He took a few bites of food and chewed for a while before answering. "The hospital, of course, and the shareholders. There's also a bonus plan for the hospital administrators for reaching certain revenue goals. Some of the doctors could benefit. Most doctors use the hospital facilities, but charge separately for their work. Of course some doctors, like those in ER or those handling general hospital calls, are on salary. Those on salary could order extra tests all day long, and it wouldn't fatten their personal paychecks. But the hospital benefits."
"Are you a shareholder?" I dared.
"Me? As a board member, it's part of the compensation."
"Do the other employees get stock options?"
"Sure, the doctors certainly do."
Similar to a computer company, it was mostly the managers and executives who got the perks. "So any or all of them could benefit from profits in some way or another." I was surprised to look down and see that my fish was already gone. "This was really a delicious meal."
"I'm glad you liked it." Amy lowered her eyes guiltily, and it wasn't until she pulled her hand back up from under the table that I realized she had been giving the dogs a taste. I smiled. Her eyes darted to her husband. He hadn't missed it either.
He tousled her hair as he pushed back from the table. "Let's go into the living room, and you can ask more questions there. Is that dessert I see?"
"Sedona brought it," Amy said. "Not," she emphasized to her husband, "that we need it. You two run along. I'll bring the cake out. Would you like coffee or tea?"
"Tea would be excellent." Talk about service. I wondered if they would consider adopting me.
On the way through the kitchen, I snagged the medical records and handed them to Dr. Dan. "Here are a few examples of the things we've noticed. It could be nothing at all, mind you, but these three patients have similar charges. They all happen to be…" I stopped myself before saying old. Dr. Dan was retired and age references would be putting my foot in it. "Well, they might not always pay a lot of attention to the billing."
He laughed softly and looked over the bills. "Hmm. Looks to me like a typical exam for checking the colon. The barium enema," he pointed to a line on the medical record, "is a dead giveaway on this one." He frowned over it for a while. "But the results are missing."
"What results?" I asked.
"The medical record doesn't say whether or not the BE found anything. Something must have been abnormal because the patient stayed overnight." He looked at the billing date and shook his head. "I would expect more doctor notes and an x-ray report. Polyps must have been found because there are also charges related to a colonoscopy. If there was a tumor or large mass, surgery would be warranted, but I can't determine what was found."
He looked at the other two bills and then went back to the first. "The patient may have been told no solids before the barium enema. Because of that, some patients don’t drink enough and get dehydrated. That could be the reason for the fluids, but why an overnight stay unless the patient was kept for another reason? Maybe there was a surgery done." He handed me back the bill. "Is this the last page of the medical records or just the dates that match this billing?"
Since Radar had packaged the stuff, I didn't know. "There might be more. I'm not sure."
He moved to the next patient record. "This looks like a test for ulcers or other stomach problem. Barium swallow, x-rays and fluids." He flipped to the medical record sheet and frowned. "These are some pretty ambiguous notes. They look almost like the colon work. The doctor's name is also missing."
"Uh, that might be because all the names were deleted to protect privacy. I can get the names if you need them."
He raised his eyebrows. "I see."
He didn't ask how, so I didn't offer. He moved his focus back to the third bill. "These three bills are remarkably similar, but more so because the results are missing than the fact that the tests ordered are the same. Is this the whole file?"
"I'll double-check, but I think so." Missing notes were circumstantial evidence; the doctors could be lazy.
Dr. Dan sat back. "There are several procedures that might look similar from a billing standpoint. There are multiple billing codes here, but no detailed explanations or findings. If a patient came for a colon cancer screening, these don't look quite as I would expect. I suppose if you compare all three there might be a pattern." He looked up at me. "An ulcer check was the procedure added to my sister-in-law's bill. Do you think this one," he held up the last bill, "is an add-on also?"
"Possibly." I didn't want to tell him that the cause of suspicion was that Brenda believed the patients hadn't been in at all. It could be a billing mistake. Someone could have accidentally entered the admittance code for what should have been an outpatient x-ray. But that was the whole point. If there were lots of "mistakes" of this type, it implied more than incompetence.
Dr. Dan tapped the sheet he held. "In a hospital this size, I'm not sure three similar bills are indicative of a problem. Four, if you add my sister-in-law."
Dr. Dan's wife chose that moment to bring in generous servings of cake. It was a good distraction although Dr. Dan kept staring at the files as we all dug in with enthusiasm.
While I ate, I thought long and hard about how Huntington treated me. Dr. Dan was the one who had hired Huntington, so Huntington should be the one explaining things, but he rarely bothered. Reluctantly I said, "We're not sure the patients were actually in the hospital on those dates. Therefore we don't know that they received any of the services listed."
He paused mid-swallow and looked up. "Ah."
"We'll have to catch it in progress of course, but in the meantime…look, I have to protect the people helping me on this. Faulty memory could be playing a part here too." Brenda could be credible and competent on the witness stand once she wasn't pregnant and dressed up in various costumes, but it would be a lot better to find proof that didn’t require her testimony.
He waved me silent. "I understand. That's precisely why I hired Steve. The last thing I can afford is to have government officials subpoenaing records and causing all kinds of trouble."
