Cutter's Trial

by Allen Wyler

  An alarm rang in the back of his mind. Don’t say anything incriminating.

  Jesus, what’s happening to me?

  He chose the most neutral answer that flashed to mind. “Costal County administration wants him to build the caseload. Sounds like he’s doing just that.”

  Raj’s eyes continued to scan their surroundings. Still whispering, he said, “Yeah, I get that part. That’s not the issue.” Raj paused to lick his lips. “Thing is, he’s doing things that, uh, make us all nervous.”

  Raj appeared as genuinely paranoid as Alex felt. This wasn’t just an act.

  “For example?”

  “He’s ma … fac … ing cas …”

  “Say again? I can’t hear you.”

  Raj cleared his throat, stepped closer. “He’s manufacturing cases.”

  “What do you mean?”

  “Okay, for example, a simple, linear, nondisplaced skull fracture comes in. Used to be we’d scan the patient, make sure there wasn’t any clot under it, and observe it for twenty-four hours. We’d never operate on it and—best I can tell from reading the literature—there’s no reason to do so. But now he makes us take them to the OR to plate the fracture.” This meant anchoring metal struts across the fracture line with small screws to hold the fracture in place to heal.

  “He has us write up the case as a depressed fracture”—where a fragment of skull is pushed below the inner surface into the brain—“so he can bill the surgery as a depressed fracture.”

  Ah, so this was how Dick had tripled the number of neurosurgical cases overnight. This explained a lot.

  “Give you another example,” Raj continued, now apparently more at ease. “Last week a subarachnoid comes in. Okay, fine, we squirt her, see the aneurysm, take her to surgery, and clip it. Soon as she’s out of the OR we take her back to angiography and squirt her again. Weiner says the clip isn’t across the aneurysm—which is simply wrong. It was. So back she goes to the OR. We reopen the crani but don’t do squat for fifteen minutes, then close her up. Back we go to angio. Same thing. Back to the OR. Three times now. Finally he goes, ‘Okay, we’re done.’ He bills for all three surgeries, but the clip never changed; it was just fine in the first place.”

  Alex still didn’t say a word.

  “This is felony fraud, Doctor Cutter. He’s forcing us to be accomplices.”

  Alex massaged the back of his neck, the muscles tight with anxiety. “Couldn’t agree more.”

  “If we question him, he goes ballistic, like you saw him do today in conference. Oh my God, yesterday? He laid into Waller like you wouldn’t believe, tore him a gaping new one, said he had to stay another year to graduate.” Waller was a chief resident only months away from graduating.

  Anger boiled up inside. The contract residents stipulate five years. However, in actuality residents were allowed to graduate only if the residency director certified them as adequately trained.

  Raj shifted his feet, talking quickly. “We like being busy and all, but this is over the top. He insists on being notified about every ER call we get. I’m talking real time. So, if something trivial comes in—like the fracture I just mentioned—he operates it. Did another one of those yesterday. And if he’s running another case when a patient comes in, he tells us to go ahead and start the case in another room—but most the time he never sets foot in the OR. When that happens, he has us document him as being there. We’re all scared shitless of being busted for felony fraud. It’d ruin our careers before we even start.”

  Sure would. They’d lose their licenses. The FBI would have a field day with Weiner if they found out. But what could he do? Nothing. Well, he could be a whistle-blower, but only at the risk of getting Raj or other residents arrested, fired, or both. Alex took a deep breath and closed his eyes, still massaging his neck. “Aw, Jesus. When you dictate the op report, who do you say were the surgeon and assistants?”

  Raj was back to a whisper. “We have specific instructions to put him as attending surgeon, present and scrubbed.”

  “And you do that?”

  Raj gave desperate shrug. “Like we have a choice? Look what just happened to Waller. I sure as hell don’t want to stick around another year. Would you?”

  “Good point. What about the nurse’s records?”

  Raj laughed derisively. “They’re more afraid of him than we are. Okay, let’s say one of them blows the whistle. How they going to prove it? Who are the investigators going to believe? And with the administration so happy about the increased billings, he’s their golden boy.”

