North Carolina nurse accused of killing patients with lethal doses of insulin

Welcome to another episode of Behind the Headlines, where we feature experts and journalists discussing a variety of topics.

In this latest episode, Virginia Annable, a reporter for Lee Enterprises Public Service Journalism team based in Hickory, North Carolina, discusses her story about Johnathan Howard Hayes, a nurse in Winston-Salem, North Carolina.

Hayes stands accused of murder and attempted murder of patients in a hospital where he worked. Hayes is accused of intentionally administering a near-lethal dose of insulin to a patient in the same year he was nominated to be a nurse of distinction.

He is also accused of administering similar lethal doses of insulin to two other patients in early 2022, killing both, according to Winston-Salem police. Hayes was arrested in October 2022, on one count of attempted first-degree murder and two counts of murder.

Read the story

NC nurse accused of killing 2 patients was family man with history of medicine mismanagement

About this program

Host Terry Lipshetz is a senior producer for Lee Enterprises. Besides producing interviews for this Behind the Headlines program, he produces the daily Hot off the Wire news podcast, co-hosts Streamed & Screened movies and television program and is the producer of Across the Sky weather and climate podcast.

Lee Enterprises produces many national, regional and sports podcasts. Learn more here.

Episode transcript

Note: The following transcript was created by Headliner and may contain misspellings and other inaccuracies as it was generated automatically:

Terry Lipshetz: Welcome to another episode of behind the Headlines, where we feature experts and journalists discussing a variety of topics. I'm Terry Lipshetz, a senior producer for Lee Enterprises, and your host in this latest episode, Virginia Annable, a reporter for Lee Enterprises public service journalism team based in Hickory, North Carolina, discusses her story about Jonathan Howard Hayes, a nurse in Winston Salem, North Carolina, who is accused of killing two patients with fatal doses of insulin. Hayes was arrested in October 2022 on one count of attempted first degree murder and two counts of murder. Virginia, welcome to the program.

Virginia Annable: Thank you for having me.

Terry Lipshetz: Can you talk a little bit about the case, what exactly happened and where things stand at the moment?

Virginia Annable: Sure, yeah. This case came to public attention in October 2022, when the district, attorney of Forsyth County and the atrium, Wake Forest Baptist Hospital, came out with a press conference and announced that they had arrested Jonathan Howard Hayes. He was a nurse at Wake Forest, and he was accused of killing two patients and attempting to kill a third. Since then, there hasn't been a lot of movement in the case, but it really caught the public's attention. Just the fact that there was this nurse who lived in the community, had been a nurse for 20 years, on the surface, seemed like everything was right. And then they were accusing him, of some pretty horrific things. So it really caught the attention of the whole state with these accusations.

Terry Lipshetz: Has there been a trial date yet? What's the status?

Virginia Annable: He has only appeared in court for his first appearance. They gave him no bond. And since then, there's been a couple dates set for an appearance. And it just keeps getting pushed back. It's really gotten dragged out. I mean, it's been almost a year now and, there's been very little movement on it.

Jonathan Hayes is accused of killing two patients with lethal doses of insulin

Terry Lipshetz: You talk a little bit about the two patients that died and also the one that survived, but what was the cause of death and what is he essentially being accused of here?

Virginia Annable: The hospital gave a really thorough timeline and a lot of information into the police, and that was all detailed in the search warrant application. So we have a really good look at what happened and what the hospital is saying. Their investigation found the first accusation was Pamela Jean Little. In December of 2021, she had an overdose of insulin and had a hypoglycemic event, which is when their blood sugar drops very, very low and it can cause a coma or death. Little was lucky enough to survive, but the accusation is that Jonathan Hayes overdosed her with potentially 100 units of insulin. When the typical, largest amount you would get is twelve. Then the second patient is Gwenda Zelda Crawford. And on January 5, at least, the doctors say that she had an overdose of about 100 units of insulin. She went into a coma. They took her to the ICU. Ah. But she unfortunately passed away a few days later. And then there was a third patient, Vicky Lynn Lingerfeld. And on January 22, she also had a hypoglycemic event where her blood sugar just dropped out. They did the blood test. They believe it was again over 100 units of insulin. And she went to the ICU, but she also passed away a few days later. The documents and all the hospital investigation found that Hayes was the only nurse present at all three events.

Terry Lipshetz: In your reporting, it mentions that Hayes administered seven times more insulin than others at the hospital. Can you talk a little bit about that finding?

Virginia Annable: So it sounds like after these three events, the hospital started looking into it and realized there was something wrong. And, then they kind of found the link to Hayes. And once they saw that, they did investigation into his medication usage and the amount of insulin he was using. And it's really interesting, the number that they found was he was the top administrator of insulin in the entire hospital. It's a very big hospital of any employee for a three month period. And he was also administering seven times the average of the whole hospital staff. So for how much insulin? Everyone the average of what everyone was administering, he was typically administering, like, seven times that. So there's a pretty big indication that there are some issues with medication administration. There is also some it's a little bit more tricky to explain, but the way that he was supposed to be verifying, medication administration, he was oftentimes saying it was given by other instead of putting a specific name down when administering medication. The hospital says that of the 130 times that given by other was used during medication administration, he did it 88 times. And that's for the entire hospital.

