Ep. 54 | Root of All Evil
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Hey Prime members, you can binge episodes 49 to 56 right now and ad-free on Amazon Music. Download the app today. Just before dawn on a cool fall morning, cars full of federal agents pulled into the parking lot of what looks like an abandoned strip mall. They parked outside of a brown brick building and waited until the final vehicle had arrived. When the team leader gave the go-ahead, the agents leapt out of their cars and headed inside flashing their badges.

Most of the agents immediately fanned out as the team leader strode right up to the receptionist and delivered a search warrant. These agents were on the hunt for a killer, and they expected to find evidence here at this industrial laboratory in a suburb of Boston, Massachusetts.

As the receptionist began frantically calling the executives who ran this facility, the lead investigator looked around and he saw the dingy linoleum on the floor and the yellowed ceiling panels overhead and the visible layer of dust on a nearby desk. He had been in plenty of laboratories over the years and typically they were all kept in immaculate condition, but this place was not.

The investigator stepped aside as the other agents strode through the facility, hurrying to grab vials before employees could shred them and to save vials of liquid before lab techs could dump them out. This was easily the most disgusting laboratory the lead investigator had ever stepped foot in. But he had to keep searching this building or more lives would be lost.

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There's more to imagine when you listen. A title I can't recommend enough is The Only One Left by Riley Sager. You know I love a good plot twist, and this one has like five, and they are all excellent. The ending of the book is sort of chaotic and packed, but if you stick it out, the last two pages really pull the entire story together. It's awesome.

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From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. If you like today's story, kindly gift the follow button a trip to Los Angeles, but don't tell them they'll be staying at the Cecil Hotel. This episode is called Root of All Evil. It was a humid Saturday afternoon in August of 2012.

55-year-old Thomas Rybinski stood at the helm of his boat, steering it across the lake near his home in Tennessee. He'd spent all day on the water with his wife Colette and a few friends, and it had been the perfect day for boating. Hot and steamy, but with a light breeze sweeping across the lake.

Thomas couldn't believe that he'd almost cancelled on his wife and friends that morning. He'd woken up with a headache and an upset stomach. But Colette had made him some coffee, which had helped him feel better. And once he was up and moving, Thomas felt okay. Still a bit shaky, but good enough to keep their boating date with their friends.

Thomas was actually accustomed to having to push through discomfort. He had chronic back pain from an old accident that flared up every time he rode his motorcycle, went on a strenuous hike, or really did any sort of strenuous activity at all. But Thomas loved exercising and being outdoors, and so he wasn't about to stop doing those things just because of a little backache. And he also got cortisone injections every month, which helped manage the pain in his back.

Thomas was feeling especially grateful to be boating as he looked out over the bow, navigating the boat around a corner toward a little cove. Once he was in the cove, he dropped the anchor and Colette started unpacking the food they'd brought for dinner. A few hours later, Thomas was halfway through a lively story about his recent hiking trip to Colorado when he felt a tap on his arm. It was Colette, and he knew she was giving him the signal that it was about time to head back.

Thomas looked up and realized the sun was starting to set. He'd been having such a nice time, he really hadn't noticed how late it was getting. And he knew they wanted to be tied up at the dock by nightfall. So Thomas helped his wife pack up quickly, then he pulled up the anchor line and steered the boat back to shore. About a week later, on the following Friday morning, Thomas sat at his desk at General Motors, looking over a blueprint. For years, Thomas had worked as an automotive designer, and right now, he was designing a new vehicle interior.

He doodled ideas on a spare sheet of paper as he brainstormed. But today, he was just drawing a blank. In fact, the only thing he could even think about was the pounding going on in his head. Last weekend's headache that almost made him cancel that boating outing had come back, and it actually had gotten worse and worse throughout this last week. Now, the pain was sharp and persistent, like somebody was snapping a rubber band against his temples over and over again.

Thomas put his elbows on his desk and cradled his face, trying to block out the stark overhead lighting in his office. Thomas hated the idea of leaving work early, but for the first time in years, he was debating whether or not he should go home sick. But ultimately, after rubbing his eyes and thinking about it for a second, he decided he would just try to tough it out. If he was going to have a headache, he figured he'd rather have it here, where at least he could attempt to kind of occupy his mind for a moment by working on a project that he loved.

But once the clock in his office finally reached 5pm, Thomas was so ready to get out of there. He packed up and headed home for the weekend, glad to have the next two days to rest up and recharge. But that weekend, his headache didn't go away. And on Sunday morning, Thomas awoke to some of the worst pain he'd ever felt in his life.

