Tampered

by Ross Pennie

  Horvat took the paper, studied it, then shook his head. “I not knowing this name. Is customer here?”

  Natasha’s mouth felt as dry as sandalwood. She hadn’t expected the third degree. “I am sorry, sir. I am not knowing.”

  Horvat turned to his computer and clicked at the keyboard. “Address and phone number.”

  “My grandmother’s?”

  He looked at her as though she’d just grown a beard. “Of course.”

  She hesitated, frightened to give Horvat her grandmother’s personal details. All of a sudden, her entire family seemed at risk. Would he come after them? Dr. Zol said this had to be a bona fide transaction if they were to catch Horvat willfully selling counterfeit meds. It had been Natasha’s idea to come here undercover; Dr. Zol had tried to talk her out of it. And now it was too late to turn back.

  She told Horvat her grandmother’s real address and phone number, then stumbled over the postal code.

  “Date of birth?” he asked, squinting at the computer screen.

  Natasha had to think for a moment, then forced herself to recite what seemed like the greatest violation yet.

  “Then she a senior,” he concluded. “Over sixty-five. Need health card number.”

  In what felt like a final act of betrayal, Natasha pulled a photocopy of her grandmother’s Ontario health card from her purse. The only consolation was that the copier did such a poor job of the photo that her grandmother was unrecognizable.

  Horvat shook his head. “Need to see card. Copy no good.”

  “But . . .”

  Horvat sighed heavily, his metallic tooth a piece of machinery between his heavy lips. He took the photocopy and seared her with a stern look. “This real? You sure? You people . . . always try to cheating.”

  Natasha squared her shoulders. How dare he? She opened her mouth, steadied herself for a sharp retort, then dropped her gaze. She studied her size-six Stuart Weitzman pumps. Dainty steps today, she told herself. If she did this right, the cops would be stomping all over Horvat by next week — Canadian strides in sturdy leather boots.

  “I am sorry, sir,” she said meekly, concentrating on the authenticity of her accent. “She is always keeping card in handbag.” She pointed to the crinkled photocopy. “That is proper number from goh’ment.”

  Horvat huffed and typed the number into the computer. The printer beside him spat out a label, which he detached and tossed into a basket on the counter. “Ten minute.”

  CHAPTER 23

  Ninety minutes later, having ditched the wig, the sari, and the tilak, Natasha stepped into the staff room at the Lakeview Pharma on Concession Street, a good three dozen blocks east of Steeltown Apothecary. She felt safe in this part of town, up the street from the health unit. She took a seat next to Todd Jarvie, the medical student helping Dr. Wakefield at Camelot Lodge. Todd’s uncle, Wayne, closed the door behind him and dragged a chair in front of it.

  A hesitant smile lit Wayne Jarvie’s face as he slid into the chair opposite Natasha. Wayne and Todd looked more like brothers than uncle and nephew — same neatly trimmed moustache and goatee, similar mid-brown hair, though only Wayne’s was highlighted. Wayne lacked Todd’s muscle-man shoulders. As the owner of a chain of drugstores throughout the Hamilton region and a high-profile Rotarian, he wouldn’t have time for toning his pecs. Still, he looked fit and had the healthy glow of a recent few days in the south. He seemed too earnest for tanning salons. His delicious cologne wafted her way. How wonderful to own the store and wear any perfume you wanted, on the house.

  “It’s very good of you to help us out, Mr. Jarvie,” Natasha said, lifting her briefcase onto her lap.

  “Todd said it was important,” Wayne replied. He glanced at the door. “And very hush-hush. But please, call me Wayne.”

  Todd pulled his chair closer to the table and turned to his uncle. “I know how pissed you were about those two guys operating that counterfeit drug scam on Barton Street.”

  “Bad news for pharmacists everywhere,” Wayne said. “They tainted all of us, made us look like charlatans. It took six months before my customers stopped looking at me sideways.”

  Natasha undid the toggles on her briefcase, then hesitated before revealing its contents. “I’m not sure how much Todd told you on the phone, but —”

  “I’m all ears,” Wayne said. “So go ahead and start at the beginning.”

