In the winter of 2000 and 2001, patients at Nocona General Hospital, a small hospital in a North Texas town of about 3,200 people, began to stop breathing in the night. Deaths in December and January ran at about twice the usual level, hospital officials later said, and nearly all of them, according to later lawsuits, happened on the night shift. Vials of a paralytic drug called mivacurium chloride, used to stop a patient's breathing for a short time so a breathing tube can be inserted, were reported missing from the hospital's emergency carts.
The nurse on duty for most of those deaths was Vickie Dawn Jackson, a licensed vocational nurse who had grown up in Nocona and was known there as a quiet, dependable caregiver. She was fired in February 2001 and indicted for capital murder in July 2002. In October 2006, as her trial was about to begin in San Angelo, she pleaded no contest to capital murder in what news reports described as the deaths of ten patients, and a judge sentenced her to life in prison. She has never admitted guilt. Investigators have suggested that she may be linked to as many as 24 deaths at the hospital, a figure no court has tested.
The fullest account of Jackson's life comes from the Texas Monthly writer Skip Hollandsworth, who interviewed her in jail and in prison and spoke with her relatives and with the families of the patients. He reported that she was 34 in December 2000. Her family moved to Nocona from Indiana in the early 1980s, when she was 15, so that her younger brother, who had asthma, could live in a drier climate. Her father worked for himself as an auto mechanic, and her mother cooked, often on double shifts, at the Nocona Nursing Home.
Vickie went to work after school in the nursing home's laundry and was promoted to nurse's aide in her junior year of high school. She told Hollandsworth that she had decided to become a nurse after watching her great-grandmother die and after reading about Florence Nightingale. "I want to devote my life to helping people," she remembered telling herself.
In her junior year she married a construction worker five years older than she was, before a justice of the peace; they divorced within a year. She graduated from high school in May 1984 and was pregnant within six months. In May 1985 she married a self-employed mechanic. They had a son and, in 1986, a daughter. She started nursing school part time in 1988, became a licensed vocational nurse in 1989, and that year was made the night-shift nurse at the Nocona Nursing Home. She and her second husband separated in 1994 and divorced about two years later.
In May 1997, at a country dance hall outside town, she met Kirk Jackson, 31, a nursing home aide from St. Jo. They married on July 4, 1997, at a park near Lake Nocona. When he was hired as a night-shift nurse's aide at Nocona General Hospital, she took a job there as a licensed vocational nurse.
By Hollandsworth's account the marriage soon came under strain. In late 1999 her son moved in with his father, and her daughter followed a few months later. A judge ordered Jackson to pay her former husband $300 a month in child support. She saw a counselor in Bowie, whose notes, as Hollandsworth reported them, described her as feeling "rejected and unloved" and recorded tearfulness that alternated with irritability and rage.
Her daughter, then 14, told Hollandsworth that her mother once said she might be bipolar and, asked what that meant, answered, "It means I could kill you and get away with it." The daughter said she began sleeping with a baseball bat beside her bed. In February 2005, shortly before the first trial date, the daughter told reporters that her mother had been angry and verbally abusive at home while others saw her as caring and compassionate. "I don't know if she did it or not, but she's perfectly capable of it," she said.
Jackson denied to Hollandsworth that anything in her life had made her angry enough to kill. "I would never kill anyone, Mr. Hollandsworth," she told him.
Nocona General was among the smallest hospitals in Texas, Hollandsworth wrote: a single hallway of 18 rooms that rarely held more than 15 patients. The Associated Press described it in 2002 as a 38-bed hospital. Its administrator in 2000 and 2001 was Charles R. Norris, and its director of nursing was Barbara Jean Perry, according to the federal appeals court that later heard the families' lawsuits. A handful of doctors practiced there, among them the chief of staff, Dr. Len Dingler, and his brother, Dr. Chance Dingler.
The night shift was small, and Jackson knew many of the patients. Most of the people who came into the hospital that winter were townspeople, often elderly, admitted for problems that were not expected to kill them. In 2000, the director of nursing later said, the hospital had received no complaints from patients about Jackson's manner or her skills.
