Oh, well, nothing else could go wrong today. Ah! A dollar bill stuffed behind the seat. Now if he could only find another couple of bills.
“Did you lose something?”
He froze. Mercy.
He groaned aloud and turned over in the seat to look at her. Time to come clean. “Uh, well, when I switched from the Jeep to the car, I forgot and left my wallet…”
“In the Jeep.” She grinned and shook her head. “I paid the waiter already. I figured it was the least I could do for today’s entertainment.”
He smiled, relieved, and watched the lines of humor play across her face. She was pretty. Really pretty. Why hadn’t he noticed that before? Probably because he hadn’t seen her like this very often. She’d laughed more today than he’d ever heard her laugh. It looked so natural on her. So good.
He sat up and slid out of the car. “I’m sorry. I didn’t mean for you to have to pay.” He opened the front passenger door for her.
“You can pay next time.”
He raised a brow at her. Next time? There would be a next time? “Sounds good to me. Ready to go see the Knights?”
Estelle Pinkley loved being the Knolls Community Hospital administrator. She’d held the job for five years, well into retirement age, and had no plans to retire until she was forced. And then she’d fight it.
What she didn’t like was the particular job she was doing now, as she faced Bailey Little, president of the hospital board, across the broad expanse of her mahogany desk. She and Bailey had a shared history together—not a good one. She had represented Bailey’s wife against him during divorce proceedings ten years ago. She and Mrs. Little had won big-time after an ugly fight. Dwayne, their son, had lost the most. The poor boy had been in trouble at school ever since, and his good grades had dropped until he barely graduated.
“Let me get this straight, Bailey,” Estelle said slowly. “You think I’d fire Dr. Bower on your word alone, no questions asked, just because he insulted Dwayne the other day?”
Bailey leaned forward in his cushioned, straight-back chair and watched Estelle over the top rim of his silver-framed glasses. “I think it would be a very wise move on your part. Unprofessional behavior is always grounds for termination in my opinion. And Missouri is—”
“A right-to-fire state,” Estelle said drily. “I’m well aware of the laws of this state. Don’t forget that I, too, was an attorney.”
“Do you take exception to Missouri law?”
“I have no intention of firing a man without just cause, whether or not state law backs me up.” She also had no intention of firing the first emergency room physician this hospital had ever had. She’d been the one to push this, and she wasn’t about to back down now. “What, exactly, did Dr. Bower do to your son?”
“I told you, he implied that Dwayne was a drug addict. He sent him out of the emergency room without treatment for his headache.”
“So you’re telling me that Dr. Bower did not offer Dwayne any treatment?”
“He did not offer him sufficient treatment.”
“What do you call sufficient treatment? I thought the physician was supposed to make that decision. I wasn’t aware you had a medical degree, Bailey.”
His face remained stony. “He refused to give the treatment Dwayne has received before from qualified physicians. Further, Bower had the secretary inform other area EDs that he felt my son was a drug seeker. In my opinion, that is defamation of character and directly affects my name, as well. It will not be tolerated.” He sat back, holding eye contact.
Estelle couldn’t shake the image of an eagle seeking prey. His stern demeanor and strong, well-defined nose fostered that impression, and he used it to his benefit when cross-examining a witness on the stand. She would not let him intimidate her the way he did others. She never had.
Estelle raised an eyebrow. “You plan to take it further, then, if I don’t fire Dr. Bower?”
“I do indeed, especially after speaking with Dr. George about Dr. Bower’s background. Jarvis is, after all, still the E.R. director, and he agrees with me.”
Ah, yes, Dr. George. Why wasn’t she surprised? Not only had he opposed a full-time physician, he had opposed computerizing the hospital office system and the addition of the new outpatient clinic. If it were up to him, this hospital would still be using lanterns and leeches. She’d seen to it that he didn’t get his way, and she could do it again.
“I’m well aware of Dr. George’s opinion of Dr. Bower,” she said. “I also know that Dr. Bower has the lowest patient complaint rate in our hospital.” She had decided not to count Dr. George’s patients, whom she felt had been brainwashed.
“Are you also aware that Dr. Bower was terminated from his residency program at Cunningham in Kansas City?”
“Yes, and the physician credentials committee is also aware of it.”
Bailey paused, obviously struggling to control his surprise. “And you withheld this information from me?”
Estelle bristled. “Is the hospital administrator now required to go running to the hospital board for approval every time she makes a decision? My judgment has always proved to be sound, as can be attested to by the fact that we are still operating as a hospital, have not been bought out by the big boys, and are in the black for the first time in years. Our census continues to increase, and no one on the board has seen fit to criticize my actions in any way, except for you and Dr. George. Are you speaking as the president of the board in this case, or as an angry father who is using his position to try to intimidate me?”
“The only reason I’m here is to stop this thing from getting out of hand,” Bailey snapped. “You can take care of it quickly, with little outside involvement, and protect the name of the hospital. It’s your call.”
Estelle held Bailey Little’s steely gaze. “Oh? So now the reputation of the hospital is at stake? I’m not buying it, Bailey. The hospital board president is threatening the hospital?”
