Medical Error pft-2

by Richard L Mabry

  The prescriptions she'd seen appeared to be written on authentic clinic prescription forms. There had been talk at the medical center of changing to tamper-proof prescription pads, but that hadn't been implemented yet. Anna suspected that wouldn't be done until a legal mandate galvanized someone in administration into action, securely locking the barn door after the horse had disappeared over the horizon.

  The simplest explanation was the first one that had popped into Anna's mind: a patient took his or her Vicodin prescription home, did a little magic to alter the numbers and patient name, photocopied it, and began selling the results. Or they could have started fresh and simply forged the prescriptions. The pads currently in use could easily be duplicated at any of the hundreds of print shops in Dallas. Even someone who was good with a computer could make up blanks.

  Anna kept coming back to the same thing: the DEA number was hers, the name was hers, and they matched. If a patient wasn't the one behind this, it had to be someone who had access to Anna's DEA number. It would most likely be a person at the medical center with whom Anna had regular contact-a doctor, a nurse, a pharmacist. It made her shiver to think that a colleague could be the one responsible for the mess she found herself in right now.

  And why would they choose her, use her name and number? Had she done something to make herself vulnerable? Surely she hadn't been any less cautious than all her colleagues. She flinched at the thought that kept intruding itself. Did someone have it in for her?

  Names and faces spooled through Anna's head. Start with the patients. She couldn't think of anyone who jumped out as a likely suspect. Maybe if she went over the patient list for her last twenty clinics or so, a name would pop up and trigger a memory. Of course, to do this she'd have to go back to the med school. Could she face the looks she was sure to get from the staff?

  Anna set her jaw. Let them stare. She'd stare right back at them, while she searched for the person who was dragging her good name in the dirt and putting her professional reputation in jeopardy.

  Ross Donovan looked at the papers heaped on his desk, sighed, and swiveled in his chair to stare out the window at the Dallas skyline. As slow as his practice had been, it was amazing how much stuffaccumulated in two weeks away. He swung back and opened the bottom drawer of his desk. He reached down, then pulled his hand back as though a snake were hissing at him from the dark depths of the space. No, not anymore.

  Donovan walked through the outer office, trying to ignore the empty desk that was once his assistant's. In the tiny workroom, he moved to the coffeemaker in the corner. He measured out coffee from the almost-empty can, filled the pot at the sink, and pushed the button. As he stood there, listening to the gurgle of the filling pot and enjoying the aroma of the brew, his thoughts ranged far and wide.

  He poured coffee into a thick white mug that told the world it belonged to the "World's Best Husband." That brought a chuckle, his second of the day. Must be some kind of a record, Donovan thought. Not many chuckles in his life for the past few months. He sat at his desk, pulled the wastebasket a bit closer, and began to go through the accumulated mail on his desk. Bills went into one stack, letters from past and potential clients into a much smaller one, junk into the trash. He finished his coffee just as he heard the front door open. He swept the mail into his center desk drawer, looked approvingly at the pristine desktop, and straightened his tie from its usual half-mast position. Time to talk with his next client. Time to be a lawyer again. And this time he intended not to blow the chance.

  The slow ride up in the elevator gave her plenty of time to change her mind, but Anna was determined to see it through. The building was nice enough on the outside, but the halls were narrow, the walls dingy, the carpet worn. Definitely a lowrent venue.

  Suite 1212 was at the end of the hall. The door had a frostedglass window in the top half, where flaking, faded gold-leaf letters announced to the world that this was the office of Ross Donovan, Attorney At Law. The waiting room held six chairs with worn upholstery, a coffee table with three tattered copies of D Magazine, and an empty desk, apparently meant for an administrative assistant. Two doors were on the back wall. The one on the right was partially open, allowing a view of a coffee machine, metal shelving laden with boxes and papers, and the corner of a sink. The door on the left was closed.

  Apparently no one was coming out to welcome her. Anna knocked on the closed door. In less than half a minute, Gregory Peck opened the door. Well, not him, but a handsome man with black, wavy hair, a cleft chin, and sparkling blue eyes that hinted of secrets that could not be shared.

