“To that end, we propose an intensive training program for every staff member who handles medications. Never again will a novice pharmacy technician — such as the young man I fired last week for causing your daughter’s heparin overdose — step one foot in the pharmacy until she or he is completely conversant in the computerized medication administration system we adopted just days before Ariel’s hospitalization.”
Baumgarten interrupted. “Would have been nice if you’d done that before my clients’ baby entered your hospital.”
Marsh was not cowed. “We agree with you. We thought our training was sufficient, but clearly, we were mistaken. However, we aim to correct our mistake, and Mr. DiPerna here,” she motioned to her right, “will explain to you in detail how we aim to make the system as fail-safe as is humanly possible.” With that, she handed off the presentation to the chief designer of the BCMA system. He piggy-backed on what Marsh had said, making a point-by-point case for massive, onsite tech support from his firm. In addition, the BCMA system would be redesigned to add audible alarms when scans did not match. DiPerna closed by saying that such a plan would further reduce the probability of an error such as the one that had affected Ariel Arkin.
Finally, Ted Ainslie explained the cost of all the proposed improvements in staffing and training — over ten million dollars in the first year alone. Maintaining high staffing levels among nurses, and providing training for all new hires, would cost at least as much in each subsequent year. Projected out three years, the bill would top thirty million dollars.
It was Sarah’s job to conclude the presentation. Taking the floor once again, she looked directly at the Arkins. “In closing, I want to emphasize the seriousness of the hospital’s commitment to eliminate medication errors. We are on a mission. Although we have no power over the pharmaceutical company, we have initiated talks with the heparin manufacturer about a redesign of the labeling for their products in order to eliminate the type of mix-up that occurred in Ariel’s case. Those discussions are part and parcel of our overarching goal: that no other patients suffer as Ariel did from a mistaken dosage or from an incorrect medication. We are willing to fund that effort despite, as Mr. Ainslie just illustrated, its eight-figure price tag. And, to guarantee our good faith, should you agree to our remediation plan, we propose that it be monitored for compliance by a neutral third party — mutually agreed upon — for the life of the agreement, that is to say, three years.”
Sarah took a sip from her lukewarm latte and continued. “Of course, we want to address the pain and suffering Ariel experienced because of our error. We are offering your daughter a monetary settlement of five hundred thousand dollars as compensation for the trauma she experienced.”
Sarah had no sooner announced the figure than she heard Baumgarten remark in a stage whisper, “You’ve got to be kidding.”
She’d anticipated that reaction from the Arkins’ representative and remained calm and measured in her presentation. “Though her response to treatment has been so encouraging, giving us all great hope that Ariel will make a full and complete recovery, our settlement has contingencies built in for remedial therapies through age twenty-one in the event of physical or cognitive damage associated with the medication error.” Sarah saw Catherine shudder.
She was nearly done. She looked down at her watch: five minutes to eleven. At that point she knew it was time to open the floor to the Arkins and their counsel. “I understand that you are anxious to get back to Ariel. However, I want to give you every opportunity to ask questions about what you just heard.”
Baumgarten went first. “Very nice presentation. We appreciate your efforts to prevent another little baby from suffering the way Ariel did. Jesus, you guys nearly killed her. So it’s nice that you don’t want to kill off any other babies who come in with a simple staph infection. We appreciate that. We really do. But how does your plan do my clients any good? The harm has already been done to their little one. Five hundred thousand? Why, that’s chump change. You know that, Harry,” he said, turning his attention to Meinig.
Harry could see the storm clouds rolling in. God bless Sarah. Her idea of admitting guilt was a logical strategy given the damning evidence of hospital culpability, but it looked like Mark was aiming to play hardball. He had to try to salvage the plan. “Reid, what I know is that we’d all like something good to come out of what was nearly a catastrophic error. Thank God the error was caught immediately and Ariel was given state-of-the-art treatment by Dr. Smith here and the rest of the medical team. We all hope and pray that she’s going to be okay. But as important as making sure she’s okay, we want to make sure her ordeal brings about something positive. That’s the thrust of our proposal. And we hope you and your clients will give it some thought. That’s all we’re asking — that you give it serious thought.”
