by Andrew Smyth
‘Don’t listen to him, Greta,’ said Sally. ‘Philip’s always had a chip on his shoulder about anyone who went to a private school.’
‘So would you, if you’d been brought up in an orphanage,’ I replied. ‘The only thing it has in common with your school was that it was residential. Apart from that, it couldn’t have been more different. Your school had bars on the outside to keep people out, mine had them on the inside to keep us in.’
‘You haven’t done too badly out of it,’ Sally said. ‘You did well in the army – first in your year when you passed out, as I remember.’
‘I was always good at passing out,’ I said. ‘And things look so very different when you wake up in the morning.’
‘Facetiousness, like sarcasm, is the lowest form of wit,’ Sally said, rather archly, I thought.
‘You always told me that I was the lowest form of wit.’
‘And I was right. If you hadn’t tried to pretend everything was a joke – even things you really cared about – then perhaps we’d still be married.’ She paused. ‘On second thoughts, perhaps not. We’re too different.’
‘You’re too much of an idealist, tilting at windmills trying to tend to all the world’s ills. After Afghanistan, I’ve had enough of trying to help people I don’t know and who aren’t grateful for it anyway. Someone else can do that now.’
‘I know you better than that. You try not to show it, but underneath you care as much as I do.’
‘If you say so.’ I knew better than to argue with her. ‘But if there are people out there manufacturing counterfeit drugs, the damage they do could be massive.’
‘Deadly. And it’s still happening. It’s difficult to control in the less developed countries but my agency is trying.’
‘I’d certainly never have the patience to be a doctor. I’d feel too helpless much of the time.’
‘At least we’re agreed on that, but you might be able to find out where these drugs came from.’
‘That’s only if you’re still prepared to see it through,’ Greta interjected. ‘I’m still willing to pay for your time.’
Greta and Sally were both looking at me expectantly.
‘I always want to see things through,’ I said.
8
It wasn’t until sometime later that evening that they left. It had done Greta good to be with us and she appeared much more cheerful than when she arrived. Sally finally agreed that I should keep my appointment with Bob Tyler at the hospital so the next morning I was back at Harley Street. I announced myself at reception and remembered the way to Bob’s office upstairs. I knocked and went straight in. Bob was talking to one of his staff and held up his hand. ‘Just a second,’ he said. When he’d finished his conversation, he turned back to me. ‘So what can I do for you now?’ His colleague nodded as he passed me and shut the door behind him.
I fished inside my bag and brought out the two evidence envelopes and put them in front of him. ‘These were found with Greg Satchwell’s other medications.’
‘So?’ he said. Clearly he was forcing me to make the running.
‘Look at them carefully.’
He took the bags and held them up one by one. ‘Can I take them out?’ he asked.
I nodded. They’d been through so many hands that a few more wouldn’t make any difference.
He pulled out the insulin phial and turned it around frowning. He stopped as he saw the edge of the label where it had been partly pulled off. ‘What’s this?’
‘You can see for yourself. The label’s been stuck over another one. It’s out of date.’
He examined it more carefully, and pulled at the edge of the overlapping label until it started to peel off. ‘Is this Greek underneath? It looks like it.’ He put the phial down and took out the Oxaban. ‘What about this one?’
‘It’s got the same supplier’s name as the insulin but it didn’t look as though it was the original label so it’s got to be suspect. We think it might be counterfeit.’
‘We?’ he repeated. ‘And who exactly is “we”?’
‘Greta Satchwell and me. Does it matter who? You can see for yourself.’
‘So what do you want me to do about it?’
I sighed in frustration. He’d already told me he wanted to help and now he was trying to stonewall me. Clearly someone had got to him and warned him off, so I thought I’d give it to him straight. ‘You realise that this could blow your hospital apart if it became known that you were providing counterfeit drugs to patients. Think of the headlines – it wouldn’t only be in this country, either. This would echo around the world, especially in America with all the problems they’ve had with your major competitor. Professor West told me about that. “The largest fraud settlement in history” wasn’t it? Nearly a billion dollars it cost them. Think how much it’ll cost your group if this became public. Treating people with phoney drugs, with no active ingredients – I can see the headlines now.’
‘How do you know they have no active ingredients?’ he asked but I think after my little speech he was stalling for time.
‘Because insulin degrades after a few months.’ I pointed to the packet of phials. ‘That stuff is useless and could have killed your patient. In fact, it’s almost certain that it’s already killed someone, if not Greg Satchwell. There could be dozens of people we don’t know anything about who’ve died because of this.’
Bob Tyler stared at me and then picked up the phone.
‘I wouldn’t do that,’ I continued. ‘Until we find out what’s happened, the fewer people who know about this the better.’
He paused with the phone in his hands. Eventually he nodded. ‘So what do you want me to do?’ he said, replacing the handset.
I think he was beginning to realise how serious things were.
‘The first thing to do is to find out where these came from,’ I said.
