Lethal Practice

by Peter Clement

  The secretaries for the salary pool would prepare and submit bills in the name of supervising psychiatrists, having power of signature in billing claims for the entire staff. So, Gil, you could add hours of claims for sessions never done, hours per day per week per psychiatrist. With a staff of twelve, at a rate of one hundred an hour, and two to three bogus supervised hours a day per doctor per year, an extra million would be easy.

  A last handful of earth arched into the grave. A wisp of dust hung in the air, then vanished. The mourners had finished. The man of God hadn’t. His words drifted in and out of my thoughts.

  It could be done only in a salary pool, Gil, and only in a psych pool at that. Your docs would bring into the pool an annual income reflecting both their work with patients and money generated by supervised sessions. Out of this total, two-thirds would be paid back to the physicians as salary. The balance would be used to cover operating expenses. Even so, your docs would end up innocently taking home a little extra—and who questions a raise, or a year-end statement that shows increased productivity?

  “Look what I’m worth,” each would think, or “I knew I was working harder.” The documented increase would be readily taken as a well-deserved pat on the back.

  We were now in a moment of silence. A lone plane droned overhead.

  Nor would Medicaid or Medicare officials handing out these funds call psych patients and ask for a detailed account of their treatments and the hourly breakdown. The bureaucrats got away with checking with Mr. Jones if indeed Dr. X had seen him on such-and-such a date for pneumonia, thus verifying the billing. But no way would the public tolerate bureaucrats delving into psychiatric matters, even at the excuse of avoiding fraud, such was still the stigma of mental illness. So they acted only on patient-generated complaints, and those would mostly be for some claim of abuse, usually sexual.

  So, Gil, you could bill a little extra here, a little extra there, and as long as your staff didn’t diddle the patients, you ‘d be safe.

  But you got careless. I know now why Voyzchek wanted July’s roster. Because she was on vacation then, had switched with someone at the last minute, had let us know, and found a substitute. But she probably hadn’t changed your master list. As long as the roster’s covered, none of us really keeps track of who’s away. So you did your usual creative billing, including her name. She might not know how many hours she supervised, but she ‘d catch supervision billed to her while she was on the beach in Acapulco.

  How did it start, Gil? The dashing champion of care daring to steal from the bureaucrats and deliver it to the healers? More funds for research? Special patient programs and equipment? I’d like to think so; at least I’m pretty sure it started that way.

  If it had ended there, you wouldn’t have chosen to die. No, you would have been a hero—in trouble, but a hero. You would have been a masked protector of the mentally ill undoing the evil bureaucrat kings and rendering better means of care to the sick. No, if it had ended there, you would have stuck around, played Zorro against the technocrats and basked in the glory of the docket, a pulpit for your cause,

  But it obviously hadn’t ended there.

  The clouds begrudgingly shifted enough to let a needle of sunlight through to our little graveside band and then snapped it back.

  Hunched in pain, an older version of Fernandez cried silently. His hands were weathered. He had the leathery look of a man who had worked outdoors most of his life, probably to give his son the education that, till Gil Fernandez, I’d been told, no one in the family ever had. Beside him, her face invisible under veils, erect and silent, sat Fernandez’s wife. She was surprisingly young and slim-figured. I winced at the chilling mix of grief and rage that came out of her stillness. I didn’t know if Fernandez’s mother was sedated somewhere, unable to bear this, or long dead. I hadn’t read the obit.

  But the pity I felt for Fernandez’s father and wife was a fraction of what I felt seeing the horror and agony in the hollow face of his young son. I estimated his age at ten or eleven. He stood at the side of the grave, a brittle sentinel, looking as if he were on the verge of speaking, of calling his dad back. I felt no one in that sad huddle loved or needed Fernandez more. Certainly no one had been more betrayed than that poor boy. He would always wonder why his dad had chosen to desert him so finally. From the grave, Fernandez’s suicide gave an answer the boy would dodge all his life. “My love was enough for you. Your love was not enough for me.”

