SAN ANTONIO — Three decades ago, a young nurse named Genene Jones made international headlines as the suspected serial killer of more than a dozen infants in the pediatric intensive care unit at San Antonio’s charity hospital.

The story brought to life every parent’s worst nightmare: losing a child at the hands of a caregiver who took some sort of perverse thrill from the baby’s final moments.

Jones was ultimately convicted of a single charge of murder at a clinic in Kerrville, a nearby town. None of the parents who lost their children in San Antonio under suspicious circumstances had the solace of hearing a jury foreman intone “Guilty of murder in the first degree” in a trial involving their loved one. But they took comfort in knowing that Jones was serving a 99-year sentence and would remain behind bars for the rest of her life.

No more. A few years ago, it became clear that the state of Texas would be forced to release Jones in March 2018 because of an effort to reduce prison overcrowding that gave convicts outsized credit for good behavior. Hoping to keep Jones locked up, prosecutors launched a secret investigation to see if they could bring a new murder charge in one of the coldest cases imaginable.

On Thursday, that effort took a big step forward: A San Antonio grand jury indicted Jones, now 66, for murdering 11-month-old Joshua Sawyer on Dec. 12, 1981. Her alleged weapon: a massive overdose of the anti-seizure drug Dilantin.

“It’s the right thing to do,” District Attorney Nicolas “Nico” LaHood told me. “This woman is evil. Her behavior shocks the conscience of anyone with a moral compass. Genene Jones is in a class by herself. This is doing what’s right. But it’s a 30-year-old case. It’s not going to be easy.”

Getting to this point wasn’t easy either: It involved a grizzled criminal investigator who wouldn’t give up; a young prosecutor who was shocked to hear about Jones for the first time; and a mom who clung to her dead child’s medical chart for three decades.

The prosecution is certain to face an array of legal challenges. In an interview before Thursday’s grand jury action, San Antonio attorney John Convery, president of the Texas Criminal Defense Lawyers Association, says the very idea of bringing a new murder charge in the decades-old case raises fundamental legal and fairness questions. (He spoke about the matter without knowing the DA planned to seek such an indictment.) “I’m not being critical of victims,” Convery says. “I’m completely understanding of their incredible loss. But that isn’t justice; it’s revenge.” Any such move, he says, would be “bringing a murder case to solve a parole problem.”

While the legal prospects for the case are uncertain, it’s clear that the prosecution will rekindle painful memories for the families who have spent decades mourning their lost children. “I’m scared,’’ said one sobbing mother as she prepared Thursday to deliver her testimony before the San Antonio grand jury.

Jones has always insisted she was innocent of any crimes. She never testified at the trial that ended with the 99-year prison term or during a second case, for injury to a child, that produced a 60-year sentence to be served concurrently. A prison spokesman says she has instructed officials to decline requests for interviews.

Early in my journalism career, I wrote extensively about Jones, first in a lengthy 1983 Texas Monthly article, then in my 1989 true crime book, titled “The Death Shift.” Decades later, after prosecutors told me of their plan to try Jones again for murder, they agreed to speak with me for a story about how and why they were bringing their new case. There was just one condition: I would keep the news secret until the grand jury handed down its murder indictment.

This is that story. It is based on detailed interviews with the DA, two deputies responsible for today’s indictment, two mothers invited to testify before the grand jury and my own decades-old files on the troubling case of Genene Jones and the Texas baby deaths.

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During a 15-month period between April 1981 and June 1982, the eight-bed pediatric ICU at Bexar County Hospital experienced a strange epidemic: 42 children — an extraordinarily high number — died there. Even more peculiar: 34 of the patients died during the 3-11 p.m. shift, and Jones, a licensed vocational nurse, had cared for 20 of them.

