by A. Turk
Laura checked the patient’s drips and temperature. Mrs. Malone was getting a high dose of antibiotics and morphine, and the thermometer read 104.8. Sweating profusely, she was literally lying in a puddle of sweat.
“Help me, I’m burning up. I want my doctor. I need Dr. Herman, please,” the patient whispered weakly.
Laura left the room and went directly to the nurses’ station. Carole Black, RN, had returned to her post while Laura was with Mrs. Malone.
Wasting no time with pleasantries, Laura asked, “Where were you?”
Nurse Black looked annoyed. “Ladies’ room. When nature calls, it must be answered.”
Laura accepted the response but pushed forward. “What’s the story on Rosie Malone?”
“Miss Rosie has been a regular around here. She was admitted in February 1990 for a heart attack. We almost lost her then. This is her third hospitalization since that time. Last week Dr. Herman diagnosed her with gallstones after she presented with abdominal pain. This was all confirmed by an ultrasound at Dr. Herman’s office. On the 31st, Dr. English performed a laser procedure removing her gallbladder, but it appears he nicked something. Her white count is off the chart. I was about to retake her temp.”
“Don’t bother. I just took it—104.8. The gentamicin isn’t working. We should try vancomycin or maybe alternate gentamicin and vancomycin. This patient is septic, and without a change in course, she’ll die. You need to call Dr. Herman and get him here immediately. His patient is deteriorating quickly.”
Without another word, Laura returned to room 303. Mrs. Malone had both cardiac and pulmonary history and needed to be referred to a cardiologist and a pulmonologist. She also needed an infectious disease specialist to address her septicemia. However, none of those specialists was on the hospital staff. Rosie Malone needed to be transferred to Nashville where she could get the care from the subspecialists she required.
Without warning, a hand was placed on Laura’s shoulder, and she was spun around. She was face-to-face with Dr. Herman, who did not look at all happy.
“What the hell are you doing to my patient? Everything is under control.”
Herman’s antagonistic demeanor took her by surprise, but Laura immediately explained the situation: “I heard this patient calling for help, and there was no one at the nurses’ station. Her temperature is over 104. It needs to be addressed, and at the very least, she needs her bedding changed. Despite the high dose of morphine, she’s still in pain. It appears she’s septic, and her systems are in distress—”
Herman cut her off. “Look, Doctor, this is not your concern. She’s my patient. Thank you for your interest, but this is a complex case, and I don’t need you second-guessing Dr. English and me. Now get out of my way so I can treat my patient.”
She was astonished by Herman’s words and attitude. One of her responsibilities as the physician on call was to check on all patients in the critical care unit and to provide treatment as needed. It was not unusual for the on-call physician to write orders for other doctors’ patients.
“Doctor, I was just trying to care for your patient. She was in obvious distress and needed treatment.”
“Well, I’m here now, so move on. I will not be second-guessed by a DO.”
Laura realized she was getting nowhere with Herman. Whether it was the fact she was a woman or a doctor of osteopathic medicine, she couldn’t be sure. All she knew is that he never liked her, and he certainly didn’t respect her. She wondered if her sexual orientation created resentment as well or just made Herman feel threatened. She left the doctor with his patient and continued her rounds.
An hour later, she returned to the CCU. Nurse Black was seated at her desk, but Dr. Herman was nowhere in sight. Laura was somewhat concerned that Nurse Black would report patient follow-up to Herman. Nevertheless, she grabbed the Malone chart and walked into an empty room to read it undisturbed.
A more careful review of the surgical report confirmed what she and Nurse Black suspected. Dr. English had nicked the patient’s bowel three days earlier during a laparoscopic gall-bladder surgery. Two days post-op, Mrs. Malone’s fever spiked and continued to rise. Twelve minutes prior to Laura’s return, Dr. Herman had taken the patient’s temperature, and it was up to 105.1. Herman’s physician note and order were illegible, but Laura made an educated guess about his intended course of treatment.
