Corruption in the Or

by Barbara Ebel

  Bobby slipped his hand up and tapped the OR bonnet they’d put on his head. “Damn good thing you put this hat on me after making me ditch my hair piece. I wouldn’t want any of my girlfriends to see me like this.”

  Susan smiled at Viktoria and secured her patient’s arm to the arm board. “Does your wife know about your girlfriends?”

  “Nah, I’m only kidding.” His voice trailed off as Susan fed him another cc of fentanyl.

  Viktoria scanned the work area and Bobby’s vital signs one more time. “Looks like we’re ready to go.”

  “Thanks, Dr. Thorsdottir.”

  “I’ll be back.” She scooted out of the room and, with a break in the action, headed for a quick cup of coffee.

  -----

  Jeffrey Appleton sat down at his desk, and leaned forward over his computer screen. He had a pile of work to dive into on Tuesday morning, but there was also the priority of Dr. Thorsdottir’s anesthesia billing slip that she had found in Jay Huff’s office, a copy of which she had emailed him yesterday.

  He opened up his hospital Gmail account, printed out two copies of the email and, without delay, went to the corporate offices on the top floor of the hospital and waltzed into the billing office.

  Jeffrey knocked on the department manager’s open door as the woman looked up and waved him in. He always figured Sarah Wentworth’s sculpted breasts were the work of a plastic surgeon. He approved of her professional attire—her tailored beige skirt and jacket were more upscale than most of the women’s attire in hospital administration.

  “Good morning, Sarah.”

  “Jeffrey, to what do I owe the pleasure?” She stood and undid the breast button on her jacket, revealing a silky white blouse. As she pointed to the chair in front of her desk, she wore a full smile.

  Jeff’s light brown eyes acknowledged her as he remembered her often flirtatious behavior when they met. He wasn’t in the mood nor was he interested, but he didn’t want to be discourteous either.

  “Perhaps you can help me out with this anesthesia record for billing,” he said, handing over the copy and declining her chair. “Was it filed with the outside anesthesia billing service for payment? Can you check for me?”

  “It must have been a long, involved case for you to show interest. We try to leave no bill unpaid, so I hope to inform you that reimbursement was fine.”

  “I don’t doubt you do an excellent job. I’m actually wondering if somehow the charge slip was lost in a shuffle between the OR and your office, which means it never went to the outside agency.”

  Jeff didn’t take a seat, so she stayed standing and glanced at the sheet.

  “I will find out immediately. As soon as you leave, I’ll fax this over to the person-in-charge to investigate. After all, if one billing slip fell through the cracks, who knows how many more do the same thing?”

  “Precisely, that’s what I’m worried about,” he said with a frown and turned. “You have my number.”

  Sarah’s gaze followed him out the door. She wished she could use his number for something other than business.

  -----

  Jeffrey went back to his office, returned phone calls, and dug into one small pile of work. An hour elapsed before he felt the need for a second cup of coffee, so he stretched and headed to the doctor’s lounge. Several physicians were at the tables and counter and the television played the local weather.

  With a couple of nods and “good mornings,” he poured coffee into a hospital mug and spotted Viktoria in a soft chair. The surgeon she’d been talking to got up and left, so Jeff walked over.

  “Dr. Thorsdottir, may I?” He pointed to the empty chair.

  “Of course.”

  “Did Buddy sleep as well as Mattie last night?”

  “Based on the number of twitches in his sleep before I fell asleep myself, I’d say so.”

  Jeff placed his cup on the side table between them and rolled up his sleeves. “Ha. Mattie jerks around in her sleep like she’s got firecrackers going off in her legs.”

  “That sounds disruptive. How is your day going so far?”

  “Fine, but you’re the one with the more important responsibility of putting people to sleep and waking them back up again. If you do something wrong, it can be catastrophic. If I goof up with something on my agenda, no one will be paralyzed, narcotized, or not wake up because of it.”