Several nurses had complained directly to supervisors about this disturbing pattern, later documented by a Centers for Disease Control investigation. But the supervisors had dismissed the notion that Jones — who spoke passionately about her patients — could be deliberately harming children. Certain something was terribly wrong, members of the medical staff began calling Jones’ hours on duty “the Death Shift.”

Jones, then 31, was a deeply divisive figure in the ICU, overbearing and foul-mouthed yet exceedingly confident of her medical knowledge and nursing skills. She seemed to thrive on the excitement of being in the middle of a “code” — a life-threatening medical emergency. But was she drawn to crises or causing them? The CDC study would later conclude that during a shift Jones worked in this period, a child was 25.5 times as likely to suffer a medical emergency — and 10.7 times as likely to die. Kids who were recovering on other shifts took a sudden turn for the worse under Jones, in a pattern repeated on multiple days; there were dozens of unexpected crises. When a patient didn’t make it, Jones broke down, sobbing as she picked up the baby’s body and rocked it.

Joshua Sawyer arrived at the pediatric ICU on Dec. 8, 1981 — at the height of the ICU’s mysterious “epidemic.” Eleven months old, he was suffering from severe smoke inhalation after being rescued from an explosion and fire at his family’s small rental home. Like many of the ICU’s patients, the little boy had been transferred to the county hospital because his family lacked insurance. Recalls Connie Weeks, Joshua’s mother, who was then 20, “We were very, very poor.” Weeks describes her son as “pretty laid-back … just a happy-go-lucky kid.”

Joshua came to the ICU in a coma and covered with soot; he’d already experienced seizures and one arrest. Doctors ordered drugs — Dilantin and phenobarbital — to prevent more seizures. Though Joshua’s condition was critical, a scan of his skull revealed brain activity, an encouraging sign. “Given the patient’s age and early signs of brain’s general recovery,” a pediatric neurologist noted in his records, “prognosis for further neurologic recovery, though guarded, probably warrants aggressive treatment.”

By Joshua’s fourth day in the ICU, his seizures had stopped, and he was breathing without a respirator. His mom let a friend talk her into taking a break — for a shower, a change of clothes and a movie at the nearby Galaxy Theater. “I knew he was doing better,” says Weeks.

An usher came into the darkened movie theater to summon her back to the ICU.

Jones had taken over Joshua’s care at 3 p.m. that day. At 7 p.m. his heart began beating too rapidly, a condition known as tachycardia. Doctors pulled him out of that emergency. Another ICU nurse, Pat Alberti, later recounted hearing Jones tell Connie and her husband afterward that their son would have permanent brain damage if he survived. Their baby would have to be institutionalized, Jones declared. He would be better off dead. (Weeks says she doesn’t have any recollection of Jones.)

The next day — again under Jones’ care — Joshua Sawyer died at 9:22 p.m. The baby’s downward spiral had surprised his doctors. Joshua had suffered two arrests during the 3-11 p.m. shift. His heart had begun contracting erratically at 7:55 p.m.; electrical shock and drugs had brought it back to a normal rhythm by 8:20 p.m. Thirty minutes later, his blood pressure started to drop, and then his heart failed a final time.

During the brief period between the two arrests, doctors had sent a blood sample down to the lab to check the level of Dilantin in his body; Joshua’s last scheduled dose of the drug had been 11 hours earlier. The test result was not completed before the baby’s demise, and in the chaotic aftermath — coming too late to make a difference, with parents to inform and paperwork to finish — the lab study was ignored. But it told a troubling story.

Joshua’s sample had gone to the hospital’s third-floor pathology lab, where a technician took the test tube of blood and fed it into a large, complex machine called an Automated Chemical Analyzer. The normal range for Dilantin was between 10 and 20. But the number that registered was more than double that — 55.5, bumping the equipment’s upper limit the way boiling water would overheat a body thermometer. To get a precise reading, the technician carefully diluted the sample’s concentration by half, recalibrated for the dilution and ran it through again. This time, the Automated Chemical Analyzer showed 59.6 — a toxic level of Dilantin, more than enough to throw a baby’s heart into cardiac arrest. The technician entered the result into the hospital’s computer, which printed it out for Joshua’s bulky medical chart, where the evidence would go unnoticed for more than a year.

