Angel of death or victim of fate? Hospital deaths cast a shadow over Shawnee woman [The Kansas City Star :: ]
(Kansas City Star (MO) Via Acquire Media NewsEdge) Jan. 26--Jennifer Hall had a compelling reason to ask that her face be shadowed when The Kansas City Star photographed her for this story.
The Shawnee woman is accused in civil court records of being a serial killer.
Lawsuits, affidavits and depositions allege that 12 years ago, Hall intentionally injected at least five patients, perhaps as many as nine, at a Chillicothe, Mo., hospital, poisoning them to death.
Or could it be that Hall is extraordinarily jinxed -- a two-time victim of false allegations?
She was initially convicted of setting a fire at another hospital in 2001, when Hall was just starting out as a respiratory therapist. She served a year in prison and then her conviction was overturned. In a retrial, she was cleared.
Now she faces accusations as frightening as they come, that she is an angel of death.
"Never," she said, more calm than angry in a recent interview at her attorney's office. "No, never."
And Hall has no legal recourse to defend herself. She is not a defendant in the lawsuits, which seek wrongful-death damages from the deep pockets of Hedrick Medical Center and St. Luke's Health System, not from her.
"My name is just thrown out there, and it's for horrifying reasons," she said.
She has never been charged in the deaths.
But even the Missouri Court of Appeals, in what lawyers called an unusual move, included the name of Jennifer Hall in a recent opinion that detailed the lawsuits' allegations.
The appellate court's opinion laid bare claims of a "spike in deaths" at Hedrick in the first half of 2002, when Hall was a hospital newbie.
Even though most of the lawsuits came a decade after the deaths, they could move forward despite the state's three-year statute of limitations on wrongful-death cases, the court said. That's because loved ones of the deceased didn't know that hospital officials allegedly had concealed a poisoning spree, according to the court's opinion.
Families were told the patients died of natural causes.
St. Luke's Health System attorney Christopher L. Schnieders said "we vociferously deny" the civil claims leveled at the Chillicothe medical center. He expressed confidence that the Missouri Supreme Court will overturn the appellate court's Nov. 26 opinion.
St. Luke's had no stake in the city-owned hospital at the time of the alleged killings -- the Kansas City-based nonprofit entered into a lease agreement to operate Hedrick a year later. The hospital group is named as a defendant along with a few other health care entities.
On the criminal side, Livingston County Prosecutor Adam Warren has reopened a long-moribund investigation into the 2002 hospital deaths.
He told The Star the allegations against Hall are too serious to ignore.
All sides agree they are very hard to prove.
If Hall did deliver fatal injections, as the suits claim, she somehow gained access to medications a respiratory therapist has no business possessing -- and ones that forensic scientists can't easily detect in a corpse.
Civil court affidavits and sworn depositions reveal a tangled, circumstantial case of suspicion, hearsay, crimes alleged but unseen and strong denials of a cover-up by hospital officials.
And a lot of time has passed.
Hall was 21 then. She is 33 now.
In the years between, she left the health care field to pursue a quiet life of office work in the Kansas City suburbs.
Even though Hall today finds herself at the center of a series of alleged killings, she is nowhere near the legal action.
"Nobody has asked me if I've done anything or if I haven't done anything" regarding her five months at Hedrick Medical Center, she said.
Law enforcement hasn't questioned her. Lawyers haven't deposed her.
"I want my name to be cleared, yes," Hall said of her decision to talk to The Star about the accusations.
"... At the same time, I don't want my character destroyed."
So to keep strangers from recognizing her in the park or out shopping, she asked to be photographed in the shadows.
It's happening again, said Hall's attorney, Matthew O'Connor.
"You're talking about someone who's been falsely accused before."
In 2000, Hall had just turned 20 when Cass Medical Center in Harrisonville hired her as a respiratory therapist. She was fresh off a 10-month training course at a Kansas City career institute.
Six months into the job, on Jan. 24, 2001, she arrived at work with a new hairstyle, curlier than usual.
Other than that, it seemed like any other day at Cass Medical.
Until about 7:10 p.m.
The fire alarm sounded. A small blaze had broken out in the respiratory therapy office where Hall had a desk. The room was vacant of people but contained liquid oxygen tanks that could blow if flames reached them.