“I warn you, Mrs. Pinkley, I’m a father before I’m the hospital board president.”
“Oh, come on, Bailey. The only time you ever put your son ahead of your career was when it was convenient and beneficial to you.” Estelle knew she was striking below the belt, and she saw that she’d hit her mark.
Color suffused his face. “I think the public will listen to a well-respected family physician and an attorney-at-law.” He paused, a nasty half-smile touching his lips. “I also think a COBRA violation, if worded correctly, could shut the hospital down.”
Estelle went cold. COBRA was the federal watchdog of hospital operations. If they investigated a hospital and found a problem, they could issue a huge fine, or even withhold Medicare and Medicaid payments, which would effectively shut down a hospital—a large percentage of medical income came from those sources, and hospital emergency rooms were required to accept any and all emergency cases.
Bailey nodded with satisfaction at her silence. “Refusing to give the proper treatment for pain is considered a violation. But of course, as an attorney, you’re already aware of that.”
Estelle raised a brow. “I’m also aware that under COBRA law the hospital cannot be held liable if the patient refuses the treatment offered. You don’t have a case, Bailey.”
He stood up. “I strongly suggest you review the chart in question. In order for the hospital to be held harmless, the patient must sign an AMA form, which my son did not.” An AMA form simply stated that the patient checked out of the hospital against medical advice.
“I find it hard to believe there was nothing signed to that effect, whether by the patient or the staff.”
“Check for yourself. It’s not in his file.”
“Where did you get permission to go digging through the hospital files?”
“From the patient in question, or have you suddenly made a rule to disallow release of patient information to the patient himself? If you like your job so much, you’d be wise to think about this for a few days before you make you final decisi
on.”
“I’ve done all the thinking I’m going to do. If I have to, I’ll go public with this thing. Bailey, you have to answer to the taxpayers just as the rest of us do. It’s a county hospital, and they won’t take kindly to a COBRA call by the president of the hospital board, especially if the hospital shuts down. Maybe you’d better consider your own job.”
Bailey glared at Estelle for a moment. “The next board meeting is two weeks from next Monday. Be there. I would suggest you bring Bower with you. Both of you may be without jobs by the end of the month.” He turned and walked out.
Chapter Seventeen
Clarence was awake this time, and he looked worse than he did two days ago. As before, however, the preliminary sparks flew between the patient and Mercy before she carted Darlene off into another room for a breathing treatment.
“What’re you back here for?” Clarence asked Lukas after the two women had left. His gruff voice sounded weaker than before, and his eyes looked more listless.
“We have the results of your tests, and I wanted to come and talk to you about them and give you some medications that will help.”
Clarence laid his head back on his pillow and closed his eyes. “I can’t pay.”
“We’ve already been through that.” Lukas stepped forward with his stethoscope. “Mind if I listen to your chest?”
The man didn’t answer, but made a vague motion with his hand. Lukas decided to take that as permission. He leaned over and pressed the bell of the stethoscope to Clarence’s massive chest. As before, heart sounds were very muffled due to the thickness of the fat layer, but Lukas thought he could hear a lub-da-dub of a diastolic murmur. Could be heart failure. It wasn’t conclusive.
“Clarence, can I get you to sit up?”
The big man’s eyes opened. “Why? What d’you hear, Doc?”
“I can’t be sure. That’s why I need to listen to your lungs. Then I’ll tell you.”
For a moment Lukas thought Clarence was going to refuse, but instead he heaved a sigh of resignation and struggled to force his body forward. Lukas knew better than to try to help.
As soon as the patient sat up enough, Lukas auscultated the thick flesh of the back for breath sounds. These came through more clearly than the heart tones. The diffuse nature of the coarse, crackling breath sounds, and the labored breathing, confirmed the preliminary diagnosis Lukas and Mercy had discussed two days ago.
Lukas straightened and wrapped the stethoscope around his neck. “Okay, you can lie back, Clarence.”
The big man obeyed with relief. “Well?” he growled.
“Pretty much what I expected to hear. You’re definitely in heart failure. Tests have also confirmed that your blood sugar is high.”
Lukas thought he detected a fleeting expression of fear cross Clarence’s face. “So I’m dying.” It was not a question. It was a statement of acceptance.
“Your heart is being overworked due to your size,” Lukas said. “The condition can be treated and even reversed, but only if we start treatment now.”
Clarence sighed as if he hadn’t heard Lukas. “How long do I have?”
“Could be years.”
Clarence’s eyes widened in shock.
“It’ll keep getting worse, of course.” Lukas steeled himself against the harshness of his own words. “Your condition could deteriorate until you have to be on oxygen all the time. You won’t be able to walk, and your kidneys could eventually fail. We didn’t pick up on any intestinal obstruction, which is a relief, but it is a future possibility. We’ve brought drugs to help get some of the excess fluid out of your body and to bring your blood sugar down closer to normal.”
“Why drag it out?” Clarence asked bitterly.
