Thoughts from Mark "Hat" Rackley

I’m Detective Staff Sergeant Deviled Yeggs.  I work homicide in the big city of Tracy.  My partner is Jim Wednesday.  Poached Yeggs, homicide detective and my nephew, has been working with Jim and me.

I thought about writing this report in a sequential way, as usual, but this was possibly one of our most bizarre cases yet.  In a way, it was both visceral and mundane, but strange nevertheless.

I thought I would take a different approach:

The Discovery:

Two workers at a restaurant parked in the employee parking lot that was shared by four businesses: the restaurant, a sandwich shoppe, a doctor’s office, and a kidney dialysis center.  They saw two bare legs sticking out from the shrubbery.  They were so freaked out that they did not look at the body.  They called 911 and our precinct got the call in case it was a homicide.  Patrolmen Guy Weiss, known as Wise Guy, was nearby and was dispatched to the scene.  He confirmed that we had a homicide victim and he said that I needed to be at the scene.  This one was no ordinary crime scene.  In his words, “Nothing makes sense.”

The Victim:

The victim was a middle-aged woman.  She was wearing a dress, but no underwear.  She was lying face down with her face pointed slightly toward the shrubbery.  Her skirt of the dress was pulled up over her head, exposing the buttocks.  She had no socks or shoes. There was no purse or identification found.  The crime scene people took the fingerprints, but something went wrong within the system.

She had matted blood in her hair.  The M.E., Dr. Quincy Isles, stated that the blow to the head was only to disable the victim.  There were 36 stab wounds or deep slashes.  All the wounds in the left arm or in the chest and left side of the torso.  Each wound seemed to be made with a different force than the others.  Not all the knife marks seemed to be from the same knife.  There were some scratches with the knife blade.  Most of the 36 stab wounds were not fatal, most quite superficial.  None of them needed to be fatal, but a few cuts were into arteries.  She simply bled out.  The blow to the head knocked her unconscious.  Then if she could have regained consciousness, she had probably lost too much blood.  That would induce unconsciousness and then death.

Okay, for that to be the case, why did the dress have no stab wounds through the fabric?  Why did the body have only a superficial amount of blood?  Did the victim not wear underwear?  This was not the time of year to go barefoot.

And then from the M.E.’s office, they discovered that the dress was two sizes too large.  And that there were postmortem scratches on the victim’s heels with brake dust and fragments from car tires embedded in the scratches.

The Victim’s ultimate Identity:

With the fingerprint issue, the body’s identification was delayed until after normal business hours.  We discovered that the body was that of a nurse, required to be fingerprinted in almost every state in the USA, including our state in the heartland.  The name was Kimberly Toppan.  Her last known employment was the dialysis center near where we found the body.

A day after the body was found, the kidney dialysis center claimed to have a nurse who had not shown up.  For that first day, they complained that we were in their way, and they refused us access to interview employees and patients.  We got no better reception from the doctor’s office.  As it turned out, the doctor’s office, in a separate building but next to the same parking lot, was a group of nephrologists that supported and ran the dialysis center.

Their attitude changed, at both locations, but we had lost a day in doing interviews.  Oddly, in delaying one day, the patients that we interviewed were among the last patients to see Nurse Toppan alive.  Dialysis is done every other day, three days each week.  But even then, the patients were afraid to talk where others could hear.  The room where dialysis was done was a huge room containing eighteen chairs and machines to perform the dialysis.  Since the patients were hooked up to the equipment, we had to wait until they got off dialysis.  We left Poached there to catch people coming in and leaving.  They were evasive, but they gave hints.

As for the staff, we said that she had been found wearing a dress and nothing else.  The staff shook their heads.  She always wore underwear, shoes, socks, and nursing scrubs.  She never wore a dress.

The Scene of the Crime:

The location where the body was found was at the far end of the parking lot from the kidney dialysis center and between the two dumpsters and the shrubbery.  Just like the body, there was only a superficial amount of blood.

Let’s say that her body has ten pints of blood.  Exsanguination should be at about 40% or four pints.  That’s a half gallon of blood and we hardly had enough to justify a nosebleed.  Arteries were cut with some of the stab wounds and especially the slashes.  There should be arterial spray.  Nothing.

