Shoot Not to Kill

by Daniel L Stephenson

  “And how did you place personnel into my hospital without my knowledge? I have nearly two thousand people employed in this hospital, and it is extremely critical to every agency that has oversight on us that we know who has access to this hospital. Your operatives,” and with this she looked at Colin and Michelle, “could very well have violated some extremely critical mandates under which we must operate.”

  “Ms. Yost, do you recall a meeting of the board of directors a few months ago that was offsite and with a selected membership? It was a meeting I called, and those members of the board of directors are aware of this operation. It was their determination at that time to keep you and everyone else out of the knowledge pool. Now it is time to bring you in,” Door said. “It was my decision not to involve you earlier. If I had to do it over again I would have brought you in from the first meetings with your board of directors.

  Ms. Yost walked away, looking down at the carpet. She turned and said, “The presence of someone in the hospital had been hinted at to me by several sources, and I elected to know nothing about it. Now it appears I’m being pushed into the “pool” as you call it. Tell me what you are up to and why.”

  “OK, do you want the whole story, or just the high points?” Door asked.

  “Oh, tell me it all,” Ms. Yost said as she started making coffee.

  “I’d sure like a cup of that coffee, Ms. Yost.” Door said.

  “I’m Lynda, if I’m in on this, and I’ll make plenty.”

  Derek turned to Michelle and said, “Michelle, will you brief Ms. Yost?”

  Michelle pulled a chair out and sat. “My name is Michelle. I have worked for the LAPD for five years, four as an analyst and one as a field agent. The work before was in the analytical branch, where I had to do many activities that were important, but pretty mundane. One such activity was personal inventory. I came across a vial of Acozil from a decedent. It was a curious finding. We traced an adulterant in this vial and found it was atropine. This is an unusual chemical to put into a vial of Acozil, but after doing some intensive stumping, we came across one anesthesiologist that routinely adds a minute amount of atropine to her Acozil vial. She works here.”

  Ms. Yost laughed lightly and said, “And that’s a crime?”

  “No, ma’am, it is not, but it may be connected to a series of crimes. I approached this doctor that routinely mixed atropine with Acozil for anesthesia. I asked her how she would have lost a bottle of Acozil, and initially she was extremely cautions and did not want to discuss this. I eventually gave her enough information that she confided in me that the hospital had been having problems with these chemicals disappearing from the anesthesia carts, and it was to the point that she requested and received special locks, which seemed to have cured the problem. I came in working undercover with her as an assistant. My name was Shelly within the hospital.”

  Ms. Yost poured coffee for herself and Doreveck, delivering the coffee and sitting across from Michelle.

  “We went one more step. LAPD employs a hacker, and we asked that he do a perfectly legal review of the last two, four, six, twelve, twenty-four months, and, finally, twenty years back. He used a very powerful and mysterious commercial software program that made inferences and determined patterns. The data we plugged in were wrong for many runs, but finally we identified a pattern of increased numbers of attempted homicides within the area that this hospital serves. The vial of Acozil was found a mile from where we are. This led me to your file room where we had to get data for admissions and discharges. These data were very difficult to acquire, but eventually we employed an agency that had legal access to your files, and we found a pattern that correlated with these increased attempted homicides. The pattern emerged from the thoracic trauma admissions. These patterns eventually lead us to a physician who you have as a surgeon here. He is—” Michelle started to say.

  “Dr. Stanley Morris Bishell, chief resident in thoracic surgery,” Ms. Yost said as she slapped the table top with her palm.

  Michelle was stunned. “Yes, that’s right. How ever did you guess?”

  “Two things I can say. One is that the auditing agency that reviewed our trauma coding did so under the most unusual pretexts that it caught the eye of one of the coders here in the hospital. This coder took her suspicions to her boss, and her boss brought these concerns to me. This coder noted that the survival rate until discharge data for providers had a spike. It was the code for gunshot wound, chest. What she really noted was that Dr. Bishell was the senior resident on nine out of every ten cases of high velocity trauma to the chest. I discussed this with the senior staff of the cardiothoracic surgery department and their comment was, ‘Residents are supposed to live here, so why is it surprising that one does?’”

  “The second thing, Ms. Yost?” Derek asked.

  Ms. Yost stirred her coffee for a few moments and then answered, “We have close to eight thousand admissions and as many discharges here at this hospital every year. We recently were recognized in the National Residency Board as having one of the best cardiothoracic residencies in the country. Quoted in this recognition is the fact that we had turned the number of thoracic gunshot wounds surviving to discharge around in three years. In the last three years we’ve had no turnover of staff of significance. We have had no change of address to a more violent neighborhood. We have had many times the usual number of gunshot wound, chest than at any other period in our existence. We have been looking at these ourselves, but we were looking outside the hospital. What did you find?”

  Michelle turned to Colin and said, “This is your part of the case, Colin.”

  “We have been looking at those data as well. When Michelle established the atropine link to your hospital, we all started working on the Diamond Miner to find out why the vial was at a crime scene,” Colin began.

  Ms. Yost smiled warily and said, “We use the Diamond Miner here, too. As a matter of point, it is the tool that does our case internal auditing and control, but we digress, go on.”