  Natasha told him about the empty vancomycin capsules on Camelot’s Mountain Wing, her trip to Steeltown Apothecary to fill her grandmother’s Zytopril prescription (she left out the part about her disguise), and the sampling of Zytopril tablets from among the eighty percent of Camelot residents who were taking it.

  “Eighty percent of them are on Zytopril?” Wayne said.

  “Does that seem like a lot?” Natasha asked.

  “Sure does. Most people do fine with tried-and-true generic antihypertensives. Zytopril is new and expensive. Government reimbursement kicks in only if the doctor verifies that cheaper drugs haven’t worked or are contraindicated.” He examined his nails and absently twisted the large black opal on his left hand. “I can guess who prescribed it,” he said softly. “Dr. Jamieson, eh?”

  “Hey,” Todd said. “How did you know?”

  “In this city, he’s Zytopril’s biggest fan. I see more prescriptions from him than anyone else.”

  “An early adopter?” Todd suggested.

  “I suppose,” Wayne said. “But it could have something to do with his sister being the regional sales rep.”

  Natasha pulled out the bottle of Zytopril blood-pressure tablets Viktor Horvat had handed her at his dispensary. She set it on the table and shivered at her grandmother’s name glaring from the label.

  Wayne dipped into his lab-coat pocket and pulled out a large white plastic bottle. The drug company’s logo beamed from the label, and under it Zytopril 50mg. Natasha knew the logo well; she saw it every morning when she shook a pill from her birth-control dispenser. She figured any company that saved her from mortal shame and the eternal condemnation of her family was a lifesaver.

  Wayne opened his jumbo bottle of Zytopril and shook a dozen tablets onto a small plastic tray. “Let’s have a look at these first. As far as I can tell, they’re the gold standard. I trust my wholesaler.”

  Natasha picked up three of Wayne’s brand-name Zytoprils and examined them. Each tablet was round, about four millimetres in diameter, and a pretty shade of turquoise. ZYT was printed on one side in bright white letters, and below it, 50mg. The obverse was blank.

  “Okay,” Wayne said, “now let’s look at what Natasha got today from Vik Horvat at Steeltown.”

  She opened her small bottle and poured a few pills onto a blank sheet she tore from her notebook. Her heart sank in disappointment as she studied the tablets. They looked exactly like Wayne’s, the gold standard. All that sweating under a silly wig to catch Viktor Horvat deceiving the public had amounted to nothing.

  Wayne examined her tablets carefully then shot her an inquiring look. “What do you think?”

  “They’re the same as yours,” she said, feeling defeated. “Identical in every way.”

  “Yeah,” Todd said. “But . . . could they be knock-offs anyway?”

  “It’s possible,” Wayne said. “Counterfeits often look perfect, though occasionally the printing may be slightly off. The fakes from Barton Street looked perfect, except for the printing. You had to look closely to see that the letters weren’t uniformly crisp and the ink wasn’t quite the right colour.”

  “Can we look at these?” Todd asked, holding Mr. Greenwood’s blister card from Camelot.

  Wayne pulled a magnifying glass from his coat pocket. “Sure.”

  Each compliance-enhancing blister card was the size of a sheet of letter paper and contained a resident’s weekly allotment of pills in a four-by-seven matrix of easy-to-open blisters: four times a day for seven days. The cards made it convenient for nurses to dispense drugs accurately in nursing homes and for inde
pendent residents to manage their own medications. Dr. Wakefield had obtained a dozen cards from Camelot this morning and given them to Todd. Narcotics were kept under lock and key at the Lodge, but the other drugs were readily accessible from the Belvedere residents themselves.

  “Do you provide these to your customers?” Natasha asked Wayne.

  “Sure do. For over twenty institutions — retirement residences, nursing homes, group homes.”

  “Wow. How many clients does that work out to?” Todd asked.

  “Oh, about fifteen hundred. Steeltown has a good deal more. I know, ’cuz the bugger often underbids me.”

  “You have to bid for the institutions to give you their business?” Natasha asked.

  “In a backhanded way,” Wayne said. “In general, pharmacies make so much money on the dispensing fees that nursing homes expect a kickback for granting them access to their residents.”

  Kickback, thought Natasha, what a nasty word. Entirely out of place in health care and so unexpected from the mouth of the genial Wayne Jarvie.

