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"I said, 'This is confirmation of the suspicion that there was murder. You have got to call in the police at this time.' And he said no," Christensen remembers. "And he directed me not speak to anyone else about this. And I reiterated, 'You have got to call in the police at this time,' and he said no. And we went back and forth, back and forth."
Finally Kurzejeski agreed to alert the Department of Veterans Affairs; Christensen agreed that this would be acceptable, figuring it would give him a chance to review his data and make sure he was correct. After taking a second look, he was absolutely sure his conclusion was solid: Williams had an astronomical death rate of 30 percent -- that is, for every three shifts he worked, one patient would die under his care.
"A statistician does not believe in absolutes," says Christensen in a low, serious tone. "For example, there is a calculable number that is the probability that you will disappear right now and end up on Mars and live for 10 minutes. There is a probability that will occur. It is so astonishingly small that you would obviously say, well, that's an impossibility. Well, this is the same thing. There is a probability that this could occur naturally, but the probability is so astonishingly small that it's essentially impossible."
Christensen left the hospital for Labor Day weekend; when he returned, he says, he expected the hospital to be "crawling with police." Instead, all was quiet.
"So then I wrote a letter to Dr. Dick, explaining all this and casting my wording clearly with the word 'murder,'" Christensen says. "I felt that what I was saying was not getting through ... I thought maybe people weren't hearing what I was saying: Murder. Homicide."
When Kurzejeski met with Adelstein, the doctor demanded that the Federal Bureau of Investigation be called in; Adelstein later said Kurzejeski had hinted that VA administrators and staff could lose their jobs if the FBI were called and that the investigation should stay internal. Adelstein vehemently disagreed.
After several internal meetings, the regional VA office appointed an expert panel to come from Ann Arbor, Mich., to review Christensen's data. Then someone leaked information about the deaths to the media, and hospital management quickly issued a "white paper," in which an attempt was made to discredit Christensen's statistics. Christensen now says he naïvely believed this was a move to keep reporters at bay so the hospital could have more time to investigate the deaths. Kurzejeski had given Christensen no opportunity to speak with the author of the paper to defend his statistics. When the expert panel came to Columbia, managers tried to keep them from meeting with Christensen.
But Christensen told Dick that if he was not allowed to meet with the panel, he would go straight to the police, then call the media. Under this threat, Dick managed to get Christensen a meeting with the panel, which, Christensen believed, was there to give a "rubber stamp" to the white paper, denying that murder had occurred.
"I went ahead and I just went through the data," Christensen remembers. "You go through page by page ... and it would get deeper and deeper and deeper. And then you would show them this picture of these deaths ... and there was no earthly explanation for this, and you could just see it on their faces -- you just say, 'Oh my God, this really is true' -- and you could see it on the faces of this group. At the end of this, you could see it had changed; they no longer could give the stamp that everything is OK."
Local reporters began staking out the trailer park where Williams lived with his wife, Melissa, near an industrial section of Ashland, about 15 minutes from Columbia. They tried to talk to Williams about the deaths, but he said very little. "I didn't become a nurse to mercy kill or decide when people would die," he told one reporter, and he gave one television interview in 1992 in which he denied killing patients and said he would "never do anything like that."
The FBI put more than 30 agents on the case. Christensen spoke to agents, who performed a crude replication of his statistical studies and found a disturbing link between Williams and the deaths. Although 42 deaths were examined, investigative results are only available for 26 because of the FBI's evidence rules. Of those 26, the agents and their forensic pathologists, or the VA's own experts, rated 20 as "suspicious" or "highly suspicious" because the patient had not been expected to die or because the symptoms before death did not match the presumed cause of death.
In early 1993, FBI Agent Phil Williams met with the Havrums and asked their permission to exhume Elzie Havrum's body. "Your father did not die of his disease," son David Havrum later testified that Richard Williams told him. Later, David Havrum said, when he told FBI agents the family had retained Kansas City lawyer John Kurtz for a possible civil lawsuit against the U.S. government, the FBI agent said, "You don't need a lawyer," and promised that the FBI would take care of the situation.
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