The body was moved.  It was stripped and redressed, staged for the body to be discovered, and not discovered by anyone who worked at the dialysis center.

The parking lot had two security cameras.  They had difficulties in the past with roof shingles slipping and blocking the camera’s view.  Both cameras had that issue the night of the murder.  With closer inspection, someone had approached the cameras from behind and glued a roof shingle to block the view of each camera.

The True Crime Scene

In further searching, especially nearer the dialysis center, we found the arterial spray.  Still, there were no four pints of blood, but with the arterial spray, we were more confident in having found the true location of the attack.  We saw the spot at night, and we confirmed our suspicions.  It was in a shadowed area of the parking lot.

The Victim’s Clothing:

Nurse Toppan’s clothing was finally found by Wise Guy, helping out on some off-duty volunteer work.  We think he is getting tired of patrol duty, but we have no detective positions open at the present time.  He found nurse’s scrubs a block away in a dumpster.  Whoever had gathered the soiled clothing was probably worried that some blood would get into the car trunk’s carpet.  The clothing contained a lot of blood, retained in plastic bags, but still not four pints.  Whoever had handled the bags left no fingerprints.  Wise Guy also found a fish knife that was duct taped to a broom handle.  It matched some of the wounds.  We were thinking that the other weapon was a butcher knife, held in the hand of the assailant.

Quincy Isles still stuck to his theory that multiple people handled each of the two weapons.  But with the clothing, the knife cuts in the scrubs matched the body blows.

Wise Guy, probably trying to get people’s attention for detective consideration continued his dumpster diving in his spare time.  He found some feminine hygiene pads next to a dumpster about a half mile south of the dialysis center.  The dumpster had been recently emptied, but these must have fallen out when the truck picked up the dumpster, maybe overloaded with trash.  The blood was much more than was expected for its usual use, and the blood matched the victim’s blood.  So, the majority of the blood was in a landfill somewhere.

The Poached Composite Report:

Poached had difficulty in getting any of the patients to talk.  Some simply said, “We do not speak of such things.”  They never defined what “things.”  But in being gentle and showing concern, Poached got a good idea that the patients suspected that they were being abused by the staff, Kimberly in particular.  They suspected malpractice, but they had no proof.  And with no proof, if they talked, there would be reprisals.  Even playing along and suggesting that Kimberly was gone, so who would enact the reprisals, the patients winked and said that others were probably standing in line for Kimberly’s job.  It just had to be someone that would “play ball.”

When I complained that Poached had created a story instead of giving a report, he handed over about one hundred pages of transcribed conversations, since there were around one hundred patients at that center.  That again got me thinking about 36 knife wounds.  There were 18 people being helped at the dialysis center at any one time, but then if you had about a thirteen-hour workday, they could use each station three times: set up time, four-hours of dialysis but sometimes less, unhooking time which includes stopping the bleeding, and cleaning time.  But then the center had six days of operation, Monday, Wednesday, Friday, and Tuesday, Thursday, Saturday.  Three times 18 was 54, and double that, you get 108.  And while 18 were in the center, there were possibly 36 either coming or going.  Thirty-six?  No, it can’t be.  These people were mostly old people, and they did not have the energy to kill a healthy woman.  But could the 36 be symbolic?

The Dialysis Business Manager’s Response:

I asked the business manager which nurses were in charge and what Kimberly had done for the clinic.  It seems there was a clinic head nurse that checked on things and did a lot of paperwork.  Of course, all her reports were that everyone was doing their job satisfactorily and no one had any reported incidents.  Then there was a floor nurse for each shift.  Kimberly was neither of those two.  She was not even the most experienced nurse at the clinic, but she had been tasked to train all the new technicians.  Where most clinics have the nurses insert the needles while the technicians monitored the computer screens and responded to alarms, at this clinic, Kimberly taught the technicians how to insert the needles into the graft or fistula.  The nurses monitored the screens and then told the technicians to respond to the alarms.  The business manager thought it worked better that way, but I had a feeling that Kimberly told her it worked better that way.

