RUTH BONNEVILLE / WINNIPEG FREE PRESS Enlarge Image

Jennifer Laferriere, centre, 41, mother of Kristie, right, and Karlie, 15, started dialysis shortly after Karlie was born and has been waiting for a kidney for about three years.

There are days when Jennifer Laferriere wants to smash "The Machine."

It's not that she's ungrateful. She knows it keeps her alive -- it does the job her kidneys can't. But 15 years of dialysis is enough.

"Yesterday, hooking up the machine, I thought, 'I'm going to have to do this forever.' It's just depressing," says Laferriere, 41, a mother of two teenage daughters.

At age 15, after a routine doctor's visit, she learned she had a rare kidney disease. By age 26, four months after the birth of her second child, she started dialysis.

Her girls -- Kristie, 18, and Karlie, 15 -- can't remember a time when their mom didn't need to plug into a machine.

Three years ago, she got a bad infection, probably from her cat or her dog.

It forced her to switch from peritoneal dialysis to hemodialysis; although she can do the therapy at home, she is literally tethered to the dialysis machine all night long. It turned her bedroom into a lab, with The Machine towering beside the bed, a centrifuge on her desk and in her closet, under her colourful skirts and blouses, a reverse osmosis unit.

Around this time, Laferriere decided to put her name on the province's kidney transplant wait-list. She soon discovered she wasn't going to be an easy match.

"They told me that I was highly sensitized and that I matched only 10 per cent of the population," she says. A cousin, a friend, and her boyfriend each offered a kidney, but lab tests determined none of the organs was a match.

"I kinda knew that's how this would all be," says Laferriere, and laughs with a sort of sadness doused in resignation. "I always have to do what's different. It's just how it goes."

But Dr. Peter Nickerson, medical director of transplantation at Canadian Blood Services (CBS), says it isn't how it has to go. Nickerson is associate dean of research for the University of Manitoba's Faculty of Medicine and a key architect in the ongoing construction of a first-class national organ donation and transplantation system.

"We have a mediocre system today," Nickerson says from his sunny office in the CBS building on William Avenue. "I don't want to be mediocre. I don't think Canadians or Manitobans, if we want to talk locally, want mediocre either. Why shouldn't we be the best?"

This year, maybe as soon as late spring or early summer, CBS will unveil two new national organ registries: NOW and HSP. The National Organ Waitlist (NOW) registry will be a real-time list for those in urgent need of organs other than kidneys; the Highly Sensitized Patient (HSP) registry will be a nationwide matching service for hard-to-match kidney candidates like Laferriere. These electronic registries will replace an "archaic," patchy, and opaque paper-based system that depends on weekly updates, fax machines and urgent phone calls.

The aim of these national registries is to more efficiently and effectively compile and wed these specific types of organ recipients with a supersized donor pool, which, ideally, is fashioned from provincial intent-to-donate databases. Manitoba is expected to launch an online intended donors registry this month. Those who want their organs to be donated after death will be able to register online and make their wishes known. If organ donation becomes a possibility, medical staff can access the registry and share those wishes with the family.

If the CBS can get the kind of buy-in it anticipates from the Canadian public and provincial governments, which largely legislate heath-care policy in this country, then almost 1,000 more transplants could occur annually, says Nickerson.

In 2010, 2,153 transplants were performed in Canada from 1,017 people, a combination of living and deceased donors. Every year since 2001, approximately 2,000 people fail to obtain an organ transplant, the vast majority of whom need kidneys. And each year, somewhere between 230 and 250 people die waiting for an organ.

While it appears from the outside that the system is, at best, treading water, Nickerson insists a closer look reveals a different story. Perhaps the best evidence of this -- at least in his opinion and in the opinions of many others in the transplant community -- is the remarkable success of the first national registry the CBS initiated in 2009, the Living Donor Paired Exchange (LDPE) registry. It's both a donor and a recipient registry that optimizes the use of kidneys from living donors. Donors and recipients are registered in pairs and if a cross-matching pair is identified, a "swap" can be made. As of this February, 316 pairs have registered in the LDPE, 122 transplants have been done, and 27 more are scheduled. This registry has resulted in approximately an additional 50 transplants per year, or roughly a 10 per cent increase in living donation.