Mark had sat stock still throughout the presentation while his wife took copious notes. His face was blank, betraying nothing but fatigue. When he broke his silence, he turned toward Dr. Smith. “My good Dr. Smith. I haven’t heard squat from you. What’s your impression of this so-called ‘plan for remediation?’ Is it worth a rat’s ass? I’m interested in hearing what you think. I know you work for the hospital, but I also know you’re not afraid to call things as you see them. After all, you called me an asshole when I was being an asshole. Not too many people have ever done that and lived to tell the tale. So I figure you’ll level with me. What’s your take on what you just heard?”
Harry winced when he heard that Dr. Smith had called Mark an asshole to his face, though he couldn’t agree more. He wondered where he had gotten the balls to do that. The same question crossed the mind of nearly everyone else in the room. Not Sarah, though. She found herself suppressing a little smile.
Rick colored when he was reminded of the scene in the baby’s room — when the father was yelling and he couldn’t think straight as he tried to counteract the effects of the overdose.
“Sorry about that, Mr. Arkin. Things were happening pretty quickly at that moment. I apologize for losing my cool.”
“I don’t give a crap about that. You saved my daughter’s life. By my lights, you’re a straight shooter. Is this plan the real deal? That’s all I’m asking.”
Rick had had his share of moments in the sun. He’d been a two-sport varsity athlete in high school. He’d won academic honors in college. Beating out the competition, he’d been appointed pediatric chief resident. Now he was in one of the country’s best fellowship programs in pediatric intensive care. But nothing had prepared him for this. He thought for a moment and then sat up a bit straighter in his chair.
“You want the truth, Mr. Arkin? All right, here’s the truth as I see it.”
The members of the hospital team held their breath when they realized a sixty-grand-a-year fellow decked out in scrubs and sneakers might well hold the hospital’s fate in his hands.
“Mr. Mess here will confirm that I just about fell out of my chair when I heard that the hospital was going to take responsibility for the error. Frankly, such honesty is a rare occurrence, Mr. Arkin, and I was happy to hear the hospital was willing to do the right thing. We doctors and nurses — and all the staff — we’re just people. We’re not automatons. We do our best — and believe me, I work with the very finest people in the field — and despite that, we sometimes make mistakes. Believe me, nobody woke up that morning and said to themselves, ‘Oh, gee, maybe I’ll injure a little baby at work today.’ Just the opposite. The people I work with are driven by the desire to help kids get better. But despite that, a series of circumstances allowed well-meaning people — highly competent people — to deliver an overdose to your baby.
“I’ve reviewed this plan at length. Ms. Abadhi had me going over it with a fine-tooth comb. I would have to conclude that, using your terminology, this is ‘the real deal.’ It’s a good-faith, comprehensive effort to address the circumstances that allowed good people to make a terrible mistake. If it’s implemented, I believe it will
go a long way toward helping competent, well-meaning doctors, nurses and pharmacists do their very best for each of our patients, and will get us as close as we can to eliminating medication errors at the hospital.”
It was as though every person on the hospital team exhaled at once. The man in the scrubs and sneakers had spoken, giving the plan his seal of approval. Harry thought that after that ringing endorsement, it was possible they might still have a shot at convincing the Arkins to bypass the malpractice route. It depended on how great their desire was for vengeance, since it was clear they didn’t need a cent from the hospital. Baumgarten would be key on that point, emphasizing the need to “teach those bastards a lesson,” or some such tripe. The question was, would they accept the remediation plan as proof that the lesson was learned?
Catherine had stopped her note-taking to look directly at Dr. Smith. “Thank you, Dr. Smith. As is obvious, we put a great deal of faith in your opinion. My husband and I appreciate your assessment of the hospital’s proposal.”
