Richard Angelo was a 25-year-old nurse from Lindenhurst, Long Island, when Suffolk County prosecutors charged him in November 1987 with injecting patients at the hospital where he worked with a paralyzing drug. The patients went into respiratory failure. Angelo, according to the district attorney, would then be the first to arrive when the emergency was called and would lead the effort to revive them. He told investigators he wanted to be a hero. Some of the patients could not be saved.
He had worked as a nurse at Good Samaritan Hospital in West Islip since April 6, 1987, mostly on the overnight shift in intensive care. On a night in October a patient who survived told staff that he had seen a man put something into his line. Tests later showed a drug in his system that no doctor had ordered. Angelo was suspended the next day and arrested in mid-November. Bodies were exhumed, tissue was tested, and in December 1989 a jury in Riverhead convicted him over the deaths of four patients and of assault on others. In January 1990 he was sentenced to 61 1/3 years to life, a term state law limits to 50 years to life. The New York Court of Appeals upheld the verdict in 1996.
United Press International described him in November 1987 as short, heavyset and bearded. He lived in Lindenhurst, in a rented apartment, and was a volunteer paramedic with the Lindenhurst Fire Department. He was the only child of two former schoolteachers who had retired to Florida.
After his arrest his father told UPI that his son had been an Eagle Scout and an altar boy, and that the charges did not match the person he had raised. "It just doesn't fit into the type of person he's been," his father said. His parents said they were standing by him.
Before he joined Good Samaritan, Angelo had worked at two other Long Island hospitals, in Amityville and in East Meadow. In November 1987 prosecutors said they had opened inquiries into his time at both.
Angelo started at Good Samaritan on April 6, 1987. By the autumn he was working nights in the intensive care unit. UPI, quoting the authorities in January 1988, gave his shift as midnight to 8 a.m.; the prosecution at trial put the deaths it charged in the 11 p.m. to 7 a.m. shift, when he was assigned to the unit. Co-workers, according to UPI, had a nickname for him: the "Angel of Death."
The four patients whose deaths were later tried had all been improving, prosecutors told the jury, before each went into respiratory failure in September or October 1987. They were John Fisher, 75; Milton Poultney, 75; Anthony Green, 57; and Frederick LaGois, 60.
Frederick LaGois lived in West Babylon. He was in the hospital for elective surgery and died on October 9, 1987, the night before the operation was scheduled.
In the early morning of October 11, 1987, at about 6 a.m., a 73-year-old cardiac patient told hospital staff that a man had injected something into his intravenous tubing. He described the man as bearded and heavily built and said he wore a white coat. He said he saw a needle, looked away, and almost at once felt his body changing. He needed resuscitation, responded well, and went home four days later with no lasting harm, the hospital's president said.
Angelo was the only nurse on duty who fit the description. Prosecutors later said Angelo had helped to revive the man. A supervising nurse questioned Angelo, who denied it. An internal review found no immediate evidence to support the patient's account, but Daniel Walsh, the hospital's president and administrator, said there was "sufficient doubt and concern" to suspend Angelo with pay and to report the incident to state health authorities. Angelo was suspended on October 12 and did not work again.
The day after the incident a check found that a vial of Pavulon was missing from a nursing unit. Walsh described Pavulon as a drug that paralyzes the diaphragm, used when patients have to be ventilated by machine. On November 3 the results of blood and urine tests on the patient came back positive for Pavulon. No one had prescribed it for him.
The district attorney's office was not told until November 3, weeks after the incident, UPI reported. District Attorney Patrick Henry said hospital officials "apparently didn't understand what was going on over there."
The case became public in mid-November 1987. On November 15 UPI reported from West Islip that Suffolk County police wanted to question Angelo and that he had left his apartment. Walsh said the hospital was reviewing every case in which a patient had needed emergency resuscitation or had died during Angelo's shifts since April 6, and that it had given the authorities records of at least ten patients who may have received medication they should not have had. He would not say how many had died. "This could be a multiple-death case," Henry said. He did not rule out exhumations.
Police searched for 48 hours. They found Angelo on a Sunday at a paramedics' conference at a hotel in Albany. He returned to Long Island voluntarily and was arrested that night.
Angelo made written and videotaped statements to investigators. According to Henry, Angelo said he would inject a patient during the overnight shift, wait until the patient's breathing became labored and a "Code 1,000" was called, and then rush in to lead the resuscitation. "He would be the first one on the scene to resuscitate," Henry said. The district attorney said Angelo had felt inadequate and wanted to stand out among the other nurses. Angelo also said he had been "experimenting" with the drugs, a remark Henry did not explain.
Henry named two drugs: Pavulon and Anectine, both of which can kill. He said Angelo had seemed remorseful during questioning and "might not have wanted the patients to die." UPI reported on November 19 that Angelo had confessed to injecting more than ten patients.
A confession was not enough to charge murder. Henry said Angelo's own statements could not by themselves support a murder charge. "We have to prove there was a crime, and we have to produce a corpse," said Edward Jablonski, chief of the district attorney's homicide bureau.
