by Harry Kraus
Part Four
Chapter Thirty-Five
March 2001
Claire hated depositions. She sat at the conference table with her attorney and yawned. “Ramsey should be here any moment. He’s punctual to a fault.”
“When it suits him, he is.”
Claire wrinkled her nose. “I’m still not so sure I understand all this. Why does Ramsey want to talk to me? Why not depose someone like Beatrice Hayes? I’m sure she’d be glad to talk about me.”
“You’ve told me yourself that you suspect Beatrice has already been giving information to Ramsey. It’s clear someone did. Otherwise, I have my doubts as to whether we’d be here today. You only need to depose witnesses who won’t talk to you otherwise. If Beatrice is feeding information to Ramsey already, there’s no need for him to examine her in a deposition.”
Claire nodded.
Franklin Peters smoothed the lapels of his gray suit and explained to Claire what she could expect of the deposition.
A few moments later, they looked up as the door opened and Ramsey Plank escorted in Mr. and Mrs. Jones. Claire stood and shook Ramsey’s hand, but the Jones stood back. Celia looked at the carpet and clutched her husband’s arm. When Claire briefly made eye contact with Roger, he quickly diverted his gaze to his wife. Claire studied Roger Jones for a moment, being careful not to stare or appear angry. But inside her plastic pleasant appearance, her stomach churned. Have you been threatening me, Mr. Jones?
Claire would go first. She quickly found out just how much Mr. Plank already knew. For the first ten minutes, all Claire had an opportunity to do was confirm the educational data that he had discovered. Claire relaxed. Mr. Plank was pleasant enough and he continuously apologized for asking probing questions.
“You are an intern, Dr. McCall?”
“Yes.”
“And you were completing your first month of internship when Sierra Jones became your patient, is that right?”
“Yes.”
“Dr. McCall, how many pediatric patients have you taken care of?”
Claire shrugged. “I don’t know. I’ve cared for dozens of children while doing my medical school pediatrics rotation.”
Ramsey smiled. “How many pediatric trauma cases have you managed?”
“A few. I don’t know the exact number.”
“Have you cared for any pediatric trauma cases outside Lafayette University Hospital?”
“Yes, a few during my surgery rotations at Brighton University.”
“But you were a student then, were you not? And therefore you were not really responsible for the patient’s care, is that right?”
“I learned from them, and helped take care of them, and I was a responsible medical student, but no, I was not solely responsible for their care.”
“Dr. McCall, how many pediatric trauma patients did you care for during the month of July?”
“I’m not sure.”
Ramsey pulled out a computer printout. “Let me refresh your memory. During the nights that you were on call during the month of July, the trauma team admitted twenty-two patients under the age of twenty-one, but only four patients under the age of twelve. And the other intern, Dr. Beatrice Hayes, who shared your night call, did the workups on the other three. That only leaves one patient under the age of twelve on whom you did the initial workup.”
Claire shifted in her seat uncomfortably.
“And that one patient would be Sierra Jones. Only one. Could my information be correct?”
Her mouth went dry. “I suppose.”
Ramsey seemed satisfied with that knowledge and opened his briefcase. He lifted a few papers. “Here is a copy of the health insurance application that you filled out when you became an intern at this university.” He held it up to Claire. “Do you recognize this as your handwriting?”
“Yes.”
“Dr. McCall, do you possess any health difficulty that could in any way hamper your ability to function as a physician?”
“No.”
Franklin caught her eye and wrinkled his forehead as if to say, Where’s he going with this, Claire?
Ramsey leaned forward. “Did you knowingly omit any information about your personal medical history from this insurance application?”
Claire shook her head. “Of course not.”
“Is there any part of your past medical history, such as your family history, which you have intentionally kept hidden from the university because you felt it might damage your chances to continue in this program?”
Claire looked at Franklin. How could Ramsey know about Huntington’s disease? She felt warm and longed to loosen the collar of her new navy dress.