  I left that graveyard hating Fernandez.

  It was Sunday morning and the traffic was sparse. The hospital was a twenty-minute walk, but anger would get me there in ten. I wanted the time alone.

  During the service Hurst had quietly gone from chief to chief asking us to meet briefly in his office afterward and hear his strategy to get the hospital back to normal, starting tomorrow. It looked like he was giving condolences, but he was really counting on our respect for the family to prevent us from making a scene and telling him to get lost.

  As I walked, I returned to my one-sided conversation with Fernandez.

  It was probably Kingsly’s strategy all along. He snagged you to play Zorro, and then he got you dirty.

  Were the prints and etchings offered you as a tribute to your noble work and the service you were doing the hospital? He’d say, “You, more than anyone, both deserve and can appreciate a collection of fine art. Savor it. You’ve earned it.”

  But here, my dear psychiatrist, your ego bought a bill of goods, allowed your fantasy as superhero to excuse and explain going on the take.

  And Kingsly had you; he owned your soul. Probably less and less of the pilfered money went to extra care, while more and more went to him. You must have hated him and feared that one night in a haze of booze he’d do something that would expose the scheme and your part in it. Is that why, at every meeting, every encounter, on record, you ran your boast that psychiatry gave back funds to the hospital? To warn him that he was also under your control and force him to at least make some show of funds back into research and patient care?

  But your position was the more precarious. He had what he wanted, a cash cow. You had lost what you thought justified larceny. The money going to research and treatment programs became a barely maintained trickle. Now most of what you stole went to a pathetic alcoholic who’d trapped you with your stupid ego and a moment of greed.

  You probably didn’t need a lot of time to figure your options when Bufort’s investigation seemed poised to expose you. Hell, you’d been living with imminent exposure for years. I don’t think it was being a thief or a fool that you couldn’t live with. Even jail, if you got that far, I think you ‘d have taken.

  No, I think what killed you was the automatic loss of your license to practice medicine ever again, the consequence of a criminal conviction. That, and the even more immediate loss of your reputation. The adoration of grateful patients would change to shock and outrage. Your articles would be relegated to trash cans the world over. They would never be refuted scientifically; no one would bother. It would just be that Gil Fernandez, world-famous psychopharmacologist, would now become “That fraud, convicted, in jail, on parole.” And academic psychiatry would move on to its next hero.

  I stopped at a streetlight and admitted I’d never know for sure how Fernandez had slipped and crossed the line that doomed him. But cross it he had.

  The light changed. So’d my thoughts. I kept seeing the grief-stricken face of Fernandez’s son and his hand reaching out and dangling empty at the grave’s edge.

  My own hands were fists in my raincoat pockets by the time I reached the hospital drive. I scowled my way through the stone arches and automatic doors. A security guard was too busy eating a doughnut to challenge my ID.

  In the lobby, a gaunt old man was pushing his IV pole through the racks of get-well cards by the gift shop. The wheels made muted squeaks. My own steps cut through me echoing hush that settles over a hospital on weekends. It’s a brief respite, a truce between the weekday
hustle of white coats and shuffle of patients scurrying to endless probings and tests. Both sides need the pause before going back at each other Monday morning.

  While I was waiting for the elevator, the old man’s IV pole stopped its whimpering. He reached for a card and then studied it carefully. The racks were full of treacly verses; maybe he’d found one he hadn’t seen before. The noisy arrival of the elevator rang through the lobby, and the old man looked up. His face and eyes were yellow. He watched me as I stepped in and in turn watched him through the closing doors. He looked terminal. He probably envied me for having a place to go.

  My mood got no better walking the deserted corridors to Hurst’s office. I couldn’t help seeing Fernandez, stepping to oblivion, and that old man downstairs, clinging to his remaining moments when just a guy taking the elevator was an event.

