by Mark Gilleo
“It could cause significant cognitive impairment. But not always.” The doctor paused before asking a question. “Have you ever had surgery, Detective Wallace?”
“Sure.”
“Before any surgical procedure, the patient has to answer a battery of questions pertaining to past drug usage. Alcohol consumption. Prescription medication. The obvious reason those questions are asked is to ascertain whether there is a likely medicinal or chemical composition conflict with current medication and the anesthesia that is going to be used during the surgical procedure. Allergic reactions are a concern, of course, but not the only one.”
“What are the other concerns?”
“Equally important is determining the patient’s drug tolerance threshold. You get someone in the operating room who consumes twenty drinks a day, or shoots up regularly, and it can be difficult for anesthesia to work effectively. When I first started out in medicine, as a resident, we had a career alcoholic come in for surgery. It took four times the usual dose of Propofol, administered intravenously, to render him sufficiently unconscious. And even then, when the procedure was over, this particular patient was able to recall certain details that indicated he wasn’t as incapacitated as we like when we perform invasive surgical procedures.”
“So you’re saying that, potentially, a patient could be using the morphine lollipop and be in full control of their faculties.”
“Hypothetically, yes. It depends on the individual.”
“What are the other side effects of Fentanyl?”
“The lollipop version, as you call it, tends to rot the teeth. Fentanyl, in general, has other side effects. It can cause the shakes. It doesn’t react well with some asthma medications.”
Wallace scribbled in his detective’s notebook. “Changing gears a little, I was wondering if we could ask some questions about the procedures of this office?”
“In the hope of solving a bank robbery where you’ve already apprehended a suspect?”
“Actually, no. We’re looking for information that could aid in several open criminal investigations.”
“Sure, though I’m not sure how I can help,” Dr. Smithson answered, leaning back in his chair.
“You’re an oncologist, correct?” Wallace asked.
“Yes.”
“What exactly does that entail?” Emily asked.
“There are several types of oncologists—surgical, medical, and radiologists. Patients often see more than one of us. I am a medical oncologist.”
“Do you perform surgeries?” Emily asked.
“I do not perform surgeries. Typically a medical oncologist employs chemotherapy, as well as other medicinal options, to treat cancer. A radiation oncologist, as you can imagine, employs radiation. A surgical oncologist probably needs no further explanation. There are rare instances where doctors have more than one specialty, and there are oncologists who specialize even further within a medical field. For example, gynecological oncologists are pretty prevalent.”
“Would you treat someone who has both a brain tumor, and let’s say, ovarian cancer?”
“I can treat all cancers, but my specialty is the GI tract, liver, pancreas.”
Wallace wasn’t sure where to take the conversation next and Emily stepped to the plate for a swing.
“Who in the medical profession would have access to records across different patients with different cancers?”
“Well, electronic medical records were mandated a couple of years ago, so if someone has access to the system they certainly could piece together a patient’s history.”
“So if I want to know Daisy Duke’s medical history I could look her up in the system and see the history of her treatment.”
“That is the implied usage, correct.”
“And what if I wanted to do that with more than one patient? What if I wanted to know all of the Daisy Dukes out there who have recently been diagnosed with cancer?”
“That is a different question. Medical records don’t work that way. Well, not exactly. For example, I can’t search for all males with prostate cancer in the United States in the last year. That is not what the medical records are designed to do. There are different hospital systems that share information but there isn’t a national medical record system. Not yet anyway. In addition to the cost of such a system, there would be no reason for a medical doctor to access information on that level, outside of research, which a typical doctor with patients wouldn’t be involved in.”
Wallace looked at the doctor and then over at Emily.
The doctor continued. “This is how medical records work: If the medical records have been entered properly, we can search for patients by name, address, social security number. Most insurance companies have a member ID number as well. But unless I’m missing something, you are asking about a general search for all cancer patients.”
“Yes, we are. Specifically, we are wondering if there is a way to obtain a list of all terminally ill cancer patients in a given area.”
The doctor scowled as if the sudden gravity of the questions the detectives were asking moved from theoretical to reality. “Why would you be interested in that information? Why would anyone outside of medical research be interested in that information?”
Wallace nodded at Emily. “We have reason to believe that someone is targeting terminal cancer patients for various illegal reasons.”
“Identity theft?”
“Sadly, no. We believe someone out there is interested in people with cancer who are still alive. Specifically, we believe someone is hiring terminally ill patients to conduct criminal activity. Perhaps even murder.”
“I see,” Dr. Smithson said, his face showing disgust at the prospect of the notion shared by the detectives. “Very perverse.”
“Can you imagine any way that someone could identify multiple terminally ill people with potentially different types of cancer?”
“Hmm…”
“Put yourself in the mind of a criminal.”