Cass Medical colleagues saw Hall retrieve a can of soda from her pickup truck just before the alarm went off. She rushed inside the hospital and toward a smoky hallway.
She and two co-workers tried crawling toward the burning office in an effort to reach the oxygen tanks and shut off the valves.
Before they got to the fire, emergency crews arrived to put it out. The oxygen tanks were spared, and damage was minimal.
But a Harrisonville police detective, Wayne Schraml, sensed something serious, court records show.
As the city's chief fire investigator, Schraml arrived at the scene and found a suspicious clutter of burnt paper on the floor next to Hall's desk, where the fire appeared to have started.
He found no signs that accelerants had been used, no kerosene or matches. But neither did he find evidence that the fire started accidentally, he would testify in criminal court.
Among the first people he encountered at the hospital was Hall, who had a slight burn on her right hand.
Hall told co-workers, and later a jury, that she suffered the injury touching a hot door frame when she was trying to shut down the oxygen tanks.
Prosecutors filed charges, alleging she suffered the burn setting the fire.
Investigators learned that Hall had lodged a sexual harassment complaint against a male co-worker a month before the blaze. He would inappropriately massage her shoulders, she said.
When the hospital later told her that the co-worker's punishment would not exceed a verbal admonishment, "she was not pleased with our findings," the human resources director testified.
So displeased as to reduce Cass Medical to ashes?
That made no sense, her attorney told the court. The alleged sexual harassment had ceased before the fire. The overfriendly co-worker, 52, died of a heart attack a day after being chewed out.
The trial commenced in late September 2001. At one point, Circuit Judge Jacqueline Cook turned to Michael Yost, the Cass County assistant prosecutor, and told him: "I'll be very honest with you. This is not a very strong case, Mr. Yost, in my mind."
Still, Cook considered the circumstantial evidence -- including the burn on Hall's hand and conflicting testimony as to how it got there -- and allowed the trial to run its course.
After Hall took the stand, prosecutor Yost charged in his closing arguments that Hall "lied, lied, lied, lied, lied."
The big mystery was motive. Why would she torch her office in the first place?
Was she seeking attention, having arrived at work with a new hairstyle that would look good on TV? Could she have been angry about the hospital going easy on the co-worker who liked to massage her shoulders?
"Bottom line is we don't know," Yost told the jury. "We don't have a psychic police force who can reach into someone's mind."
The jury was out a little more than five hours before it rendered a verdict.
Guilty. Second-degree arson.
Twelve weeks later, Hall was sentenced to three years. She immediately dumped her defense lawyer and hired a new one, O'Connor.
He filed an appeal that bought Hall some time on an appeal bond.
By this time, early 2002, Hall was performing respiratory therapy elsewhere –– at Hedrick Medical in Chillicothe.
Hospital officials didn't know she was appealing a felony conviction. Hall said she never told them.
At Hedrick Medical, one of the first signs of a potential problem with code blues surfaced on Feb. 18, 2002.
Working the emergency room that night was Cal W. Greenlaw, an internal medicine physician and licensed doctor of pharmacology.
A female patient he was treating suddenly coded. Her blood sugar levels plummeted.
Toiling through the night, trying different drugs to elevate her blood sugar, Greenlaw kept the patient from dying.
"In my professional opinion," he recalled in a signed affidavit filed in late 2011, "she did not have a valid medical basis to have unusual and irrational blood sugar/insulin events causing her to go into cardiovascular events or code blue."
In the weeks and months to come, Greenlaw would become certain that a murderer was lurking about the hospital, perhaps slipping insulin into IV bags.
His suspicions turned to Hall, the new girl working nights.
"She would come in saying, 'I think we're going to have excitement tonight,' " the physician testified 11 years later in a deposition. "Sure enough, someone would code."
Some on staff -- particularly a longtime registered nurse named Aleta Boyd -- also were troubled by Hall's behavior.
"She liked code blues," Boyd would testify.
As a risk manager for the hospital in 2002 (she no longer is with Hedrick), Boyd reviewed unexpected events. In this case, she evaluated medical charts for what she later characterized in an affidavit as "a drastic increase in code blues and deaths."
The 49-bed hospital typically responded to maybe three code blues per quarter, she said in her deposition last spring. But just in February 2002, there were as many as five.
At least six more code blues and three more deaths occurred in March.