Ramsey persisted. “Are there any illnesses that run in the McCall family?”
Franklin Peters shifted in his seat. “Ramsey, I object. This can’t be relevant to this case.”
Ramsey shook his head. “We agreed on the format for this deposition. There were to be no objections.”
Franklin sighed. He tapped his pen against the table and looked at Claire. “Answer the question, Claire.”
“There is a genetic illness that runs in the McCall family,” she reported mechanically. “But I did not know of it when I started this internship and filled out the application you have in your hand.”
“And it is?”
“Huntington’s disease,” Claire answered quietly.
The hospital attorney, Ondrachek, shuffled a stack of papers in front of him. Emmit Grabowski, the CEO, cleared his throat and glared at the hospital attorney.
Franklin stood up. “Could we have a recess?”
Ramsey smiled again. “Sure.”
Franklin Peters shut the door to the small conference room where he had retreated with Claire. “What’s Ramsey getting at? What is Huntington’s disease?”
Claire paced the room. “A genetic illness which results in mental deterioration and loss of ability to control voluntary muscle movement. It usually has its onset in midlife. It has a dominant inheritance pattern, so that there is a fifty-fifty chance of children of affected parents inheriting the disease.” She pulled up a chair and sat. “My father has it.”
Mr. Peters frowned. “Do you have it, Claire?”
“I’ve never been tested. But I’m not showing any signs.”
“This disease, it would prohibit you from practicing medicine?”
Claire nodded soberly. “Definitely. But there is no reason a person with Huntington’s disease couldn’t practice successfully until symptoms began showing.” She leaned forward until she held her forehead in her hands. “But how does he know this? No one in Lafayette knows this.” She paused. “Except one other resident.” She shook her head. “And he wouldn’t tell.”
“Ramsey has his ways. He probably sent an investigator to your hometown or something. These guys have big money on the line here. Ramsey’s cut on twenty million dollars could be huge.”
“But this is irrelevant. What does this have to do with my performance on Sierra’s case?”
“Nothing really, but Ramsey could use this in a few ways. First, he is setting you up in front of the jury to look as if deceit is part of your character. If he can convince them that you are less than honest in other areas of your life, he can make the jury suspicious of other things you say during trial. If Ramsey can convince them that you are a woman who would do anything to stay in the program, even deceive your own program director, he can make them question whether you might be hiding facts to make yourself look good in this trial as well.” He took a deep breath. “Have you been keeping this a secret, Claire?”
She kept her head in her hands and focused on the tabletop. “Yes.” She looked up. “I didn’t know about the disease until I was already an intern. I have tried to keep this from Dr. Rogers, because I didn’t want him to think I may practice only for a few years.” She stood to pace again. “But I really don’t think it’s an issue here. I’m not showing symptoms. There’s no way I could function at my present level
if I had symptomatic HD.”
Franklin scratched his chin. “People with this disease have intelligence problems?”
“A serious decline.” She hesitated. “Mr. Peters, there is no way I’m showing symptoms—”
“But that’s the second way Ramsey might try to use this to his advantage. If he can introduce the idea that you are already showing subtle signs of this disease, he can make them think that you knowingly put this child at risk by assuming her care. He can make them wonder whether you made a mistake because of this disease.”
“That’s ridiculous. I hadn’t even diagnosed my father with HD at the time I cared for Sierra Jones. I would never knowingly put my patients at risk.”
Franklin tilted his head suddenly and his eyes brightened. He held up a finger. Claire imagined seeing a lightbulb going on above his head. “What did you say? You diagnosed your father with HD?”
“Well, basically, yes.”
Her attorney opened up a yellow legal pad and began scribbling notes. He looked at his watch. “Okay. I want you to tell me everything. There’s got to be a way for us to turn the tables on Ramsey here.” He tapped his pen against the table. “I’ll probably want to ask you some more questions in front of Ramsey. That’s a bit unusual for a deposition, since you’re my client, but I think it might be beneficial in this case for Ramsey to see what he’s getting into. It might discourage him from his present tactics.” The corner of his mouth lifted slightly, showing the first hint of a smile. “And maybe, just maybe, it will help the Jones to understand you better too.”
