Medical Error pft-2

by Richard L Mabry

  "Excuse me," he said to the first of the men to reach him-a husky African American who scowled as though someone had just kicked his dog. "What's going on here?"

  "Sir, I can't discuss it." The man brushed past Nick, followed in close order by a thin Caucasian man displaying a similar disposition.

  Nick hurried up to the door and rang the doorbell. When there was no answer, he rang it again. He was about to ring for a third time when the door opened.

  Anna stood there with her hands on her hips. "I thought I told you-"

  "Anna, are you all right?"

  She was dressed in the same black skirt and green blouse she'd worn in his office earlier that day. When she recognized Nick, the fire flashing in her green eyes died down and she gestured him in, double locking the door behind him.

  "Sorry. I didn't mean to bite your head off," she said. "I thought those two detectives had come back to harass me some more."

  "What were detectives doing here?"

  "Sit down. Let me put on some coffee. It's a long story."

  Twenty minutes and a cup of coffee later, after Anna had explained about the visit from the police, Nick's blood was boiling. "Of course, they didn't find anything, did they?"

  Anna's expression told him he'd struck a nerve. Her tone of voice confirmed it. "No, they didn't find anything! Of course, they were still looking when I threw them out, so they could have missed it."

  "Sorry. I didn't mean to-"

  "I know," Anna said. "I'm just upset. Anyway, I can assure you that there's no money hidden in the coffee can or stashed in the sugar canister. No envelope taped to the underside of the toilet tank cover. Of course, that doesn't mean they didn't look in those places, and everywhere else in the house. At least, until I made them leave."

  Nick looked around. "Doesn't look like they messed up your house."

  She ran a hand through her hair. "No, I have to admit they weren't malicious. They were clinical about it. Sort of, 'we have to do this, so stand back and don't bother us.' "

  "Are they through now?" Nick asked.

  "Laura Ernst said they couldn't come back without a search warrant, but I doubt that they're through. They mentioned that one of the things they were looking for was the money from my 'prescription racket' as they called it. Now I guess they'll check to see if I have any secret accounts in the Cayman Islands or Switzerland." She grimaced. "Just wish I did."

  Nick drained the last drops of coffee from his cup. "They've got to realize that you're a victim in this whole mess."

  "I told them the same thing." Anna picked up the cups and disappeared into the kitchen, returning in a moment with refills for them both. "But I still can't figure out why."

  "Why the police are investigating you?"

  "No," Anna said. "Why-and how-someone would steal my identity."

  Anna stood in the doorway and watched Nick climb into his car and pull away. She closed the door, turned the key in the deadbolt, then went through the house closing blinds. Since the search, she no longer felt secure in her little duplex. Instead she felt dirty, violated.

  She wondered about the loneliness she felt now that Nick was gone. They'd only known each other a short time, but she felt a bond forming. Not a good time for that, though.

  Dinner for Anna was almost always fast food purchased on the way home or something frozen that she nuked and ate in front of the TV. Tonight the screen was dark. Even the most inane sitcoms were beyond her. Her mind still buzzed like a beehive, filled with incoherent thoughts.

  Anna drifted into the kitchen, opened the refrigerator door, and berated herself because she still hadn't made it to the grocery store. She had no milk, no eggs, not much of anything. Finally, she settled for a peanut butter sandwich on stale bread, washed down with a Diet Coke, all consumed while standing over the sink. As she choked down the last bite, she couldn't help wishing she were back at Benny and Maria's restaurant, eating good food, enjoying Nick's company, and totally oblivious to her troubles.

  She rinsed her plate, tossed her soft drink can in the recycle container, and leaned against the kitchen cabinet. Anna had never felt so lost, so absolutely bereft of a sense of direction. She remembered what she'd told Nick about her faith during trials. She'd tried to sound confident when she assured him that God would care for her. But right now, her faith was sort of like a south Texas river during a drought: half a mile wide and two inches deep.

  In her bedroom, Anna lifted a worn, leather-covered book from the nightstand and flopped onto the bed. She propped herself on two pillows and opened the book to the place she'd long ago marked with a dark blue ribbon. She'd depended on this promise in the past. Maybe the words would help now: "For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future."