  As much as I was raging against Fernandez for betraying his son, and as readily as I could find him capable of fraud and a lethal mix of greed, shame, and pride, I couldn’t go the rest of the way and label him a murderer. When a patient’s condition was a mystery, when the residents were trying too hard to force an easy diagnosis onto symptoms and signs that didn’t fit, I had an instinctive sense, developed over the years, that told me not to trust their conclusions. And now, with the same intangible intensity, I knew that Fernandez was not the killer.

  This was Hurst’s meeting, but when I entered, it was a victorious Bufort I saw strutting around the room.

  “—obviously this case is closed,” he trumpeted. “Since there won’t be a trial, the hospital will be—”

  “You’re out of line!” I blurted out.

  Everyone looked at me in surprise.

  “We just buried Fernandez,” I said hotly. “I watched his family at the graveside. I don’t want to watch you dance a jig on his grave, Bufort.”

  “Dr. Garnet!” Hurst was horrified. The others glanced nervously at one another.

  “And what are you doing here anyway?” I demanded. “We were told this was a meeting to agree on the best way to get St. Paul’s back to normal.” I was still standing, and Sean reached over to put his hand on my arm, trying to get me to sit down beside him.

  “Detective Bufort is here at my request,” answered Hurst. “The first step to help everyone move on from this tragedy is to explain what happened.”

  Bufort pompously held up his arm to me as if I were oncoming traffic. “Why, Dr. Garnet, you of all people should be grateful it’s over. Fernandez tried to kill you and gravely injured your dog. Now, I understand how upset you are, but go home. It’s over. You and your family are safe.”

  “Why did he try to kill me? It makes no sense!”

  A Gallic shrug. “Perhaps Kingsly had secretly started to blackmail him while overtly being his partner in crime. He might have sent Fernandez anonymous letters, demanding money orders for cash, funneled through a series of post office boxes. Who knows? I’ve seen that method used many times before. In any case, Fernandez couldn’t be sure it was Kingsly, but he’d certainly suspect him. He already had cause to feel it was too risky to let him go on, what with him drinking more and more. The chance of Kingsly babbling was just too great, so he killed him. Then you made some crack to Fernandez in the parking lot about finally checking the books.” He stopped, stepped over to his briefcase, and lifted out a sheaf of papers. “I read that in your own report,” he continued, holding the document up for the others in the room to see. “Suddenly Fernandez thinks he made a mistake. Thinks that you were the blackmailer all along, and that you’d probably heard Kingsly burble out the truth one drunken night. But now, in Fernandez’s mind, you also could expose him for murder. You had to die, and fast.”

  I felt stunned. Bufort had taken the dictated report of my movements and conversations he’d insisted I write and was using it to dismiss my doubts. He’d even made sure he had it with him today. Given that I had little more than my instinct to go on, I was pretty easy to dismiss. He rushed on, waving my own statement at me, the better to demolish my protests.

  “Already terrified, he feared his worst nightmare had come true. On impulse, he followed you out of town. He probably couldn’t believe his luck, that you’d let yourself be so isolated, so vulnerable. If he were thinking right, he’d have realized that had you been the blackmailer and were willing to take on a murderer, you wouldn’t have been so foolish. But he was probably in a panic. That chance comment about an audit confirmed you were dangerous and set him off.”

  He stopped, obviously enjoying the theatrical hush, and then delivered the denouement. “The first time at your cabin, the dog chased him off. The second attempt was better planned. You survived only by chance.” He turned his back to me and added my report to a stack of files on Hurst’s desk. He appeared done.

  “Why a cardiac needle?” I asked quietly, slipping into a seat beside Sean.

  Bufort whirled around. “Why not?” he snapped. “It nearly worked.”

  He glared at me. “It was pure luck you found the needle. It was his bad luck it broke off. Probably his original plan was to insert and withdraw, but Kingsly struggled, or convulsed as he died, and it snapped, just as you and Dr. Watts originally surmised.”

  “And what about the wino?”

  His cheeks flushed. “Winos die. Doctor! You know this as well as I do, and no one makes a thing of it. And I suspect you never have before either.”

  “Because they don’t die of cardiac needle stabs.”

