Inside the apartment, a faint smell of chicken nuggets mingled with an air freshener’s floral scent. A dark-haired boy dressed in pajamas looked up from playing with a car on the thin gold carpet. He assessed the strangers warily.
“This is Ryan,” Carla said. “He’s my live-wire four-year-old recovering from strep throat. As you can see”—she waved a hand around the room—“he’s feeling better. Mandy, my six-year-old, hasn’t come home from school yet.”
“Hi, Ryan.” Kate waved to the youngster.
“Hey, buddy,” Paul added with a smile. “What have you got there?”
The child held up the bright red vehicle with black racing stripes down the sides. “It’s a sports car. Vrooom!” He swooped the vehicle through the air.
Paul leaned over and planted his hands on his knees. “I used to have one of those. A real one. Only mine was green.”
“For sure?” A grin erased the caution from the boy’s face.
In the next second, the pastor was cross-legged on the floor, checking out the car and the rest of the fleet around the child’s knees. Kate laughed, joined by Carla.
The young woman flapped her arms against her sides. “I guess that takes care of what to do with Ryan while we talk.” She nodded toward Kate. “We can go in the kitchen.”
“Is that all right, honey?” Kate asked Paul.
Her husband barely afforded her a glance. “Can’t you see we men are busy?”
“Busy,” Ryan echoed and buzzed a vehicle across the carpet.
“I guess we’re dismissed,” Kate said and followed Carla around a corner into a compact kitchen that barely held the basics for cooking and storage plus a small oval table, where several unwashed dishes sat.
Carla motioned her to a seat and took one herself. “How is Mrs. Kraemer?”
Kate smiled. Big points for Nurse Trexler that her first concern was the patient, not her own predicament. “She’s out of the woods as far as the initial allergic reaction is concerned, but she’s having a few problems with her heart arrhythmia. My husband visited her today, and unfortunately, she’s developed shingles from one of the meds they’re using to treat her heart.”
Carla let out a sigh. “I’m so sorry to hear that.” Her gaze narrowed on Kate. “You said you were friends with someone involved. Who is that?”
Kate set her handbag on the floor beside her chair. “As I mentioned, we’re from Copper Mill. Shirley Kraemer’s daughter is married to our town mayor.”
“You tricked me.” The young woman sprang up and glared down at her. “They want me to lose my nursing license, and you’re here to spy for them.”
Kate kept her seat and touched Carla’s balled hand. “Lucy Mae and Lawton are good people. They only want the truth. But right now, all they know is what others have told them—that you negligently administered a medication her mother is allergic to. Can you tell me anything that would prove otherwise?”
Carla shook her head, the twin curtains of her straight hair swinging back and forth. “It’s just my word that the prescription for Vicodin was in the chart, but you’ve got to believe I’d never administer anything without being sure it was listed in the orders.”
“I do want to believe you, Carla. Truly.” The young nurse spoke sensibly and had already demonstrated compassion for Mrs. Kraemer. Kate had enough questions about what had happened to give Carla’s guilt a margin of doubt.
“Then you might be the only one.” The young woman’s shoulders drooped. “Everyone seems ready to write me off.”
Kate patted the cheap vinyl-covered seat of the kitchen chair. “Why don’t you sit and tell me what happened?”
Carla eased down, eyeing Kate as if this unexpected supporter could disappear at any moment. “We-e-ell, it’s a pretty straightforward story. Mrs. Kraemer was complaining of pain from her hip, so I checked the chart to see what she was supposed to have for postsurgical discomfort. The medication order for Vicodin was front and center. I double- and triple-checked the dosage and then got the pills out of the locked TMA cart.”
“TMA cart?”
“Stands for Trained Medication Aide. TMAs go around with the cart and distribute routine medications to the residents.”
“Do all aides have access to the medications?”
“Oh no.” Carla waved a hand. “TMAs have to take special training before they can even touch the key to the cart.”
