The Death Shift: The True Story of Nurse Genene Jones and the Texas Baby Murders.

The Death Shift: The True Story of Nurse Genene Jones and the Texas Baby Murders. Peter Elkind. Viking, 19.95. It's diabolical enough that Nurse Genene Jones murdered as many as 16 babies in the early 1980s. But what is more chilling is the failure of a San Antonio public hospital and medical school to account for such heinous criminal activity. Scared of lawsuits and negative publicity, the medical establishment did nothing to bring suspicious

deaths to the attention of law enforcement officials. Instead, it simply attributed these deaths to organizational "growing pains," poor staff morale, and lack of effective leadership. Nurse Jones was removed during a staff reorganization, and ushered off to further employment (and further murder) with a recommendation. Peter Elkind presents this story as a first-rate murder mystery, with such characters as an egomaniacal hospi-

tal administrator who once entered a meeting to the musical theme from Star Wars, a 300-pound snuff-dipping judge, and a Mickey Spillane gumshoe who calls pretty girls "dollies" and bad guys "scumbags." At the center of the mystery is Genene Jones, a bizarre, complex woman who lavished affection on infants as she injected them with a variety of lethal drugs. When babies began to die mysteriously, her hours on duty became known around the hospital as "the Death Shift." But a hospital committee investigation failed to uncover proof of wrongdoing and recommended judicious silence on the issue." It was not until Jones moved to a clinic in a small town, and began to kill again, that several local doctors blew the whistle and had the nurse arrested. Somehow, personal responsibility is choked by the bureaucratic tangle of hospital administration. San Antonio's Medical Center Hospital is, after all, an institution that employs not only an executive director, but a senior associate executive director, three associate executive directors, an executive assistant to the executive director, and several administrators. Committees are formed and memos are circulated, but no one grasps the seriousness of the baby deaths. The one doctor who has deep suspicions about Genene Jones is eased out of his position as medical director; the administration prefers to see the problem as one of personality conflict and "solves" it by recommending the removal of both Jones's critics and defenders. But the real problems of this public hospital and its partner medical school run deeper than bureaucratic tangles. There is an economic price

to pay when medical establishments get bad press or face litigation for malpractice or criminal conduct. Medical Center Hospital, relatively new, ambitious, and deeply concerned about its image, was desperate to attract paying patients to offset the costs of the charity cases the hospital was ostensibly created to accept. The bottom line, then, became money, not health care or justice. For this hospital, like many medical establishments, the cost of carefully monitoring its employees, risking public investigation, and protecting its economically disadvantaged patients was simply too high a price to pay. A traditional English confession of sin states "we have left undone those things which we ought to have done, and we have done those things which we ought not to have done," attaching equal seriousness to sins of omission and commission. Elkind's book reveals that while our society is able to bring a nurse who commits a crime to justice, it still has far to go in its ability to pin responsibility on a medical establishment that omits its duty to serve the public.