I danced around the idea that Kimberly Toppan may not have had the best interests of the patients at heart.  I can usually ease into such a claim, but maybe I was tired.  Maybe I was irritated that Nurse Kimberly had been dead for nearly 48 hours before the clinic allowed us in, and then only with a warrant.  Kimberly did not call in to say she was sick.  They knew someone was dead in the back parking lot, and they stonewalled us.  Even their answers were evasive when they were simple questions that had nothing to do with Kimberly, malpractice, or the murder.

The business manager suddenly interrupted me in mid-sentence, “Kimberly was a good nurse, and you are accusing her of malpractice with no evidence.  Detective, you better stick to the case of a murdered treasure of a woman and quit your smear campaign.  Your murder case has nothing to do with this clinic.  You should be ashamed of yourself.  These patients have suffered enough.”

“And as for my nurses, you don’t understand what it is like watching people die slowly.  The nurses don’t get chummy with the patients.  If they do, a little of the nurse dies with the patients.  The patients are a bunch of cry-babies.  They want the nurse to be all loving, with hugs and kisses, but that is not the way it works.  So most of what you heard was whining.  So, do your job and leave us alone so that we can do ours.”

I replied, “I am the detective here, and the more you point elsewhere, I am more and more convinced that the motive for the murder is right here in this clinic.  Here is a warrant for all financial records, all employee records, including parttime fill-in nurses and technicians from other facilities, and all patient contact information.  You will give me the information, or I will gladly have you arrested for impeding the progress of this case.  I have already talked to the DA, and I only need one call and you will be in handcuffs.”  Okay, not subtle, she was through with any answers.  I would be talking to lawyers before she said another word, but Poached downloaded the files that we had permission to download.

But then, I was surprised.  She spoke.  “If you had investigated the prowler that kept coming to the parking lot, Kimberly would still be alive.  Her death is on your shoulders.”

I had no idea if she was throwing out a red herring or not.  Why wait until she was nearly in cuffs to surrender such information when one of her employees had been killed.  But for giggles, we asked and received the security camera footage.  The cameras were run by the business complex managers, so the clinic could not give us a hard time.

The Prowler Identified:

The clinic had called in complaints about a prowler on four occasions, but the prowler was always gone by the time the police arrived.  With the dates of the complaints, we got a rough description of the prowler from the video, hanging out near the dumpsters.  Odd, the dumpsters were at the far end of the parking lot from the clinic, but only the clinic complained.  On those dates, there was no frame of the prowler’s face, but we then started looking at the dates between the complaints.  The prowler often went dumpster diving and on one occasion, he looked toward one of the two security cameras.

He was a private detective, Gideon Marlowe who often worked on malpractice cases.  We called him in for questioning.  He arrived with two large rollaboard suitcases, filled with files.  This case got even more strange.  Private detectives would go to jail without telling what they knew, and if working under the management of a lawyer, he could, in some cases, declare confidentiality, but here he was open to all questions.

We gave him what we found at the scene of the crime.  He snickered a few times, nodded his head a few times, and his eyes got wide when we mentioned that Kimberly was not wearing underwear, was found face down and her bottom was showing.  He then said, “I didn’t think they would go that far.”

I stopped the description and asked, “Who are they?”

Gideon replied, “I am just guessing, but I am thinking the patients, all of them.  You only had 36 knife penetrations, stabs or slashes, but you mentioned scratches.  That was either some among the 36 who were getting up the nerve to thrust the knife or it was a few of the severely infirmed who could not physically stab her.  There may be some among the hundred plus that had moral reasons to not do it, and the eighteen that were being treated have an ironclad alibi.”

I interrupted, “Wait, what are you talking about?  The patients at the clinic?”

Gideon nodded, “The lawyer that I worked for took their claim of malpractice and their method of taking advantage of their patients is diabolically clever.  He did not think they would ever see any justice, and all the clinic had to do was get the courts delayed until most of the claimants were dead.  I interviewed all hundred plus, and most of them had very good reason to hate Kimberly Toppan and hate the entire clinic.  Since the same group of doctors owns all but two dialysis centers in Tracy, there really is not any competition.  The clinic keeps patients breathing, but there is no ‘life’ unless they have hope of a kidney transplant.  They essentially keep breathing and keep paying the clinic to keep them breathing.  The one dialysis competitor only works Monday, Wednesday, and Friday, which leaves few slots for new patients.”