He turned over in bed and told Colette that it felt like the inside of his head was about to explode. Colette looked totally shocked, and Thomas knew why. He never complained about pain. So for him to say something like this meant it must be really serious. And so Thomas didn't even argue when Colette told him they had to go see a doctor. About an hour later, at the Vanderbilt University Medical Center, a doctor named Annie Wilkins walked into an exam room.

Thomas was her first patient of the day. He was sitting on the exam table, clutching his head with his hands while Colette rubbed his back. And so from the moment Dr. Wilkins saw Thomas, she could tell he was in immense pain. Dr. Wilkins asked Thomas to lift his head up for a moment so she could give him a routine examination. But as Dr. Wilkins moved her finger around in front of Thomas's face, she noticed that his eyes were struggling to follow it. In fact, it didn't seem like Thomas could focus on anything at all.

That lack of focus, coupled with this extreme headache he was describing, made Dr. Wilkins suspect that Thomas had an infection in his brain, a condition called meningitis. She wondered if he had been exposed to something out of the ordinary that could cause meningitis, and so she asked him if he'd traveled anywhere new recently.

Thomas nodded and said actually he'd just gotten back from a hiking trip in Colorado, and that was a red flag to Dr. Wilkins. Any time a patient mentioned hiking, she knew that tick bites could be a factor. Ticks can be infected with bacteria and viruses and can spread diseases through their bites. Dr. Wilkins wondered if maybe Thomas had been bitten by a tick in Colorado and developed something called Rocky Mountain Spotted Fever, whose symptoms include meningitis.

To find out, Dr. Wilkins told Thomas that he would need to undergo a spinal tap so the lab could study his spinal fluid for signs of disease. First, she wanted to know whether or not he had meningitis, and then also whether or not Rocky Mountain Spotted Fever caused the meningitis. Thomas grimaced at the thought of a needle going into his spine, but the doctor told him really it was no big deal and they would have answers soon. About 90 minutes later, Dr. Wilkins received the first results from the spinal tap.

Thomas did indeed have meningitis. So Dr. Wilkins asked a nurse to start Thomas on antibiotics right away, which would help reduce the swelling around Thomas' brain and his spinal cord. But about an hour later, Dr. Wilkins got a surprise when the rest of Thomas' lab results came back. Thomas' spinal fluid showed that he did not have Rocky Mountain Spotted Fever. In fact, there was no trace of any bacteria or virus in his spinal fluid at all, which left Dr. Wilkins feeling totally perplexed.

She had been fairly confident that Thomas would test positive for Rocky Mountain Spotted Fever, and if not that, then definitely some other virus or bacteria. After all, viruses and bacteria cause the vast majority of meningitis cases. Dr. Wilkins knew that other invaders can also cause the disease, such as parasites, but that usually only happened to people who traveled internationally.

And in extremely rare cases, patients could get meningitis from a fungus that lives on unsterilized surgical equipment, but Thomas hadn't had any surgeries. So Dr. Wilkins was at a total loss as she walked back towards Thomas' room. She found him inside, lying awake in bed, with his wife Colette sitting nearby in a chair. Dr. Wilkins was relieved to see Thomas looking much more alert than when he'd come into the hospital a few hours ago. The antibiotics already seemed to be helping him.

Colette stood to greet Dr. Wilkins and then quickly asked her if they knew what was wrong with her husband. But Dr. Wilkins had to be honest and said no, she didn't know yet. She was going to keep Thomas in the hospital for a few days. That way they could keep an eye on him as the antibiotics fought the infection. But she still did not know what had caused this infection in the first place.

Over the next few days, Thomas steadily recovered, and on the fifth morning of his hospital stay, Dr. Wilkins was glad to see that Thomas was nearly back to his usual self. He wasn't in pain and he no longer seemed groggy. Dr. Wilkins felt so confident about Thomas' condition that she actually discharged him from the hospital so he could finish recovering at home. One week later, on September 7th, an epidemiologist named Dr. April Petit returned to work at Vanderbilt University Medical Center after a week off.

She began her day by looking over her patients' charts, and one caught her eye. Thomas Rybinski was back at the hospital and had just been transferred by Dr. Wilkins to Dr. Petit's care. Dr. Petit looked closer at his chart, and she saw that Thomas had been given a two-week treatment of antibiotics to take it home, but after only a few days of that, he'd felt so sick that he had to come back to the hospital. Dr. Petit made her way to Thomas' room, and when she went inside, she saw Thomas laying in bed with a dazed look on his face.