In the weeks after Joshua’s death, officials at the county hospital and its affiliated University of Texas medical school had begun taking suspicions of “purposeful nursing misadventure” (as the pediatrics department chairman put it) seriously. They convened high-level meetings, prepared internal memos, conferred with their outside lawyer and brought in an expert review committee to quietly investigate. They’d explicitly identified Jones as the central problem.

But in the midst of an image makeover for the old charity hospital — it was being renamed Medical Center Hospital — they were unwilling to alert the authorities, fearing bad publicity and lawsuits. So instead of simply firing Jones outright, they replaced all seven LVNs in the ICU in March 1982, under the cover of upgrading the unit to an all-RN staff. While they privately celebrated Jones’ departure, hospital officials presented her with a warm letter of recommendation, calling her “loyal, dependable, and trustworthy” and “an asset to the Bexar County Hospital District.” The letter added: “This move in no way reflects on her performance in the unit.”

With Jones finally gone, the pattern of unexpected emergencies and deaths in the San Antonio hospital immediately stopped. But it wasn’t the end of the problem.

Five months later, Jones began work in Kerrville, a small town 60 miles to the northwest, at the new pediatric clinic of Dr. Kathleen Holland. Holland had trained at the Bexar County hospital but was dismissive of the rumblings about Jones — and reassured by her letter of recommendation.

Over a period of 31 days starting in late August, six different children arriving at Holland’s clinic with routine problems suddenly stopped breathing and were rushed to Sid Peterson Hospital in Kerrville. One of them — a blue-eyed 15-month-old girl named Chelsea Ann McClellan — died on Sept. 17. Chelsea had gone into respiratory arrest after Jones gave her what were supposed to be routine baby shots. Tests later confirmed she’d been injected with succinylcholine, a powerful muscle relaxant.

This bizarre outbreak prompted local doctors to confront Holland and report their suspicions to the Texas Rangers, triggering parallel criminal investigations in Kerrville and San Antonio. Sam Millsap, the newly elected Bexar County DA, soon leaked the story to a local TV reporter, leading to a front-page headline in The New York Times: TEXAS INQUIRY ON 47 BABY DEATHS.

Under public suspicion, Jones remained defiant. “I’m sick and tired of being crucified alive and having people think I’m a baby killer,” she told me in May 1983, three weeks before her indictment. “I haven’t killed a damn soul.” In February 1984, after being tried and convicted for Chelsea McClellan’s murder, Jones received a 99-year sentence.

Months later, Millsap won the only case brought against Jones in San Antonio, for injury to a child, a one-month-old baby named Rolando Santos. Santos had nearly died after receiving repeated overdoses of the blood-thinner heparin under Jones’ care — even when he wasn’t supposed to be getting any heparin. A doctor had halted his final massive bleeding episode with an emergency injection of protamine sulfate, a drug that reverses the effects of heparin. Jones was sentenced to 60 years, to run concurrently with her murder sentence.

As the end of the 20-month probe neared, Millsap’s criminal investigators, led by a relentless Army vet named Art Brogley, pushed hard for more indictments. They’d recommended charging seven top hospital and medical school administrators for failing to stop Jones — if they’d alerted criminal authorities promptly, the investigators noted, Jones never would have harmed so many children. Instead, the San Antonio officials had volunteered nothing — even after learning about the nurse’s rampage in Kerrville — following instructions to maintain a “judicious silence.” (Medical school and hospital officials later acknowledged they were fearful of civil lawsuits and reluctant to call authorities without proof of wrongdoing.)

Brogley had also pressed for murder indictments against Jones, whose San Antonio victims, mostly Hispanic, were poor and powerless. If it had been the mayor’s kids, he angrily told his bosses, they’d pursue it to the bitter end.