Dr. Smithson squinted. “Well, if you wanted to identify potential terminally ill patients, you could always stake out an oncology office. Our waiting room has a large number of such patients. Another alternative would be to find a cancer treatment facility. Identify a radiation or chemical therapy location and try to determine who is ill based on who is receiving regular treatment. It would be traditional detective work, I imagine, but it could certainly be accomplished.”
Emily and Wallace both nodded their heads in silence. Wallace jotted notes in his detective notebook.
Emily asked another question. “How many people have access to medical records that would allow them to search by name, social security number, whatever?”
“In the country? A lot. I think the most recent count put the total number of medical doctors in the US in the neighborhood of three hundred thousand. Of course, not all of them would have access to electronic medical records. There are MDs in a lot of different fields that don’t deal directly with patients. Education. Research. Conservatively, tens of thousands of people could have access to a single patient’s medical records.”
Wallace stroked his chin and then backed up to a simpler question. “Doctor, how do you know a patient has terminal cancer?”
“We perform tests and do a biopsy.”
“You take actual tissue samples and test them, yes?”
“That is correct.”
“Do you do that here?”
“Initial diagnosis is done in a lab down the street. If that diagnosis is determined to be positive, or if there are extenuating circumstances, or if the results indicate the possibility of a particularly aggressive form of cancer, then additional tests are ordered.”
“What do the additional tests tell you?”
“They confirm the original test results as well as provide insight into the nature of that particular cancer, if available.”
“Where is this follow-up testing done?”
“We send most of our follow-up biopsy t
issue to Johns Hopkins in Baltimore.”
“How many other doctors use this same center?”
“It’s one of the major biopsy evaluation locations in the country. Thousands of doctors and hospitals use it.”
“So, hypothetically speaking, if I wanted a list of people who were recently diagnosed with terminal cancer, Johns Hopkins would have the list.”
“Well, I don’t think they keep a master list, per se. But they would have that information.”
“For different types of cancer?”
“Yes. Breast. Ovarian. Brain. Prostate. Colon. Pancreas. You name it. But Johns Hopkins is a massive facility, with different departments of specialization. It’s not as if there is one person sitting behind a desk who gets a list of all of the tissue results and then stuffs envelopes and licks stamps.”
“They don’t use snail mail?”
“When you’re talking about stage four cancer, time is not a luxury expended on the United States Postal Service.”
“So how do you get the information, the actual biopsy results?
“If the news is dire, they will call. Followed by a fax. Updates in the electronic medical system may not show up until a day or two later. Could be a week if there’s a backlog.”
“Can you give us the address of the lab at Johns Hopkins that provided the results for Amy Conboy?”
“The office staff can provide that information to you.”
Chapter 42
Accordion folder in hand, Dan strolled through Alexandria, home to more nonprofit organizations than any other jurisdiction in the world. Offices, large and small, littered the old streets where history seeped from the cobblestone and brick sidewalks. In the first half of his walk, Dan passed the headquarters for the Salvation Army and the United Way. On the far side of the block, he passed the main office for the guys who drive the little cars in figure eights at the Memorial Day parade.
Dan checked the address on his phone, looked up at the door without a name, and pushed his way inside. He climbed a narrow staircase and turned the corner into a small waiting room on the second floor. The sign over the paper-filled reception desk read The Carry On Foundation. The sound of the door shutting behind him lured the receptionist from her location in another room.
“May I help you?” the elderly woman asked.
“Yes, my name is Dan Lord. I’m here to see Jeanie Simpson.”
“Have a seat, I’ll let her know you’re here.”
Dan sank slowly into the lone chair in the waiting area. The thick burgundy carpet and a large dark bookcase along the wall matched the rest of the room. Dan got the distinct impression the furniture had been abandoned by the previous tenant, which could have easily been a branch of the retirement homeowners association, based on the décor.
Jeanie Simpson appeared at precisely ten and checked her watch as if to prove she was on time. “Good morning, Mr. Lord.”
Dan stood.
“You mentioned on the phone that you’re a private detective and attorney in need of information?” Jeanie asked with genuine curiosity.
“That is correct.”
“Please follow me,” she said, starting down the lone hall. She turned left at the second door and Dan followed her into a small office with additional bookcases closing in on three walls. Dan waited for his host to find a seat at the small table, and then sat across from her, placing his accordion folder in front of him.
“I’ve never met a private detective in real life. But I have watched my fair share of them on television. Magnum PI is still a dream. The Rockford Files. Mike Hammer. Some of those guys were probably on TV before you were born. I’m also a big fan of the CSI shows, which is a little different, I know. But I loved them all—Miami, New York, Vegas. I was secretly holding out for a DC version. I would even take Baltimore.”
“I can’t speak to crime scene investigators, but I assure you private detective work is not as glamorous as it seems on television. No Ferrari. No friends with a helicopter.”
