Off the Record

by Jill Elizabeth Nelson

  Kate carried a second plate of bars over to his desk and set it in front of him.

  Paul rubbed his hands together in anticipation. “Yum. You can visit bearing gifts any time.”

  “I don’t want to keep you away from whatever you’re working on.” She motioned toward the computer.

  “It’s a ‘secret, surprise project.’” He bracketed the last three words between quotation marks with his fingers.

  Kate laughed. “Don’t tell me it has something to do with this whole blood-drive craziness.”

  Paul grimaced. “Exactly, but if I don’t work the kinks out of it by three o’clock, it won’t do a bit of good. I’m writing a letter to the editor for this week’s newspaper, and three o’clock is the deadline for submission.”

  “Ambitious!” Kate whistled under her breath. “And brave.”

  “Believe me, I’m trembling, but I love this town enough to risk some figurative egg throwing or irate phone calls in order to encourage an attitude adjustment when it’s needed.”

  Their gazes met in understanding.

  “We’ve taken the risk before, and it’s always worked out by the grace of God,” Kate said. “Comes with the pastoral territory.”

  He reached across the desk for her hand and squeezed it. “You’re onboard with me then?”

  Kate smiled, knowing that her sensitive husband would do a wonderful job reaching the hearts of the people in Copper Mill. “I’m all for it. Are you going to let me take a look?”

  “I thought you’d never ask.” That heart-stealing grin appeared once more. Paul clicked with his mouse, and the printer whirred out a copy of the letter.

  Kate took the sheets and read. She’d always admired how articulate her husband was, but this was eloquent in the folksy way that would appeal to the citizens of Copper Mill. “I love how you’ve applauded Renee for her concern for the comfort of the donors and patted Joe on the back for his civic spirit. Nice way to highlight the positives of what the organizers are doing, without the competitive element.”

  She read on. “Ooh, good stuff. ‘A blood drive allows a little town to make a lifesaving difference in a far bigger world.’ Way to broaden the people’s vision. I’m so impressed. If you were running for president, I’d vote for you.” She laughed.

  Happy color shaded Paul’s cheeks. “Any thoughts or suggestions?”

  She pondered this for a moment. “Just whip up a few savory sentences about the many times you’ve seen this town pull together for a cause or a crisis, and now it’s time to do it again.”

  “Perfect.” Paul pumped his fists. “I might actually make the deadline.” He rose and came around the desk with his arms out.

  Kate walked into his embrace. She kissed his chin, then rested her cheek against his shoulder.

  He pressed his lips to her forehead. “I never plan to run for president, but you’ll always be my first lady.”

  KATE BASKED IN THE WARMTH of her husband’s love and approval the rest of the afternoon as she performed routine household chores.

  At suppertime, Paul came through the door, carrying the mail in his hand. He stood by the counter sorting through letters and magazines and tossing the junk mail in the basket while Kate prepared their meal. A sudden long whistle stopped Kate in the act. She looked over to see her husband standing transfixed, frowning at an open letter.

  “What is it?”

  “You’re not going to believe this.” He held out the paper, lips compressed in a whitewashed face.

  She took it and glanced at the banner and heading on the stationery. “It’s from Regions Hospital in Memphis, addressed to you. Are they looking for a donation?”

  “I have no idea.”

  She studied the sheet, then gasped. “This is a bill for nearly five thousand dollars!”

  Chapter Eighteen

  What did they say?” Kate sat, literally, on the edge of her chair as Paul hung up the phone from talking to the Regions Hospital business office the next morning.

  Her husband sank into a chair opposite her at the dining table, one hand running through his salt-and-pepper hair. He’d done that so much during the conversation that Kate had started to wonder if he was going to rub himself bald.

  “Every bit of the information they have on the person who ran up the bill matches mine—except I never had stents put in my heart. They’re going to fax a form to the church office so I can request a copy of ‘my’”—he bracketed the words in finger quotation marks—“medical record. And that’s not all.” He shook his head with a wince.

