D E A T H O N W A R D C
She liked to play the star
second of two parts
By Thomas Farragher, Globe Staff, 10/09/00
NORTHAMPTON - When Julia Hudson's telephone rang late on that raw December night in 1995, she wildly misunderstood her caller's mortal message.
During her trial, which opens a week from today with jury selection in Springfield, prosecutors will argue that Gilbert murdered for thrills and attention.
She killed, they say, because she enjoyed the excitement generated by the cardiac emergencies, or "codes" as they are known in hospital parlance. She loved the spotlight they drew to her, she appeared energized by them.
Above all, the government contends, Gilbert killed because the emergencies allowed her to perform in a starring role in front of her new lover, VA Police OfficerJames G. Perrault, with whom she was having an extramarital affair.
Perrault, who helped Gilbert move out of the house she shared with her husband and two young sons a week before Hudon's death, was at her side during every cardiac emergency Gilbert reported in late 1995 and early 1996, prosecutors say.
The attraction between the nurse, then 28, and the police officer, then 25, was unmistakable -- on duty and off.
As her patients fought for their lives, authorities charge, Gilbert would glance at Perrault, smiling at him flirtatiously.
"One witness will testify that he observed Gilbert playing `footsie' with Perrault during the middle of a code," said Assistant US Attorneys William M. Welch II and Ariane D. Vuono in court papers. "Another witness will testify that Gilbert touched Perrault affectionately during the middle of a code."
Hospital regulations called for Perrault to perform cardiopulmonary resuscitation upon a doctor's request during codes. Gilbert would wipe Perrault's brow as he perspired under the rigors of CPR, prosecutors say.
Co-workers noticed Gilbert slipping away during her shift to spend time with Perrault. She hurried through her duties to meet him as soon as her shift let out at midnight, prosecutors say.
As fall turned to winter and 1995 faded into 1996, the nursing staff on Ward C -- for whom Gilbert helped arrange holiday swaps and with whom she socialized after work -- launched an unofficial alert.
Why, they wondered, were so many patients suddenly dying? And why was Gilbert nearby so frequently when they did?
They began to secretly monitor the moves of their nursing colleague, hoping their frightening suspicions were baseless.pinephrine is the synthetic chemical twin of adrenaline, the bodily substance that produces the so-called flight-or-fight instinct. It's the rush triggered by extreme, unexpected circumstances: a sudden sidewalk fistfight, for example, or a frightening near-miss traffic accident.
For patients suffering a cardiac arrest, epinephrine can be a life saver. Injected into a person with a healthy heart, however, it can cause anxiety, nervousness, a hike in blood pressure, and skyrocketing heart rates.
"It changes the normal beat to one of a very, very fast rate and then eventually it's so fast that the heart behaves like a bag of worms. And it just wiggles," Dr. Fredric Rieders, a toxicologist who will testify for the prosecution, said at a pretrial hearing. Rieders is perhaps best remembered for his examination of the bloodstains on O.J. Simpson's socks during that 1995 murder trial in Los Angeles.
It is this colorless, odorless drug that authorities say was Kristen Gilbert's murder weapon, a liquid easily available to her as she made her rounds on the second floor of Building One. It breaks down quickly and is difficult to trace.
The VA hospital stocked two different strengths of the drug. One was packaged in a large, prefilled syringe and was designed to revive heart attack victims. The other -- 10 times more concentrated -- was packaged in a small, glass ampule. It was used chiefly to fight anaphylactic shock touched off by an allergic reaction or a bee sting.
During the six-month period when prosecutors say Gilbert was killing or trying to kill sick veterans in their beds, medical records show there was no authorized use of the stronger dose of epinephrine on Ward C.
Yet nurses on Gilbert's shift are expected to testify at her trial that they twice saw used ampules of the medication in the intensive ward unit's needle disposal box after Gilbert's patients suffered cardiac distress.
"When one of the nurses suspected foul play and suspected that perhaps these patients had been given some sort of drug that would precipitate a cardiac arrest, this individual began to count the number of viles stored at the VA," said prosecutor Vuono, at a pretrial hearing. "And she noticed the dwindling amount of these viles."