  “I’ve had lots of training just like you in your current business profession which hinges on your clinical years. And as you know, I don’t always render general anesthetics. Right now, a man is having his knee replaced under an epidural. It’s the perfect anesthetic for the case.” She smiled and nodded.

  “I take it you enjoy doing regional anesthesia. You don’t smile a lot, and you just expressed your pleasure.”

  “Don’t smile a lot?” She tilted her head, and knew that to be true, but wondered how he would respond.

  He widened his smile and took a few seconds to consider her. “In my opinion, you are not an unhappy person. However, you carry a serious expression on your face quite often. Maybe you adopted it during childhood, from the rugged environment you grew up in.”

  “I never break down with laughter like some folks do, and I certainly worked hard as a child. Not unlike some kids in the U.S. who grow up on farms and ranches and get their hands dirty on a daily basis. You're right, though. I only hope I’m not too staid or gloomy.”

  “I bet your husband doesn’t think so.” He raised his coffee cup and took a sip.

  “Often his perception of things is altered, so I don’t know.”

  He wondered what she meant, when his cell phone rang. With a nod, he waved his finger in the air, acknowledging a call he was waiting for. “Sarah,” he said, “anything to report so soon?”

  “Of course. I tracked that anesthesia slip down pronto. But, in other words, there’s no record of it being submitted. It was never sent to billing.”

  Although he suspected the news, he still gritted his teeth at the truth. “Nice work, Sarah.”

  “You’re welcome. They are also going to go ahead and bill for that case.”

  Jeff peered over at Viktoria. “I can tell you the results. It won’t get paid because it’s been sent in for payment already.”

  “What? By whom? Jay Huff?”

  “Give me a few days, and we’re going to have to put our heads together about this. I may need to bring this to the attention of Cathy Banker.”

  “If you’re talking about bringing this to the attention of the CEO, then I’m with you.”

  “One shady ‘lost’ reimbursement is one thing. I’m going to follow up with you again tomorrow about the possibility of more.”

  “I was hoping we could work closer together,” she said, her voice flirtatious.

  Jeff frowned, his brown eyes still on Viktoria, and he ignored her remark. “Talk to you tomorrow.”

  “Was that about what I thought it was about?” Viktoria asked.

  Jeff leaned over, and lowered his voice. “Yes. The billing office checked on the information you sent me. They have no record of that case being submitted for payment.”

  “I hate to hear that. I was hoping it was not true. Means we should check on what happens with the case slips tonight.”

  “Exactly.”

  The door opened, Jay Huff strutted into the lounge, and veered straight for the donuts.

  “Buddy gets his stitches out today,” she said, changing the subject. “I am like an excited kid wanting him to earn a clean bill of health on his back leg. He’s become so important to me. I should have had a dog before now.”

  “But then you wouldn’t have had Buddy. Specific dogs come into our lives when and how they are supposed to—when we both need each other the most. And you have been a God-send, caring for him the way you do.”

  Viktoria became emotional. She nodded and took a big breath, clearing the sentimentality she felt for the dog.

  “Thanks, Jeff.” They both rose and, carrying his c
offee along the way, they parted outside his office.

  -----

  The first person Casey earmarked for a morning break was his own wife. Most surgical cases were underway, and without a prompt from Jay Huff to begin breaks, he went straight back to the OR rooms.

  He slipped into OR 9, where Jennie was settled at the head of the table with a general anesthetic underway for a lower leg debridement of a diabetic. The surgeon was engrossed with removing the dead skin and tissue and chatted with the tech about the little care his patient had taken to prevent the infection in the first place. He wiggled between her and the anesthesia cart and crouched down.

  “I came to give you a break first,” he said softly.

  “Being married to the floater has its advantages,” Jennie joked. “What did you find out in the ICU about Fred?”

  He gave a disapproving shake of his head. “That damn idiot overdosed on our drugs. He’s on the ventilator, and it gets worse than that. Two cop types with ‘DEA’ on their shirts came walking out of the unit when I went in.”

  Her smile faded. “Perhaps that’s just a coincidence and has nothing to do with Fred.”

