Deadly Errors

by Allen Wyler

  “You’re blowing smoke at me, Ms. Richardson. Surely there are cases where physicians or nurses have blamed the system. Are you telling me there’s been nothing even close to that?” He locked eyes with her.

  “I don’t understand why you’re so adamant about this hacker theory. Do you have any idea how much testing was done before we allowed that software to be installed and tested here? The HIPAA requirements alone required an entire extra layer of security. Do you really believe Med-InDx and Maynard would allow a flawed security system to be used on patients?”

  Tyler laughed. “C’mon, you’re joking, right? No software system—especially one that’s still in development—is secure. Certainly not one that hasn’t been in wide spread use. Hell, look at Microsoft. They send out Windows patches every week and still don’t have it right. And that’s only an operating system, not a complete information system. Tell me you’re not trying to sell me on the possibility our EMR’s the one and only exception in the universe.” He shook his head slowly. “I won’t buy it.”

  She seemed to consider this.

  He added, “Look at it this way. Let’s say you’re right and nobody’s ever mentioned a problem before. Does that mean there isn’t one? One that no one knows about? Of course not. And if there is, it’s killing patients. Would you, as the head of risk management, like to stand by and know that possibility was never investigated?”

  When she still didn’t answer he added, “I already know about Dr. Robin Beck. She claims there was a problem with the computer. So there must be others.”

  She gave a resigned sigh and threw up both hands. “Alright already. I’ll give you the chart identifiers of three cases that struck me as suspicious, but only on one condition.”

  “And that is?”

  “If anything turns up, you’ll discuss it with me before doing anything foolish.”

  Tyler punched his chest with a thumb. “Me do something foolish?”

  She grimaced. “Especially you.” She paused, seemed to be thinking of something. “But for what it’s worth, you should also know a few things about Doctor Beck. The incident was investigated. She clearly made a mistake. Also, she’s an impaired physician. Alcohol and drugs. We have a long record of complaints about her. The incident you’re speaking of was the final straw. We had no choice but to let her go. She’s now got a ten million dollar malpractice suit against her on the case in question and that’s probably going to settle before the insurance company spends any more money on expert witnesses. And she’s now in rehab.”

  “I still want to look at the record.”

  6:15 PM, QUEEN ANNE HILL

  WITH AN UNEASY gut feeling, Tyler approached the front door to the small, gray with white trim Dutch Colonial. Beck hadn’t answered any of his phone calls all day. That alone didn’t bother him as much as the fact no voice mail had picked up either. He didn’t know many doctors who made themselves totally unreachable. None that were successful, that is.

  He rang the front door bell.

  No answer.

  He rang again.

  Still no answer.

  He took a cracked concrete path around the house to a postage-sized, dandelion-infested, patch of grass surrounded by a weathered cedar fence. A detached garage held a red Mazda Miata. Top down.

  He walked up onto the back porch and peered through the glass window in the center of the door, saw a commercial grade stainless steel gas stove, a Subzero refrigerator matching white European style cabinets. Obviously remodeled within the past few years. A coffee mug sat on the Corian counter next to the sink. The well equipped kitchen of someone who likes to cook. Not the kitchen of a substance abuser.

  He rang the back bell and pounded on the door.

  Two minutes later he sat in his car trying to curb a bad feeling brewing in his gut. He’d start calling again in the morning.

  17

  BACK IN HIS car, cellphone in hand, Tyler unfolded the scrap of paper with Gail Walker’s phone number scribbled across the top. He dialed. It rang twice before connecting to a computerized female voice informing him the number had been disconnected. Just as it had earlier today. He punched off and for a moment stared at the paper—her address scrawled below the phone number—weighing his next move. Walker’s address appeared to be in Ballard, a neighborhood not that far from Beck’s Queen Anne residence. Why not?

