The Chairmen

by Robert I. Katz

Tolliver, and now Banks, and at least five more to go. Kurtz glanced at his watch. In fifteen minutes, he was due in the OR.

  Chapter 9

  Was there an undercurrent of fear when he walked the floors? Perhaps he imagined it, but he thought that there was. The voices were not as loud as they used to be. The staff seemed to look at each other with quick, side long glances, wondering…or perhaps not. Perhaps this was only his imagination, but he liked to think that they did. Everybody, even those who had not received a letter or a phone call, seemed to sense that something was up.

  He smiled. Yes, he thought, things were coming along nicely. The work had taken on a life of its own, aside from the original cause, the target and the justice of his motives. Art for art’s sake. Beauty needs no other justification. It simply is. Was this a conceit? If so, it was one that artists all throughout history would have recognized.

  An artist of mayhem. He smiled at the thought. He liked that idea. He liked it a lot.

  Jonas Saltzman said all of the right things. He talked about the rewards of the academic life, the joys of patient care, teaching and research, and the dismal requirements of dealing with HMO’s. Nevertheless, the committee was not impressed with Jonas Saltzman. He had a slow, languid way of speaking. His eyes barely moved. The same half smile stayed fixed on his face. He looked, talked and acted as if he were sleep-walking through the interview. Chairman is a leadership position and a necessary part of leadership is the ability to inspire the troops. Jonas Saltzman was more likely to put them to sleep. Forget Jonas Saltzman.

  Maurice Sexton, on the other hand, was tall, slim and good-looking, with iron gray hair and deep green eyes. His voice was animated, his gestures fluid and arresting. Maurice Sexton looked good and he sounded good. The Committee added Maurice Sexton to the A-list.

  Vivian Connelly had an impressive CV. She was personable and pleasant. She seemed to know her stuff and she said the right things. The Committee liked her and so did the Dean. Unfortunately, Vivian Connelly had obvious reservations. New York was crowded. It was cold in the Winter. Vivian Connelly had lived most of her life in Southern California and pined for blue skies and sunny days. It wasn’t entirely clear why she had bothered to interview but she wanted a Chair and Staunton was offering one. In the end, it seemed apparent that Vivian Connelly was destined to go somewhere else.

  Dennis Cole was a problem. Vice-Chairman of the Department, Peter Reinhardt’s prize import, he was the obvious heir apparent. Unfortunately, his vision was not compatible with that of the institution. Dennis Cole wanted a “Cardiac Center,” with himself as its head, an integrated institute combining cardiology, cardiac surgery and invasive radiology, with his own building housing his own operating rooms, cath labs, MRI’s, CAT scans and bed floors, with a commitment to expand Cardiac Surgery from its present six surgeons to at least ten. Dennis Cole was thinking big. Too big.

  “Dennis Cole is too expensive,” the Dean said.

  Moller had asked the Dean to come to their next meeting, just to discuss Dennis Cole. “I’d hate to lose him,” Moller said. “He’s a top-notch surgeon, a gifted researcher and an excellent administrator. But we can’t give him what he wants.”

  “He’ll probably leave if we don’t,” Serkin said.

  The Dean looked grim but he shrugged. “Then he’ll leave. No one man is bigger than the institution. Let him find a place that can afford him.”

  So much for Dennis Cole.

  George Ames. Thomas Alan Dean. Niles Schobin. Lester Washington. Francis Xavier Jenson. William Harold Schapiro. After a while they began to blur together in Kurtz’ memory. And finally, mercifully, they were done.

  “So, we’re agreed?” Moller asked. The question was rhetorical. They had considered every candidate, dissected every interview and arrived at a short list of the very top candidates. Henry Tolliver, Maurice Sexton, Francis Xavier Jensen. A good list, Kurtz thought. All of them were top notch, or at least they seemed to be. It was always possible to be fooled. Nevertheless, the references were glowing and unqualified. In the end, they had not needed to compromise. These three names had it all, research, administrative experience, clinical competence, glowing personalities, cool heads.

  Now, it was up to the Dean.

