“I don’t understand, sir,” Samantha replied, her voice cracking with alarm.
“Samantha, your liver is still failing, even with the interferon. It’s time to do more testing.”
“Doctor, I’m only nineteen. Am I going to die before I’m twenty?” Samantha asked.
“Samantha, I have no intention of letting you die, okay?” Dr. Stevens replied as he handed her a Kleenex. “We may have to get you a new liver sometime soon. If we do, you’ll live a pretty normal life. There are thousands of people in the country who have had liver transplants. The even better news is that with your youth and good health, your chances of a normal life are really quite good.”
Samantha continued to sniffle. Luke had been quiet up to this time. “What’s on tap today, Dr. Stevens?” he asked now.
“We’re going to do a bunch of scans and imaging. CT, MRI, HIDA scan, ultrasound. They’re all designed to focus specifically on the liver. Samantha, the only one that will hurt a bit is a liver biopsy. We’re going to have to stick a needle in your abdomen and draw out a little piece of your liver. It’ll be done under local anesthesia and will take about twenty minutes.”
Samantha got through the day and was exhausted at the end of it. Dr. Stevens told Luke that he would call in no more than two days with the results. He lowered his eyes and refused to make eye contact with Luke as he spoke. Luke left, thinking he knew what the answer would be.
53
At ten the next morning there was a knock on the door. Luke opened it to find a FedEx delivery driver with a large box from Dr. Challa’s office. Luke knew it contained Dr. Challa’s charts. By midafternoon Luke, Whizmo, Sue Ellen, Brad, and Samantha were gathered around Luke’s conference table. Luke had tried to talk Samantha into staying in bed since the day before had been traumatic. She refused, insisting it was her lawsuit and she would help. Sue Ellen had taken the afternoon off from prosecuting criminals. Whizmo had planned to do research for a paper he was writing on the effects of the Vietnam War on modern America. That could wait.
“Thanks for coming, everybody. Sam, if you start feeling bad, you need to go back to bed.”
Samantha nodded her understanding, knowing she would stay until the last document was studied.
“I’ve already glanced through these. Ceventa is the manufacturer of the drug, named Exxacia.”
“Hell, Luke,” Whizmo interrupted. “I just saw some actor on television a couple of nights ago, telling people to ask their doctors about Exxacia. When it comes to drugs and advertising, we got one screwed-up system.”
“I couldn’t agree more, Whiz, only that system is for discussion on another day,” Luke replied. “They’ve got a very detailed protocol, at least on paper, that outlines what Dr. Challa was to do. The subjects have to be between eighteen and sixty-five. They don’t qualify if they don’t have pneumonia, bronchitis, sinusitis, or tonsillitis. They’ve got to sign a detailed consent form and initial six other pages. The dates have to match. When they get the pills, they don’t know whether they’re getting the drug or the benchmark antibiotic. However, there’s a numbering system so that, if Dr. Challa followed it, Ceventa knows which patients got the drug. We all know that Sam must have. Then the patients have to come back once a week for six weeks for a short physical—vital signs and more blood work—followed by a last visit at ten weeks. We need to check all of that on every one of these one hundred and five charts. Any questions?”
“Just one,” Whizmo said. “At the end of the day, what are we going to do with our findings?”
“Let me save my answer until the day’s over, Whiz, okay?”
Whizmo nodded, and they began to pore over the charts.
“By the way,” Luke added. “If you run across Sam’s chart, holler. Lorance has already told me the consent form is missing.”
“But Dad, I didn’t read anything. He just handed me a form and told me to sign the back page. Now I see that these forms had places to initial on each page. I don’t remember doing that,” Samantha protested. “I didn’t have any sinus problem, either, not even a sniffle when I went into that office.”
Luke walked around the conference table and patted his daughter on the back. “I understand, Sam. Believe me, I understand. One step at a time, though, okay?”
