Medical Error pft-2

by Richard L Mabry

  The salesman led Anna on a whirlwind tour of the lot, and after half an hour she sat in his office while his fingers flew over the keys of his computer. "Well, Doctor, I believe we can put you in that car at a price you can afford. Let me get a little information, and I'll run a credit report."

  Ten minutes later, the salesman swiveled away from the computer screen, and the look in his eyes told Anna everything she needed to know. "I've done a credit check. I think we might have some trouble financing that car. We can probably do it, but I can't get the interest rate I wanted. And that would make the payments-."

  "No, I understand." Anna wanted to argue, but realized how futile it would be. The red flags were already up. Her credit had become suspect. And even though the credit reporting companies had promised to put things right, it wasn't going to happen today.

  She found the service advisor and said, "Okay, just do the repair. I'll wait."

  "Thanks anyway." Nick Valentine hung up the phone and rummaged through the books and journals scattered in front of him. The desk of his academic office, never the most organized eighteen square feet in the Pathology Department, looked like a war zone. He was computer-literate and often did online searches for information, but at times it was comforting to feel the heft of a textbook in your hands, to mark an important passage with a yellow highlighter. For this problem, he'd pulled out all the stops: a computer search, back issues of journals from the department library, textbooks-old and new- taken from his shelves. And now he'd just hung up from a short, albeit rather unsatisfactory, conversation with the head of the Allergy Division. His head swam with information overload.

  He let his gaze rest on Eric Hatley's chart and the notes he'd made when he reviewed it again. Nothing he'd found changed his mind about the cause of Hatley's death. However, there was one bit of information that puzzled him. Maybe he'd go downstairs and get some coffee to help him think.

  "Got a minute?"

  The voice brought him instantly alert. Anna McIntyre stood in the doorway. Her shoulders sagged just a bit, even though she had a faint smile plastered on her face. Nick wondered if something more had gone wrong. Then he noticed the two paper cups in Anna's hands.

  "I come bearing gifts from Starbucks," she said, advancing and placing one of the containers on his desk like a priest laying a sacrifice on the altar. "I wanted to thank you for the dinner last evening, and for the work you're putting in on the Hatley case."

  Nick flipped the lid offthe cup and tossed it into his wastebasket, barely hitting his target. He nodded his appreciation and took a deep sip. "No thanks necessary, but you don't know how much I needed this pick-me-up. I've been working all afternoon trying to find a blood test for allergy to Omnilex. Unfortunately, there isn't one, at least not one that's reliable. Mainly because the drug's too new."

  Anna eased into the chair across the desk from Nick and took a taste of her coffee. "So there's no way to know for sure whether Eric Hatley had his anaphylactic reaction because of the antibiotic we gave him."

  Nick recognized this as a statement, not a question. "His tryptase level came back this morning-sky-high. Hatley defi- nitely had a severe anaphylactic reaction. I just finished the microscopic exam on the tissue samples from the autopsy. Nothing else showed up. Bottom line, there's no question that a massive allergic reaction was the final event. But we can't prove the cause."

  "Could this be due to the anesthesiologist giving him a wrong medication of some kind?"

  "What makes you ask?"

  "The staffman was out of the room. JeffMurray is a first- year resident, not experienced, not necessarily good under stress. At the time I didn't make too much of it, but as I thought about it later, I wondered if maybe he didn't give Hatley something other than the antibiotic Luc ordered."

  Nick shook his head. "No way. I went so far as to go up to surgery this morning and look through one of the anesthesia carts. Other than various antibiotics, I couldn't find anything there that could have done this."

  "So I can't blame anesthesia for this."

  "Afraid not. But this should interest you." Nick reached past the pile of articles and books on his desk, moved aside Hatley's hospital chart, and picked up a thin file held together by a metal fastener strip threaded through two holes punched at the top.

  "What's that?"

  "I had them pull the emergency room record for Eric Hatley, the visit that was the basis for your choice of antibiotics. Have a look."