Baumgarten, who would have liked to put a sock in the doctor’s mouth, cut Catherine off before she could say another word. “Yes, thank you, Dr. Smith. And thank you all for your presentation this morning. My clients and I will be getting back to you after a thorough review of your proposal. I’m assuming, Ms. Abadhi, that you’ve prepared a document for us to review?”
“Yes, of course, Mr. Baumgarten.” She got up and handed each of them a copy.
“I really have to get back to Ariel now,” Catherine said as she stood up to leave. “You’ve given us a lot to think about.”
“My clients and I will be going over their options. We’ll get back to you,” added Baumgarten.
Sarah tried to get a read on Mark, but his face revealed nothing. She had given it her all. Everyone did their part during the presentation, none more than Dr. Smith. Time would tell whether their efforts would pay off.
CHAPTER FIFTEEN
As each day passed with no word from the Arkins or their attorney, Sarah grew more on edge. With Thanksgiving coming up, word from the Arkins would likely be further delayed. She decided to distract herself by spending the holiday at her parents’ house in Westchester. During the big feast, Bubbe Rivka regaled her children and grandchildren with tales of romantic intrigue at the Brighton Beach Senior Center, but Sarah was too worried to enjoy her grandmother’s storytelling. That night and the next, she slept poorly in her childhood room.
If she’d been a fly on the wall at the Arkin home, she might have enjoyed her Thanksgiving more. Daily life changed after the Arkins brought their baby home from the hospital. Mark lingered in the mornings, not leaving for work until ten. He was back for dinner each night by six. His company had always been his reason for living, but now all he cared about was Catherine and Ariel. He forced himself to show up at the office and put on a good front, so people wouldn’t think he was losing his edge. He knew they’d take advantage, just as he would if he sensed a weakness in someone else. But the truth was, all he really wanted to do was stay home with Catherine and help her take care of their daughter. He even changed a diaper or two.
Mark had shoved the hospital’s settlement offer to the back of his mind, despite Baumgarten’s daily attempts to set up a meeting to discuss it. Mark knew the lawyer’s take on it: Let’s clean the hospital’s clock. Normally, he’d have been one step ahead of him. Vengeance was not only sweet, it was necessary to ensure that others didn’t try the same stunt. But the realization that he had no urge to destroy the hospital left Mark confused and worried; so much so, he kept both Catherine and Baumgarten at bay every time they brought up the subject of the settlement offer.
Two weeks had passed since they’d received the hospital’s proposal. For Catherine, every day that Ariel awoke happy and healthy was a red-letter day. Although she couldn’t forget what had happened, she felt the sincerity of the hospital’s apology could be measured in its proposed improvement plan. She thought it well designed, and no one could say that they were trying to do it on the cheap. She’d written a piece on the economics of health care a few years back and knew what hospitals were up against: cuts to reimbursements from Medicare, more uninsured patients turning into charity cases, competitive demands that drove them to keep up with neighboring hospitals — be it with sunlit atriums for their lobbies or the newest robots for microsurgery. She thought the hospital’s proposal was on point. And for her, the idea of something positive coming out of their nightmare held great appeal.
On a sunny morning in early December, as she and her husband sat at breakfast with Ariel next to them in her baby seat, she decided to force the issue that Mark had been so artfully dodging.
“Sweetie, I think it’s time we talk about the hospital’s proposal. I get the sense you’d rather not and I can understand why. The whole experience was…well, we both know how devastating it was. But Ariel’s doing well now. I’ve given the proposal quite a bit of thought and I know you likely have, too. So I think it’s time we share our thinking.”
Mark had been dreading this. What he shrank from was admitting that he didn’t have the thirst for blood that had always driven him. That nice-looking lawyer representing the hospital had made a good case. And, as soon as Dr. Smith had told him the improvement plan was the real deal, he had no reason to doubt it. That wasn’t the problem. The question was, would he make the hospital pay for nearly killing his daughter, for making his wife almost lose her mind? To his amazement, the answer that kept coming to him was, “No.” He was just relieved that it was over and that they’d had a chance to pick up with their lives again.