Emmit Grabowski was a hulk of a man, a suit-and-tie hospital administrator who’d bought a Harley during a midlife crisis and smoked Cuban cigars when his wife was sipping banana fruit smoothies at their private health spa. He tugged at his silk tie and grabbed Peter Ondrachek by the elbow, ushering him into his office during the recess. “Where’s Ramsey going with this?”
“I haven’t the foggiest. And I suspect Franklin is clueless as well, and he’s probably giving that intern the once-over for keeping secrets.”
“I don’t like it.” Emmit imitated Ramsey Plank’s plastic grin. “Every time that weasel smiles, I just know he’s up to something.”
The hospital attorney nodded. “But don’t be too quick to despair. Ramsey may have uncovered something worth listening to. If the intern really has deceived the university, it may give us a way to save face.”
“What, use the girl as a scapegoat?”
Peter smiled. “It’s too early to tell, but we need to listen carefully to what Ramsey says. We’ll have to stand with our intern unless Ramsey makes the jury believe she’s a real danger to patients.”
“Then what?”
“Emmit, we have to think about the university. That’s what I’m paid to do. It might be necessary, however unpleasant, to sacrifice the intern in order for the university to save face.”
Emmit shook his head. “I won’t enjoy letting her go.” He rubbed his hand through his silver hair. “It doesn’t help that she’s so pretty.”
“Really.” The attorney lifted the corner of his mouth. “I’d like her to be my doctor.”
“Not me,” Emmit scowled. “Give me some ugly old man for a physician. Just let Dr. McCall check me for hernias, and I’d probably have a heart attack right then and there.”
“You’d die happy and you know it.”
The CEO chuckled. “Come on, Franklin,” he spoke to no one in the room. “Let’s finish this recess before I admit something I’ll regret.”
When they returned from the recess, Ramsey stood and looked intently at Claire. “Could you tell me if there is any test available for Huntington’s disease?”
“Yes.”
He chuckled. “Would you tell me?”
“There is a genetic test to determine who will develop the disease.”
“Have you taken such a test?”
“No.”
“Don’t you think it would be prudent to be tested? Certainly you would want to protect your patients should your brain begin to deteriorate.”
Claire risked a glance at Mr. Jones. His gaze was pure steel. With his jaw clenched, he sat forward with his eyes locked on Claire. She cleared her throat and answered the question. “Perhaps, but it is a personal choice I’ve made not to be tested for now. I am not showing any symptoms of the disease, and I am not a risk to my patients.”
“How do you know? Have you been examined by a specialist to determine this?”
“No.” Claire made no elaborations.
“So it is a personal choice?”
“Yes.”
“But shouldn’t you take a test which has the chance to put to rest our doubts about whether this disease could be affecting your performance even now?”
“No.”
Ramsey tapped his fingers on the table. “A private choice? One you’ve chosen not to share with your superiors?”
“Yes. And one that has no bearing on my current performance,” Claire added with her eyes glued to Ramsey’s.
With that, the attorney declined to ask Claire any further questions. He seemed content to have raised the issues, and confirmed his suspicions that Claire’s secret family life might work to his advantage.
“If you don’t mind,” Franklin said, “I would like to ask Dr. McCall a few questions of my own, for the record and for clarification.” He looked at Ramsey, who nodded professionally.
“Dr. McCall, could you explain Huntington’s disease to us?”
Claire nodded and gave a detailed answer.
“It’s a rare disease?”
“Yes.”
“And yet it was you who made the diagnosis of Huntington’s disease in your own father, was it not? And you made this diagnosis of this rare disease during your internship as a relatively fresh young physician. I’d say that shows remarkable diagnostic skill for an intern.”