  "You must be Dr. McIntyre," he said, offering his hand. "I'm Ross Donovan. Won't you come in and sit down? Would you like some coffee?"

  It smelled good, but she decided to pass. "No, thank you."As she settled into one of the two client chairs across the desk from Donovan, she gave him a quick appraisal. Probably forty years old or thereabouts. Crisp, clean white shirt with cuffs turned back a neat two folds, a conservative blue tie, dark blue suspenders. And although a reappraisal showed her that he wasn't exactly a dead ringer for Gregory Peck, his looks would probably melt the hearts of female jurors from ages sixteen to sixty.

  Donovan uncapped a pen-an actual fountain pen, not a ballpoint, she noted-and pulled a legal pad from a desk drawer. "Suppose you tell me what this is all about."

  "Don't you want a retainer or something first?"

  He waved away the question. "The TV shows always talk about giving your attorney a dollar to make the relationship formal. If Laura sent you, I suspect we can work out financial arrangements. I assure you that I'll consider anything you tell me to be privileged, even if you decide not to hire me."

  Anna digested this and decided it made sense. "One more thing before we get started. Why did Ms. Ernst recommend that I consult you, and in the same breath say that you're a liar and a cheat?"

  "The short answer, I guess, is that I am… or at least, I was. I lied to her and cheated on her. That was before our divorce."

  Anna tried to conceal her surprise. Well, she wasn't hiring a husband. She needed a lawyer. "And I guess when I asked her for the name of a lawyer, she had to call to see if you were free to accept me as a client?"

  Donovan grinned, and two dimples flanked the Pecklike cleft in his chin. "Nope, she called to see if I was out of rehab."

  Anna wheeled into what was probably the last open spot in the faculty parking garage and hurried across the campus. She didn't want to be late for the Morbidity and Mortality Conference, especially today, when she might well have center stage. She wished she'd had time to accept Donovan's lunch invitation, though. He'd left the invitation open, and she might end up having a working dinner with him, depending on how things progressed.

  Once she'd gotten past the preliminaries with Donovan, she'd been impressed by his incisive questions and sound counsel. They'd settled on a payment schedule she could meet. He'd advised her to have no more contact with the DEA or the police, assuring her that he would handle all that.

  Anna stopped at her office long enough to toss her purse into a desk drawer and snatch up her white coat. The Surgery Department conference room was packed with doctors. The faculty members sat in upholstered swivel chairs scattered at intervals around the long conference table. Third- and fourthyear resident physicians ringed the table, occupying lightly padded wooden side chairs without arms. The more junior residents were scattered around the periphery of the room in plastic shell chairs guaranteed to keep them uncomfortable and awake for the proceedings.

  A few medical students, easily identifiable by their short white coats and worried looks, sat together in one corner, trying to avoid being noticed, or even worse, called on. Anna figured that some were here to learn, but most were in attendance because general surgery was a required rotation they had to pass.

  The long white coats of the faculty were starched and pristine, in contrast to those of the residents, which ranged between slightly wrinkled and grungy. Although scrub s
uits seemed to be the uniform of the day, some of the male faculty members wore dress shirts and ties. Anna had chosen a simple white blouse and black skirt, trying for a professional look beneath her white coat. She would have preferred to remain anonymous throughout the entire conference, something she knew was impossible, but she had no intention of calling attention to herself through her choice of clothing.

  Neil Fowler moved aside the remains of his box lunch and pulled a stack of papers toward him. Like a ripple around the table, the residents and staffphysicians put aside their food. Most conversations died away, some chopped offin midsentence. Anna felt the few bites of ham and cheese sandwich she'd been able to choke down trying to push their way back up. She gulped the last of her Diet Coke.

  "Let's get this month's M amp;M Conference underway. We'll start with cases from the junior residents. Shelly?" Fowler took a handkerchief from his pocket and began to polish his glasses, his gaze directed to the far corner of the room. Although two of the medical students exchanged glances, apparently wondering if the chairman's attention was wandering, Anna knew better. She'd attended more than fifty of these conferences, first as a resident and for the past years as a faculty member. Neil Fowler wouldn't miss a word that was said.

