An Almost Perfect Murder (10 page)

“It would be irresponsible for me not to do this for Dad,” Greg said. “He did suffer a stroke, but he was getting better.”

Charles Augustine had also been moved into the hospital’s rehabilitation ward when he suddenly took a turn for the worse and died.

Dr. Cyril Wecht, the famed forensic pathologist, attorney, and medical-legal consultant, agreed with Greg Augustine’s actions about having his father’s body exhumed.

“I think they’ve got to in light of the facts of this case,” Wecht told a reporter for the
Las Vegas Review-Journal.
“I would.”

In preparing his case against Chaz Higgs, Detective David Jenkins had learned as much as he could about the potent muscle relaxant known as succinylcholine. A pharmaceutical grade relative of curare, which originated in Central America and the northern part of South America, succinylcholine ranks among the highest in terms of being most potent on toxicity charts of known poisons. Its primary medicinal use, as previously stated, is to temporarily paralyze a patient so that emergency medical personnel can insert a breathing tube into the trachea. Hospital ER personnel like to use it because it is fast-acting and its paralytic effect diminishes rapidly. It only works as it is supposed to do when injected.

After succinylcholine enters the body, there’s no turning back as it rapidly begins muscular paralysis, beginning in the area of the face and eyelids. Shortly thereafter, the person injected loses his ability to swallow or to even lift his head. The pulse drops radically as it moves into the area of the diaphragm, and the person becomes unable to breathe on his own as the drug paralyzes the lungs. If the person has been placed on a respirator, as they would be under a controlled medical setting, there are usually not any problems with the drug as it metabolically works its way out of the body and gradually releases the person from its grip of temporary paralysis.

Although there are no antidotes, if artificial respiration is performed during the time that the drug is active, the person generally recovers and suffers no adverse side effects. On the other hand, if the person does not receive artificial respiration, they die a slow, horrible death of suffocation, all the while being able to see and hear the actions of the killer as additional organs become damaged and begin to shut down.

In Kathy Augustine’s case, it isn’t readily known why she was still alive when the paramedics arrived. Not breathing, and with a pulse so weak as to be only barely detectable, she should have been dead. Perhaps it had all been a matter of timing—had the paramedics been a minute or two later, perhaps they wouldn’t have been able to keep her alive through artificial respiration. Her body, however, had apparently been deprived of oxygen long enough to cause sufficient brain damage for her to become comatose.

“You have to breathe for them,” said Dr. John Brouwers, a Las Vegas anesthesiologist. “The breathing muscles become paralyzed, and you can’t breathe for yourself.”

Although succinylcholine hasn’t been widely used as a drug for deliberately killing people, it has been chosen by those bent on murder, particularly by those within the medical profession. It appears to be a favorite of such killers because it mimics the symptoms of heart failure.

Succinylcholine was first synthesized in 1906, but its usefulness as a neuromuscular blocking agent was not realized until 1949. Typically, the drug is administered through intravenous injection, and the aforementioned paralysis occurs and ends within about five minutes when the amount being injected is controlled. Reason dictates that a subcutaneous injection of the drug, such as would be the case if injected into the hip or buttocks, would likely take longer for it to act, as well as run its course, and might entail the holding down or some other incapacitation of the victim to prevent her from seeking assistance, or fighting off the killer, before the drug took effect. Before the 1980s and the case of Genene Jones, there had been no definitive method of analysis for succinylcholine in human tissue.

As he learned more about the drug, Jenkins found himself grateful for Nurse Kim Ramey’s tip. Even though his gut had told him that Kathy had not died from a heart attack due to stress, as Higgs had claimed, he had sensed foul play. After all, Kathy’s own family, including Greg, her stepson, did not believe that she had died from a stress-related heart attack.

“This woman thrived on stress,” Greg Augustine said. “She has been through seven or eight elections, and an impeachment. Running for treasurer wouldn’t cause her stress. She would have been excited.”

One of Kathy’s friends had echoed Greg’s sentiments, Jenkins noted.

“I don’t believe that stress would have caused a heart attack,” said the friend. Kathy did not drink alcohol, and she did not take drugs, either, according to the friend. “Even when she was in the roughest times, the toughest times, she was always above it.”

Furthermore, nothing that incriminated Higgs in Kathy’s death had been found inside the house in Reno that the two had shared. When Jenkins and his colleagues then checked with the Carson-Tahoe Hospital, where Higgs had worked, an inventory of the hospital’s supply of succinylcholine did not confirm that any was missing or otherwise unaccounted for. If not for Ramey, Jenkins realized, no one would have thought to look for succinylcholine at the time of autopsy, because it is not normally included in routine toxicology tests. If they hadn’t suspected its use because of Higgs’s slip of the tongue, Kathy’s death would likely have been labeled a heart attack and gone unsolved.

