Deadly Errors

by Allen Wyler

  “See you then.”

  TYLER ENTERED THE ICU nurses, station and glanced around. At one of the charting computers sat a male nurse he recognized. When he approached, the young man glanced up. “Something I can do for you, Dr. Mathews?”

  He decided to use the plausible story concocted during the eight-floor elevator ride. “Here’s the deal,” he glanced at the nurse’s ID tag dangling from a neck lanyard, “Paul. I’m writing up a case report to submit to Neurosurgery. In going over the chart I discovered a nurse, name of Gail Walker, took care of the patient. She works on this floor doesn’t she? She working today?”

  Paul scratched his cheek, seemed to think about it. “Walker? Yeah, I seem to remember her. She left Maynard several months ago, I believe.”

  “Think you could find out where she went?”

  “No problem.”

  Paul used the telephone to call the nursing office. After a brief conversation he hung up, turned to Tyler. “Story is she didn’t show up for work a couple months ago. No one’s heard of her since.”

  BACK IN THE physicians’ lounge Tyler logged into Qwest-Dex again. It listed two G. Walkers but neither phone answered after twenty rings. The G. Walker he was searching for could be married and listed under her husband’s name. Or, she might live in one of the numerous suburbs of Seattle, leaving too many possibilities to search.

  From his wallet he pulled a business card—a King County detective in his basketball league at the Seattle Athletic Club. He dialed Jim Laing’s number with little hope of actually catching him, figuring he’d leave a voice mail. To his surprise, Jim answered.

  “Jim, Tyler Mathews … yeah, I know, I missed the last game … look, this isn’t about hoops. I need a favor …” He asked the detective to run Gail Walker’s name through the DMV computer. A moment later he had an address.

  8:10 AM, SEATTLE FIELD OFFICE, FBI, FEDERAL OFFICE BUILDING

  SPECIAL AGENT IN Charge Nina Stanford made no attempt to hide a yawn as she picked up a black Braun coffee carafe on the credenza behind her oak desk.

  “My flight out of National had a cockpit light that wouldn’t shut off when they tried to button down the plane, so we sat there for an extra goddamned hour while some engineers worked on it. I assumed it was either fixed or irrelevant since, in the end, we landed intact. In any event, I didn’t get into Sea-Tac until eleven thirty. Which meant I didn’t even get to bed until after one this morning. Want yours black?”

  Ferguson answered, “Black is fine.” They were in her 16th floor office of the Federal Building. The west side, with an expansive view of the harbor and huge orange dock cranes lining the Harbor Island piers. Framed pictures of the Director and the President hung on the drab federal green-gray walls as the only attempt at decorating.

  Stanford wore one of her smartly tailored business suits. This one was light chocolate, which contrasted well against her flawless ebony skin. Ferguson wore his uniform—classic navy blazer, white shirt with a rep tie, and slacks. Slacks was the one change he made in recognition of the only two seasons he figured occurred in Seattle: suntan for summer, charcoal gray for winter. The routine had simplified his morning wardrobe selection ever since Susan, his fashion police, filed for divorce.

  “Enough of my trip to Hooverville,” Stanford said, handing him a white ceramic mug—the no-handle navy style she preferred. “Tell me what happened with the good Doctor Mathews?”

  He accepted the warm mug. “That’s one nervous as hell doc. Couldn’t wait for the interview to be over once I broached the subject. Bottom line, he went out of his way to dodge answering anything. He was definitely holding back.”

  She swept a palm toward a chair in front of her desk. “Please.” Then settled into the executive black leather chair behind the oak monster.

  “What exactly was his reaction when you told him about it?’

  “That’s what made my impression. Guy didn’t even bat an eyelash. It was like he expected to hear it. In fact, I got the impression he was kind of relieved to find out about it.”

  She blew across the surface of her coffee. “Then my next question is, is he likely to cooperate?”

  “Didn’t commit one way or the other. Guy’s still gun-shy from the raw deal he ended up with in California … and I can’t say that I blame him.”

  She sat, swiveling the chair side to side. “Couldn’t be helped. You know that.”