“Thank you.”
“And when did you become aware of this disease in your father?”
“After I began my internship.”
“And therefore after you filled out those insurance forms that Mr. Plank showed you earlier today.”
“Correct. I filled out all of the forms completely and honestly, with no intended deception.”
“And you’ve made a personal choice not to be tested. Can you elaborate?”
“Huntington’s is a horrible disease, and I’m not ready to accept knowing I would get a disease that has no known cure. I’d rather not know. It’s a personal choice.”
“Help us understand, Dr. McCall. The test would reveal only the presence or absence of a gene which could cause a disease in later life, is that right?”
Claire nodded.
“Answer verbally for the record.”
“Yes.”
“So, since the disease cannot be cured, the test, in effect, would have no ability to change destiny, is that right?”
“The test changes nothing. It only tells me whether I will later get the disease.”
“So you’ve made a personal choice. But of course, if you had signs of the disease, you’d get tested to avoid any concerns about your ability to care for patients?”
“Of course.”
“Dr. McCall, I know you are a humble woman, but would you please tell me about your recent board preparation exam which is given to residents in training to ready them for the American Board of Surgery exam?”
“Sure. I scored in the ninety-second percentile of all surgery residents in the country.”
“All surgery residents? Certainly you mean among interns.”
“I mean among all surgery residents, even chief residents in their last year of training.” Claire smiled. She had been coached well. “Would you like to see a copy of my test scores?”
“That won’t be necessary.” He paused and looked at Mr. Plank and the plaintiffs, before gazing back at Claire. “Tell me, Dr. McCall, is there any way a person with Huntington’s disease could pull off an exceptional score like t
hat?”
“Absolutely not.”
Franklin nodded and looked at Ramsey. “I have no further questions.” He leaned over and whispered to Claire, “That should keep him from harping on your family history at trial.”
Next, it was Franklin’s turn to examine Celia and Roger Jones. When he suggested that he needed to ask a few questions, Mr. Jones shifted in his seat. “We aren’t on trial here,” Jones barked.
“But there are important issues that need some clarification,” Mr. Peters responded, looking at Mr. Plank.
Mr. Jones huffed and shook his head. Ramsey leaned toward him and whispered. Claire could see Mr. Jones opening and shutting his fist as if he were ready to enter a boxing ring. Finally, she heard him respond, “Okay, okay, but make sure you realize I don’t like this.”
Mr. Peters was gentle and apologetic. He spoke to Celia first. “Mrs. Jones, I know this must be very painful for you to talk about, and I’m sorry to have to bring it up, but I need to ask you a few questions.”
Celia looked down and nodded.
“Mrs. Jones, you have heard the previous testimony of the expert witnesses involved in defending Dr. McCall and Lafayette University Hospital. You understand that the extensive liver trauma suffered by your little girl is associated with a high chance of dying.”
Mrs. Jones stared at the table.
“Mrs. Jones, you do understand that, do you not?”
“Yes,” she said quietly.
“And you understand, again from expert testimony, that the complication of air being pulled into a central intravenous line is rarely a fatal event.”
“But it can be fatal, you know that too, Mr. Peters.”
He nodded quietly. “I know. But there is a critical question at stake here. In order to find my client guilty of malpractice, we have to prove that my client’s actions deviated from the standard of care, and that if a deviation occurred, that deviation resulted in harm to her patient, your daughter, Sierra.” He paused. “It is a horrible experience to lose a loved one. I can’t imagine your sorrow. But it is also a horrible experience to be accused of causing such a horror. And there is a way to have determined for certain whether your daughter died from liver trauma directly, or whether the disconnection of the IV could have contributed. An autopsy could have been performed.” He lifted his hand toward Claire. “And then we’d know for sure. But as it is, the question remains unanswered.” He turned to Celia Jones. “Is it true that Dr. Overby approached you to request an autopsy examination of your daughter?”
