According to the CDC’s study of the pediatric intensive care unit, Bexar County Hospital, which was later renamed Medical Center Hospital, was a 600-bed teaching hospital at the time of the investigation. There were eight beds in the pediatric ICU. The hospital also was affiliated with the local medical school.
In 1983, the New York Times reported that there were three internal reviews conducted within the hospital regarding the unexplained deaths of patients.
The first review was done by the former head of pediatrics, and it determined that there was an increase in deaths in the pediatric ICU, but at the same time, there was ''about a hundred percent increase in patient census.''
In The Death Shift, Elkind details how a visiting doctor from Canada, Dr. Alan Conn, began the second internal review by investigating specific cases within the ICU. This review happened during Genene Jones’ final months in her position.
The following is an excerpt from the New York Times' archive report on the internal reviews. It was titled: “Questions on infant deaths beset San Antonio hospital:"
"The report recommended a more intensive review of individual cases and resulted in a third inquiry that lasted from April into February of this year. Dr. John C. Mangos, chairman of the pediatrics department at the University of Texas Medical School, became head of the inquiry midway through it. On Feb. 3, the results of that study were seized under a grand jury subpoena, and the results of the rest of the inquiry, three more weeks, were turned over to the grand jury in March.
Although the results of the reviews are protected by the grand jury's mandate of secrecy, the recommendations of the Conn review were made public at the time. One of these was that the nursing staff in the pediatric intensive care unit be upgraded wholesale, and that all the licensed vocational nurses there be replaced by registered nurses.
In her deposition, Ms. [Jones] said she was given ''a great recommendation'' when she left the hospital in March of 1982. Dr. Holland finished her residency three months later and opened her office in Kerrville on Aug. 28, 1982."
Ted Dracos, the KENS-TV reporter who had broken the story about the suspicious deaths of babies, also covered this clandestine investigation.
The day after the story was first reported on Eyewitness News in February 1983, Dracos went on the air and offered a new revelation: Hospital officials had brought in an outside expert to address their grave concerns.
The following is the script from his report:
“According to reliable sources in the medical community, the investigations center on this unit: The pediatric intensive care unit of the Bexar County Hospital District. It is believed that the suspicious deaths of infants occurred here during portions of 1981 and 1982.
By January of last year, an intensive effort was being made by the hospital district to isolate causes for the suspicious deaths. In fact, an expert on infant mortality was called in from Toronto, Canada.
Presently, all requests for substantive information are being considered by the hospital district.
Eyewitness News has asked for specific information regarding the use of certain drugs on children in the ICU during portions of 1981 and 1982.
Those requests have been referred by the hospital district to their attorneys. In another major development, the Bexar County District Attorney's Office has informed the hospital district that it will not offer further legal advice because of a possible conflict of interest if any criminal action were to be taken.”
After Conn’s review was completed, the recommendation was to replace all licensed vocational nurses, or LVNs, in the ICU.
Cheri Pendergraft, the nurse who gave Genene Jones her orientation to the ICU, explained how that decision effectively removed Jones from her position.
“They came up with a plan to get rid of all the licensed vocational nurses from the unit and just make it an all registered nurse unit, making it look like this is an all RN change that we’re doing," Pendergraft said.
In Kerrville, Genene Jones was under suspicion in Chelsea McClellan’s death. Former Kerr County District Attorney Ron Sutton was building his case for the grand jury. Sutton said he was also familiar with the issues in San Antonio.
“Dr. De Maio was the head medical examiner in San Antonio. None of these cases were ever referred to him as a medical examiner to determine the cause of death.
I think the hospital suspected that something was going on because the hospital sent somebody [from] Toronto, Canada, to say, ‘We’ve got a problem down here.’ They went over it with this doctor [from] Toronto, Canada, and his recommendation was for the nurses in the pediatric section. Change them from LVNs to RNs. Well, by doing that, they got rid of Genene Jones. Isn’t that interesting?” Sutton said.
With the decision to “upgrade the ICU” to only employ RNs and not LVNs, Genene Jones was out of a job there. She resigned from Bexar County Hospital in 1982.
“They never called the authorities at that point. In fact, they never called the authorities period. They instead sent her off with a good recommendation. Even when they discovered that she was harming kids in Kerrville, and they got word about it in San Antonio, they discussed what they should do about it at that point," Elkind said of the hospital review committee.
“She could present to any potential employer a letter that was on Bexar County Hospital District stationery from her former supervisor, which didn't warn people about her, but offered a warm endorsement. She got exactly the same recommendation that the other LVNs received," he said.
Elkind read the recommendation letter Jones received, which he obtained during his reporting in the early 1980s.
It reads, in part:
"Genene Jones LVN has been employed in the Pedi ICU since 1978. This move in no way reflects on her performance in the unit. She has gained valuable knowledge and experience in pediatric intensive care nursing. During the time of employment, this employee has been loyal, dependable and trustworthy. Genene Jones LVN has been an asset to the Bexar County Hospital District, and I would recommend continued employment."
"Just remarkable. A remarkable thing," Elkind said.
As the criminal investigation against Genene Jones was underway, Elkind also gained access to meeting minutes from the hospital’s review committee.
"I obtained it from sources with whom I was in contact in the process of doing my story for Texas Monthly first and then doing my book. It's one of many documents that I got that detail exactly what happened inside the hospital and did a lot to supplement the memory of the doctors, nurses and staff that I spoke to as well. These were absolutely secret internal documents," Elkind said.