"Is there any forensic evidence other than what you've just told us, Jack?" Alex looked at him, expectantly.
"Labs aren't back yet. We don't know if we're even going to get the PEPA and the PGM – you know, those semen tests – because too much time may have gone by." Jack shook his head. "I sure hope we can nail him with the forensics."
"You’ve got to catch him first, Françoise," Dr. Desmonde reminded the commander.
Jack raised his eyebrows and glared at the shrink. "Not to worry, Doc, not to worry. I'll get 'em. In fact, I plan to get him soon. You know me, Get Back Jack," the stocky police commander declared to the psychiatrist.
Alex was deep in thought. As a nurse and an attorney, she knew the proper collection of forensic evidence was critical for a court conviction of a rapist. She also knew that semen usually contains three genetic markers at levels adequate enough to allow for routine typing for evidence. Unfortunately, PEPA decreases within three hours after intercourse and PGM would not survive for more than six hours. Consequently, the early gathering, testing, and analysis of the semen specimen were pivotal to building a successful case. The semen genetic markers were ABO blood group antigens and testing was done by quantitative electrophoresis analysis. Since the genetic markers occur in variable amounts in different populations, their presence or absence in combination with each other often were used to arrive at a percentage or likelihood of whether the suspect is the rapist or not. Hopefully, the comparison of the crime scene evidence with blood and hair samples from the suspect would provide compelling evidence in court and would render a guilty verdict.
Alex continued to review her knowledge of forensic medicine and asked, "Jack, how do the experts handle the bite marks on her back and shoulder? Who did you call in to look at that?" She shuddered as she thought about Angie being bitten by her attacker.
"Damned bastard, a real animal. SOB must be crazy. Probably one of your patients, Monique! Have you thought about that possibility?" Jack turned towards the psychiatrist, flashing his angry, dark eyes.
"Yes." Monique practically hissed at him. "I've thought about it, Françoise! Do you think I'm an idiot? That's all I have been thinking about since this morning! I've got the team working on it now, looking at charts, and putting together a profile among the inpatients." Dr. Desmonde glared at the commander from across the table, barely able to conceal her anger.
Alex ordinarily would have interceded between the two, but knew Jack and Monique had been friends since childhood and were actually pretty close. Alex also knew that Jack was uncharacteristically affected by this rape because of his fondness for Bridgett and Angela. It would be difficult for the psychiatrist and the police commander to be completely objective on this one. And, me as well, Alex thought. Angie and Bridgett have been my friends since I've been here.
Alex asked again, "What about the bite marks, Jack? What do you make of them?"
"Don't know yet. The crime guys photographed them and were smart enough to include a reference scale this time." Jack rolled his eyes and told Alex and Monique about the time the NOPD crime team had forgotten to use a reference scale with the bite mark. "When we got to court, the evidence was useless because there was no reference scale with which to compare the size of the bite with the mouth and teeth of the suspect. As you can imagine, the evidence was inadmissible. It was a big loss to the prosecution. Lots of heads rolled on that one."
"I bet they did and they should have," Alex said. "A huge error of omission. I bet the prosecutor was enraged." Alex could imagine the colorful and politically astute Harry Connick Senior, the New Orleans prosecutor, being caught with his pants down. The man just hates to lose, just like me, Alex thought. I do hate to lose.
"Are you all sure you did everything right this time?" Alex inquired, with a hint of that old Virginia Southern drawl slipping passed her lips.
"Yeah. Best I can tell. We took the photos, included the scale, and called in a forensic dentist. The crime team also asked that casts be made to use later to identify the perp. I think we’re covered. One thing the CSI team said is that one of the forensic nurses noticed some puncture wounds on each side of Angie's neck. She said they were hard to see because they were in the slice wounds going around her face."
The three sat in silence for a few moments, pondering the horrific attack on Angie. Finally, Alex said, "Puncture wounds. Why would she have puncture wounds? Have you ever seen that before, Jack?"
Jack thought for a few minutes and answered, "No, I haven't. I really didn't notice them in the E.D., but we'll crosscheck that with other similar injuries in the database. We may get a hit."
