by Alec Peche
"I've never had someone on my table for an autopsy from a perforation, but it does happen occasionally. Not the heart puncture, but just deadly consequences from a perforation."
Jo pronounced, "You've made us afraid to ever have surgery."
"Sorry about that. While some of these complications sound really bad, they often are not, resulting in no additional treatment whatsoever. You're safe having surgery in a hospital but it wouldn't hurt you to ask the surgeon how many of the type of surgery that you are about to have he or she has done in the past year.”
"So we don't have any report on complications from Nick yet,” Angela noted. "Are you sure that we'll find that data in these files?"
"No I'm not sure. Every hospital operates differently. I'm just hopeful. Shall we gather up our laptops and head to police headquarters?"
Soon they were all out in the car with Marie driving them to police headquarters.
Chapter Thirteen
Jill had been in more police stations in her role as a consulting forensic pathologist then as someone who worked for the state crime lab. Marie and Angela had joined her here the previous day, but Jo had not been inside before. The Green Bay Police Department, in Jill's experience, reflected more of a small town feeling. In her mind that was a good thing since Angela, Marie, and Jo had known few if any criminals in their life. It reduced the distraction to their murder case if they did not have to walk through a group of handcuffed thugs on the way to a meeting room.
They were soon directed to the Detective Division. Detectives Haro and Van Bruggin were with a group of officers and, they guessed, crime scene investigators. Marie and Jo had their computers with them, but they left them turned off and stored in the shoulder bags. The two detectives had everyone take a seat and introductions were performed.
"I'd like to start with a summary of where we are with this case so that we’re all on the same page," Van Bruggin remarked. "From there, I would like Dr. Quint and her team to share what they have researched in regards to this case. I feel as though they are chasing some longshots here, but given my experience in the role of detective, I sense there is substance to those longshots. Let’s start with my team first. Please summarize all evidence that we have found both on the golf course and at Helen's house. Be sure to specify whether the results are back, and if they're not, when they're expected back.”
One by one, the detective team described their evidence, as well as the theories they were pursuing in regards to the results of that evidence. It was pretty much what Jill expected with a few caveats. They had confirmed the bullet caliber for Doug’s death. The door knobs at Helen's house were wiped clean. It was a clue that would connect Helen's unconsciousness to an intruder in the house. A person about to commit suicide does not go around and wipe all the door knobs clean of fingerprints.
There were no findings in the autopsy that presented any surprise to Jill. Dr. Easley died from a bullet shot to the brain and she was pretty certain she would have arrived at the same cause of death. In the case of Helen, the initial toxicology screens were completed and Helen had no illicit drug or alcohol in her bloodstream. She also lacked several prescription drugs rumored on the internet to be great suicide drugs. There were a few drug tests outstanding as well as an analysis of her stomach contents.
The crime scene techs had also collected a lot of evidence from Helen's house. While they had found the door knobs to be wiped clean, there were fingerprints elsewhere in the house that they were analyzing. They had also done swabs of glassware and items in the garbage looking for something that shouldn't have been there. They debated whether to use goggles to examine her skin for puncture wounds, but thanks to the great emergency care that she had received, she was full of puncture wounds for IVs and blood draws. In summary, they seem to have no new clues amongst the physical evidence found at both scenes.
Next they discussed who they had researched as far as suspects. Using a variety of their computer systems sources, they were able to verify Michelle's alibi at the time of the shooting. Those sources also provided data on her interior design firm and there were no red flags there. From there they moved on to Doug's anesthesia firm and again the firm seemed to be financially sound.
Jo took the opportunity to speak up, “Would you mind sharing those documents with me? I'm a CPA and I am usually really quick at analyzing documents like tax returns.”
The law enforcement team looked nonplussed. It was simply a question that had never been asked of them before. They looked at each other and then at the two detectives for an answer.
Finally, Van Bruggin spoke, “you can look at the document here but it can't leave the station. Please sign this confidentiality agreement and this is a reminder that all documents that you view are confidential. I would like each member of the Dr. Quint team to verbally affirm that nothing we share with you here will be shared by you outside of the station."
He then made eye contact with Jill, Jo, Marie, Angela and each individually stated they understood the confidentiality and graveness of the information that was about to be shared with them and they promised not to share the contents with anyone outside the station.
Shortly thereafter, Jo was looking at the tax records of Michelle Easley. In about a three minute time span, she scanned the document with its attachments and agreed with the police that everything was in order. She took a little longer with Doug's anesthesia firm’s records. Again while nothing looked incorrect or suspect, she was curious to view the range of salaries of the firm's partners. If there was great disparity between the partners and it couldn't be traced to hours worked, then they had a potential motive for murder. When she calculated the hours worked by each partner, the variance was less than five percent.
"Detective Van Bruggin, I agree with your team that there is nothing suspect in Michelle's tax filings. Furthermore, based on the hours that each partner worked, the variation between anesthesiologists is less than five percent or about twenty-five thousand dollars. With these large salaries, I can't imagine that the five percent is cause for murder."