In all, hospital records cannot account for about 88 of the 135 ampules of epinephrine dispensed to Ward C between Aug. 20, 1995, and Feb. 17, 1996, the period when Gilbert allegedly struck.
That unexplained depletion of the ward's medicine supply helps account for Francis Marier's cardiac arrest on Dec. 20, 1995, officials believe. Gilbert, who prosecutors say grew agitated after her request to leave early that night was denied, is charged with trying to murder Marier, a 72-year-old veteran who stormed the beaches of Normandy during the historic turning point of World War II.
Just a month later, on Jan. 22, 1996, they say Gilbert poisoned Thomas Callahan with epinephrine. Callahan, admitted with pneumonia and pulmonary disease, lapsed into a potentially deadly cardiac arrhythmia. He was eventually stabilized and survived.
Gilbert would later tell investigators that Callahan, an Army veteran, complained of pain after she flushed his existing intravenous line. But, prosecutors said, one of Gilbert's fellow nurses, who covered for her in the ICU while she took a break, told authorities that she checked the needle disposal bucket after Gilbert had walked away that night.
Inside, she told authorities, were three broken ampules of epinephrine. That's evidence of attempted murder, prosecutors say.
But Gilbert and her lawyers argue that the hospital's recordkeeping -- since revised and strengthened -- was so poor that they don't know for sure how much epinephrine was used on the ward. Perhaps the medicine was disappearing because it was being tossed out after its expiration dates came due, they suggest.
"I think the most anybody can say is that there is an amount of epinephrine that they can't account for," David P. Hoose, one of Gilbert's court-appointed lawyers, said in an interview. "That doesn't mean that [Gilbert] took it, or that she was using it. I don't think they have any meaningful evidence of that."
Yet there is at least one eyewitness account of Gilbert in possession of the drug she allegedly used to kill. In that episode, prosecutors see compelling circumstantial evidence. Gilbert's lawyers dismiss it as an example of dark and harmless workplace humor.
On Jan. 28, 1996, Gilbert was alone with patient Michele Cascone, who later had four cardiac emergencies and died. Gilbert is not charged in his death and there is no evidence that he died of epinephrine poisoning.
Each time Cascone went into cardiac distress, Bonnie Bledsoe, a respiratory therapist friendly with Gilbert, had to respond from a different ward, running a considerable distance. Bledsoe is an asthmatic. After the third "code," prosecutors say Bledsoe jokingly told Gilbert she hoped there would be no more long-distance dashes down hospital corridors.
"If I have to keep running over here, I'm going to start wheezing in a minute, Krissey," Bledsoe said.
At that point, prosecutors say, Gilbert reached into her pocket and pulled out a vial that looked like an ampule of epinephrine, identical to the ones they say she used to kill.
Gilbert flashed the ampule at Bledsoe, the government said, and then asked her:
"Want some epi?"s Valentine's Day 1996 approached, the love affair between Kristen Gilbert and James Perrault was in full flower. And the alleged killings on Ward C reached a crescendo.
"You are the love of my life," Gilbert wrote to Perrault that February in one of several letters between the two that have been read into the court record. "I love you so much, Jim. Let's hope this will be only the first of many happy days together. Love, Kristen."
Another love note from Gilbert read: "Never has love touched my heart so gently, moved my soul so powerfully."
Perrault returned her tender affections. He, too, was in love.
They were living near each other in neighboring Easthampton. The VA police officer worked the 3-to-11 shift five days a week, arriving and leaving an hour earlier than Gilbert. She worked 32 hours a week, 4 to midnight.
Sometimes Gilbert would leave early to spend more time with Perrault, colleagues reported. She frequently brought a change of clothes to work. It speeded up her rendezvous with her boyfriend after her shift ended, they said.
On Feb. 2, 1996, Perrault said he and Gilbert had a late date. To keep it, prosecutors say, Gilbert executed perhaps her most brazen attack.