“You have to be thinking of it and looking for it, or it’s not going to show,” Dr. Cyril Wecht told a reporter for the
Las Vegas Review-Journal.

When all was said and done, just about everyone at the Reno Police Department and at the Washoe County Coroner’s Office were of the opinion that the succinylcholine had been injected into Kathy only a short time before she was admitted to the South Meadows branch of the Washoe Medical Center. There was little, if any, doubt in anyone’s mind that Higgs was responsible for his wife’s death. Being a critical care nurse, Higgs had the means to obtain the drug that had killed his wife. Being alone with her inside the house also provided him with the opportunity to kill her. What seemed to be lacking was the motive.

A number of people that Jenkins had spoken to during the course of the investigation had described the marriage between Kathy and Chaz as unusual and odd, and some had even said that Kathy was making plans to divorce him at the time of her death. She had even confided to a close friend, whose husband had recently died of cancer, that she had made a mistake in marrying Higgs.

“You know, I made a big mistake,” the friend quoted Kathy as saying.

She had reportedly told her friend that she had rushed into her marriage with Higgs after her husband Charles had died, and she cautioned her friend not to make that kind of mistake.

“She said, ‘I know you are going to be lonely,’” her friend said. She said that Kathy told her that “it’s going to hit you all of a sudden that you are alone. But don’t make the same mistakes that I made. Don’t listen to someone say they can take care of you.”

Jenkins, as well as prosecutors, began to wonder if an impending divorce was a strong enough motive to murder someone. It was, they reasoned, if he stood to lose financially because of a divorce, but had everything to gain if Kathy died. On the other hand, a simple divorce often takes care of a lot of problems—without going to the extreme of killing one’s partner. Plus, there was the fact that Higgs had been married, and divorced, multiple times before hooking up with Kathy. That fact served to diminish an impending divorce as a motive for murder. Why should he suddenly change his routine now and resort to murder? It just didn’t seem to make much sense.

 

 

Having flown to Virginia to participate in the arrest of Chaz Higgs and the search of his car, Jenkins finally took possession of the yellow-and-black backpack that had previously been noted in the Reno house that Higgs and Kathy had shared. Jenkins removed the backpack’s contents one item at a time, and carefully documented each item: a can of tuna fish, a can opener, medical literature, Higgs’s identification, a belt, and documents and papers associated with employment at a hospital. He also found the
Nurses’ Drug Guide
, the
Handbook of Hemodynamic Monitoring,
a pamphlet outlining the
Nevada State Board of Nursing Practice Act
,
Mosby’s Diagnostic and Laboratory Test Reference
book, and a Sudoku puzzle book. There was also a nurses’ dictionary that had been bookmarked between pages 214 and 215. Interestingly, the subject matter on those pages concerned intramuscular, subcutaneous, intradermal, and intravenous injections.

Also found during the police search of Higgs’s car was a stack of three-by-five index cards that contained information regarding medical treatment, dosage, and therapy procedures. The first card on top of the stack read:
dosing for endotracheal intubation and paralytics
and
intubation medications and succinylcholine.
On the surface, of course, this all seemed like damning evidence against Chaz Higgs considering the circumstances of his wife’s death. But Jenkins also knew that these types of publications and notes could likely appear in the possession of nurses anywhere, and that required him to keep an open mind. It was great circumstantial evidence, but it could also be shot down by a good defense attorney.

Chaz Higgs was scheduled to appear in a Hampton, Virginia, courtroom on Monday, October 2, 2006, where a decision would be made on whether to initiate extradition proceedings or not. If Higgs fought extradition, it would likely take about ten days to obtain a governor’s warrant. However, Jenkins was grateful that Higgs had decided to waive extradition and had simplified the process of returning him to Nevada. Detective David Jenkins, along with another investigator, brought their prisoner back to Nevada.

During the course of his investigation, both before and after Chaz Higgs’s arrest, Jenkins continued putting the case against Higgs together, bit by bit. Some of the information that he would be going over had already been stated in the press, but being a detective, he naturally wanted to put his casebook together with hard information and one-on-one interviews with everyone involved. Among the things he narrowed his focus on at this stage of the investigation were the events of Saturday morning, July 8, 2006, when Kathy Augustine was rushed into South Meadows’ emergency room, only to be transferred to the main hospital a short time later on the orders of Dr. Arun Kolli, Reno Heart Physicians, which is one of the two largest cardiology practices in northern Nevada. According to Dr. Stanley Thompson, a physician and cardiologist who was also with Reno Heart Physicians, Dr. Kolli had been on call to take all of the emergencies for the group when Kathy was brought in that morning. However, because it had been determined that an angiogram was needed, a procedure that Dr. Kolli doesn’t perform, Kathy was sent to the main hospital, where Dr. Thompson performed the angiogram, also sometimes referred to as heart catheterization. He was on backup call on that date.