Among the potential murder cases the investigators scrutinized, Brogley viewed the death of Joshua Sawyer as his best prospect. He prepared a separate 23-page report on the case, backed by 46 exhibits and 30 witness statements. The toxicologist for the Bexar County medical examiner’s office told him Joshua’s death resulted from a massive Dilantin overdose.

But this particular crime scene presented major obstacles to a murder conviction. No one had actually seen Jones give Joshua the drug. Many people were in and out of his room. And as Dr. Arthur McFee, a surgeon who chaired the ICU’s oversight committee, reasoned, explaining the hospital’s dismissiveness about possible criminal acts: “If they’re sick enough to be in the pediatric ICU, they’re fucking sick enough to die.”

After securing the resignations of key medical administrators, Millsap was ready to call it quits. “There will be no additional indictments of Genene Jones,” he announced in October 1984. “No useful purpose will be served. I think she will spend the rest of her life in jail.”

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It was nearly three decades later that relatives of Genene Jones’ victims began to realize she might someday walk free. Under a 1977 Texas law that was changed in 1996 (but not applied retroactively), Jones has received credit for about two days of “good time” for every day she’s been behind bars. That set her mandatory parole date at March 1, 2018, after imprisonment in Gatesville, Texas, for 34 years and eight months.

(During my most recent contact with Jones — a 1987 prison interview for my book — she appeared less angry, citing newfound religious beliefs, but was no less adamant about her innocence. She doesn’t appear to have granted a media interview since.)

In 2013, family members formed a Facebook support group called “Victims of Genene Anne Jones,” and began pressing the Bexar County DA’s office to bring a new murder charge against her. (There is no statute of limitations on murder.) Andy Kahan, the crime-victims advocate for the city of Houston, coordinated an informal media campaign. A grown-up Rolando Santos made a TV appearance to oppose Jones’ release, displaying a needle scar from the ICU bleeding episodes that had nearly claimed his life back in 1982.

The group’s most passionate advocate was Chelsea McClellan’s mom. A secretary at the time of her daughter’s death, Petti McClellan had become a nurse two years later. She spoke of her fear that Jones would get out and kill again. “This is my mission now,” she said in 2013. “Losing a child does not consume you; it drives you.”

Winning a new murder conviction was a formidable challenge. The evidence in the hospital deaths, involving seriously ill children, had always been circumstantial; with the passage of time, witnesses had died, memories had faded and records had disappeared. The county hospital even had a new name: It was now called University Hospital.

After four-term DA Susan Reed invited tips from the public, generating hundreds of calls, the Jones case became the personal project of investigator Larry DeHaven, a dogged former San Antonio cop. “I’ve been wanting to get her for a long time,” says DeHaven, now 70 and a year from retirement. “To me, I don’t really believe in coincidences. For her to be in one spot, and all those babies die, and when she leaves, the deaths drastically reduce? That’s too much. You’ve got one common denominator, and that’s Genene Jones.”

DeHaven retrieved files from the widow of Art Brogley, who had died in 2012 but stashed materials from his 1980s investigation — including a seven-foot color-coded chart of suspected victims — in his garage. He perused what could be found in storage. But most of the medical records from the 1980s were missing — from the DA’s files and the county hospital. A difficult prosecution now looked hopeless.

After LaHood, a former criminal defense attorney, ousted Reed in November 2014, DeHaven was assigned to a new court, overseen by an aggressive assistant DA named Jason Goss. Over lunch in the summer of 2015, DeHaven bent his ear about the Jones case.

Goss, now 36, had never even heard of Genene Jones; he was six months old when Joshua Sawyer died. But the story DeHaven told — and the prospect of Jones’ release — shocked him. In December 2016, Goss decided to take on the mission of trying to keep her from getting out, and won LaHood’s blessing. But he had to do all the work after hours; Goss was the lead prosecutor in a busy criminal court. (His most recent trial pits a gunman named “Fat Boy” against a wheelchair-bound man under investigation for ordering torture and capital murder.)