She reported for work on time and took over in the ICU, where Kenneth Cutting had been a patient for five days. Cutting was the ICU's only patient; Gilbert its only nurse.
Cutting, a 41-year-old Army veteran from Leominster, had multiple sclerosis and had been a VA patient for 20 years. Despite his blindness, he customarily greeted his visitors with a cheery salutation. "You'd always get a big hello from him even though he was blind," recalled Walter Cutting, his father. "He'd say, `Boy, you look good today."'
Cutting's health remained unchanged that afternoon. Gilbert took her dinner break at 6 p.m. A half hour later, prosecutors say, she asked this startling question of her supervisor: If Cutting died, could she leave early?
The supervising nurse said she could.
Moments later, Gilbert returned to the ICU. At 7:10 p.m. Cutting suffered a cardiac attack, a "ventricular fibrillation," and died. Gilbert delivered his body to the morgue and checked out sick at 9 p.m.
Perrault is expected to testify that Gilbert kept her date with him that night.
Gilbert's lawyers say Cutting's death is "consistent with his end stage multiple sclerosis." Prosecutors say Cutting was Gilbert's third murder victim. And two days later, they allege, she committed her third attempted murder, this one against Marine Corps veteran Angelo Vella, whose heart rate reached about 300 beats a minute before he passed out.
"He said [Gilbert] had come in and she was putting some kind of medication in his IV with a syringe which he felt was a routine thing that she was supposed to do. He didn't know," Vella's stepdaughter, JoAnn Sell, would later tell a grand jury.
"And he said that during the period while she was doing the injection, he felt really flushed and hot. And then he started to feel stomach pain and chest pain and he just remembers another nurse, Frank, coming in the room, yelling something about taking the IV out. And then everything kind of went foggy."
By the time Edward Skwira was admitted to the VA on Feb. 15, 1996, the nursing staff on Ward C had gone to the medical equivalent of full alert. Gilbert was being watched closely.
In the seven years that she worked at the hospital, authorities say that Gilbert was on duty for about half of the 350 deaths that occurred on her ward. A prosecution statistical study said the odds that Gilbert attended so many deaths simply by chance is 1 in 100 million.
So when Gilbert came to work the day Skwira's heart stopped, another nurse, Kathy Rix, who suspected her of harming patients, said she checked the ICU's medicine cabinet and counted three ampules of epinephrine.
Again, Gilbert was the only nurse on duty at the ICU. Skwira, a 68-year-old Army veteran of World War II with a history of chronic cardiac problems, was her only patient.
At 5:07 p.m., Skwira went into cardiac arrest. He died three days later. Skwira's medical file shows that he did not receive any epinephrine during treatment. But when Rix returned to the medicine cabinet she said the three vials of epinephrine were gone.
"The nurse then opened the needle disposal bucket and saw three broken, epinephrine ampules," prosecutors said. Gilbert says it was Skwira's poor heart -- not poison -- that killed him.
But two days later when an AIDS patient, on the ward for a simple antibiotic treatment, reportedly became nauseous, felt a burning sensation, and passed out after he said Gilbert flushed his intravenous line, Gilbert's colleagues had seen enough.
They reported their suspicions. An investigation was begun.wo things happened when officials opened a formal inquiry into the deaths on Ward C: Kristen Gilbert immediately left her job, never to return, collecting workers compensation after reporting a workplace shoulder injury; and, authorities say, the death rate on the evening shift began to drop dramatically.
The investigation that would soon explode across the front pages of newspapers in Western Massachusetts was still in its infancy -- a public secret, but the talk of Bear Hill nonetheless.
From a computer in her bedroom at home, Gilbert remained tethered electronically to Building One.
She kept tabs on the inquiry via e-mail with Perrault. He passed along what he knew about who was saying what to whom.
"Because I believed in Kristen," Perrault explained. "I wanted to support her and help her through this."
Gilbert was interviewed by investigators from the VA's Office of Healthcare Inspection from Washington on March 8, 1996. Their questions were not subtle: Why are you finding patients dead all the time? Why are you the first one finding patients in distress?