The first death that law enforcement officials later put in the series, Hollandsworth reported, was that of Donnie Jennings, 100, a widow, who was found dead at about 1:45 a.m. on December 11, 2000. Law enforcement gave December 11 as the start of the period they investigated.
Seven patients died of respiratory arrest at the hospital in December alone, according to Hollandsworth. Those he named included Elgie Hutson, 87, a farmer who had come in with a broken leg, and Sanford Mitchell, 62, a retired supervisor for an electric company; both died on December 20. On December 24 Boyd Bruce Burnett, 87, who had been admitted because he felt disoriented, died. Barbara Atteberry, 50, had been admitted for back pain. Hollandsworth placed her death on December 24; the timeline in the federal appeals court's opinion says she was given the drug on December 24 and died on December 30 at another facility. On December 29 James Gore, 80, admitted after he had inhaled food, died, and Gertie Matthews, 79, died about seven hours later.
No one at the hospital treated the deaths as suspicious. The chief executive, Charles Norris, later testified that he had not believed anything abnormal was happening, given the patients' ages and the higher death rate in winter. Dr. Chance Dingler testified that he had assumed the hospital was having a run of bad luck. Some nurses, Hollandsworth wrote, joked among themselves that the night shift was the "killing crew," and one noticed that Jackson was often the last staff member to see the patients who died. In January the hospital ran a nearly full-page advertisement in the Nocona News praising its nurses, with Jackson's photograph at the top.
The deaths continued into the new year. Hollandsworth reported that five more patients died of respiratory arrest in the first eight days of January. The appendix to the federal appeals court's opinion, which set out the families' allegations in date order, lists Dorothy Jean Vanderburg as having been given the drug and dying on January 6, and Jimmy Ray Holder and Alma Dixon as dying on January 7. Hollandsworth wrote that Holder's wife was sitting beside him.
On January 11, J.T. Nichols, 82, a retired machinist admitted with pneumonia, and John Walter Williams, 78, a retired rancher and oilman who had come in with a sore on his foot, were both found dead. Oma Wyler, 95, died on January 24, 2001, according to CBS News; her doctors at first attributed her death to natural causes. In the account Hollandsworth drew from investigators, she had stopped breathing once in mid-January and been revived, and she died four days later. "I'm still mad, I'm just so angry that someone could have done that," her daughter told CBS News in June 2001.
William Griffin, according to the court's appendix, was given the drug on January 24 and died on January 30. On the night of January 30 and the morning of January 31, several patients went into respiratory arrest within a short time of one another. A teenage patient was revived, and another patient was put on a breathing machine in time and survived. Donna Sue Curnutte, 46, never regained consciousness; the court's appendix gives the date she was given the drug as January 31 and the date of her death as February 19.
The drug at the center of the case was kept on the hospital's emergency carts. According to the families' complaints, as summarized by the federal appeals court, mivacurium, sold under the brand name Mivacron, was found missing from the hospital's crash carts, the movable carts of emergency supplies, about ten times between November 23, 2000, and January 30, 2001. Each time it was replaced from the pharmacy's stock.
On January 30 the pharmacist began looking for the missing drug, and the hospital opened an internal investigation. After the arrests of January 30 and 31, Hollandsworth wrote, a pharmacy technician asked Dr. Len Dingler whether it mattered that vials of mivacurium chloride were missing from one of the crash carts. In early February, according to the families' complaints, hospital managers realized that 22 of the 23 deaths at the hospital since November had happened on the night shift, and that Jackson had been on duty for most or all of them. The complaints said the death rate was at least double that of the same two months a year earlier. The Associated Press reported in 2002 that hospital officials had noticed the deaths in December and January ran at twice the normal level and traced them to the same shift.
On February 4, 2001, Everett Ethridge Jackson, 91, known as "Preacher," who was Kirk Jackson's grandfather, died. He had been admitted with a high fever and cellulitis, and Vickie Jackson told the staff that he had died. Hollandsworth reported that Kirk went outside and wept, and that Vickie brought potato salad to the reception after the funeral.