“Hey,” Sue Ellen said to no one in particular as she thumbed through a chart. “Let me fire up my computer.” Sue Ellen turned on her Dell, clicked through to the county clerk’s Web site, and went to a section listing deaths in the county by year. “Aha! Just as I suspected. Here’s a form completed by a dead guy, Francisco Saldana. I remember that name because I sent him to prison for cocaine possession a few years ago. I saw in the paper he died a while back. Must have been some powerful drugs he was doing. He came back from the dead, signed these forms, and even had a pulse and blood pressure.”
“I’ll be damned,” Luke said. “Challa was reading the obituaries.”
“I can get him for fraud, Luke,” Sue Ellen replied.
“Not just yet. Let’s see where this goes.”
They spent the rest of the afternoon carefully analyzing the charts. When they finished, they’d found a handful that appeared to be valid in every respect. The rest had problems, including twelve charts completed by people who had died long before they supposedly volunteered for the trial.
54
The phone rang in Luke’s office, and he picked it up. “Luke Vaughan.”
“Mr. Vaughan, Dr. Stevens here. Is this a good time to talk?”
“Good as any, Dr. Stevens. What do you have to tell me?”
‘I’m sorry, Mr. Vaughan. The results are about what we expected. Sam’s liver is failing. The interferon we had her on hasn’t worked as we had hoped. It’s time to find her another liver.”
Luke put the phone down, tried to regain his composure, wiped his eyes, and then retrieved the phone. In a halting voice he asked, “Doesn’t that mean she’s going to have to get on some damn waiting list? Aren’t there a whole lot more people in this country that need livers than there are donors? Isn’t a transplant expensive? Why can’t I just give her my liver?”
“Mr. Vaughan, slow down a minute. Let me try to answer some of your questions.” Dr. Stevens had been down this road numerous times and was prepared for the interrogation. “First, there is a waiting list. Based on her MELD score, a scoring system we use to evaluate potential liver transplant recipients, Sam will be in the top twenty-five percent on the list. That’s good. As to cost, I’m afraid you’re right. The current cost is close to half a million dollars, and after the transplant the cost averages about twenty-five thousand a year.”
“Is that for the rest of her life?”
“Afraid it is.”
“How long will it take for her to get to the top of the list?”
“That, Mr. Vaughan, is the sixty-four-thousand-dollar question. Actually, the anomaly is that the more her liver deteriorates, the faster she moves up the list. Even when she gets close to the top, we still have to find a match to minimize rejection of the donor liver.”
“What about my liver, Dr. Stevens?”
“I’ve already checked that. Living donors are becoming more common. We can take a piece of someone else’s liver and it’ll grow in the person who needs it. Then the donor’s liver will grow back in a few months.”
“Then let’s do that.”
“Mr. Vaughan, I took the liberty of checking your blood type with Dr. Hartman. The two of you aren’t a match. Samantha has a rare blood type, and I need to tell you that that’s going to make it even more difficult to find a suitable donor. What about her mother? I don’t have any information about her. Is she still around?”
Luke searched his mind and came up blank. “I haven’t heard anything about her in more than fifteen years. Last I heard she was in Tennessee. I’ll see if I can find her.”
Luke paused and stared out the window long enough that Dr. Stevens asked if he was still on the line.
“I’m stil
l here, Doctor. How long does Sam have?”
“These situations can vary widely. My best judgment is at least several months. I’ve already taken the initial steps to get her on the national liver transplant list. Normally, she has to be interviewed by a number of people before she’s approved, but I pulled a few strings. We’re going to do our best, Mr. Vaughan. The good news is that people are living a lot longer with a transplanted liver than they did twenty years ago.”
“Thanks, Doc. I’ll be in touch.” Luke replaced the phone and rubbed his eyes. Finally he rose and walked out of his office.
He found Samantha sitting at the bottom of the stairs, her face in her hands. “I heard all of that, Dad.”
Luke sat beside his daughter and wrapped his arms around her. “It’s going to be okay, Sam. I told you that. It’s just that now we’re going to have to get you a new liver.”
Samantha jumped up from the steps and ran out the front door. Luke followed. She had curled up in one of the rockers. “I don’t want to live like this, Dad. I don’t even have a life. I want to die now, not when my liver finally fails.”
