waiting for the dinner trays to be delivered, looked up and saw Gilbert standing by the entrance to his room.

Adjusting her eyes, Baronas noticed that Gilbert was drawing a syringe, but she couldn't really make out what she was filling the syringe with because it appeared as though Gilbert was trying to hide what she was doing.

After the syringe was full, Gilbert entered Vella's room.

Respiratory therapist Bonnie Bledsoe had just finished giving Vella a treatment, in which, afterward, she checked his heart rate.

It was normal.

With her back to the door, while she was washing the nebulizer she had just used on Vella in the sink, Bledsoe heard Gilbert walk in. She then looked over her shoulder, noticed the syringe in Gilbert's hand, spied the med cart outside the door and, without worry, continued with what she was doing.

John Wall was the charge nurse, with Baronas, Jeff Begley, Liz Corey and Frank Bertrand working the floor. Although she was assigned to the ICU, Gilbert was responsible for administering meds to several patients. Angelo Vella, however, wasn't one of them—and hadn't been scheduled to receive any type of injectable medication, anyway.

Seconds later, as Frank Bertrand stood by the nurse's station, he heard Vella's heart monitor alarm go off. Bledsoe, still standing by the sink in Vella's room, turned when she heard a scream.

“Ow, it hurts . . . it burns!” Vella yelled.

The ward was busy at this time of the night. Shifts were overlapping.

When Bertrand heard Vella scream, he raced into his room, while the other nurses in the vicinity looked on. Bledsoe rushed to Vella's bedside, while Gilbert, frozen in her tracks for the moment, just stood there in some sort of daze.

Bertrand, a twelve-year employee of the VAMC, was related to Gilbert by marriage. Bertrand had married Glenn Gilbert's cousin.

Entering Vella's room, Bertrand saw Gilbert at his bedside, standing by his left arm. She had a syringe in her hand.

Just then, Vella's heart rate began to race uncontrollably—as much as 300 beats per minute.

Vella, however, remained conscious.

“Mr. Vella?” Bertrand asked.
“Mr. Vella?”

“She did it!” Vella lashed out, pointing at Gilbert. “It started when she flushed my line . . .”

A moment later there was a flatline . . . and soon . . . Vella's pulse stopped.

Bertrand then called a code because Vella was now in full cardiac arrest.

The small crowd that had congregated over by the nurse's station swarmed into his room.

Bertrand immediately began resuscitation efforts as one of the nurses, in what had become a routine lately, called in the chaplain to administer last rites.

Meanwhile, Melodie Turner and Lisa Baronas, who were back at the nurse's station, began watching Vella's cardiac episode as it was being recorded on the telemetry monitor at the nurse's station. Although it was a Sunday, and Turner wasn't supposed to be there, she had attended an annual ceremony in the VAMC's chapel earlier and decided to make a pit stop by the ward before she went home.

“Grab all of that tape,” Turner ordered Baronas. “Grab every single bit of the rhythm strips off that monitor. I want them saved.”

John Wall had run down to Vella's room from the ICU when he heard the alarm. When he entered, he saw Bertrand at Vella's bedside, trying to get him to respond. Gilbert was leaving as Wall walked in.

When Vella regained consciousness, he was frantic. Although he had just had a massive cardiac event, the first thing he did when he came out of his comatose state was look at the doctor in the room and shout, “When she put that in my arm, it burned and my chest was heavy.”

The doctor was speechless. No one could believe that here he was, only moments after being resuscitated, talking about what had just happened.

“The burning sensation happened,” Vella kept insisting, nearly out of breath, “after she injected it into my arm.”

Although he was still in the ICU and being monitored continuously, by 5:30, Angelo Vella was out of immediate danger. Frank Bertrand's quick thinking and years of experience had saved Vella's life.

When Vella began to talk about what had taken place shortly before his code, it would shed an entire new light on what Kristen Gilbert had been doing up on Ward C.

Mary Vella was at a friend's house when her mother phoned with the horrible news.

“Your father has just been given his last rites,” the former Mrs. Vella said. “Go down to the [VAMC] right away.”

When Mary walked into the ICU, the first thing she saw was her weak-looking father, lying serenely in his bed. He looked colorless and gaunt, machines buzzing around him, tubes coming out of his body. On the face of it, though, Mary knew her father well enough to know that he wouldn't give into death without a fight.