‘That shouldn’t be too difficult.’ He pulled his computer keyboard towards him. ‘We keep records of all patient prescriptions.’ After a few moments he pulled out a page as it emerged from his printer and turned back to me. ‘We’ll have to go downstairs to the basement to check the drugs registry. All drugs delivered to us are listed and their origin checked for just such a situation. Counterfeit pharmaceuticals are everybody’s nightmare so we keep strict records of where everything comes from, with batch numbers and sometimes even electronic tags.’
I followed him down the stairs into a basement, past humming radiotherapy suites and into a room harshly lit by neon fluorescents. There wasn’t much doubt how important the people who worked in this office were regarded.
Tyler nodded at the staff as he walked in and a woman came over. ‘Lisa, this is Philip Hennessey. He’s… he’s helping us with a stock problem. Can you find the record for this consignment?’ He handed her the printout.
Lisa went straight to a shelf of lever-arch files and, checking along the row for the correct dates she pulled one out and rifled through it.
‘These are doubled up,’ Bob explained. ‘In addition to the computer prescription, we file a hard copy which is referenced back to the original batch number of the supplier’s delivery to us.’
Lisa wrote down the delivery note number and Bob went over to a nearby computer terminal and keyed in his password. He went through various menus until he found what he was looking for and printed it out. He handed the delivery note to me.
‘Holden Healthcare,’ I said, reading the heading. ‘Do you do much business with them?’
‘I thought it probably was them. They supply most of our pharmaceuticals.’
‘So if we can show that they’re the source of these adulterated drugs, then it could put your hospital in the clear.’
He didn’t say anything for a while, before shaking his head. ‘I don’t think so.’
‘Why not? If you demonstrate that you knew nothing about it and bought them in good faith then how can you be held responsible?’
‘IHG owns Holden Healthcare. They’re in the same group as
this hospital.’
Perhaps I should have known that a hospital chain as big as this wouldn’t pass up the profits to be made wholesaling drugs, but then this wasn’t my field of expertise, although I seemed to be learning fast.
We were back in Bob Tyler’s office and he was looking up the hospital’s records for Holden Healthcare. ‘I’d say, looking at these figures, about eighty percent of the drugs we buy come from Holden,’ he said. ‘The rest come from a variety of sources – most from wholesalers but some even come direct from the manufacturer.’
‘So where do the wholesalers get them from?’
‘It’s a very fragmented market. There are hundreds, probably thousands of companies selling pharmaceuticals and they source their supplies from all over. I think we should go to Holden Healthcare and ask them. They would want to know if this batch has been relabelled.’
‘Not if they did it themselves.’ I said it without thinking. ‘No, forget that. It doesn’t seem very likely that they had anything to do with this, but even so let’s play it safe – we don’t want to alert them that we’re investigating them. I don’t think they’d give us any answers, anyway.’
‘I suppose I could go up there and say that I’m carrying out a routine audit and see where it leads.’
‘If you’re going, then I’m coming with you. I want to see their set-up for myself. Tell them that I’m a consultant and leave it at that. Whereabouts are they, anyway?’
‘They’ve got several depots.’ He picked up the delivery note and read it again. ‘This comes from Northampton. That’s an hour or so up the M1.’
I didn’t bother to tell him I knew where Northampton was. Instead, I reached over and picked up his handset and held it out to him. ‘Call them now. Make an appointment for tomorrow. We can’t afford to hang about.’ Once again he hesitated before taking the telephone. I could almost read what was going through his mind from the expression on his face. But, finally, he must have realised that he had little choice and had to appear to help me if only to delay matters. Perhaps even to bring in his bosses.
‘And if you want to keep your job, I wouldn’t talk to anyone about this,’ I added. ‘From what I’ve seen of your general manager, the first thing he’d do if he heard about this would be to send you on indefinite gardening leave. He’d see you as a danger to him and big corporations like IHG probably have lots of practice in cover-ups.’
Once again, I could see his mind working and finally accepting what I had to say. He dialled an internal number. ‘Lisa? Who’s our contact at Holden Healthcare?’ he asked, and wrote down the name she gave him. He pulled the delivery note towards him and dialled the number and turned on the speakerphone.
I listened as he got put through to the Holden rep who appeared surprised at the apparent urgency of the request. Tyler handled him well and didn’t give anything away or invent any story that might trip us up later. Finally, he hung up, having made the appointment for the following morning.
‘You didn’t say anything about me,’ I said. ‘You didn’t tell them there’d be two of us.’
‘As you said, there was no need. You can come along as long as you don’t say anything and let me do the talking.’
Fat chance, I thought, though I nodded sagely, as though in agreement.
On my way back, I tried to make some sense of what Bob Tyler had told me, but the situation was getting complicated by these interconnecting threads. I’d researched the US hospital group that I’d told Bob Tyler about and it was all there on a website. I couldn’t understand how fraud on such a large scale was even possible, let alone apparently undetectable. From what I’d read, I couldn’t tell whether it had been calculated criminal action that had led the hospital to defraud people, or whether it was simply naivety – just thinking that they wouldn’t get caught. Now, faced with the involvement of another multinational hospital group, I couldn’t tell what I was getting involved in. I could only guess that the stakes were probably high.
