CANADA

The bough breaks, the cradle falls

JOANN WEBB April 6 1981
CANADA

The bough breaks, the cradle falls

JOANN WEBB April 6 1981

The bough breaks, the cradle falls

Toronto

When Jacqueline Cook last saw her baby alive, he was cradled in the arms of a nurse at Toronto’s Hospital for Sick Children. “She was sitting in a chair with Justin in her arms, just like she was his mother. We felt he couldn’t have been safer.” Twelve hours later, the call came: Justin, 3V2 months old, had died—presumably of the heart defect that sent him to “Sick Kids” in the first place. But there was to be more, and it was to be worse. The baby did not die of his heart condition, but from a lethal dose of an unprescribed drug and, last Wednesday, one of the hospital’s nurses, 24-year-old Susan Nelles, was charged with firstdegree murder.

Incredibly, the horror didn’t end there. Two days later, Nelles was

charged with the murder of three other infants; like Justin, they had been killed by overdoses of digoxin, a form of digitalis prescribed for some heart patients (but not for these babies). And, in an ever-widening investigation, police are reviewing all other unexpected deaths over the past 18 months in the cardiac unit where the four infants died. In all, up to 40 deaths could be involved—and exhumations may be necessary.

Intensifying the series of shock waves was the fact that the deaths occurred at Sick Kids, an institution that has inspired the confidence of parents throughout Canada and the world for more than a century.* In the case of Justin Cook, for example, there was no question that the hospital’s cardiac unit was the best possible place for him. After his heart problem was discovered March 20, at an Owen Sound, Ont., hospital close to his parents’ home, he was referred immediately to Sick Kids. Without hesitation, Jacqueline Cook, 19, and her husband, beef farmer Brad-

ley Cook, 20, set out with Justin on the five-hour drive to Toronto. But the baby died early Sunday before any tests could be conducted.

While Justin’s death led to the first murder charge, it is possible that the true circumstances might never have come to light had it not been for two suspicious deaths in the same ward; one on March 12 and one just a day before Justin’s. Normally, the hospital’s autopsy procedure does not include toxico-

*The Hospital for Sick Children treats more than 200,000 patients a year. Of those, 25,000 are admitted and WO die—roughly 10 per cent of them in the high-risk cardiac unit.

logy tests to determine the presence of drugs or poisons. But Toronto coroner Dr. Paul Tepperman, already called in to investigate the March 12 death of 27day-old Kevin Pacsai Garnett, who died after being referred to the hospital for tests, recommended that Justin undergo more thorough examination. Similar tests established that the two other victims—11-month-old Allana Miller of Kitchener, Ont., and 16-weekold Janice Estrella of Toronto — also died of digoxin overdoses.

The accused, Susan Nelles, had been part of the highly qualified cardiac team for about a year and, from all accounts, her performance was as impeccable as her personal and professional credentials. After police laid the first murder charge against her, thirdyear medical student Helen De Vos, who had shared a house with the nurse, was incredulous. “Oh my God, I don’t believe it,” said De Vos. “She was very much a stable person.” Neighbors in the eastern Ontario town of Belleville, where Nelles grew up, confirmed that observation. She lived in the better part of town, as befitted the daughter of one of the town’s most respected citizens. Her father, James, a doctor who did his residency at Sick Kids (where her brother, David, is currently doing his residency), is chief of pediatrics at Belleville General Hospital. Like her father, mother and brother, Nelles attended Queen’s University in Kingston, Ont. After graduating in 1978, she spent a year at a Vancouver hospital before joining the Toronto hospital 18 months ago.

Understandably, the Nelles family is as shocked by the week’s events as are the parents of the victims. But, said David Cole, one of Nelles’s two lawyers, “Her family is standing by her completely. Despite the potential loss of

reputation on the part of both the father and the brother, their first thought is for her. They’ll stand by her throughout what will be an ordeal.” In her brief court appearances so far, the tiny, attractive brunette has been tightly guarded. Ashen and dazed, she has spoken publicly only to identify herself. “She’s shocked; she cries; she’s totally bewildered by what’s happening to her,” said Cole. He also declared that Nelles will plead not guilty to all charges when arraigned in court this week. She is being held under maximum security, isolated from other prisoners, in a Toronto detention centre.

Along with all the other victims, those already identified and those who may be in the days ahead, there is the Hospital for Sick Children itself. The bond of trust between Sick Kids and the people it serves has been severely strained—borne out by the hemorrhage of calls from frightened parents last week—and a once-shimmering reputation has been tarnished, if only for the moment. That one of the world’s great children’s medical centres should be placed in such a position is unthinkable. But the unthinkable has already happened. —JOANN WEBB

JOANN WEBB