His wife Colette was sitting by his side and she explained that Thomas had been acting confused all morning and also for the past few days he'd been complaining of lower back pain. Dr. Petit nodded and then walked over to Thomas's bedside and gently asked him how he was feeling. And Thomas looked up at her but he had this look on his face like he didn't understand the question and then he just stayed silent.

Dr. Petit frowned, knowing her job just got much more difficult because clearly Thomas was not going to be able to tell her exactly how he was feeling. All she'd have to go on was Thomas' medical records and anything Colette could tell her. Dr. Petit suspected that Thomas' meningitis must have flared up again, so she ordered an MRI of Thomas' spine and brain as well as another spinal tap.

She also started Thomas on a new cocktail of antibiotics, and she asked the lab to test his spinal cord fluid again to try to find the cause of this infection. Later that evening, Dr. Petit stopped by Thomas' room to check on him, and she was pleasantly surprised to see that he already seemed to be improving. But as she headed home that night, she couldn't help but still feel nervous for Thomas. After all, they thought he was getting better once before, and now he was back in the hospital, sicker than ever.

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Six days later, on September 13th, Dr. Petit arrived for an early morning shift, feeling sleepy as she drank the last sips of the coffee she'd gotten on the way to work. The moment she sat down in her office, her pager went off, calling her to Thomas Rybinski's room. Dr. Petit had a bad feeling. Even though Thomas had improved slightly in his first afternoon back in the hospital, he was incoherent again by the next morning, just as Dr. Petit had feared. And he'd only been getting worse as the week wore on.

When she arrived in his room and said hello to Thomas, she immediately noticed that the right side of his face was completely slack. His features were drooping and Dr. Petit suspected that Thomas had suffered a stroke. And so she pressed the call button because Thomas would need a brain scan right now. An hour later, Dr. Petit received the brain scan results, which showed that the arteries at the back of Thomas' head were blocked. They also showed a pool of blood where Thomas' brain and spinal column met.

Dr. Petit shook her head. Thomas definitely suffered a stroke. She knew that this damage was caused by something that was trying to invade Thomas' brain. But what was it? Thomas' spinal fluid was still free of bacteria and viruses. It made no sense. And yet there had to be some logical answer. Dr. Petit just needed to find it. The next morning, when Dr. Petit arrived at the hospital, she found a shocking lab result waiting for her.

At last, she knew what was causing Thomas's meningitis. But the answer was truly bizarre. The infection came from a fungus that normally would not cause disease in healthy patients like Thomas. And so it seemed impossible. But the lab results were undeniable. A shiver ran down Dr. Pertti's spine. Fungal meningitis is not only rare, but it's also deadly.

Many patients die from it, even with proper treatment. And so Dr. Petit raced down the hall to order new medication for Thomas, hoping they were not too late. Five days later, on September 18th, Dr. Petit sat in her office, combing through medical journals. She was still stunned over Thomas' diagnosis and was trying to find a published study that might help her understand how Thomas' brain had been invaded by fungus. But it was not until late afternoon that she finally landed on an article that piqued her interest.

The article was about a cluster of fungal meningitis outbreaks that occurred following a devastating 2004 tsunami in the Indian Ocean. Following the tsunami, pregnant women began developing fungal meningitis after getting epidural shots in their spines with needles that had been stored in damp warehouses. The dampness turned out to be a breeding ground for fungus, which made these needles deadly.

Dr. Petit wondered if something similar could have happened to Thomas, that he'd been injected with a fungus-covered needle. If that was the case, then other people might have gotten the same dangerous treatment. She began drafting an email to the Tennessee Department of Health. She needed to report Thomas' case right away. But as she typed, her pager went off. It was another alert about Thomas, and this time he was crashing.

So, Dr. Petit got up and raced out of her office and down the hall to Thomas' room, and when she went in there, she saw Colette in the corner crying and a nurse who was right by Thomas' bedside preparing to intubate Thomas because Thomas had stopped breathing. That same afternoon, so on September 18th, Dr. Marion Kaner was answering emails from her desk at the Tennessee Department of Health where she specialized in tracking infectious diseases.

Dr. Kaner yawned and lifted her rimless glasses to rub her eyes. She was normally peppy and focused, but always seemed to get a bit tired when it was time to sign off for the day. But then an email labeled urgent popped into her inbox. The email was about Thomas Rybinski's rare case of fungal meningitis and his doctor's suspicion that it could have been caused by dirty needles. Dr. Petit had managed to stabilize Thomas, but he was in critical condition and Dr. Petit was worried that others might get sick too.

