“You’re thinking this might be the murder Kelly had in mind?” she asked.
“It’s a place to start,” I said. “I have a couple of questions. Should I call you back when you get home? Or are you at a place where you can answer them?”
“Just pulling into my driveway,” she said. “Shoot.”
“Okay. When you were MacDonald’s nurse, did you ever have any contact with his family or neighbors?”
“Nope. His wife was dead, he had no children, and as far as friends were concerned—well, he seemed to be pretty much alone in the world. The woman across the alley looked in on him every now and then, though. I’m sure I have her name in my notes. It might be worth the trouble to drop in and talk to her.”
“He was an over-stay,” I said. “He was in hospice for eleven months before he died. And Kelly has marked him as ‘unqualified’—not sick enough for hospice. Do you happen to remember right off what his illness was?”
There was a pause. “Stomach cancer is what I remember,” she said slowly. “Not a surprise, given the man’s diet. He wouldn’t stop smoking, either. But there were some questions about the . . .”
Her voice trailed off. After a moment, she said, “Look. Kelly’s death has been pretty hard for me, and I’d rather get into all this when I’m fresher. Tomorrow is my day off at the clinic. I’m scheduled to have lunch with Rich and Kelly’s mom to talk about funeral arrangements. But maybe you and I could get together in the morning? We could try to connect with the woman across the alley and see if she knows anything about MacDonald’s death. Also, I’d like to pick up the things Kelly left in your cottage. No point in leaving them for you to store.”
“Of course,” I said sympathetically. “I’ll get Caitie off to school in the morning, then give you a call and we can make our plans.”
“Thanks,” she said, letting her breath out in a long whoosh. “You know, China, I have the very strong feeling that Kelly is riding along with us on this. It may be just wishful thinking, but I still believe that we will find out who rear-ended her—and that it was deliberate.”
I wanted to say, And then what? but I held my tongue. Lara didn’t know any more than I did, and neither of us knew enough to answer a “then what?” question. Anyway, she had enough on her plate right now. So I wished her a good night’s sleep and hung up.
I sat for a moment, sipping my tea and thinking about a game plan for tomorrow, now that Lara and I were planning to get together. I glanced at the clock. It wasn’t ten yet, and Ruby was a night owl. I picked up my cell and called her.
“Have you come up with any more magic words about doors and why I shouldn’t go through them?” I asked.
Ruby sighed. “I hope you’re not going to hold that against me.”
“Not at all,” I said. “I’m just seeking guidance. I’m looking for a door to go through, but I’d hate to open it and have a gun go off in my face. Or the ceiling fall down on my head. Or something.”
We both chuckled. Then she said, very soberly, “I’m so sorry to hear that Kelly died this evening, China. I know that she was your friend, and you’ll miss her.”
“You’ve heard about that already?” And then I understood. “Oh,” I said, remembering that this was a complicated affair, and that there were lots of different threads woven through it. “Ramona must have told you.”
“Right.” Another sigh. “She was here this evening, crying on my shoulder about the way things have turned out.”
“Crying?” I was taken aback. “Excuse me for saying so, Ruby, but I would think your sister would be happy. Well, maybe not celebrating with champagne and party hats, but at least quietly satisfied. She got what she wanted, didn’t she? Just last night, she was telling me how eager she was for her brewmaster boyfriend to divorce his wife so they could be married and spend the rest of their natural lives together, brewing blood orange beer and adding herbs to every beer recipe they can think of. And now his wife is out of the way, without even the bother of a divorce and the distribution of property. Everything that belonged to Kelly probably now belongs to her husband.”
“My, aren’t we snarky tonight,” Ruby said.
“Well, yes,” I replied drily. “And likely to get snarkier. Excuse me, but Kelly is dead and I hate the thought of your ditzy sister—your evil twin—gloating.”
“She’s not gloating.” Ruby was very serious. “She’s miserable. He told her to go away and leave him alone. Forever.”
“Kelly’s husband?” I asked in surprise. “Kelly’s widower, I mean. He told Ramona to go away?”