On February 6, 2001, hospital officials notified law enforcement. Hollandsworth reported that Norris met that day with Nocona's police chief, Kent Holcomb, who called in the Texas Rangers and the FBI. On February 8 the pharmacist reported to the Texas State Board of Pharmacy the loss or theft of at least ten vials of Mivacron.
With no physical evidence, the police set up a hidden camera aimed at the hospital's supply of the drug. In mid-February the night shift held a birthday party for Jackson. A few days later, on February 17 or 18 (the sources differ on the date), a patient on her shift was found unable to breathe and was resuscitated. He later told doctors that a nurse with blond hair had come in and given him something, and had smiled and asked whether she could do anything else for him. The court's appendix says that as a result of this incident Jackson "is caught." Law enforcement treated February 18, 2001, as the end of the period it investigated.
Two days after that incident, officers found a syringe in a garbage can at the Jacksons' home. Tests found traces of mivacurium chloride in it. Both Vickie and Kirk Jackson said they had no idea how it had got there. The hospital fired both of them; the court's appendix gives the date as February 20, while the hospital's chief executive in 2002 said Jackson had not worked there since February 21. Police did not treat Kirk Jackson as a suspect: as an aide he was not allowed to handle medication, and he had not been working during some of the deaths. The hospital's administrator described his firing as being in the hospital's best interest.
In June 2001 investigators began exhuming patients who had died at the hospital, under court orders, to test their bodies for the drug. CBS News reported that month that investigators suspected 23 deaths might have been poisonings, that Jackson had been on duty for 22 of them, and that at least 11 more exhumations were planned. Mivacurium is very difficult to detect, CBS reported, and the FBI estimated that it could take up to a year to learn whether the patients had died of natural causes. The Associated Press reported in July 2002 that ten bodies, chosen as the best candidates for autopsy, had been exhumed in June 2001, and that the authorities had not yet said whether the drug had been found in any of them.
Jackson declined interviews. Hollandsworth, who went to Nocona in the spring of 2001 to try to speak with her, said she also turned down network television crews.
Jackson stayed in Nocona for the next year and a half. She went on ordering her taco basket at the Dairy Queen, Hollandsworth wrote, and went back to dancing at the hall where she had met her husband. Kirk Jackson left town. She took a job as a vocational nurse at a nursing home in Gainesville and was fired within weeks, after administrators there suspected that she had tried to steal medication; Hollandsworth said investigators saw the attempt as a possible sign that she meant to kill again. She then worked in the deli of a grocery store in Bowie.
The families of patients who had died began going to court. By July 2002, the Associated Press reported, Jackson had been named in civil lawsuits on behalf of two former patients.
On July 16, 2002, a Montague County grand jury indicted Jackson on two counts of capital murder. Each count involved the deaths of two patients, Police Chief Kent Holcomb told the Associated Press. Under Texas law, capital murder can be charged when two or more people are killed in the same criminal transaction. She was arrested at the grocery store in Bowie immediately after the indictment and was held in the Montague County jail on $2 million bond. The Associated Press said the charges were the first in an investigation, then about 18 months old, into the deaths of at least two dozen people at the hospital. The hospital's chief executive at the time, Michael R. Graham, called the indictment "a very healthy first step" toward finding out what had happened.
Three days later, on July 19, 2002, a grand jury in neighboring Cooke County indicted Jackson for theft of property worth between $1,500 and $20,000, a state jail felony. She was accused of taking $5,000 in cash from her employer, a retail store. The 235th District Court appointed a lawyer, James Martin, to represent her in that case alone. On August 23, 2002, she pleaded guilty and received the one-year state jail sentence that prosecutors had offered.
Her lawyers in the capital cases, Bruce Martin and Michael Curtis, asked for a new trial in the theft case. They argued that the plea had not been knowing and voluntary and that her theft lawyer had failed her by not warning her what a felony conviction would mean for the murder charges: with that conviction on her record, she could never ask a jury for probation. At a hearing on October 29, 2002, James Martin testified that he had known of the capital charges but had never advised her about the consequences, and that looking back he would have advised against the plea; he also said the evidence of theft was overwhelming. The Montague County district attorney, Tim Cole, testified that a reasonable lawyer probably would not have made that plea. Jackson did not testify, and her own affidavit was not offered in evidence. The trial court denied the motion.