“Sorry I’ve been putting you off. I wanted to think it over.” Stalling some more, he asked, “You said you have an opinion. How do you think we ought to respond?”
“Well, I have to admit that as tired as I was that day, I was impressed by that attorney’s presentation. What was her name? Something funny, I can’t recall. She and the other lawyer made a good point. If millions are going to be spent because of what Ariel went through, let those millions do some good. The truth is, the patients would be the beneficiaries. Better nurse-patient ratios, less fatigue in the nursing ranks, effective implementation of the computerized medication system. The downside, of course, is that Ariel’s cash settlement would be much smaller than what she would get if we filed a lawsuit.”
“There’s no doubt about that, Catherine. The case is worth millions, particularly because they confessed to all their mistakes. The question is, is that the route you want to take? If so, I’ll get Baumgarten on the horn and give him the go-ahead to prepare for war.”
“Well, how do you feel, Mark? Do you want to go to war? I wouldn’t blame you if you do.”
Trying not to sound too sheepish, he finally made his admission. “The truth is, I just don’t have much of a stomach for it. I can’t believe it myself but I just want to put all of it behind us. But I’ll go to war with the hospital if that’s what you want. I will, Catherine.”
“No, I don’t want to go to war,” she said as she started to well up. “I feel just as you do. Let’s delight in this beautiful baby and get satisfaction from knowing that her suffering produced some good. Truth be told, Ariel doesn’t need millions from a settlement. It would likely ruin her. She’d become one of those disaffected rich kids getting into trouble with all their money. We don’t want that, do we?” she teased.
“We certainly don’t want her to fall victim to the corrosive influence of wealth,” he said, tongue in cheek.
“No, we certainly don’t,” Catherine said, smiling. “So what do you say? Can we accept the offer — maybe with a counter that they throw in free medical care for Ariel until age eighteen or something like that?”
“Well,” her husband replied, laughing to himself in disbelief, “we certainly don’t want to look like a couple of chumps. Let’s demand free medical care.” Then he added, “Baumgarten’s going to think we’ve lost our minds. He’ll be furious when he sees the fees he would have earned f
rom a fat settlement — or better yet, a jury award — go up in smoke. And you know what? I don’t give a crap.”
Catherine got up from her chair and sat down on her husband’s lap. As she kissed him, a feeling of wellbeing flooded over Mark. Much to his surprise, his groin played no role in it. He wondered if he was turning into some blissed-out pansy. But as he kissed his wife back, his shlong came to life, restoring his faith in himself as a man’s man.
CHAPTER SIXTEEN
Word of Sarah’s success spread quickly through the law firm. Harry went straight to the firm’s managing partner and lobbied for a substantial raise for his protégée. John Mess, delighted and relieved, passed the Excedrin to Ted Ainslie, whose job it was to find the money to implement the remediation plan. Mess made good on his promise to recognize Dr. Richard Smith, Dr. Esther Cho and Jeannie Lopez. For delivering the apology to the Arkins, they each got two extra weeks of vacation — or two weeks’ pay if they preferred. On top of that, Dr. Smith was made an offer to join the hospital as an attending in pediatric intensive care when he completed his fellowship in June. With the single exception of Reid Baumgarten, the Arkins’ attorney, all parties involved concluded it was the best possible outcome from the near-tragic medical error.
Rick wasted no time in contacting Sarah to offer his hearty congratulations. He suggested they celebrate at an Asian fusion restaurant and continue their discussion of all things non–work related. Sarah readily agreed. She was fairly certain his endorsement of the improvement plan had tipped the scales in their favor. But beyond that, she wasn’t averse to the prospect of spending more time with the doctor. He was not only as tall as she — and handsome in a rough-hewn way — he was also smart, driven about his work and gutsy. Had she met him under similar circumstances before she dialed back her expectations for happiness, a date with Rick Smith would have been cause for some excitement. As it was, she was open to the idea of sharing a meal with him.
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