In April 2008 the dialysis clinic in Lufkin, in East Texas, became a place where patients collapsed in their chairs. Paramedics were called there again and again that month. Five patients named in a later indictment died, either that month or after episodes that month, and others fell suddenly and gravely ill during treatment. On April 28, with state health inspectors on the premises, two patients reported that they had seen one of the nurses give bleach to two other patients. That nurse was Kimberly Clark Saenz, a licensed vocational nurse who had worked at the clinic for about eight months.
Four years later an Angelina County jury convicted her of capital murder and of three counts of aggravated assault, and it chose life in prison without parole over a death sentence. The case was built on two eyewitnesses, laboratory tests for bleach in the patients' treatment equipment, a blood marker of chlorine exposure that federal scientists measured, and her own internet searches. Her lawyers said she was a scapegoat for a badly run clinic. The appeal raised a question about Texas law that went to the state's highest criminal court: whether jurors who convict someone of killing more than one person must agree on which people were killed.
Saenz lived in Pollok, a small community in Angelina County outside Lufkin. Reports from her trial describe her as a mother of two, a son and a younger daughter, and say she left high school to have her son before her senior year. Witnesses at her punishment hearing in 2012 described her helping with her children's schoolwork and sports and attending church. A softball coach who had worked with her daughter's team said he had never had any concern about her being around the girls.
The state of Texas licensed her as a vocational nurse in November 2004, according to The Lufkin Daily News. Her nursing record was troubled before she reached the dialysis clinic. The Texas Board of Nursing later received a complaint about an August 2005 accusation that she had stolen Demerol, a painkiller, at a Lufkin hospital. At her trial a Lufkin police detective testified that she had been fired from that hospital for stealing the drug, and the Associated Press reported that she was fired after drugs went missing and were found in her purse. The Lufkin News reported in 2018 that she was never convicted of a theft charge in Angelina County.
Her home life was also strained. Records shown at the punishment hearing indicated that her husband had filed for divorce and obtained an emergency protective order against her in June 2007; her lawyer brought out that the couple had reconciled. The prosecutor told the jury about a 2007 arrest for assault involving family violence and a later public intoxication charge, both arising from domestic disputes with her husband, and police officers testified about an arrest for public intoxication and a citation for criminal trespass. The district attorney, Clyde Herrington, described her after the trial as depressed and frustrated, unhappy in her marriage and at work.
She came to the dialysis clinic after 10 weeks of dialysis training, according to The Lufkin Daily News in 2009, and had worked there about eight months by April 2008. The clinic was run by DaVita Inc., a Denver-based dialysis company. It had about 120 patient places, according to a 2009 report, and about three dozen people worked there. Saenz was often assigned as a patient care technician, the Fourth Court of Appeals noted, and on other days she worked as the nurse who prepared and gave medications. Herrington said she complained about some of the patients, and the appeals court recorded witness testimony that she had voiced dislike of several of the people who later became the victims named in the case.
Emergency crews responded there as many as 30 times that month, including seven calls for cardiac problems, according to the Associated Press, which cited state health records showing only two such calls in the previous 15 months. Federal records later cited by the AP put the April ambulance count at 34, more than three times the March figure.
In mid-April a senior official of the Lufkin fire department wrote an anonymous letter to state health inspectors asking them to look at the clinic. "In the last two weeks, we have transported 16 patients," the letter said. Inspectors from the Texas Department of State Health Services arrived in the days that followed.
The appellate courts set out what happened to each patient named in the case. On April 1, Clara Strange and Thelma Metcalf went into cardiac arrest at the clinic and died. On April 16, Garlin Kelley went into cardiac arrest; a nurse supervisor testified that emergency workers carried him out of the clinic not breathing. Another patient lost consciousness the same day. On April 22, Cora Bryant went into cardiac arrest. On April 23, another patient suffered a severe drop in blood pressure and was taken to the hospital. On April 26, Opal Few went into cardiac arrest and died, and another patient became ill with a severe drop in blood pressure. On April 28, two more patients suffered sudden drops in blood pressure.
Garlin Kelley and Cora Bryant did not die at once. The 2014 opinion of the Fourth Court of Appeals gives Kelley's date of death as August 18, 2008, and Bryant's as July 15, 2008; the court's 2015 opinion says Kelley died two days after his collapse and Bryant about three months after hers.
Little is recorded about the five people as individuals, and most of what is known comes from relatives who spoke after the verdict.
