Nurses fired after Augustine death
June 20, 2007
RENO (AP) — Twenty-two employees were fired and one employee committed suicide after an internal investigation at the hospital where Nevada Controller Kathy Augustine died, court testimony revealed Wednesday.
Marline Swanbeck, an emergency room nurse, confirmed the firings while under cross examination by an attorney for Augustine’s husband, Chaz Higgs, a critical care nurse on trial for killing Augustine with a paralytic drug.
During the second day of testimony, jurors also heard from emergency medical personnel who treated Augustine and they heard conflicting accounts about the condition of her heart.
Swanbeck worked with Higgs at a satellite facility of Washoe Medical Center, the hospital where Augustine lingered in a coma for three days before dying July 11. It has since been renamed to Renown Regional Medical Center.
Swanbeck confirmed the previously undisclosed firings while being questioned by Alan Baum, one of Higgs’ defense lawyers, and said the “terminations” were for a “breach of confidentiality.”
One person, a social worker, committed suicide, she said.
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Prosecutors did not follow up on the issue in front of the jury.
Outside of court, co-defense counsel David Houston said the 22 employees were fired “based on a number of improprieties.”
But he said neither employees nor officials at the hospital now known as Renown Regional Medical Center have talked to attorneys about the firings.
“Current employees won’t talk about it, won’t deal with it,” Houston said.
Prosecutors dismissed the admission as irrelevant.
“It has nothing to do with the damn case,” Chief Deputy District Attorney Tom Barb told The Associated Press during a break in court.
Deputy District Attorney Christopher Hicks said the firings were for violations of federal confidentially regulations “regarding the case after the fact.”
“Some of the nurses looked into her files,” Hicks said of Augustine’s medical records. “It’s irrelevant to what’s going on in here,” in the courtroom.
“It was a firing over Kathy Augustine because of what they had alleged to be circulation of her files or (privacy) violations concerning her condition — too much discussion as to what was occurring,” he told AP. He said one hospital employee told him “it was a mass firing to cover up the firing of one, and I don’t know what that means.”
Higgs, 42, is accused of killing Augustine with a lethal dose of succinylcholine, a powerful muscle relaxant used to immobilize a person when inserting a breathing tube. If convicted, he faces up to life in prison without chance of parole.
Doctors initially thought Augustine, 50, suffered a massive heart attack, though an autopsy showed no signs of heart disease. After another co-worker tipped police to alleged incriminating statements made by Higgs, samples of Augustine’s blood and urine were sent to the FBI lab in Virginia, where toxicologists confirmed the presence of succinylcholine.
Swanbeck said the drug was readily accessible to staff, though procedures have since been tightened.
The day after Augustine was hospitalized, Swanbeck said Higgs called her at work and asked if she’d meet him in the parking lot and bring his paycheck.
He thanked her for taking care of his wife and gave her a box of doughnuts.
“To need your paycheck when your wife is ill and to bring us doughnuts — the timing didn’t feel right to me,” she said, adding that she and other nurses had suspicions of Augustine’s sudden illness.
Earlier, Benjamin Pratt, a paramedic who went to the couple’s home July 8, testified that Higgs was waiting for them on the sidewalk when the ambulance arrived.
Higgs said he found his wife unresponsive in bed, and attempted cardiopulmonary resuscitation.
Pratt said Augustine was not breathing and had no pulse when they arrived.
He said they moved her to the floor and immediately began CPR and administered drugs to try to restart her heart.
Pratt and others said it’s common knowledge among medical professionals that CPR must be performed on a hard surface, such as a floor, to ensure adequate compression on the chest to keep blood pumping through the heart.
Pratt said Higgs stayed out of the bedroom, and was not agitated or excited — a point the prosecution pressed with multiple witnesses on Tuesday who said they would have expected Higgs to be more emotional.
As Augustine was being transported from a suburban branch of the medical center to the main hospital later that morning, Higgs sat in the passenger seat of the ambulance “pretty quiet and kept to himself,” without asking about his wife’s condition, said Manny Fuentes, the paramedic driving the ambulance.
“He grabbed the newspaper (off the dash) and started flipping through pages,” Fuentes testified.
Dr. Stanley Thompson, a cardiologist who treated Augustine before she died, testified that her arteries were clear and her blood was running smoothly through her heart.
“You can say they were 100 percent normal. Everybody in this room would love to have those arteries,” he said.
Pressed by Higgs’ lawyer, the doctor said he could not rule out that she died from another type of heart problem.
And Thompson also noted that when he told Higgs at one point that his wife’s “outlook was not good considering her condition” that Thompson was “a little surprised in he was unemotional compared to what I would guess.”
Houston noted as he had the day before that Higgs was a critical care nurse trained to remain unemotional and had served 15 years as a medic in the military.
But Thompson said he himself had served as a Navy doctor and “in that situation, I would be very emotional.”
In other testimony, defense lawyers said a cardiologist diagnosed Augustine with a heart condition in 1995 in which a heart valve doesn’t always operate properly.
Thompson said he was not aware of that but “that would not surprise me.”
Dr. Paul Katz, a neurologist who attended to Augustine at the hospital, said his findings in regard to the condition of her brain were consistent with either being administered succinylcholine or sudden cardiac death.
And in testimony that varied depending who was asking the questions, Dr. Steve Mashour, a physician specializing in pulmonary and critical care, said that if the drug was injected in fatty tissue of the buttocks rather than intravenously “that would be unlikely to be the cause of death in my opinion.”
But he said later that he didn’t know succinylcholine was found in her urine and if that was the case, “it would change my opinion.”
Testimony was to resume at 9 a.m. Thursday in a trial expected to last through next week.
— Associated Press writer Scott Sonner contributed to this report.