  He fired up the ignition, took a route off the northwest side of Queen Anne Hill down onto 15th NE then north across the Ballard Bridge. He found her building more easily than a parking space. After dumping the Range Rover next to the curb on a side street, he walked two blocks back to the five-story stucco building. Either condos or apartments, he reckoned, while jogging up three concrete steps to a glass front door. Recessed into the wall to the right of the door was an intercom system. He scrolled through the directory without finding Walker. A small sign at the bottom of the intercom read Manager, Unit 102. He punched in the number, hit the # key. A moment later a woman’s voice answered.

  Tyler asked, “Are you the manager?”

  “Hold on a second. I’ll get my husband.” The intercom clicked off.

  Just as Tyler was about to punch in the number again, a tall thin man in Levi’s and a denim shirt appeared in the lobby and approached the door. He cracked it enough to look out and ask, “May I help you?”

  “I’m trying to find Gail Walker.”

  The man’s eyes narrowed. “And you are?”

  Tyler pulled out is wallet. “I’m a doctor from Maynard Hospital. She used to work there.” He displayed his Washington State professional license. “I need to speak with her about a case she was involved with several months ago.”

  The man opened the door further but didn’t offer Tyler entrance. “Doesn’t live here no more.”

  “When did she move?” The uneasiness in Tyler’s gut intensified.

  “Don’t know, exactly. Matter of fact, we’re not sure what happened to her. One month she didn’t pay her rent, which wasn’t like her at all. I started going to her apartment, knocking on the door, but she never answered. Got to the point her mail completely filled up the mailbox, so I finally felt forced to open her unit. All her things was there, but she wasn’t. Haven’t seen hide nor hair of her since.”

  “And you’ve never heard from her since? No change of address notice? Nothing like that?”

  The man shook his head. “Nope.”

  “And her furniture and things? They still in the apartment?”

  “Nope. In storage. We ended up renting the unit a month ago.” He gave a guilt-absolving shrug. “Had no choice, what with her not paying rent.”

  8:55 PM

  FLAT ON HIS back, head propped against a pillow, Tyler clutched a longneck Red Hook and studied his beige living room ceiling while a cloud of anxiety churned his stomach. On the stereo Ester Phillips was singing Sweet Touch of Love. How long since listening to this CD? He loved Ester’s distinctive voice. Even more, he loved these particular lyrics. They reminded him of Nancy.

  The irony of his fondness for Phillips’s singing hit him. Throughout her career she battled narcotics addiction. Now he was battling a narcotics rap even though not addicted. Shit!

  Unable to lay still, he got up and paced.

  What to do? The only way out of this mess seemed to be finding proof of the software bug. But both Beck and Walker were gone. There had to be another way.

  He set the beer on the faux rattan coffee table and picked up the portable phone and thumbed redial. He let Nancy’s phone ring ten times before hanging up. He needed to talk with her, get her take on the situation. That’s what they’d always done in the past when either one had a problem. God, he missed her now that she was back in his life.

  The song ended and the next cut began. Tyler checked the time. He’d already made up his mind: tonight no sleeping pill. No excuses. No matter what.

  He shut off the CD player and headed for the bedroom. If need be, he’d lie in bed all night staring at the ceilin
g rather than pop even half an Ambien.

  11:13 PM

  TYLER LISTENED TO an overhead jet head for Sea Tac and tried to force his muscles to relax. But Michelle’s death served as a premonition about Robin Beck. The fact that neither she nor an answering machine had answered the phone ate away at his mind, leaving unsettling anxiety. He changed positions, tried to think of Nancy.

  12:32 AM

  TYLER SAT ON the edge of the bed and palm wiped his mouth. What would be the worst case eight hours from now, being too tired to think carefully or having taken a half Ambien to get to sleep? Once he put the question in this light, the answer seemed obvious.

  Weighed down with regret—but hey, what was he supposed to do?—Tyler walked into the bathroom and chewed a half tablet of Ambien.

  7:45 AM

  WITH THE ALL-TOO-FAMILIAR fuzziness of sleep deprivation accentuated by residual Ambien molecules coating his neurons, Tyler set a Starbucks latte Grande on his desk and flipped on the computer.