What is the dual verification process for certain medications?

Terry Lipshetz: Yeah, I wanted to follow up on that a little bit, because in your story, you talked a little bit about a dual verification process. So the idea being that with certain medications or maybe all medications, when a nurse is about to administer it, somebody else is there. Can you talk a little bit about that and what the expectation is under normal circumstances?

Virginia Annable: Yeah. So with hospitals, certain medications they call high alert. Medications that are maybe like an opiate or something like insulin that's more regulated. Nurses or doctors, et cetera, are required to have two people present and two people verify that this dose is acceptable and this is how much we're giving to the patient. There is a small way to get around that. And that's the given by other designation, which is typically reserved for, like, if there's an emergency or someone gave the patient the medication while they were getting an X ray or just something a little bit out of the ordinary where it might be harder to get that dual verification. But then medication was needed. But it seems very rarely used.

Terry Lipshetz: So under a normal circumstance, if a patient's in a hospital room and there's nothing else crazy going on, the expectation would be there'd be a dual verification and not just given by just one person.

Virginia Annable: Not just one person and given by other. Like, there's two medical personnel who kind of sign off on it.

What is a risk management team at hospital?

Terry Lipshetz: You mentioned a little bit, too, about the risk management team at the hospital. What exactly is that, and what's the function?

Virginia Annable: The risk management team, they kind of look into when the, hospital staff or anyone kind of says, there's a problem here. So in this case, they saw a pattern of these hypoglycemic episodes, and the risk management team steps in and does an evaluation, and they actually have a whole form that they fill out for each event and what happens, and they go as far to interview employees, and they check all of the records related to it. And they were, like, a full system check of what nurses were accessing, what information related to the incident. it's pretty interesting, just the amount of detail that they looked into. And the risk management team was able to meet with the police and turn over all of that information. And so the police can investigate from there and kind of verify everything they found.

Terry Lipshetz: Once this risk management team discovered there were some issues here with this case in particular, what did they do?

Virginia Annable: It sounds like as soon as they realized there was an issue, hayes was let go. And that was in late March of 2022. So a couple of months after the second death in January, they assessed the situation, and then the hospital let Hayes go. And then probably two I think it was three days after Hayes was let go, they met with the Winston Salem Police Department to let them know about these concerns. And the police department opened the investigation from there.

Terry Lipshetz: There was a sidebar that goes with the story as well. Now, you didn't write this. It's written by, Kate Farrish, but I know you've got some insight into this as well. And it gets into insulin. So it mentions that there is a former nurse, from West Virginia that's currently serving life in prison for killing seven elderly veterans. there is a registered nurse accused of killing two patients, at a Pennsylvania nursing home. There's another nurse that's been charged with killing patients. The common link here is insulin. What is it about insulin that has become such a common thread in some of these cases where a medical provider is being accused or convicted in a murder?

Virginia Annable: Yeah, that was something that kind of stood out to us and made us want to look into it. And that's why we had Kate Ferriss do a great story on that. And one of the things that we found just talking to some experts was that insulin, while it is a high alert medication, often still doesn't have that barrier to access as maybe an opioid or some other medication that's more highly regulated or has more street value, which is someone can't necessarily walk out of, the hospital and sell insulin for a lot of money like they could with other drugs. So that means a lot of times it looks like the insulin is easier for nurses to access. They can get more of it in some instances, like the medication carts were left unlocked or easy to get to, even if someone wasn't supposed to have access to that medication. So it's really just, the barrier to access is a lot lower with insulin.

Terry Lipshetz: And it would also seem, too, that because of the nature of diabetic patients, it's possibly a little bit easier to get around. Too right, because you have to give it at certain intervals, depending on when a patient might need it. And it's a very unique thing.

Virginia Annable: It can be left up to the provider to decide if that patient needs it as well. So, that decision can land on one person, and they can say, this person blood sugar looked like they needed insulin. So there's a little more flexibility where there isn't as much with higher level medications. But this insulin obviously can still lead to death and can, cause comas and a lot of health issues.

Terry Lipshetz: Another interesting point, too, is that for teams at hospitals, or looking at maybe misuse of medications, and the various safeguards that are in place, is not necessarily about catching someone who's maybe trying to cause harm, but maybe about catching mistakes, like medication errors more than anything. Too so is that part of the problem here, or is it just yeah.