An earnest native of Bryan, Texas, Goss dips snuff and wears Caiman boots. After having 20 boxes of Jones files — and Brogley’s giant chart — moved into an unmarked windowless office, Goss began spending his evenings at work, poring through decades-old records and searching for a winnable case. “I did Genene at night,” he says. DeHaven was no longer operating solo.

A breakthrough came from Connie Weeks, now 56 and employed at a bank, who revealed that she’d saved her son’s three-inch-thick medical record for 30 years. “It’s all I had left of Joshua,” she says. “Everything else was destroyed in the fire.” The Sawyer case moved to the top of the list. Goss and DeHaven began tracking down witnesses, including the lab technician who ran the test revealing the baby’s massive Dilantin overdose; he’s now a suburban San Antonio dentist.

In late April, Goss took his case for bringing a new murder charge to LaHood, making his argument with a two-hour PowerPoint presentation. LaHood signed off, and says he hopes to seek more murder indictments against Jones in future months. “I don’t want her stepping out onto free soil,” says the DA. “My goal is not to leave one baby behind. In a perfect world, we believe she’d be held accountable for every baby we believe she stole from their families.”

Today’s action is proof that prosecutors can quickly win a grand jury indictment in even the most complex matter. Goss says he presented all his evidence in a single day, starting with the PowerPoint presentation that persuaded his boss. He brought in just a handful of witnesses, including Connie Weeks, Joshua Sawyer’s mother, and Petti McClellan, who watched Jones inject Chelsea with a muscle-paralyzing drug.

Goss says he expects the Sawyer case will take up to two years to get to trial, but believes the $1 million appearance bond that the grand jury set minutes after issuing its indictment will keep Jones behind bars until then. (She will be transferred to the Bexar County jail in San Antonio before her March 1 release from state prison.) Should Jones manage to put up the money to get released, her bond conditions require that she remain under house arrest with GPS monitoring, have no contact with children under 18, and stay away from any medical facility of any kind unless it is for her personal medical treatment.

Winning a conviction in a case judged too tough to bring back in 1984 won’t be easy. But Goss believes he’ll benefit from changes in the Texas rules of evidence, providing freer rein to introduce related acts — including previous offenses — to prove the identity, motive, methods and intent of the perpetrator. “It’s not necessarily that we need a needle in her hand. It’s that we can show this is how she is, how she does her crimes, this is her M.O.”

“It’s difficult,” says Goss. “The documents are old. There’s no smoking gun. There’s no confession. If it’s not a Hail Mary, it’s fourth and 15, so you’ve got to really draw up the right play. If you do it right, this case will be won. We feel like we can go all the way. Everybody wanted to make this baby killer accountable.”

Jones’ defense will surely dispute that notion. Convery, the president of the Texas Criminal Defense Lawyers Association, says he believes prosecuting a 35-year-old murder would violate Jones’ rights to due process and a speedy trial; availability of witnesses and chain-of-custody issues involving documents may pose “serious evidentiary problems.” (A defense lawyer could raise this issue about Joshua Sawyer’s medical records.) Any such prosecution would be “an extraordinary event,” Convery noted. “To think you can just dust the case off and throw it up there is wishful thinking. Cases don’t get better over time; they get worse.”

But prosecutors and parents fear Jones’ release would pose a threat to a new generation of children. “I feel like she’s been waiting 30 years to get that Code-Blue feeling again,” says Goss. “I don’t think it’s ever gone away. That’s dangerous. The only control we have is to do this.”

For her part, Connie Weeks says she is “scared and nervous,” as prosecutors finally seek to convict Jones of killing her son. But she has no doubt about her goal: “I want her to stay in prison. I want her to die in there.”