“Death is not inevitable. At this rate, Darlene could die before you do.” Lukas paused to let that sink in. “Her asthma is already bad, and one serious attack could kill her.” He sat down on a bedside chair. “She needs your help, Clarence, and you’re in no shape to be there for her the way you are now. The way I see it you only have one recourse.”
“What’s that?”
“State aid.”
“No.”
“Do you have a better suggestion?”
Clarence winced as if in pain. He closed his eyes and shook his head.
“Clarence, you don’t want to die. I know you’re desperate not to be a burden on Darlene, but death is not the answer.”
“Neither is taking handouts.”
“Then don’t consider state aid a handout. Consider it a loan that you’ll pay back when you get well. That’s what I’m doing.”
Clarence’s bushy brows rose in surprise.
“I don’t come from a wealthy family,” Lukas said. “We had a dairy farm outside of Mount Vernon, Missouri, and we sure didn’t make enough money for all my education, or that of my brothers. We got school loans backed by the government. I’m still paying on the loans.”
“That’s not welfare.” Clarence shook his head, glowering at Lukas. “Don’t you even compare ’em!” His face flushed with anger.
For a moment Lukas wondered if he’d done the right thing.
“You didn’t have to use food stamps at the grocery store and have to listen to the whispers and feel the disgust from other shoppers.” Clarence jammed his thumb at his chest. “I did. Darlene and I grew up like that. The kids at school called us trash because we took welfare. Their parents said our parents were too lazy to work, so they shouldn’t eat. You know what? They were right.” He paused to catch his breath. Even the exertion of talking wore him out quickly. “When I got old enough, I got a job and moved out. That way my parents couldn’t draw money on me. Darlene moved in with me as soon as she could, and we both worked our way through trade school.” He stopped to breathe again. “We didn’t draw a dime off the state, and when we moved to another town, no one even knew we’d been welfare kids.” He huffed for a long moment. “We won’t go back to that.”
“Are you saying you think your parents were welfare abusers?”
“I don’t think, I know. They just didn’t want to work. My father was born into a welfare family, and he got good at milking the system. How could anybody respect someone like that?”
Lukas waited while the man’s breathing returned to normal. “I understand now. It’s not self-respect you’re worried about. It’s public respect.”
“That’s not it.”
“You’re going to let public opinion dictate your future…or lack of one,” Lukas said.
“You don’t know what you’re talking about.”
“Do you realize that if you accept help, you could relieve the burden from your sister practically overnight? I know some charitable organizations that would be willing to help you out until the state aid kicked in. Don’t consider it charity. Consider it a loan. You don’t have to end up like your parents.”
Clarence held his huge arms out to his sides and looked down at his enormous bare torso. “Do you know how long it could take to lose this?”
“Not as long as it could take you to die. I believe you would qualify for stomach surgery to cut down on your consumption. You can be up and around long before you reach your target weight. You could even get a job, maybe get a loan to set up your own business.”
Clarence shook his head. “You’ve never been fat, have you, Doc? I haven’t been outside this house in months.” He paused to catch his breath. “The only place I can walk to is the bathroom. Nobody’ll give me a job or a loan. People hate a fatso. Doctors hate Medicaids. I know. We went through six doctors when Darlene and I were growing up. As soon as they could dump us they did.”
Lukas sighed heavily and watched the big man’s sad, dark eyes for a moment in silence. He thought about the drugs in the bag beside his feet. Maybe he could convince Clarence to take them, and maybe he couldn’t. Maybe the man was planning to hasten his own death by refusing to do anything to help himself. Oh, Lord, help me to convince him of his worth.
“Our emerge
ncy room gets Medicaid patients all the time,” Lukas said. “Some of them are abusers, some are legit.” He leaned forward. “I don’t like the abusers. They come into our department and smoke their cigarettes just outside the doors and let the smoke drift in and choke the rest of us despite the smoking ban on the hospital campus. They buy Coke and candy from the vending machines, then refuse to pay the four-dollar fee at the desk because they’re ‘broke.’ Most of the time I’m civil to them and treat the sore throats they get from too many cigarettes and the stomachaches they get from drinking too much booze. For the most part, these are the rudest, most demanding patients I see. It really frustrates me.”
“Why do you treat ’em?”
“State law says I have to. Sometimes I get brave and send the obvious abusers away. Others are young children who can’t do anything about their situation. I treat them with as much care as I’d treat my own family, and I care what happens to you. I’m sorry you had such a bad experience when you were a kid, but if you decide to draw Medicaid, Clarence, you can come into the emergency room anytime, and I will take care of you gladly. I know you’ll be legit.”
Clarence jerked his head toward the door. “What about the other doc?”
“She’s here now, isn’t she? Ask her yourself.”
Clarence thought about that for a moment, then laid his head back wearily on his pillows and closed his eyes.
“I’ll help you sign up for help, Clarence.”
“No.”
Lukas bit back a protest and sighed in frustration. “Okay. Have it your way. Will you at least use the medications we brought with us today?”
Clarence opened one eye, as if too tired to open both. “You’ll keep taking care of Darlene?”
“Of course.”
Sacred Trust Page 20