Bob Tyler gave me a lift the next morning in his rather elderly but well-maintained BMW which still seemed a source of great pride to him. For a change, there were only two sets of roadworks on our way up the M1 motorway and we reached Northampton in good time. Apart from the remnants of the old shoe companies, it’s a town devoted to warehousing and huge new sheds were being erected right up to the edge of the motorway.
We followed the signs to one of the older industrial estates and pulled up outside an anonymous building surrounded by a high wire fence. On the surface at least their security seemed quite impressive, as our details were noted at the gatehouse and our photographs taken and inserted into security passes before we were allowed to drive across to the reception area.
Instead of the hospital’s normal rep, we were met by Colin Farrow, the sales manager, sharply dressed as befits a salesman. He took us up to a first floor office which overlooked the car park on one side and the warehouse floor on the other, where rows of racking stretched into the distance. I could see that the glass was armour plated with an alarm sensor running around its perimeter. More security.
‘So how can we help you?’ asked Colin after arranging coffee. ‘We were intrigued at the urgency, so perhaps you could tell us why it couldn’t wait.’
‘I discovered that our quality control system hasn’t been followed and we’re required to have regular meetings with our suppliers and this one’s overdue.’
I thought Bob Tyler’s lying was quite smooth. We’d agreed that at this first meeting we would sound them out and not tell them anything about the switched labels.
‘So why is the hospital’s security manager involved?’ Farrow seemed quite on the ball and I wondered if he suspected something was amiss. ‘Why isn’t it Lisa? – Isn’t she the person we normally deal with?’
‘I happened to be free and fancied a drive,’ replied Tyler. I thought that was pushing it – not since it first opened has anyone ever fancied a drive up the M1. ‘Also, since Mr Hennessey was due to be visiting us today, I thought it would be useful for us both to learn a bit about our suppliers and how they operate. Mr Hennessey is a management consultant and I thought it would kill two birds with one stone if he came along and saw the supply chain at first hand.’
‘Yes,’ I said. ‘I’m interested in the way you source your stock – the sort of suppliers you have. Also, the distribution side – how you store the drugs and how the flow of orders works and what happens once you’ve received them.’
Farrow looked at me for a moment before replying. ‘We like to think of ourselves as a one-stop shop.’ He pointed to an information chart on the wall. ‘You can see it here. We’re aiming to be a single point of call where our customers can get the majority of their requirements.’ He turned to Bob. ‘Your own hospitals, for example, take most of their day-to-day requirements from us. There are some more specialised drugs that they get from elsewhere, but we try to be able to provide them with most of what they need.’
‘And what about the ordering process?’ I asked. ‘How does that work?’
‘We’ve taken a leaf out of the automotive industry and linked our computer systems with our key customers,’ he said finally. Even if he thought this was a charade he had clearly decided to go along with it until he could find out what it was really about. ‘It’s like a just-in-time system but perhaps not quite as sophisticated. We’ve installed our programs and databases on the hospitals’ computers and new orders are sent directly online. It’s like any other stock control system except that the storage conditions and shelf life of each drug can be different, so it ensures that when replacements are ordered each batch is well within its use-by date. Most drugs have a long shelf life, but if they don’t it can be critical.’
‘And what happens when you receive the order?’ I asked.
‘The computer matches up all orders received during the day and prints out a picking list – that’s a list that is taken into the warehouse and each item is put into a single delivery.’
‘Can we see how that works?’
Once again, Farrow hesitated fleetingly. ‘I don’t see why not,’ he said, although I couldn’t tell whether his teeth were gritted or not.
‘Fine,’ I said. ‘But can I use your facilities first? It’s the coffee…’ I added lamely.
‘At the end of the corridor on the right,’ said Farrow.
I got up and left the room, shutting the door carefully behind me. I was surprised, given their obvious suspicions, that they didn’t accompany me. Towards the end of the corridor was a staff noticeboard. Checking that I wasn’t being watched, I looked through it quickly, but there seemed to be only the usual announcements, plus the warning of a fire drill at the end of the week. There didn’t seem much of importance but I took out my phone and photographed it just the same. You never know.
When I returned, Colin took us downstairs and punched a code into the combination lock and led us into the warehouse. ‘It’s carefully temperature-controlled,’ he said, turning back to us. ‘Exactly fifteen degrees, night and day.’ He pointed towards an enclosure with what looked like a huge fridge door. ‘Over there we keep the pharmaceuticals that need to be refrigerated. They have a different stocking policy to the rest.’
‘You mean like Father Christmas?’ I said, immediately aware that it wasn’t one of my best.
Colin Farrow ignored me and led us past the racking through to a separate, partitioned-off part of the factory. He took us into a small office. ‘You have to put on protective covering before going in here,’ he said, handing us plastic bonnets, gloves and overalls. ‘It’s to protect the stock, not you.’
Attired a bit like Grayson Perry, we emerged into a huge space where several large machines were lined up, their compressed air lines hissing and sucking as the packaging capsules were fed into them like a belt of machine-gun cartridges.
‘This is our re-batching area,’ Farrow had to raise his voice above the noise. ‘Over there you can see the consignments that we’ve brought in. Normally they’re loose but sometimes they’re already packaged so we have to strip out the packaging to relabel them.’