“And what is this diabolically clever system?”, I asked.

“Glad you asked. I have the report right here.  I put it in the form of a scenario, from beginning to end. We’ll start with someone that gets into stage 4 kidney failure. That’s the stage before the end stage, stage 5, when dialysis is required.  These people don’t need to go on dialysis until they get down below 15% kidney function. This way the doctors that are taking care of them can see the progress and see who the next candidate might be to go to dialysis. If the clinic gets a free chair either by someone dying or by someone getting a kidney transplant, then that doctor looks at the one that’s closest to 15%. Let’s say their latest calculation was 18% function. I say calculation in that it takes a few numbers from the bloodwork and then a calculation to get the kidney function percentage.  Somehow the report that they hand to the patient says 13%, since an eight can become a three easily.  I never figured out if the doctors were involved or the lab reports were doctored before the doctor saw them.  I have dug up the files and found the results from the lab saying that the levels indicated 18% kidney function and the records that they showed the patient said 13% kidney function. They would be going to dialysis sooner or later, but it became sooner than necessary.  I have proof that they doctored the files, but someone might consider that it was just a typo.”

Gideon waved his hands, and then continued.  “Then the patient that should not be a patient gets into dialysis but beforehand they have to go to an access center first. That’s where the clinic’s money is made. Not that about $100,000 per patient for each four weeks of dialysis, but you have the overhead on the dialysis side.  You can cut corners and staff on the surgery side, since you do it at your own place instead of the hospital.  They have three surgeons on staff.  The surgeons, for a new patient, will put catheters in their neck, really they come out at the shoulder but they’re tied in to the main artery and vein going to and from the head. Then they are scheduled for a fistula later on.  A fistula is a vein that is sewn so that it ties the artery to the vein, just below the skin. When they get that done by some vascular surgeon, then they come back to the center.  Once the fistula is matured, they put two needles in the fistula.  That way they can put fluid into the bloodstream that is used to filter out the poisons and then they can draw fluid from the bloodstream to go to the filter system as long as the needles are far enough apart. Too close together and the fluid shortcuts from the in to the out and the dialysis does not happen.  If the fistula doesn’t work, they’ll go to a graft.  But they will work on that fistula till they’re blue in the face to get it to work because every time it doesn’t work, they have to go back to the access center, and they have to have an angioplasty done.  That is a catheterization where they balloon out the fistula.  Sometimes scar tissue builds up and it messes up the fistula completely, and that’s where they go to the graft.  Now the graft is not human tissue and getting the bleeding to stop after each dialysis session becomes harder and harder.  I’m simplifying this a lot.”

He continued, “Yeah, sure, there’s other things that can happen but that’s one scenario. Now that they have the fistula or graft working, they end up having problems with the fistula or graft, even when it works perfectly fine. So they get the patient back to the access center so they can charge surgery type charges.  And that’s where they need a nurse on the inside. In this case Kimberly, she was extremely competent as a nurse at being incompetent. She would screw up the fistula.  No one questioned her word that the patient had to have another angioplasty.  Often patients would have one once each month. She, or the technicians that she trained poorly, would infiltrate the patient.  That means, she would stick the needle in the front of the fistula and out the back of the fistula.  She’d do the same with grafts, but grafts were a lot worse because grafts were made out of artificial tissue and a fistula is made out of human tissue so when you infiltrate you stick the needle all the way through and then you pressurize the system with the dialysis equipment.  It leaks out the hole on the backside and you get monstrous bruises and a lot of pain. A fistula might heal during dialysis, but a graft will leak until pressure is applied with the dialysis equipment not running.  And you have no idea if the graft was even necessary.  It is all based on Kimberly saying that the fistula was too thin, too deep, too short, or some other excuse – all the work being done based on one nurse’s assessment, and that nurse always called for the patient to go back to the access center.”