Gilbert, according to Assistant US Attorney Welch, told them that when it came to patients in trouble, her medical intuition was especially fine-tuned.
Welch said in a hearing that Gilbert told investigators she was around death and dying so frequently "because the codes always came in spurts." The prosecutor said Gilbert explained "her presence for so many codes was merely a coincidence; and that her numbers are artificially inflated because licensed practical nurses and nursing assistants look up to her as the best in codes and they run to get her and bring her to a patient in distress."
As it became clearer that Gilbert was the investigation's target, her 6-month-old relationship with Perrault grew increasingly strained and stormy.
She was scared and angry. Perrault said she lashed out at co-workers she blamed for triggering the investigation and pointing the finger at her.
"She was upset with them and couldn't understand why they were trying to do this to her," said Perrault. When he suggested she move away from Northampton, he said Gilbert refused. "She wanted everybody here to see what they had done to ruin her life," Perrault said.
Gradually, he began withholding from Gilbert the details of the probe he collected at work. "I just started wondering actually what was going on," Perrault said.
One day, investigators approached Perrault -- who yearned for work on a big-city police force -- in the parking lot outside his apartment. They handed him a grand-jury summons and a blunt message. "I better decide which side of the fence I'm going to play my game on because if I stayed on Kristen's side, I wouldn't have a job when this was done," he recalled.
Gilbert was growing increasingly isolated and bitter. Perrault said she accused him of secretly spying on her for investigators. During one spat, he said, Gilbert punched him twice in the testicles. Still, she clung to their volcanic relationship.
But as the first federal grand jury began a criminal investigation into the deaths on Ward C in June 1996, Perrault wanted out. He unsuccessfully tried to end the affair with Gilbert at his apartment in Easthampton after a night out at the VFW.
"She was distraught, upset with me," Perrault said, "begging me not to break it off because she had no one else to support her." Perrault said Gilbert went to the back bathroom in his third-floor apartment. "She came back and threw a pill bottle on my bed and she said, `Now look what you made me do,"' the security officer said.
She was going through a divorce. Her relationship with Perrault was unraveling. She was the focus of a murder investigation. Migraine headaches tormented her. Gilbert began what became a series of admissions to the psychiatric wards at various hospitals.
"They have unlimited money and resources," Gilbert told one psychiatrist about the investigation. "And they just don't stop."
On July 8, 1996, she was taken by ambulance to Holyoke Hospital after taking an overdose of Fiorinal tablets. She was admitted the next day to the hospital's Center for Psychiatry.
That night, Perrault said his telephone rang. Gilbert was calling from her hospital ward. She had a message that Perrault would precisely reconstruct a week later when he sat before a federal grand jury in Springfield.
Gilbert, said Perrault, told him: "You know I did it. I did it. You wanted to know. I killed those guys."
Then she hung up.n the summer of 1996, the VA's internal investigators compiled a draft report into deaths on Ward C. It concluded that 70 of the deceased patients whose cases were reviewed were seriously or terminally ill. Their deaths were not unexpected, the report said.
But the VA's early findings provided little respite for Gilbert. Federal prosecutors were bearing down. Court documents publicly identified her as a suspect in patients' deaths. In between hospital stays, Gilbert moved in briefly with former co-worker, Karin Abderhalden, a VA nurse with whom she had shared after-work beers.
"She was upset with a couple of other co-workers, certainly Jim Perrault," Abderhalden said in court. "Their relationship was very up and down at that time.... During this investigation she had hired a private detective. And I recall that she was upset with a couple of people that would not speak with him. She felt there needed to be a sharing of information."
Gilbert's romance with Perrault had eroded to the point of collapse. One of its tumultuous, closing chapters was played out in the same parking lot, where a year before they had shared their first kiss.
"I was at the VFW one night and she came walking in and we had a minor argument," Perrault said. "I walked out and got in my car. She ran to her vehicle. Put it in reverse and flew at a high rate of speed towards my car. She stopped short a foot or two."