Dr. Thompson’s educational background revealed that he studied at the University of Colorado Denver School of Medicine, and at the University of Louisville, in Louisville, Kentucky. He performed his internship and residency while in the navy, and his cardiology fellowship was at the San Diego Naval Hospital. He had been practicing cardiology in Reno since 1979, making him well-qualified in his specialized field.

After the catheter has been inserted through the leg and has reached the heart, pressure measurements from within the heart are taken and X-ray dye is then injected through the tubing to determine whether a blockage exists and has caused a heart attack. Artery blockage, particularly coronary artery blockage, is one of the primary reasons that people suffer heart attacks. When the dye is injected into the main heart chamber, it allows the cardiologist to see how well the heart pumps and functions as the dye makes its way out into the arteries, such as the left and right coronary arteries. In the search to determine if a blockage existed in Kathy’s arteries, they were photographed from different angles. If a blockage existed, it would be seen as plaque in the artery, a whitish material that would make the artery appear pinched off in the X-ray. But there wasn’t any plaque. Kathy’s arteries were normal, and Dr. Thompson determined that she did not have coronary artery disease. Normal arteries are not what anyone would expect in a person who had suffered an actual heart attack. The entire procedure, of course, was recorded and could be replayed at will from a CD or DVD.

While her arteries had appeared normal, Kathy’s heart, however, at the time that Dr. Thompson had performed the angiogram, had not been pumping correctly. The angiogram had shown that Kathy’s heart was not pumping vigorously, and when contracting, it only pumped 23 percent of the blood out of the heart chamber—a more normal reading would have been in the 70 to 80 percent range. Although he hadn’t known why Kathy’s heart had been beating so poorly, he knew that it wasn’t because of a typical heart attack or atherosclerosis, also known as hardening of the arteries. What he had seen was an almost “dead heart,” the cells of which were either dead or dying or had been stunned and hadn’t recovered from whatever had stunned them.

Dr. Thompson had met Chaz Higgs that morning when Higgs had accompanied his comatose wife to the cardiac catheterization lab at Washoe Medical Center’s main hospital. Dr. Thompson told Higgs that the outlook for his wife did not appear very good, considering the state of her condition at the time. He would later recall that he had been somewhat surprised by the lack of emotion shown by Higgs during the meeting in which they had discussed Kathy’s very bleak prospects for survival.

Dr. Paul Katz, medical director for the Institute of Neurosciences at Washoe Medical Center, and his partner, Dr. George Bigley, their specialty being neurology, had both seen Kathy Augustine at various times between July 8 and July 10, 2006. After consultation with Kathy’s family, it was decided that a CT scan would be performed on her brain, as would an EEG, also known as an electroencephalogram. The CT scan would allow the neurologists to look at the brain itself, while the EEG would show them the type of brain wave activity that was occurring.

The CT scan, according to Dr. Katz, “showed obliteration of the gray-white differentiation,” which means that under normal conditions the two can be easily distinguished from each other. However, when the brain becomes swollen as a result of a lack of oxygen, as Kathy’s had, the distinction between the gray and white matter becomes obliterated and difficult to discern. Similarly, the results of an EEG that was performed on July 9, 2006, turned out to be severely abnormal, “showing diffuse, poorly organized swell activity,” Katz said. When the EEG was repeated on July 11, 2006, the results were worse than they were two days earlier. It all added up to a condition of severe encephalopathy, meaning, in Kathy’s case, a dysfunction of the brain because of lack of oxygen. There was no evidence of a stroke or any other bleeding of the brain, and there was no evidence of trauma to the brain. After presenting their findings to Kathy’s family, the decision had been made to remove Kathy’s life support.

Later, in hindsight, as far as the two neurologists were concerned, the lack of oxygen to Kathy’s brain was consistent with her having been administered succinylcholine without any mechanism for breathing assistance. Their findings, however, were also consistent with sudden cardiac arrest.

Yet another physician, Dr. Steve K. Mashour, whose specialty is pulmonary and critical care medicine, attended Kathy while she was in the ICU at Washoe Medical Center. Jenkins learned that Dr. Mashour had performed a full examination of the patient that included her heart, lungs, abdomen, and neurologic functions. Her pupils, as they had been when some of the other doctors had attended to her, were fixed and dilated. Dr. Mashour ordered a CT scan of Kathy’s head, without contrast, to see if there was any reason that her pupils “could be blown, meaning an intercranial bleed or whatnot,” he said. Because Kathy had “gone down in a [cardiac] arrest–type fashion,” he also ordered a CT scan of her thorax, with contrast, to rule out a pulmonary embolism. He explained that a pulmonary embolism is a “blood clot in the lung that basically blocks off oxygen from being extracted from the environment and into the bloodstream,” a condition that could easily be fatal. However, when all was said and done, Dr. Mashour had found no evidence of a pulmonary embolism, nor had he found any evidence of brain bleed.

