Virginia Bayless, an 84-year-old woman, was a patient at Community Hospital of the Valleys in Perris, California, when her hospitalization became part of one of the most disturbing series of patient deaths in the state's history. On the night of April 19 into the early morning hours of April 20, 1981, Bayless was admitted to the hospital's intensive care unit after suffering a stroke and a possible heart attack.
She was already in a coma when she entered the unit and required close nursing care. Registered nurse Robert Rubane Diaz was working the night shift along with other hospital staff.
Nurse Susan Stroman helped care for Bayless, including bathing and catheterizing her. At approximately the same time, another critically ill patient, Henry Castro, was being treated nearby. After Stroman finished attending to Bayless, Diaz directed her attention toward Castro, telling her that he looked strange. Castro suddenly began suffering violent seizures followed by respiratory and cardiac arrest, creating an emergency that drew the staff's attention. While efforts were being made to save Castro, nurse Donna MacDonald went back to check Bayless and discovered that she no longer had a heartbeat. Resuscitation efforts failed, and Bayless was pronounced dead at 1:38 a.m. on April 20. Castro died several hours later.
Bayless's death would prove particularly important to investigators because her medical history did not provide an ordinary explanation for what toxicologists later found in her blood. Unlike many of the other patients whose deaths were investigated, there was no evidence that Bayless had suffered the dramatic seizures associated with the suspected poisonings. There was also no documented evidence that she had been therapeutically treated with lidocaine, a powerful antiarrhythmic medication commonly used to control certain dangerous disturbances in heart rhythm. Her treating physician and nurses did not recall administering the drug, and her medical chart contained no record that it had been prescribed or given.
Despite that absence, testing of a blood sample taken from Bayless revealed an extraordinarily high concentration of lidocaine. Prosecutors presented experts who concluded that she had received more than 1,000 milligrams shortly before her death. The amount was described as a massive dose capable of causing death within minutes. Even an expert testifying for the defense agreed that the concentration indicated a massive exposure. Prosecutors argued that the fact Bayless had already been comatose explained why she did not display the violent seizures seen in many of the other patients. The medical and toxicological evidence ultimately persuaded the trial court that Bayless had died from a deliberate lidocaine overdose administered by Diaz.
Diaz disputed that conclusion. His defense argued that Bayless might have received lidocaine therapeutically in the emergency room and that hospital personnel simply failed to document it. The defense pointed to missing physician notes and to an earlier statement from MacDonald in which she believed Bayless might have arrived in the intensive care unit with a lidocaine drip. Diaz also testified to that effect. The prosecution maintained that even if some therapeutic medication had been given, it could not reasonably account for the enormous concentration discovered in Bayless's blood. The California Supreme Court later determined that the evidence was sufficient to support the finding that Diaz murdered her.
Bayless's death occurred amid a remarkable surge in deaths at Community Hospital of the Valleys. Diaz had begun working nights in the cardiac care and intensive care unit on March 29, 1981. Over the following weeks, numerous patients experienced sudden seizures, respiratory arrest and cardiac failure. Nine patients died during that period at the Perris hospital under circumstances later examined in the prosecution. Investigators learned that the hospital had recorded 24 patient deaths between March 8 and April 20, while a coroner's investigator reported that the facility normally experienced approximately three deaths per month.
Authorities began reviewing medical records, conducting autopsies and testing tissue and blood samples. Their attention increasingly turned toward Diaz because he had been involved in caring for the patients shortly before many of the medical crises. Investigators also learned that syringes containing unusually concentrated lidocaine had been discovered at the hospital. Diaz stopped working at the Perris facility on April 23 and immediately began working at San Gorgonio Pass Hospital in Banning. Patients there soon suffered similarly suspicious medical emergencies while he was working.
On May 1, 1981, investigators executed a search warrant at Diaz's home. Police seized syringes, an empty lidocaine box and a vial containing lidocaine, evidence that later became part of the prosecution's case. The investigation continued for months as authorities assembled medical records and toxicological findings. Diaz was formally arrested at his home on November 23, 1981, and accused of murdering 12 patients, including Bayless. Eleven of the charged deaths occurred at the Perris hospital and another involved a patient at the hospital in Banning.
Prosecutors contended that Diaz had deliberately injected patients with massive quantities of lidocaine while entrusted with their care. They presented a largely circumstantial but extensive case involving toxicological evidence, patient symptoms, Diaz's presence during the medical emergencies, contaminated or unusually concentrated syringes and the materials found at his residence. The defense maintained that some patients had died from their serious underlying illnesses and that others might have experienced adverse reactions to medications administered legitimately. Prosecutors did not establish a definitive motive, and the case was not presented as a series of mercy killings.
Diaz waived his right to a jury, leaving the determination of guilt to a judge. After a lengthy nonjury trial, he was convicted on March 29, 1984, of 12 counts of first-degree murder, with Bayless's death included among the convictions. The court also found multiple-murder special circumstances and imposed a death sentence. The judge emphasized that Diaz had occupied a position of extraordinary trust, caring for vulnerable hospital patients who depended upon his professional skills, yet had used that position to kill them with drug overdoses.
Diaz appealed, challenging numerous aspects of the prosecution and the sufficiency of the evidence in individual deaths, including Bayless's. In 1992, the California Supreme Court specifically rejected his argument that the evidence was insufficient to establish that he killed her. The court pointed to the massive concentration of lidocaine in her blood, the lack of evidence that the medication had been legitimately prescribed and expert testimony that the quantity would have been fatal within minutes. The court affirmed the judgment and death sentence while striking 11 duplicate special-circumstance allegations.
Diaz was never executed. He remained under a sentence of death for more than two decades as his case continued through the appeals process. On August 11, 2010, he died of natural causes while still a condemned California prisoner. Thus, nearly three decades after Virginia Bayless died in her hospital bed in Perris, the man convicted of deliberately causing her death ultimately died while still serving the death sentence imposed for her murder and the murders of 11 other patients.