Kate leaned forward with one elbow on the table. “What about the resident charts? Who can look at those?”
“Nurses, of course. But any aide can ask for information from the record, and they have forms to fill out for updates on resident status or services they’ve provided. Those are placed in the chart by the nurses. We try to document everything.”
Kate studied the tabletop. There was only one nurse she’d seen handling a chart. But who was the mystery person who had gotten the chart out in the first place? She was no nurse.
“Is anyone besides licensed staff authorized to access resident records?”
Carla canted her head and nodded. “Health Information Management personnel do certain things with the records, depending on their job duties.”
“Health Information Management? Do you mean medical records?”
The young woman chuckled. “Bingo. Euphemisms abound in health care like any other field. The department that was simply medical records is now HIM—Health Information Management.”
Kate decided not to give Carla a description of the thin woman and ask who she might be. She didn’t want to spotlight anyone for suspicion in the young nurse’s mind at this point—or single anyone out as a scapegoat if Carla was making her story up. She’d find some other way to discover who worked in the HIM department at Orchard Hill.
“Okay,” she said. “Where were we on the sequence of events when Mrs. Kraemer had her reaction?...Oh yes. So you checked the dosage and got the pills. Then what did you do?”
Carla tucked a strand of her sleek hair behind an ear. “I went to Mrs. Kraemer’s apartment. The woman was in her recliner, groaning, and was so grateful for the medication. I joked around with her a little to take her mind off the pain until the meds had a chance to kick in. Then I took her blood pressure and pulse. I noticed the pulse rate quickening. Her breathing started to come in rasps.” Carla pressed her hands together between her knees, cheeks pale. “And her face was swelling. I recognized the symptoms of anaphylactic shock and called for help immediately. After that, the charge nurse took over.”
“Nurse Pritchard?” Kate asked.
“Yes, Carolyn Pritchard. She asked right away what I’d given the resident, and when I told her, she looked at me like I’d lost my mind. I guess it’s common knowledge around there that Mrs. Kraemer can’t have anything containing hydrocodone.” Carla’s eyes blinked rapidly. “Then why was the prescription for Vicodin in the chart?”
Kate knocked on the table. “I second that question.”
“So did Pritchard.” Carla snorted. “And she was pretty hot about it, implying that I must have looked at the wrong chart.”
“Did you?” Kate stared the young nurse in the face.
She didn’t flinch. “Absolutely not. I double- and triple-checked. We’re trained in precautions before administering medications or treatments.”
Kate nodded. That matched the information she’d gotten from Nurse Pritchard. “I figured you were.”
Carla’s gaze fell. “I stood my ground at first, but some of the other staff kept making comments.” She took a ragged breath. “Mrs. Kraemer was getting worse, and everyone was blaming me, and I felt so awful even though I’d done everything just like I was trained to do.” She sniffed. “I guess I lost it and ran out of the apartment crying.”
Well, one mystery was solved. “So it was you.”
The young woman stared at her.
“I was coming out of Mrs. Naples’ place,” Kate explained, “when I heard someone run past crying.”
“Big baby, I was.” Carla scrubbed a
t one cheek with the side of her hand and looked as if she might tear up again at any moment. “And then they fired me. But at least Mrs. Kraemer didn’t die from the Vicodin.” A spurt of laughter came from the living room, and Carla’s lower lip trembled. She leaned close to Kate. “How am I going to take care of my kids if I don’t have a job?”
“Have you tried applying at other facilities?”
The young woman shook her head. “No one will hire me as a nurse until this investigation is over.”
“What about unemployment benefits to tide you over?”
“Hah! That’s a joke.” Carla swiped a hand across her forehead. “My benefit would be figured based on my wages from the past six months of employment. I was only at Orchard Hill for two of those months, earning a decent salary. Before that I was just a part-timer at a department store while I went to school. Sure, I’ll apply for benefits.” She got up and began gathering the dirty dishes. “But what I get will only be a fraction of what I need.”
