New lab results led Crane to act

Thursday, August 7, 2003 | 12:00 a.m. CDT; updated 7:17 p.m. CDT, Saturday, July 19, 2008

More than a year after his arrest and less than three months before his scheduled jury trial, the former Truman Veterans Hospital nurse charged with killing 10 patients was released from jail.

All 10 counts of first-degree murder against Richard Williams were dismissed at Boone County Prosecuting Attorney Kevin Crane’s request on Wednesday morning. Crane said he recently received lab tests that scientists said provided “no definitive conclusions” that the patients died as a result of being injected with succinylcholine, a muscle relaxant.

“After consultation with both scientific and legal experts I have tried, even up to this last moment, to identify a way to maintain this prosecution,” Crane said in a press release Wednesday morning. “However, absent additional evidence, the legal standard for proving murder beyond a reasonable doubt cannot be met at this time.”

Crane said there is no longer adequate evidence to show that the patients did not die of natural causes.

“My ethical obligation as a prosecuting attorney is not only to zealously prosecute criminals but also to be fair to those accused of crime,” he said.

Don Catlett, Williams’ attorney, said the scientific tests were really the only evidence in the case.

“I think this process is going to have to be looked at very closely,” Catlett said. “The conclusion that you cannot draw is that this evidence was caused by succinylcholine.”

Williams was released just after 9 a.m. Wednesday from the Boone County Jail, where he had been held since June 3, 2002.

Williams was suspected of injecting 10 patients with succinylcholine, which causes paralysis of the muscles, including the diaphragm, resulting in respiratory arrest. When succinylcholine is metabolized in the bloodstream, it is changed into succinylmonocholine, which was found in tissue samples of 10 of Williams’ former patients last year.

But new testing by Kevin Ballard at National Medical Services Laboratory in Pennsylvania found succinylmonocholine in a sample of control tissue. Crane said he received a report from Ballard on Monday that said low levels of succinylmonocholine can be found naturally in tissues taken in autopsies.

John Murray, executive vice president of the National Medical Services, said it is the evaluation of the results, not the tests themselves, that is in question.

“It’s the interpretation of the results — whether the substance was administered or is naturally occurring is the question,” Murray said.

Boone County Medical Examiner Eddie Adelstein, who was formerly the chief of pathology at Truman and has actively followed the investigation, said the validity of any test depends on the accuracy of all aspects of the test, including the control group.

“If the controls don’t work, there is no way of knowing what the results will be, and the new evidence may not be substantial,” Adelstein said.

Murray said future testing in the case will depend on Crane’s request. Crane declined to comment Wednesday on future investigation into the case, though he said the Veterans Administration Office of the Inspector General still considers the case to be under investigation. Murray also said he didn’t know if new tests were being developed specifically with succinylcholine, though the National Medical Service constantly creates new tests.

“We are an esoteric lab,” Murray said. “But one problem we have is that there are very few (labs) that are attempting to do something like this. That’s why you don’t have a lot of collaborative data.”

In May, succinylcholine evidence also tested by National Medical Services led to a Florida appeals court overturning the murder conviction of a doctor, William Sybers, in his wife’s death.

Another case in California involved a respiratory therapist referred to as “the angel of death.” Efren Saldivar used another muscle relaxant, called Pavulon, as well as succinylcholine to inject patients. Tests were able to detect Pavulon in tissue samples but not succinylcholine. The detection of Pavulon in Saldivar’s patients and his guilty plea provided enough evidence to sentence him to life in prison.

Succinylcholine was also involved in the 1984 conviction of a Texas nurse, Genene Jones, suspected of injecting a 15-month-old in 1982. Jones was sentenced to life in prison.

Adelstein said he was “uncomfortable” last year about the succinylcholine tests that led to Williams’ arrest because the results were almost too perfect. But he said that the deaths could still be attributed to other drugs or agents.

Statistics in the case may be more powerful than scientific tests, Adelstein said. The FBI, which investigated the case for five years, looked into 43 deaths in the hospital and found that the deaths of 22 patients at Truman under Williams’ care were “moderately suspicious” and 11 were “highly suspicious.”

“Sometimes the relationship is so strong, there is no other explanation,” Adelstein said.

Crane has scheduled a press conference for 9:30 this morning at the Boone County Courthouse to talk about the case. Robert Middleberg, the laboratory director for National Medical Services, will also be in attendance.

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