Facts

The defendant, a registered nurse, was working on the night shift at a community hospital. During a 3.5-week period, 13 patients on the night shift had seizures, cardiac arrest, and respiratory arrest; nine died. The unit closed, and the defendant went to work at another hospital. Within 3 days, a patient died after exhibiting the same symptoms as those of the patients in the previous hospital while the de-fendant was on duty. The defendant was arrested and tried for 12 counts of murder. The testimony revealed that the defendant in- jected the patients with massive doses of lidocaine (a rhythm-controlling drug). Evidence showed that the defendant assisted the patients before they ex-hibited seizures, providing opportunity for the nurse to administer the drug. She was observed acting strangely on the nights of the deaths, and high con-centrations of lidocaine were found in the patients' syringes. Moreover, syringes containing the drug and lidocaine vials were discovered in the defen-dant's home.Pretrial investigation revealed that 26 other pa-tients had died at the defendant's ï¬rst hospital while under the nurse's care. All had the same symptoms. The defendant, who waived her right to trial by jury, was found guilty of the 12 counts of murder. The nurse appealed the judgment of death.

Issue

Did the expert testimony support the ï¬nding that an overdose of lidocaine caused the patients' deaths? Did the evidence prove that the defendant had the opportunity to give patients overdoses of lidocaine?

Holding

The California Supreme Court upheld the convictions.

Reason

The expert testimony about the levels of lidocaine in the patients' tissue, coupled with the nurse's testi-mony concerning the symptoms prior to the deaths, conï¬rmed that the patients died from overdoses given to them by the defendant. Testimony showed that the defendant was the only nurse on duty the night each patient was poisonedonly some of the nights, and only the defendant had the opportunity to administer the fatal doses.

Question:

Examine how the evidence showed-when there were no eyewitnesses-that the defen-dant was the one who killed the 12 patients.2. Discuss the processes hospitals should imple-ment to prevent such occurrences (e.g., hiring practices and background checks).