Clara Strange had raised her grandchildren. Her granddaughter told the court at sentencing that her mother died when she was 7 and that her grandmother "stepped in to raise us." After the verdict she said that, with each new development in the case, it felt as if her grandmother kept dying over and over.
Thelma Metcalf was the mother of a son who lived in Zavalla and of a daughter who spoke for the family at the sentencing. On the first anniversary of the deaths, her son told The Lufkin Daily News that it had been a very hard year for the family and that he blamed the clinic for failing to supervise its staff. Her daughter told a reporter in 2009 that she could not believe that something like this could go on without anyone noticing.
Garlin Kelley was carried from the clinic on April 16. The State's evidence was that bleach was found in equipment used for his treatment and that his blood tested positive for the chlorine marker discussed below.
Cora Bryant had a daughter who spoke after the verdict. She said she did not believe in the death penalty, but that God had said vengeance was his.
Opal Few's daughter, speaking in 2009, wondered aloud how someone that sick could walk around and seem like a normal person.
On the morning of April 28, Saenz was assigned to work as a patient care technician rather than as the medication nurse. A DaVita supervisor told The Lufkin News years later that the reassignment upset her and that she felt the work was beneath her.
State inspectors were in the building. During the morning two patients became suddenly unwell, and two other patients receiving treatment nearby said they had watched Saenz pour bleach and then give it to those two patients. At trial the two eyewitnesses testified to what they had seen. The appeals court noted that their accounts differed in some details and that both had problems with their eyesight, but it held that the jury was entitled to believe them.
One of the two patients' treatment equipment later tested positive for bleach. The other patient's equipment had already been thrown away and was never tested. A technician who worked with Saenz that day testified that she found the first patient in difficulty after returning from a morning break; the patient told her she could not describe the feeling but "couldn't get right."
Saenz was sent home. The clinic called the police, though her lawyers later complained that DaVita waited about eight hours to do so. DaVita closed the clinic on April 28 and fired Saenz the next day.
The Texas Board of Nursing suspended her vocational nursing license on May 14, 2008, after two complaints: one alleging the bleach poisonings, the other the 2005 Demerol accusation. Lufkin police arrested her on May 30, 2008, on two counts of aggravated assault with a deadly weapon, covering the two patients the eyewitnesses had described. She posted bond on June 2. She surrendered her nursing license on January 12, 2009.
The clinic stayed closed for about two months. It reopened on July 2, 2008, under state monitoring, and in 2009 it was treating about 50 patients with two state nurse monitors on site. A Texas Department of State Health Services survey reported 19 patient deaths at the center over five months in 2008 before it closed, and said its mortality rate was 7.1 percent above the state average; the survey found failures in monitoring patient care and in keeping accurate records. Herrington said in 2009 that investigators had no medical evidence linking Saenz to those other deaths, and that DaVita had discarded tubing and equipment before staff realized how unusual the death count was.
The criminal investigation was led by the Lufkin Police Department, working with the Office of Inspector General of the U.S. Department of Health and Human Services and the Texas attorney general's office. The Centers for Disease Control and Prevention and the Food and Drug Administration did the scientific work. The lead detective was Stephen Abbott of the Lufkin police.
About a year after the deaths, an Angelina County grand jury returned a six-count indictment. The single capital murder count named five patients, Thelma Metcalf, Clara Strange, Garlin Kelley, Cora Bryant and Opal Few, and alleged that Saenz had caused their deaths by introducing bleach or another chlorinating agent into their bloodstream. Under the Texas capital murder statute, killing more than one person in the same criminal transaction or in the same scheme or course of conduct is a capital offense. Five further counts charged aggravated assault on five patients who survived. In all, the indictment alleged that 10 patients had been harmed.
Saenz turned herself in after the indictment and was held without bond, according to The Lufkin Daily News and the Associated Press. Relatives of some of the patients who died told the AP that they had long suspected her and were not surprised. DaVita called the indictments a painful reminder of the deaths. Not every family agreed: the husband of one surviving patient told the Houston Press that week that Saenz had been good to them and that he did not believe she had done it, and he blamed the clinic's operators instead. At her arraignment in April 2009 she pleaded not guilty and was released on bond. By July 2009 prosecutors had announced at a pretrial hearing that they would seek the death penalty.
Bleach is used in dialysis clinics to clean equipment, and that fact ran through the whole case. The prosecution had to show that bleach had reached the patients' blood, and that it was Saenz who had put it there.