Initially, Dr. Kaner thought that Dr. Petit's worry about some kind of a fungal meningitis outbreak seemed far-fetched. That is, until she read a very interesting detail in Dr. Petit's letter. About two weeks before Thomas got sick, he had gone to a nearby clinic for a steroid injection to help with his chronic back pain. So, it was at least possible that that clinic injected him with a dirty needle.

Dr. Kaner was familiar with the clinic in question. She knew they saw about 160 patients each week, which meant that if one patient had been infected by a dirty needle, there were likely to be more cases. Dr. Kaner decided to launch an immediate investigation. Two days later, Dr. Kaner parked her car at the St. Thomas Pain Clinic, which was where Thomas had received his steroid injection.

Earlier that morning, Dr. Kaner had received word that two additional patients had shown up at Tennessee hospitals with fungal meningitis, and both of them had also been treated at this St. Thomas pain clinic. Dr. Kaner called the clinic to inform them of the infections, as well as her suspicions that the pain clinic could be at fault. To her relief, the clinic director immediately volunteered to shut down until they could determine what was causing the meningitis.

Dr. Kaner and a few colleagues got out of the car and walked inside the modern-looking clinic with big glass doors and tall windows. The clinic director came out into the waiting room to greet them. Dr. Kaner shook his hand and explained they would need to swab the entire clinic for signs of contamination. And the director said that was totally fine, you know, take your time, and just said, if you need anything from me, let me know. Dr. Kaner and her team followed the clinic director through the facility, which Dr. Kaner noticed was sparkling clean.

The director showed her where supplies were kept, including syringes and needles. Then he walked them over to the industrial fridges where they kept the steroids and other medicines. The investigators took samples and got busy making sure everything was up to code. Meanwhile, Dr. Kaner kept an eye out for mold. She even got down on her hands and knees to inspect the refrigerators, but she found nothing. Dr. Kaner would still test the samples they'd collected, but she had to admit, the clinic appeared clean and safe.

There were no expired steroids, no dirty instruments. It was clear the medical staff took great care of the place and followed protocol to a T. But for the purposes of Dr. Kaner's investigation, this actually was a big problem. Because if this clinic wasn't to blame for the three cases of fungal meningitis amongst the clinic patients, then something much bigger must be going on.

Dr. Kaner thanked the clinic director before heading back to her office, knowing it was time to alert the Centers for Disease Control, or CDC, the agency that handles national disease outbreaks. A few days later, Dr. Kaner sat in a conference call with researchers from the CDC who were calling from their headquarters in Atlanta, Georgia. After first contacting the CDC, Dr. Kaner had reached out to medical professionals all across the state.

So far, she had received word of one confirmed death and five cases of suspected fungal meningitis. All of the cases were linked somehow to the St. Thomas Pain Clinic, but investigators couldn't find any source of contamination there. CDC investigators raised the possibility that the clinic could have received supplies that were already contaminated when they arrived, so they had started to carefully track these suppliers for every single item used at that clinic.

They were checking not just the needles, but also the syringes, anesthetics, surgical dye, even the trays used to hold the instruments. But despite several days of work, they still had not found the source of infection yet. As Dr. Kaner listened in on this conference call, one of the investigators in Atlanta reminded everybody on the call that many of the patients at the St. Thomas Pain Clinic had received steroid injections to relieve their discomfort.

So, if the clinic's needles weren't dirty, then maybe the problem was actually the steroids themselves. Another CDC official then added that it would be easy enough to check because all of the clinic's steroids had all come from the same place: the New England Compounding Center, or NECC for short, which was located in Framingham, Massachusetts.

The CDC investigators said they should let NECC know which steroid batches were being linked to the meningitis cases, that way the company could recall the batches immediately. And so Dr. Kaner suddenly felt hopeful. She left the conference call feeling certain that NECC would recall the drugs and this meningitis scare would soon be over.

At 6 a.m. on October 2nd, so a couple of weeks after Dr. Kaner began her investigation, a U.S. Food and Drug Administration investigator named Stacey DeGarmo pulled into the NECC's parking lot. One of her colleagues sat in the passenger seat taking photographs. Thomas Rybinski, whose case started the investigation, had now passed away from his fungal meningitis.