"At this point, everything is a bit confused. We need more than a patient or two making claims. On a witness stand, at least two of these people would look…frail."
He corrected me. "Old and muddled."
"Muddled," I agreed, still afraid to bring age into it.
He laughed. "They'd look pretty old too, trust me."
"Okay, okay." I had to laugh myself.
I finished my cake, and as I stood up to go, Rabbit barreled out from under the Christmas tree. She grabbed my pant leg with her little teeth. Her growl was almost as threatening as a mosquito. Amy was just coming back from the kitchen with the fish recipe on an index card. She scolded right away, but I held up my hand. "It's okay. My parents have dogs."
I crossed my arms and looked down at Rabbit. "Ahem." I pushed my leg in the direction she was pulling. She growled and pulled some more. I didn't bother to try and get away from her. "Listen, you little squirt, you let go of my pants or I will dangle you over the garbage disposal by your tail."
Growl…growl…Her little eyes checked mine. She tilted her head to study me better, my pants still captive. Then, with a little yap, she let go. She barked a few more times, but in a friendly way.
"A likely story." I patted her on the head after carefully letting her sniff my hand so that she knew we weren't playing some kind of "kill the hand that pets you" game.
"Thanks for the info." I shook Dr. Dan's hand solemnly. "I might have some more questions."
"Call anytime. Come on over. Bring cake."
"Oh," his wife gasped. "Let me have you take some of that back with you!" She scurried off to the kitchen, the two yappers on her heels.
I looked at the good doctor. We understood each other. I was gone before she made it back to the living room.
By the time I got home, barely twenty minutes later, there was a message on my answering machine from Dr. Da
n. He asked me to call him back so I complied. "Hello, Dr. Dan? I mean, Dr. Hernandez?"
"Dr. Dan is fine. I was thinking about those medical records you showed me. It occurs to me that unlike the bill for my sister-in-law there is a way to check and see if work was actually done for these patients. It ought to confirm whether or not the patients were in on those dates."
"How?"
"In the case of my sister-in-law, we already know the work wasn't done, but for these others, if work was done, there should be x-rays in the patient files."
My brain churned. "You're suggesting that if I were to obtain the hard copy of the patient files, I could verify if x-rays exist for that date?"
He sounded troubled when he answered. "I'm not suggesting anything. I don't even want to know how you check." He paused then and took a deep breath. "Well, that isn't really fair is it?"
"Don't worry about it." If Dr. Dan had wanted to be involved, he wouldn't have hired Huntington.
"This is very difficult for me," he said. "I have the utmost respect for those who have chosen this profession. It's harder than ever with the cost of medical school, the hours away from your family and the sacrifices. I can't tell you how many patients think we're raking in the cash while they are in pain, and sometimes, despite all our training, we can't even help. To think that someone is giving us all a black eye--it's just wrong."
"Every profession has its bad apples," I said. "The computer industry has the same troubles. Just because there are a couple of lousy engineers who don't care about their design doesn't mean there aren't an awful lot of professionals who take pride in their work."
There was silence and then a grunt. "Nobody’s life is at risk if your computer doesn't boot, is it?"
Messing with a person’s health and their health records was a lot more serious than poorly written software. "Well, no. But don't worry. I'll look for the x-rays."
After I got off the phone, I thought about the problem. As a volunteer, I was allowed down in records. The storage room was located in the basement near where Radar worked, but it was kept locked. Unless I was sent down there to retrieve old records, how could I obtain a key?
Of course, I knew someone with the ability to get in. And this was exactly the sort of task he was good at too.
Chapter 11
Monday morning, as soon as breakfast trays were distributed, I buzzed by the nurses' station and told Crissa I planned to spend the rest of the day in x-ray.
"Did you schedule it officially?" she asked.
"No, not yet. I'm not sure about working down there. Tell Attila I had a special request for help so I went." I wasn't sure how long it would take me to find out what I needed to know.
Crissa didn't look convinced. "She doesn't even like the fact that I work two of my shifts down in ER. I don't think she’ll buy a "special request" excuse."
"Okay, just tell her I went down to x-ray if she asks. If the work goes well, I'll ask the volunteer coordinator to schedule some permanent time down there." It probably wouldn't go that far. If I couldn't get the key to the storage room today, I'd call in someone with special skills.
"Okay," she agreed reluctantly.
Despite the disapproval, I went looking for Holly. She was sitting at the desk, sorting some x-rays.
"Hello," I called out. "I came over to see if you can use a volunteer for a few hours. I'm Sedona from upstairs." I pointed to my volunteer apron in case she had forgotten me and mistook me for a nut off the street.
She turned, the x-ray light above the desk creating a halo behind her head--and making it obvious from dark roots that blond was not her natural hair color. With her fair skin, I never would have guessed. "Hi! Yeah, I remember you, the code brown. Those x-rays turned out well since she was all cleaned out."
My smile slipped a bit. In my opinion, people here threw bodily functions around a little too casually.
"You really want to learn this stuff?" She flicked off the lights on the x-ray tray.
"I do, but if you don't need me right now now I can come back."
