LUFKIN (AP) - Paramedics were making so many trips to a dialysis clinic in the East Texas city of Lufkin, a top fire department official wrote an anonymous letter to state health department inspectors pleading for somebody to take a look at the place.
"In the last two weeks, we have transported 16 patients," the mid-April 2008 note said. "This seems a little abnormal and disturbing to my med crews. Could these calls be investigated by you?"
State medical surveyors within days showed up at the DaVita Dialysis clinic in the Texas Piney Woods community about 125 miles northeast of Houston. By then, EMS had been called as many as 30 times that month, including seven for cardiac problems, and made at least 19 runs. Four people had died. Over the previous 15 months, there had been two calls, according to the Texas Department of Health Services.
On Monday, Kimberly Saenz, a 38-year-old nurse who worked at the clinic, was set to face trial for one count of capital murder that accuses her of killing as many as five patients and five counts of aggravated assault for injuring five others.
With the inspectors present April 28, 2008, two patients undergoing dialysis said they suddenly didn't feel well and two others reported separately they saw Saenz inject bleach into dialysis tubing used by fellow patients Marva Rhone and Carolyn Risinger.
Saenz, who had worked there for eight months, was sent home, police were summoned and the clinic was shut temporarily amid fears patients were in immediate jeopardy. The next day, Saenz was fired.
A year later, an indictment listed sodium hypochlorite, commonly known as bleach, as her "deadly weapon" that killed the five, including Rhone and Risinger. The disinfectant is a normal cleaning solution used at medical facilities like the dialysis clinic where Saenz worked as a licensed vocational nurse, an entry-level health care position.
If jurors convict the mother of two in the trial expected to last a month, prosecutors have said they'll seek the death penalty. Jurors also could choose life without parole as punishment.
She has pleaded not guilty and has been free on bail.
A motive was unclear.
"She has no motive to kill anyone," one of her lawyers, T. Ryan Deaton, has said.
All parties involved in the case were under a gag order from State District Judge Barry Bryan that blocks them from speaking about it outside the courtroom.
"Kimberly Saenz is a good nurse, a compassionate, a caring individual who assisted her patients and was well liked," Deaton said in a recent court motion.
Saenz herself swore in an affidavit she had no previous felony record.
But Angelina County District Attorney Clyde Herrington, in pretrial court documents, listed about a dozen instances of wrongdoing he planned to present to jurors, including allegations Saenz overused prescription drugs, had substance abuse and drug addiction problems, was fired at least four times from health care jobs, put false information on an employment application and sought a health care job in violation of terms of her bail.
Bryan said last week he understood a plea bargain offer from prosecutors had been withdrawn after Saenz's lawyers rejected it.
Federal investigators examined blood tubing, IV bags and syringes used by the patients who could spend three days a week tethered for hours to a machine that filters their blood -- a job their kidneys can no longer do.
A Food and Drug Administration report found some samples linked to some of the victims tested positive for bleach while others showed bleach "may have been present at one time."
According to policy at the clinic, bleach was used in various concentrations to clean blood from surfaces, chairs used by patients and internal parts of machinery. Then chemical reactive agents were used to confirm bleach residue had been removed and the cleaned areas were safe.
Deaton has insisted his client is being made a scapegoat for mistakes and policy violations at the clinic. State health department investigators found dozens of "adverse occurrences" like incomplete and undated entries on logs required to document the disinfecting procedures.
He also has questioned findings that bleach was the source of the problems.
"Chest pain and cardiac arrest are not specific for bleach infusion," he wrote in a motion.
A review of the clinic's records by an inspector affiliated with the federal Centers for Disease Control and Prevention found Saenz was on duty for 84 percent of the instances where patients suffered chest pain or cardiac arrest. Deaton downplayed the finding, saying one other clinic staffer was there for all of the instances and another for 89 percent.
About three dozen people worked at the dialysis center, which was shut for about two months before reopening.
Joel Sprott, an attorney DaVita Inc., operator of the Lufkin clinic, said the Denver-based company has turned over more than 10,000 pages of records related to the case. Through 2011, DaVita operated or provided services to 1,809 dialysis facilities in the U.S., serving some 142,000 patients and employing more than 41,000 people.
The company said at the time of Saenz's indictment it looked forward to the justice process "that will hold this individual accountable for her heinous acts."
Spokesman Vince Hancock, citing the judge's gag order, would say last week only that DaVita was proud of the care provided daily at its Lufkin clinic and looked forward "to continuing our steadfast commitment to the Lufkin community."
Of the 300 convicted killers on Texas death row, only nine are women. And although Texas is the nation's most active state carrying out capital punishment with 479 executions since 1978, only three women have been put death since the Civil War.
(© Copyright 2012 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)
Also Check Out:
for more features.