Deadly Errors

by Allen Wyler

  “Sure.”

  “When?”

  Day shrugged. “Later today, I guess … possibly tomorrow.” He studied Tyler a second before asking, “Why,” his eyebrows furrowed, “you want me to check it out this minute?”

  “Hell, yes. My patient died this morning. Don’t you think that makes it a priority?”

  Day shrugged. “Fine. I’ll check it.” He turned to the computer and started typing.

  “Let me ask you something. Instead of a physician, doesn’t it seem more likely it’d be someone else fooling around in the system? Maybe someone who didn’t realize how serious a seemingly simple change might become?”

  Day hit a key hard, then looked up. “Your hacker theory?”

  “Why not?”

  Day’s look hardened. “Because, my man, that system is one impenetrable sonofabitch. It’s that simple.”

  The answer surprised Tyler. No computer system connected to the outside world was impenetrable. “You honestly believe that? I sure as hell don’t.”

  Day sighed, gave a resigned let-me-explain-it-to-you look. “Doc, listen up. I know what you’re driving at—that old theory that no network’s secure? Maybe true for just about everything outside the NSA, ‘cept this one? This one insecure? Uh uh, nooooo. I’ve never seen security like this one. That, my man, is the absolute strong point of the Med-InDx system. That and its database engine.”

  “Sure, easy for you to say. The company signs your paycheck every two weeks. Your 401k’s probably overflowing with stock options.”

  “Hey, man, lighten up.” Frowning, Day held up his hand, his expression one of genuine hurt. “I’m telling you straight up, breaking that system’s security is harder than knocking off a Federal Reserve Bank.”

  “So you say. But I have a patient whose brain rotted out from a radiation overdose and the dosage field says he got 200 gray. So are you going to check it out or what?”

  “Sure, I’m checking it out as we speak. You got me interested now.” He held up a wait-a-minute finger and returned to his computer. A moment later, “Nope. No evidence that field was altered.”

  Tyler thought about that a moment. “Bear with me a moment on this. If a hacker had enough access to change the data field, couldn’t he also have enough access to cover his tracks?”

  Day’s eyes widened. “You mean, like, alter the validation fields? You out of your fucking mind, man? No way.”

  “I want you to check it out.”

  Day studied him a moment. “You’re serious, aren’t you?”

  “My patient just died. Of course I’m serious.”

  “I don’t know if it’s possible to really check that out, but to do it right I’ll have to go back over a few of the oldest back up tapes. They’re stored off site. A place outside Salt Lake City. I’ll have to request they upload them for me to take a look at. That’ll take a few hours at best. At best,” he emphasized. “Assuming of course, I can whip up some enthusiasm from the unlucky bastard who gets my request.” He slid out of the chair, an obvious sign the meeting was over. “You can wait a day or so, can’t you? No way I’m going to get that answer for you sooner.”

  Tyler stood up also. “Hell no, I can’t wait a day or two.” He flashed on a potential hot button that might get Day’s attention. “Besides, this has to be reported as a sentinel event. Which means a root cause analysis with—at this very moment—you in the spotlight. That means getting JCAHO involved. Understand?” Anger flickered across Day’s eyes. Good. Maybe that would get some action out of him. “If I don’t have word back from you by tomorrow, I’ll report it as a suspected hacker intrusion. Then it’s your problem to prove otherwise.”

  Day’s expression grew even harder. “I wouldn’t advise that.”

  “Then get me the information so I can file the report accurately.” Tyler turned and stormed out of Day’s office.

  9:45 AM, MAYNARD MEDICAL CENTER BOARDROOM

  “CAN YOU BE a little more specific about the exact reasons you and several of your committee members are in Seattle at this particular time, Doctor Vericelli?” The reporter glanced down at the glowing little red RECORD light on her portable Sony cassette recorder.