"Are you kidding me? The only reason I ever leave on time is because I run out of approved overtime hours. They'd rather pay a tech a couple of times a month to help me catch up because it's cheaper. Having a volunteer would be perfect. I worked two extra hours yesterday, so I'm scheduled to leave here early and go to The Pavilion."
"They have x-ray machines over at The Pavilion?"
"Yup, and it pays better. There are four or five doctors over there. It's easier for them to take x-rays there rather than schedule patients to come over here. I moonlight over there a lot. All the doctors order x-rays for one reason or another, plus Dr. Staple runs his sports practice from there."
"I thought Dr. Staple was a surgeon?"
"He is. But his private practice is sports medicine. A lot of doctors start out with a hospital career, but if they want more control over pay and hours they have an outside office. He can't do big surgeries privately unless he went into cosmetic surgery and that means a lot of expensive equipment and time."
"Oh, I didn't know that."
Turning to business, she asked, "Have you done this before?"
"No."
"Then let me show you how to load the x-ray cassettes. I'll teach you to develop later."
We went in the dark room where she walked me through loading fresh film into the protective metal cassettes. "This drawer is full of the unexposed film. Never open the drawer until after the lights are off and the red light is on. Otherwise you'll expose this entire drawer full of film, and that would be extremely expensive." She opened the long metal drawer. "The larger films are in the front. Each size is separated by metal dividers."
"They all look the same." The films were lined up along the top, nice and even.
She lifted a section out. "See the metal dividers? As you go backwards in the drawer, the shorter films are pushed up by these little metal supports. That keeps us from smashing the taller film when we try to get our hands in there for the smaller films."
She pulled out a couple of different sizes. "It'll take you a while to memorize which size is where, but just remember they get smaller as you go to the back of the drawer." She demonstrated how to put the thin sheets of x-ray film into the cassettes. "Once it's loaded and ready to go, put it in this pass box."
I recalled seeing matching doors on the outside wall.
She pointed. "This other pass box is where I put the cassettes once I've done the x-ray. You pull them out and develop the films."
There was a knock on the door. She looked at her watch. "Show time! Nothing like a live example, huh?"
Out we went. A skier from ER with either a bad sprain or a broken ankle awaited. "Good," she whispered. "This will be an easy one."
She entered his name, the doctor's request and other information into her computer. Since she had already loaded a cassette with fresh film, she pulled it out of the pass box and loaded it into the x-ray machine. I helped position the patient, a young guy who was very stoic.
Holly took the x-ray and then put the cassette in the second pass box. "Okay, let's develop it."
Inside, she turned on the red light, retrieved the cassette and demonstrated. "I'll provide this card for each patient." She held up an index file card. "This flashcard has the patient information on it. You stamp the film before you develop."
It was hard to follow everything she was doing because she moved fast. She put the flashcard in a little slot and then put the cassette in another slot and pressed a button. "There's a little door that opens and exposes the flashcard information right onto the x-ray."
She pulled the cassette out. "Once you've labeled the x-ray, you process it." She slid the film into the machine for processing. "That's it!"
"What if I forget something?" It seemed likely.
"If you forget to put the patient info on there we can always label it with a sticker. Sometimes when it gets really busy, I forget to take the old flashcard out and end up flashing th
e new patient with the previous patient's information, but when that happens I just cover it up with a sticker that has the right information."
"So every x-ray is marked with the patient data?"
"Yup."
Dr. Dan was right. If I could find the x-rays, they would have the patient name and date right on them. The only question was, did the x-rays exist?
Holly pulled the films out and kicked the drawer that contained the fresh film. "Be very sure the drawer with the unexposed film is closed before you turn on the light."
I nodded dutifully and asked,"Did the x-ray turn out?"
She walked out into the regular room and held it up. "Yup, it's a good one. Sometimes we have to do them again, but with a guy like that it's an easy shot. It's the crabby old cigarette smokers who are usually the problem. You tell them to hold their breath, and they can't do it because they take a big gasp of air and start coughing."
I thought of good old Mrs. O.
"So what do you do with the shots now?"
"They go to the radiologist first, and then the doctor will look at them. Since there is no splintering of the bones, the ER doctor will cast the leg. The x-rays are necessary to find out if it's broken and whether it's a clean break or broken badly enough to require surgery."
Naturally, Holly had assumed I was interested in the patient rather than the x-ray. I went after the information I really needed. "When everything is all done, does the x-ray come back here? Where in the world do you keep them all?"
She waved a hand. "Not in this tiny space, that's for sure. He's not even from this area, so it will go straight down to records in the basement. If he asks for a copy later, we’ll have to go get them and make him one for his local doctor." She pointed to a section of moving shelves. "Local x-rays stay up here about three months or whenever the shelves get too crowded. Then they go downstairs too." She laughed. "Don't worry. I won't make you go down there. The place is dusty as hell and filing these things is a pain in the ass. We usually hire a temp worker to come in and file them periodically."
"Oh." I had been about to volunteer myself even though filing paperwork was foreign to my nature. Maybe I could filch the key. It had to be around here somewhere.
Executive Sick Days Page 8