  Alex began to massage his aching temples. “Why tell me this?”

  “What do you mean? You ran that service. We thought maybe, you know …”

  “I could talk to Weiner about it?”

  Raj shrugged. “Yeah, I guess. Something like that.”

  What a mess. He didn’t dare to directly intervene but felt compelled to help the residents. How, he had no idea. “At the moment I’m in no position to do a thing. Certainly, I can’t talk to Weiner about it.”

  Raj appeared annoyed. “What about us? What’re we supposed to do?”

  “Let me think about it. At the moment, there’s nothing you guys can do other than keep a detailed record of every case he falsifies. All the details. These things seem to have a way of working out. Like you said, you can’t go to the administration for obvious reasons; he’s doing exactly what they hired him to do.”

  Raj’s eyes widened in fear. “You’re not going to mention this to him, are you?”

  “No, of course not. I’d never do that to you guys.” An idea germinated. “For now, keep your powder dry and make it through the next year and a half. In the meantime, I’ll work on it.”

  “Says he never promised me a thing.” Alex sipped his martini. His anger caused his hands to shake, making it difficult to pick up the glass without spilling the contents. The restaurant smell of grilled meat and spices, usually pleasant, was making him nauseous. Kitchen clatter, the other muted voices, and the music from the recessed overhead speakers competed with their attempts to keep their voices down for privacy. This restaurant was theirs for special occasions, good and bad. They had celebrated their engagement here. But tonight was far from celebratory.

  Lisa was playing with the toothpick-skewered olive in her drink. “What do we do now?”

  “Far as I can see, I have two options: try to start a private practice here in town or look for another university to hire me. Either way, my research will have to stop. Least until I can get settled.” Research would be out of the question if he opted for private practice. Strange, he’d just been awarded his first grant, but now that dream seemed elusive as ever, the timing ironically perverse.

  The waiter walked over, pen in hand. “You folks ready to order?”

  Alex nodded for Lisa.

  “I’ll have the fried oysters.”

  “And you, sir?”

  “The sautéed chicken livers,” he said, knowing he’d be unable to eat a bite.

  17

  Alex pulled into the basement parking lot early the next morning with plans to call friends outside Weiner’s sphere of political influence, which had expanded significantly since being awarded the chairmanship of such a prestigious department. Academic job hunting could be difficult and politically tricky.

  This time of morning the halls were empty, something he was grateful for. At his office, he inserted the key into the lock. It wouldn’t turn. He double-checked. Yes, the correct key. Tried again. Same thing. A sick feeling rippled through his gut. He backtracked to his lab to try that key. Didn’t work either. One lock might be a mechanical error. Two locks indicated intent. Fucking Weiner.

  As he turned the corner on the way back toward his office, he saw Nancy, a staff secretary, unlock the main office door. “Morning, Nancy,” he called, suppressing his anger. “Forgot my keys. Would you pleases unlock my office for me?”

  She busied herself dumping her own keys into an oversized purse, avoiding eye
contact. “Sorry, can’t do that.”

  He nodded slowly. “What’s going on?”

  Without looking him in the face, she turned and crossed the hall to unlock the two doors to the conference/break room. “Not sure what you mean.”

  “The locks to my office and lab have been changed. Know anything about that?” He immediately regretted putting her in the middle of a bad situation. With no place to go, he followed her into the break room as she started the day’s first pot of coffee.

  From the hall a booming voice called, “Cutter, I want to talk to you.”

  He recognized the voice before looking. Weiner filled the entryway. “In my office.” Weiner headed for Dr. Waters’s empty office.

  “Close the door,” Weiner ordered, his back to the windows that overlooked a massive parking lot, the football stadium in the distance. Reminding Alex of pleasanter times.

  Alex closed the door but kept his hand on the knob. The conversation, he knew, would be short. With a smug expression, Weiner leaned casually against the windows, hands in the pockets of his white coat. “I reassigned your office and secretary.”

