Tiny Hospital Searches for Clues as Death Stalks Intensive Care Unit : Indiana: In a 22-month period, 147 patients died, and the same nurse attended 130 of them. Anonymous letter spurred investigation.

It was an anonymous letter with an alarming claim: Patients were dying mysteriously in a tiny hospital, each case marked by an eerie consistency--the same nurse was on duty.

“Would you want one of your loved ones to be a patient in that hospital with a death angel working?” the letter asked. “ . . . We need to stop this nurse and I hope you will help us.”

After the Indiana Department of Health received that letter--one of several copies apparently sent this spring to newspapers and authorities--it dispatched investigators to Vermillion County Hospital.

They were looking for answers. They weren’t alone.

State police already were on the trail, having been contacted by the hospital, which was concerned about a startling rise in deaths in intensive care--so concerned, in fact, that it had suspended a male nurse.

The mystery at Vermillion County Hospital has since mushroomed into an unnerving tale of anxiety, suspicion and questions about some disturbing numbers: In a 22-month period ending in March, 147 people died in the intensive care ward; in 130 cases, one nurse was on duty. In 1994, 100 people died in that unit--more than triple that of previous years.

Whether this is a benign twist of tragic coincidences, shoddy medical care or perhaps, more ominously, a diabolical pattern of evil is something the police, lawyers and courts will sort out.

The hospital says it has done nothing wrong. Orville Lynn Majors, the 34-year-old licensed practical nurse who has been temporarily stripped of his license, says he is a scapegoat and that he, too, has done nothing wrong.

But several anguished families whose relatives died--sometimes unexpectedly--sense something isn’t right.

“Each person who lost somebody needs to know the answers for all of us to have peace of mind,” said Judy Miller, whose 51-year-old husband, Tom, died in October. “If we don’t, we’re not going to be able to go on with our lives.”

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The stories are strangely similar: In each case, relatives seemed to be holding their own--or even improving--in intensive care, then died within a day. Some visitors remember seeing Majors; others do not.

Tom Miller, who had been suffering from bronchitis, died less than 24 hours after being hospitalized last October. The death certificate listed the cause as pneumonia.

“They told me he wasn’t that sick,” his wife said. “We never dreamed that he would die.”

Majors twice asked her to leave the room while he tended to her husband, Judy Miller said, but she has no proof he acted inappropriately. After learning of the investigation, she began to cry. “Why didn’t the doctors notice an increase in the patients dying?” she asked.

John Rozsa is looking for answers in the 1994 death of his wife, Ethel, 61, who entered intensive care after experiencing heart attack symptoms. His wife was doing well the next morning, but after he stepped out briefly, he says, he returned to find her lying in the dark, unplugged from all monitors.

An emergency code was called. Soon after, he was told that Ethel was dead.

“I could not accept the circumstances surrounding her death,” Rozsa said, shaking his head. “There was something wrong there, something drastically wrong.”

Marjorie Doran wonders too, about the death of her father-in-law, John, 76. He was hospitalized last October after complaining of loss of appetite. The next morning, she said, he seemed OK until he was moved to intensive care, where his breathing became more erratic. She said Majors treated him, giving him injections into his intravenous tube.

“We all feel guilty,” she said. “We put our faith and trust in the hospital. . . . We had talked him into going there.”

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Vermillion County Hospital, a concrete-and-glass building, sits on Main Street in this southwest Indiana town of 5,000, part of a tranquil area that is home to many retirees and several nursing homes.

The unusual rise in deaths at the 56-bed hospital--only four beds are in intensive care--coincided with Majors’ work schedule.

Majors, who was rehired in May, 1993, for a second stint at the hospital, has repeatedly maintained his innocence.

“I know I have done absolutely nothing wrong,” the husky, shaggy-haired nurse declared in a recent interview. “I’m an excellent nurse.”

His 1994 job evaluation seemed to agree: It said Majors “exceeds expectations” and praised his accuracy, judgment and people skills.

Clifford Beyler, a lawyer acting as hospital spokesman, would say only that the suspension was “the appropriate action to protect the health and safety of our patients.” He did not identify Majors.

But Beyler also insisted there has been no improper care at the hospital, including intensive care.

“Our doctors have said they are not aware of any inappropriate medical treatment of these patients,” he said. “Our nurses have said the same thing by virtue of the care that was given and by review of the death charts.”

