For two years, officials at Rio's Salgado Filho Hospital could not understand the high death rate in the hospital's emergency intensive-care unit. The patients--many victims of grave accidents, cancer, strokes or heart disease--never had a particularly bright outlook. Still, the public hospital had invested in high-tech equipment, in new procedures and training, and the death rate had stubbornly refused to fall. That is, until they discovered the cause of the discrepancy: longtime nurse's aide Edson Guimaraes, a purported serial killer.
Guimaraes, 42, initially confessed to five murders, saying he had ended the patients' lives to ease their suffering. He also admitted to racing to notify the city's highly competitive funeral homes of the deaths, in hopes of earning a $60 tip if he was the first to report the death and the family signed a contract with the funeral home.
"He's no Dr. Kevorkian," said Flavio Silveira, the administrator of Salgado Filho, one of Rio's largest public hospitals. "This guy said he wanted to abbreviate suffering and also make some money on the side, because everybody gets some money on the side." Guimaraes' victims were mostly unconscious or comatose patients, whom he killed by lethal injection or by removing oxygen masks, prosecutors charge.
In late April a cleaning lady first spotted the gray-haired aide drawing a syringe of deadly potassium chloride from the supply room, slipping it into his pocket and then strolling into the intensive-care unit, doctors and prosecutors say. While Guimaraes made his rounds, the woman reported, he quietly pressed the needle into the IV drip bag of one of the unit's half-dozen patients and hit the plunger. Moments later the patient was dead. Alerted, administrators as a test transferred Guimaraes to an outpatient unit on his next shift. The death rate in intensive care fell to zero. When Guimaraes returned three days later, on May 4, four patients died, even as police waited in a nearby office to make an arrest.
A check of hospital records since has revealed that the unit's death rate doubled during Guimaraes' 12-hour shifts, from an average of just under two deaths to four or more. Between 1 January and 4 May, 131 of 225 deaths in the hospital's emergency ward occurred while Mr Guimaraes was on duty. After Guimaraes' arrest and confession, his lawyer appeared to be preparing an insanity defense. In a recent court deposition, however, Guimaraes, who has hired a new lawyer, changed his story. He said he confessed only because he was threatened by police.
Asked by reporters at a press conference if he had poisoned patients, Guimaraes said: "Some patients, yes." Asked if he had taken away patients' oxygen masks, he said: "The oxygen mask was taken away, yes. There were five patients that this happened to... I chose the patients I saw suffering, generally patients with AIDS, patients who were almost terminal. I am calm because the patients were in a coma and had no way of recovering."