Then Gideon changed his countenance.  He looked like he might cry. “But this isn’t all that goes on. When someone gets on the kidney transplant list, they must keep their health up or the kidney transplant people will drop them from the list.  If you’re not on the transplant list you’re simply going to die.  You just don’t know when.  But when you’re on that transplant list you have hope. And Kimberly was great at stealing that hope. In the files that I gave you, you’ll find a lady who was overweight. Kimberly doctored the files to make it look like she was gaining weight. They maintain your dry weight and try to remove the excess fluid to bring you back to that weight, but they rarely checked to see that the dry weight on file was accurate.  When the overweight lady got close to the top of the transplant list about ready to get a kidney, the transplant team looked at her records and saw the drastic increase in dry weight. All of that information was doctored information from Kimberly but the woman was dropped from the transplant list, and she has no hope left now. Then, since she’s off the transplant list, they figured out that this is not her dry weight.  They started taking off more fluid.  She started feeling better, but she had no chance of getting back on the transplant list.  And to think that the excess fluid was damaging her heart that whole time.   Kimberly doctored other people’s files saying that they called off for no excuse for dialysis.  The kidney transplant people want you to be serious about your health, so they dropped the person from the list because they didn’t care whether they were dialyzed that day or not.  Then others were taken off the transplant list for not taking medication on schedule, but it was medication that the dialysis center provided through an IV, nothing about forgetting to take a pill.  I could go on and on. They’re all in the list. She doctored people’s records.  She verbally abused people, laughing while she would yell at them or refuse to help them and their blood pressure would spike. She took fluid off too quickly so that the person would have their blood pressure drop because of dehydration, and that caused them to have to be taken off dialysis early.  Not getting twelve hours of dialysis each week was a black mark for the transplant people, but short-cutting dialysis means that some of the poison is not filtered out of the system. Do you need any more information? Those people in the files are real people, and they’re hurting, and they have suffered enough.  When I told them that the lawyer thought most of it was hearsay and anecdotal, he did not want to file the claim.  The patients resigned themselves to die without justice.  But some of these people are young and strong enough to pull this off.  You give a fish knife on a pole to someone in a wheelchair, and they could break the skin, maybe superficially.  So, my guess is that if you asked any of them if they did it, and all will say that they did.”

Gideon looked at the suitcases.  “Can you empty those suitcases?  My wife and I have a trip planned this weekend.”  We gladly transferred the information to evidence bags.

Before he left, I asked why his shock about the body on its stomach with a naked bottom shining for all to see.

Gideon laughed, “I never got any proof on that one, but the rumor was that Nurse Kimberly had a nice bottom, or maybe it was that she allowed people to have a piece of her … you know.”

I asked, “Meaning the doctors?”  Gideon nodded, and he held up one and then two fingers, maybe meaning one or two doctors.

The Precinct’s Dialysis Center:

We arranged with the competitor of the dialysis center to set up two dialysis machines in our precinct’s interview rooms, one being my office.  We got the competitor’s nurses to do the dialysis for the patients and then “borrowed” a few patients each day, asking them questions that they might not answer under other circumstances.  They were more forthcoming; we made them comfortable, and they felt safe.

We handpicked the people who had the worst treatment by Kimberly, according to Gideon Marlowe.  They repeated what they had told Gideon Marlowe.

We could see why the lawyer would not touch the case.  The patients were old, many not thinking clearly.  They stumbled over their words, but their stories did not vary much.  But pieces of the stories were what they thought happened rather than eyewitness seeing it happen, and much depended on motive.  Was this a scam for the clinic and thus the doctors to make a lot of money?  Gideon Marlowe had shown some financials that probably came illegally that showed Kimberly was getting paid overtime that she never worked, but only Kimberly and the person signing the paperwork, the business manager, knew what that extra pay was for.

But then with each interview, the last question was, “Did you stab Kimberly?”  With only 36 knife wounds, we got 80 confessions, but the remaining patients also confessed of knowing about it, but having a moral issue in doing it.  They all wanted to go to prison.  Without the hope of a kidney transplant, they were already, in their opinion on death row, but they would get better medical treatment in prison, and they were such a burden on their families.

