Judge Thomas Kleeh looked across the courtroom at former nursing assistant Reta Mays and directly addressed her awful crimes.
“You walked in off the street and confessed your guilt to killing seven people and trying to kill an eighth,” the judge said at her sentencing.
Yet illuminating the nursing aide’s guilt was not as simple as that.
Mays, who was sentenced to seven consecutive life terms and another 20 years, abruptly decided to plead guilty a little less than a year ago.
But her sudden decision came after months of interviews and detective work, with investigators working backwards to narrow down suspects before finally leading to Mays.
And along the way, the 5-foot-2 night shift aide who Kleeh called “the monster no one sees coming,” had denied her role in the killing of veterans who had come to the hospital for care.
“You thrice lied to investigators about your role,” the judge said to Mays.
‘Tough case’
Mays was sentenced May 11 for killing veterans Robert Kozul, Robert Edge Sr., Archie Edgell, George Shaw, a patient identified only as W.A.H., Felix McDermott and Raymond Golden. She is also accused of administering insulin to “R.R.P.,” another patient who was not diabetic, with intent to kill him.
Mays admitted causing their deaths by administering unnecessary and lethal doses of insulin while she worked the overnight shift. She had obtained the insulin from supplies at the hospital, although she was not supposed to possess it or administer it.
The deaths spanned from June, 2017, until June 15, 2018. Three of the veterans died April 8, 9 and 10, 2018.
A hospital physician called “Hospitalist B” in a federal probe was the first to sound the alarm. “Something is going on” and it might be criminal.
But to make sense of the quiet killings and point to a culprit, investigators had to cast a broad net and then focus.
“This was a really tough case to prove since there were no eyewitnesses, no confession,” Michael Missal, the inspector general for Veterans Affairs, told reporters.
The investigation kicked into motion June 27, 2018, when the the VA hospital’s director contacted the Office of Inspector General’s after-hours duty agent to request an inquiry “with the belief that there was at least one criminal act, possibly more, committed.”
The next day, the Veterans Health Administration’s executive in charge informed Missal that “there may be an Angel of Death in Clarksburg.
Inspectors were on site at the hospital starting July 2 and 3, a Monday and Tuesday.
On July 5, 2018, a Thursday and a week after the investigation was initiated, Reta Mays was identified as a person of interest.
It would be almost two more years, July 14, 2020, before she would stand up in court and quietly admit her guilt.
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Building blocks in case
Even as Mays became an early suspect, questions were just beginning.
Early on, the inspector general reached out to the Department of Justice, describing suspicion at the Louis A. Johnson VA Medical Center. As the case built, the federal inspectors wanted insight about what would be necessary to prove it.
The questions, Missal said, included “Who was there at particular times? Who was swiping in and out of the hospital?” Forensic analysis was also a key aspect of the investigation.
“It’s really the building blocks, building on on top of another until you have a case where you think you can prove it beyond a reasonable doubt,” Missal said. “It really was taking the hard evidence and putting it all together.”
Evidence was divided into two categories, said Jarod Douglas, an assistant U.S. attorney in West Virginia’s northern district.
One was medical expert opinion — “what caused the deaths?”
And secondly, attribution — “who caused the deaths.”
Speaking at a podium outside the federal courthouse in Clarksburg after the sentencing, Douglas described what initially was a medical mystery.
Unraveling it required the consultation of an endocrinologist who concluded the only possible cause of the veterans’hypoglycemia was insulin. That work was complicated because medical providers had not already performed diagnostics to determine whether insulin was involved.
“So, therefore, she had to back her way into insulin being the cause. She had to rule out all the other things that can cause the hypoglycemic conditions,” Douglas said.
Next was a pathologist who determined the insulin caused the veterans to die. That came after families had consented to autopsies after some of the veterans had been buried for months. The pathologist used a process called immunohistochemistry staining to determine where the fatal insulin was applied, using specific protein markers. During five of the autopsies, the process uncovered the presence of insulin.
A pharmacokineticist, who studies the effect of medication on the body, concurred that hypoglycemia had caused the deaths. That doctor also provided an estimated window of time when the patients received the insulin, down to the hours.
That was the how.
Investigators also worked to unveil the who.
Clues lead to nursing assistant
Pinpointing Mays required narrowing the suspects.
“There was no relevant surveillance video. There was no eyewitness who observed Reta Mays give the patients insulin. There was no tracking of insulin to find missing insulin. There was no murder weapon. There were no fingerprints. There was no confession,” Douglas said.
“A confession was sought — including through three separate law enforcement interviews — but never obtained. So again the investigators were forced to back their way into who this could be.”
One of those interviews with Mays was six hours long. But she never admitted involvement.
So investigators went at the case the hard way, a blend of CSI and workplace mystery.
Investigators reviewed 1,200 employees’ human resources records, revealing that only four employees had worked during all the victims’ night shifts. That included Mays, who was the only one of those on Ward 3A, where the victims had been treated.
The investigators ruled out the other three employees by reviewing card swipe records, as well as computer access records to place the other three employees elsewhere in the hospital during the timetable that had been identified by the pharmacokineticist.
An extensive review of medical records revealed that Mays had been the documented one-on-one sitter during the suspected foul play that killed Edge, Cozul, Shaw and Golden. Progress notes also documented Mays’ contact with Posey.
That left three more veterans to be tied to Mays. Investigators relied on more than 300 interviews to make those connections.
In the end, Mays did walk in off the street and confess to the killings. But Douglas said that came after all the work that had narrowed the suspects to the nursing aide. A target letter named her as a suspect, prompting the appointment of defense attorneys.
Investigators laid out the evidence to the defense attorneys and offered a choice: cooperate with an information or wait for indictment by a grand jury.
“That process is not her coming in and saying ‘Yes, I confess, confess, confess.’ That’s not what happened.”
In the end, the evidence added up enough that Mays chose to plead guilty.
That left one more mystery.
What could possibly be the motivation to kill veterans who had come to the hospital to heal?
“Unfortunately the ‘why’ can’t be answered here,” defense attorney Jay McCamic said at her sentencing. “Reta Mays doesn’t know why.”