Crime Library: Criminal Minds and Methods

Murder in the Intensive Care Unit

Heparin

The hospital turned over "12 to 16" thick medical records, McKeon said. In the records of all the patients in question the nurses on duty had noted excessive bleeding where surgical wounds had been closed and where the IV catheter had been inserted in their arms. Bleeding in the brain is extremely dangerous since it causes swelling inside the cranium, increasing pressure on the brain which often results in death.

Bottles of the drug Heparin
Bottles of the drug Heparin

Dr. Clarence Mersky, the chief hematologist at Einstein, had tested all suspect blood samples and concluded that all the recovering patients had been given heparin. Heparin is an anticoagulant used to decrease the ability of the blood to clot and prevents harmful clot obstructions from forming in the blood vessels. Heparin is used in open heart surgery, bypass surgery and dialysis among other procedures. McKeon learned that as many as five patients had died as a result of the unprescribed administering of heparin.

Dr. Mersky explained to McKeon that heparin was never given to patients undergoing or recovering from brain surgery because of the bleeding it induced, explaining to the young ADA that it would be like "throwing gasoline on a fire."

Dr. Michael Baden, M.D.
Dr. Michael Baden, M.D.

Dr. Michael Baden, M.D., the now-celebrated pathologist, was Deputy Chief Medical Examiner in 1977. He remembered the Einstein ICU cases being discussed in the office of Chief Medical Examiner Dr. Dominic DiMaio, M.D. (now deceased) with "others." As best as Baden can recall none of the victims were delivered to the Medical Examiner's Office in Manhattan to be autopsied, as required by law when foul play is suspected, because too much time had passed and the bodies had been returned to the families for burial or cremation. One thing of which Dr. Baden was sure was that if unprescribed heparin had been injected into brain surgery patients then "they had bled to death."

There was little doubt to McKeon that he had multiple, linked cases of homicides on his hands. Because of the magnitude of the ongoing investigation and the volume of work that had to be done Merola assigned another ADA, Nicholas Iacovetta, to assist McKeon. Iacovetta was one of the DA's prized assistants who would later become a Bronx County Supreme Court Judge, an office he still held in 2007.

Before the DA's office was called in to investigate, related McKeon, the hospital had already begun to monitor the ICU ward. Other than the usual comings and goings of medical staff charged with care of the patients nothing unusual had been found. McKeon related that as soon as his office got involved the heparin-related deaths stopped. The ADA was aware that word had spread like "wildfire" throughout the hospital that the authorities were investigating the questionable deaths in the ICU. He was relieved that his office at least, by their involvement in the case, had stopped the killings.

McKeon and the five NYPD detectives assigned to him pored over the patient files and tried to determine when the trouble started. Their only clue to a timeline was from the ICU attending nurses' notes indicating that the affected patients were bleeding "excessively from the wound and the IV line." The investigators tried to determine a pattern, trying to link the episodes to a particular doctor or nurse on duty, and to any common feature shared by the affected patients. The patients were black, white, Hispanic, rich and poor. The only fact that stood out was that the unprescribed drugs were only being administered to the patients of neurosurgeon Dr. Stephen Weitz.

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