  Alex didn’t want to give Weiner the satisfaction of seeing his anger.

  “You have the office next to the conference room.” Weiner’s hand came out of his pocket to toss Alex a key. “Here.”

  Reflexively, Alex grabbed for it and missed but made no effort to pick it up. “What office is that?”

  “First door to the left of the conference room. Can’t miss it—straight out the office and across the hall.” Weiner was grinning now.

  Puzzled, Alex mentally replayed the sentence, visualizing the location. “The janitorial closet?”

  Weiner shot a finger gun at Alex’s head. “Bingo.”

  Enough. “Why you doing this, Dick?”

  “Hold on, gets better. I reassigned your priority time”—designated OR time—“to Delaney.”

  Alex stopped listening. He needed to be on the phone job hunting. Dick won. Anything would be better than this.

  He noticed Weiner waiting for an answer. He didn’t know what he’d asked, so Alex cleared his throat and changed tactics. “Why single me out, Dick? I supported you with the search committee. I don’t get it. Explain it to me.”

  Weiner approached, poking a finger at Alex’s face. “You deaf or just fucking stupid? This is my department. And I will change it. The only way to do that is for everyone to understand I mean business. Guess what? You’re leading by example.” Weiner waved his hand dismissively. “I’m done with this conversation. But before you leave, here’s one more revelation: your patients have been reassigned to Delaney.”

  Alex was dumbfounded. “Why my patients? Why not Baxter or Geoff?”

  “Seriously?”

  “I’m asking.”

  “Jesus Christ! Think about it. News flash, Cutter: they’re harder to get rid of. Told you once and I won’t tell you again. I need your spot for Delaney.” He pointed to the door. “Out of the fucking office. Now.”

  Alex was relieved to find the elevator empty, allowing him to avoid the embarrassment of a face-to-face encounter with anyone. By now everybody in the department knew he was fired, that his entire world had just been incinerated. He was left with a mortgage, two car payments, and absolutely nothing to show for all his research. The depth of his rage frightened even him, the flint and tinder sufficient to spark violent acts.

  Alex drove to a large city park. There, he aimlessly strolled jogging trails while ruminating through his options. Beg for a job with one of the local groups? That’d be difficult for two reasons. A smoldering adversarial chasm historically existed between the academicians and private surgeons, fueled in part by Waters’s not-so-subtle Ivy League style. Being a state school, most faculty salaries were paid by tax dollars, causing the private surgeons to claim this represented unfair, tax-supported competition. The far right-wingers claimed it verged on communism. On the flip side, the academicians were expected to fulfill multiple academic obligations other than practice, making it impossible to devote the same amount of time to competing for patients. Of more direct economic relevance was that university physicians were required by law to accept all patients regardless of insurance—which a majority of the time came to zilch. This was the foundation for their accusation that the private surgeons cherry-picked the well-insured cases, referring to them only the unfunded or high-risk ones. Each side had valid points, but it distilled down to one thing: Alex would have difficulty finding an established group to accept him.

  Starting a solo practice would be daunting. In addition to his current debt, he’d need to secure a multi-million-dollar line of credit to pay overhead—such as a fifty-thousand-dollar malpractice insurance premium—until his practice became profitable. In a city saturated with neurosurgeons, his best shot would be to find a less-desirable suburban hospital with unsophisticated operating rooms and staff. He’d have no choice but to do craniotomies in an OR used by all surgeons. He cringed at the thought of opening a head in an OR used earlier that day to remove an infected appendix.

  By late morning he was walked-out, depressed, and ready to head home. He dreaded telling Lisa the bad news, but perhaps she’d help him see an overlooked possibility, maybe even be willing to help start a practice if that’s what they decided. One of her strong attributes was a rock-solid business sense.

  Stop by the store and ask her to leave early?

  No. He would be more productive spending the afternoon job hunting.

  At his desk, thumbing absentmindedly through a medical journal, the telephone rang. He debated whether to answer it. Friends knew neither he nor Lisa would be home at this hour. Another ring.