“Yes, that one. And yes, that’s what he said.”
“Wait a minute, Ruby. I don’t understand. Just last night, Ramona was thrilled by the idea that Rich was going to divorce Kelly and marry her and she would own a big piece of the brewery and—”
“She may end up with the brewery,” Ruby said. “She’s already invested quite a bit of money in it. But Rich feels terribly guilty about their affair, and now that his wife is dead, he’s heartbroken. He says he’s going to sell out and move away. He blames himself. He says that if he and Ramona hadn’t been involved, Kelly would have been home last night, safe and sound, instead of driving on Limekiln Road.”
“There might be some truth to that,” I said. “But Kelly has been dead only a few hours. I’m sure Rich will feel differently before long. Ramona just needs to give him some time, and some space. If she could just be patient and stand back for a couple of months while he sorts things out—”
The minute the words were out of my mouth, I saw the problem. Ruby’s sister has never been able to practice patience for one single instant, let alone a few weeks or a couple of months. What she wants, she wants now, and if she can’t get it now, she doesn’t want it. If she had been insensitive to Rich’s grief and had shown that side of herself to him today, she could easily have revealed an aspect of herself that turned him away once and for all. He might even begin to blame her for what had happened, as well as himself.
Ruby was reading my mind. “Yes,” she said sadly. “You and I both know that Ramona doesn’t have a patient bone in her body. Of course she hasn’t said this, but I’ve had the idea all along that the romance was more her idea than his. Listening to her tonight, I have the feeling that Rich really is through with her. And I don’t blame him, one single bit. I hate to say it, but you’re right, China.”
“Right about what, exactly?”
“She really is my evil twin. And I don’t know what to do about her. When she was here tonight, she flew into one of her little tizzy fits. Stuff started rocketing around the room and—” She stopped. “Sorry,” she muttered. “I know that sounds idiotic, but it’s true.”
“It doesn’t sound idiotic at all.” I glanced up at the cuckoo clock, which hung sedate and silent on the wall. “When she was here last night, she got . . . excited. The cuckoo clock came back to life, the microwave went berserk, the TV switched itself on, and Winchester joined in with his very best howl. It was a cacophony.” I blew out my breath. “And I have the idea that this was just a little exercise. I hate to think of what might’ve happened if she had shifted into high gear.”
“Sorry,” Ruby said apologetically. “I’m at my wits’ end. If you have any suggestions for ways we can handle her . . .” Her voice trailed off.
I sighed. If Ruby couldn’t deal with her sister, nobody could. “Well, it’s nothing we can solve tonight. Listen, there’s something important I need to do tomorrow morning. If I open up, can you keep an eye on the shop for me for a couple of hours?”
“Oh, no problem,” Ruby said. “Miriam is coming in the morning to help me put up some new shelves. Between the two of us, I’m sure we can manage. In fact, you don’t even need to open up. We can handle that for you.”
“Well, if you’re sure,” I said. “I really appreciate it, Ruby.”
“It’s the
least I can do,” she said. She paused, and in a smallish voice, added, “But I’d feel a lot better, China, if I knew you were being careful about that door.”
“I’d feel a lot better,” I countered, “if I knew which door to be careful about. Please let me know if something comes to you.”
“Oh, I will,” she said earnestly. “I will. I promise.”
I went upstairs, kissed Caitie good night, then took a long, slow bath. After that I climbed into bed and read for an hour, still hoping that McQuaid would call. But I couldn’t stop glancing at the clock, and I finally gave up. I punched up my pillow and turned out the light, my cell phone on the bedside table and Winchester, snoring gently, sprawled across the foot of the bed. Every so often his stumpy little legs jerked as he chased rabbits and armadillos in his sleep. He gave a gleeful little yip every time he caught one.