"Moving on to the new suspect, Dr. Bradley Lewis, we see red flags everywhere we look. Let's go through some of the highlights now."
With that introduction, one of the crime scene investigators began a discussion on what their research had yielded in regards to Dr. Lewis. Much of it was a repeat of what Jill and her team had noted earlier.
“Do we know where Dr. Lewis spends his money?” asked Marie. “Given the financial problems he has had to contend with in the legal system, and given that his salary as a general surgeon should be quite adequate to keep one’s head above water; we wondered where he was spending money.”
“Yeah we noted that in our research,” said the investigator, “but we haven’t figured out a source yet either. We’re checking with the narcotics division to see if he has any reputation in the community and then we are examining his credit card records to see if that throws us any clues.”
“Do you have his tax return?” asked Jo.
“We have the most recent return but the State is also giving us his returns going back to the failure to pay for his engagement ring small claims suit. It will take them an additional twenty-four hours to get those returns for us. We also have the court documents filed with the county takeover of property for delinquent taxes and the small claims case around the engagement ring.”
With a non-verbal question eliciting a nod from his supervisor, he passed the documents over to Jo. Silence reigned in the room while she quickly skimmed the documents. She held out one piece of paper and said, “this is the detail provide by Dr. Lewis as to why he couldn’t pay for the ring. He indicated two-hundred-thousand in medical school student debt. That seems weird. Medical School was much cheaper in the early 1980s when he would have graduated. It’s also suspicious because of the trust the first wife set up. I would love to talk to the attorney or the kids to understand why they think the first Mrs. Lewis wrote the trust. Do they live in this area
? Were the kids incorporated into the second marriage? Since they were likely no more than ten years old at the time of her death, they should have been a part of the new household.”
“Those are excellent questions and we’ll see if we can answers by the time you finish your description of what information you found for Dr. Lewis,” directed Van Bruggin.
“Thanks for that lead-in,” replied Jill. “As I mentioned earlier to the two detectives, we started by looking at the leadership positions that Dr. Easley occupied. Leadership positions can have an impact on either power or money in any setting. Jo looked at his Anesthesia practice, but all the physician partners were compensated equally once you calculated their hours worked. Next we moved on to leadership roles at Our Lady. That was when Marie discovered that he was the interim chair of surgery after the previous chair had died on a snowmobile trip. I think the odds are small that two physicians holding the same title should die so close in time to each other when it's not related to a disease like cancer. It was then that we looked into the details of that snowmobile accident.
“The four of us are not snowmobilers, but living in this part of the world you hear about snowmobile deaths and injuries every winter. I never paid attention as to where those deaths were or how they were handled by the local coroner. Dr. Phillips could have died just as was described in the coroner’s report, and it probably made perfect sense to many people at the time it occurred. However, an autopsy should have been done to confirm the findings of a heart attack. You would have seen heart muscle death related to a blockage of the artery. I suspect that likely it would have been done except for some influence by Dr. Lewis. He was a powerful witness and a physician and that might have been all the evidence the local coroner needed to complete the death certificate. Why leave a huge scar on a young man's body if you have confirmation from a physician on the cause of death? I think we need to exhume the body of Dr. Phillips, but I don't know what we could tell his widow is a reason for the request without pointing the finger at Dr. Lewis. If he should be innocent, we will have decimated his reputation for the rest of his life.
"My team agreed that if he murdered both physicians, he had to have had a reason. Both physicians would have had minor impacts on his earnings, unless they were threatening his privileges at the hospital."
"Dr. Quint, what do you mean by threatening his privileges at the hospital?" asked a puzzled Detective Haro. “What are privileges and how do they affect income?"
"Every physician in every hospital in America has been granted privileges to practice medicine by a group of their peers. Generally, a decision to grant privileges is based on education, training, and past experience. So for example, an orthopedic surgeon would never be granted the privilege to deliver babies at a hospital. They simply are not qualified to perform that procedure. It's a way for hospitals to control which physicians do what procedures with the desired outcome of better quality for patients. Likewise, a physician can lose a privilege because they are doing a low-volume of that procedure or because they're experiencing higher than expected complications. So, again as an example, let's say you have a physician delivering less than a baby each month and you have other physicians delivering a baby daily. You would likely pressure that low-volume physician to give up their privilege to deliver babies. Does my explanation make sense?"
"It sounds very complicated, but where is the money or power impact?” asked Van Bruggin.
“The fewer privileges you have, the less opportunity you have to earn income by caring for hospitalized patients. With some physicians a single procedure might be responsible for a quarter of their income. That is the money impact. The power side comes from one group of physicians taking away the privileges of another physician. If they don’t voluntarily give up privileges, then the individual physician does not see the problem. If they can’t see their own problem, then they likely view the reduction of privileges as a power move.”
Van Bruggin agreed, “So how do we find out if Dr. Lewis lost or was scheduled to lose privileges? Who at the hospital do we talk to find out about such actions?”