  “The Diamond Miner was tough to get gems out of for many parameters. It wasn’t until our miner decided to run the analysis against discharges for thoracic trauma. The geek that does the data work for the Miner ran it against every variable he could come up with, and your hospital hit a peak for white, middle-class males who had insurance. This was a field that demonstrated a surprising result. There were other fields that could not show anything statistically significant above the violence of the city, except insured victims, and your hospital was a singular spike. That is what brought us here. The reviews by the peer review organization lead us to Dr. Bishell.

  “Michelle has been following Dr. Pengill for two months and was on a case tonight that fits the Miner’s parameters. We’re getting more information on the pre-hospital phase of this case now to see if it fits. We’ll be analyzing the blood samples drawn in ER for Acozil and atropine. We will also be going to where the paramedics picked him up, etcetera. But we get complicated now that our investigation is within your hospital.”

  Derek began pacing and said, “We followed the index into surgery. Michelle was posing as a student and accidentally dropped her handcuffs. Dr. Bishell thought it was a surgical instrument and eventually saw the cuffs. He shot out of the surgery room and we suspect he broke into Michelle’s locker within minutes of getting out of the surgical suite. We think Dr. Bishell picked up Colin and Michelle’s trail and followed them from the locker room to another floor. We cannot find Dr. Bishell now, and we do not have enough evidence to get a warrant for him, nowhere near. I’m getting a search warrant now, and the plan is to search his apartment and his car. The car may be too late, but we’ll do what we can.”

  “Meanwhile, Detective Doreveck, I have responsibilities to the patients and the staff. This means I need to bring in the senior physicians on credentials and determine if we have heard enough from you to place Dr. Bishell in abeyance for privileges of surgery,” Ms. Yost said as she twirled her cell phone on the table.

/>   “I don’t pretend to understand what you have to do,” Derek began, “but I can say that presently, we have a pretty weak case. This is Saturday night. There are things we need to do tonight and tomorrow, not the least of which is get a statement from Dr. Bishell and get samples for analysis from his body to see if he’s discharged a weapon. To do this we need reasonable degrees of suspicion, which frankly we may not have as of yet. Numbers are there and a pattern, but still just numbers.”

  “Mr. Doreveck, I cannot allow Dr. Bishell privileges with the suspicions you have already developed. I will need to take action, and as long as I am doing this, you must know about it because the whole hospital will know. Few will care, but some will want to know the whole story, and we’ll see it in the papers in six hours. I suggest we get things rolling now. In that vein, what else can we do to help?” Ms. Yost asked.

  “We’ll need to go over the last few cases that Dr. Bishell did the surgery for, maybe the last ten. Then we’ll need to start an investigation at the sites those ten patients came from, and finally we’ll need to establish that Dr. Bishell was at one of the scenes. With those associations, we can make our move,” Derek said.

  “The medical records are secure. I’ll need legal to tell me what you have to do to get legal access unless you have a warrant, and legal will be involved, nonetheless. I’ll need to pull Bishell’s privileges, Derek. That will happen within the hour, and any order that is entered on the HIMBox will be rejected. That’s the computer entry device we have all throughout the hospital. This may or may not be an obvious change to Dr. Bishell, as you’ll find junior residents do most of the order entering at his direction. But if he writes an order, it will flag and fail. This will start a cascade for your investigation, I suspect. I might need your input for my senior physician staff when I drop this, so how can I reach you?”

  “Call this number,” Derek said as he pulled his badge case out, looking at Michelle as he fumbled through a pile of personal cards and information. He gave Ms. Yost a card and added, “This is the dispatch operator. Ask to talk with The Door. They all know me, and if someone doesn’t, name’s on the card. At your service 24/7.”

  “Thank you, Derek,” Ms. Yost said as she placed the card in her cell phone case and stood up. “I want this cleared as soon as possible, but what connection do you suspect with the drugs and his surgery?”

  Michelle stole a quick glance at Colin and said, “Ms. Yost, we think Dr. Bishell is inflicting these wounds in the effort to create cases for himself. We’re trying to connect him to the crime site and then through the care of the patient.”

  Ms. Yost paled and sat down again, and then in a quiet voice said, “You have to be joking, no, no. Of course, you’re not joking. Do you realize what this will do to our hospital’s reputation?”

  “Ms. Yost, your board of directors understood that, yes,” Derek said.

  “That would explain recent decisions by some board members.”

  “What decisions are those?” Derek asked.

  Ms. Yost bit her thumbnail for a second and then continued as she brushed her hand on her jeans, “We have a board of directors that has been stable for many years. There are a few benefits they enjoy. Recently, five of the nine members of the board terminated their services and are now unaffiliated with our hospital after many years of service. Two said retirement was pending, two for health reasons, and one said she was moving. Unbelievable. Derek, were these members placed on a gag to not discuss the investigation?”

  “Yes, ma’am. We interviewed them three months ago telling them only that we had concerns for a pattern of attempted homicides from outside the hospital that required an internal investigation. They knew no more than that, but apparently that was enough to concern them enough to terminate their affiliation with the hospital,” Doreveck answered.