Those sorts of numbers were enough to convince most doubters in the medical community that the CBS is the right interprovincial vehicle to drive this system.

"I think that right now the transplant community that was hesitant and reluctant at the beginning is fully onside," says Dr. Sam Shemie, a critical care physician in Montreal and Nickerson's counterpart as the medical director of donation at the CBS. "Quebec took the approach, show us that it works and we'll join in, as opposed to join in and we'll make it work. But that's OK. It was overt and upfront. And the proof is in the actions. Quebec is wanting 'in' on all three registries."

Here in Manitoba, Nickerson, with the support of the Winnipeg Regional Health Authority and the province, has also quietly racked up a series of impressive successes. Besides making the lab work done here in matching organs the national standard, he's helped turn a province with the worst donation rate in the country, at five donors per million population in 2004-05, to 15.3 donors per million population in 2010. This brought a 76 per cent provincial bump in kidney transplants. To realize this gain cost the province approximately $4.3 million in program funding, but because so many more kidney transplants resulted, it actually saved $6.3 million in dialysis costs.

But such improvements, provincially and nationally, don't send Nickerson in search of a La-Z-Boy. He sees countries like the U.S., Spain and Italy scoring donation rates between 22 and 30 donors per million population and says: "Why not us?" Shemie shares his attitude and his sense of urgency, born, in part, from an understanding of the bedside pains of those who wait for an organ.

"There's a saying: How long you wait depends on which side of the bathroom door you're on," Shemie says. "Thus far, this process has all been typically Canadian, a gradual, incremental increase in co-ordination. But if I'm on the transplant waiting list, I'd be pretty frustrated by the lack of pace and urgency I'm seeing in certain places... This gradual inertia is related to the federal-provincial relationships and the division of heath-care responsibilities in our country."

Such constitutional concerns appear far removed from The Machine in Laferriere's bedroom, but there's no doubt what side of the "bathroom door" she's on. There's also no doubt what she hopes these new registries and a better national system amount to: that phone call.

"If that ever comes, I'm probably going to be crying and happy and scared," she says. "It'll just be crazy and the kids will be so excited and we'll just get through it. I'm just hoping that day comes."

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She got to work around 4:30 a.m., her deadly secret only hours from being discovered.

It was April 28, 2008. Kimberly Saenz arrived at the DaVita Dialysis clinic in Lufkin wearing ponytails and scrubs. Her supervisor, Amy Clinton, told her she would be working as a patient care technician that day.

Clinton, a DaVita head honcho brought in from Houston following two deaths at the clinic three weeks earlier, said the news distressed Saenz, as she was accustomed to being a medication nurse. In her usual role, she had free rein of the facility, going from patient to patient to “push” medication from a syringe, sometimes needle-tipped, into dialysis lines and ports.

According to Clinton, Saenz became visibly upset, wiping tears from her eyes as she reluctantly got ready to do a job she felt was beneath her — monitoring patients, cleaning up vomit and wiping up blood, as it commonly spilled during dialysis.

Around 6 a.m., patients Marva Rhone and Carolyn Risinger entered the facility. For people with failed kidneys, spending hours attached to a dialysis machine three times a week can mean the difference between life and death.

Although everyone at the clinic was on high alert with the recent string of deaths, it seemed to a be a day like any other until two patients said they saw something disturbing.

Sitting no more than 40 feet from Rhone and Risinger, patients Lurlene Hamilton and Linda Hall said they watched Saenz squat down to place a jug of bleach on the floor. She then poured the bleach into her cleaning bucket and drew up 10 ccs of the caustic liquid into a syringe, according to their testimony.