At his first court appearance, on a Monday in mid-November in Hauppauge, Angelo faced a charge of assault in the first degree over the injection of the 73-year-old visitor. He had no lawyer. Judge Wallace Boyle of the First District Court entered a plea of not guilty for him, advised him to find counsel and ordered him held without bail at the Suffolk County jail in Riverhead until a hearing later that week. The patient he was accused of injecting had by then gone home and told a grand jury what happened.
On November 19, 1987, a Suffolk County grand jury indicted Angelo on first-degree assault charges involving that patient, and he was due to be arraigned in Suffolk County Court in Riverhead the next morning.
Bail was later set at $50,000. His lawyer said in January 1988 that Angelo could make bail but would stay in custody because he feared for his safety after the publicity.
To bring murder charges, prosecutors needed the drug in the bodies of patients who had died. On November 19, 1987, gravediggers began exhuming the first of seven former patients who had died in the hospital's intensive care unit between June 28 and October 11. Frederick LaGois was among the first two. Caskets were opened and photographed to confirm identities, and the remains went to the county medical examiner's office for testing for Pavulon and Anectine. "We are trying to get to all of these today," said Rick Lazio, the assistant district attorney working on the case.
The tests were slow and uncertain. Leo Dal Cortivo, director of laboratories at the medical examiner's office, said there was "no way of predicting" how long the work would take. Tissue would go through several tests, he said, water was "the nemesis," and there was "always the possibility" that the drugs had broken down and could no longer be found.
By January 1988 twenty bodies had been exhumed, and tissue from nineteen patients other than LaGois was still being tested for Pavulon. Testing for Anectine was put off until the Pavulon work was finished. Lazio said there could be as many as ten more exhumations. In the end investigators exhumed 33 patients who had died in suspicious circumstances during Angelo's time at the hospital, and Pavulon was found in six of them, according to the Deseret News report of his sentencing.
The first result came on January 6, 1988. Charles Hirsch, the Suffolk County medical examiner, said tests had "conclusively demonstrated the presence of Pavulon" in the organs of Frederick LaGois and that his death was a homicide. Authorities said Angelo had confessed to injecting him. Henry said he was "optimistic" that the drug would be found in other patients and said he believed Angelo was responsible for more than ten deaths. At that point Angelo faced only assault charges: the one already brought over the surviving visitor, and two more, not yet presented to a grand jury, over patients who had recovered.
On January 13, 1988, UPI reported that a grand jury had indicted Angelo on charges of murder in the second degree and assault in the first degree in the death of Frederick LaGois. Prosecutors said they would seek a second murder indictment, in the death of Milton Poultney, 75, after the medical examiner found Pavulon in his body and ruled his death a homicide. They said Angelo may have injected as many as 30 patients with Pavulon or Anectine so that he could revive them and look like a hero. Tests on eighteen more exhumed bodies were still under way.
The trial opened in Suffolk County Court in Riverhead in October 1989. Angelo was 27. The four patients whose deaths were before the jury were Fisher, Poultney, Green and LaGois. UPI reported the charges at the opening as murder in the second degree and three counts of assault: one for a patient who was revived and two for patients who were given the drug but whose deaths were put down to other causes.
In his opening statement Assistant District Attorney John Collins described Angelo as a killer dressed in a nurse's whites who had experimented on helpless patients to build his own reputation. He cited Angelo's statement that he gave the drug in the hope of reviving the patients and being seen as a hero. Collins asked the jurors to imagine being unable to scream or to control their own breathing. All four patients, he said, had been getting better in a special care unit when they went into respiratory failure in September and October 1987, and every death came during the 11 p.m. to 7 a.m. shift, when Angelo was assigned to the unit.
The defense did not dispute the injections. Eric Naiburg, Angelo's lawyer, told the jury that Angelo had given the drug to several patients without medical authority and that some of them may have died from it. The question, he said, was whether Angelo had acted with "depraved indifference to human life," the state of mind that New York law requires for this kind of second-degree murder. The jury would hear from a defense psychiatrist and a psychologist about how Angelo's mind worked.
Angelo did not raise an insanity defense. His lawyers argued instead that he suffered from a dissociative disorder that kept him from recognizing the grave risk of death his actions created, so that he lacked the mental state the murder counts required. The defense psychiatrist wanted to tell the jury that his opinion rested partly on a polygraph examination of Angelo. In that test Angelo said he had not been present when any patient died, although he had been present at one death at least. The trial court would not allow the psychiatrist to rely on the polygraph.
On December 14, 1989, the jury returned its verdict. It found Angelo guilty of two counts of murder in the second degree under the depraved indifference theory, one count of manslaughter in the second degree, one count of criminally negligent homicide, and six counts of assault concerning five patients, according to the Court of Appeals. The four homicide verdicts covered the four deaths. The Deseret News reported that he was also convicted of assault over the patient who survived.
The verdict was a mixed one. On two of the deaths the jury accepted that Angelo had acted with depraved indifference. On the other two it returned lesser homicide verdicts: manslaughter in the second degree on one, criminally negligent homicide on the other.
