Crime Immemorial

In the heart of Toronto, the Hospital for Sick Children—affectionately known as SickKids—has long been a beacon of hope for families facing pediatric crises. But between June 1980 and March 1981, its cardiac ward became the stage for a chilling enigma: the sudden, suspicious deaths of at least twenty-one infants, with autopsies revealing lethal doses of digoxin, a powerful heart medication, coursing through their tiny veins. What began as a heartbreaking spike in mortality evolved into one of Canada’s most haunting medical scandals, implicating nurses, exposing hospital flaws, and leaving a trail of grief and unanswered questions that lingers four decades later.

The trouble started quietly on June 30th, 1980, when the hospital reorganized its cardiac clinic into two adjacent wards: 4A and 4B. These units cared for critically ill infants recovering from heart surgeries or managing congenital defects. Within two months, an alarming pattern emerged: twenty patient deaths, far exceeding the norm for such a specialized area. Nurses whispered about a “jinx team”—a group led by Phyllis Trayner, the ward’s team leader—whose shifts seemed cursed with tragedy.

By early 1981, the excess mortality had persisted for months, but the hospital kept the investigation internal to avoid demoralizing staff. Cardiologists discussed the issue in fall 1980 and again in January 1981, attributing many deaths to the babies’ underlying conditions. Yet, doubts festered. On March 12th, 1981, bereaved father Kevin Garnett confronted hospital staff about his son Justin’s sudden death, prompting Metro Toronto coroner Dr. Paul Tepperman to intervene.

Tepperman’s probe uncovered horrors. An autopsy from January revealed sky-high digoxin levels in infant Janice Estrella. Eight days later, another baby tested at thirteen times the therapeutic dose. On March 22nd, yet another infant succumbed to apparent digoxin poisoning. Police descended on the ward, searching lockers and scrutinizing logs. In a separate incident in January 1982, babies in another department fell ill from unauthorized epinephrine injections disguised as vitamin E—though this was later deemed unrelated to the cardiac deaths.

Over the period, the Grange Commission—a provincial inquiry—would scrutinize thirty-six deaths, deeming eight outright murders by digoxin overdose and thirteen “highly suspicious.” The total suspicious toll: twenty-one lives lost in under a year.

The spotlight eventually fell on twenty-four-year-old nurse Susan Nelles, a quiet, dedicated staffer on the cardiac ward. Colleagues’ subjective recollections—her “inappropriate” reactions to deaths, like seeming detached—fueled suspicions. Police logs showed her on duty during several fatal shifts. On March 31st, 1981, Nelles was arrested and charged with four counts of first-degree murder: the deaths of Justin Cook, Janice Estrella, Kevin Pacsai, and Allana Miller.

The charges stunned Toronto. Nelles, held in a stark detention cell, became a media sensation. The public grappled with the idea of a “killer nurse” preying on vulnerable babies. As investigations deepened, data sent to the U.S. Centers for Disease Control pinpointed Trayner as the only nurse present for all twenty-nine cases under review—a red flag that shifted some focus.

Nelles’ preliminary hearing in January 1982 unraveled the case. Crucially, she had an ironclad alibi for one charged death, and the judge ruled it a murder—undermining the prosecution’s narrative of her sole culpability. The notion of multiple nurses committing motiveless killings seemed implausible. By May 1982, charges were stayed; Nelles walked free, her reputation scarred but her innocence affirmed.

Trayner faced no charges but endured grueling televised testimony during the inquiry. She denied wrongdoing and resigned post-report, fading from public view. The lead detective resigned amid the fallout, frustrated by the inconclusive probe.

In 1983, Ontario Premier Bill Davis launched the Grange Commission, led by Justice Samuel Grange, to dissect the failures. Over eighteen months, it heard from hundreds of witnesses and pored over records and autopsies. The 1984 report—delivered amid intense media scrutiny—was unflinching: eight deaths were deliberate homicides via digoxin, with thirteen more probable. The commission lambasted the hospital for lax drug controls, unreported death spikes, and poor oversight, recommending locked narcotics cabinets and better supervision.

Yet, legal shackles prevented naming suspects. Grange hinted at a prime culprit—widely believed to be Trayner—but stopped short, citing risks of defamation. The report contradicted the hospital’s former chief of pediatrics, who insisted no homicides were proven. It spurred reforms: SickKids adopted unit-dose syringes, enhanced training, and stricter protocols, crediting these for safer care in the years since.

Decades on, the case defies closure. In 2011, a theory emerged: rubber tubing in medical equipment might have leached mercaptobenzothiazole (MBT), a compound mimicking digoxin in tests and potentially toxic to infants. Researcher David Seccombe identified a “digoxin-like substance” in autopsied babies, suggesting false positives inflated suspicions. Gavin Hamilton, a forensic expert, echoed this, proposing equipment contamination explained the cluster.

Epidemiologist Alexandra Levitt, in her 2015 book In the Darkest of Days, clung to homicide as the likeliest cause. Nelles, who resumed nursing and earned honorary degrees in 1999 and 2015 for her advocacy, has rebutted the Grange findings, insisting in 2011: “There were no murders.” Parents like Garnett still seek truth, their grief compounded by ambiguity.

The SickKids saga reshaped pediatric care in Canada, embedding vigilance against “Angel of Death” scenarios—echoed in later cases like Britain’s Lucy Letby. It exposed how institutional secrecy can amplify tragedy, forcing hospitals to prioritize transparency.