  Sergio Vericelli straightened his posture and elevated his goateed chin an inch—a posture he felt befitting his stature as committee head. He cleared his throat while reaching for the nearby glass of water. Both well-rehearsed ploys to kill extra seconds while mentally reviewing his answer for potential chuckholes. As a full-time employed physician for the Joint Commission on Accreditation of Healthcare Organizations—otherwise known as “Jay-Ko” by health professionals in the trenches—he was a press conference combat veteran. However, he knew full well this was not just your usual lightweight collection of hacks from the local rag and television station of some Podunk Hollow community whose 100-bed hospital just passed accreditation. No indeed. This was The Big Time. He recognized the stringer for the Wall Street Journal, the Forbes writer, the cute CNBC reporter in a miniskirt with her video cameraman joined to her shoulder, to name just a few of the industrial-strength media at the other end of the highly polished boardroom table.

  Sergio flashed his newly whitened teeth in a benign smile. “Maria,”—he loved calling her by her first name—“that’s a fairly open-ended question. Could you be a bit more specific?” He knew exactly the point the question was intended to ferret out, but wanted to toy with her a moment, see if she was really as bright on her feet as rumors indicated.

  “Fair enough. We all know your committee is charged with making a decision about the new JCAHO EMR, eh, electronic medical record system, requirements within the next thirty days. And it’s no mystery your committee’s been looking very seriously at the Med-InDx solution. Is there any reason to believe this trip signifies any problems for the Med-InDx product?”

  Sergio’s smile widened. Perfect. “No, Maria. In fact, quite the contrary. To answer your question, we are here to review the last four months of data from Maynard Medical Center. I must admit, those data continue to demonstrate an outstanding consolidating decline in medical errors.” He loved to emphasize the correct grammatical plural of datum since so many illiterates missed this particular fine point. “In particular, it demonstrates the remarkably low level of common medication errors that can be achieved with a high-quality, comprehensive EMR.”

  He cleared his throat again and readied himself to launch into his dog-eared speech. “By EMR I am referring to an Electronic Medical Records—not a complete clinical information system such as offered by the Med-InDx company. JCAHO’s emphasis on the switch to computerized charts represented a drastic change from the time-honored clinical chart so characteristic of medical record keeping for the past 100 years. As I’m sure you are all aware, in November 1999, the Institute of Medicine concluded a study entitled, ‘To Err Is Human: Building A Safer Health System.’ It focused attention on the issue of medical errors and patient safety. The report indicated that as many as 44,000 to 98,000 people die in hospitals each year as the result of preventable medical errors. But the point is, very little progress has been made to correct this problem. Think about it. If the airlines had the same record of crashes, who would fly?” He glanced around the room knowingly and smiled as this thought sunk in.

  “Look what happened to American auto manufacturing when they got sloppy. Several automakers went bankrupt. The big three lost a huge market share to the foreign automakers. Well, it’s time to reform the error rate in hospitals.

  “The Institute’s report estimated that medical errors cost the nation approximately $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct health care costs. These preventable errors are exactly what electronic medical records are intended to reduce.”

  The Wall Street Journal stringer piped in. “Hold on a moment, Doctor Vericelli, you’re straying from the point of the last question. Some of us would like t
o drill down on this. Would you share the exact figures with the group?”

  He raised his eyebrows in mock surprise. “Figures?”

  “Yes. What are the error figures for the Med-InDx system.”

  Sergio shook his head with a good-natured grin. “You know I’m not at liberty to disclose data of that nature at this time. Once the committee has reached their final decision and made their finding public, those data will be released as a matter of public record. But until then, the committee can not disclose proprietary information, especially in a case such as this where the company’s public offering is slated only days after the committee’s ruling.”

  Frowning, the journalist shook his head. “That’s ridiculous, Doctor. With the timing of Med-InDx public offering so close to the committee decision, it is unreasonable for you to withhold this information. One has to wonder if there’s more than mere coincidence here.”

  Other reporters murmured agreement.