It wasn't just the heart attack,
Mary thought as she stared at him.
Something else was wrong.

Vella's wife, stepdaughter and stepson were there, too.

“It happened when she put something in my arm,” Vella whispered to everyone as they gathered around him.

“What, Daddy?” Mary asked, leaning over.

“Angelo, get some rest,” his wife said, gently wiping sweat off his brow.

“Are you all right?” Mary asked. “What happened?”

“It began as numbness,” Vella continued in a raspy tone, “in my legs and arms. Then my heart felt like it was about to explode.”

Mary thought how vulnerable he looked just lying there trying to explain what had happened. Her dad, she thought, had always carried a lot of inner strength. “He was very tough,” she later recalled. “He just seemed so scared . . . frightened.”

Mary's stepsister, Joann Sell, then leaned in to tell him to be quiet and get some rest. Being a nurse, Sell was surprised he was so alert.

“How are you?” she asked.

“I'm okay. . . .”

“What happened?”

“I'm not quite sure,” Vella began to say. He took breaks while speaking. It seemed as if it took everything he had just to get the words out. “The nurse came in, and she was putting something . . . she was flushing my IV and”—he stopped for a moment to swallow—“I felt flushed and had some chest pain. Then there was a lot of activity going on around. Frank was saying something about pulling the IV out. I can't remember anything else until I woke up.” He stopped for a moment to catch his breath. Then, “But Frank . . . Frank saved my life.”

Vella was clear about those crucial moments before his cardiac episode. He had spent enough time in hospitals throughout his life to know procedure. He had no doubt that when Gilbert flushed his IV, with what he presumed was nothing more than a harmless saline solution, something went wrong.

Just then, Frank Bertrand and Gilbert entered the room. Bertrand walked over to the family to offer his support.

“Glad to see you're doing better, Mr. Vella.”

Gilbert walked toward a table near the back of the room and shuffled some papers around, trying to look busy.

“Thank you for saving my father's life,” Mary Vella said, in tears.

“It's okay,” Bertrand said.

Gilbert was paying no attention to what was going on. But Mary wanted to thank her for what she presumed at the time was a noble effort on her part. So she walked over and extended her hand.

“Thank you,” she said in her sweet and calm voice.

Gilbert wouldn't look into her eyes, much less shake her hand. She seemed cold and distant. This struck Mary as odd, because Gilbert had always been so friendly and cordial in the past.

When Kathy Rix returned to work on February 6, one of the first things she did was check the ICU medicine cabinet to see if any of the eighteen ampoules of epinephrine she had counted before her vacation were missing.

On December 6, 1995, a box of twenty-five ampoules had been delivered to Ward C. About six weeks later, another box of twenty-five had been delivered because the first box was gone. Since August 1995, one hundred and thirty-five ampoules had been dispensed to Ward C.

But again, no one questioned where they had been going.

Epinephrine was one of one hundred and ten medications delivered under Automatic Ward Stock procedures to Ward C. Having such a large amount of the drug available on the ward was merely a precautionary measure—so that when the hospital pharmacy was closed, the ward could have access to whatever it needed, whenever it needed it. After the ampoules arrived on the ward, nurses and doctors were allowed to use them at their own discretion. According to a later audit by the office of Inspector General, Criminal Investigations Division of Veteran's Affairs, there was “no accountability.”

Kathy Rix knew what she was going to find before she opened the doors to the medicine cabinet. Her gut had told her for the past two weeks that something was amiss with Kristen Gilbert, as far as the increasing amount of codes and the drug epinephrine were concerned. Although several patients had survived sudden cardiac events during her absence, several more had died. To Rix, there were just too many coincidences adding up for her not to continue looking for an answer.

She still wanted some sort of proof, nonetheless. Rix's husband was a cop. She understood procedure and policy, and lived by it.

Epinephrine was rarely—if ever—used on Ward C. The majority of the patients who required a dose of epinephrine came in through the triage room, or ER. The epinephrine used during medical emergencies came in a different form, a bristo-jet. The smaller ampoules that Rix had been keeping track of were for injection by syringe only.

When Kathy Rix opened the medicine cabinet, she saw just three ampoules of 1:1000 strength epinephrine, which meant that in just two weeks' time, fifteen ampoules of the drug had been used.

“Fifteen,” Rix gasped.
Oh. My. God.