  “Can I ask,” Todd said, “how . . . um . . . how much coin a pharmacy brings in a month from providing prescriptions to a place like Camelot?”

  Wayne smiled. “Don’t need to be bashful about it, Todd. We’re all grown-ups.” He pulled out a pen and jotted down a few calculations. “Each retirement-home resident is on six to twelve different medications at any one time,” he explained. “The pharmacy’s dispensing fee, paid by the government, is eight dollars per month, per medication. That’s for each resident, of course. But if the person is a patient admitted to a certified nursing home, the dispensing fee is even higher — twenty dollars per month.”

  Natasha was amazed at Wayne’s final calculation. A pharmacy with fifteen hundred elderly clients, twenty percent of them in nursing homes, took in $125,000 in dispensing fees every month.

  Wayne saw the amazement on Natasha’s face. “That goes to the pharmacy as its professional fee. Putting together the compliance packs is labour-intensive,” he said, a tinge of defensiveness in his voice. “The drugs are extra, mostly covered by the government with an eight- to twenty-percent mark-up for the pharmacy. Fifteen hundred residents, each taking eight medications, would bag the pharmacy an extra $25,000 per month.”

  “Big business, when you add it up,” Todd said.

  “You could say that,” Wayne said, then chuckled. “Are you sure you want to stay in medical school, Todd?”

  Natasha removed a Zytopril blood-pressure tablet from Mr. Greenwood’s Camelot blister card and examined it under Wayne’s magnifying glass. Same size, shape, and colour, same crisp white printing as those from Wayne’s bottle and her grandmother’s Steel-town prescription. The real thing. She looked at Todd, who made a face. He was as disappointed as she was. They each took another card and popped out other Zytoprils. The pills were perfect.

  Wayne studied the Zytoprils from four other Camelot cards under the magnifying glass, then grinned and raised an eyebrow. “Have a good look at the blank side. What do you see?”

  The tablet in Natasha’s hand had a scratch on it, but that was it. She could see no differences between Wayne Jarvie’s Zytoprils from Lakeview Pharma and Viktor Horvat’s from Steeltown Apothecary.

  After a few moments, a quizzical look came over Todd’s face. He pointed to twelve of Horvat’s tablets, six from Camelot and six from Natasha’s bottle. “All of these are scratched,” he said. “But Wayne’s tablets are not. Does that mean anything?”

  Natasha looked again. “The scratch marks are identical on every pill.”

  Wayne shook his head. “Those aren’t scratches. They’re a mark from the stamping machine used to make the tablets. Comes from a blemish inside the equipment. Whoever made these has an old machine, probably snapped up on the cheap. Or retrieved from a dump site. In Turkey or Mexico. Or even Congo.”

  “Congo?” Natasha said. “They make pills in Congo and ship them to Canada?”

  Todd popped the Zytoprils from four additional Camelot cards and examined the blank side of each tablet. His eyes twinkled as he raised his fist in victory. “Got him.”

  Natasha wasn’t so sure. They still had to prove these were counterfeit and not a legitimate but cosmetically wonky batch from the brand-name company. She opened her briefcase and pulled out the cards from the nineteen Camelot residents taking Xanucox for severe arthritis. “We’d better look at these, too,” she said. “Out of the nineteen people on Xanucox, eighteen have had epidemic gastroenteritis.”

  “Xanucox is a heavy-duty anti-inflammatory,” Wayne said. “I’m amazed that Jamieson has so many of your Camelot residents on it. It’s pretty hard on the immune system.” He popped three maroon-and-white Xanucox capsules from their blisters, turned them over in his palm, and examined them closely. He popped out three more. Then he pulled two of them apart and shook their powdery contents onto a sheet of paper. He licked his index finger, picked up a little of the powder, and placed it on his tongue. “Hmm,” he said, screwing up his face and spitting into the waste bin. “Like many drugs, it’s very bitter. That’s why Xanucox is formulated as a capsule, not a tablet. Must be the real thing. And just as well — they’re eight bucks each and paid for by the ministry only under their limited-use directive. You could make a fortune selling counterfeits of these if you figured how to bypass the red tape.”

  “How much would he make from scamming the Zytoprils, Uncle Wayne?” Todd asked.

