Off the Record

by Jill Elizabeth Nelson

  Forty-five minutes into the game, Kate was sweating, and her arthritic knee had offered up more than a few twinges. Time to find an activity that didn’t have her crouching down to look under beds.

  Kate checked on Mandy and found her asleep on the sofa. “Shall we bake some cookies to surprise your mother and sister?” she asked the four-year-old.

  Ryan clapped his hands and jumped up and down. She took that as a yes. Soon the delectable smell of Amish sugar cookies wafted through the apartment. Evidently the scent appealed to Mandy because she opened her eyes and sat up.

  “Can I have one of those?” she asked Kate.

  “You surely may.” Kate felt the child’s forehead. “Your fever is down. I’d like you to try a little broth first. Does that sound all right?”

  Mandy nodded.

  Kate heated the broth, and the little girl padded to the table in her pajamas and slippers. She spooned up every bite of the small bowl of broth and received a warm cookie as a reward. Meanwhile, Ryan ate two cookies.

  After Kate cleaned up the table, she proposed a game of Candy Land. Both children wanted to play, and Kate didn’t discourage Mandy. The little girl was definitely feeling better, and she felt especially good when she won.

  They were just putting the game away when Carla walked in. The young woman had a spring in her step, and her gaze was bright. “Yum. Something smells good in here.”

  Ryan ran up to his mother and wrapped his arms around her legs. “We maked cookies, and I got to pour in the puffy powder and stir the goop.”

  Carla looked over at Kate.

  “He got to add the flour and stir the dough.”

  The women laughed.

  “I take it your interview went well,” Kate said.

  “I think I might get the job.” Carla grinned.

  Kate clapped her hands. “You think?”

  “I won’t know for sure until tomorrow. My interview went well, but they had a few more scheduled, and then they’re going to make a decision.” The young woman’s gaze intensified. “I hope those prayers work.”

  “Oh, prayer works,” Kate said. “We don’t always get the answer the way we think it’ll come, but it’s always the best thing for us.”

  Carla went over and hugged Mandy, who was still seated at the table. “I see you’re feeling better, peanut.”

  “I had a cookie too,” the little girl announced as if the treat were the key to her recovery.

  “Ah, Auntie Kate gave you cookie therapy.” Carla kissed her daughter’s forehead. “Much cooler. You’ll be back to normal before you know it.”

  Kate smiled as she put several cookies on a plate to offer Carla. “Can I visit with you about a few things before I head back to Copper Mill?” she asked.

  “Sure,” Carla answered. “I’ll set these two up in the living room with a movie.”

  Both children chorused approval and scampered out of the kitchen. Kate made cups of tea for herself and Carla while the young woman settled her youngsters. A few minutes later, Carla joined her at the table. Kate pushed the plate of cookies toward her, and Carla gobbled one in a few bites.

  “These are delicious. You’ll have to give me the recipe.”

  “The key is in creaming the butter, sugar, and eggs together thoroughly.” Kate took a sip of her tea. “I see you got your education at the University of Tennessee here in the city.”

  Carla flickered a smile. “You noticed the diploma, huh? I’ve been so proud of that, and now look what’s happened. I feel really bad about how things have turned out, when Orchard Hill was so good to me. They gave me a scholarship to help with expenses on condition that I commit to work there for at least three years. Now I don’t suppose I’ll get the money.”

  “Get the money?” Kate stared at her. “I thought you said they gave you the scholarship.”

  Carla shook her head. “It doesn’t work like that. Facilities are crying for nurses, so this scholarship thing is a pretty common arrangement. But they don’t put in the money up front. That would be like paying a contractor in advance for building a house. No incentive to stick with the agreement.” Her smile held equal parts sadness and apprehension. “Orchard Hill agreed to repay so much of my loans over the next three years of my work commitment. It’s a win-win situation. Or at least it was until this happened.” She grimaced.