An 11-member state police team is examining medical records and interviewing relatives and staff. They have not identified Majors as a suspect.

“We have not been able to determine [whether] any crime has been committed,” said State Police 1st Sgt. Mark Hartman. “If you don’t have a crime, you don’t have a suspect.”

The hospital clearly did have problems, according to the state health department, which fined the institution $80,000, citing eight violations.

Among them: It didn’t notify the agency of suspicions about increased deaths, and the administrator didn’t act when he became concerned about a jump in cardiac arrests.

“He had a gut feeling in November that something was amiss in the ICU” because of the high number of code blue calls--cardiac or respiratory arrests--and unexpected deaths, but he didn’t act until March, said Art Logsdon, assistant commissioner of consumer health services.

Logsdon said doctors didn’t review death records as required and “from 1993 to 1994, deaths in ICU tripled and the hospital simply didn’t have a clue.”

A state inspection in December, however, didn’t detect the problem either; Logsdon insists it’s the hospital’s responsibility to alert the agency of anything unusual.

The hospital has developed a plan to correct problems cited by the state, but a national quality-monitoring group decided this month to deny it accreditation--a step that could affect some insurance coverage.

The hospital is appealing the fines, said Beyler, the attorney. He offered a simple explanation for higher death numbers: Sicker, older people are ending up in intensive care.

Majors said he even voiced concern about the death rate in 1993 to a supervisor. But he noted, too, that the hospital is in an elderly community and that many deaths under review were very sick people in their 70s and 80s; a few even were 100 or older.

That explanation didn’t satisfy the author of the anonymous letter, who said the suggestion people are sicker is “one big cover-up. . . . These are hometown people we all knew that were KILLED in that hospital.”

The letter the health department received--it was addressed “Dear Editor,” indicating that it also was sent to newspapers--claimed 23 patients died in the presence of one nurse, but provided no time frame.

Days after the fines were announced, the state nursing board held an emergency hearing in which two of Majors’ fellow nurses suggested that patients became more unstable when he was around. But one of those nurses had worked with him only one day.

Several nurses interviewed also confirmed Majors’ presence during times of emergency codes and deaths, according to a health department report.

The board temporarily suspended Majors’ license, declaring him “a clear and immediate danger to public health and safety.”

Majors was not notified of the hearing.

“It’s been a very unfair process,” said his attorney, Marshall Pinkus.

Majors said he had no chance to explain that he worked many overtime hours--which could account for his presence during many deaths--and that he wasn’t the only staffer treating patients.

“They made it sound like I was alone with 130 people [when they] died,” he said. “There were many people there. Ninety-five percent of the time, I’m there with someone.”

The state says the intensive care death rate has returned to normal since his suspension; Majors’ attorney disputes that.

Majors said he understands the gnawing suspicions.

“If I had somebody who died in the hospital, I would question it too. Anybody in their right mind would,” he said. “[But] there’s nothing there.”

“If they were to go through those charts one by one, there was no wrongdoing,” he added. “If they exhume everybody who died in the hospital in the last 10 years, there’s not going to be any negligent care given by me or anyone else.”

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While Orville Lynn Majors fights to clear his name--he will tell his side at a nursing board hearing in September--he busies himself with a pet store and an antiques business he owns in his hometown of Linton.

His attorney has collected dozens of letters from friends, co-workers and patients--some he cared for as a home health care nurse--attesting to Majors’ professionalism, compassion and dedication.

Pinkus said if his client wanted to harm anyone, he had ample opportunity to do so unchecked, when he cared for the blind and ailing in their homes.

“If they have to dig up 147 people,” Pinkus said, “they should start doing it. I don’t think they’re going to find anyone who was murdered. We have no fear of them doing that, if that’s what it’s going to take.”

He suspects some of the families “see dollar signs” from lawsuits.

Some disagree vehemently.

Russell Dulaney is “not out for a buck,” said Marilyn Willis, a family friend.

Dulaney’s wife, Betty, 62, had heart trouble, but walked three miles a day. In 1993, she checked into the hospital with a migraine. Majors gave her a shot for her pain, Willis said.

The next day, her husband, who had expected to take his wife home, was told she had been moved into intensive care. Shortly after, he was told her heart had exploded.

Now, Willis said, Dulaney “wants to know what happened to her. . . . He just wants to know the truth.”