Days later, as Perrault prepared to drive to Springfield for an interview with US attorneys who suspected Gilbert of serial killing, he said she blocked his car with hers. She begged him not to go.
"I told her to leave the property because I was going down to the meeting, and if she refused to move I would honk my horn until the neighbor called the police," Perrault said.
When he left, he said she followed.
After he walked out of his two-hour interview with investigators, Perrault found air let out of his right front tire. Over the next few days, Perrault said his car was egged and scratched with a key four or five times. Its windshield was spray painted.
"[Gilbert] was like a pot of boiling water with the lid sort of clanging up and down as the steam is trying to come out," said Welch, the federal prosecutor.
The rage boiled over on Sept. 26, 1996. That afternoon, Gilbert walked into the Toys R Us store at the Holyoke Mall. She bought a Talkgirl Jr., a child's toy capable of disguising voices. She later purchased Energizer batteries from a nearby drug store. Within hours, Perrault -- on desk duty at his VA hospital security post -- began receiving a series of strange, abusive, and threatening phone calls.
"It was not a normal tone of voice. It sounded distorted, staticky, almost like there was a mechanical ring to it," Perrault said.
"You sound dumb," Gilbert said during one call. "You must be pretty stupid," she said during another.
In another, Gilbert, her voice disguised to sound like a man's, told him: "There are three explosive devices in Building One. You have two hours."
The phony bomb threat would lead to the evacuation of Ward C and its annex, where Kristen Gilbert's former co-workers scurried to get 50 patients out of the building. And, after a jury was persuaded the caller's voice was hers, it would land Gilbert in federal prison for 15 months.
Before her arrest and conviction on the bomb-threat charge, Gilbert appeared alternately energized and depressed by the case and the attention she was receiving from reporters and camera crews who sought her out.
Her next-door neighbor in Easthampton, Micala O'Donnell, told authorities that Gilbert said she was happy her last name was no longer Strickland. Gilbert told her that "Strickland" didn't sound nearly as good on TV, O'Donnell said.
After the earliest news reports that identified her as a possible killer, Perrault said Gilbert worried less about the seriousness of the accusations than she did about the quality of her pictures in newspapers or on television screens. She hoped those images would flatter her.
Gilbert suggested to one friend that Bridget Fonda -- who costarred in the 1992 movie "Single White Female" about a psychotic killer roommate -- should play her in the movie.
In a search of Gilbert's apartment, authorities seized what they assert were three suicide notes written by Gilbert.
In one, she wrote: "Well, over the past few months I have changed, I was a fairly likable, independent woman that ended up a weak, dependent, unlikable person who can't make it through 2 hours, never mind a whole day, without crying.
"I've become completely unpredictable, impulsive, and self-destructive. I don't really like this person."
And in one of her final communications to her now former boyfriend, postmarked four days after the bomb threat, Gilbert wrote Perrault a dark goodbye letter.
"It should be over when you get this..... It's kind of funny because earlier this week it was you that convinced me this was the right choice," Gilbert wrote. "I was out driving one night and I drove by the VFW and saw your car. I couldn't help myself. I pulled in. I saw you in the window playing darts. But I couldn't go in, so I just watched you a while.
"... I never lied to you about loving you. I meant it from the first time I said it."
On Oct. 8, 1996, Gilbert was arrested and charged with threatening to bomb the hospital ward where she once worked.
"I will admit she caved in to the pressure," Richard Strickland told a reporter at the time, suggesting his daughter's behavior was fueled by swirling suspicions of death on her watch. "How would you feel if you were accused of being a mass murderer?"
As she awaited trial on the bomb-threat charge, insisting that she "would never intentionally hurt anyone," authorities began exhuming the bodies of the men who died on Ward C when Gilbert was on duty.f Kristen Gilbert, 32, is convicted of capital murder and put to death for her crimes, she would become the first woman to be executed in a federal case since December 1953, when Bonnie Brown Heady died in Missouri's gas chamber.
