She got to work around 4:30 a.m., her deadly secret only hours from being discovered.

It was April 28, 2008. Kimberly Saenz arrived at the DaVita Dialysis clinic in Lufkin wearing ponytails and scrubs. Her supervisor, Amy Clinton, told her she would be working as a patient care technician that day.

Clinton, a DaVita head honcho brought in from Houston following two deaths at the clinic three weeks earlier, said the news distressed Saenz, as she was accustomed to being a medication nurse. In her usual role, she had free rein of the facility, going from patient to patient to “push” medication from a syringe, sometimes needle-tipped, into dialysis lines and ports.

According to Clinton, Saenz became visibly upset, wiping tears from her eyes as she reluctantly got ready to do a job she felt was beneath her — monitoring patients, cleaning up vomit and wiping up blood, as it commonly spilled during dialysis.

Around 6 a.m., patients Marva Rhone and Carolyn Risinger entered the facility. For people with failed kidneys, spending hours attached to a dialysis machine three times a week can mean the difference between life and death.

Although everyone at the clinic was on high alert with the recent string of deaths, it seemed to a be a day like any other until two patients said they saw something disturbing.

Sitting no more than 40 feet from Rhone and Risinger, patients Lurlene Hamilton and Linda Hall said they watched Saenz squat down to place a jug of bleach on the floor. She then poured the bleach into her cleaning bucket and drew up 10 ccs of the caustic liquid into a syringe, according to their testimony.

Her actions bothered the women for two reasons — one, the floor isn’t sanitary, and two, Saenz seemed nervous. Hall and Hamilton said they then watched her inject bleach into ports on the dialysis lines of Rhone and Risinger.

Although neither of them went into cardiac arrest, testing would later reveal that Rhone’s dialysis line tested positive for bleach. Risinger’s line was not tested, as it had already been thrown away.

Being seen that day marked the end of Saenz’s reign of terror on the clinic. A little more than four years to the day, a jury found her guilty on a charge of capital murder, set to spend the rest of her life in prison without the chance of parole for killing at least two of the five murder victims named in an indictment. Five other people who did not die were listed as victims of aggravated assault.

Looking back at the trial, prosecutor Clyde Herrington said there was very little of the state’s evidence that the jury did not see. He said he believes there were more victims than just the 10 indicted cases, based on the research of a Centers for Disease Control epidemiologist. Using the dates of adverse occurrences dating to 2007 paired with the days Saenz worked, the epidemiologist statistically connected her to the events more than any other DaVita employee. Because Lufkin Police detectives were only able to obtain medical waste from two weeks prior to April 28, Herrington could not obtain enough evidence to indict Saenz in the other incidents.

“The only days there were deaths in April, she was there,” Herrington said. “Dialysis patients are sick, but every source of information we can find says it is very unusual for patients to die during dialysis treatment.”

While the state doesn’t have to prove motive for a conviction, Herrington said they did talk with a registered nurse who studied more than 100 health care killers. According to her research, only 50 percent of health care killers that go to trial are convicted. The most common method used by a health care killer is injecting a patient with some type of medication or substance.

“Criminal behavior is something we’ve been trying to understand since Cain killed Abel,” Herrington said. “Only when the health care killer confesses do we know motive.”

As to Saenz’s specific motive, Herrington said he believes at the time she was a troubled woman with marital problems who lashed out because of job dissatisfaction. Before working at DaVita, he said, Saenz was fired from Woodland Heights Medical Center for stealing Demerol, a powerful narcotic painkiller.

“From talking to some of the folks who worked with her, it sounded like her husband didn’t want her to quit (DaVita),” Herrington said. “She was depressed. She was frustrated, and I think she took those frustrations out on the patients.”

Maintaining his client’s innocence, defense attorney Ryan Deaton said there is a lot of information he wishes the jury had heard. He said he intends to be involved with Saenz’s appeal. She appeared in court Wednesday to start the process.

“Hopefully she’ll get a new trial,” Deaton said.

Before her trial began, Deaton fought for the jury to have access to a U.S. Department of Health and Human Services report from May 2008 that was heavily critical of DaVita’s practices. The report was ruled inadmissible by state District Judge Barry Bryan.

According to the report, from Dec. 1, 2007, to April 28, 2008, the facility had 19 deaths compared to 25 for 2007. Those numbers put the facility at a mortality rate 7 percent above the state average.

The facility was also not keeping proper records of adverse occurrences, the report stated. From Sept. 1, 2007, to April 26, 2008, there were a total of 102 DaVita patients transported by ambulance to local hospitals during or immediately following dialysis. Of those, 68 did not have a complete adverse occurrence report.

The report went on to state that based on record review and nursing staff interview, the facility “did not demonstrate competence in monitoring patients during treatment alerting nurses or physicians of changes to a patient’s condition and following the physician’s orders for the dialysis treatment.”

DaVita spokesman Vince Hancock said the company’s actions in April 2008 did not kill any Lufkin patients, as evidenced by the jury’s decision.

“We hope that healing can start to occur for families of victims and for our teammates who also have been victimized by the murderous acts of Kim Saenz,” Hancock said.

While Saenz’s family has maintained their silence since the sentencing, her husband said they are planning a press conference in the near future.

Saenz remains in the Angelina County Jail pending prison transport.