And "each time you look at a (patient's) chart," Boyd testified, "Jennifer Hall is the common denominator."
Boyd expressed her concerns to a supervisor who "blew me off" and denied there was a problem. The supervisor, she said, commented about the hospital looking bad if TV news crews showed up.
Staff suspicions mounted. Boyd claims in the deposition that she was "85 percent" certain that Hall was killing people.
Still, nobody has yet proved Hedrick experienced a jump in code blues far beyond the norm, said St. Luke's attorney Schnieders: "By their very nature, code blues are random. They can go in clusters."
And when questioned recently by The Star, Hall said she never expressed a love for code blues or mentioned "excitement" when arriving at work.
Hall said she couldn't even recall her colleagues buzzing about a spike in unexpected deaths.
Livingston County Coroner J. Scott Lindley in an affidavit cited a total of 18 suspicious code blues and nine deaths over a 14-week period. Seven families would later sue.
Nearly all nine of the deceased patients named in civil documents -- seven men and two women -- were longtime residents of the Chillicothe area.
Some of them:
Coval Gann, 82, was a retired state conservation agent who had served on the local parks board.
Charles E. O'Hara, 89, was a former town councilman and World War II veteran who fought at Okinawa.
Shirley Eller, 49 and a recent widow, was a dietary aide.
Clarence B. Warner was 74, a retired school principal who folks called "Curly." "He enjoyed quail and pheasant hunting, raising bird dogs, gardening and playing snooker," Warner's obituary said.
Irvin Rounkles, who died the following year at Liberty Hospital, was a farmer, plumber and longtime leader of a country music band called the Tater Hill Gang. His family's suit alleges that Rounkles survived a suspicious code blue at Hedrick, but he suffered injuries that lasted until his death at 90.
The youngest to die was David W. Harper, 37, of nearby Ludlow, Mo.
According to a deposition taken last May of a former Hedrick nurse, Harper had been admitted for treatment of pneumonia. He was walking in his gown and chatting it up with nurses at their station the night before he was to go home.
But later Harper coded and breathing stopped. He couldn't be revived.
"Everybody was just, like, what happened?" the nurse testified.
Harper's death certificate indicated a history of lung problems. For others who coded and died during the time of Hall's employment, the stated causes of death ranged from cardiac arrest to pneumonia to heart disease.
In all cases, the certificates indicated the manner of death as "natural."
But physician Greenlaw suspected something foul.
A month after that February night when he struggled to keep his patient's blood sugar from zeroing out, Greenlaw called a secret meeting in the intensive care unit.
He told the gathering of nurses, two doctors and the nursing director that he thought "someone on staff at Hedrick ... was attempting to kill and sometimes succeeding in killing patients," according to his 2011 affidavit.
The affidavit describes a plan for catching that killer.
Greenlaw had relayed his concerns to his good friend and hunting companion, coroner Lindley, who contacted the sheriff's office and then-county prosecuting attorney Doug Roberts.
They decided that Greenlaw would arrange a March 26, 2002, meeting with Hedrick's administrator at the time, James K. Johnson, to suggest that video cameras be placed around the respiratory therapy department, Greenlaw's affidavit states.
"After the meeting," Greenlaw said in the affidavit, Johnson "told all nurses that if they were seen talking to me or even walking with me that they would be fired."
The retired Johnson, in a sworn deposition last year, sharply denied threatening workers and said such a meeting with Greenlaw never took place.
At some point, Greenlaw began to chart the suspicious codes and deaths on calendar software on his personal computer.
His calendar is now a key exhibit filed with the lawsuits. But there is at least one puzzling glitch: He cites patient Rounkle's death as occurring in February 2002 at Hedrick, when in fact Rounkle died 22 months later at Liberty Hospital.
Greenlaw told The Star the mixup resulted from misinformation he received from nurses trying to recall early cases.
In late May 2002, coroner Lindley and prosecutor Roberts met with the Hedrick administration.
"I asked Mr. Johnson if he had tapes of the video surveillance. ... He replied, 'No,' " Lindley stated in 2011. "I was so shocked and angry. ... I said nothing further and left the premises."
It was around this time that Hedrick Medical placed Hall on paid administrative leave.
The hospital prepared a document a year later, when St. Luke's Health System was preparing to acquire Hedrick. The document, now part of the open court record, laid out what hospital officials knew at the time.