  Did God really have a plan to get her out of this mess, to give her a hope and a future? She rested the Bible on her chest and closed her eyes. Talk to me, God. I'm listening.

  The shrill tone of the telephone startled Anna out of her semi-slumber. She sat up and the Bible tumbled onto the floor. It took her a moment to clear her head and reorient herself. She lifted the receiver, cleared her throat, and said, "Dr. McIntyre."

  "Sorry to call so late." Laura Ernst didn't sound sorry. She sounded ticked offat having to deal with this. "It's taken me a little while to get the information I needed."

  Anna decided the silence that followed was her cue to apologize, so she did.

  "Anyway," Ernst continued, "here's the name and number of the attorney I suggest you call."

  Anna scrambled to find a pad and pencil, finally locating both in the bedside table. She scribbled down the information and read it back to Ernst. "Ross Donovan. 214-555-1870. Got it."

  "He's a bulldog on cases like this. Of course, he can also be a liar and a cheat, but I've never known him not to do a good job for his clients."

  "What do you mean?"

  "Call him first thing tomorrow morning. He can tell you what I mean." There was a sharp click.

  Anna held the silent phone until a strident stutter tone prompted her to hang up the receiver. What kind of lawyer was this guy? She swung her feet offthe bed and hurried to her desk, where she put Donovan's number by the phone. One more call to make tomorrow.

  The world didn't look any better or her situation any clearer in the morning. Anna hurried through breakfast and sat at her desk to make some calls. The first was to Ross Donovan. She got a recorded message, asking her to leave a number, which she did.

  Anna looked at her watch. Eight in the morning. Too early to expect a quick callback from the lawyer, but not too early for things to be stirring at the medical center. She figured this might be tricky, and it was. It took Anna three phone calls to find a sympathetic clerk in the Medical Records office to track down the name and address of Eric Hatley's mother. With the monthly Morbidity and Mortality Conference coming up in less than a week, Anna wanted to know more about the real Eric Hatley, including the reason someone else would use his health insurance to get treatment.

  Her phone rang as she headed out the door. She didn't recognize the number, but the caller ID showed UT Southwestern Med Ctr. The chances that this would be something good ranged from slim to none, but she decided she couldn't dodge the call. Her curiosity wouldn't let her.

  "Dr. McIntyre."

  "Doctor, this is Laura Ernst. Have you called Ross Donovan?"

  "I called and left a message. I'm waiting for a callback."

  "Ross isn't an early riser, but he'll get back to you," Ernst said. "Anyway, that's not why I called."

  "Oh?"

  "My assistant just had a call from the supervisor in Medical Records. You apparently persuaded a clerk to give you contact information for Eric Hatley's next of kin."

  No use denying it. "That's right."

  "Those records are supposed to be off- limits except as authorized by my office. I hope you don't plan to make contact with the family."


  "Why do you say that?" Anna asked.

  Ernst cleared her throat. "When a patient dies while they're under our care, there's always the possibility that the family might bring suit against us, especially if there's a suspicion of medical error. I've looked into the circumstances of this case, and it appears to me that the proximate cause of the patient's death was the antibiotic you and Dr. Nguyn ordered."

  "But-"

  "Given the situation, I feel strongly that it's best that all further communication with the family come through our office."

  So much for any care and concern from Ernst. Now it was going to be all about protecting the institution. "In other words, you think we're at fault, and we should keep our heads down," Anna said.

  "I wouldn't put it that way, but there's something to be said for doing exactly that."

  Anna switched the phone to her other hand and flexed the fingers that cramped from their death grip on the receiver."Well, Ms. Ernst, how do you feel about my expressing my sympathy for this woman's loss? This isn't a statistic she's burying, it's her son. And there are some questions that I'd like to get answered, questions that might shed some light on why Eric died."

  "Of course, I can't order you not to extend your condolences, but I wish you'd do it with a sympathy card, nothing more."