  He held out the folder and watched Anna thumb through it the way physicians learn to do, scanning the pages and picking out the important nuggets of information. He could tell when she got to the part that had stopped him cold.

  "What do you think?" he asked.

  "I think this patient signed in with the same name, address, and date of birth as the man who died on the operating table."

  "But?"

  "Our Eric Hatley was a middle-aged Caucasian male."Anna looked down at the page where her finger marked the line that Nick knew would get her attention, as it had his. "It says, 'The patient is a young, African-American male who complains of-' "

  "Right. Same identifying data. Different people." Nick drained his coffee cup. "Looks like you're not the only person who's had their identity stolen. But in this case, Eric Hatley lost more than his credit cards. He lost his life."

  4

  Anna stood quietly by as the emergency room clerk explained to a young Latino boy that his father would be seen as soon as possible. The boy nodded gravely and rattled offthe translation so rapidly that Anna, who prided herself on being able to communicate in that language, couldn't follow the Spanish. The father grimaced, clutched his stomach for a moment, then shrugged in resignation and edged back toward a seat in the crowded waiting room.

  When the clerk was free, Anna stepped up to the desk."Shirley, what doctor's running the ER today?"

  The woman turned with a start. "Oh, Dr. McIntyre. I didn't see you standing there. I thought you were on vacation."

  Anna leaned over and dropped her voice. "News travels fast around here. Yes, I'm on a leave of sorts, but there's something I need to. .. I have to get some information from one of the doctors for the project I'm working on. Who's the Pit Boss today?"

  Shirley ran her hand through blonde hair that Anna was willing to bet didn't start out that color. "That would be Dr. Fell."

  "Do you know if he's tied up right now?"

  "I think he just slipped back for a cup of coffee." Shirley pointed the way.

  Anna nodded her thanks and headed for the break room. Just being in the Emergency Room made her pulse quicken, as she relived memories of her own time as "Pit Boss"-the second-year surgery resident charged with overseeing the ER at Parkland Hospital, arguably one of the busiest in the nation. The pressure was tremendous, but the opportunity to hone one's clinical judgment and skills was almost unlimited.

  She recalled the time when one of the senior staffsurgeons had found her sobbing in the ER break room at the end of her shift. He'd put a gentle hand on her shoulder. "What's wrong, Anna?"

  She told him about her feverish struggle to save the victims of a horrible crash on North Central Expressway. In the end, the only survivor was a three-year-old child, left orphaned when his mother, father, and older sister died. "I did all I could. And it wasn't enough."

  The doctor had eased into the chair beside her. "If you've given it all you had, don't blame yourself when you lose the battle. You can't die with them, you know. If you do, who'd take care of the next one?"

  Anna gave a little shudder as she recalled that advice. She'd recently had a patient die-one who should still be alive right now-but for the moment she needed to put any thought of guilt and blame aside. She needed to do something positive. She'd start by questioning the doctor who'd treated the "other" Eric Hatley.

  "Dr. McIntyre, what brings you down here? I thought you were on leave." Dr. William Fell was slumped on the couch, sipping from a Styrofoam cup. He started to stand, but Anna waved
him back.

  "Will, I'm glad you're on duty today. I need to know what you remember about this patient." She held out the emergency room file she'd taken from Nick's office.

  He flashed a grin. "Hey, this was two weeks ago. I can't remember the patients from yesterday."

  "It's really important. Look at your note. Tell me if it rings a bell."

  Will scanned the scrawled note. "Matter of fact, I do recall this guy. In the first place, if you notice the time stamp, he showed up here at two a.m. with a chief complaint of a sexually transmitted disease. I'd just stretched out to take a nap when they woke me. I gave him a pretty good tongue-lashing for picking that time to come in for something like that. Know what he said?"

  Anna shook her head.

  "Said that he knew we wouldn't be as busy at that time of the morning, and he was up anyway." Will flipped back to the cover sheet. "I remember telling him that, since he had private insurance, he should have gone to his regular doctor during normal hours. He blew me offand asked me if I was going to treat him. I did a quick exam, confirmed my diagnosis with a lab test, and gave him an IM antibiotic. Told him to make a follow-up appointment, but you know they never do. End of story."