Judge Tisch sentenced Angelo in Riverhead in January 1990. The sentences added up to 61 1/3 years to life, the judge said, but state law limited the time Angelo could serve to 50 years to life. The Deseret News called it the maximum sentence.
Angelo stood before the judge without visible expression, UPI reported, now and then biting his lip. No statement from him was reported. "During my many years on the bench, I've heard many stories of horror, but this is at the top of the list," Tisch said. "The course of conduct taken by this defendant gives new meaning to the concept of depraved indifference." He told Angelo, according to the Deseret News: "You had no right to usurp God's function."
The Appellate Division affirmed the conviction and the sentence. The New York Court of Appeals, the state's highest court, granted leave to appeal. On March 28, 1996, in People v. Angelo, it affirmed in an opinion by Judge Levine, with Chief Judge Kaye and the other five judges concurring.
The court described the case as arising from the unauthorized injection of seven patients with a neuromuscular blocking agent, a drug that causes respiratory distress. Six of the seven died of respiratory failure. Angelo had not denied the injections.
The appeal turned on the polygraph. Angelo argued that the trial court had wrongly kept his psychiatrist from relying on it. The Court of Appeals disagreed. The rule that governs expert evidence in insanity cases did not apply, it said, because Angelo had not pleaded insanity; he had offered psychiatric evidence to negate an element of the crime. Under New York's common law, an expert may rely on material from outside the courtroom only if it is accepted as reliable in the profession or comes from a witness who can be cross-examined. Both routes required general scientific acceptance, and polygraph results had not been shown to have it. The defense could not get around that by saying the test's validity was not at issue, the court held, because the test was offered to show that Angelo was being honest, and its worth depended on whether it was reliable.
The court found that Angelo's claims under the federal and state constitutions had not been raised at trial and so were not preserved, and that his complaint about the lack of a hearing on the science had not been preserved either, since his lawyers had not asked for one. It also rejected his challenge to the annotated verdict sheet the jury used. Sending such a sheet to the jury without the defense's consent is an error, the court said, but here defense counsel had reviewed and approved it.
When the Court of Appeals ruled in March 1996, Angelo's conviction and his sentence of 61 1/3 years to life, limited by law to 50 years to life, stood.
How many patients Angelo harmed has never been settled in court. The convictions cover four deaths and assault on five patients. Beyond those, the figures came from officials while the case was being built, and they changed as it went on.
In November 1987 the hospital gave the authorities records of at least ten patients who may have received medication they should not have had. UPI reported the same month, attributing it to unnamed sources in New York Newsday, that records for 37 patients who had problems on Angelo's shifts over two months had gone to the medical examiner, and that ten of those deaths were classed as "irregular." In his own statements, as UPI reported them, Angelo said he had injected more than ten patients. In January 1988 the district attorney said Angelo was responsible for more than ten deaths and authorities said he may have killed as many as ten. A week later prosecutors said he might have injected as many as 30.
The medical evidence set the limits. Of 33 exhumed patients, Pavulon was found in six, according to the Deseret News. The Court of Appeals described seven patients injected, six of whom died. Prosecutors at trial told the jury that two of the patients named in the assault counts had been given the drug but that their deaths had been attributed to other causes. No other deaths at the hospital were charged.
Any further deaths during Angelo's months at Good Samaritan, and any harm at the hospitals where he worked before, remain suspected only. No death beyond the four covered by the verdicts was charged as a homicide.
April 6, 1987: Angelo starts work at Good Samaritan Hospital, West Islip.
June 28 to October 11, 1987: the period in which seven patients later exhumed in November had died in the intensive care unit.
September and October 1987: John Fisher, Milton Poultney, Anthony Green and Frederick LaGois die after going into respiratory failure.
October 9, 1987: Frederick LaGois dies, the night before his scheduled surgery.
October 11, 1987: at about 6 a.m., a 73-year-old visiting cardiac patient reports that a man injected something into his line; he is revived.
October 12, 1987: Angelo is suspended with pay; a vial of Pavulon is found missing.
November 3, 1987: tests on the surviving patient show Pavulon; the district attorney's office is told.
Mid-November 1987: police search for Angelo for 48 hours; he is found in Albany, returns to Long Island and is arrested on a Sunday night; arraigned on the Monday on a first-degree assault charge and held without bail.
November 19, 1987: exhumations begin; a grand jury indicts Angelo on first-degree assault charges over the surviving patient.
January 6, 1988: the medical examiner rules the death of Frederick LaGois a homicide.
January 1988: Angelo is indicted for second-degree murder in the death of LaGois; prosecutors seek a second murder indictment, over Milton Poultney.
October 1989: trial opens in Suffolk County Court, Riverhead.
December 14, 1989: the jury convicts Angelo of two counts of second-degree murder, one of second-degree manslaughter, one of criminally negligent homicide and six counts of assault.
January 1990: Judge Alfred Tisch sentences him to 61 1/3 years to life, limited by law to 50 years to life.
March 28, 1996: the New York Court of Appeals affirms the conviction.