  “What?” Kate wound her fingers together.

  “The nice woman from the business office offered to send a Charity Care application for me to fill out, since I claim I can’t pay my bill.”

  “Huh?” Kate stiffened. “I believe you told her you won’t.”

  Paul grimaced. “I think she interpreted that to mean that I’m unable to pay it.”

  Kate rose and began pulling ingredients from the cupboards to make banana bread. Her brain was going full tilt, and she needed a little baking therapy to help her think. “She didn’t believe you weren’t the guy who had the surgery?”

  “Let’s just say she was skeptical, since all the identifying information matched.”

  Kate slapped a mixing bowl onto the counter. “There we go again with the information mix-up. I wonder if this problem is a glitch in the system connected with the electronic medical record. Carla made it sound like that thing was developing tentacles all over the place.”

  Paul rubbed his temples with a long sigh. “Good theory. Why don’t you check it out?”

  “I plan to.” She started measuring the flour. “Just as soon as I whip up a few loaves of banana bread.”

  Paul went to the kitchen door, then turned and waggled his brows. “I wonder if the business office at the Mayo Clinic offered to send Loretta a Charity Care application.”

  A laugh spurted between Kate’s lips. “That would have gone over like a lead balloon.”

  Paul mugged a wry smile. “I’ve got a meeting this morning with the other ministers, and then I’ll be in Pine Ridge for hospital and nursing-home visits, so I probably won’t see you until tonight.”

  Kate waved him off with the banana she was peeling.

  “Don’t worry, hon,” Paul said. “The Lord’s got this in hand, just like everything else in our lives.”

  Kate paused, thankful for the reminder. “I know. I just need time to process.”

  Her husband mouthed her a kiss and left.

  Kate began mashing the fruit. It had to be more than coincidence when two Copper Mill residents were being billed for medical services that weren’t theirs. And perhaps there were more victims she didn’t know about yet. Both Paul and Loretta were in the Chattanooga Health System...and come to think of it, so was Shirley Kraemer. Plus she’d discovered that the Chattanooga system was seeing a spike in medical errors.

  Did the problems all trace back to a defect in the CHS electronic medical record? Maybe these issues weren’t the fault of any person, just a computer problem that needed fixing. She had to talk to the medical-records director at Orchard Hill as soon as possible.

  Kate tucked three loaves of banana bread into the oven, then went to the phone. Her call met with frustration once again. Margo Meyers still hadn’t returned to work. What might be keeping the woman away so long?

  She started cleaning up her baking mess. Of course, a software glitch didn’t explain why a medication order would disappear from Mrs. Kraemer’s record immediately after she went into anaphylactic shock. Something of that nature had to be deliberate. That is, assuming that Carla was telling the truth that the prescription was there in the first place. But maybe she wasn’t. She’d lied without batting an eyelash about her father. It would be too bad for those little kids if things turned out for the worst for their mama—losing her license and facing criminal prosecution.

  What sort of person was their grandpa? From the way Carla reacted to the m
ere mention of his existence, he could be a horrible monster. But then, family blowups of epic proportions could happen over a misunderstanding that could have been straightened out by simple communication. She and Paul had seen these avoidable tragedies time and again in their years of ministry.

  Lord, please help Carla make wise decisions in these coming days.

  Kate was getting ready to go out the door to pay a visit to the library when the phone rang.

  “Hanlon residence,” she answered.

  “Is this Kate Hanlon?” a woman’s voice asked.

  “Speaking.”

  “Oh, good. Margo Meyers here, returning your call.”

  “Well, hello, Ms. Meyers.” Surprise held her frozen for a moment. “I was told you were still out of the office.”

  A soft chuckle met her ears. “Margo, please. I am out. Technically. Just stopped by my office to see if there were any fires to dowse before returning home. I’m dealing with an ongoing family issue that I hope will be resolved soon so I can get back to work,” she added in weary tones. “But I see you’ve tried more than once to contact me. How can I help you?”