“Sam, don’t say that. Don’t even think like that.” He took her chin in one hand and gently raised her head until she was looking at him. “I promise, Sam. Trust me.”
Samantha saw the horror on Luke’s face. “I didn’t mean it, Dad! It’s just that I’m so tired. I’ll stick it out.” She sighed. “Now I’m going back up to bed.”
Luke returned to his computer and started trying to locate his ex-wife on various Internet sites. After a half hour he paused and stared at the screen. Josie had died in a one-car accident ten years before, apparently drunk. He got up, paced the office, and then walked back out to the porch, where he sat in his rocker and contemplated his next step. He considered whether to tell Samantha about her mother and rejected the idea. Sam already had enough on her plate. Finally he returned to his office.
Luke spent the rest of the day trying to figure out where to raise half a million dollars. The equity in the house was thirty thousand. He had another forty thousand in his 401(k). He had a modest business line of credit, and his credit cards were all paid off. He figured that got him to roughly a hundred and thirty thousand if he maxed out his credit line and credit cards. Next he checked the Medicare/Medicaid site. Naturally, even as a small-town lawyer he made too much money to qualify for funds. He went to his personal insurance folder and read the medical insurance policy he had taken out for himself and Samantha when they moved to San Marcos. It was just as he remembered. He’d had an option to add a hundred thousand in coverage for any transplant and had decided to save a few hundred dollars a year in premiums. It had never occurred to him that either he or Sam would need such coverage. Now he mentally kicked himself in the butt. The Internet gave ideas for fund-raisers, but he had seen newspaper articles on such events, and apparently they rarely raised more than a few thousand dollars. Needing someone to talk to, he called Sue Ellen and arranged to meet her at the river for an early dinner.
55
Sue Ellen found Luke sitting at a table by the falls. Two empty beer bottles told her he had a head start. He rose and gave her a peck on the lips.
“Not good, huh, Luke?”
“It’s worse than that, Sue Ellen,” Luke said, his voice not much more than a whisper. “Sam’s liver is barely functioning. She’s got to have a transplant. She even briefly threatened suicide.”
Sue Ellen’s hand went to her mouth. “Oh my God, Luke. Was she serious?”
“I don’t think so,” Luke said. “I convinced her I’d get her a transplant, only there’s one problem. It’ll cost about half a million dollars, and I can’t figure out a way to raise much more than a hundred and thirty thousand. On top of that, she’s a rare blood type that’s tough to match. I’ve made a promise to my daughter that right now I have no way of keeping.”
“I’ve got twenty-five thousand in Josh’s college fund. It’s yours if you need it,” Sue Ellen replied as she took Luke’s hand.
“Thanks, Sue Ellen, but I’m not looking for charity. There’s one more thing. I researched Sam’s mother to see if she could be a donor. She died in a drunken car wreck ten years ago.”
“Oh, Luke, I’m so sorry. Did you tell Sam?”
“Thought about it and decided not to tell her.”
Sue Ellen shook her head. “That could be a mistake, Luke. She even talked to me once, wondering why her mother deserted her. On the one hand, it would be hard on her. On the other hand, it might ease her mind about being abandoned by her mother. I think she’s entitled to know.”
Luke stared down at the table as he spoke. “I value your opinions, Sue Ellen. You know I do. Only, I have to make the decision, and I just don’t think this is the right time.”
Luke and Sue Ellen sat in silence, both uncertain what to say next. Sue Ellen chose to change the subject. “What about your lawsuit against Dr. Challa?”
“He’s only got fifty thousand in coverage. If Lorance offered it tomorrow, it wouldn’t pay for a liver transplant.’
Luke ordered two more beers and invited Sue Ellen to order dinner, saying that he really wasn’t hungry. Sue Ellen replied that she, too, had lost her appetite.
After the waiter brought their beers, Sue Ellen said, “Why don’t you sue Ceventa? They’re the ones that caused this problem, not Dr. Challa.”
“I’ve actually thought about that, only I know how these drug companies handle litigation. They declare all-out war. They’ll hire an army of lawyers and drag the trial out for two years. Then even if we were to win, they’ll appeal for another three years. They have an unlimited budget in these things. I’m sorry to say that by the time we got through all of that, Sam would be dead.” Luke shook his head. “It just won’t work.”