On June 3, 2004, the Second Court of Appeals in Fort Worth affirmed the theft conviction. Justice Anne Gardner, writing for the court, held that the trial lawyer's performance had fallen below the required standard, because the bar on seeking probation was a direct consequence of the plea. But Jackson had not shown that she would have gone to trial if she had been properly advised, because she had offered no evidence of it: her affidavit had never been introduced, and she had not testified. The decision is reported as Jackson v. State, 139 S.W.3d 7.
In January 2004 a Montague County grand jury returned a new indictment. The Associated Press, in a report printed by the Deseret News, said it accused Jackson, then identified as Vickie Dawn Carson Jackson, of killing six more people and injuring a disabled man in her care. It charged three counts of capital murder, each alleging two deaths on a single occasion in 2000 or 2001, plus one count of attempted murder and one count of injury to a disabled person. She was already awaiting trial on the two earlier counts, which covered the deaths of four patients, and her bond now stood at $6 million. News reports later described the capital case as covering the deaths of ten patients.
In January and February 2003 relatives and representatives of eleven patients who had died, and of one surviving patient who was a minor, sued in federal court. They named Jackson, the hospital, its administrator, its director of nursing and others. Their claim, under the federal civil rights statute, was that Jackson had deprived the patients of their lives by giving them Mivacron, and that the administrator and the director of nursing had been deliberately indifferent to the missing drug and the rising deaths. The deceased patients named in the suits included Barbara Atteberry, Boyd Bruce Burnett, Dorothy Jean Vanderburg, Jimmy Ray Holder, Alma Dixon, J.T. Nichols, John Walter Williams, William Griffin, Donna Sue Curnutte and Everett Ethridge Jackson. The complaints alleged that the drug had been used to kill as many as 22 patients between November 2000 and February 2001.
The administrator and the director of nursing asked to have the claims against them dismissed on grounds of qualified immunity. A federal district court in the Northern District of Texas refused in September 2004, and on November 3, 2005, the U.S. Court of Appeals for the Fifth Circuit affirmed. Chief Judge King, writing for a panel that included Judges Barksdale and Clement, held that the families had pleaded enough to claim deliberate indifference, and that the conduct they alleged would not be protected by qualified immunity at that early stage. The court was ruling only on the pleadings and treated the families' allegations as true for that purpose; it made no finding about what had happened. Hollandsworth reported that many families also sued the hospital and its doctors for negligence.
Jackson's trial on the first two capital counts was set for February 2005 in Montague County, where jury selection was to begin that week, according to a report in the Southeast Missourian. At that point she was 38 and faced up to life in prison if convicted. The trial did not go forward then. Later in 2005, the Associated Press reported, the case was moved to San Angelo, about 330 miles southwest of Nocona, because of heavy publicity in North Texas. The delays were blamed partly on budget problems and partly on the difficulty of finding an impartial jury.
The district attorney for Montague, Clay and Archer counties, Jack McGaughey, planned to call 58 witnesses at the San Angelo trial, which was expected to last through the end of October 2006. Prosecutors were not seeking the death penalty, so a conviction would carry an automatic life sentence. Hollandsworth suggested that they doubted a jury would sentence to death a woman who had been, by many accounts, a devoted nurse.
On the morning of Tuesday, October 3, 2006, prosecutors received the completed jury questionnaires, and testimony was due to start the following Monday. Instead, Jackson told the court that she wanted to plead no contest to capital murder. "Frankly, I've never been so surprised in a case in my life," McGaughey told the Associated Press.
Her lawyer, Bruce Martin, said she had made the decision because her adult daughter was on the state's witness list. "She has never admitted guilt and she was never convicted by a jury," he said. "And her daughter never had to testify against her. Those things meant something to her."