  “Yes, it would also explain why the hospital’s retained counsel has resigned. Well, I’m the last to know, and I’m the one to fry for this. Why did you not come to me?” she asked, looking at Derek.

  “Lynda, you would have had to get concurrence from the board of directors to allow the investigation, for one thing. The second reason we could not come to you is that there exists a complication that we have not shared. Dr. Bishell has been dating your daughter, Ms. Yost, or at least they have met on a few occasions. We only picked up on this because we followed him outside the hospital on several occasions on our first attempts to be onsite when Bishell acted. We are glad to say there was no association to criminal activity when your daughter met him. Were you aware of that activity?”

  Ms. Yost looked coolly at Derek and asked, “How familiar are you with the relationship my daughter and I maintain?”

  “We did not know she was your daughter until we followed the two of them on a date. They took your daughter’s car, was registered to your address. We checked her out and discovered her name was Yost. The association with you was gleaned when Michelle met with your daughter to ask questions concerning Dr. Bishell. Your daughter has been deposed, so she is under a gag for discussion, and has not been out with Clinker since,” Derek said.

  “Who is Clinker?” Lynda asked.

  Colin spoke up, “We’ve been using Clinker as a nickname for Dr. Bishell. It came from one of his famous lines in the operating room, something about loving to hear the clink of bullets in a stainless steel pan. We actually read that line in two of his charts that we’ve managed to see. I guess he makes a big show of dropping the bullet into a stainless steel basin after the surgery just to hear it clink.”

  “Colin, my background is HIM, health information management. I was here in this hospital when we had pneumatic tubes that moved pieces of paper and material throughout the hospital. I know records. I know the law, and I suspect you had no authority to be in those records. I do not want an explanation, but someone eventually will want an explanation if that statement is made publicly. It is unusual for me to advise LAPD’s finest, but I will advise you all that I can if I see situations that will cause you to lose this case if they were discovered by counsel for the defense. Whatever are your resources to keep you on the straight and narrow, you had better do so,” Lynda said as she stood up.

  “Advice taken,” Colin said as he looked at Michelle.

  “My daughter has only recently returned from Atlanta, and I’ve not seen her but a few times. She was with me at the residents’ welcome, several months ago. That would likely explain where they met. OK, I need to start my processes,” Ms. Yost said.

  Michelle spoke up, “Ms. Yost, the records were reviewed by me, and the fault is mine. I posed as a coder for your hospital for two months to get early data. It was what first confirmed the connection here, but the coding department let me go for errors in coding, which I must say is the most confusing and difficult thing I have ever done.”

  “What you did, then, Michelle, is break the law yourself. If I were counsel, I would have this case blown wide open now. Bishell may never work as a doctor again, but he would never go to jail.”

  Derek cleared his throat and said, “Ms. Yost, I’ve not been entirely frank with you. Michelle’s placement in your coding department did have legal backup, and occurred three months ago. That time line, if you follow our earlier discussions, lines up nicely with the board of directors meeting. They are under gag, but we can bring them in with you now. That brings up another point. You will also have a gag order. The board placed Michelle with the inference that she was related to one of the board members, and the appointment was a summer hire.”

  “You folks have been busy. Michelle, if your discovery was covered as such you’re OK as far as I know, but you should still be careful. I need to pull in my credentialing committee, and they will demand evidence as to why they must do the very serious action of modification of credentials on one of their physicians. I must have Dr. Bishell out of patient care until this has been entirely cleared up. What can I tell the credentials chairman?” Lynda asked as she gathered her phone and notes.
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  Derek scratched his head and said, “At this point, I would suggest telling him or her that Dr. Bishell is under investigation of aggravated assault with a weapon, and it might involve as many charges as twenty-three. That is the number of insured, white, male gunshot victims that our Diamond Miner came up with during the time Bishell’s been here, and how may cases Michelle was able to identify.”

  “So I go to the credentials committee with assault on white males that become his own patients. Wholly buckets, as they say in the Midwest. Thank you. I need to start my legal requirements on this now, and it appears you have things to do, as well. What do you suggest I do with Dr. Bishell after I suspend his privileges? He is a very highly paid member of our staff and will be idled by these allegations,” Lynda asked as she stood, straightening her jeans and pulling Derek’s card back out of her cell phone case.

  “Ms. Yost, I would suggest that is a question for Mr. Crawford and your senior staff. I hope to have a collar on him within the week, but suspect your suspension of his privileges will be enough to make him a risk for running. That will make things much more complicated. We’ll have a fugitive on our hands,” Derek said.

  “I will need to meet again with you tomorrow. I’ll tell you the credentials committee’s actions. Michelle, the authority for you to be in the computer system sounds intact. Were there limitations to time and data that the board authorized or you requested?” Lynda asked.

  “I am not sure, Ms. Yost. We can check from our side. Why?” Michelle asked.

  “I would like to have those twenty-three cases for peer review within the hospital, and I need them as soon as possible. I would suggest you pull your data miner over here and get him digging tonight. I will need those cases by tomorrow, I’m sure.”