Toronto hospital baby deaths
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(Redirected from Susan Nelles)
The
Toronto hospital baby deaths were multiple alleged poisonings of babies at
Toronto's
Hospital for Sick Children
that occurred between June 1980 and April 1981, when charges of murder
were laid against a nurse at the hospital. The story was a major news
event throughout the year, and ended with the nurse being exonerated.
Although suspicion was cast on other people, no further charges were
ever laid.
Later analysis suggests that the tests and methodologies that pointed
to poisoning were flawed, and may have been generating false positives.
Specifically, chemicals used in the manufacture of everyday medical
items may have contributed to the test indicating high levels of the
alleged poison. It was also demonstrated that a "wave" of similar
alleged poisonings were occurring at that time.
Initial accusations
During an investigation of baby deaths in the cardiac unit of the
Hospital for Sick Children, abnormally high levels of the heart
medication
digoxin
were found in as many as 43 of the infants. The levels were measured
using a newly introduced testing method known as HPLC, and the levels
were high enough to suggest that it was the cause of death.
A police investigation followed during which time it was found that a
nurse that the hospital had been working shifts during the times that
23 of the deaths occurred. Susan Marguerite Nelles (born in
Belleville, Ontario),
[1] was arrested and charged in March 1981 with murdering four babies. The deaths then stopped.
During the case that followed, it was discovered that Nelles had not
actually been on duty during the noted times, having swapped shifts with
other nurses who had access to the same medication. Although the deaths
ended after Nelles' arrest, the hospital had introduced restrictions
for access to digoxin and had implemented a policy that kept infants in
intensive care longer. Total deaths between the two units remained
identical.
[clarification needed]
Nelles asked for legal counsel when she was arrested. Her request was
interpreted by the investigating police officers to be an indication of
her guilt, but the court later ruled that such requests should not be
interpreted as evidence of guilt. The court also ruled that the Crown
lacked evidence to convict Nelles. The government eventually paid for
Nelles' legal costs after she sued the province's
Attorney-General,
Roy McMurtry for
malicious prosecution.
Inquiry and aftermath
A
Royal Commission, led by Justice Samuel Grange, found that eight infants had been murdered. Although another nurse, Phyllis Trayner,
[2]
fell under scrutiny, no one was charged. Moreover, the experimental
test that detected digoxin may have given false results for other
chemicals.
Nelles has since remained in the medical care world after her trial.
In 1992 she became Director of the Belleville Dialysis Unit of
Kingston General Hospital. She also counsels nurses on legal issues and on dialysis. In 1999, Nelles received an honorary degree from
Queen's University in
Kingston, Ontario
(from which she had graduated with a Bachelor of Nursing Science degree
in 1978) for her work in promoting integrity in the nursing field.
[1]
She helped establish the Nelles Scholarship for Queen's Nursing Science
Students in memory of her father, Dr James Nelles and brother Dr David
Nelles.
[3]
As of 2005, only Nelles had been charged with a crime involving the baby deaths.
[4]
MBT
As per 2010 LawNow.org article,
[5]
there is some question as to whether any of the infants were murdered –
but perhaps killed by a substance called MBT (mercaptobenzothiazole)
that was used in the manufacture of the syringes used to medicate the
babies and can mimic digoxin in autopsies. To quote from the epilogue,
"Today, no one can even say with certainty whether any crimes were ever
committed on the pediatric cardiac ward."
Gavin Hamilton, M.D., of London, Ontario, published a book,
The Nurses are Innocent – The Digoxin Poisoning Fallacy,
[6]
proving that very high blood digoxin levels should be expected in
autopsy blood samples. He described an epidemic of baby poisoning
occurring at the same time as the Toronto baby deaths (Hammersmith
Hospital, London, England),
[7] caused by a cumulative toxin leached from pharmaceutical rubber (syringes, ampoules, and I.V. apparatus).
[8]
Any babies receiving multiple injections (such as the seriously ill
Toronto babies), worldwide, were exposed to this contaminant, MBT. In
the FDA's National Center for Drug Analysis, MBT was proven to give
falsely high digoxin readings by HPLC testing,
[9] the test method used by the Toronto Centre for Forensic Sciences during the criminal investigation.
Editorial Reviews
Maclean's magazine
...The real parallel remains unknown to most Canadians even now; it's not that the wrong person was fingered for murder, but that no murders were committed at all. That's the conclusion meticulously and persuasively argued by retired physician Gavin Hamilton in The Nurses are Innocent.From the Publisher
...The real parallel remains unknown to most Canadians even now; it's not that the wrong person was fingered for murder, but that no murders were committed at all. That's the conclusion meticulously and persuasively argued by retired physician Gavin Hamilton in The Nurses are Innocent.