But I lay awake for a very long time, thinking about McQuaid and Blackie and wondering where they were and what they were doing. They weren’t trying to infiltrate one of the Mexican drug cartels, were they? Oh, please, no. No! Sometime just before dawn, I woke up with a gasp, drenched in a cold sweat. I had dreamed that I opened a door and found McQuaid lying facedown on the floor in front of me. I awakened before I discovered whether he was alive or dead.
After that, it was impossible to get back to sleep. About four o’clock, I got up, turned on my laptop, and began doing some research on Medicare fraud.
Chapter Fourteen
The opium poppy (Papaver somniferum) blooms in a variety of beautiful colors, from pale lavender to an intense, vibrant orange. It’s a lovely garden flower and remarkably easy to grow, but you’re not going to see it in most American gardens. The plant’s dried latex sap is known as opium, and opium’s main psychoactive substance is morphine, named for Morpheus, the Greek god of dreams. Because it operates directly on the central nervous system, morphine is a powerful—and powerfully addictive—painkiller.
Morphine was first extracted from opium in a pure form in 1804, and rapidly came into pharmaceutical use as a painkiller. Many soldiers became addicted to morphine during the Crimean War and American Civil War, where it was widely used in battlefield hospitals. Laudanum, a tincture of opium, was used in many patent medicines and as a sleep aid, increasing the addiction problem. In 1874, a chemist attempted to create a less addictive form of morphine and synthesized heroin. But it was two to four times more potent than morphine, and addictions skyrocketed.
China Bayles
“The Opium Poppy: The Sleep Herb”
Pecan Springs Enterprise
“That’s the house,” Lara said, pointing to a neat yellow bungalow. I pulled over and parked half a block away from it, leaving the motor running. The morning was warm and bright with April sunshine, and bluebonnets and yellow-orange paintbrush were blooming in the grass along the curb. We had stopped at the diner and picked up cardboard cups of coffee to go and a couple of Lila Jennings’ jelly doughnuts, strawberry for Lara and raspberry for me. That made two mornings in a row. I was beginning to feel downright decadent.
Ronald MacDonald’s neighbor hadn’t been listed as a contact in Kelly’s file, but Lara had found her name, Mary Jo Mueller, in the personal nurse’s log she had kept during her years at the hospice. “You can never keep too many records,” Lara remarked, and I agreed.
It hadn’t been hard to locate Mrs. Mueller’s house. As Lara had recalled, it was on the other side of the alley behind 137 Wheeler Avenue, where MacDonald had lived—and died. It was in an older neighborhood of rental houses and small one- and two-story apartment complexes. We drove past the MacDonald address first. I wasn’t surprised to see that the house had been razed, and a new one was going up in its place. Years ago, on a case back in Houston, I had gotten too close to a decomposed human body. The smell of it clung like a stubborn ghost to everything, no matter how thoroughly the site and its furnishings were disinfected, and clung to my skin and hair—for real, or perhaps just in my imagination—through a week of showers. The owner of the house in which MacDonald had died no doubt found it cheaper to tear the rental down than to clean it up.
I finished the last bite of my jelly doughnut, reached for my coffee, and studied the Mueller house. It was set back behind a small green square of lawn, bisected by a neat brick sidewalk and centered with a single large pecan tree. The morning sunlight brightened the tree’s new green leaves and dappled the lawn.
“Before we talk to this woman,” I said, “maybe you could bring me up to speed on MacDonald. You’ve said he was hard to get along with. Tell me more.”
Lara licked the sugar off her fingers and picked up the spiral notebook she had brought. She looked professional today, in brown slacks, a red jacket, and a white blouse. Both of us did, in fact: I was wearing khaki slacks, a navy top and blazer, and black loafers, a big change from my usual jeans and T-shirt.
“MacDonald was admitted to hospice care with stomach cancer, on the referral of a doctor in San Antonio. Chris—Dr. Burgess—signed the admissions paperwork. Dr. Burgess and I made the first visit together, then I made weekly visits for the next five weeks.”
I saw the red stain on her cheek and wondered whether she was embarrassed by her former relationship with Burgess or whether she still might harbor some feeling for him. “Weekly visits,” I said. “Is that standard for hospice?”