"Did they mention a lot of blood at the scene?"
"Nope. It didn't come up, but I haven't been to the scene yet. If there was, it'll show up in the crime scene photos," Jack replied, looking at both women.
After several minutes of silence, Dr. Desmonde asked Alex, "What do you think the liability of the hospital is on this?"
Alex shook her head. "I don't know yet, probably significant. Personally, I feel that we should provide a safe place for our staff to work and that we should provide security for them to get to and from their cars, which we do..."
Monique interrupted her angrily, her face flushed. "Dammit, Alex. You sound just like a Main Street lawyer! You know as well as I do that the location, staffing, and administrative management of the psych department are unsafe. It's a joke!"
"Unsafe to you and me, Monique, nevertheless, the standard of care." Alex sighed. This was getting difficult. She continued, hesitating a little and then continued, "Well, the nurses can choose to call security to escort them to their cars when they get off and…"
"Stop it, Alex. That's shit." The usually tranquil chief of psychiatry at CCMC was livid, her pale face colored with anger. Monique rarely used bad language. "You and I both know it! Escorting nurses to their cars during the off hours is the lowest security priority in the entire hospital. Last night Angie Richlieu stayed late. There was some sort of patient commotion. One of the patients attacked a woman in the day room. I don't have the details, yet. Anyway, the patient incident got the entire unit in an uproar. Angie stayed late to help the nightshift calm the unit down. She didn't have to. She doesn't get paid for staying late anymore. In exchange for staying three hours overtime, she's told it'll be thirty to forty-five minutes before security can escort her to her car! Alex, for heaven's sake, give it up. You know it's wrong!" Monique's voice and hands were shaking.
Alex sat quietly and said nothing. She knew it was a losing conversation.
Commander Françoise placed his big, callused hand over the psychiatrist's small, manicured one. He said to her, "Monique, you've got to calm down some. Things are terrible, but for us to help Angie and her family, we've got to get ourselves together. You're an important player in this. Right, Alex?"
"Right, Jack." Alex looked at Monique. "I agree with everything you say, Monique. You're singing to the choir. Don't forget, I'm a nurse! I've been on your side the entire time about everything – about relocating the Pavilion, putting up lights, increasing staff. This will give us an opportunity to really address these things and make some changes. Let's take the lead on this for now. First things first."
Dr. Desmond retorted angrily, “Alex, don't give me any of that psychobabble. That's my job!” Monique hesitated for a moment, thinking. Then, she said to Jack and Alex, her voice uncharacteristically sarcastic, "So what did the esteemed leaders of the hospital do for the psychiatric service? They contracted it out and gave us to strangers to manage. People who have no knowledge of New Orleans, our culture, heritage, or diversity. Give me a break! We now have contract management in psychiatry, which is inadequate to say the very least, and the patient care conditions, safety, and units are less safe now than they were last year. This is totally pathetic and self-serving of hospital administration. The contract administrator has actually cut staffing."
Monique paused briefly and continued angrily, her voice becoming hig
her and higher, "I'm sure the bottom line has come up. The place is probably making money now, but what a dump. That contract administrator, Lester Whitset, looks like a patient. He even gives me the creeps. I’d like to give him a frontal lobotomy.” Monique tossed her head angrily, her dark hair bobbing, her tone of voice acrimonious.
Alex and Jack sat quietly and watched the conflicting emotions trail across Monique's usually well-controlled face.
After several very long moments, Monique finally reached for Alex's hand and squeezed it. "I'm sorry and you're right, Alex. I'm overwhelmed and incredibly tired and I am being a total bitch. Angie shouldn't be fighting for her life and her husband shouldn’t be wondering if their young daughter will ever have the mother that she once knew. The whole thing just stinks and I hate that it's happened. And even though I've got concerns about Lester and the contract management group that is handling CCMC’s psychiatric services, they came well recommended and are leaders in Behavioral Health Services. Perhaps I am over-exaggerating, but it seems to me our administration and the contract management service is much more concerned with money than with patient and staff safety. I'm afraid that with our growing, acutely ill, psych population we could be in for more trouble, particularly with health reform coming onboard. The delivery system they've implemented is simply not safe for our patient population. We are the only inpatient facility in the state that houses such dangerous psychotics and the criminally insane. It is truly a dangerous place."