  After the first presentation, Fowler swept his eyes around the room, focusing one by one on the faculty members, inviting comments. A couple of the more senior faculty had a few words about the management of the case. Each agreed that the morbidity-in this case, a severe postoperative infection that kept the patient in the hospital an extra week-might have been avoided had certain things been done differently. Fowler closed the discussion by mentioning a specific antibiotic that would likely have been more effective. "Moving on. Tim?"

  Anna was still processing the chairman's remarks, adding the knowledge to the mental card file she maintained on management of complications, when it hit her. Fowler hadn't looked directly at her since she'd taken her seat. Not at any time during lunch. When he polled the faculty for comments on the previous case, he'd passed over her. It was as though she weren't there. Was this the way it was going to be until she could clear herself of the suspicion that hung over her like a cloud?

  Her initial hurt gave way to grim determination. She wasn't about to be kept in limbo until those guys at the DEA found out who was using her information. And as for the Dallas Police, if Green and Dowling were typical examples, she wasn't sure she'd trust them to find a lost dog. They'd probably fine the owner for failing to keep it on a leash. No, she was going to become more actively involved in the process. And she planned to start right after M amp;M.

  Anna's reverie was interrupted when she heard Fowler say, "Luc, how about Mr. Hatley?"

  Anna pulled a blank three-by-five card from the bunch she kept in the pocket of her white coat. As Luc related the events of Hatley's case-his emergency admission, the surgery, the measures taken to replace blood loss and combat the infection that was sure to follow the colon injury-she jotted notes, all the while wishing that she could be the one making the presentation. But it was protocol that the resident on the case detail what happened and what went wrong. After that, the attending was free to speak up, defending where necessary and accepting any criticism alongside the resident.

  As Luc wound down the presentation, Anna found her toes tapping in a nervous dance under the table. She picked up her soft drink can, found it empty, and longed for something to counteract the sandpaper-like feeling in her throat.

  Anna was trying to organize her thoughts when the door at the back of the room opened, and the anesthesiologist Buddy Jenkins slipped in. He eased into one of the empty chairs along the far side of the room. His eyes met Anna's. Although his expression was carefully neutral, Anna knew what was behind it. Don't try to hang any of this on my resident… or on me. Well, she couldn't blame him. She'd probably do the same thing if she were in Jenkins's place. Besides, Nick had pretty well convinced her that the young anesthesia resident's only error had been failing to make the diagnosis early on. But then, neither she nor Luc had picked up on it either. They'd depended too much on that incorrect history, had been too complacent.

  "Okay. Dr. McIntyre, your comments?" Fowler's tone conveyed neither approval nor censure.

  Anna cleared her throat. "Luc's summarized things pretty well. He put first things first, treated the shock and stopped the bleeding. His repair of the perforated bowel was perfect. Since there was considerable fecal spillage into the abdominal cavity, antibiotic coverage was important." She lifted her eyes from her notes and looked directly at Fowler. "We've already been reminded today how it's possible to have a good surgical result compromised by an infection, and in this case the risk of fatal sepsis was significant. It's unfortunate that, even though we had good information that Mr. Hatley should tolerate the Omnilex, he suffered a severe anaphylactic reaction."

  "Who decided on Omnilex? You or Luc?" The speaker was Linda Farley, new to the surgery faculty, fresh out of her training. Anna was pretty sure that Linda felt the medicine practiced here in Texas could never compare with what she'd learned in Boston at Peter Bent Brigham Hospital, in the shadow of Harvard.

  "Luc felt, and rightly so, that Omnilex gave the best coverage in this situation. I agreed."

  Linda was like a dog trying to wrest a bone away from a rival. "But if there was any antibiotic allergy, especially to penicillin, Omnilex was almost certain to produce anaphylaxis -which it did."

  "I realize that, but-"

  "Let's move on." Fowler's voice was calm, but there was no mistaking the way he was taking command of the situation."There are a lot of 'what ifs,' but in the final analysis, I think there's nothing to be gained by exploring them. We can conjecture all day about how this would have turned out if you'd chosen a safer but less effective antibiotic, or if the anesthesia resident had picked up on the anaphylaxis earlier and started treatment."