He increased her antibiotic dosage and her morphine, read Laura. But this patient is at serious risk of cardiac arrest and is in severe pulmonary distress. Although the morphine was helping to manage the pain, it was also shutting down the patient’s systems. To receive the necessary standard of care, Mrs. Malone should be transferred to either Vanderbilt Hospital or Saint Thomas Hospital in Nashville where specialists can treat her. What is Dr. Herman thinking? This patient will die if she remains at Plainview.
Laura suddenly understood the real reason Mrs. Malone was not going anywhere: those bastards were trying to cover up their mistakes. By keeping Mrs. Malone at Plainview, Drs. Herman and English would be able to control and maintain the medical records, thus concealing their breach of the standard of care. Those assholes! She almost yelled out loud.
Laura felt ethically obligated to advocate for the transfer of Mrs. Malone, even though she was not the treating physician. She couldn’t just let a human being die, nor could she let Herman get away with his deception.
She approached Nurse Black, who was checking the monitor of the patient in room 301. “Carole, I just looked in on Mrs. Malone in room 303. When are you scheduled to take her vitals again?”
“Dr. Herman ordered that they be taken every half hour, and if there is any deterioration of her condition, I’m to call him at his home. He’s very concerned about her.”
Laura decided to continue monitoring the situation. An hour and a half later she returned to the CCU and checked in with Nurse Black. Mrs. Malone’s temp was at a constant 104.8, and her vitals were about the same. At least the temp had gone down slightly.
She went back to the critical care unit at 6:00 a.m. The patient’s temp, taken just minutes before, was still 104.8. Laura decided to report Mrs. Malone’s condition to Woody Douglas, the hospital administrator.
At 7:10, Laura walked into Douglas’s office and asked his secretary if she could see him immediately. Douglas’s secretary knocked and led Laura into his private office.
Woody Douglas was seen as a hero, taking Plainview Community Hospital from red to black under his leadership. This turnaround was quite an achievement. It had been difficult for Douglas to recruit doctors after the bankruptcy four years earlier, so the thirty-seven-year-old had definitely earned the huge golden trophy, prominently displayed on the corner of his desk, from an appreciative board.
“Hello, Dr. Patel. What can I do for you?” Douglas asked.
“Woody, we’ve got a serious situation in critical care. Rosie Malone has a temperature of almost 105, and there’s no indication that it’s going anywhere but up. She’s septic and needs an infectious disease specialist. In addition, she has a cardiac and pulmonary history. She needs to be transferred to Nashville.”
“Since you’re here and reporting these concerns, I assume she’s not your patient.” Sitting back in his chair, he folded his hands on the giant desk. “Whose patient is she?”
“She’s Dr. Herman’s and Dr. English’s patient.”
“Have you discussed your concerns with either of them?”
“I tried to talk to Dr. Herman last night, but he abruptly told me to mind my own business.”
“I suggest you let the treating physician handle the care.”
“Woody, this patient is going to die if she’s not transferred to Nashville. You’ve got to intervene,” Laura insisted.
Douglas quickly responded, “I’m not a physician. I can’t second-guess two members of our medical staff. You did what you could. You expressed your opinion to Herman, but he’s the one who has to make the final medical call. It’s hospital policy.�
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“Then I want to make a formal complaint.”
“That’s your prerogative, but it’s against my advice. A formal complaint will go to committee at the next scheduled meeting. What will that accomplish, considering that it’s two weeks from now? If she dies, you can file an incident report with the Morbidity Committee.”
What a cold-hearted jerk! Laura seethed.
“It will be a little late, Woody. Mrs. Malone will be dead and buried by then. Is Dr. Kelly here? I want to bring this to his attention. Dr. Kelly, as the medical director of the hospital, can call an emergency meeting of the Executive Medical Committee. I have no alternative if you’re going to sit on your hands and let this patient die.”
“Dr. Kelly is on vacation out of town and won’t be back until Thursday. You can take it up with him then.”
“Rosie Malone will be dead by Thursday.”
“Then Dr. Kelly won’t need to call an emergency meeting, and the transfer of Mrs. Malone will be a moot point.”
