Insulin Deaths: 5 Things to Know About the NC Nurse Accused of Murder
By Virginia Annable Nov 21, 2023 on www.tulsaworld.com
Last year, a nurse in North Carolina was accused of killing two patients and nearly killing a third with overdoses of insulin. The accusations and his arrest caught the attention of the Winston-Salem community, where he lived and worked for decades.
Johnathan Howard Hayes, 48, was arrested on Oct. 25, 2022, and charged with two counts of murder and one count of attempted murder. Hayes, a nurse at Atrium Health Wake Forest Baptist, is charged in the deaths of Gwen Zelda Crawford, 60, who died on Jan. 8, 2022, and Vickie Lynne Lingerfelt, 61, who died on Jan. 28, 2022, both of whom died of extreme overdoses of insulin, according to their death certificates. He is also charged with attempted murder of Pamela Jean Little, who was 63 at the time.
An investigation by Lee Enterprises’ Public Service Journalism Team dug into the case, and reveals details about Hayes, the investigation and the regulations of insulin.
Here are five key takeaways from the investigation:
1. Hayes was a Family Man and Long-Time Nurse
Records show Hayes appeared to be a family man and caring nurse. Hayes had been a nurse in North Carolina for over 20 years and lived on a quiet street with a manicured yard on the corner of the block with his wife and her two daughters.
In 2021, Hayes was nominated by his wife, Misty Hayes, to be a Winston-Salem Journal Nurse of Distinction. At the time, Misty Hayes said Hayes always went the extra mile to ensure his patients would be taken care of.
Court records show Hayes filed to adopt his wife’s children from a previous marriage in late 2021. The adoptions were finalized on Jan. 26, 2022, four days after Hayes was accused of allegedly administering a third lethal dose of insulin to a patient at Atrium Health Wake Forest Baptist.
2. Investigation Found Links Between Hayes and Insulin Overdoses
Information from Atrium Health Wake Forest Baptist’s risk management investigation and investigative efforts led Winston-Salem police to find links between Hayes and three insulin overdoses. On Dec. 1, while under the care of Hayes, Pamela Little suffered from a hypoglycemic episode, which is caused by too much insulin. She recovered. Little recalled being scared of a male nurse who matched Hayes’ description, according to a search warrant application by Winston-Salem police. Little described Hayes as sneaky.
Gwen Crawford was also under Hayes’ care on Jan. 5, when she also suffered a hypoglycemic episode and died three days later. Hayes was seen on camera leaving the secure medication dispensing room with an entire vial of insulin — about 300 units, nearly 25 times the maximum dosage given to patients by nurses, according to the warrant.
Vicky Lingerfelt was a patient when she died on Jan. 28, 2022, due to hypoglycemia. Hayes was not her primary nurse, but did help her while Lingerfelt’s primary nurse was away for lunch, a police warrant said.
Records showed that during that time, Hayes accessed Lingerfelt’s medical records, despite having no need or right to do so, according to police. Within hours, Lingerfelt had a hypoglycemic episode and had to be taken to the ICU. Hayes was seen again on video during that time removing another full vial of insulin from the medication room.
3. Hayes had a History of Medicine Mismanagement, Police Say
Hospital records showed Hayes administered seven times more insulin than the hospital average, according to police. He was the highest user of insulin in all regards for the entire facility over a three-month period, the hospital found.
Hayes also often incorrectly recorded medication administration. For insulin, nurses and other hospital staff are supposed to have a second health care worker verify the amount of medication being given — a dual verification process. There is an option in the hospital system to say the medication was “given by other,” in rare instances when medication is given during an emergency or by someone not in the same hospital area where a patient is located.
The “given by other” label was used only 130 times in the over 33,000 times medicine was administered from Jan. 1, 2022, to the time of the meeting with police in March. Of the 130 instances when the “given by other” label was used for medication administration records, 88 were recorded by Hayes, the warrant said.
4. Deaths Fit a Pattern of Hospital Murders
Lee Enterprises’ reporting found that insulin is often the culprit in hospital murders.
In several states and in Canada, Germany and England, police have accused nurses and nursing assistants of killing patients with excessive doses of insulin.
Reta Mays, a former nursing assistant, is serving life in prison for killing seven elderly veterans in West Virginia using insulin. Pennsylvania nurse Heather Pressdee is accused of administering excessive amounts of insulin to patients in her care, resulting in at least 17 deaths, the Pennsylvania attorney general said.
Hayes’ case also shows other similarities with other nurses accused of killing patients, according to David Wilson, a Scottish criminologist who specialized in serial killers and has done research on nurses who are serial killers in hospitals.
Hayes has not been convicted, but a link between nurse serial killers Wilson studied was a high turnover in jobs, which Hayes’ resume reflects, according to police.
Wilson also said women over the age of 60, which includes Little, Crawford and Lingerfelt, are one of the five groups most often targeted by serial killers.
5. Insulin Not Well Regulated
Lee Enterprises’ investigation found that despite the link between insulin and several cases of hospital murders, the drug is not always effectively regulated.
The federal government and many states have regulations on how medication should be handled in hospitals and nursing homes, but often stop short of dictating that the facilities track the top administrators of drugs, which may have raised a red flag in the Hayes case. There are also no federal laws or regulations that require hospitals to use bar codes, an automated medication dispensing system or other technology for insulin.
The Institute for Safe Medication Practices’ guidelines for insulin use say that hospitals have “overlooked and inadequately addressed” the risks of insulin.
Virginia Annable is a member of the Lee Enterprises Public Service Journalism Team.