Interestingly, while Dr. Mashour had been going over the lab work results in Kathy’s medical chart, he noticed that her urine drug screen had come back positive for the presence of barbiturates. As a result, he had requested that a serum barbiturate level be sent off for reference testing. To his knowledge, however, the reference testing had not been completed as directed, because he had never received any results for the reference testing. Was it possible that, with Kathy’s impending death, the order for the reference testing had somehow slipped through the cracks? Whatever the case had been, the results of a confirming test had come back negative for barbiturates, and the matter appeared to have been dropped.

Because of the manner in which Kathy had been stricken, the first medical conditions that doctors would rule out would be heart attack or cardiac arrest, stroke, and pulmonary embolism, which they, in their professional opinions, had done. After each condition being examined had turned out negative, the next thing that would normally be looked at in a case like Kathy’s is the possibility of a drug overdose of some kind. In Kathy’s case, however, much of the toxicological testing had been done posthumously.

 

 

At one point in his investigation, Detective Jenkins spoke with Jennifer Dado, a registered nurse who worked in the emergency room at South Meadows Hospital since May 2004. She had worked with Chaz Higgs, Jenkins learned, for approximately 1½ years, until he had left for South Carolina and Virginia after Kathy died. She had worked with Higgs somewhat regularly, and, she said, there had been an ongoing joke of sorts that had involved him. According to Dado, anytime the nurses were caught up with their own work, particularly during the slower moments in the ER, they would occasionally ask each other, “Is there anything I can do to help you with any of your patients?” When Dado or another nurse would pose the question to Higgs, his reply would sometimes be “You can get rid of my wife for me.” Everyone would just laugh it off and then get on with their work, because it had seemed like it was all in jest, a little dark—or gallows—humor that is so common among those who deal with emergencies on an everyday basis. It’s a mechanism that is often used to help offset the high-stress levels that go with the job.

According to Dado, sometimes it would seem like Higgs had made the comments because he was unhappy in his relationship. She and the others realized, of course, that Higgs hadn’t meant for any of them to literally get rid of his wife for him, but the implication in their minds was that Higgs simply wasn’t happy and didn’t want to be with Kathy anymore. Dado said that she once advised Higgs that if he and his wife were that unhappy, they should try marital counseling, or that it might be best to just cut their ties with each other and move on. After all, it wasn’t as if Kathy or Higgs were inexperienced in severing spousal relationships. Higgs had responded that he was “working on moving out,” but that the timing wasn’t good at that point.

On the other hand, when Kathy had been going through the impeachment proceedings, Higgs had seemed very supportive of his wife during that time frame, but as time went on, something had begun to change, according to Dado. He became less supportive of Kathy, and had started making the
joke
about getting rid of her. However, even when Higgs had been supportive of Kathy, Dado said, she had never heard him refer to his wife in an affectionate manner.

Nonetheless, Jenkins asked Dado when she had last heard Higgs make the “get rid of my wife” remark. She said it had been approximately six months prior to July 8, 2006.

According to Dado, on one occasion when Higgs had the day off, the ER was short-staffed and she had called his home to ask if he was available to come in to fill a shift. Kathy had answered the phone, and hadn’t seemed too happy about the call.

“Chaz, are you interested in working a shift or part of a shift?” Dado said, recalling her brief conversation with Higgs that day when he got on the phone.

“You know, I can’t,” he said.

Dado explained that she had sensed that Kathy and Higgs were both a little upset that day, and she said that she had expressed that feeling to Higgs on the day that he had returned to work. She said that she was concerned that she might have caused an argument between them.

“No. She’s just a bitch,” Higgs had replied, according to Dado.

Dado had also heard rumors that Kathy Augustine had attempted to use her influence to get a couple of nurses at South Meadows Hospital fired, but she was unable to relate anything more specific to help validate or refute the rumors.

Jenkins knew, of course, that just because Higgs had purportedly used derogatory language in describing Kathy, and making dark humor jokes about having someone get rid of her, that didn’t mean he had killed her. After all, couples frequently call each other names or make derogatory remarks about one another without ever committing an act of violence against the person. Such could easily be the case in Higgs’s situation. But the detective equally knew that such dimly lit glimpses into the frame of mind of an intensely frustrated person could also mean the opposite.