Kate rose and helped carry items to the sink. “Well, then, how about getting a temporary department-store job until your name is cleared?”
“Do you think it will be?” Carla sent Kate a bleak look, then began rinsing dishes.
“I’m a firm believer in clinging to hope, and I always want to see the innocent prevail.” Kate prayed that she was talking to an innocent person right now. Carla was very likable and seemed sincere. Plus, she was a single mom with young children, so Kate’s heart automatically went out to her. “Can you tell me something else?”
The young woman stopped her nervous activity and faced Kate. “I’ll walk across a bed of nails to get to the truth.”
“Who checked the record for the prescription, and when did they do it?” Kate tapped her chin with her forefinger. The answer to that question could be quite revealing.
“Pritchard, of course,” Carla said, “but not until after we got Mrs. Kraemer safely out the door.”
“And Nurse Pritchard said the prescription wasn’t there.”
“Oh, it wasn’t, all right.” Carla crossed her arms. “I was standing behind her when she looked, and I didn’t see it either anymore.”
Kate frowned and drummed her fingers on the laminate countertop. “So you’re saying that at some point between the time you administered the Vicodin to when Shirley Kraemer was taken to the hospital, the prescription was removed from the chart.”
“That about sums it up.”
“What about—”
A masculine throat clearing interrupted the discussion. Kate turned to find her husband standing at the kitchen entrance.
He sent her an apologetic smile. “Sorry to break this up, but I have to get back to Copper Mill. That board meeting tonight. Remember?”
Kate checked her watch. “Where did the afternoon go? I didn’t realize it had gotten so late.” A million questions still pressed behind her lips, but they’d have to wait.
“Yeah.” Carla wiped her hands on a towel. “Mandy’ll be home any minute from school. I need to think about starting supper.”
Kate touched the young woman’s arm. “Thanks for your time.”
Paul stepped closer. “Do you have any family in the area who can help out?”
Carla shook her head. “My dad passed away when I was little, and my mom died just a few years ago. Cancer.” She grimaced. “My husband didn’t like coping with two small children and my trying to take care of an ailing parent, so he skedaddled. It’s just the kids and me now.”
“That’s a tough row to hoe,” Kate said.
Gaze stoic, the young nurse rippled an elaborate shrug.
“Here.” Paul pulled a card from his wallet. “Give us a call if we can help, even if it’s just to pray. Speaking of which, if you’re open to it, that’s what we should do right now. There’s a lot at stake for a lot of people—”
“—and we need all the divine guidance we can get,” Kate finished for him. They smiled at each other.
Carla chuckled. “So that’s what old married couples can be like. Pretty cool. Yes, please pray.” She bobbed her head. “I can go along with that. It sure couldn’t hurt.”
Kate surrendered her hand to Paul’s and took Carla’s. The young nurse’s palms were dry and her grip was firm but not tense. Either Carla had been telling the truth or she was the scariest kind of liar—the kind with no conscience about it. They bowed their heads.
“Lord,” Paul began, “please bring comfort and provision to this household. Right now, we walk through a valley that to us appears dark and confusing.”
Out of the corner of her eye, Kate noticed Carla’s dark head nod in agreement, though her expression was hidden by the veil of her hair.
“But you see and know all things,” Paul continued. “Even the deeds done in secret and the deepest motivations of the heart. We ask, Father, that you would reveal the truth in your way and your time. In Jesus’ name. Amen.”
Kate lifted her head and smiled down at the little boy who had inserted himself between Paul and his mother sometime during the prayer.
“I’m hungry,” he announced.
“That’s good.” Carla smiled toward Kate. “His appetite has been off. I’m glad he’s ready to eat again.”
“We’ll be going then and let you take care of your children,” Kate said. “But first, why don’t I write our home phone number on the back of the church card Paul gave you?”
“Good idea,” Paul said while Kate dug a pen out of her handbag. Then he squatted in front of the child. “Good-bye, Ryan. Thanks for showing me your cars.”