Massachusetts is one of 12 states without capital punishment. But because Gilbert's alleged crimes occurred on US property she is eligible for the federal death penalty. Attorney General Janet Reno approved the decision to seek the death sentence last year.
"The patients were murdered in their hospital beds by a nurse who used her position and her specialized knowledge to commit the crimes," said US Attorney Donald K. Stern, after Reno's decision.
But Hoose, one of Gilbert's court-appointed attorneys and the former president of Massachusetts Citizens Against the Death Penalty, said that in a murder case where the scientific evidence is so uncertain, death should not be an option.
"This is the kind of case where you're never going to have certainty," said Hoose, who has represented capital murder defendants in Georgia. "There are no eyewitnesses. There are no confessions. The case rises or falls on the testimony of scientists.
"They have scientists who say these people were poisoned by epinephrine. We have scientists -- and believe me when I tell you they are not quacks -- who say that's ridiculous. These people did not die of epinephrine poisoning."
Indeed, the hundreds of potential jurors, who will begin assembling next week in Springfield's Symphony Hall because the courtroom is too small to accommodate them, face a daunting task if they make it into the murder-trial jury box.
The centerpiece of the case is likely to be a highly technical battle of dueling scientists, dissecting dense medical theorems.
Federal Judge Michael A. Ponsor, who will preside during Gilbert's trial, has wished both sides luck in trying to present the complex evidence in a way jurors can comprehend it.
Because two of Gilbert's alleged victims received legitimate doses of epinephrine in efforts to revive them, government toxicologists will have to persuade jurors that they can distinguish between those legal injections and the epinephrine Gilbert is said to have used for murder.
"It is sophisticated, but it's not rocket science," Rieders, the prosecution's expert toxicologist, said in an interview. "My job is to educate people."
But Ashraf Mozayani, the laboratory director and chief toxicologist for the Harris County, Texas, Medical Examiner's Office, said it is impossible to differentiate between legal and illegal doses of epinephrine, especially since only Hudon was autopsied within hours of death. The other three alleged victims were autopsied after they had been embalmed and buried for many months.
"There's no way," Mozayani, a defense expert, said. "How can you do that? They're going to have a tough job."
Tougher still, prosecutors say, because Ponsor has ruled that the jury will not be allowed to hear about the bomb threat, or Gilbert's alleged attempt to kill her husband, or about their statistical analysis that concluded the chances of Gilbert attending to so many deaths simply by chance was an astronomical 1 in 100 million.
"Put simply, any juror who was convinced that this defendant was the `sort of person' who would try to murder her husband would find it difficult, if not impossible, to avoid the temptation to conclude that the defendant was also `the sort of person' who would murder a hospital patient," Ponsor ruled. "...To afford [Gilbert] a fair trial, this evidence must be excluded."
Welch said rulings like that have the effect of forcing the government to try its case with "one arm tied behind its back."
Gilbert's lawyers say they will not use their client's mental health as a defense in the upcoming trial. The former nurse, they say, is an active and valued participant in her own defense.
They hear from her by telephone three or four times a week from her new home, the Hampden County Correctional Center in Ludlow, a rambling complex of beige corrugated-steel and concrete buildings. It is protected by a double chain-link fence topped with shiny coils of razor wire.
Gilbert has passed her time since her first arrest by reading, working on puzzles, and watching videos. She speaks regularly with her family. She now regards Perrault as simply "a jerk," according to her psychiatric report filed with the court.
As she awaits her trial, Gilbert almost certainly has abandoned one of her jailhouse pastimes: aspiring author.
When authorities learned, after reviewing audio tapes of phone calls Gilbert placed from prison, that she was writing a novel, they obtained a search warrant and seized the manuscript.
The book was a murder-mystery.
"I can say I drew on some life experience for it," Gilbert said in one taped call.
Her story was set at a government installation.
It involved theft and murder.
She hadn't fully developed the plot before her book was taken from her cell.
But, Gilbert told a friend, she was toying with the idea that the murder victim would be a security guard.
It was, the former nurse made plain, an innocent work of fiction.End of series.
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