  Morning rounds, or the lack of them, had ignited another surge of anger at whoever planted the drugs in his locker. He had discharged his last post-op patient and then rounded on Torres, the bright spot of the morning. By now Torres was sitting up in bed talking fluently. Rowley hadn’t yet seen him today, but from the looks of things, Torres could be transferred out of the Neuro ICU.

  The nauseating Windows introductory melody played, bringing Tyler back to the task at hand. He spread the paper listing the patients’ names and chart numbers on the desk and moused the medical record icon. A moment later he was ready to begin. He entered the first patient’s chart number and hit enter.

  REQUESTOR NOT AUTHORIZED appeared on the screen.

  He typed the second patient’s name. Same response.

  Tyler crumpled the piece of paper into a ball and threw it against the wall. “Shit!”

  Fuming, he typed in Torres’s number. The chart immediately appeared, no problem. He requested the chart of the patient he had discharged a half hour ago. It popped up too.

  He picked up the wadded paper and smoothed it on the desk, then tried accessing the third patient. Again, access denied.

  Still fuming, he picked up the telephone and dialed the IT help desk. A young sounding female answered with a chirpy, “Help desk, may I have your name and department?”

  “Tyler Mathews, Neurosurgery.”

  He heard keyboard clicking followed by, “And what can I do for you, Doctor Mathews?”

  “I can’t seem to access several medical records. Is there something wrong with the server this morning?”

  “Not that I know of. Hold on, let me check.” A moment later she returned with, “All servers are functioning, Doctor. Tell you what, let me check on your account. I’ll be right back.” Click.

  Vivaldi’s Four Seasons filled the cyber void. Tyler waited.

  About thirty seconds later she was back on the line with, “I’m sorry, Doctor Mathews, it appears that your account is restricted to only patients you’re presently seeing either as an inpatient or outpatient.” So mechanical was her delivery, Tyler almost mistook her for a recording.

  His anger spiked again. “Does it say who placed that restriction on my account?”

  “No sir. I guess you’d have to ask one of the system administrators for that kind of information.”

  “Thank you.”

  “Have a nice day.”

  You’ve got to be kidding. He slammed down the receiver.

  KHAN’S OFFICE DOOR was closed when Tyler arrived, so he banged on the frosted glass window, almost breaking the pane. From inside came a muted, “Come in, please.”

  Khan sat behind his cluttered desk, his white shirtsleeves rolled to the elbows, computer printout spread across the surface before him. His expression remained masked when Tyler locked eyes with him.

  “Good morning, Doctor Mathews. May I interest you in some tea? I am just fixing myself a cup.” He nodded at a chipped royal blue mug on the credenza behind him. A heating element plugged into a nearby wall outlet submerged in the water.

  “I want to know why my medical records privileges have been restricted.”

  “Ah yes.” Khan interlaced his fingers on the desktop and straightened his posture, striking the pose of a high school teacher about to address the class. “You see, Doctor Mathews, I am only following protocol.”

  “And what protocol is that?”

  Khan now seemed uncomfortable, “Ah, well, yes …” and broke off eye contact. “For some reason—and I am not told these reasons, Doctor—you are being classified as impaired. The rules regarding access to medical records forbid impaired physicians from accessing all but their own patients.” His eyes dropped to his folded hands. “I am sorry but I am only following orders.”

  “Bullshit. Orders from whom?”

  This time Khan met his stare. “This I can not tell you.”

  “You can’t tell me or your won’t tell me.”

  Khan shrugged. “What difference does this make if in the end you do not find out?”

  Only better judgment restrained Tyler’s reply. Instead, he turned stormed out of the office, slamming the door behind him.

  “GOT A SECOND?” Back in the Neurosurgery Department, Tyler stood at the door to Bill Leung’s office. His partner sat at his desk sorting through a pile of phone messages. Tyler wondered if Bill—or any of his partners for that matter—knew about the drugs in his locker yet.

  “What’s up?”