  Sergio hesitated, unsure of the reporter’s intent. “I understand your eagerness for some preliminary indication of the committee’s findings, but even I, as committee chairman, have no knowledge of what that decision will be since there has yet to be a vote.” There, that should answer the bastard.

  “But,” the reporter interrupted, “surely you’re aware of the committee’s sentiments. If the Med-InDx product truly is as superior as rumors have it, then the decision is all but made.”

  Too smart to get suckered into that game, Sergio shook his head, “Sorry,” and nodded at the next reporter. “Next.”

  “Any truth to the rumor that so far results clearly favor the Med-InDx product? That Prophesy’s solution isn’t even considered in the running anymore?”

  “I thought I just answered that question, however differently you might have phrased it.” Sergio wagged an admonishing finger before turning to Bernie Levy. The Med-InDx CEO sat staring out at the reporters with vacant eyes and a Bill Gates haircut. “I’m sure Mr. Levy would like that to be the case, but so far all I can tell you is the committee believes both products are excellent. This also means there is no clear leader as far as the committee has determined.”

  Another reporter asked, “If you can’t give us the figures, perhaps you can let us know any areas in which Med-InDx shows particular strengths?”

  Sergio’s face grew serious. He stroked his salt and pepper goatee in a manner he believed demonstrated thoughtful consideration. Which was far from the case. He knew the figures cold, but intended on leaving a very different impression. After an appropriate pause, he said, “Their product shows solid strength across the board in all areas in which a complete EMR might be anticipated to compete. Using their solution,” tossing in a little Silicon Valley buzz word, “we have seen a dramatic lowering in patient ID confusion, particularly for those patients with the same last name. The committee has seen a significant decrease in miscommunication among caregivers and an absolute zeroing of wrong-site surgery in the past 12 months. There are other areas of improved performance too, such as medication delivery, especially with infusion pumps. But most dramatically, the Maynard Medical Center trial has demonstrated a remarkable and statistically significant drop in medication and blood product mix-ups when compared to the same period of time preceding the implementation period.”

  Pausing with a dramatic flourish, Vericelli, turned to his right side where Arthur Benson, Maynard Medical Center CEO, sat at military attention. “And this brings me to my next point. I thank Mr. Benson for allowing his medical center to be used as the clinical trial site for the Med-InDx product evaluation. Most of you have no idea of the cost in time and personnel a study of this magnitude and nature requires. Although in the final analysis the Maynard Medical Center will reap the benefit of acquiring a world class Clinical Information System, the medical center has spent millions of dollars over the past three years phasing in this entire complex system.” He paused, nodding his head slightly. “Yes, millions. Think about the increased IT staff required to install and convert the software to the present computer networks and then to train every one of the three thousand employees—the doctors, nurses, admitting clerks, pharmacists, just to name a few—who use the various components of the CIS in their day-to-day activities.”

  He sipped water from the glass next to the podium while deciding the appropriate words to best conclude the press conference. Slowly he set down the glass and raised his head for proper emphasis and raised his voice like a Baptist preacher reaching the climax of his Sunday sermon. “The ground breaking report from the Institute of Medicine opened our eyes to the risks every man, woman, and child takes when being cared for in hospitals, doctors’ offices, or emergent care facilities. The know-how to prevent these errors exists in the form of electronic medial record systems. We now need to focus on making sure that health care organizations are actually taking these preventive steps.”

  He turned first to Bernie Levy, shook his hand, then did the same with Arthur Benson before strutting from the boardroom.

  TYLER’S BEEPER STARTED chirping. He didn’t recognize the number but the exchange indicated the call back number was within the medical center. Tyler reached for his cell phone.

  “Doctor Mathews, Joe Delaney. I’m reading histology of one of yours marked urgent. From last night? A patient by the name of Childs?”

  Tyler wasn’t sure if he wanted to hear the answer now that Larry was dead, but he had to sooner or later. He sucked a deep breath. “Let’s hear it.” His chest tightened.

