by Alec Peche
Ann reached over to give her mother a hug as she remarked, “I have served on hospital committees for about nine years and have only recently joined the hospital’s board of directors. I met Doug for the first time during my orientation. The hospital set up a four-hour orientation and had various managers explain hospital reports and sort of the regulatory role of board oversight of the hospital. It was a lot of information to absorb in the four hours. I'm trying to think back to whether Doug's presentation stood out in my mind and I can’t say that it did. I had never before thought about quality in the hospital and may be for the first half of his presentation I kept thinking ‘doesn't the hospital do everything perfectly?’ And then I would tune back in to what he was saying. I don't remember any of the presentations alluding to a problem area in the hospital; there were no temper tantrums mentioned nor inappropriate behavior between anyone associated with Our Lady.”
"Have you attended any board meetings or has it just been the orientation so far?" queried Jill.
"I have attended two board meetings and the orientation was between my first and second board meeting. I would be the first to admit that I had a hard time understanding the language – acronyms used by people during the first meeting. I felt slightly more comfortable at the second meeting due to the orientation I had although I still didn't know many of the acronyms.”
"Do you have the materials from the board meetings or the orientation sessions? As a not-for-profit business, some of Our Lady of Guadalupe hospital’s board proceedings are confidential,” Jill observed. “Any malpractice discussions, any physician performance discussions, or any business affiliations discussions would be considered confidential under peer review statutes or competitive business rules. Ann, would you be willing to share the materials that you received for those board and orientation sessions? I can assure you that they will remain confidential. My sole purpose in reading them is to look for Doug's killer."
"Jill, you put me in a difficult position. I have responsibility as a board member to protect and strengthen the hospital. I also have a duty as a human being to do what I can to help find Doug's killer. I know I would not want you to share anything you saw in those materials with the police, and I don't know how you could not share something with the detectives if it was material to finding Doug's killer."
The conversation was getting hairy and Angela broke in with her view of Jill's request.
"Ann, you know I've worked with Jill on her cases over the past five years. We have had confidential information pass through our hands in the past and we have not immediately picked up the phone to call law enforcement. I think that those documents might help us by directing us to a motive for this murder. If for example it said in the medical staff meeting minutes that a fight was broken up between Doug and Dr. B, we wouldn't turn around and share that with anyone outside of this room. Instead we would do a lot of research on Dr. B trying to ferret out a potential motive for the homicide. You could choose to share the information with just Jill as she knows no one at the hospital. Marie, Jo, and I would excuse ourselves from reading any of the documentation and we would simply follow Jill's direction into researching whether certain people might deserve to join our suspect list. Will that meet your confidentiality standard?"
Ann seemed to be ruminating on Angela's remarks and then she said, "I'm going to return to my house to gather up the documentation. I'll make my mind up as I drive home and think about what you said as to whether I will share the documents with Jill. If by the time I get home I decide not share, I'll give you a call and let you know. I'd still like to help with the case if I can even if I make the decision not to share documentation with Jill."
Angela gave her friend a hug and added, "You know you can trust us, and we will love you even if you decide not to share. There'll be no hard feelings as I know we have put you in a difficult position."
Ann nodded and she and her mother left Marie’s house.
Jill looked at Angela and asked, “Do you think she will bring the documentation back here?"
"I really don't know. We have put her as in a very awkward position."
Jill sighed and looked over at Jo who was maniacally tapping away at her computer. She seemed to be in the zone and despite her curiosity as to what Jo was typing so enthusiastically she knew she had to leave her alone. Looking over at Marie and Angela, she was stumped. Her mind blanked out as to which direction they should take next.
"You know, guys, I am fresh out of inspiration as to where this investigation should do next. Angela, did you complete that search on shooting skill competitions containing contestants from this area?"
"Not yet. Let's do that search now and see if the three of us can find any Olympic sharpshooters calling Green Bay or the surrounding cities, home.”
Chapter Nine
A short while later after an extensive internet search, they were unable to find any sharpshooters that listed the Green Bay area as home. Sighing in disappointment and with a lack of forensic evidence to explore, Jill was again dumbfounded as to where to go next. Fortunately, they got a call from Ann indicating that she would share the documents that she possessed concerning Our Lady of Guadalupe. She was going to put her trust in Jill and the team that her documents would stay confidential. She wanted to do her part to help find Doug's murderer.
Jill looked over at Jo and commented, "Okay I've had the patience of a saint; what has so engrossed you that it required all of that high-speed tapping on the keyboard? Have you found the vaguest link to a possible motive for murder?"
Jo looked up quickly, and then her eyes returned to the screen as she questioned, “Huh? Did you ask me a question?"
"Yes I did. What have you found that has you so entranced?"
"I have been trying to understand where Doug had influence on other people's salaries. I have found multiple angles for us to investigate. Let me explain how the medical staff is organized at the hospital. There are a series of medical staff departments like Surgery, Medicine, Pediatrics, OB/GYN, Anesthesia, Emergency Medicine, and Radiology. As you can imagine there are many more departments that operate to provide care to patients or service for patients. The laboratory consists of pathologists and those physicians are part of the Department of Surgery. Likewise there are Intensivists which are critical care physicians and they are in the Department of Medicine. So every physician has a hospital department that makes decisions about policy and procedure and has a plan in place to monitor quality.”