“The information is protected under the law, and I would guess that we lack evidence for a judge to issue a subpoena to allow you to review the records. There is a database called the National Practitioner DataBase and hospitals are required to report the removal of privileges to that organization. The data is operated by the federal government so again it will take a court order to gain access to the system.”
“So you’re telling me the motive for murder may be out there, but because of privacy rules I can’t get to the data?”
“Basically, yes. Also, keep in mind that this is a very slow process. It can take months to spot a trend and months more for the peer process to occur and appeals be handled. I am aware that the removal process from start to end can take two years in some cases because attorneys get involved helping the physician fight for their rights. So if this is a recent problem, there won’t be much of a paper trail at the hospital.
“As for your second question, who knows at the hospital? Most of the time, these actions are kept as quiet as possible because you don’t want to impact a physician’s reputation unnecessarily. Just because they lose the privilege to do one procedure does not mean that their entire body of work is bad. A physician may also choose to give up certain privileges and that avoids some reporting. The records are kept in a department called Medical Staff Services and perhaps their CEO or Chief Medical Officer may be aware.”
“So these problems are always handled in such a confidential manner that few people know and there is little to no paper trail for us to follow and examine,” Haro summarized. “So how do we go about approaching this angle? I understand your explanation of what occurs in a hospital, but we are no farther ahead as to how to verify if Dr. Lewis had problems and was eliminating the physicians that were trying to take action with him.”
“We don’t have an answer for how to find evidence of Dr. Lewis’s problems yet. We’re exploring a few avenues and if anything turns up, we will share with you,” Jill noted. “We need to leave soon to get to our meeting with Dr. Easley’s widow, Michelle. One of the questions we are discussing with her was anything said in passing by her husband concerning problems at work.”
“We already asked her those questions when we initially interviewed her," Haro stated.
"We assumed you did, but you know through your vast years of experience that people remember different things at different times," Angela pointed out. "You spoke with her on the day of her husband's death, hours after she was notified. I think most people in that position don't have their best thinking on. I am hopeful that in the casual setting of a winery and with the aid of a glass of wine that we might learn some new information from Michele. I am really quite good at drawing information out of people. This comes from years of trying to make people comfortable on the other side of the camera lens.”
The detectives sighed, but really had no ideas on how to proceed at that point in time. Maybe a few hours away from the case spending time with their families might stimulate an idea on how to move this case forward. The women started packing up their belongings getting ready to leave when Marie paused to ask, "Any word on how Helen is doing?"
"The hospital says that her vital signs are stable, but she was still unconscious.”
The women piled into Marie's car and decided to sit there for a moment composing questions for the upcoming interview with Michelle.
"Anyone have any ideas on how to ask Michelle if her husband had any problems with Dr. Lewis without mentioning his name?" asked Marie. "That seems to be the crux of what we need to question her about."
"As usual, I would like to handle the majority of the interview.," Angela said. "However, I think in regards to the question about problems with Dr. Lewis, we would all do well to take a combination tag team and exploratory tone to our questioning. We can do that by having a puzzling inflection in our voices. So I will ask her the question o
f ‘what kind of concerns was your husband having with his coworkers’. That would be a great time for Jo to add ‘were any of the physicians concerned about dropping income as it's something I hear occasionally from the physicians I deal with’; and Jill, once Michele answers, you can tag onto changing insurance reimbursements’. Let's play this by ear and see where the strategy gets us. She may really have no knowledge of anyone upset with her husband."
Marie started up the car and they drove the few short blocks to the Captains Walk Winery to meet with Michelle. It was easily a distance they could've walked, but for some reason they didn't want to advertise that they had come from a meeting with the Green Bay police.
Chapter Fourteen
Walking into the winery, they could see that they had arrived before Michelle. A sign stood at the base of the stairs announcing a private party for the upstairs parlor. They checked in with the tasting room attendant and each selected a glass of wine before venturing upstairs.
The parlor contained a sofa and three wingchairs. Jo and Marie occupied the sofa, while Angela and Jill took two wingchairs. Angela would do most of the interviewing and would be directly facing Michelle. If she arrived without wine, Jill would obtain some from the attendant. Marie had removed a box of Kleenex from her car and it rested on the coffee table in front of the sofa. The players were in position and the stage was now set, they just needed the tragic widow to arrive for the show to begin.
About five minutes past the agreed upon meeting time they heard Michelle approach. After introductions were made, Jill left to get Michelle a glass of Chardonnay. Soon they had all resumed their seats and the interview got underway. Michelle was anxious to return home to her two daughters who were greatly in need of comfort over their father’s death.
"Michelle, we appreciate you taking some time to meet with us here during what has to be a very difficult time for you and your family," murmured Angela as she started off the interview. "As you may know there is not a lot of evidence that would lead law enforcement to your husband's killer. We are equally puzzled, because this seems like almost the perfect murder there is such a lack of clues. Tell me about Doug's mood prior to the golf outing. Was he his usual self? Was he happy and looking forward to the outing? Did he seem secretly worried about something? Describe his state of mind for us, please."