  “True, in all likelihood … but still, you have to admit Mathews got handed the brown end of that particular stick.”

  Stanford hitched a shrug. “You present him with his options?” Her perfectly groomed eyebrows arched.

  “Yep. And he’s not a tail wagging puppy over it.”

  She barked a sarcastic laugh. “Wouldn’t expect him to be.”

  “Way we left it, he’ll get back to me.”

  “When?”

  “I plan on giving him two days before I start applying pressure.”

  “I wouldn’t wait any longer than that.” She paused a beat. “And if that doesn’t work what’s plan B?”

  8:10 AM, OFFICE OF JILL RICHARDSON

  TYLER CLOSED THE door behind him. “Good morning.”

  Richardson looked up from her keyboard. “What’s wrong? You look annoyed.”

  He dropped into the chair directly in front of her. “When are we going to file the sentinel event report?”

  “Never.”

  He sat in stunned silence a beat. “You’re joking.”

  She broke off a chunk of bagel sitting on a white paper plate next to a latte, both next to the keyboard. “Not at all. Right now there’s not a shred of evidence Childs received an overdose. Sure, he suffered an unfortunate outcome from treatment—which, by the way, I know for certain, since I checked on this—is a known complication. And a complication in and of itself is not a sentinel event.” She popped the bagel her mouth.

  She stopped chewing, put a hand to her mouth, asked, “What?”

  “You’re part of it, aren’t you.”

  “Part of what?”

  “The cover up.”

  “Oh for Pete’s sake. That’s ridiculous.” She held up a finger until she could swallow. “Where’s your evidence that the record was manipulated? The way I see it, your patient died. Naturally you feel some empathy toward him and the family. That’s natural. I would hope any good doctor would react that way. But complications happen, Tyler. You need to move on.”

  “Bullshit. There’s a problem with the computer and I’m not moving on ’til I find out what it is and get it fixed. And if you won’t help me, I’ll file the sentinel event myself.”

  She studied him a moment. “You’re serious.”

  He let out an audible breath of exasperation. “Jesus, what does it take to get through to you? Damn right I’m serious.”

  “Do that with what you have now and you’ll make a fool out of yourself. I don’t want to see you do that.”

  “Then help me so I won’t make a fool of myself.”

  “Fine. What do you want me to do?” She crossed her arms.

  “I don’t trust the information I’ve been getting from Day. I need to have someone outside this medical center and Med-InDx have a look at the backup records. I know for a fact that backups are made daily in a thirty-day cycle. There should be several days of records still out there with the original value still present. I want you to ask Khan to freeze the backup records for the day Childs was admitted. Then I want an independent evaluation of them.”

  Richardson swallowed again, dabbed her lips with a paper napkin. “I’m not going to do that.”

  He felt his jaw muscles tighten. “Why not?” They were giving him a headache.

  With a resigned sigh she glanced away. When her eyes returned a moment later, she asked, “Did anyone else see the overdose value?”

  An alarm went off in his mind. “Why do you ask?” He thought of Michelle.

  “I simply want to know if you have any witnesses. Is there something wrong with th
at?”

  “I don’t like your tone. It implies I made the whole thing up.”

  “Why don’t you answer my question instead of dodging it with righteous indignation? Is there a problem, Tyler?”

  His gut said she knew something he didn’t. “Doctor Lawrence, the anesthesiologist saw it,” and watched her response.

  Another dismissive wave. “Lawrence of A Labia? The Dickless Dyke? Hah! Nobody in their right mind is going to believe her.”

  “Why not?”

  “Because, Tyler, she’s on probation for sexual harassment and she’s really pissed about it. She’d just love to find a reason to slam us.” She shook her head in apparent disgust. “Got anybody else who can back your story?”

  Obviously she didn’t know Michelle was dead. Or if she did, she covered it well. No, he decided, she didn’t know.

  “Jim Day. But under the circumstances …”

  “Then let me tell you something I shouldn’t. But I think you need to know this. And I’m telling this to you as a friend.” She paused. “The other day, after we met with Khan, I went back to see him. I asked him to check the data field to see if there was any record of it being changed. There were two attempts to change the record but they were both unsuccessful.”