A plea of no contest is not an admission of guilt, so the state still had to present its case, which it did at a short hearing before State District Judge Roger Towery on Thursday, October 5, 2006. FBI Special Agent David Burns testified that Jackson had become angry with patients when other nurses showed them compassion or joked with them. He said the patients had come in with minor problems, such as a sore on the foot, diarrhea or dementia, and were close to being sent home, which left them anxious and more demanding. In the words of KSWO's report, he speculated that they were "the kind of patients who needed more care," and that this angered her.
Judge Towery sentenced her to life in prison. Jackson showed no emotion. Asked by the judge whether she was giving up her right to appeal and whether she was satisfied with her lawyers, she answered "yes" quietly both times. News reports described the case as the killing of ten patients with a drug that stopped their breathing. One of the patients, KSWO reported, was from Terral, Oklahoma.
After the plea Jackson agreed to talk with Hollandsworth, first at the Montague County jail and later at a state prison near Waco. His article appeared in Texas Monthly in July 2007. He wrote that he did not believe her protestations of innocence, but he gave her account at length.
She insisted that she was innocent and denied that she was the cruel figure the case had made of her. "I spent my whole life trying to be good," she told him. She described two former high school cheerleaders who came to visit a patient while she was working and never acknowledged her. "But they looked right through me," she said. She wrote him letters signed "Respectfully, Vickie Jackson." In their last meeting she blinked back tears and said, "I was a compassionate person." She told him she hoped that one day she might be allowed to work in the prison infirmary.
Others gave a different picture. An inmate who had been held with her in the county jail gave the district attorney an affidavit saying that Jackson had received a package of evidence from her lawyer, including autopsy photographs. When the inmate said the families must be suffering, the affidavit said, Jackson replied, "Screw those families." Kevin Benton, an investigator for the Montague County district attorney, told Hollandsworth, "She didn't try to save anyone at all," and "She wanted people dead. Lots of people." The same inmate told the writer that Jackson had lost weight before the trial date, apparently to look good for the cameras.
No motive was established in court. Agent Burns's testimony at the sentencing hearing was the state's suggestion: that Jackson resented demanding patients who received kindness from others. Hollandsworth, who interviewed relatives of the patients, came to a related view. In an interview published by Texas Monthly, he said that the patients were people Jackson knew, that none were suffering in a way that would make the deaths mercy killings, and that he believed she was taking revenge for slights, real or imagined, that she had suffered in Nocona. He also suggested that she may have enjoyed, for the first time, being noticed. These are his views and the investigators' theory; Jackson has denied the killings, and the question was never tried before a jury.
Years later Jackson went back to court. In a handwritten petition dated March 18, 2014, she asked for a court-appointed lawyer to help her seek DNA testing of the syringe found in the trash at her home. She then filed an application for a writ of habeas corpus in the 97th District Court, seeking a new trial. It was the second time she had asked for an evidentiary hearing, according to KAUZ Newschannel 6.
The hearing took place in the Montague County courthouse on July 9, 2015, before Judge Towery, by then retired. Her lawyer, Julia Bella, called seven witnesses: two lawyers from her former defense team, the man who had been Montague County sheriff at the time of the deaths, Nocona's police chief, the former investigator for the 97th District Court, and a doctor who works with Nocona General Hospital. The witnesses said that the syringe had been tested for the drug and for fingerprints and then destroyed, and that it was never tested for DNA. Bella argued that the syringe had been handled in a way that broke a state law requiring that evidence be kept unless the defendant is given notice, and that a DNA test could have helped prove her client innocent. "Now the judge will determine whether or not, the fact that that has happened entitles her to a new trial," she told KAUZ. The state, represented by District Attorney Paige Williams, asked that the application be dismissed.
Judge Towery asked each side for proposed findings of fact and conclusions of law. Bella filed hers on August 7, 2015, and Williams on August 10, the Bowie News reported. The district attorney said the judge would then prepare his own findings, usually within about 30 days, and send the case to the Texas Court of Criminal Appeals in Austin.
In August 2015 Jackson was serving her life sentence.