“It depends on the case. Yes, most patients are visited weekly by a nurse. The social worker, the chaplain, or a household helper sometimes make additional visits. The focus is supposed to be on pain management, you know, for people who are dying. So the nurses do what they can to make the patients comfortable, see that they have what they need, and so on.” She took a breath. “My first few visits with him were pretty routine, and then he began to be . . . well, abusive. Verbally abusive.”
I asked the question I’d been wondering about since my predawn foray into Medicare fraud. “How ill was he, as far as you could tell?”
She reached for her coffee, parked in the cup holder. “You know, that bothered me. He was supposed to be terminal. But during the time I was assigned to him, his physical condition didn’t change. Of course, stomach cancer isn’t something you can actually see, and I’ve known other patients who have seemed to plateau for a time. But he didn’t experience any weight loss, which I thought was strange.”
“Do you know what happened in his case after you stopped making visits?”
“That’s where it starts getting a little squirrely.” She sipped her coffee and put it down. “Last night, I checked the file you emailed me—Kelly’s computer file—and found that she had been assigned to him, too, for about six weeks. Then another nurse took over, someone whose name I didn’t recognize, and several others after that. Over the eleven months of his stay in hospice, he had five or six different nurses.” She finished her coffee and put the cup on the floor. “The visits weren’t regular, either. There were weeks when nobody visited. Or if they did, the record is incomplete.”
“Six or seven different nurses.” I thought about that for a moment. “Is that the usual practice? I would think it would be a lot better for the patient if he or she had just one nurse during the stay.”
“It wasn’t usual, China. Most of the time, we were assigned to a patient and stayed with that patient until the end. Of course, nurses sometimes go on vacation. And if there’s a late-night or weekend emergency, the on-call nurse handles the situation.”
Lara leaned toward me, her gray eyes intent behind gold-rimmed glasses, her brown hair frizzing around her face. “But China, listen to this: I got up early this morning and went through Kelly’s files again, looking at her ‘unqualified’ patients, the ones marked yellow. All of them were admitted by the same two San Antonio doctors and certified by Chris Burgess. All of them were visited by the same four or five nurses. They were nurses whose names I didn’t recognize, even though it looks like we worked there at the sa
me time.” She shook her head. “It’s not like the hospice was a huge business, you know. We all attended the same staff meetings at least once a month—at least, we were supposed to.”
A mockingbird landed on the hood of the Toyota, regarded us with one bright, beady eye, then flew away. “Those four or five nurses,” I said. “Is it possible that they didn’t really see the patients? That they signed off on visits that were never made?”
She nodded slowly. “Yes. We were paid by the visit, and only occasionally supervised. So maybe they just didn’t visit.”
I might have been surprised, if I hadn’t already begun to see the pattern. “How about this?” I asked. “Could those nurses have been paid not to visit? And could the patients themselves—or some of them, anyway—be fictitious? So the hospice was billing Medicare one hundred seventy-two dollars a day for ‘patients’ who received no services at all. Is that possible?”
She chewed on her lower lip for a moment, then said, very quietly, “It’s possible, China. I mean, I know that the hospice delivered real services to real patients, because I worked with many of them while I was there, and so did the other nurses. But it’s also possible that some of these people in Kelly’s files were never patients at all. And here’s another thing. The patients Kelly coded as ‘unnecessary general inpatient care’ were all moved to a small medical facility down in Seguin, when it would have made a lot more sense to put them in the Pecan Springs hospital.” She looked up at me. “I’m wondering whether there was some kind of kickback arrangement on those patients.”
“Ah, yes,” I said. “I see.” And what I was seeing was the jagged outline of a very large fraud that had been playing out for a very long time, to the lucrative tune of hundreds of thousands of dollars.
Lara turned to look out the window, watching a young mother pushing a baby carriage down the sidewalk. After a moment, she said, “But whatever the case, they’re not patients now.”
Blood Orange: A China Bayles Mystery Page 21