The first strand was direct testing. An FDA chemist found bleach or chlorate in treatment equipment recovered from the clinic; some samples tested positive, while others suggested that bleach "may have been present at one time." The appeals court recorded that bleach was found in the equipment of four of the five patients named in the murder count. Cora Bryant's equipment tested negative, but a blood enzyme, lactate dehydrogenase, was elevated.
The second strand was a biomarker. Hypochlorous acid, whether made by the body or coming from chlorine outside it, produces a compound in the blood called 3-chlorotyrosine. Dr. Mark Sochaski, a bio-analytical chemist, had studied the marker in laboratory animals, and his testing found it in the blood of the patients in the case but not in control patients. Dr. Michael Schwartz, a physician and toxicologist with the CDC, testified that the levels were far above anything natural causes would produce and that they fell over 72 hours, as would be expected after exposure from outside the body. He concluded that each of the five deaths resulted from bleach poisoning during dialysis.
The third strand was the pattern of who was on duty. A CDC-affiliated investigator found that Saenz had been working during 84 percent of the episodes of chest pain or cardiac arrest at the clinic. Herrington told the jury, "The only days there were deaths in April, she was there." The defense answered that another staff member had been present for all of the episodes and another for 89 percent of them.
The fourth strand was a computer. Investigators found that searches for "bleach poisoning" had been made on a computer she used in the early hours of April 2, 2008, the day after the first two deaths. Further searches on May 3, 2008, after she was fired, asked whether bleach given during dialysis could be detected and what symptoms dialysis patients would show.
Saenz has always denied harming anyone. She told a co-worker after the deaths that she did not kill those people. She told police that she was scared to go to work. Before the grand jury she called herself a scapegoat and denied ever giving bleach to a patient.
She did admit that she had been handling bleach on April 28. She said she had been measuring it for cleaning and wanted to be precise. A DaVita monitor testified that the tool Saenz described using was meant for medicine, not for harmful solutions, and could not measure bleach for the two-and-a-half-gallon cleaning pails. The appeals court held that the jury was free to find her explanation not believable.
The case took almost three years to reach trial. The Daily Sentinel of Nacogdoches reported at the verdict that she had spent no more than nine days in jail since she was first charged. A defense lawyer, T. Ryan Deaton, wrote in a court motion that she was "a good nurse, a compassionate, a caring individual who assisted her patients and was well liked," and said she had no motive to kill anyone. According to her own affidavit, she had no prior felony record.
Before trial Herrington listed about a dozen alleged wrongs, among them prescription drug overuse, being fired from health care jobs at least four times, false information on a job application, and looking for health care work in violation of her bail terms. A plea offer was withdrawn after her lawyers rejected it. Judge Barry Bryan of the state district court in Angelina County barred all parties from speaking about the case outside the courtroom. DaVita said it had turned over more than 10,000 pages of records.
The trial opened in Lufkin on March 5, 2012. A prosecutor read the six-count indictment, and Deaton answered "Not guilty" to each count for her. Herrington told the jurors that the bleach was real and that "the defendant in this case is the one that put it there." He pointed to the eyewitnesses and the internet searches.
Deaton's opening blamed DaVita, which he called "the puppet master in this case"; the judge sustained the prosecution's objection to the phrase. He argued that the clinic was chaotic, that the eyewitnesses' accounts did not agree, and that what Saenz was seen doing was measuring bleach for cleaning. He suggested that chlorine in the clinic's water was to blame and cited a 1996 outbreak at a dialysis center in Brazil caused by contaminated water. In court motions he argued that chest pain and cardiac arrest are not specific signs of bleach in the blood.
Witnesses over the next four weeks included clinic staff, patients, police and scientists. A former patient care technician testified that she watched her patients closely and would have noticed if one were given bleach; under cross-examination she agreed that she had been watching her patients at the times the two patients fell ill on April 28. A nurse supervisor described the April 16 emergency and the April 26 illness of another patient, who testified that she felt pain unlike anything she had known and had asked Saenz what she had been given. Defense experts testified that the patients' chronic illnesses explained their decline, and a forensic pathologist who had not examined the patients testified that the deaths were natural.
Judge Bryan refused to let the defense put before the jury a May 2008 federal health report critical of DaVita, which cited 19 deaths at the clinic from December 2007 to April 28, 2008, against 25 in all of 2007, and missing adverse-occurrence reports. He also kept out testimony about the shredding of documents and unsanitary conditions. The appeals court later upheld those rulings because none of the evidence was tied to the patients in the case.