  He slapped down the journal. “Cutter here.”

  “Hey Alex, Jim Reynolds.”

  Who? “Yes?”

  “James Reynolds,” he repeated, clarifying his position as neurosurgery chair at a southern university. “Heard you might be fixin’ to relocate.”

  “How’d you hear that? Weiner tell you?”

  “What? Oh, no. Was talking to Bob Chang at a meeting last week. Bob mentioned you’d interviewed in Cleveland but turned it down. We need to fill us a position, so thought I might oughta run it by you, see if you were interested.”

  Suspicious, yet desperately wanting something positive, Alex leaned back in his chair. “What do you have in mind?” After hanging up, Alex opened a copy of the AANS membership list and jotted down the phone numbers of Paul Tunny and John Krause, fellow residents who, like many of Waters’s graduates, had gone on to academic careers, both friends he could trust for honest, unbiased opinions. For the first time in two days, a glimmer of hope motivated him.

  18

  “Gawd, what a royal asshole,” Lisa muttered, referring to Weiner, just before taking her first a sip of the Junipero martinis. For the second night in a row, they were at their favorite restaurant. Neither wanted to cook, and moreover, Alex felt the need to get out of the house. The restaurant felt comfortable, a touchstone of normalcy.

  Alex nodded and did the same, savoring the juniper botanical. “Nothing like Junipero.” He’d decided to hold off mentioning Reynolds’s phone call until she had a moment to relax from work. They had left the house soon as she returned home, and he’d just finished telling her of the embarrassment of being delegated, quite literally, to a broom closet.

  She sighed and leaned back against the booth. “What do we do now?”

  “For the moment, nothing. I need to scout around for a job. I was too upset to make any real calls. I thought about trying to set up a private practice so we wouldn’t have to move, but I just can’t bring myself to seriously consider it.”

  She spooned a few ice cubes from her water glass into the martini, a trick they both used to dilute it some.

  “I did get an interesting phone call shortly after I got home.”

  “Oh?” She replaced the spoon on the linen napkin, the restaurant din and piped-in music making it a little hard to hear
again in spite of being in a booth.

  He told her of Reynolds’s pitch to fly there for a job interview.

  She wrinkled her nose. “You said no, didn’t you?”

  He spooned a few ice cubes into his drink. “Actually, I agreed to come.”

  She sat back against the booth, hands in her lap. “Really? I’m surprised.”

  “Why?”

  “Well, for starters, it’s in the South. You’d seriously consider living there?”

  “I know, I know … but the way I see it, I can’t be very choosy at the moment. Considering our finances, my highest priority is finding a job. The longer I stay unemployed, the deeper in debt we’ll be. Besides, there’s no harm looking. Chances are I won’t take it, but hey, who knows?”

  She nodded. “Good point.”

  “And say I do take it. Once our lives stabilize and the pressure’s off, I can start to nose around seriously for something more ideal. But you never can tell, maybe we’ll discover it’s our dream place. Neither one of us has set foot in a southern city other than New Orleans, and that was only a couple of days at a convention.” He picked up his martini. “Who knows? We might like it.”

  “Okay, granted, but think about this: we’re both non-church-going liberal democrats. The place you’re talking about is the heart of the Bible Belt. We’d be surrounded by right-wing Christian conservatives. You ready to deal with that?”

  Having already considered this, he nodded agreement. “Every word you say is true, but we may be getting ahead of ourselves. I haven’t even looked at the job. In fact, he was pretty vague about the details, so I’m not exactly sure what the job actually entails. After I hung up and thought about it, I got the distinct impression his intent is to get me down there and take a look at me before he decides what he wants to offer. But hey, it’s university-based and has a residency. From everything I’ve heard, Reynolds is a straight shooter and well connected politically. Might be a good temporary job. You never know, sometimes these things work out for the best. And as I said, what do I have to lose by looking? Besides, I’ll get frequent flyer miles.”