  Kate pursed her lips and looked away. Carla had strong incentive to do anything or say anything, no matter how absurd, to keep her place at Orchard Hill. But people like Nurse Pritchard or Margo Meyers would also have a motive to protect their jobs if either of them had made a major charting error. And then there were other characters she’d seen hanging around the nurses’ station that afternoon—Rita and Stephen. But what would be their motive for covering up an error? Plus, their access to the charts was restricted.

  She finished her tea and set the cup on the table. “Was the prescription for Vicodin in the paper chart or on the computer?”

  Carla looked surprised by the question. “The computer.”

  “Do you remember the doctor’s name who signed the order?”

  Carla’s face scrunched up. “Oh, man, you would have to ask that. The signature was only about half legible. A couple of the classes doctors have to take in school are Gobbledygook I and II in order to learn how to write like that.” She let out a brief laugh, and Kate chuckled with her.

  The young nurse drew her brows together. “Let me think. The first name began with an N. Nolan or Nathan or something like that. And the last name...I just remember it was something long and unusual. I couldn’t make it all out.”

  Kate frowned. “It wasn’t Dr. Rogers, then.” She remembered that when Lucy Mae approached her outside Betty’s Beauty Parlor and asked her to look into the incident with her mother, she’d mentioned Dr. Rogers as Mrs. Kraemer’s attending physician.

  Carla waved a hand. “Nothing as simple as Rogers. I’m positive about that much.”

  Kate rubbed her palms against her jeans and frowned. What was a prescription doing in Mrs. Kraemer’s file from a doctor who wasn’t treating her? If this story of Carla’s was more than a fairy tale, the situation was starting to sound more and more as if a critical error had been made in the record. “So how does a prescription get onto the computer at Orchard Hill?”

  “It’s a scanned document. We don’t deal much with paper prescriptions anymore. Electronic transmission is a lot faster and more efficient. Actually”—Carla leaned toward Kate—“there’s a national push toward going paperless and interfacing an electronic medical record nationwide. That way, we can streamline the exchange of vital information between health systems.”

  The words “between health systems” sent electric chills through Kate’s middle. Was this the answer to Loretta Sweet’s problems too?

  “What about the privacy of medical information?” Kate twined her fingers together and wrapped her hands around one knee. “Isn’t there a danger of computer hacking? People’s sensitive information could fall into the wrong hands or be manipulated by unscrupulous characters.”

  The young woman bobbed her head. “Those are legitimate concerns. They’re part of the ongoing debate about implementing the national EMR, but it looks like it’s coming anyway. The powers that be are determined. There are a lot of advantages to weigh against the risks.”

  “Like what?”

  “Well, say, you take a vacation to Florida”—Carla waved a hand—“and you have an accident that renders you unconscious so you can’t communicate critical information about yourself—that you have a weak heart or something. Authorized personnel at the hospital there would have instant access to medical history that might save your life.”

  “Oookay.” Kate nodded. “I can see that. What else?”

  “The business-office staff says it would streamline billing big-time. You know how long it can take for turnaround on insurance claims.” Carla rolled her eyes. “Plus, the EMR should eventually reduce patient charges because of time savings t
o doctors and nurses, not to mention pretty much every department in the facility. I heard the administrator say one day, ‘Efficiency equals dollars.’” She snickered. “The money end isn’t my concern so much as serving the patient, but I get excited about anything that helps me do that better and faster.”

  Kate laughed and clapped her palms together. “You’re a good saleswoman. I see there are a lot of facets to this EMR thing. I’m going to dig around on my own. Maybe I’ll find something that sheds light on our current problem.”

  “Cool!”

  “One more question for now. Did Nurse Pritchard check only the electronic record for the Vicodin prescription, or did she look in the physical record as well?”

  “Both, yes. I can’t complain that she wasn’t thorough. But we knew if it wasn’t in the computer system, it wouldn’t be in the paper chart.” Carla’s shoulders slumped.

  Kate rose. “I’d better get going. I still have a couple of stops to make before I head for home.”

  One of them for sure was Orchard Hill to finally speak to the woman who was working on the charts during Shirley Kraemer’s allergic reaction. Maybe the prescription for Vicodin wasn’t found a few minutes later because Ms. Meyers had already disposed of it.