  Anna saw Jenkins stiffen. If Fowler saw it, he didn't react. He was already closing the chart and opening the next one."Luc, you and Dr. McIntyre made the right clinical decision based on the information available to you. Unfortunately, there was a bad outcome."

  Fowler pulled a sheet of paper toward him and began reading a series of announcements, but Anna had already tuned him out. It was over. She took several deep breaths but still felt claustrophobic. She saw Jenkins slip out, and she wanted desperately to do the same. Unfortunately, the way everyone was packed into the conference room, it would have drawn attention she didn't want. As Fowler continued to speak, Anna uncrossed her legs and put both feet flat on the floor. She rested her hands on the arms of her swivel chair, ready to push up and make a quick exit when the conference finally came to an end. She'd made it through this test. But she knew there were more to come.

  Nick looked around the cafeteria. It was two-thirds full of medical school staff- administrative assistants, students, residents and faculty-but he and Anna had managed to score a table with no neighbors nearby. Besides, the buzz of conversation was better than a white noise machine for protecting them from eavesdroppers.

  His call had caught Anna as she was walking into her office after the conference. It took some persuasion on his part, but she finally agreed to meet him here so they could talk while he grabbed a late lunch. Thus far, she'd been about as talkative as the Sphinx-although a whole lot prettier.

  "You didn't bring up the new information about Hatley?" Nick took a bite of hot dog and wiped the corner of his mouth with a paper napkin.

  Anna shook her head. "I was going to mention that I'd found out he was penicillin-allergic. I figured if I didn't say something about it, Fowler would. I mean, I'd already told him about my visit with Hatley's mother. But he moved things along before I could bring it up. I got the impression he was trying to get the discussion over with." She sipped her iced tea."Maybe he was trying to protect me. Or maybe he was trying to protect the department."

  "He knows that Hatley's mother told you he was penicillinallergic. But does he know abo
ut the second Eric Hatley?"

  "He learned about it when he and I met with Laura Ernst and the dean," Anna said. "But I'm pretty sure none of them is going to spread that knowledge around. I was afraid that Will Fell, the resident I talked with about the fake Hatley, would be at M amp;M today and mention it, but he wasn't. One of the residents told me that Will just got offa twenty-four-hour shift in the ER, and I'm pretty sure he's in dreamland right now."

  "So it's not common knowledge that Hatley died because someone stole his identity." Nick took another bite of hot dog and chewed thoughtfully, parsing the implications of what they knew so far. He washed the food down with coffee, wincing as the hot liquid hit his tongue. Anna shoved her iced tea toward him. He scooped out a piece of ice with his spoon and rolled it around in his mouth before continuing. "And you don't want anyone to know yet that you've caught on about the identity theft?"

  "I'm not sure how they tie together, but I keep getting the feeling that what happened to me-the credit cards, the DEA number-and what happened to Hatley are linked. I don't know how or why, but if they are, then whoever stole my information had to get it someplace, and I'm betting it was-"

  "Here at the medical center," Nick said. "And you don't want to tip your hand while you investigate?"

  "Right. I figure it has to be someone around here who has access to my personal stuff." She lifted her glass and drank."When you change into a scrub suit in the dressing room, what do you do with your wallet?"

  Nick's hand went to the hip pocket of his scrub suit. He felt the reassuring bulge. "I put it in my pocket. I keep my change and keys in my white coat, and the wallet goes on my hip. I'm used to feeling it there, where it's safe."

  "Exactly. Now think of what a woman does. No woman- at least none that I know-wants to walk around with a bulge in her hip pocket." She held up the small clutch that had been sitting on the table. "Most of the female doctors and nurses around here have either a fanny pack or something like this that they can drop into the pocket of their white coat when they need it. But you don't wear a fanny pack under your surgical gown, and there's no place for a purse there, either. So our valuables end up in a drawer of our desk or in a locker in the dressing room."