  Anna took in a huge breath through her mouth and exhaled through her nose. It came out as more of a snort than she'd intended, but then again, maybe that was the message she felt like sending. "Ms. Ernst, unless I receive a direct order from either my chairman or the dean, I intend to visit Eric Hatley's family. I'll make sure that your office is made aware of any information I might gain. There are some questions that need to be answered, questions that affect the way other patients are treated. I intend to get those answers." Anna took a deep breath and tried to make her voice calm. "I do appreciate your help in my dealing with the police, but on this one I think we're going to have to agree to disagree. Thank you for calling."

  Anna pushed the button to end the call and longed momentarily for an old-fashioned phone that she could slam into its cradle. She'd never been fond of attorneys, and this little episode hadn't done anything to change her mind. Nevertheless, as she closed the front door behind her, the tiny seed of doubt Ernst had planted in the back of her mind began to grow. Anna hoped she was doing the right thing.

  5

  When there was no answer to her knocks, Anna called, "Mrs. Hatley?"

  The door opened to the limit of the safety chain, and an eye peered out. "Who are you?" The voice was a husky contralto, the words without inflection, as though the speaker were reciting them from a script.

  "I'm Dr. Anna McIntyre. Remember, we met briefly at the hospital? I was with your son when he… when he died."Anna shifted uneasily from side to side. "May I come in for a moment?"

  The door closed. As she waited, Anna tried without success to recapture an image of Mrs. Hatley from their only other conversation.

  A rattle, a couple of clicks, and the door swung open. Mrs. Wanda Hatley stood a head taller than Anna's five feet six. Stick-thin arms and legs protruded from a shapeless flowered housedress. Flyaway brown hair liberally streaked with gray topped a gaunt face. Red-rimmed eyes with amber irises burned a hole through Anna.

  "What do you want?" The words were delivered as a challenge, not a question.

  "May I come in? I want to talk with you about Eric."

  The woman nodded once, then turned and walked away. Anna stepped inside and closed the door behind her. She followed Mrs. Hatley into a living room that contained pieces selected with care. There had probably been a time when this woman took pride in her home. If so, it was long past. Now there was a film of dust on the furniture. The covers on the backs of two upholstered chairs-what were they called? Antimacassars, Anna recalled. These were skewed and wrinkled.

  Mrs. Hatley dropped into one of the chairs and picked up a cigarette that smoldered in a half-full ashtray on the end table beside her. "Eric's dead."

  Anna eased into the chair opposite. "I know. I was with him when he died. We tried to save his life. We tried everything we could, but it wasn't enough. And I wanted to tell you how sorry I am."

  The woman waved away the apology as though waving away the smoke that wafted around her. " 'Sorry' doesn't bring him back."

  So much for sympathy. Time to move on. "Mrs. Hatley, was Eric allergic to any medicines?"

  For the first time, Anna thought she saw a spark behind that dull facade. "Uh-huh. He almost died a couple of years ago. He went to our family doctor for a Strep throat. Eric had four or five of them a year ever since he was real young. Doc Mercer always gave him a shot of penicillin. Cleared them right up. But this time he had one of those whatchamacallit… those allergic things… epileptic reactions."

  "Anaphylactic," Anna said softly, afraid to break into the narrative now that the woman was talking.

  "Yeah, that. Made him swell up like a toad. Doc had to give him two or three shots of that adrenalin stuff. And some cortisone."

  In Anna's mind, the pieces dropped into place. A previous severe reaction to penicillin was a warning flag to every doctor who treated the patient after that. Never give penicillin or any of the drugs that might produce a similar reaction. Like Omnilex, the antibiotic the fake Eric Hatley received in the emergency room. The drug that undoubtedly killed this woman's son.

  "Mrs. Hatley, do you have any family? Do you have anyone who can be with you right now?" Anna asked.

  The woman shook her head, and the curtain of listlessness descended once more. "No family. My husband passed last year. Eric was my only child."

  "Do you have brothers or sisters?"

  She shook her head.

  "Was Eric married?"

