Hospital workers were fired

RENO -- Twenty Washoe Medical Center nurses and two other employees were fired after a police investigation into the death last July of former state Controller Kathy Augustine, a nurse and lawyers said Wednesday.

One employee, a social worker, committed suicide after she was fired, registered nurse Marlene Swanbeck testified before District Judge Steven Kosach during the murder trial of Augustine's husband, Chaz Higgs.

Higgs, a 43-year-old critical care nurse who worked at the hospital with Swanbeck, has been charged with killing his 50-year-old wife by injecting her with succinylcholine, a muscle relaxant used in hospital emergency rooms.

Prosecutors contend Higgs as a nurse at Washoe Medical's South Meadows branch and also at Carson-Tahoe Hospital in Carson City would have access to succinylcholine.

Defense attorneys maintain Augustine died of a sudden heart attack, caused by stress of her job and the fact she suffered from mitral valve prolapse, a condition in which heart valves do not close properly and blood can leak from the heart.

Swanbeck was called to the stand to testify about a lack of security measures in place for removing drugs from a hospital refrigerator.

She testified nurses could use the last four digits of their Social Security numbers and a code to remove something as simple as a tetanus shot out of a refrigerator, yet access plastic kits with succinylcholine.

Swanbeck told jurors she was not one of those who were fired, and Alan Baum, one of Higgs' defense lawyers, did not ask her to explain why the firings occurred.

In an interview during a break, Deputy Washoe County District Attorney Thomas Barb said the employees were fired for violating the federal Health Insurance Portability and Accountability Act.

Under the law, hospital workers may not release information about a patient or even acknowledge a patient is in their hospital without the patient's permission.

Barb said hospital workers looked at the health records of Augustine, who was admitted under the name "Sarah Lambert."

"It has nothing to do with the damn case," Barb said of the firings. "I don't think they (nurses) gave out anything."

But neither Barb nor co-counsel Christopher Hicks objected when Baum elicited testimony from Swanbeck about the firings.

In an interview, David Houston, Higgs' other lawyer, said he did not know why the employees were fired, but the social worker jumped off a parking garage after she was fired.

"You don't fire 20 experienced nurses for a HIPAA violation," he said. "It was definitely related to the death of Kathy Augustine."

A hospital official declined to comment on the firings.

"Due to employee confidentiality, we cannot go into detail on specific human resource issues," said Don Butterfield, communications director for the hospital. "We can confirm that no disciplinary actions were taken concerning unauthorized access to medications. However, disciplinary actions were taken for failure to comply with company policies designed to ensure compliance with federal patient privacy laws."

The revelation about the firings was the highlight of a day of testimony that dealt mainly with medical issues.

Reno cardiologist Dr. Stanley Thompson, who performed tests on Augustine in the hospital July 8, testified Wednesday that in 30 years of medical work, he never has seen a patient die from the mitral valve condition. He added that 10 percent of women suffer from the condition.

Questioned by defense attorneys, Thompson acknowledged he could not rule out the possibility that Augustine died from a sudden, unexplained heart attack.

"Twenty five percent of (people with) heart attacks have no symptoms," Thompson said.

Thompson showed jurors a film of the angiogram he performed on Augustine on the day she was taken by ambulance to the hospital. Thompson testified his angiogram showed Augustine's two coronary arteries were normal.

"Everyone in this room would love to have these arteries," he said. "The arteries are perfectly normal, not what I would expect from a heart attack."

But when questioned by Baum, Thompson said the possibility existed she could have suffered a heart attack and the arteries still would have appeared normal.

Baum said a sudden cardiac death might begin with mitral valve regurgitation of blood.

"In 30 years I've never seen it," Thompson responded..

"Have you ever seen anyone hit by lightning?" Baum asked.

"Yes, two friends of mine," replied Thompson, prompting laughter from jurors.

Swanbeck said she worked more than two years with Higgs at the South Meadows hospital and respected him as a medical professional.

But she testified she was not comfortable discussing personal matters around him. She said he never had anything nice to say about Augustine and often called her "a bitch."

She said that Higgs showed little emotion when he arrived at the hospital July 8 and that nurses were concerned about his behavior.

"We were suspicious," she said.

Review-Journal writer Annette Wells contributed to this report.