The words from the business manager and Gideon Marlowe rang true. “These people have suffered enough.”

The Strange Conference Meeting:

In attendance were the District Attorney, Randolph Edmund Jennings, our Police Commissioner, Captain Hart, Lt. Tagliolini, the M. E. Quincy Isles, Jim, Poached, and I.

I laid out what we think was going on, much of it Gideon Marlowe’s idea, but what little information we gathered pointed in that direction, mostly conjecture.

Then the M.E. gave a rundown of the wounds and the cause of death being exsanguination.

Then I gave them a list of roughly eighty people who confessed.  We could only eliminate three or four as being in dialysis when we think the attack happened.  Time of death could have been later, since she bled out.  The M. E. would not support two stabs in the same wound.  He had been careful to count the wounds that partially overlapped.  But in looking at the patients during dialysis, the M.E. could probably eliminate another dozen as being too infirmed, even when holding a knife on the end of a stick.

Jim and Poached suggested that they either had help to blacken the security cameras and transport the patients or they could reduce that list to only a few who were young and virile enough to climb a ladder.  The bus to bring wheelchair patients was driven by a younger patient with a commercial driver’s license.  Those patients were easily tracked to the scene of the crime, but the rest could have driven or had a family member drop them off.

The confessions roughly doubled the wounds.  The defense would have a field day with this one.

Randolph finally spoke, “You have said that many of those witnesses that were not patients said that these people had suffered enough.  The defense could get a hung jury easily, but I have a feeling these people would gladly go to jail to get better care, waving their right to a trial by jury.  We would never know who really killed her.  Most of the wounds were superficial, but a few could have led to exsanguination without treatment.  Messy, messy, messy.  I do not want to be known as putting away seventy grandparents, at least many of them are, when there was 36 wounds.  But I see your face twisting up, Det. Yeggs.  If we send these people back to the dialysis center, it is indeed like sending them to death row.  I will talk to the medical malpractice experts at the state capitol.  I wonder if we could do a friendly take-over under humanitarian principles.  I will look for precedents, but let’s send this case to the cold case files for now.  We’ll have independent nurses do daily audits to keep the clinic honest until this thing is resolved.”

Credits

Kimberly Toppan is a mash of Kimberly Clark Saenz (1973-present) who worked in a dialysis center, who killed at least five victims by injecting bleach into their dialysis fluid.  Jane Toppan (1854-1938), or “Jolly Jane,” injected overdoses of morphine into her patients and then climbed into bed with them until they died.  She confessed to killing 33 victims.  Both of these women were nurses.

When I worked in the nuclear industry, if we had a water spill, the water was absorbed by “atomic wipes” which was really the rejected feminine hygiene pads from a local papermill.  They are “super absorbent.”  And if that spill might be contaminated, why not be assured that the spill area was clean?

The private detective, Gideon Marlowe, is a combination of Gideon Fell, the locked-room master detective, created by John Dickson Carr, and Phillip Marlowe, Raymond Chandler’s hardboiled detective.  I would love to have used Sam Diamond, but Neil Simon penned him into Murder by Death with Peter Falk playing the character in the movie.

And this story is coming out just before Christmas.  In a way, it was a Christmas present for my wife.  When we went on a short trip to a Christian Bookstore that we love to visit, we talked about the nurse’s strange behavior and how all the problems revolve around one nurse, whom the staff seems to be afraid of, and a couple of the technicians that she trained.  We came up with scenarios, and none made sense unless illegal, or at least immoral, activities were going on. Simple incompetence would get someone fired, but when that incompetence led to the clinic making more money? … Then my wife said something strange, “This is a case for Deviled Yeggs.”  She hardly ever reads the mysteries, but since she knew he was a homicide detective, I asked, “Who kills her?”  I had assumed who she meant.  While I was driving and she stared out the window and said, “All of them.”  Then after a pause, “Like that Agatha Christie novel.”  I suggested, “Murder on the Orient Express?”  She added, “That’s the one!”  With that, this story was born.  She thought it could be a book, and if I had written it the way I normally do, it might become one.