  "Can you recall what he looked like?"

  "Vaguely. Twentyish black male. Taller than me, quite a bit thinner."

  "Remember anything else about him?"

  Will closed his eyes and Anna could almost hear the wheels turning. "Sorry, nothing stands out. Is it important?"

  "Not really, I guess."

  "What's this about?"

  "The man's name came up in connection with another case, and I'm following up on it," Anna said. "We may have gotten a couple of patients with the same name mixed up. But you didn't do anything wrong, so don't worry about it. Thanks."

  "I'll walk out with you," Will said. "It's time for me to get back to work."

  They stopped in the hall and Anna put her hand on Will's arm. "Hang in there. It's a tough rotation, but it's worth it- sort of like putting iron into a fire to temper it."

  As she started down the hall, Anna couldn't help wondering whether the problems that plagued her right now would temper the iron of her resolve or shatter it.

  "Hi, Lisa. I'm picking up some things. Pretend I'm not here." Anna ducked into the sanctuary of her office before her administrative assistant could reply.

  She scanned the mail and rummaged through the papers in her "In" box. Nothing that couldn't wait another day. And if things didn't get straightened out pretty soon, none of it would matter anyway. Anna unzipped the backpack she used as a briefcase and pulled out a manila folder bulging with the documents to duplicate. She was still shuffling the papers, deciding how many copies she'd need, when Lisa appeared in the doorway.

  "Dr. McIntyre, I know you said to pretend you aren't here, but there are two detectives out there, and they want to speak with you."

  Anna decided she was getting entirely too experienced at meeting with members of the law enforcement community."Have you looked at their credentials?"

  Lisa nodded. "Yes. They're with the Dallas Police."

  Anna squared her shoulders. "Very well. I'll talk with them."

  Lisa paused with her hand on the doorknob. "I want you to know that I think this whole mess with narcotics numbers and forged prescriptions is ridiculous. Nobody in the department thinks you did anything wrong."

  "Thank you," Anna said. "I guess you'd better send them in."

  The moment the two men-one white, one African American-came through the door, Anna decided she would have pegged them as policemen without any advance warning. Not just because of the wardrobe-off- the-rack sport coats, slightly rumpled dress shirts, shoes obviously chosen for comfort rather than style. No, it was a subtle presence that said, "I'm in charge and I've got my eye on you."

  Anna held out her hand. "May I see your credentials?" She left the men standing while she sat and carefully examined their badges and identification cards. She jotted down their names and badge numbers, adding them to the sheet she'd started for the DEA agents.

  Lamar Green was a burly African American with a shaved head and what looked to be a permanent scowl on his face. His whole demeanor said, "Don't mess with me."

  Burt Dowling was a rail-thin white man with a pronounced five o'clock shadow and thinning dark brown hair. Whereas Green seemed to jangle with nervous energy, Dowling appeared to observe the world with a touch of disappointment through hooded eyelids.

  She handed the credentials back and motioned the men to the two chairs across from her desk. "How may I help you?"

  Green pulled a notebook from his pocket but didn't open it. Instead, he fixed her with a glacial stare. "Doctor, we need to ask you some questions about all the prescriptions you've been writing for large amounts of narcotics."

  Anna fought to control her temper. "I believe you mean that some prescriptions bearing my DEA number and forged with my signature have turned up. I'm unaware of any evidence that even vaguely suggests I'm anything but a victim in this situation."

  Dowling patted the air in a calming gesture. "Doctor, we understand you're upset. Now, it may be that you're as innocent as a lamb." Then, like Texas weather in the spring, his manner turned dark. "On the other hand, maybe you're ticked offthat we've found out about this little racket of yours. Now, if you'll come clean about your involvement, I'm sure we can put in a good word for you with the district attorney."

  Anna took a deep breath. "There's no need to put in a good word. I'm the victim here. Why don't you get out of here and trace back some of these forged 'scripts to their source? And, while you're at it, maybe you and the DEA can communicate so that I don't have to answer the same questions again and again."