  “Thank you so much, Margo, for returning my call.” Kate picked up the pen they kept near the phone, along with a pad of paper. “I don’t want to keep you from your family. We could make an appointment for when you’re officially back, if that would be better for you.” She poised the pen over the pad.

  “That’s all right. The note from the receptionist says that you have questions about the electronic medical record. The EMR is a passion of mine. Dry subject, I know. So I’m curious to know what’s caught your interest in it.”

  Kate tapped the pen against the countertop. “I’ve heard a lot of pros and cons about the electronic sharing of medical information, and I was wondering how connected Orchard Hill is into the system. A dear friend of ours lives there, so we often visit.”

  “Ah, I see. You’re concerned about your friend. Which resident is it?”

  “Nehemiah Jacobs.” Would the woman even know who he was?

  “Hmm. Yes, I recall working with his record from time to time. I’m glad to hear he has regular visitors. So many of our residents seem to have no one.” She clucked her tongue.

  Interesting that Margo talked as if she cared about the residents but was so seldom anywhere to be found among them. Maybe her job duties didn’t allow much mingling. It was possible, too, that her jittery behavior the afternoon of Mrs. Kraemer’s crisis had more to do with a tender heart than participation in chart tampering. It would be nice to think that.

  “So what can you tell me about the EMR at Orchard Hill?” Kate continued.

  “Honestly?” The woman huffed. “We’ve got a long way to go, and we seem to be moving at a snail’s pace. This facility is part of the Chattanooga Health System, which includes most of southeastern Tennessee. All CHS facilities are fully integrated with each other for digital transmission of records, but we’re not yet online with other systems. It’s in the works, though. In fact, I’m on the committee.”

  Kate scratched below her ear and frowned. “How do you pass along medical records outside the CHS community, then?”

  “Some things we scan and e-mail. Others we send by fax or even snail mail. I know. The Dark Ages, right?” She laughed. “Do you need records sent somewhere?”

  “Not at the moment, but you never know.” Kate turned and leaned a hip against the counter. “The information about the EMR intrigued me, so I thought it would be nice to know how it would happen if my information or the record of someone I care about needed to be transferred somewhere. Thanks for settling my mind on that issue. I really appreciate your time.”

  “No problem. If you have any other questions, feel free to get back to me.”

  “I will. Thanks again.”

  Kate hung up the phone and stood staring out her kitchen window. If the Chattanooga system was integrated internally but not externally, there went her theory that the billing problem stemmed from a glitch in the EMR software. And if the deletion of the prescription from Shirley Kraemer’s chart wasn’t an accident, then it had to be deliberate...but how and why?

  “HEY, LIV.” Kate stood in her friend’s office doorway at the library. “What’s new with you?”

  “Well, hi. It’s good to see a smiling face.”

  “You’ve been seeing a lot of long ones?” Kate lifted her brows.

  Livvy motioned toward the guest chair opposite her desk. “I think the whole town’s grouchy about the upcoming blood drive. I’ve even had to toss a couple of arguing patrons out of the library.”

  Kate expelled an exasperated breath and sat in the offered chair. “The rivalry is getting way out of hand. I’m not sure what it’ll take to settle things down.”

  Livvy nodded. “Copper Mill doesn’t need quite this brand of excitement.”

  “Speaking of excitement.” Kate frowned. “Paul and I got a whopper of a surprise in the mail yesterday.” She filled Livvy in on the erroneous medical bill and the results of the telephone attempt to straighten it out that morning.

  Livvy gaped at her, goggle-eyed. “Weird doesn’t even begin to describe it.” She planted her elbows on the desk and leaned toward Kate. “Is this the sort of thing that’s happening to the other person from Copper Mill whom you’ve mentioned having medical-error issues?”