  “Winos die with everything under the sun inside them. From drain cleaner to gasoline.”

  Mistake, Bufort, I thought. Now you’re on my turf. “This guy’s tox screen was clean.”

  He backed up. The expression on his face told me he wasn’t about to get suckered into a slugfest with me on medicine.

  “Quite right. Doctor, but didn’t he have some medicines in him that we hear on TV not to take together because they stop the heart?”

  Good move, Bufort. Reduce it to civilian medicine. If I clobber you here, I’ll seem an arrogant prick.

  I answered quietly. “The post showed that the needle killed him. The rest may have helped, but that needle went into a live man and stopped his heart.”

  “Fine, Doctor, then Fernandez killed that homeless man. Wherever he killed Kingsly, the derelict was hiding for the night. Too late, Fernandez realized he had a witness and got him as well. Later he moved the body out to an alley, and it was picked up as a DOA. Again it was you. Dr. Garnet, who told me homeless people sometimes sneak into the hospital to get out of the cold.”

  I sat there, speechless.

  I glanced at the others. They were looking at their watches, shuffling their feet, shifting restlessly in their chairs. Someone murmured, “Come on, let’s go. It’s over.” I heard similar mutterings behind me. Hurst nodded in agreement, almost encouraging the protests. If he’d organized this little show just to kill any arguments against Bufort’s “solution” of the murders, he’d succeeded. The increasing unwillingness of everyone in the room to put up with any more of my questions proved that.

  Bufort quietly gave me the coup de grace. “Haven’t bag ladies and derelicts been found on cold nights hiding in stairwells and in the basement to keep warm?”

  I didn’t answer, but he wasn’t about to let me stay silent. “Haven’t they. Dr. Garnet?”

  “Yes,” I conceded.

  With operatic show, Bufort finished putting his papers away. “I want to thank you for your cooperation in this difficult time. Without your help, I—we wouldn’t have been successful.”

  I nearly pointed out that in our profession, a man’s brains all over the parking lot is not a success. I looked over to Watts, but he gave a me a dismissive wave. There’d be no mention here of checking other dead street people for signs of intracardiac stab wounds. The others in the room began pushing their chairs back from the table. They all wanted out of there. So did I.

  As the meeting broke, I saw Riley standing in the doorway, his jaw muscles working overt
ime. When I got near, the side of his face relaxed and he seemed about to say something to me. Instead, he glanced at Bufort, stepped aside, and let me leave the room. I was halfway down the hall when Hurst’s call from behind made me wince. “Dr. Garnet, could I see you a minute?”

  He hurried along the corridor, pulling on his coat as he came up to me. I knew he often used the walk to the lobby after a meeting for a conversation he didn’t want to be official or recorded in a set of minutes. “I’ve canceled elective activities tomorrow as part of the memorial to poor Kingsly,” he began to say, falling into stride beside me. “That means you can have surgical beds for emergency until Tuesday, providing, of course, your staff withdraws their threat to withhold service.”

  I’d expected this. It meant Hurst’s hospital lawyers hadn’t found a way to prevent us from shutting down emergency—yet. This was to buy time until they could.

  “Of course.”

  He stopped walking. My ready agreement must have caught him off guard. Until I turned to him and added, “For the duration of the day’s memorial to poor Kingsly.”

  Had he been anatomically equipped with venom and fangs, I’d have been looking for shots. As it was, I left him standing there, narrowing his eyes and making do with his lizard imitation while I continued down the hall. When I reached the next corner, I looked back and saw him still watching me.

  I’d bought a day of respite for emergency, but I wondered what I’d bought for myself.

  I took the stairs down to the main entrance on the ground floor, but even on a Sunday, I couldn’t leave the hospital without walking over and checking the ER. On my way, I wondered about Hurst and Bufort’s curious need for quick closure on the murders. I guessed each had different reasons—Bufort because he had no one but Fernandez to blame the murders on; Hurst because he wanted the scandal over with ... or because he was the killer.