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A hospital death is often preceded by a "code blue" -- a dramatic resuscitation attempt by an ad hoc team of doctors and nurses summoned over the PA system. The nursing instructor who trained Williams, Mary Wideman, was also a member of a hospital's CPR Committee, which monitored code-blue resuscitation attempts. Shortly after Havrum's death, the doctor in charge of the committee stopped Wideman at a stairwell and asked her to guess where the hospital was having the most code blues. Logically, it would be the intensive-care unit, but the doctor said that wing 4-East, where Williams worked, had the most code blues.
"Once I thought about it, it was a surprise to me," Wideman later said in court. "However, when I reflected back, I did know that I had been getting more CPR flow sheets from 4-East." Those sheets document the actual events of a code blue; Wideman remembered that the increased paperwork from 4-East had started early in 1992, when Williams first began working alone.
On a Friday at the end of July, a nursing supervisor asked Wideman to collect data about code blues in recent months on 4-East. The flow sheets did not always reliably report which nurses were in attendance at each code, but Wideman noticed that Williams attended a disproportionate number of them. At around that time, 4-West nursing manager Kathy Knight told Wideman that Knight's staff had been gossiping about the increase in code blues on 4-East and Williams' possible association with them.
The next weekend, Wideman noticed another strange death among Williams' patients. Agnes Conover had come in for simple surgery to remove a bowel obstruction and was ready to go home. Her family was arriving to pick her up when she died inexplicably. On Monday, Wideman took the woman's case to the CPR committee's lead doctor. He could offer no medical explanation for the death, she later said.
Meanwhile, nurses on 4-East and even 4-West were becoming more and more convinced that Williams' dead patients were homicide victims. His sinister comments disturbed them. One 4-East nurse later said in court that he told her one morning, "I took another three out last night." And a 4-West nurse who was upset after a patient of hers died said Williams asked her, "What are you trying to do, race me?"
At one point in August 1992, a doctor angrily approached Williams and asked him, "Are you killing my patients?" After an investigation, hospital director Paul Kurzejeski wrote to Williams, saying, "I am happy to inform you that the board that investigated the allegation of possible patient abuse involving yourself, found no evidence to support such an allegation."
At the end of August, two more code-blue deaths occurred in one weekend, and hospital chief of staff Dr. Earl Dick called an emergency meeting with the quality-assurance coordinator and several other supervisors. The possibility of transferring Williams away from patient care was discussed. Supervisors instead came up with a plan to always have two registered nurses on the night shift at 4-East. The plan failed when Williams' nursing partner called in sick, and there was another code in late August while he was alone. Supervisors again discussed several possible plans and decided to assign another nurse to work with Williams at all times.
Shortly after this round of meetings, Dick left town for several days, leaving Dr. Edward Adelstein as acting chief of staff. Before leaving, Dick told Adelstein the rumor that a nurse was killing patients on 4-East, but Adelstein tells New Times he'd dismissed that as "hysteria." But in Dick's absence, a group of nurses asked to meet with Adelstein about the deaths.
"They said, essentially, 'We know he's killing people, and you need to take him off the floor, and if you don't do something right away we're going to the police,'" Adelstein recalls. "They were really frantic, and so I said, 'What we need to do is call in someone who can look at the data and determine whether this is a real relationship here.'"
So Adelstein requested that Dr. Gordon Christensen, Truman's statistician and epidemiologist, take a look at the data. Christensen recalls that he believed there "was nothing to this" and that the accusations were false, because a statistician first assumes that the obvious explanation is the correct one and murders in hospitals are rare.
"What I wanted to do then was to take a look at this and see whether this guy was just the unhappy winner of a one-in-a-million lottery, that basically there was a spurious association or that there was a genuine association between him and these deaths," Christensen tells New Times.
Christensen spent three nights poring over data and got almost no sleep. He looked at raw data related to deaths and each nurse, using a code to keep himself ignorant of the nurses' identities and avoid bias. He asked everyone involved not to tell him who the suspect nurse was. Once he'd compiled his preliminary data and cracked the code, there was absolutely no doubt in his mind: One nurse -- Williams -- stood out, he says, "head and shoulders above the rest." Christensen went immediately to the director of the hospital, Kurzejeski.
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