  Tyler entered Bill’s office. More spacious than his own, more personal touches too—like the green shade bankers lamp and the silver framed picture of his wife, Anita. Made Tyler want a picture of Nancy on his desk, too. The joke, Tyler realized, with Bill married to a Caucasian, if the four of them ever went out to dinner, people would automatically assume Nancy was Bill’s wife.

  “Want your opinion on a case.” He moved to Bill’s desk. “The patient’s name is Torres.” He watched Bill turn to the computer and pull up Med-InDx and log in. Once the chart was on the screen, he went through the case with him.

  Leung drummed his fingers on the desk. “I’m not sure I understand the problem. Looks to me like you handled this situation perfectly. Oh sure, Rowley can be a real butthook when he’s on the defensive, but hey, who isn’t at times?”

  “Thanks. Just wanted to know if you would’ve handled it the same way.”

  His partner scrutinized him a moment. “Sure there isn’t something else to all this?”

  “Naw. Thanks.” Tyler saluted, turned and left.

  BACK IN HIS own office Tyler glanced back up and down the hall he’d just traveled. Satisfied no one was watching, he closed and locked the door—a practice completely foreign to him. Before now, his office door always stood open and unlocked. He sat down at his desk, flipped on the computer. As he waited for the machine to boot his eyes wandered out the window. Across a small alleyway another professional office building loomed. He pushed out of the chair and pulled the cord to close the Venetian blinds. Satisfied no one could observe from the other building, he dropped back down, sucked a deep breath and wiped both palms on his thighs.

  Using Bill’s password, he signed into Med-InDx. Once there, he pulled up the record of Tyrell Washington, the first of three patient names Jill had given him. His fingers froze over the mouse. The admitting physician was Robin Beck. Michelle’s image flashed through his mind along with their conversation in the cafeteria the night of Larry Childs’s admit. This had to be the incident Michelle had mentioned.

  He punched the left mouse button, moving the screen deeper into the record. Washington had been admitted to the Emergency Department last November in coma. Robin Beck made the diagnosis of diabetic coma based on the history in the record. She had treated him with a large dose of insulin and charted the reason as being the suspected diagnosis of ketoacidoses due to lack of insulin. Problem was, the chart now showed that Washington wasn’t diabetic and certainly wasn’t taking insulin. Washington died in cardiac ar
rest only minutes after being treated.

  The telephone rang. Tyler jumped, his heart rate racing. He picked it up.

  Click. Then dial tone.

  The caller ID was already blank by the time he thought to look. A chill snaked down his back. Coincidence or simply a wrong number? Another chill nudged a sense of urgency into his work. He picked up the paper and typed in the second medical record number.

  The next case was just as interesting. Later that same month a second case had been reported to Risk Management. A GI bleeder in the Intensive Care unit had been transfused with mismatched blood resulting in a massive transfusion reaction resulting in fatal cardiac arrest. It took a few mouse clicks to find the nurse of record, Gail Walker.

  How could this possibly happen, he wondered. This is exactly the type of screw-up electronic medical records eliminate. He knew before even checking what the record would show. Sure enough, it appeared that Walker had never scanned the bar coded label on the bag of red cells before hanging it. Clearly Walker’s error. Or at least, that’s how it looked to anyone investigating the complication.

  Tyler paced nervously around the cramped office, his need to move fueled by restlessness and a gnawing anxiety in the pit of his stomach.

  He dropped back into the chair and entered the last of the three names, hit enter.

  This case occurred just last January. A nurse injected a patient in the Cardiac Care Unit with a potent antiarrhythmia medication less than an hour after a prior dose of the same drug had been given. The second nurse, the one responsible for the mishap, swore that the prior injection had not been recorded on the medical record. In fact, upon review of the record, the pharmacy portion clearly showed the drug being prepared and delivered to the CCU twice in less than an hour, a finding directly supporting the nurse’s assertion. The nurse responsible for the first injection also swore she had given and charted the injection—a claim the chart clearly supported.