  Natalie Ward was seven months pregnant and very pissed off. “Is it true, Doctor Jones, that in the last three years, you have been sued five times for malpractice?”

  Conrad Jones was an obstetrician, a hard-working obstetrician, a good obstetrician. But like all obstetricians in New York State, he paid more than a hundred thousand dollars a year in malpractice insurance, precisely because obstetricians do get sued. They get sued a lot. These were not the good old days, the days when people trusted their physicians, meekly accepted fate, and put their faith in God. Nope. People came into the hospital to have a baby and they expected top of the line service, a happy experience and an A-one product. They were paying for it (well, their insurance companies were, but so what?) and they expected to get what they paid for. The simple reality was, however, that the large majority of congenital anomalies and pre-natal accidents were both unpredictable and unavoidable. You can’t detect them and you can’t prevent them, but unhappy parents and duly aggrieved lawyers do not necessarily care about reality. To a lawyer, reality is whatever he can talk a judge and jury into believing.

  Sure, Conrad Jones had been sued five times in the past three years. Name an obstetrician who hadn’t?

  He had nothing to feel guilty about, damn it. Still, it was almost impossible to escape the nagging doubt, the suspicion that things might have turned out differently if he had just done…something. Even if he couldn’t for the life of him figure out what that something might have been. “Mrs. Ward, I’m not going to lie to you. I have been sued a number of times. Most obstetricians do get sued. I’m sorry about that but there’s nothing I can do about it.”

  She looked at him, her expression radiating contempt. “Baloney,” she said.

  Conrad Jones shrugged. “I’m sorry you feel that way.” After a moment, he asked, “Where did you get this information from?”

  “I received a phone call.”

  “A phone call…”

  She gave a curt nod.

  “And from whom did you receive this phone call?”

  For the first time, Natalie Ward seemed uncertain. She looked away and frowned. “I don’t know. It was a man. He told me that he wanted to warn me that my physician was a malpracticing quack.”

  “And you believed him.”

  “Why shouldn’t I? It’s true, isn’t it?”

  He opened his mouth, then closed it.

  She looked at him again, her expression radiating contempt. “When I’ve selected a new obstetrician, I’ll have him contact your office for a copy of my records.

  “Goodbye, Doctor.”

  “Aren’t the records sealed?” Moran asked. Harry Moran was in his early forties, a tall, husky guy who evidently cared about his appearance. His hair was slicked back. He wore suspenders instead of a belt over a shirt of Italian linen and his suit looked expensive. Kurtz had worked with Moran and Lew Barent before and he counted both of them among his friends.

  “Not exactly,” Kurtz said.

  They were sitting in a diner a few blocks from Easton. Moran had a tuna fish sandwich on whole wheat toast sitting in front of him. Occasionally, he poked at it with a finger, frowning unconsciously down at the plate. He had yet to take a bite.

  “It’s not going to poison you,” Kurtz said.

  Moran snorted. “I hate tuna fish.”

  “So why did you order it?”

  “The lesser of all the evils. My cholesterol is high. If my doctor had his way, I’d live on bread, celery and carrot sticks.”

  “A fine, healthy diet,” Kurtz said. Kurtz was eating a hamburger, with a side order of fries. Moran looked at the fries, naked longing in his eyes.

  “Oh, for Christ’s sake, take some,” Kurtz said.

  “Well, maybe just a
few.” Moran slid more than half the fries onto his own plate, dipped one into some ketchup, popped it into his mouth and closed his eyes in ecstasy. “Thanks,” he said. “I needed that.”

  “I think it was better for you than it was for me.”

  “So,” Moran said, “tell me about the medical records.”

  “Okay. Most of the charts are kept in a file room. It looks like a library, with the charts arranged alphabetically in stacks. Normally, any physician on staff can request any medical record. You have to put in a written request and sign for the ones you want, but nobody is going to say no and nobody is going to question your motives.”

  “You’re saying that the guy is a doctor.”

  “Not necessarily. He has to have a doctor’s ID to get access to the charts but it wouldn’t be too difficult to forge one.”