  Chapter Fourteen

  Kate stepped through the front doors at Orchard Hill intent on heading straight for the administration floor. As she passed the sunroom, a nursing assistant bustled out into her path. Kate put on the brakes and backpedaled.

  “I’m sorry, Rita,” she said, laughing.

  The aide grinned. “Sometimes I think we need traffic lights in the corridors.”

  “Did everything turn out all right with Mrs. Naples’ television?”

  “Huh?” Rita’s expression went blank, and then her hazel eyes brightened. “Oh yeah. That was the day Shirley Kraemer got sent back to the hospital. The batteries did the trick for Edie, and she’s happy as a clam. Er, as happy as Edie ever gets.” She wrinkled her nose. “Sure wish it had been that easy to help Shirley. We’ve got enough heartache to go around in this world without adding careless and dishonest nurses to the mix.” The young woman sniffed and lifted her chin.

  “I’m just trying to give people the benefit of the doubt until the investigation is over.” Kate sympathized with the aide’s concern for Mrs. Kraemer, but evidently Rita hadn’t grown tired of flaying her former co-worker to anyone who would listen. Some people were like that, unfortunately. Even if Carla was guilty, and Kate’s personal jury was still out on that, the attitude didn’t sit well with her.

  Rita frowned and took a step backward. “You here visiting Nehemiah like usual?”

  “Actually, no, I need to see someone upstairs in administration. I’ve developed an interest in electronic medical records, and I’m hoping Margo Meyers will have a few minutes to enlighten me.”

  The aide’s expression soured. “Good luck talking to her. She walks somewhere above us mortals with her nose in the air.”

  If there was an award for negativity, this nursing assistant would win it. Kate put on a smile. “What you do is important, Rita. We appreciate the good care the residents get here.”

  “Thanks!” The tiny encouragement brightened the aide’s face.

  Maybe that’s all the young woman needed to improve her outlook.

  “Have a good day.” Kate continued her journey toward the elevator. When she emerged on the third floor, a red-haired receptionist younger than Carla stood up from behind a counter and greeted her with a smile.

  “Can I help you?”

  “I’m here to see Margo Meyers,” Kate answered.

  The receptionist’s perky expression slackened. “Do you have an appointment?” The words were cautious.

  “No, I’m dropping in to ask her a few questions about the EMR system, if I may.” Kate stepped closer to the counter.

  The smile reappeared. “Oh, then you’re not an appointment I forgot to cancel for her.”

  Kate frowned, confused. “Beg pardon?”

  “Ms. Meyers is out,” the young woman explained. “Could someone else help you?”

  “I don’t think so.” Kate shook her head. “When do you expect her back?”

  The receptionist shrugged. “Next week sometime. I don’t have a definite day.”

  “I hope she’s not ill.” That seemed like the most logical reason for someone to be absent for such a vague period of time.

  The receptionist eyed her soberly under lowered lashes. “I-I don’t think so.”

  “A business trip, then? People in her position must have to go on lots of those.” But if it was a trip, why wouldn’t the receptionist know when the woman would be back?

  “No, not a trip.” The young woman’s expression went stern. “Look, I really don’t know the reason, and I wouldn’t give it out to anybody off the street if I did.”

  “I don’t blame you.” Kate smiled at the young woman. “I’m sorry I made you uncomfortable with my questions.”

  Kate returned to the elevator and pushed the button. So the medical-records director was gone from work for an extended period of time, and the receptionist didn’t know where she was or what she was doing. Did the absence have any connection to the issues Kate was looking into? Or was it just another frustrating coincidence? She’d be back to find out.

  On the way down, the elevator stopped on the second floor, and the male aide, Stephen Hancock, got on. Everyone she’d talked to said the guy wasn’t half bad. She offered a smile. The stony planes of his face didn’t soften as he turned without a word and pushed the button for the first floor. The door whispered shut, and Kate wished she’d thought to dart out to pay Nehemiah a visit—any excuse to leave the elevator before the door closed.