The one-page report, titled "Synopsis of Jennifer Hall Investigation," was stamped confidential and signed by then-administrator Johnson:
"In the first five months of 2002, a pattern of increased code blue and diabetic critical events was noted by nursing service. This pattern numbered 15 in occurrences. ...
"A growing concern arose ... related to the coincidental nature of our night respiratory therapist Jennifer Hall's behavior, demeanor and proximity to these unexpected events."
In early May 2002, hospital administrators appointed its legal counsel and an outside evaluator to look into the matter.
"The review did not indicate cause for concern," the document stated, though the "nursing staff was encouraged to monitor the therapist's behavior" from then on.
Just 10 days after the review, 75-year-old patient Fern Franco coded and died, the last of the suspicious deaths on the coroner's list.
And the hospital told Hall to leave, with pay, "pending investigation of the incidents," Johnson's synopsis said.
It concluded: "The county coroner and prosecuting attorney were informed of our concerns although our concerns were unsubstantiated."
As for the families of patients who died at Hedrick, they would not learn of the hospital's concerns for several years.
Contacted recently by The Star, Johnson declined to comment. Several others whose names surface in the civil cases -- including nurse Boyd, former prosecutor Roberts and the attorney general's office -- also declined.
Attorney Schnieders said no one at Hedrick concealed anything from law enforcement officials. In fact, he said, hospital officials approached them.
"Since then," he said, "there's never been any proof of wrongdoing in any way, shape or form."
Hall told The Star the hospital never mentioned anything to her about suspicious deaths when Hedrick let her go.
The reason Hedrick officials gave for placing her on leave, according to Hall, is that they found out about the arson conviction.
She was terminated without pay in February 2003.
And by that summer, her freedom would run out.
The appeal of her 2001 arson conviction was denied, and Hall would enter the maximum security prison in Vandalia, Mo.
Her cellmate was a woman serving four consecutive life sentences. Hall said she feared for her life.
Her parents in Shawnee took extra jobs at a pizza delivery call center to pay for her ongoing appeals.
Hall's lawyer, O'Connor, finally scored a legal victory in 2004 when he filed a motion for the original judge on the arson case to reconsider Hall's conviction on grounds of ineffective counsel at her trial.
O'Connor had lined up an expert to examine the charred evidence of the Cass Medical fire -- something Hall's first attorney hadn't done.
The expert concluded the fire was electrical in nature, not arson.
Judge Cook set aside Hall's sentence and Hall was paroled from Vandalia. Cook wrote that expert testimony citing an electrical cause to the Cass Medical fire "clearly ... could have changed the outcome of the trial."
Cass County prosecutors decided to retry Hall in February 2005, even though she already had served prison time.
The jury deliberated three hours before acquitting her.
"It was a no-brainer" that the fire was sparked by a short circuit in the cord of an old clock, said Carl E. Martin, who offered expert testimony at the second trial.
The founder of Independence-based Engineering Perspective Inc., Martin had spotted the problem within seconds of stepping into an evidence locker to examine remnants of the fire.
A molten chunk of copper bulged out of the clock cord, signaling a burst from within the wiring. Any fire investigator who saw that should have ruled out arson, Martin told The Star.
Photographs of the alleged crime scene cinched it for him.
"Jennifer Hall's purse was sitting there near the desk," recalled Martin. "When I told that to my wife, she said, 'No woman is going to set a fire and leave her purse behind.' "
An exonerated Hall moved in with her parents and turned inward, spending less time with friends. She wondered aloud if things would ever be the same after spending a year behind bars.
"I think everybody sees me different," she said at the time. "I will always be the girl who went to prison."
Hall told that to The Star in April 2005, when the newspaper chronicled her ride on the legal roller coaster.
Nothing about her stint at Hedrick Medical Center had yet made the news.
Hard to prove
Lindley, the county coroner, is known around Chillicothe as a hard-charging perfectionist who doesn't cotton to lazy criminal investigators.
The owner of Lindley Funeral Home, he earns less than $15,000 a year as the elected coroner. But he pours his all into investigating suspicious deaths, often scolding and alienating those around him, he concedes.
In rural counties with limited investigative resources, "you need to have laypeople like me on it or the job doesn't get done," Lindley said.
He had autopsy samples from two of the deceased Hedrick patients. But proving they were poisoned would be tricky, if possible at all, given the medications that were suspected to have been used.