How many deaths. News reports describe the plea as covering ten deaths. The Bowie News reported in 2015 that investigators had suggested as many as 24; CBS News reported in 2001 that 23 deaths were under suspicion; the families' lawsuits alleged as many as 22; and Hollandsworth reported that law enforcement believed she had probably killed about ten more patients beyond the ten and had tried to kill five others. None of the additional deaths has been tried, and they are not her proven killings.
Which ten. The ten patients whose deaths the capital charges covered have not been publicly identified. A patient whose death has been tied in reporting to the night shift, or whose family brought a claim, is not thereby shown by any court finding to be one whose death Jackson caused.
Dates. Sources differ on several dates: Barbara Atteberry's death (December 24 in Texas Monthly; December 30, at another facility, in the court's appendix); the incident that led to Jackson being caught (February 17 in Texas Monthly; February 18 in the court's appendix); her firing (February 20 in the court's appendix; the hospital said in 2002 that she had not worked there since February 21); and Oma Wyler's death (January 24 in CBS News; mid-January in Texas Monthly's account).
The hospital's size. Texas Monthly described 18 rooms on a single hallway; the Associated Press described a 38-bed hospital in 2002.
Motive. No motive was proved. The theories offered are those of the FBI agent who testified at sentencing and of the journalist who interviewed her.
Early 1980s: Jackson's family moves from Indiana to Nocona, Texas; she is 15.
May 1984: She graduates from high school.
May 1985: Second marriage; a son and, in 1986, a daughter follow.
1989: She becomes a licensed vocational nurse and the night-shift nurse at the Nocona Nursing Home.
July 4, 1997: She marries Kirk Jackson near Lake Nocona; both later take night-shift jobs at Nocona General Hospital.
Late 1999: Her children move to their father's home.
November 23, 2000, to January 30, 2001: Mivacron is found missing from the hospital's crash carts about ten times, according to the families' later lawsuits.
December 11, 2000: Donnie Jennings, 100, dies; the start of the period law enforcement investigated.
December 2000: Seven patients die of respiratory arrest, by Texas Monthly's account.
January 2001: More deaths, including J.T. Nichols and John Walter Williams on January 11 and Oma Wyler on January 24.
January 30 and 31, 2001: Several patients go into respiratory arrest; the hospital pharmacist begins looking for the missing drug.
February 4, 2001: Everett Ethridge "Preacher" Jackson, 91, dies.
February 6, 2001: Hospital officials notify law enforcement; the Texas Rangers and the FBI join the Nocona police.
February 8, 2001: The pharmacist reports at least ten vials of Mivacron lost or stolen to the Texas State Board of Pharmacy.
February 17 or 18, 2001: A patient is resuscitated and later describes a nurse giving him something.
About two days later: A syringe with traces of mivacurium chloride is found in the Jacksons' trash.
February 20 or 21, 2001: The hospital fires Vickie and Kirk Jackson.
June 2001: Exhumations begin.
July 16, 2002: Indicted on two counts of capital murder (four deaths) and arrested in Bowie; $2 million bond.
July 19, 2002: Indicted for theft in Cooke County.
August 23, 2002: Pleads guilty to theft; one year in state jail.
January and February 2003: Families file federal civil rights suits.
January 2004: Indicted on three more counts of capital murder (six deaths), plus attempted murder and injury to a disabled person; bond $6 million.
June 3, 2004: Second Court of Appeals affirms the theft conviction.
February 2005: First trial date in Montague County; the case is later moved to San Angelo.
November 3, 2005: Fifth Circuit allows the families' civil rights claims against the hospital administrator and director of nursing to proceed.
October 3, 2006: Pleads no contest to capital murder in San Angelo.
October 5, 2006: Sentenced to life by Judge Roger Towery; waives appeal.
July 2007: Texas Monthly publishes Skip Hollandsworth's account based on prison interviews.
March 18, 2014: Handwritten petition seeking a lawyer and DNA testing of the syringe.
July 9, 2015: Evidentiary hearing on her habeas application in Montague County.
August 2015: Both sides file proposed findings; no ruling found.