  Kate smirked. “Your powers of deduction boggle my mind, Watson.”

  Her friend offered a weak smile, then wilted back against her chair. “I’d better keep a close eye on my mail.”

  Kate rose. “I’m going upstairs to rattle around online. See if I can’t get a lead on how or why this crazy stuff is going on.”

  “Keep me posted.”

  Upstairs, the computer carrels were moderately busy. She ensconced herself at a computer a good distance from anyone else. She didn’t want the steam coming out of her ears to scorch someone.

  Kate settled in and began typing on the keyboard. A general search on medical records yielded a fascinating array of articles about what they contained, how they were handled at the nursing end, the functions of a medical-records department, and electronic transmission of records between facilities. The information verified what Carla Trexler had told her about the process. But Kate had yet to locate more than a casual mention of routine correction of accidental record errors. And she found nothing on deliberate tampering or on errors in medical billing.

  Kate entered a specific search for medical-record errors. Very little came up. Maybe she was using the wrong search criteria. She entered “electronic medical record” and read several articles on the pros and cons of a national computerized system. Apparently there was a lot of support for the EMR from major political bigwigs and insurance companies at the national level, as well as concerns from privacy groups on the other end of the spectrum. There were even grants out there to help medical facilities install the hardware and software to go live with the EMR.

  Then an article heading caught her eye: AN OVERLOOKED AND POTENTIALLY DEADLY FORM OF IDENTITY THEFT. How were identity theft and electronic medical records connected? She clicked on the article and began to read.

  As paper-based, medical-record-keeping systems evolve toward electronically based, interconnected systems, the potential for massive theft of medical information is on the rise.

  Fine hairs all over Kate’s body stood at attention. She read on, and then a sentence arrested her.

  Medical-identity theft typically leaves a trail of falsified information in medical records that can plague victims’ medical and financial lives for years.

  A high squeak escaped Kate’s lips, and she leaped to her feet. “That’s it!”

  A hush fell over the library. Kate glanced around to find many eyes upon her, and she blushed, returning to her seat. But the thrill running through her continued. She’d found the problem, and it was worse than anything she could have imagined.

  Chapter Nineteen

  I’m taking you out to lunch, gir
lfriend.” Kate waved a sheaf of papers at Livvy that she’d printed out from her research upstairs. She’d found a few more articles on medical-record identity theft that echoed what the first article had said.

  “What gives? You look ready to pop.” Her friend gathered up her purse and followed Kate toward the library doors.

  “Hang on to your hat and prepare to have your socks scared off.” She led the way to the exit. “I’ll tell you all about it during our stroll to the diner.”

  They reached the sidewalk and fell into stride with each other.

  “I’m walking on hot coals here,” Livvy said.

  Kate shot her friend a dark look. “I may have found the reason why Mrs. Kraemer was given a wrong medication, and why people are getting billed for services they never received.” In hushed tones, she explained about medical-record identity theft.

  “The thief, or the person who bought the record from the thief, can have expensive procedures on your dime,” she said as she finished her tale. “Plus their medical information can get mixed up with yours, creating potential for you to get the wrong treatment down the road.”

  Livvy stopped dead in the middle of the sidewalk, and a woman detoured around them with a puzzled frown.

  The librarian planted her hands on her hips. “You’ve got to be kidding! People don’t just want to pretend to be you with your credit card at the store? They want to be you in the doctor’s office?”

  Kate grabbed her friend’s arm and tugged her up the sidewalk. “We’re blocking traffic. I’ll show you the articles when we get to the diner.”

  The meal crowd was pretty thick when they walked into the restaurant. Kate glimpsed J.B. on duty in the kitchen. Good. She needed to talk to Loretta as soon as possible. With J.B. around, the diner owner should be able to spare her a few minutes after the lunch rush eased.

  Kate slid into a booth opposite her friend and handed her the sheaf of papers. “Like the saying goes, read ’em and weep.”