  “I’m surprised your records aren’t computerized.”

  “We’re moving in that direction. Probably another couple of years.”

  “So, if somebody signed for these particular charts, then there should be something in writing.”

  “Yes. But the only reason they have people sign is so they know who to go after if the chart doesn’t come back. It’s not a log, it’s just a written request slip, and once they have the chart back, the request slips get thrown out. Also, I said that most of the records are handled this way. The ones where lawsuits are either threatened or actually filed are sequestered. They’re kept in a separate room under lock and key. A physician who wants to see them can still sign for them, but they can’t be taken out of the locked room. You have to look at them up there.”

  “Interesting,” Moran said. “The Ward woman knew that Jones had five suits against him but she didn’t mention the names of the plaintiffs.”

  “The guy may not have known the names.”

  “But maybe he did know the names. The people who work up in medical records, they must have a list of patients who are suing. Who would have access to that list?”

  Kurtz shrugged. “I don’t know. I guess I’ll ask them.”

  Moran nodded his head and gave Kurtz a wolfish smile. “Good idea,” he said. “But you may be barking up the wrong tree. Information regarding civil lawsuits is not confidential. He may have gotten it from a simple search of the court’s website.” Moran cocked his head to the side and smiled. “Then, of course, there’s the fact that all successful professional liability suits get reported to the National Physicians Data Bank, which is also public information.”

  “Not exactly true,” Kurtz said shortly. “You have to have authorization to access the data.” Kurtz, along with every other physician in America, despised the National Physicians Data Bank with a fiery passion.

  Moran shrugged. “Easy enough to work around. So, you have no evidence at all that he got his information from the hospital.”

  Kurtz sighed. “We have to start somewhere.”

  “Well, then,” Moran said. He crooked a finger at the waitress, who walked over to the table. “Bring me a hamburger,” Moran said. “Medium.” He glanced at Kurtz. “And some more fries.”

  “The list is computerized.” Lillian Mayberry looked like a stereotype of the village librarian. She was short, thin and middle-aged, with dyed blonde hair and round, frameless glasses. She had a small office with glass walls, through which she could see the activity in the stacks of medical records in the opposite room. The walls were covered with light brown blinds, which she could pull closed if she wanted privacy. At the moment, the blinds were open. “The file containing the names of patients considered to represent potential liability is protected by a password,” Lillian Mayberry said.

  Too bad. Kurtz had been hoping for something a little more old-fashioned, like say a hand-written list kept under lock and key in a location, something that might have represented a clue. “Who has access to this computer?”

  “Everybody. It’s not just one computer. You can access our website from any computer in the hospital. You can even get in from outside, so long as you have a password and ID.” Lillian Mayberry said this with evident pride. A fine modern system, all the latest and greatest in modern computer technology. Kurtz was hardly an expert in computer security, but he was fairly certain that such a system was about as secure as a sieve.

  “The file that we were talking about, the one containing the names of patients who, as you say, represent potential liability, you can access that file, too?”

  “Only if you know the password.”

  “And what does that mean, ‘represent potential liability?’”

  “A suit has actually been filed, an intent-to-sue form has been received, or we get an inquiry from a lawyer in a case where we know that there’s has been a poor outcome.”

  “How many of the ‘intent-to-sues’ and ‘poor outcomes’ actually result in a lawsuit?”

  Lillian Mayberry puffed her cheeks out. She appeared to think about it. “Certainly less than half.”

  “How long do you wait before you return the chart to the regular file room?”

  “If a suit is actually in progress, we leave the chart locked up until the case is over. For the others, we wait one year.”

  Kurtz grunted. Passwords, even passwords composed of random numbers could be hacked. Not by himself, of course, but he knew enough about the modern world of computer crime to know that anything stored on a hard drive was fair game to the right people.

  Still, this wasn’t narrowing down their options, not one bit. The perpetrator could have known what he was doing with computers to the extent of infiltrating the system, or, as Harry Moran had suggested, he could have gotten the information from the other end of the process: the courtroom.