  Tyler’s gut did a double somersault. “Did it show who?”

  Her eyes hardened. “You know the answer, Tyler. Why do you even ask?”

  “No, I don’t know. What did it show?”

  “You tried to change it the day after Larry Childs was admitted.”

  15

  PARANOIA, FEAR, AND anger began boiling in his chest. “Whoa, hold on a moment. What possible reason would I have to do something like that?”

  “Ohhh c’mon, you’re a smart man. I can think of all sorts of motivations, most of them financial. I did some checking on you, Tyler. When you were ten your birth parents divorced. Although your mother wanted custody of you, you chose to live with your father. Although he could have afforded to send you to school, he believed his son should have to pull his own weight. As a result, you financed your own education with student loans. You were just climbing out from under a mountain of debt when you fell into,” with fingers of both hands she carved quotation marks in the air, “other problems. So, after my talk with Mr. Khan I asked myself, what possible motivation could Doctor Mathews have for diddling a data field? Know what the two primary motivators are for criminal actions?”

  Before he could answer, she continued, “Money and sex. And since I could see no sex angle on this, I thought ‘Ah hah, money!’ So I asked Mr. Khan to do some checking on you. Guess what he found? A Charles Schwab account in your name. Guess what else? It has only one stock in it. And lordy, lordy, guess which stock that might be? You guessed it, Prophesy. But instead of common stock, it’s ten thousand calls. Now that’s what I’d call leverage. How do you explain that, Tyler?”

  Tyler jumped up and leaned over the desk to within a foot of her face. “This is bullshit. I’m being set up.”

  “Bullshit?” She pulled a sheet of paper from a stack and set it down in front of him. “This is bullshit?”

  He picked it up. A Charles Schwab statement, his name and address listed correctly as the owner. Just as she claimed, December calls on Prophesy Inc the only holding.

  “Right now those calls are out of the money,” Richardson said. “But should something happen to discredit Med-InDx, something that might sway the committee’s recommendation, well then, those calls will be worth a small fortune.”

  “Where did you say you got this?” He held up the paper.

  “Like I said, Yusef Khan.”

  He folded it. “Then you can get another copy.” Could Ferguson find out who opened the account? Probably.

  Tyler’s beeper began chirping. He checked and found a STAT page to the Emergency Department.

  JOHN BROWN, THE ED physician who paged Tyler, lowered his voice and said, “I was hoping to catch you before you went in there.” They stood inside the physicians work area—three walls of desk space with four computer terminals, three phones, and four rolling task chairs, two of which were occupied with scrub clad ER docs typing and mousing instead of writing. The area always seemed too hot and carried a trace of body odor, as if this large alcove off the main hall had no ventilation.

  “Is there a problem?”

  “Frankly, yes. He’s Roland Rowley’s patient and although neurology isn’t my specialty, I think Roland’s missed the boat completely on this one. He didn’t want me calling you, but I insisted.”

  Terrific, another turf war. “What’s the issue? You said something about the patient blowing a pupil. If that’s true, there shouldn’t be any problem with you calling me.” He’d consulted on a couple of Rowley’s patients. A modestly competent neurologist although a bit pompous and opinionated.

  “He’s down here.” Brown led Tyler down the hall to Trauma three. Ironically, the same room Larry Childs had been admitted to. “You’ll see.”

  Brown opened the door and entered. Tyler followed. Hunched over the stretcher, Rowley peered through an ophthalmoscope into the patient’s right eye. On the other side of the gurney a nurse busied herself tidying up the cardiac monitor leads. Brown cleared his throat, said, “Roland, Doctor Mathews is here.”

  Without looking up, the neurologist grumbled, “Everything is under control, Doctor Mathews, you can return to whatever you were doing. John made a huge mistake bothering you. I apologize for him.” The nurse glanced nervously from Brown to Rowley and back again.