  “Hard to be certain. But he’d be sharing in the seventy-five billion dollars the World Health Organization says changes hands in the counterfeit drug trade every year.”

  “Seventy-five billion!” said Natasha.

  “And growing at twice the rate of legitimate drug sales. You can thank the Internet for that. And criminal gangs. And governments that have no stomach to put a stop to it.”

  “And Horvat’s take?” Todd pressed, as amazed as Natasha at the huge money involved.

  “Let’s see,” Wayne said, “you told me eighty percent of the residents at Camelot are taking Zytopril for their blood pressure. That’s how many people?”

  “Thirty-eight residents,” Natasha told him. “And eighty percent makes . . . thirty.”

  “That’s . . . nine hundred tablets a month,” Wayne said. “At three-fifty a tablet . . . that’s thirty-one hundred dollars a month, billed to the government as brand-name Zytopril.”

  “How much would the fake ones cost him?” Todd asked.

  “Most counterfeit tablets have little or no active ingredients. Usually just talc, brick dust, or floor polish. And they’re made in developing countries where labour is cheap. The cost of production might be ten cents a tablet. The cost to Horvat would be triple that or more, after a couple of middlemen take their cuts. Let’s say he pays fifty cents each if he buys in bulk.”

  Wayne scribbled a few calculations on his notepad, then fixed Natasha with his clear brown eyes. “That’s twenty-seven hundred dollars a month in profit.”

  “Not exactly a fortune,” Natasha said.

  “But,” Wayne said, “that’s just from one facility. Horvat has arrangements with at least five old-folks homes, and signed contracts with ten nursing homes, most of them three times the size of Camelot. Zytopril-friendly Jamieson is the doctor for many of them.”

  Todd was doing the arithmetic. “If Horvat is doing the same at the other places, and only a third of the residents are on Zytopril, he’s scamming . . . $40,000 a month . . . that could be half a million a year.”

  “Plenty of bucks for prying his son out of that Mexican jail,” Wayne said. “You read about him in the Spectator, eh? He’s their celebrity du jour.”

  “Maybe his legal bills led him to scamming in the first place,” Todd said.

  Wayne pocketed his pen and pad. “Maybe.”

  Natasha found herself boggled by the amount of money involved and disheartened at the difficulty of proving that Horvat’s actions were both intentional and criminal. Last year, the pharmacis
ts covered their tracks at the first indication they were under suspicion, then pleaded ignorance. “We’ve got to prove for certain the Zytoprils are counterfeit, and that Horvat knows it,” she said. “And whatever we do, we can’t tip him off.”

  Wayne pushed his chair away from the table and crossed his legs. “Well . . . not to put too fine a point on it, but I do have contacts. When you own four of the largest pharmacies west of Toronto, the drug companies court your attention. I’ll call the firm that makes Zytopril. Their head office is in Montreal. The VP of medical affairs will want to get these tested pronto, even if they have to be couriered to Switzerland.”

  Natasha was still worried. “But will they do it quietly? I mean, we don’t want Horvat covering his tracks, hiding his involvement, then getting off with a silly warning.”

  “The company will want him nabbed and fully prosecuted, that’s for sure,” Wayne said. “And they’ll want to track down his supplier.” He checked his watch and stood up. “Look, this has been very enlightening, but I’ve got to get back to work. Those prescriptions don’t fill themselves, and we’re short-staffed today.”

  He led them out of the staff room and smiled warmly as he shook Natasha’s hand and offered her his business card. “Anything comes up you need my help with, call me on my cell. Day or night, doesn’t matter. Don’t be shy.”

  As Natasha did up her coat and put on her gloves, a key question niggled her. How had Dr. Jamieson come to prescribe Zytopril to eighty percent of Camelot’s residents — and, if Wayne was correct, countless others across the city? Was he convinced that Zytopril, used by other doctors for special cases only, was absolutely superior to every other drug? Or was he trying to help his drug-rep sister earn her annual bonus? Or perhaps the state of his wallet superseded family ties and he’d gone in with Horvat for the tax-free bonanza.

  One thing seemed sure: the drug company wasn’t getting a nickel from the “Zytopril” dispensed by Horvat, and sooner or later that would show up in its bottom line.