“Yes I’m aware of the usual medical staff department structure in the hospital,” noted Jill. “While I have never worked for a hospital, many of my medical school friends do and they talk about it from time to time.”
“So normally you would find Doug chairing the department of Anesthesiology. However, there has been turnover in the medical staff leadership ranks at Our Lady. In between elections for new department chairpersons, Doug has also served as the chairman of Surgery and Medicine, although not recently for medicine – that was more than five years ago.”
"How is this related to money or murder?” Jill asked Jo.
"I'm getting to that point, have patience. Doug has served as interim chair of surgery for the past nine months. During that time and perhaps because of his knowledge in the operating room, he has implemented a couple of policies that might anger some of the surgeons. One policy in particular might affect the income of different surgeons.”
"What's the policy? I have never heard any of my friends complain about a hospital policy that affects their income."
"From the information I can see online, I can't tell for sure if the policy disadvantaged any surgeons. I can only see that the hospital board approved that policy and I can guess that the implementation would have at least at some point affected some surgeons." Jo was in the zone of understanding something complex but she was unable to articulate to everyone else in the room what that complexity meant in terms of murder.
"What is the policy?" asked Jill for a second
time.
Jo startled and looked confused for a moment before she said, "the policy? Oh what policy am I talking about? It's the operating room policy."
"Which operating room policy?" asked Jill knowing that given the complexity of an operating room there would be many policies for its performance.
"The board minutes that are publicly available are couched in vague terms using words at a ten thousand foot level. So, about a year ago the minutes mentioned a problem with the operating rooms starting at their scheduled time. A policy was created by the hospital and approved by the board that restricts a surgeon’s access to the operating room if they have a problem starting on time. As a surgeon, you earn income by doing surgeries and caring for patients in the hospital. You also earn income from seeing patients in your office but it's generally a much smaller amount. If you see patients in your office but then can't get their surgery scheduled at the hospital, then that hurts the surgeon's income and causes dissatisfaction for the patient."
"What do you mean by the operating room starting at its scheduled time? I guess I never thought about how operating rooms schedule surgeries. I sort of thought that everybody showed up in the morning and you went to the operating room whenever someone got around to it. Do you mean to say that there is an actual schedule? I can't ever recall for myself or my family members, being told to show up at any time other than early in the morning," said Angela, her voice dripping with sarcasm.
"Actually the operating room is a very complex beast to organize with very expensive resources in order to get to the endgame of the completed surgery. Each surgeon does specific surgeries in a specific area of the body. For example, neurosurgeons operate on the brain and spinal cord and may need a million-dollar microscope for their surgery. If the microscope costs a million dollars and you have five neurosurgeons that operate at your hospital, then you would likely want to arrange the schedule so that each neurosurgeon doing a surgery that requires the microscope occurs on different days. You want to keep your million-dollar microscope in use five days a week and you don't want your expensive and talented neurosurgeon standing around waiting to use the microscope. Thus the operating room schedule has to consider certain expensive equipment, instruments that are needed for specific surgeries, specially trained staff that operate lasers, special rooms that are outfitted for different types of surgery, and then the surgeon themselves."
"Okay you make this sound like a ballet,” declared Angela. "I can imagine that much like a ballet when the dancers are not in perfect synchronicity, terrible chaos would result in the operating theater if one of the major resources did not perform according to schedule. If the patient showed up late, or the doctor showed up late, or you needed the gigantic room and you only had the medium-sized operating room, or I needed a robot and it was in use elsewhere that not only would that be bad for that scheduled case; but much like dominoes, things would fall apart around.”
"That's an awesome analogy, Angela. Amazingly, it's a fairly common problem across the country. The dancers get out of sync and the ballet looks terrible to the audience," agreed Jo. "Our Lady was having problems with their ballet. They brought in a consultant to look at the operating room and discovered many bad dancers. The previous department of surgery physician leader was committed to fixing the problem. I don't know why he left and I'm hopeful that when Ann arrives, she'll have documentation that will describe how bad the problem was in greater detail. I'm curious as to whether that is why the previous chairperson stepped down or left the organization. Marie, perhaps you could do a search on a Dr. Randall Phillips to see where he is now."
The all heard the knock on Marie's door and hoped it was Ann. Listening intently, they heard Marie and Ann exchange pleasantries; Jo was relieved to hear Ann's voice. Ann soon entered the kitchen, carrying a large canvas bag containing binders and other paper materials.
"I feel like I'm making the right decision by sharing these reports with you. They have confidential written all over them, but I want Doug's killer found."
"We are really very ethical people. Even if I found something in your documentation that would give me a competitive advantage as a healthcare leader, I would ignore it. I am narrowly focused on finding a link to Doug's killer in that documentation. Besides in all truth, if we didn't have the highest ethical behavior, Angela would have dumped us as friends long ago," Jo declared.