So now, at least two people in Tennessee had died after receiving this steroid injection compounded at the NECC, and there were 14 other cases identified across the nation. But it had the potential to get much, much worse because NECC shipped so many steroids all over the country.

Dr. Kaner and the CDC investigators had learned that the NECC had distributed 17,675 vials of potentially contaminated steroids across 23 different states. The Food and Drug Administration, or FDA, had quickly gotten involved and almost immediately decided they needed to pay NECC a physical visit.

Lead FDA investigator, DeGarmo, was certain she would find the answers they needed inside the sort of bland-looking brown brick building where the NECC was headquartered. As DeGarmo looked across the parking lot, she immediately saw something troubling.

There was a huge construction vehicle, like an excavator, with a big mechanical shovel that was tearing into a pile of construction debris and other trash, spreading dust all around. A mess like that has no business being outside of a building where drugs are made. DeGarmo shook her head and climbed out of her car. She'd never been to NECC, but she was not surprised when she'd gotten a call about them from the CDC.

Her agency had a history of run-ins with NECC, including a time 10 years earlier when their steroids had given a few patients meningitis-like symptoms. So if these executives at NECC were up to no good, well, DeGarmo was thrilled to be the one to ruin their day.

DeGarmo and her colleague walked into the ground floor laboratory of the NECC where two company executives stood waiting for them. They didn't look particularly pleased to be up so early, especially to be giving a tour to two FDA investigators. Still, DeGarmo followed after one executive while her colleague went with the other. The executive that DeGarmo had followed led her through the laboratory, and DeGarmo noticed right away that the facility was absolutely filthy.

As Degarmo looked over documents, her colleague zipped on a gown, put a respirator on her face, and entered the facility's clean room, where most of the facility's lab work took place. Degarmo remained outside because she was pregnant, but she watched through a window as her colleague moved methodically around the room, wiping surfaces with a sponge. When she finished with each sponge, she dropped it into a sterile bag so that the sponge and whatever was on it could be tested later.

From the door, Degarmo could see that one of the ovens used to sterilize the NECC drugs was obviously covered in this sort of brown muck. She watched with disgust as her colleague carefully swiped the oven and then dropped that dirty sponge into a bag. Twelve hours later, Degarmo and her colleague were exhausted, but they still were not done combing through the NECC lab.

They needed several more days to finish their investigation as NECC lawyers raised one objection after another. Finally, on the third day of the FDA investigation into the NECC facility, NECC executives just straight up would not let DeGarmo back into the building. So the following week, on October 16th, Massachusetts health agents raided NECC, and they would make a staggering discovery.

Not one, but three batches of steroids made at NECC were found to be contaminated, meaning that tens of thousands of infected vials had been sent out across the country, including to the St. Thomas Pain Clinic in Tennessee. Overall, NECC was a sanitary nightmare. Not only was the lab dirty, but the owners of the manufacturing center also owned a waste management business that was right next door.

And investigators found that NECC's whole operation was pretty much illegal. They were mass producing drugs that they had no legal right to make. And when investigators looked even more closely, they found the NECC had actually created thousands of imaginary patients just to make it seem like their operation was legitimate.

All told, more than 100 people died from NECC's contaminated steroids, and almost 800 other people got sick in what was the worst pharmaceutical disaster in decades. NECC's supervising pharmacist, whose name was Glenn Chin, along with several other executives, were sent to jail over their role in creating the dangerous conditions in their facility. Prosecutors said they had all chosen profits over keeping patients safe.

Hey, Prime members, you can listen to new episodes of Mr. Ballin's Medical Mysteries early and ad-free on Amazon Music. Download the app today. And also, Wondery Plus subscribers can listen to Mr. Ballin's Medical Mysteries ad-free. Join Wondery Plus today. Before you go, tell us about yourself by completing a short survey at listenersurvey.com.

From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

This episode was written by Aaron Lan. Our editor is Heather Dundas. Sound design is by Matthew Cilelli. Our managing producer is Sophia Martins, and our coordinating producer is Taylor Sniffen. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Vytak and Tasia Palaconda. Fact-checking was done by Sheila Patterson.

For Ballin Studios, our Head of Production is Zach Leavitt. Script Editing is by Scott Allen and Evan Allen. Our Coordinating Producer is Matub Zare. Executive Producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our Head of Sound is Marcelino Villapondo. Senior Producers are Laura Donna Pallavoda and Dave Schilling. Senior Managing Producer is Ryan Lohr. Our Executive Producers are Aaron O'Flaherty and Marshall Louis for Wondery.

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