  “Any hard copies of these passwords lying about?”

  She blinked at him. “In my desk,” she said.

  “And who might have access to your desk?”

  “Nobody. It’s locked up at night.”

  The desk was a simple office desk, the lock a simple sliver of metal turned on or off by a simple, steel key.

  “Does anybody else have a key?”

  “Only my secretary.”

  Offhand, Kurtz could think of half-a-dozen ways of obtaining copies, from temporarily lifting the original to purchasing one from the company. He shook his head and rose ponderously to his feet. “Thanks,” he said.

  For the first time, Lillian Mayberry displayed uncertainty. “What’s this all about?” she asked.

  Kurtz forced himself to smile. “A routine investigation,” he said. “Strictly routine.”

  Chapter 10

  The next morning, Kurtz had just begun a laparoscopic ventral hernia repair when the trochar hit the patient’s inferior epigastric artery and bisected it. In retrospect, this was not a surprise. The patient had had previous abdominal surgery. Her belly was covered with scars and the normal anatomy was obviously distorted. The trochar was placed in the midline, specifically in order to avoid any delicate and easily damaged structures. It was simply bad luck that in this patient, an artery that was usually situated lateral to the rectus abdominus had been pulled into the midline by scarring.

  The first warning that Kurtz had was when Levine looked through the scope, frowned, and said, “It’s red.”

  Just then, the anesthesiologist, a woman named Sylvia Waite, poked her head over the drapes and said, “Her pressure’s dropping.”

  Hurriedly, Kurtz looked through the scope. Levine was right. Red. It wasn’t supposed to be red. Red meant…

  “We’ve got to get into her,” Kurtz said.

  Levine looked at him in bewilderment, then he seemed to suddenly get it because he gave an abrupt nod, pulled the trochar and the scope out in one smooth motion, turned to the scrub nurse and said. “Give me a knife.”

  Within seconds, the patient had an eight-inch vertical incision and they could see what was inside.

  “Suction,” Kurtz said. The circulator, who was scurrying around the room, opening up a laparotomy tray, hurriedly threw th
e suction tubing up onto the field. The scrub nurse pushed a big suction catheter onto one end of the tubing and handed it to Kurtz. Kurtz popped it into the abdomen and within seconds the suction canisters began to fill with blood.

  Where was it coming from? The trochar had been inserted below the umbilicus, too low to have hit either the liver or the spleen. The inferior mesenteric artery could have done it but blood seemed to be dripping from the abdominal wall. Spurting, rather. “Give me a Kelly,” Kurtz said. “And a lap pad.”

  The scrub nurse handed him a large clamp with a slight curve on the end and a large white pad. He wiped the clotted blood from the peritoneum with the pad. Instantly, they saw it, gushing from the hole where the trochar had been, a spurt of blood with every heart beat. Kurtz took the clamp and placed it around the bleeder, then ratcheted it tight. The spurting stopped.

  “How is she?” Kurtz asked.

  The anesthesiologist answered from the other side of the drapes. “Pressure’s seventy over thirty. I’ve called for the blood.”

  “It should be okay, now,” Kurtz said. “I think I’ve got it.” He hoped. He peered back inside the abdomen, saw no more blood and breathed a relieved sigh.

  “Good.” The anesthesiologist sounded distracted. She was working at the patient’s left arm, starting a second IV.

  “How much do you think she lost?” Kurtz asked.

  “There’s almost two liters in the suction bottles.”

  Two liters. More than a third of her blood volume.

  “Shit,” Kurtz muttered.

  Levine smiled wanly. Disgusted, Kurtz shook his head. “Two-O Proline,” he said to the scrub nurse. She handed him the suture and Kurtz placed it around the base of the clamp and pulled it tight. They spent a few minutes making certain that nothing else was bleeding. By the time they had finished, two units of blood were dripping steadily through the IV lines and the patient’s pressure was almost back to normal.

  “Now what?” Levine asked.

  Kurtz shrugged. “No reason not to finish the operation. She still needs her hernia fixed and we’ve already opened her up.”