“Look, I don’t think you’ve got any choice,” Sue Ellen replied. “Your only hope is to put pressure on Ceventa. With Sam’s life in the balance, Nimitz will give you a quick trial.”
Luke sipped his beer slowly as he weighed his options. “I don’t really know much about Nimitz as a judge. How sure are you that he’ll put us on a fast track?”
Sue Ellen took both of Luke’s hands in hers as she replied, “I’m as sure of it as I’m sure that Sam is going to die if you don’t try it. I’ll be beside you all the way.”
Again there was silence as Luke contemplated what Sue Ellen was suggesting. Finally he nodded. “I’m for it, particularly if he will get us to trial in a few months. That may be all the time Sam has. I just have to clear it with her.”
56
Samantha was sitting on the front porch with Cocoa at her feet when Luke returned to the house. She remained in her rocker as he bent over to give her a kiss and sat down beside her.
“Sam, Sue Ellen and I have been talking. I want to add Ceventa to our lawsuit.”
“Dad, we already talked about that,” Samantha replied with dejection. “You said that it might take two years to get to trial and more time on appeal. I know what the doctors have said. I don’t have that much time.”
“Hear me out. I’m going to ask Judge Nimitz for an expedited trial date, ninety days if he’ll give it to us. Ceventa’s lawyers will claim they can’t get the case to trial that soon and will do everything they can to delay. Sue Ellen knows the judge well. She says he’ll work with us. If we can push a trial date, we can be ready.” He looked at his daughter. “It’s our best shot.”
Samantha was lost in thought. “What happens if we win in trial and they appeal?”
“Good question, Sam. No telling. Maybe they’ll want to settle for a few hundred thousand if we get a multimillion-dollar verdict. We’re not trying to get rich, just get you a liver.” Luke stopped, not sure whether to broach this subject to Samantha. “And there’s one more thing. I’ll have to take out a second mortgage on the house to cover the expenses. I’ll also have to turn down any other clients until the trial is over. If we lose, we may be on the street.”
Samantha digested
all the information. “Look, Dad, I know you want to do what’s best for me. I agreed to sue Dr. Challa. Now you want to sue this giant corporation and risk everything we have. Plus, you’re going to be consumed with the case.” Samantha reached for her dad’s hand. “If I don’t have much time, I’d rather have you around than fighting with Ceventa. We can still sit out here and talk and sometimes go driving in the Hill Country. Does that make sense?”
Luke squeezed his daughter’s hand. “Yeah, sweetie, it does. Forget I even suggested suing Ceventa.”
A few hours later Samantha appeared at Luke’s office door. He glanced up and smiled as she took a seat opposite him. “Okay, so I’m a woman, and a woman has a right to change her mind, right? Let’s sue Ceventa.”
Luke put down his pen and stared into his daughter’s eyes. “What caused this change of heart?”
“Brad and I talked. We talked a long time. He said he doesn’t want to lose me, and if there’s even a slight chance that we can win and I can get a new liver, he says I should do it. Dad, Brad and I want to take that chance.”
Luke continued to stare in silence at Samantha, then spoke. “Are you sure, very sure?”
“I am, Dad. Let’s do it.” Samantha paused as she faced up to reality. “There’s one more thing. If I’m gone before the lawsuit’s over, I don’t want you to give up. If I die, at least I’ll go knowing that I did what I could to stop Ceventa from killing others.”
57
Luke was up early the next morning to draft the amended petition, adding Ceventa, along with the motion for an expedited trial. Without knowing for certain, he claimed Exxacia was defectively designed in that Ceventa knew that it could cause liver failure and death. Further, he alleged, the company failed to properly warn physicians and consumers of the risk. He also complained that Ceventa enticed innocent patients into volunteering as subjects in a clinical trial that turned them into guinea pigs. Next he beefed up the section on Samantha’s condition, referring to a letter he had gotten from Dr. Hartman describing it in detail and confirming that her death was imminent if she did not get a liver transplant.
The Trial Page 14