Virginia Annable: That was something that we noticed when we saw this link of insurin and these apparently intentional deaths. We thought we would try to talk to hospitals about what they're doing that could potentially catch that. and when we looked into those regulations or steps that hospitals take, it's not about catching someone who's intentionally doing this. Many of their backstops are about mistakes, medical mistakes, which is, on one hand, you're like, okay, that's probably more common. But then we see these lengths, and you just get a little curious what could have caught these people. A lot of the hospitals weren't willing to talk about catching killers in their hospitals know, they just say they're looking for those medical mistakes. But there was an instance in West Virginia, in the VA. And a VA hospital where there were some intentional killings. There was a report afterwards kind of talking about some of the problems of what could have prevented this, what could have been done. And one of the big things that they pointed out was that when doctors and investigators kind of looked into these deaths, their thought wasn't necessarily, this was intentional. This was someone trying to kill people. Their thought was, this is a medical error, or, there's something wrong with the system, that kind of thing. So it doesn't seem like it's top of mind in these regulations to be catching someone who's intentionally killing people in hospitals.

Has there been any discussion about how insulin should be regulated?

Terry Lipshetz: Has there been any discussion, or did you find anything during your reporting where there's maybe some consideration into, looking at how insulin is regulated? Or is that not something that's widely discussed yet?

Virginia Annable: We don't see a lot of discussion about it in these ancient years where it happened, where someone's loved one was killed by insulin. Those people are advocates for there being more regulation. But regulation of insulin and of medication is so, different in each state and different hospital to hospital. There's not a lot of regularity between how it is administered and how it is regulated and how it's documented and that kind of thing, which was kind of an interesting part of Kate's story, just that there are some recommendations. There are advocacy groups that say this is how you should be documenting medication, and this is how you should be keeping it safe. But, it's really often left up to a hospital. The state or Medicaid agencies say you have to have dual verification for insulin, say, but they don't say how it has to be done, whether it has to be done electronically or your medication has to be locked up, but it could be in a cart, or it could be in a room and that kind of thing. So there's a lot of variability, from hospital to hospital.

In the Hayes case, if the accusations are true, it would meet the definition of serial killer

Terry Lipshetz: You talked a little bit in your story about the definition of serial killers, because in this case, in the Hayes case, if the accusations are true, it would meet the FBI's definition of a serial killer. Can you talk a little bit about that?

Virginia Annable: Yeah, I started looking into that. I spoke with a criminologist who said I should check that. The old definition was that it was three deaths across, a month or more. But the FBI has changed the definition now to be two intentional killings in separate instances. so there's not as much of a timeline. And so under that these deaths in the hospital do meet that definition of two or more deaths in separate instances. And including the instance with little it was over about two months that these happened.

Terry Lipshetz: What's next in the case? Where do things stand? You know, is there anything else you're looking into?

Virginia Annable: Whenever the case was announced, the DA asked hospitals to check their records and make sure know they don't see any other suspicious events or suspicious deaths if like, Hayes was working there. so I'm curious to see if anything like that does pop up. I know these investigations can take a long time, so even if a hospital did see an incident and reach out to investigators, it could take some time before we actually see if there are other linked cases. So far, there aren't any. And at least one of the hospitals I reached out to where Hayes had worked said that they immediately checked their records and tried to see how long he worked there, who he was working with, if he was ever alone administering medication. so I'm sure a lot of those hospitals did the exact same thing. It'll be interesting to see where this case goes. There's two sides to every story, so I'm not sure if this case will play out in court and we'll get to hear more or if it will end up being a plea deal. I think it will take some time. I spoke to his lawyer just to see if we could talk to Hayes or talk to him about the case. and he declined to comment. But he did say just to remember, there's two sides of the story, so we'll really see how everything plays out, hopefully, in the next couple months.

Terry Lipshetz: With Hayes, he did work at multiple hospitals, right? He hadn't been at that hospital for a very long time. He had moved around from place to place. So there is that potential then, that multiple places. Do you know exactly how many, medical, facilities he had worked at prior?

Virginia Annable: Yeah, based on his resume, which was given to police by, adrian Way Forest, he had worked at potentially like six or seven other hospitals, and all kind of in the central North Carolina area. There's a couple state hospitals there's, private hospitals. And a lot of them have kind of merged or changed over the last 20 years. So it sounds like they're, really having to dig through their records to figure out where he worked and when, and try to line that up. But, yeah, it does look like it's about seven hospitals, possibly, but it could be more or less. That was just based on a resume he gave to the hospital. He did work atrium Wake Forest for, I think, at least 15 years, but it was kind of on and off.

Terry Lipshetz: Virginia, thank you so much for joining me today and talking about this topic.

Virginia Annable: No problem. Thank you so much.

Terry Lipshetz: We hope you enjoyed this latest episode of behind the Headlines. You can find us on every podcast platform, and we'd love it if you could take a moment to subscribe and leave a review. Finally, if you appreciate what we're doing with this program, we encourage you to invest in local journalism by supporting the newspaper in your community. I'm Terry Lipshetz, thanking you so much for listening to behind the Headlines from Lee Enterprise.

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Behind the Headlines features interviews with reporters and editors from newspapers owned by Lee Enterprises, including its Public Service Journalism team. Lee Enterprises is a leading provider of local news and information, and a major platform for advertising, with daily newspapers, rapidly-growing digital products, marketing services, innovative technology and nearly 350 weekly and specialty publications serving 77 markets in 26 states.