  Casey looked at her like she had three heads. “Are you injecting yourself with drugs too?”

  “Shh. Just keep your cool. Why don’t we lie low for a while while this blows over?”

  He grimaced and rose. “Give me the rundown about the patient and take your break.”

  Jennie rattled off the pertinent information about her fifty-eight-year-old diabetic and his anesthetic care. Casey studied the syringes and vials on the top of her cart.

  “What can I take from here?” he whispered. He picked up a 2 cc vial of fentanyl and a 2 cc vial of midazolam.

  “Are you crazy? Didn’t you just hear me?”

  He didn’t like her telling him what to do. It was his original drug operation and scheme to pay the low lifes working at his rental properties with IV injectables and the left-over furniture and remnants from abandoned units instead of cash or salaries. Most of his workers used the drugs themselves, but if they were secondarily passing them on or selling them, it didn’t matter to him.

  Besides, he thought, many of them didn’t know his real name or that he worked in an OR—which was the source of the pure, non-doctored drugs that he paid them with. His actions were too slick. He received a chunky big salary as a CRNA, but his sideline because of that profession, in essence, paid him even more. Double dipping was the way he saw it and, to qualify, he had only needed to graduate from nurse anesthetist school.

  Jennie bumped his elbow, waiting for a response. She was adamant about him not continuing to pocket drugs until the heat of the situation went away.

  He glared at her and became increasingly annoyed. Many of the fine things in her life were due to his illicit dealings.

  “Go,” he said. “Take your break before I change my mind and go give someone else a break.”

  “You wouldn’t dare.” She grabbed her cell phone from the cart, stuck it in her pocket, and eyed the drugs before stepping away. There was a strong chance her husband was going to steal them anyway, she thought, and realized he was more addicted to the art of robbing sedatives and narcotics than his workers were hooked on the substances he provided.

  -----

  Viktoria went into her total knee replacement room where the orthopedic surgeon was full swing with tools and implements over the patient’s bent knee. She swiped her eyes over the surgical field to evaluate the patient’s blood loss, and found it to be minimal because of the adequacy of the tourniquet on Bobby Glade’s upper leg.

  “How’s he doing?” she asked Susan.

  “Very well. He’s healthy for his age which helps enormously.”

  “Why don’t you go take a morning break?”

  “Are you sure? Casey Johnston is the floater. He may be by soon, especially since I’m the oldest CRNA in the group, and he knows my bladder doesn’t last like the rest of them.”

  “I’m free at the moment. Please, go ahead, use the restroom and grab a drink and a bite to eat.” If she could, she wanted to give her own CRNAs a break and keep Casey out of her rooms.

  “All right, Dr. Thorsdottir. Appreciate it.” She ambled out of the OR and Viktoria turned her attention to her patient. Mr. Glade was nicely half sleeping with the nasal cannula oxygen in his nostrils and unaware of the major work being done on his knee.

  After five minutes, Viktoria sat down. Her phone had dinged earlier, and she checked to make sure it wasn’t work-related. A message had come in from Rick, only letting her know that he was potentially doing something.

  “Someone contacted me and is sending pictures of three pricey paintings for my upcoming online art auction. I should make a pretty commission on them! Insurance business slow the last two days. How are you and how’s the dog?”

  She never, ever answered personal text messages while caring for a patient, so she put her phone back in her pocket. Rick knew that as well, and, for sure, he didn’t necessarily expect an answer. He was just letting her know that he was doing a half hour’s worth of work today, she thought, and grimaced.

  Susan Rust came back in another ten minutes and Viktoria left with only one thing on her mind. It was time to find out if Evie, the laboratory director, had the results of the syringe’s contents she had left with her the day before.

  CHAPTER 29

  The clicks and buzzing of machines in the laboratory reminded Viktoria of cicadas rubbing their wings deep in the forest. She looked up and down two aisles and found no employees. Finally, she heard a voice.