“I’ll bring my formal complaint to you by tomorrow morning.”
Laura was off all day Monday and could think of nothing but Mrs. Malone. She called the CCU nurses’ station twice, learning that the poor woman’s temperature was 105.1. Laura sat at her desk in her office and prepared the formal complaint against Drs. Herman and English for failing to transfer Rosie Malone to a better-equipped hospital. She kept her report simple, never questioning the surgery or its incompetent execution. She focused on the problem she could solve: getting the patient transferred. When she finished and reviewed it twice, she let Maggie read it. Both anticipated a huge backlash from the complaint.
First thing Tuesday morning Laura dropped off her formal complaint in Douglas’s office. She planned on visiting Mrs. Malone in the CCU but made a quick U-turn when she saw Dr. Herman at the bedside. At 10:30 a.m. Laura returned to the CCU; the coast was clear. She went to the nurses’ station and questioned the nurse on duty.
“How’s Miss Rosie doing?”
“Not good at all. Her systems are shutting down.”
Laura could barely keep from yelling. “Why in the world hasn’t she been transferred to Vanderbilt or Saint Thomas?”
The nurse shook her head. “That’s a question for Dr. Herman. He’s calling the shots.”
Laura looked in on the patient, now comatose. The more she thought about what was happening, the more pissed she got. Rosie Malone was about to die, and good medicine easily could have prevented her death. The system failed Rosie Malone. The system needed to be fixed.
The next evening, Laura learned that Rosie Malone, at the insistence of her daughter, Lorraine Burke, had finally been transferred to Saint Thomas by ambulance and had died on the table during emergency surgery. The Saint Thomas surgeon could not have done anything to save her at that point.
Dr. Lars Herman signed the death certificate on February 6th. He listed the cause of death as “cardiac arrest.”
Laura wondered how many other patients would meet the same unhappy ending within the walls of Plainview.
CHAPTER THREE
VALENTINE’S DAY
FRIDAY, FEBRUARY 14, 1992
Dr. Herman pulled into his office parking lot just before 7:00 a.m. He loved everything German; he drove a German car and even looked Aryan. He had cropped blond hair and blue eyes. His skin was a pasty white. He was stockier and shorter than one would expect, at five feet seven inches, for a self-appointed German superman.
Getting out of the car, he removed a wrapped box from the backseat. When he entered the office reception area, three patients were already waiting. He smiled and said good morning to his first scheduled patient, Mrs. O’Malley. His receptionist, Sheila, was behind her desk drinking her second cup of coffee. Herman nodded to the other patients as Sheila gave him his morning charts.
He accepted the charts and handed Sheila the heart-shaped box of chocolates he had concealed behind his back. He then pulled a white envelope from his pocket and placed it on her desk.
In a deep voice that had a hint of a South American accent, he said, “Happy Valentine’s Day, my dear. Thank you for all your good work. Please take your husband out to dinner, on me.”
Sheila tore open the envelope to reveal a gift card from Ruby Tuesday. She thanked him for the thoughtful gift and tucked the card in her purse before she ripped into the box of chocolates. Sheila was a large woman, weighing more than two hundred pounds. Herman doubted she would share the chocolates with waiting patients, let alone have leftovers to take home.
Herman grabbed a cup of coffee and entered his private office. He sat behind his mahogany desk and stared at the photos of his mother and his wife, Alice, before he got to work. He studied his appointment calendar and smiled. This would be a very busy and profitable day.
Sheila knocked on the door and waited for a response before leading Patricia O’Malley into the office. Dr. Herman oozed charm and confidence as his patient took a seat.
He reached into the glass candy canister on his desk, pulled out a pink heart candy with “Be Mine” written in faded red letters, and placed it in Mrs. O’Malley’s palm.
Mrs. O’Malley chuckled nervously but kept her eyes glued on the manila folder sitting on the desk. Herman’s lame attempt at humor had only marginally broken the ice.
“I have gone over your ultrasound results, and I’m afraid I have bad news.”
He moved from behind his desk and pulled a chair next to hers. He put his arm around her shoulder and held her ultrasound film up to the light.