  Green stood, apparently trying to use his six-foot-plus height to intimidate Anna. "Doctor, we were hoping you'd be cooperative. We just want you to answer a few questions."

  "And then you'll leave me alone?"

  "Not quite. We also need to search your home."

  Anna felt her blood boiling. "Search my house? Why?"

  "Easy, Lamar." Dowling motioned his partner back into his chair before turning to Anna. "It's all part of the process. Do we need to get a warrant?"

  Anna's inclination was to dig in her heels, but then again, how difficult would it be for these two men to find a judge who'd sign a search warrant? Why should she spend another day, even two, waiting for them to come back with one? She was innocent, and she knew they wouldn't find anything. "I'll meet you at my home in fifteen minutes."

  The detectives were thorough with their search, but-give them credit-they were considerate. Anna had heard horror stories of searches that left homes in shambles, but by the time the men finished, her little apartment would look pretty much as she'd left it that morning.

  "What are you looking for, anyway?" she asked Dowling.

  "We'll know it when we see it. If you weren't looking over our shoulders, we could finish a lot quicker."

  Anna's nerves tingled. When her Irish grandmother told her about second-sight, the gift of knowing in advance that something bad was going to happen, Anna pooh-poohed it. But that's exactly what she felt now. The longer the search continued, the more she regretted her decision not to call an attorney before letting these men into her apartment.

  "Better late than never," she muttered. Anna went to her desk and picked up the phone. She found the medical school directory in the bottom drawer under a mass of papers. She rifled the pages, then glanced at her watch: five o'clock. She hoped the person she needed wasn't a clock-watcher.

  Anna punched in the number and counted the rings. She was about to hang up, when she heard, "Laura Ernst." Something in the voice told her that the medical center's legal counsel hadn't had a wonderful day.

  Well, Anna's hadn't been too good, either, so there wasn't much sympathy in her voice. "Ms. Ernst, this is Dr. Anna McIntyre. Remember, we talked on the phone two days ago."

  "Hang on." There was a sound of rustling pape
rs. "Okay, got it. The DEA says your name and number are on a bunch of narcotics prescriptions. As I recall, I told you to sit tight for now. These things usually work out if you're not guilty."

  Anna bristled at the last comment, but this was no time to argue. "Well, now two Dallas Police detectives are searching my home."

  "Did they have a warrant?"

  "No, I was so mad I just let them-"

  "Stop them. Right now. Put down the phone, tell them you've spoken with your attorney. Tell them to get out and not come back until they have a search warrant that spells out exactly what they're looking for and why."

  Anna hesitated for a few seconds, then did as Ernst had told her. The detectives tried to change her mind, but there seemed to be no conviction in their arguments. She slammed the door behind them and picked up the phone again.

  "They're gone," Anna said.

  "Good." Ernst paused. "You know, you may need your own attorney for this. Do you know anyone you could call?"

  "No."

  Ernst's sigh spoke volumes. "All right. Give me your number. I'll get back to you with a name. I have to make a phone call first."

  Nick pulled up in front of Anna's duplex and for the tenth time wondered if it was the least bit over the top for him to see her again this soon. Face it, he decided, the SS Over The Top had sailed when he took her to Maria and Benny's for dinner. He had known the kind of reception they'd give her, and it had been difficult for him to conceal his pleasure at her reaction.

  Nick climbed out of the car and reached back for the flowers he'd bought at the supermarket on the spur of the moment.

  He debated a moment and decided to leave them on the seat. Flowers would definitely be over the top.

  With his palms sweating like those of a schoolboy coming to pick up his date for the prom, he started up the walk. When he was halfway to the door, it opened and two men stepped out. It didn't take him long to link the men with the car parked at the curb just ahead of his own Chevrolet. In his experience, only one group drove around in a basic black Ford Crown Victoria with plain hubcaps, a spotlight, and two antennas: cops. What were they doing at Anna's? Had something happened? Had she been hurt?