The jury, 12 jurors and three alternates, deliberated for about 14 hours over two days. On Friday, March 30, 2012, Judge Bryan read the verdict: guilty of capital murder and of three counts of aggravated assault. Saenz gasped. The jury acquitted her on the two remaining assault counts. The Fourth Court of Appeals later noted that the convictions were on counts where Saenz had direct contact with the patient and where blood tests supported bleach exposure, and the acquittals on counts where the court found no documented contact or scientific link, or where another cause was possible.
The capital murder charge did not require the jurors to agree on which of the five named patients Saenz had killed, only that she had caused the deaths of at least two of them. That point became the main issue on appeal.
One of the patients she was convicted of harming, who had no memory of what happened to her, said the verdict gave her relief and a sense of closure. The lead detective was emotional after the verdict was read. Saenz was held over the weekend for the punishment phase.
The punishment hearing began on Monday, April 2. The prosecution introduced photographs of the victims and evidence of her drug history, her firing from the hospital, an attempt to fake a required urine test, and a 2009 job application on which she claimed years of work at a non-medical business and left out her nursing jobs. The defense called nine witnesses, among them her daughter's school principal, who said she hoped the girl would be able to have contact with her mother, and a retired Texas prison official who described life for a woman serving life without parole. Asked by her lawyer Steve Taylor whether she would leave prison only in a box, he answered, "Yes, sir."
Taylor told the jurors that she would never be released whatever they did. Herrington did not explicitly ask for death. He told the jury that the victims "went in for medical treatment to try to prolong their lives" and that the only thing they had done wrong was to trust the defendant.
The jury deliberated about 45 minutes and chose life without parole. The court added three 20-year terms for the aggravated assaults. Had the jury chosen death, she would have been the tenth woman on Texas death row, the AP noted.
Six women from the victims' families then addressed her. Thelma Metcalf's daughter called her a psychopathic serial killer and said she hoped she would burn in hell; she told a reporter she had hoped for the death penalty but was all right. Clara Strange's granddaughter told Saenz that her duty as a Christian was to forgive her, and that she would go home that night to her own children while Saenz would not. Saenz showed no emotion and wrote on a legal pad while they spoke. She left the courthouse without speaking to reporters, and her husband said she would appeal.
The U.S. attorney for the Eastern District of Texas, John M. Bales, joined Herrington in praising the agencies that had worked on the case. An official of the HHS inspector general's office said there were no winners. DaVita said it was grateful that justice had prevailed and maintained that its own conduct had not caused any patient's death.
Saenz appealed to the Fourth Court of Appeals in San Antonio with 21 points of error. Her new lawyer, Robert Morrow, argued that the jury charge was wrong, that the evidence was insufficient, that her trial lawyers had been ineffective, among other things for not seeking a mistrial over a juror said to have slept, and that the trial judge had wrongly excluded defense evidence and admitted the 3-chlorotyrosine testimony. The court heard argument on November 18, 2013.
On January 22, 2014, a panel of Chief Justice Catherine Stone and Justices Marialyn Barnard and Patricia O. Alvarez affirmed. It held that the jury had not needed to agree on which victims were killed, that the eyewitness accounts, the biomarker results and the expert testimony were legally sufficient, that the defense had offered nothing linking an alternative suspect it pointed to with the crimes, and that the biomarker evidence was reliable enough to admit. Any doubt about Sochaski's qualification to rule out natural causes was harmless, the court said, because Schwartz, a physician, had done so independently.
The Texas Court of Criminal Appeals agreed to review the unanimity question. On December 10, 2014, in an opinion by Judge Womack, it held that the jury charge was wrong. The prosecutor had told the jurors that they did not "have to agree as to which two," and the court said there was "no requirement that the jurors agree on any one specific murder," so her right to a unanimous verdict had been violated. Because her trial lawyers had not objected, the question was whether the error caused egregious harm, and the court sent the case back to San Antonio to decide that. One judge dissented and another concurred only in the result.
On August 26, 2015, in an opinion by Justice Alvarez, the Fourth Court affirmed again. It found that the charge and the closing argument pointed toward harm, but that the state of the evidence weighed heavily the other way. Saenz had direct contact with all five patients, the defense had been all or nothing, and the jurors' verdicts on the assault counts showed that they had rejected it. The record, the court said, "clearly supports that any of the five victims could have served as the predicate murder." It concluded that the missing instruction had not affected the very basis of the case. The Court of Criminal Appeals then declined to review the case again. Herrington, by then retired as district attorney, said he was relieved.