“Can you see those dark spots?”
Mrs. O’Malley nodded her head as tears formed in the corners of her eyes. Her body began to shake under his arm.
“Those dark shadows are gallstones. I’m afraid your gall-bladder is diseased and has produced these calcified foreign bodies. These objects in your abdomen are the culprits of your pain and indigestion. We’re lucky we caught this in time. Left untreated, these could cause serious damage. One of these gallstones could get caught in your bile duct and your gallbladder could rupture. If we don’t intervene now, it could lead to a life-threatening situation. I recommend the immediate removal of the gallstones and your gallbladder.”
She wiped her eyes, and he could see the fear on her face.
“Am I going to die, Doctor? How can I live without my gallbladder? I thought my indigestion was getting better when I started drinking the pink stuff after every meal. The nerve medicine you gave me also seemed to help.”
He patted her hand reassuringly. “Don’t worry, Mrs. O’Malley. The gallbladder assists in digestion, but you can live a long and productive life without it. The Valium I prescribed will relax you, but that medicine can’t cure your gallstones. That will require surgery.”
“How much is this going to cost, Doctor? The county doesn’t pay me much to drive a school bus.”
“That’s not a problem, dear. Your insurance company will pay for everything except your deductible. Sheila checked, and since it’s still early in the year, you have $350 left of your $500 deductible. I’ll waive that portion of my fee as a courtesy to you.”
“Thank you, Doctor. That’s very generous. Bless you.”
“Here’s a renewal prescription for your Valium. Remember, I only want you taking them after work. The label specifically warns you not to take them and operate heavy equipment. We don’t want you taking them and driving your school bus. You need to be alert, not relaxed, when you’re driving those kids around.”
She let out a deep breath and gave Dr. Herman a hug. She was glad he renewed her nerve medicine. It made her feel so much better.
“Will the surgery hurt? You know I don’t tolerate pain real good.”
“You won’t feel a thing. After the surgery, I’ll prescribe a powerful pain medicine that will keep you comfortable.”
He knew Mrs. O’Malley was sold. She would follow his advice unquestionably.
“I took the liberty of scheduling an appointment for you with Dr. Ch
arles English. He’s the general surgeon upstairs and will confirm my diagnosis that surgery is your best option. Please take your ultrasound upstairs to him for review.”
“I don’t want another doctor. Why can’t you perform the surgery?”
“I’m not a general surgeon. But I’ll be there to oversee your recovery at the hospital. Don’t worry. Dr. English is an excellent surgeon. I send all my patients to him.”
“Can this wait until summer? I can’t afford to miss much work.”
“I wouldn’t recommend that. However, you won’t be off your feet very long. Dr. English is the only doctor in Plains County who can perform the surgery laparoscopically. Any other doctor would need to make an eight-inch incision across your belly to remove the gallbladder. Under those circumstances, you would be out of work for two, almost three, weeks. Dr. English will make only two small holes, each about the size of a dime. In one hole, he will insert a small camera, which will let him see inside you. In the other hole, he’ll use a tiny laser to blast the stones and gallbladder into small pieces that your body will then absorb. With Dr. English’s method, you’ll be in the hospital one day, and you’ll be back to work within three.”
She was obviously relieved. Three weeks off work was more than she could financially handle. She thanked him and went upstairs to see Dr. English.
Herman owned the office building in which he practiced. He purchased the three-story building in 1990, when he first arrived in Plainview. Unlike most doctors, he was an exceptional businessman, capitalizing on all possible revenue sources. He knew it was smarter to own rather than to lease. His modest $20,000 down payment more than paid for itself. He borrowed the balance from the local bank, and the hospital guaranteed the loan. Herman was proud of the sharp deal he brokered.
His office occupied the first floor and operated virtually rent-free. His mortgage payment was covered by the rent generated from his tenants, Dr. Charles English, the general surgeon on the second floor, and an OB-GYN on the third floor. The hospital cosigned for those two doctors’ lease payments, minimizing Herman’s risk.