“I’ll take your word for it. Now, how can I help you?”
“I have a couple of routine questions I wanted to ask about your organization.”
“Please.”
“How many people work at the foundation?”
“The Carry On Foundation has locations across the US. Here in Alexandria, we are the national headquarters for the organization and we handle the Mid-Atlantic from Maryland to North Carolina.”
“How many people work at this location?”
“Five. We have a receptionist who answers phone calls and emails. We have a webmaster who handles all of the web activities. Updates to the website. Manages the content. We have a marketing staff of two. They spend time shaking the money branches, if you will. Everyone else works pro bono.”
“Who is everyone else?”
“Attorneys and accountants mostly. We have volunteer CPAs and lawyers in almost every state. We are in the business of setting up trusts for the young children of cancer victims. There are a lot of regulations that need to be followed. The regulations can vary by state, so we need regional volunteers, accordingly.”
“In total, how many employees do you have, countrywide?”
“On the payroll, we have employees here, in the South, the Northeast, Midwest, and West. Five offices, twenty-two employees. Most are part-time. We have twice as many volunteer CPAs and attorneys.”
“How much money does the foundation give away every year?”
Jeanie Simpson paused. “Have you done any research on the Carry On Foundation, Mr. Lord?”
“Just what I read on the website and in the press. But information can get outdated. Things change.”
“I see,” Jeanie Simpson replied. “Well, the Carry On Foundation doesn’t actually give money away. We facilitate the creation of trusts, which are then funded by corporations and individuals. Of course, we do use our PR reach to help influence others to fund these trusts. It is something we do quite well and pride ourselves on.”
“Who can say no to the children of cancer victims?”
“You would be surprised. But we do hold a soft spot in the hearts of a lot of people and organizations.”
“How many people does the organization help in a year?”
“On a good year, we set up trusts for over a thousand unfortunate souls. The amount of funding each trust receives varies.”
“What’s the average?”
“I cannot divulge that information. Donations are made from both public and private sources. What I can tell you is that most of the foundation’s funding—the money that pays rent and salaries—that comes from corporations and other organizations.”
“Can you walk me through the steps for establishing a trust by the Carry On Foundation?”
“Sure. As I mentioned, establishing the trusts is all handled by accountants and lawyers. Every T is crossed. Every I is dotted. We open the trust and provide a webpage where donations can be made to the trust through an independent financial institution. The foundation doesn’t handle the money. We merely provide a channel for the money.”
“How do you decide who will receive assistance from the foundation in setting up a trust? I mean, there are a lot of people with cancer who have children.”
“Most of our trust recipients are identified through nominations.”
“Meaning what?”
“Meaning that someone who has passed away, from cancer, is nominated to have the Carry On Foundation open a trust for them. If a proposed recipient fits the bill—and meets the standards of good-standing set by the organization and its bylaws—they will be considered for the establishment of a trust.”
“What are the standards of good-standing?”
“A clean police record. No known drug or alcohol issues. Financial need. Once we receive a nominee, our attorneys perform some due diligence and determine their validity.”
“So potential trust recipients are received by nominations and they are paid through money from corporations o
r anonymous donations from individuals.”
“Not exactly. The recipients are deceased, so they aren’t paid anything. A trust is created for their children, which can be funded.”
“Excuse my inaccuracy. Who can nominate an individual?”
“Virtually all of our recipients are identified through existing relationships.”
“For example?”
“We have relationships with churches, hospitals, hospices, local companies, other nonprofits, social services. Our corporate sponsors also nominate their own employees from time to time. But there is no favoritism. Everyone is vetted in the same fashion.”
“And how do they contact you?”
“Who?”
“The organizations that submit nominations.”
“Mostly mail and fax. Some organizations drop off nominee applications in person.”
“What about email?”
“Not anymore. For a while we allowed nominations via email. We also allowed the general public to nominate individuals. We tried both of those for a brief period but we were just overwhelmed with submissions. I think the first month after we opened the website to email submissions we had over five thousand nominees.”
“That is a big number.”
“Yes, and when we allowed nominations from individuals we received an inordinate amount of spam and speculators.”
“Speculators?”
“People fishing for money. The number of requests we had to vet to find real candidates was just too much for the staff to handle. Now we have a form online you can print out. The nominee fills out the application and either sends it, faxes it, or drops it off in person. There must be a contact name, a contact number, and a signature on the form. Sometimes organizations go as far as to provide videos of the deceased with their children. We receive photos. Family keepsakes.”
“Desperation.”
“That’s right. That is why the Carry On Foundation exists. To help ease that desperation as best we can.”
Dan removed a legal pad from his folder and wrote several sentences before he looked up. “So once you receive this nomination form, you turn it over to your attorneys for the vetting process?”
“That’s correct.”