Yep, that sure looks like a cold plate of revenge...

WCNC: Police: Nurse turned off alarm, gave more painkiller

The Charlotte Observer: Report reveals new details on nurse's actions

Nurse anesthetist Sally Jordan Hill administered a significant dose of pain medication without consulting a doctor and didn't participate in life-saving efforts when her patient -- a former Charlotte classmate -- showed signs of trouble, documents in the case contend.

Co-workers of Hill, now charged with murder in the 2001 death of Sandra Joyner, also say Hill was eating a biscuit and didn't immediately call for help when Joyner's condition started to deteriorate, according to a nine-page letter sent to Hill by the N.C. Board of Nursing.

Hill and Joyner were classmates 30 years earlier at Olympic High School. A source told the Observer a grudge had been festering for years, and co-workers told police they overheard Hill say Joyner stole her boyfriend.

Hill, 50, has been jailed for two weeks and has a bond hearing Monday.
The case -- a wealthy patient dying during a facelift with a high school classmate involved -- has drawn national attention. It has been discussed on MSNBC and police have taken calls from People magazine, "Good Morning America" and "Dateline."

Joyner died five days after she stopped breathing in the recovery room at Charlotte's Center for Cosmetic and Plastic Surgery after an April 10, 2001, facelift. Medical examiners ruled the death an accidental poisoning, likely caused by the painkiller. Police didn't get involved then.

The state's medical and nursing boards investigated. Both found Hill made serious mistakes, though neither accused her of intentional wrongdoing. Hill has not been a nurse since.

Joyner's family has not returned repeated calls from the Observer.

Members of a church Hill has attended for more than a decade and some nurses who used to work with her say Hill is a professional, Christian woman who was devastated by her patient's death. She would not have ignored warning signs or intentionally killed Joyner, they say.

"Only Sandra Joyner, me and Jesus were there and knew what happened," Hill told medical investigators. "I know that the patient was in trouble."

Joyner was late and apprehensive the morning of her facelift, Hill told medical investigators. Joyner was more talkative than usual, Hill thought, and told Hill that she was going through a "terrible divorce." She planned to start working again and thought the facelift would help.

Joyner did well during the surgery, where the doctor also worked on her lips, facial scars and lower eyelids. She was groggy but awake and talking when Hill wheeled her to the recovery room, Hill and others told investigators.

After Joyner was settled in a lounge chair, the recovery room nurse asked Hill to watch Joyner while she prepared for the next patient. Hill got a biscuit the doctor had brought in to celebrate Nurse's Day. She took it into the recovery room, and the two former classmates were alone for about 10 minutes.

Joyner complained that her eyes were burning. She apologized for being a "bad patient," Hill told investigators. Hill had given Joyner 5 cc's of fentanyl, a potent narcotic painkiller, in the operating room. In the recovery room, she gave her more, starting with 1 cc to "calm her down," she said. About five minutes later, she gave another 1 cc of the drug. She did not document the medications she gave Joyner in the recovery room, which she was supposed to do.

After the second dose, Hill said, is when the problems started.

A surgical technician noticed that Joyner's lips and fingernails were bluish. "I asked (Hill) if everything was OK, and she said, `fine,' " testimony in the letter says.

The recovery room nurse said she came in and placed Joyner on oxygen. The nurse said she asked Hill if she needed the doctor and Hill told her no, the letter said.

"I don't recall Sally doing anything but standing back," the technician told investigators. "She seemed very calm. I did not at first realize that it was an emergency situation."

Another surgical technician said at one point Hill was sitting at the counter eating. "One would not be alarmed that anything was wrong because she was eating."

Hill told investigators eating didn't distract her from monitoring Joyner. "After giving anesthesia for so long, I've developed a sixth sense," she said, adding she got one bite of her biscuit.

The technician said she remembered hearing Hill interact with Joyner. She repeatedly told her: "Take a deep breath," the tech said.

The recovery room nurse said Joyner's condition deteriorated, and she decided to get the doctor. Hill told investigators she was the one who asked co-workers to get the doctor.

When Dr. Peter Tucker, who performed the facelift, arrived, Joyner was in distress. Tucker started life-saving procedures; paramedics were called.

"The whole thing is like slow motion," Hill told medical investigators.

Joyner was rushed to Mercy Hospital and pronounced brain dead.

That afternoon, Hill told her office manager the problem "was all my fault," according to the letter. She later said she was upset when she said that.

Five days later, Joyner's organs were harvested for transplanting and life support was turned off.


The autopsy concluded that fentanyl likely caused Joyner's death.

Charlotte anesthesiologist Dr. Mark Romanoff, who is not associated with the Joyner case, said fentanyl is commonly used to control pain in the operating room, and 5 cc's would not be an unreasonable dose. He said 2 cc's in the recovery room is "a fairly significant dose" but not unreasonable if the patient is complaining of severe pain.

Romanoff said he rarely uses fentanyl in the recovery room because it causes patients to have apnea, or to stop breathing. "That's the thing you have to really watch out for. Morphine, Demerol and even Dilaudid ... work just as well, and the risk of apnea tends to be less at similar doses."

Occasionally, Romanoff said, he'll use fentanyl for recovering surgical patients because it works faster than the other medicines. "With proper monitoring, you can use it safely."

The nursing board accused Hill of failing to report information crucial to the safety of a patient and of failing to maintain accurate patient records. It also said Hill should not have been administering medicine in the recovery room without consulting Tucker. Hill said Tucker had OK'd her giving medication in the past -- and she believed she had his permission to do it without checking with him first.

Rather than fight the charges, Hill gave up her nursing license.

In a separate investigation, the state medical board disciplined Tucker for not supervising Hill properly. It concluded that Hill's actions were "grossly negligent."

Tucker has repeatedly declined comment through his office and lawyers.

The medical and nursing board cases and a wrongful-death lawsuit were all settled by fall 2004. Police and prosecutors said a tip led them to investigate Joyner's death this year.

Authorities haven't revealed what new information led to Hill's arrest.

"I've reviewed this a million times," Hill told medical investigators. "I can't think of anything I'd do different."