Ryan smiled. “Maybe you can come over again, and we can get out my racetrack.”
“That would be fun!” Paul ruffled the child’s hair.
Kate’s heart tugged. This whole family was starving for affection and encouragement. “If you think of anything else that might be helpful, don’t hesitate to give me a jingle.”
They said their good-byes, and Carla walked them to her door with a light in her gaze that hadn’t been there when they arrived. Kate identified the look as hope. Lord, I’ll gladly take that guidance sooner rather than later, if you don’t mind. It would break her heart to see that hope extinguished. Unless, of course, Carla turned out to be a negligent nurse and a liar. And that would break her heart even more, because of the little ones affected by their mother’s tragic lack of character.
A minute later, she settled into the passenger seat of the pickup beside her husband and clasped her hands together. “You know, I don’t mind a bit being placed in the category of old married couple.”
“We haven’t done half bad, have we, Katie girl?” Paul smiled, then his grin fell away. “I do have news of the not-so-good kind. I didn’t want to tell you before you spoke with Carla.”
“What is it?” Kate’s lungs constricted. Judging from the frown lines dug into her husband’s profile, she was going to hate the answer.
“I ran into Lucy Mae at the hospital. She and Lawton are thinking about suing Orchard Hill and pressing for prosecution of Carla.”
Chapter Ten
The next morning, Kate beat Livvy to the library and was standing on the steps when her friend arrived to open up.
“Is this a social call?” Livvy laughed as she unlocked the doors. “Or do you have some hot research to pursue that won’t wait on your doggy dial-up connection at home?”
“Definitely the latter,” Kate declared. “This mystery with the medical records gets murkier by the minute.”
Livvy flourished an invitation with her arm as she held the door open, and Kate preceded her into the building. Inside, Livvy began flipping light switches. “Tell me about it while I get everything up and running.”
Kate trailed her friend around the different sections of the building, downstairs and then up, giving Livvy the lowdown on the trip to Chattanooga, particularly her conversations with Nurse Pritchard, Carla Trexler, and Paul on the way home.
Livvy straightened from booting up the last of the P
Cs on the second floor. “So you’re saying this young mom could lose her nursing license and go to jail?”
“Paul tells me the latter is up to the district attorney after he reviews the evidence, but pressure from the mayor of Copper Mill could sway the DA.”
“Any clue how the official investigation is going?”
Kate set her handbag down beside a computer. “Carla is waiting to be contacted by the Board of Nursing, who’s investigating the incident, but Nehemiah says he thinks the administration has decided not to investigate further because they think it was due solely to one nurse’s error. The fact that they fired Carla rather than placing her on leave pending investigation bears out that conclusion.”
“But you still have reservations about her guilt.”
“More than ever after talking to both Nurse Pritchard and Carla. The older nurse lied to me about something simple, but the young nurse seemed pretty straightforward about a difficult situation. Of course, appearances can be deceiving, so I haven’t come to any conclusions yet.”
“Then have at the research.” Livvy motioned toward the computer. “What are you looking for online?”
“Information about medical errors. There’s another person right here in Copper Mill who’s dealing with a major mistake.”
Livvy’s arched brow begged the question, but Kate shook her head. She’d tried to call Loretta the previous evening but got no answer, so she still had only LuAnne’s information to go on. “I’m not free to give out details, and I can’t imagine that the two incidents could be related, but I’ll never know unless I take a closer look.”
A door opened and closed downstairs.
“Go for it, Sherlock,” Livvy said. “I guess my workday has officially started.” She trotted toward the stairway.
Kate settled in front of the computer and brought up a search engine. An hour passed as she read horror stories about medication and procedural gaffes across the country. She didn’t find any situations identical to the one at Orchard Hill, where a piece of the medical record went missing, but she thanked God that Mrs. Kraemer had survived when so many others hadn’t. Finally she clicked on a link that posted public statistics on medical mistakes.
Off the Record Page 6