  Hancock crossed beefy arms over his thick chest and stared up at the floor numbers over the door. A strong scent of woodsy cologne invaded her air passages, and she cleared her throat.

  “You’re the lady with all the questions,” he said, then looked down at her, his lips spreading in a grin that didn’t reach his narrowed eyes. “Better take care.”

  The elevator stopped, and an eternal second passed before the door whisked open. The aide strode out and went in one direction while Kate gratefully went in the opposite direction toward the front door.

  Had she just been threatened, or was she overreacting? Did the aide’s remark go back to her questions when she approached him and Rita in the hallway during the crisis with Shirley Kraemer, or did he know she was looking into the incident? If so, why would he care, and who would have told him?

  The only person in Chattanooga who knew about the unofficial investigation was Carla, and she was hoping Kate would exonerate her. Unless the young nurse was guilty and didn’t want Kate to prove it. But from the conversation she’d overheard the other day, Kate didn’t have the impression that Stephen was Carla’s friend. He seemed more in league with the Rita types who reveled in other people’s mistakes. Something didn’t make sense.

  Kate mulled over these questions on the way to the hospital, where she went up to visit Shirley Kraemer. She found Lucy Mae just emerging from her mother’s room. The woman sent Kate a tired smile.

  “Oh, you’re in town,” Lucy Mae said. “Are you here investigating?”

  “Just looking for a few answers while on a mission of mercy.” Kate fell into step with the other woman as they proceeded in the direction of the vending machines.

  “I’m sorry I haven’t kept in touch after I asked you to look into things, but I’ve been preoccupied.” Lucy Mae rubbed her forehead. “I should have let you know days ago that as far as we’re concerned, there’s no need to keep looking into the matter. Lawton and I are quite satisfied with the decisive action taken by the administration at Orchard Hill in firing that nurse. I’m sure the Board of Nursing will agree with that decision, and then we can see if the district attorney would like to proceed with prosecution.”

  “I heard you might be thinking along those lines,” Kate said. “But so
me of what I’ve found out could suggest that Carla Trexler is telling the truth about the missing medication order.”

  They stopped at the candy machine, and Lucy Mae turned toward her, frowning. “I know you bend over backward to be fair-minded, Kate, but how complicated can a simple case of nurse negligence be? Let it alone now. I should never have imposed on you in the first place. I’ve been too distraught to think straight.”

  Lucy Mae fed coins into the machine. “I crave something chocolate to keep me going, but I’ll have to eat it in the visitor’s lounge. Mother can’t have any. She’s—”

  “Allergic to chocolate,” Kate finished.

  “Right.” A bar thumped into the vending tray. “Can I get you anything?”

  Kate shook her head. “No, thanks. Are you here all day, every day?”

  “What else can I do?” Lucy Mae flapped her arms against her sides. “Mom loves me to read to her, and we’re having some great conversations. But I hate to see her in so much discomfort.”

  Kate clucked in sympathy. “She’s still not over the shingles?”

  “It’s not just that.” Lucy Mae bent and retrieved her purchase. She straightened, wearing a stricken expression. “Her heart keeps acting funny. I’m scared.”

  An alarm suddenly shrilled. Lucy Mae froze, gaze fixed in the direction of the sound.

  “That’s mother’s room!”

  Lucy Mae rushed up the hall. The candy bar hit the floor, forgotten.

  Chapter Fifteen

  Kate arrived home to find Paul in the kitchen, whipping up a batch of his famous chili.

  “Thanks for making supper,” she said. “On top of everything else, it’s raining barks and purrs out there, so it wasn’t fun driving home. I’m wiped out.”

  He leaned toward her kiss on his cheek. “I don’t blame you for being tired. How is Lucy Mae’s mother?”

  Kate sighed and leaned a hip against the counter by the stove. “Her heart stopped for a couple of minutes, but they got it going again. She’s not doing very well. Lucy Mae’s fit to be tied. I stayed there until Lawton could join her.”