Her actions bothered the women for two reasons — one, the floor isn’t sanitary, and two, Saenz seemed nervous. Hall and Hamilton said they then watched her inject bleach into ports on the dialysis lines of Rhone and Risinger.

Although neither of them went into cardiac arrest, testing would later reveal that Rhone’s dialysis line tested positive for bleach. Risinger’s line was not tested, as it had already been thrown away.

Being seen that day marked the end of Saenz’s reign of terror on the clinic. A little more than four years to the day, a jury found her guilty on a charge of capital murder, set to spend the rest of her life in prison without the chance of parole for killing at least two of the five murder victims named in an indictment. Five other people who did not die were listed as victims of aggravated assault.

Looking back at the trial, prosecutor Clyde Herrington said there was very little of the state’s evidence that the jury did not see. He said he believes there were more victims than just the 10 indicted cases, based on the research of a Centers for Disease Control epidemiologist. Using the dates of adverse occurrences dating to 2007 paired with the days Saenz worked, the epidemiologist statistically connected her to the events more than any other DaVita employee. Because Lufkin Police detectives were only able to obtain medical waste from two weeks prior to April 28, Herrington could not obtain enough evidence to indict Saenz in the other incidents.

“The only days there were deaths in April, she was there,” Herrington said. “Dialysis patients are sick, but every source of information we can find says it is very unusual for patients to die during dialysis treatment.”

While the state doesn’t have to prove motive for a conviction, Herrington said they did talk with a registered nurse who studied more than 100 health care killers. According to her research, only 50 percent of health care killers that go to trial are convicted. The most common method used by a health care killer is injecting a patient with some type of medication or substance.

“Criminal behavior is something we’ve been trying to understand since Cain killed Abel,” Herrington said. “Only when the health care killer confesses do we know motive.”

As to Saenz’s specific motive, Herrington said he believes at the time she was a troubled woman with marital problems who lashed out because of job dissatisfaction. Before working at DaVita, he said, Saenz was fired from Woodland Heights Medical Center for stealing Demerol, a powerful narcotic painkiller.

“From talking to some of the folks who worked with her, it sounded like her husband didn’t want her to quit (DaVita),” Herrington said. “She was depressed. She was frustrated, and I think she took those frustrations out on the patients.”

Maintaining his client’s innocence, defense attorney Ryan Deaton said there is a lot of information he wishes the jury had heard. He said he intends to be involved with Saenz’s appeal. She appeared in court Wednesday to start the process.   

“Hopefully she’ll get a new trial,” Deaton said.

Before her trial began, Deaton fought for the jury to have access to a U.S. Department of Health and Human Services report from May 2008 that was heavily critical of DaVita’s practices. The report was ruled inadmissible by state District Judge Barry Bryan.

According to the report, from Dec. 1, 2007, to April 28, 2008, the facility had 19 deaths compared to 25 for 2007. Those numbers put the facility at a mortality rate 7 percent above the state average.

The facility was also not keeping proper records of adverse occurrences, the report stated. From Sept. 1, 2007, to April 26, 2008, there were a total of 102 DaVita patients transported by ambulance to local hospitals during or immediately following dialysis. Of those, 68 did not have a complete adverse occurrence report.

The report went on to state that based on record review and nursing staff interview, the facility “did not demonstrate competence in monitoring patients during treatment alerting nurses or physicians of changes to a patient’s condition and following the physician’s orders for the dialysis treatment.”

DaVita spokesman Vince Hancock said the company’s actions in April 2008 did not kill any Lufkin patients, as evidenced by the jury’s decision.

“We hope that healing can start to occur for families of victims and for our teammates who also have been victimized by the murderous acts of Kim Saenz,” Hancock said.

While Saenz’s family has maintained their silence since the sentencing, her husband said they are planning a press conference in the near future.

Saenz remains in the Angelina County Jail pending prison transport.

Jessica Cooley’s email address is This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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