Prosecutor: Nurse charged in patient death acted alone

Angela Almore, 44, of 724 Berwick Valley Lane in Cary, was indicted on one count of second-degree murder and six counts of felony patient abuse. She made her initial court appearance Tuesday morning, and Superior Court Judge Abe Jones ordered her to be held in the Orange County jail under $500,000 bond.

Jones also appointed a public defender for Almore and set her next court appearance for July.

Nine of the approximately 25 patients in the Alzheimer's unit at Britthaven of Chapel Hill tested positive in mid-February for opiates, a class of controlled substances often used for pain management, officials said. Six of them were hospitalized, and 84-year-old Rachel Holliday, died on Feb. 16.

The indictments identify the other hospitalized patients as Marion Woodward, Dorothy Willis, James Scanlan, Eloise Hill, Pauline Lyons and Josephine Kernan. The indictments allege that Almore intentionally caused each to "ingest morphine that proximately caused serious bodily injury."

An autopsy wasn't performed on Holliday, but a medical examiner who reviewed her records determined that she died because of pneumonia-related asphyxiation. The report listed "morphine toxicity" as a contributing factor to her death, noting that tests done at UNC Hospitals before her death determined she had a morphine level of more than 50,000 nanograms per milliliter of urine.

Drug testing done in the military and many workplaces considers a morphine level of 2,000 nanograms per milliliter as a positive test result.

Officials have said Holliday and some of the other Alzheimer's patients who tested positive weren't supposed to be receiving any pain medication at Britthaven.

"The state's position is that the morphine was probably given to make the patients more manageable," Woodall said.

He declined to discuss where the morphine came from or how many patients hadn't been prescribed the drug, but he said he doesn't expect any more arrests or charges in the case.

"At this point, there is nothing to indicate that anyone else was involved," he said.

The state Nursing Home Licensure Section is conducting a separate investigation of any procedural violations, which could lead to penalties for Britthaven, at 1716 Legion Road.

The agency sent a team of inspectors to Britthaven two days after Holliday's death to gather information about drugs administered to Alzheimer's patients there.

A spokesman for Britthaven said Monday that staffing for the Alzheimer's unit in the Chapel Hill facility remains under review and that none of those on duty at the time of hospitalizations have returned to work. Britthaven tested all staff members of the unit for drugs in February and placed them on paid leave.

A relative of a Britthaven patient said Tuesday that she feels Britthaven is taking concerns very seriously and is trying to improve.