It was just another colorless trade show, one of thousands held each year in hotels across the United States. But it was there, at an Embassy Suites in Franklin, Tennessee, that the simple handoff of a business card proved to be the first link in a two-year chain of events that led to the horrific, tortuous deaths of the first victims in a mass killing that trailed from New England to Tennessee, from Michigan to North Carolina.
Health workers packed the hotel for the annual meeting of the Freestanding Ambulatory Surgery Center Association, hoping to network, listen to medical presentations and meet industry salespeople plying their wares. Among the hundreds wandering about on the second day of the conference–September 24, 2010–was John Notarianni, regional sales manager for the New England Compounding Center (NECC), a Massachusetts pharmacy. Like any good salesman, Notarianni was glad-handing prospects while passing out business cards and advertising material. At some point, he crossed paths with Debra Schamberg, a nurse and facility director with the St. Thomas Outpatient Neurosurgery Center in nearby Nashville.
For a few minutes, Notarianni pitched his company, telling Schamberg about the pharmaceuticals NECC had available, including injectable methylprednisolone acetate, a steroid commonly used for pain management. Since her outpatient center spent much of the workday injecting steroids into hips, joints and backs, Schamberg was intrigued. She took Notarianni’s business card and pamphlets and then went on her way, thinking she may have found a great alternative to the usual pharmacies the outpatient center used.