  “Don’t have much of anything definitive to tell you since most of the specimen shows nothing more than some nonspecific necrosis, but there are a few sections with blood vessel showing changes consistent with radiation necrosis. As I understand it, the differential diagnosis includes tumor, a viral infection, and radiation necrosis. That correct?”

  Not wanting to bias the pathologist’s opinion, he gave a noncommittal, “Yes.”

  “Well then. I’d have to say there’s nothing to suggest either tumor or a viral infection. The latter, as you know, can’t be totally excluded until the EM studies,” electron microscope, “are completed, but … well … I’ll let the entire pile of chips ride on radiation necrosis.”

  Tyler’s gut tightened as he thought again about the apparent radiation dose mix up. Jim Day hadn’t called back yet. How many hours had it been?

  The pathologist asked, “Anything else I can help you with long as you got me on the line?”

  Tyler’s mind refocused. “No, nothing more. Thanks for getting back to me so soon. I appreciate it.”

  Tyler replaced the cell phone in his white coat and picked up his latte. Cold. He set it back down just as a premonition burst into his consciousness. At first it was nothing more than amorphous foreboding, a feeling that something awful, something he had no control over, would trample his new life—especially now that there was hope of getting back with Nancy. Then, he realized what the feeling was. Because I’ve lived this before, he thought. Therefore it isn’t really déjà vu. Is it?

  He thought about calling Nancy and talking over the situation. But what was there to discuss? A simple case of paranoia? A residual feeling from California?

  Tyler stopped rotating the latte cup on his desk. Regardless of who was responsible for the radiation overdose to Larry Childs’s brain, the result was the same: a disastrous complication resulting in death. At the very least, he should file a report with the study Principle Investigator, Nick Barber, who in turn, should notify the NIH bureaucrat with overall study responsibility. That person would file an immediate written report with the DMSB—the data monitoring and safety board—who would review the problem within 24 hours and quite possibly shut down the entire study.

  Jesus, what have I done?

  Tyler looked up a telephone number and dialed.

  “DO ME A favor and pull up the data sheet on study patient MMC-LC1.”

  Nick Barber said, “Hold on a sec.”

  Tyler heard the click of compute
r keys in the background.

  “Okay, got it.”

  “What was the treatment dose?”

  It took a few seconds before Nick answered, “Ten gray. Why?”

  Tyler realized the skin on his arms and neck carried a patina of sweat in spite of the relative chilly office.

  “We have a real bitch of a problem, Nick.” A drop of sweat rolled into the corner of his eye, stinging, trigging a series of blinks.

  Tyler stared at his hand computer on the desk in front of him, the notes on Childs still visible on the screen.

  Nick said nothing, leaving Tyler with the task of continuing.

  Tyler sucked another deep breath.

  “Our records show he was given two hundred gray.”

  Tyler heard Nick draw a very deep breath. “Holy Mother of Christ.”

  He went on to describe in detail Larry Childs’s clinical course. “I have no idea how this happened,” Tyler felt compelled to add. His heartbeats were clearly audible in each ear now as rhythmic swishes.

  “Christ,” Nick Barber muttered. “How could you have let this happen?”

  “Let it happen?” The rototiller started in his gut. “I just found out about it.”

  “My point exactly.” Another pause. “I need to report this to Margaret Heit.”

  Tyler recognized the name. The NIH section chief unfortunate enough to hold their grant in her portfolio.

  “Nick?”

  “Yes.”

  “I think a hacker may have been in our system.”

  Nick gave a sarcastic grunt. “A hacker? Yeah sure, Tyler. Whatever.” He hung up.

  DOG TIRED AFTER a full night up doing cases, Michelle looked forward to a lingering soak in a hot Jacuzzi tub filled with bubble bath before taking a two hour nap. She opened her condo front door with a sigh of relief then locked it behind her. She dropped her purse on the granite kitchen countertop and headed straight for the bathroom, but stopped.