"That's true," Ann agreed. "I've known her for twenty years and she has the highest standards for integrity. I brought with me many months' worth of board meeting materials as well as the orientation packet given to me as a new board member."
"Ann, do you know a Dr. Randall Phillips? He was the prior Department of Surgery Chairman before Doug, but he seems to have left the hospital. Do you know why?"
"Actually I do know and it's really very sad. He died and the announcement was made at my first board meeting. I didn't know the man, but based on what they said of him at the board meeting, I would expect the Pope to begin the process of elevating him to sainthood."
Ann's response was not what Jo expected and so she probed, "did they say why he died?"
"I believe it was an accident; let me think back to what was said in the meeting. They announced his death from,” and Ann stopped in her tracks thinking about the meeting, “A snowmobile crash. He was up north with another surgeon and they each had their own snowmobiles and were riding through the woods. Dr. Phillips was found by the other surgeon after he had an apparent heart attack and crashed the snowmobile as he was clutching his chest. It was all very dramatic and very strange for me as I had not known Dr. Phillips."
Jill gave Marie a look that said ‘something isn't right here, please research it.’ To which Marie nodded.
Jill said to Ann, "thanks for coming over with this documentation and thanks for giving us insight into the conversation concerning Dr. Phillips’s death.
Minutes later after Ann's departure, they were sorting through her materials. Jo left the financials alone. She was confident she had found sufficient financial information online to prove the hospital had not influenced Doug's decision-making or downstream revenues. Their revenues were robust and could be attributed to good insurance contracts and strong patient volumes.
"Guys, I'm really interested in any information or orientation materials relating to quality and medical staff meeting minutes," noted Jill.
In the end, they had reviewed all of the materials since Ann had joined the board relating to medical staff information. The quality reports presented to the board were the standard accreditation reports and there was no new information contained within.
Marie called Jill over to her screen to read the police report and obituary notice for Dr. Phillips. It stated he was on a snowmobile trip with a Dr. Lewis. They were riding their snowmobiles in the northwoods, a good two and a half hour drive from Green Bay. Drs. Lewis and Phillips had been enjoying a nice ride through the trees when all of a sudden Dr. Phillips hit a tree. When rescuers reached him he was found off the snowmobile lying in the snow clutching his chest. Because of the remote location, it took the rescue squad twenty minutes to reach Dr. Phillips and he was quite dead by the time they did.
"Let's look at the police report to see if it indicates if anyone did an autopsy?" suggested Jill.
Marie continued to peruse the police report looking for a comment on the autopsy. They were staying in a cabin near a town called Glidden in Ashland County, which is small and rural. The coroner was not a physician. After rescue workers declared Dr. Phillips dead, and Dr. Lewis suggested that he had a massive heart attack, the coroner did not complete a full autopsy but rather ruled the cause of death as a heart attack.
"Hmmm, that is a little too convenient for me,” Jill mused. “Too bad we don't have autopsy results. Where is this Dr. Lewis now, is he still working at Our Lady? What type of physician is Dr. Lewis? Can you find out where Dr. Phillips is buried? We may want to exhume his body to do a full autopsy.”
"You can do an
autopsy on a body that has been decaying for nine months?” Marie asked. “Can I just say how creepy that sounds; to have to touch something that has been dead for a while?"
“Actually I have had older corpses than that. Not everyone is found immediately after they have died or have been murdered. Sadly, I have had several corpses that were in the open air for two to three years. All I have to work with is often bones and clothing. We don’t know if Dr. Phillips was cremated or buried. If he was cremated, then there is not much I can do. If he has been buried in a moisture locked coffin, then I can do a fair amount of diagnostic tests. The embalming fluid interferes with some analysis, but there is still a lot of information that I can retrieve from Dr. Phillips’s body.”
“Dr. Phillips’s obituary says he was survived by his parents, a wife, three children, two brothers and a sister. There doesn’t sound like there is a history of heart disease. It says he was laid to rest at Resurrection Cemetery so it sounds like you have a body to exhume if you get to needing that.”
"Let's go back to Dr. Lewis,” directed Jill. “Who is he and what kind of physician is he?”
Marie finished a quick search on Dr. Lewis and announced, “He is a general surgeon. He has been in town a long time as I think I remember him operating on one of my aunts. 'A nice guy with good bedside manner' according to many online reviews of the doctor. He has been at Our Lady for over twenty years. He is on marriage number two with grown children from his first marriage and a second family with his second wife.”
“Did any of the teenagers we investigated this morning have a last name of Lewis? I don’t recall that name,” Jill remarked.
“No, Lewis was not one of the last names of the kids we investigated this morning.”
“I'm going to call Ann, and see if she remembers hearing anything about Dr. Lewis? Any good or bad comments at the hospital or among her friends?" said Angela.
A minute later, she had Ann on her cell phone. She put the phone on speakerphone so the others could listen or ask questions.