  The emergency physician said, “Sorry Roland, I know mister Torres was your patient, but the moment he was admitted to the ED he became my responsibility. And I’m telling you I want Tyler’s opinion on this one.” He turned to Tyler. “Mister Torres is a forty-two-year-old Hispanic male who last week began to develop symptoms of aphasia—”

  Straightening up, Brown glowered at Rowley and said, “It’s a straight forward, garden variety TIA for which I put him on some persantin and aspirin. But, unfortunately, it seems to have progressed on into an infarct. Textbook classic. No need to consult neurosurgery.”

  Ignoring him, Brown continued, “Thing is, before this all started he presented to the ED with complaints of ear pain. A diagnosis of otitis media was made and he was placed on Ampicillin. Today his wife brought him in saying she couldn’t wake him up. He’s been running a low grade fever all week.”

  “Yes,” Rowley interrupted again, “and the cultures proved Ampicillin to be the drug of choice. The ear infection was treated correctly. It’s effectively a red herring. It has no bearing on the present diagnosis.” He replaced the ophthalmoscope in the wall holder.

  Tyler knew Brown was hinting at a brain abscess, a rare but potentially deadly complication of ear infections, treated or otherwise. Moving closer to the stretcher he realized the patient’s arms were rigidly flexed. Even from where he stood he could see the left pupil dilated compared to the right. Déjà vu all over again. He thought of Larry Childs.

  Tyler asked Brown, “Ordered a scan yet? A CT will do.”

  Brown shook his head. “Both MRIs are tied up with other emergencies and our CT is down.”

  Just then Torres’s arms locked into rigid extension—a grave sign of brain deterioration due to increased pressure inside the skull. Tyler said to Rowley, “Even if this is a stroke, he’s slipping down the tube as we speak. And there is a chance we’re dealing with an abscess. If we don’t do something now, sure as hell he’s going to crash and burn.” To the nurse he said, “Get me ten of Decadron and twenty-five grams of Mannitol STAT.”

  Brown said, “Oh shit, here we go. Look at his respirations he’s gone into central neurogenic hyperventilation.”

  Tyler looked. Sure enough, Torres’s breaths were rapid and deep, his neck muscles straining at each inhale. Another dire sign.

  “Now just a minute here—” Rowley interposed himself between the stretcher and Tyler as if protecting the patient.

  “Ou
t of the way, Roland. I don’t have time to debate this,” Moving around the internist, Tyler asked Brown. “You have a twist drill set here?”

  “Can’t say that I’ve ever heard of it.”

  “I take it that as a no.”

  Brown nodded.

  Tyler picked up the wall telephone and punched zero. When the operator connected he said, “Give me surgery central supply.” Then to Brown, “Call for a respirator and technician, pronto.”

  Rowley threw up both arms. “Mathews, this is too much. You’re overstepping your boundary, here.”

  “Stow it, Roland.” Then back into the phone, “This is Doctor Mathews. I’m in the ER. I need a twist drill tray and I need it now. Have someone run it over. Now.” He hung up.

  Tyler grabbed the otoscope from the wall holder and peered into Torres’s right ear. Clean. The tympanic membrane glistened back at him. Next, the left. Here the membrane was inflamed and bulging from yellow pus trapped behind it.

  The nurse charged into the room holding two syringes. “Here they are. Which one you want first.”

  Tyler grabbed the one closest. “I’ll give this one. Push the other.” He glanced at the label, 10 mg Decadron.

  Another nurse hurried in. “What can I do to help?”

  “I need hair clippers, razor, and a prep kit. Then get a Foley into this guy.”

  Tyler put a palm against Rowley’s chest and pushed him away. “Look, either help or get out of the way.” He grabbed the IV line, found the rubber injection port and plunged in the needle.

  The nurse returned with the shaving equipment. A second later a surgery tech carrying a sterile pack came through the same doorway. “Someone call for a twist drill set?”

  Tyler pulled over a stainless steel Mayo stand. “Just dump it here.” He turned Torres’s chin toward his right shoulder and with the hair clippers cleared a patch of black hair just above his left ear. After shaving this with a safety razor, he painted the area with Betadine.