The leading candidates were insulin and a paralyzing drug called succinylcholine, often referred to as "sux," which is used in surgery to deaden the muscles just long enough to intubate patients.
An overdose will paralyze the lungs.
"You can see and think until you slowly slip into the blackness of suffocation," said Brian D. Andresen, formerly of the Lawrence Livermore National Laboratory in California and one of the forensics experts whom Lindley consulted.
In the body, succinylcholine rapidly breaks apart into molecules that naturally exist in dead tissue. Only the most sophisticated toxicology tests can detect a possible death by overdose, and even then the results wouldn't rule out other causes.
According to Lindley's affidavit in civil court, he sent samples from the kidney of Hedrick patient Franco to two labs. The results, which he received in 2004 and 2005, confirmed the presence of succinylcholine, he said.
He then sent the lab findings, autopsy reports and medical records of Franco and eight other deceased patients to Michael M. Baden, a forensic pathologist in New York.
Notable for hosting HBO's "Autopsy" and for his frequent appearances on the Fox News Channel, Baden wrote back to Lindley in a letter dated July 7, 2006:
"It is my opinion ... that the cause of Ms. Franco's death is Acute Succinylcholine Poisoning and that the manner of her death is Homicide."
Still, law enforcement agencies appeared reluctant to take action.
A multicounty Major Case Squad assembled in the summer and fall of 2006, court records show. Lindley and investigators from the Missouri attorney general's office attended the first meeting.
The following year, however, state and local authorities filed a court petition to prevent Lindley from summoning a coroner's jury to weigh the forensic evidence.
It was the opinion of the attorney general's office that "current scientific testing had not progressed to the point to produce scientifically admissible evidence in a court of law concerning allegations ... in the ongoing investigation," wrote Michael P. Koenig, who succeeded Roberts as Livingston County's part-time prosecutor.
"Coroner Lindley," the petition added, "has a bias against certain administration officials of an entity who employed the alleged suspect in this investigation."
Lindley denies that. There's little else he can publicly discuss, he said, because of the criminal probe.
The civil cases began piling up about 2011 after word spread around Chillicothe that something sinister had happened at Hedrick years earlier.
A private investigator hired by the Lexington, Mo., law firm Langdon & Emison gathered enough information to approach families of the deceased.
"Complete shock," said Sherri Harper, widow of patient David Harper. "We were devastated. I couldn't stop shaking."
Not all chose to join the parade of litigants.
"My grandfather was very ill and had a lot of heart problems," one woman told The Star. "We weren't really expecting him to get out of the hospital."
In early 2012, Warren, the new prosecutor of Livingston County, publicly vowed to reopen a criminal investigation.
"This case was never going to go anywhere," Warren recently told The Star. "It was short-circuited ... by higher authorities in law enforcement," including the Missouri attorney general's office, which had told local investigators it didn't think murder could be proved in court.
So Warren and other local authorities are proceeding with the investigation on their own.
Warren credited coroner Lindley for keeping the criminal case from dying.
Hall and her lawyer, meanwhile, await word from anyone interested in hearing her side.
"I know I'm not the person they're saying I am," she told The Star.
A longtime churchgoer, she has traveled with mission groups to help homeless teens and deliver aid to victims of Hurricane Katrina, she and her father noted.
Attorney O'Connor said he reached out to Warren and the plaintiffs' lawyers almost two years ago: "Maybe they don't want to hear the truth."
If an "angel of death" did prowl the hospital back in 2002, it couldn't have been his client, he said.
Respiratory therapists at Hedrick lacked the passcodes needed to access medications from a locked dispenser. And Hall said, "I don't even know what succinylcholine looks like."
"You have a woman falsely accused of arson and loses her job (at Hedrick) because of those false allegations. And after she leaves, the coffee klatch of rumormongers starts talking. ...
"It becomes the telephone game. You call somebody and they tell somebody else and it gets reinterpreted and misinterpreted," O'Connor said. "There are no facts."
Warren replies: "There are enough facts to warrant an investigation," which he hopes to complete by midsummer.
Hall's dad blames himself a bit.
It was he, Don Hall, who hastily lined up his daughter's first lawyer, acting on a friend's recommendation.