  “Dr. Thorsdottir,” Evie said. She approached from the side and pushed back her streaked gray hair. Her expression stayed serious as she shook her head.

  “Now I understand why you wanted the fentanyl syringe evaluated. There’s not a trace of narcotic in it. The syringe contained Lactated Ringer’s solution, your OR standard fluids.”

  Even though Viktoria anticipated the result, she shuddered. Her heart thumped against her chest thinking of the sheer devilishness of diverting pain relief away from a patient for some sinister, narcissistic motive.

  “I wasn’t ready to hear that.”

  “Who would be, if I’m assuming someone is playing tricks in the OR?”

  “Can you please document our encounter? It may serve as some kind of record that I at least came to you for an analysis.”

  “Sure. Give me your email address and I’ll send you what transpired between us.”

  “Appreciate that.” Viktoria turned on her heels and left, but outside in the quiet hallway, she leaned against the wall. Casey Johnston was a thief and, quite possibly, so was his wife. It was one thing for a person to steal something they shouldn’t, but in this case, it had a direct bearing on patients. People who put their utmost trust in an anesthetist while they are unconscious and undergoing a surgical procedure. Someone committed to the Hippocratic Oath to ‘do no harm.’ Someone who must uphold the highest moral standards while caring for someone totally dependent on them and everything they do during that critical time.

  Casey’s patients were unaware of their blind faith in him. The more she pressed back against the wall, the more her blood boiled. And what was he doing with the drugs he was stealing? In her opinion, he and Jennie never seemed to exhibit behavior that would hint at being high or sedated with drugs.

  His presence at Fred’s bedside, however, was strange. Her instinct told her his overdose and Casey’s drug confiscations were related. The little DEA man had given her his card, to call if she had any information. Would she be a pest or an inappropriate whistle blower if she called and gave them Casey Johnston’s name along with her suspicions?

  Where she came from, if a person inappropriately cries wolf to a law enforcement agency, they deserve the reputation of a rat—a very contemptible person. She bit her lip, too hard for her liking.

  Damn, she mumbled, before realizing that she was in the perfect position to say something, if something should
be said at all. She was an outlander, not part of the anesthesia group, and the worst that could happen to her was a bad review to the locums agency. There again, the agency would understand her moral dilemma, and her speaking up about the corrupt goings-on would have nothing to do with her fine anesthesia skills. She was also on fine terms with Regina, the woman in charge.

  Screw it, she mumbled for a second profanity in a row. She slipped out the DEA agent’s card and placed the call on her iPhone.

  “Buster here.”

  “Hello again. This is Dr. Thorsdottir. We met earlier today in the ICU at Masonville General Hospital.”

  “Yes, ma’am. What can we do for you?”

  “I hesitated to call for several reasons. My imagination may be working overtime, and I may be wasting your time. I also may be out of line in telling you this.”

  If Buster had learned one thing on the job, it was that a piece of information thought by someone to be frivolous could be the key to a puzzle. “Please, Doctor, I’m all ears. You won’t be out of line, not with me anyway.”

  Viktoria flexed her knee, and put her foot against the back wall. “I am a temporary doctor at the hospital, so I am not a local who’s been working with the OR staff here for a long time. Certain codes of conduct exist for practicing anesthesia regarding the use, accounting for, and disposal of sedatives and narcotics. Working with one or two of the nurse anesthetists, I have had reason to question their behavior.”

  “You have my attention.”

  “From a case yesterday, I had the lab analyze one of these CRNAs syringes which was labeled as the narcotic fentanyl, but the analysis turned up no narcotic at all, only regular IV fluids. The implication is that narcotics are being diverted away from patients and stolen. On top of it, and perhaps an unattached coincidence, this anesthesia nurse seemed to show an interest in the ICU this morning in the drug overdosed patient you visited.”

  “What’s his name?” Buster asked, glancing at his partner.

  “Casey Johnston.”

  Buster pulled out the name that Mason had given him earlier. “How do you like that? The hotel manager also mentioned him this morning. A jack of all trades.”