  Again, the head shake. "No, he lived alone-had a bachelor apartment-but he spent a lot of time here. He took care of me. Bought groceries, ran errands, drove me to doctors' appointments. He was such a good son." She sobbed softly."Now I don't have anybody."

  "Would you like me to get something for you? Can I do anything?"

  "Not unless you can bring Eric back." Mrs. Hatley looked up, and Anna felt the eyes bore into her. "A man came by yesterday. Lawyer. Said Eric shouldn't have died. I signed the papers to sue all the doctors and the hospital and everybody. Won't bring Eric back, but it will pay for somebody to take care of me."

  "Mrs. Hatley. One of those doctors you're suing is me."

  The woman almost spat her response. "I know."

  Anna scanned the faces of the group assembled in the department chairman's office and tried to count the allies among them. Unfortunately, other than the chair, Dr. Fowler, she wasn't sure there were any. Laura Ernst, dressed in a tailored navy suit and plain white blouse, frowned and tapped a yellow pencil on the legal pad she balanced on her lap. Dr. William Dunston, the Dean of Clinical Affairs, brushed a fleck of lint offthe vest of his gray pinstripe suit.

  Fowler leaned back in his chair and polished his rimless glasses with the tail of his white coat. "Anna, why don't you tell us what you've learned about the death of your patient, Eric Hatley?"

  Anna cleared her throat. "To recap, Mr. Hatley died from a massive allergic reaction during the final phase of his emergency laparotomy for multiple gunshot wounds. We'd given him antibiotic prophylaxis in the form of Omnilex, after confirming he received that drug without incident during an earlier emergency room visit. The pathologist rendered a cause of death as anaphylaxis due to a reaction to Omnilex. Regretfully, I have to agree."

  Dunston clasped his hands over his ample belly. "So there appears to be a conflict between the man's prior tolerance of the drug and the massive anaphylaxis he experienced more recently. What do you make of that?"

  "I began looking into it." Anna passed Dunston the emergency room record she'd been holding. "The identifying data on this visit matches what we got from Hatley's wallet. However, if you look at Dr. Fell's note, the patient is described as a 'young, African-American male.' Hatley was a middleage
d Caucasian."

  Dunston scanned the record, then passed it on to Ernst, who read it and frowned. "Can you explain the disparity?" the lawyer asked.

  "I believe I can." Anna said. "Someone used Hatley's medical insurance information to get treatment. Maybe he didn't want a venereal disease reported to his own insurance company. More likely, he didn't have insurance but was able to steal Hatley's information and use it. I think that identity theft eventually cost Eric Hatley his life."

  "And did you later confirm that Eric Hatley had a history of drug allergy?" Fowler's tone was more neutral than Anna might have liked. Was he going to stand behind her?

  Anna described her visit with Wanda Hatley. "Had we known of her son's sensitivity to antibiotics of that class, we could have chosen a different drug, and the odds are that he'd be alive today. But we were unable to contact her while Hatley was in surgery. Instead, we relied on the ER record. In hindsight, I think we made the best possible decision under the circumstances. But he died."

  "I believe I asked you not to make contact with this patient's family." There was ice in Ernst's voice. "Now I understand that the mother is taking steps to file a malpractice suit against the medical center and all the doctors involved in her son's treatment."

  "She talked with that lawyer before I ever contacted her."Anna regretted her sharp tone as soon as the words were out of her mouth. She might not like Laura Ernst, but she needed her as an ally, not an enemy. "I'm sorry. I'm still trying to figure out why Hatley died. I thought maybe I could learn something from his mother that would shed light on the situation. Obviously, I was wrong."

  Dunston looked directly at Anna. "Well, the issue here of someone posing as the patient and leaving false information on his medical record certainly muddies the waters. I'll have to leave it to Laura to sort out the legal ramifications of that." He pursed his lips. "From a medical standpoint, it appears that you acted appropriately, but on flawed information. We don't know how this is going to play out, but I'd like to be kept informed of the progress in this case." He shifted his gaze to Fowler."Please send me a summary of the M amp;M discussion." Then he swiveled toward Ernst. "I want to be copied on all communication regarding any legal actions." With that, he eased himself upright and left the room.