In a letter posted in May 2012 on a website run by her supporters, Saenz asked for prayers that her appeal would move quickly through the courts. Her former appellate lawyer said in 2018 that he no longer represented her and that she maintained her innocence.
After sentencing she was taken to the Angelina County jail to await transfer to the Texas Department of Criminal Justice. During her first appeal she was held at the Lane Murray Unit in Gatesville, and The Lufkin News reported in July 2018 that she was serving life without parole at the Mountain View Unit. Her sentence of life without parole carries no parole eligibility. No later change in her status has been reported.
Ten years after the deaths, Herrington, by then a judge, told The Lufkin News that he had at first been slow to believe the accusations and that DaVita had naturally suspected its procedures or medicines before a member of staff. In 28 years as a prosecutor, he said, it was the only capital murder case he tried with multiple victims. He still had no full explanation of her motive, and he noted that some of the victims had been doing well before they died. Deaton, her trial lawyer, called it the hardest case he had ever tried. Saenz and her family did not respond to the paper's request for comment.
Motive. No court found a motive, and none was needed for the verdict. Herrington spoke of frustration, depression and a dislike of some patients; the defense said she had no motive at all.
Other deaths. Herrington said in 2012 that he believed there were more victims than those charged, and that a CDC epidemiologist's analysis linked Saenz more than any other DaVita employee to adverse events going back to 2007. Police could obtain medical waste only from the two weeks before April 28, so there was not enough evidence to charge anything earlier. No other death has been charged against her.
The clinic. The defense case, that bleach and chlorine were everywhere in a poorly run clinic and that she was blamed for its failures, was rejected by the jury, and the excluded federal report never reached it. The state's 2008 survey findings on the clinic's death rate and record keeping are matters of public record; they do not show that anyone other than Saenz caused the deaths in the case.
How many deaths the verdict covers. Because the jurors were told they need only agree that she caused at least two of the five deaths, the verdict does not show which of the five each juror relied on. The appeals court held in 2015 that the evidence supported any of the five, and press reports describe her as convicted of killing five patients; the verdict itself establishes at least two.
November 2004: Texas licenses Saenz as a vocational nurse.
August 2005: accused of stealing Demerol at a Lufkin hospital; later fired from that job.
June 2007: her husband files for divorce and obtains an emergency protective order; the couple later reconcile.
Before April 2008: after 10 weeks of dialysis training she works at the DaVita clinic in Lufkin, about eight months in all by April 2008.
April 1, 2008: Clara Strange and Thelma Metcalf die after cardiac arrest at the clinic.
April 2, 2008: searches for "bleach poisoning" on a computer she used.
Mid-April 2008: a fire department official's anonymous letter asks state inspectors to look at the clinic.
April 16, 2008: Garlin Kelley collapses; he later dies.
April 22, 2008: Cora Bryant collapses; she dies July 15, 2008.
April 26, 2008: Opal Few dies.
April 28, 2008: with inspectors present, two patients report seeing Saenz give bleach to two others; she is sent home and the clinic closes.
April 29, 2008: DaVita fires her.
May 3, 2008: further searches on detecting bleach in dialysis patients.
May 14, 2008: Board of Nursing suspends her license.
May 30, 2008: arrested on two counts of aggravated assault; bond posted June 2.
July 2, 2008: the clinic reopens under state monitoring.
January 12, 2009: she surrenders her nursing license.
By April 1, 2009: indicted for capital murder (five named victims) and five counts of aggravated assault; pleads not guilty at arraignment in April.
By July 16, 2009: prosecutors have announced they will seek the death penalty.
March 5, 2012: trial opens in Lufkin.
March 30, 2012: convicted of capital murder and three counts of aggravated assault; acquitted of two.
April 2, 2012: sentenced to life without parole and three 20-year terms.
November 18, 2013: appeal argued in San Antonio.
January 22, 2014: Fourth Court of Appeals affirms.
December 10, 2014: Court of Criminal Appeals finds jury-charge error and remands.
August 26, 2015: Fourth Court affirms again, finding no egregious harm.
After August 2015: Court of Criminal Appeals declines further review.
July 15, 2018: reported serving life without parole at the Mountain View Unit.