That was after police showed up at his door, the night before Valentine's Day 2001, to take Jennifer Hall into custody for arson. That lawyer fumbled the case, which led to everything else, Don Hall believes.
His daughter returned home emotionally distraught after her release from prison. She feared strangers who might appear on the porch.
"She was afraid of the police coming again," Don Hall said.
So the father had a surveillance camera installed near the front door. Its monitor sat for years in Jennifer Hall's bedroom.
The security system has been disconnected. But the camera outside is still there.
It's been called the perfect murder weapon: Poison someone. Never get caught.
The surgical drug succinylcholine, "sux" for short, paralyzes every respiratory muscle, but only for a moment when properly administered to intubate patients. An overdose injection will halt lung function long enough to result in suffocation.
But even in heavy doses, the drug breaks down rapidly into succinic acid and choline molecules, which are naturally present in human tissue after death.
For forensic scientists, the parent drug "is very, very difficult to detect -- not impossible," said Graham Jones, chief toxicologist for the medical examiner's office in Alberta, Canada. "Most people would say it's pretty much a long shot unless you get that tissue sample within hours of death."
Officials have suggested that sux was used in some of the suspicious deaths at Hedrick Medical Center.
In homicide investigations, toxicologists may test for traces of a compound called succinylmonocholine, which hasn't fully broken down. But it also has been found in tissue samples of people who weren't poisoned, according to studies at the FBI laboratory in Quantico, Va.
Sux has been implicated as a poisoning agent in several murder cases. Some have led to convictions. In 2007, a Nevada court handed a life sentence to hospital nurse Chaz Higgs for allegedly injecting his wife, state controller Kathy Augustine, and causing her death.
In 2002, a former nurse at Harry S. Truman Memorial Veterans' Hospital in Columbia was charged with killing 10 patients a decade earlier using sux. He was later released from jail after tests on some of the bodies came back inconclusive.
Rick Montgomery, firstname.lastname@example.org
June: Jennifer Hall hired as respiratory therapist at Cass Medical Center in Harrisonville.
Jan. 24: Fire at Cass Medical casts suspicion on Hall.
Sept. 26: Jury finds Hall guilty of second-degree arson.
December: Sentenced to three years, Hall hires new attorney to file appeal.
January: Free on appeal bond, Hall takes full-time job at Hedrick Medical Center.
Feb. 3: First of several suspicious deaths recorded.
March 12: Code blues and deaths discussed at secret meeting of doctors and nurses.
May 6: Hospital review indicates no "cause for concern."
May 18: Patient Fern Franco dies, bringing coroner's count of suspicious deaths to nine.
May 21: Hall placed on paid administrative leave.
May 24: Hedrick contacts authorities, turns over records of seven patients.
Feb. 12: Hedrick terminates Hall without pay.
July 25: Arson appeal denied, Hall begins prison sentence.
June 30: Judge finds Hall received inadequate counsel in trial, sets aside conviction.
July 23: Hall paroled.
February: In Cass County retrial, Hall found not guilty of arson.
Aug. 7: Authorities meet to discuss forming Major Case Squad in Hedrick deaths.
July: First of several wrongful-death suits filed.
March: Livingston County prosecutor asks police to conduct another investigation.
Nov. 26: Missouri Court of Appeals allows five wrongful-death suits to proceed.
A statement from St. Luke's Health System, which began operating Hedrick in 2003 and is a defendant in a half dozen wrongful-death lawsuits:
St. Luke's Health System and all of our member hospitals place the safety and health of our patients above all else. We are proud of the exceptional care we provide and of the trust and mutual respect we have earned from the communities we serve. St. Luke's did not assume operational responsibility for Hedrick until August 2003, more than a year after these alleged incidents occurred. However, when we took over operations, we also inherited its history, so though we had no association with Hedrick at the time, we have nonetheless been drawn into this discussion. We, too, are only interested in the truth, and trust that the investigation by law enforcement that resulted in no charges being filed was conducted in good faith and with integrity. However, since the case is in litigation, we are not free to comment on any specific accusations.
To reach Rick Montgomery, call 816-234-4410 or send email to email@example.com.
(c)2014 The Kansas City Star (Kansas City, Mo.)
Visit The Kansas City Star (Kansas City, Mo.) at www.kansascity.com
Distributed by MCT Information Services
[ Back To TMCnet.com's Homepage ]