Alex nodded and said, "I couldn't agree more and I couldn't be more concerned. Let's meet soon and talk about it. I've been concerned about the Pavilion for several months. Plan on my office at 10 o'clock tomorrow, okay?"
"You've got it, Alex. If things settle down, I'll be there. Do you want to invite Farve? For what it's worth, I'm sure it will be a waste of our time, but a lot of the safety issues obviously concern the nursing staff."
Alex shook her head negatively and shrugged her shoulders. "When has she ever helped the nursing staff? Why would we even want to include her? Let's get Dr. Ashby." Alex stared at Monique strangely. "I am surprised you asked, Monique. Do you really want her at the meeting?"
"Hell, no! I don't want her," Monique retorted. "She's been a pain in my butt for years. I have loathed her from the first day I met her, but we should have her there. If we can get her on our side ..."
Jack grinned at Monique and said sheepishly, "Come on, Monique. Don't hold back. Tell us how you really feel!" Jack and Monique started to laugh and Alex joined them in their laughter.
"You're right, everything you say is correct, Monique. I guess we should invite her because it's politically correct and her role should concern the safety of all staff." Alex hesitated for a moment and continued, "We’ll have to include her, it's the best thing to do. She'll be mad as a hornet if we don't and we will hear about it." Alex’s tone of voice was almost apologetic as she looked at Monique, who was once again seething with anger at the very thought of Bette Farve.
"Invite the obstructionist bitch, I don't give a damn. I'm going over to the Pavilion. Call me if there's any change in Angie’s condition." Monique grabbed her lunch tray and slammed it on the tray rack as she headed towards the door.
Alex and Jack looked at each other in amazement as Monique exited the cafeteria.
Jack spoke first, "Man, I've never seen Monique so blown away. This just isn't like her at all. I sure hope she gets it together."
"She will," Alex assured him. "This is Monique's worst nightmare. She has been waiting for something like this to happen for months and now it has and she feels responsible. Trust me, that's exactly what's going on here because that's the way she is. Jack, by any chance, did you check out that guy, Lester, who is managing the psych services? I've never seen him or met him, but I hear he's pretty weird. If you haven't, maybe you should question him."
"Not to worry, Alex. I'm questioning everyone and he is for sure on my list."
"Good," Alex said looking thoughtful and continued, "Let's see what the psych team puts together. There may be inpatients who have a history of rape or assault. We should know more about them later and we also need to do a historical chart review of former psychiatric patients who have been on the unit. What do you think?"
Françoise was slow to respond. He stared at his coffee and looked longingly at the plate that held his jelly donut.
Alex could tell by the look in his eye that he really, really wanted it.
"Well, I don't quite know what to make of this crime yet … this guy is a pervert who crosses the categories of defined rapist. If you’ve got a few minutes later on today, a representative from our sexual crimes division will be coming over to the Pavilion, sometime around lunch time. We're going to meet in the executive conference room. Why don't you join us if you can?"
Alex glanced down at her watch. "It's almost noon now. Would you be willing to meet in my office, since I don't have a secretary or administrative assistant today? I really need to get back to see what's going on."
Jack looked hesitant for several moments.
Knowing Jack as she did, Alex added, "I'll have lunch sent into my conference room. Does that help you make up your mind?” Alex asked, smiling.
"It absolutely does. You win. You know I'll never turn down a free CCMC lunch, particularly if Don Montgomery is footing the bill and won't be attending. I’m gonna make tracks over to the Pavilion and pick up Nadine. She's our sexpert – you know, our expert on sex crimes," Jack added hastily, noting the frown on Alex's face.
Alex's voice was frosty as she said, "Jack please don't use that word. Let's just refer to her as an expert on sexual crimes. In some way it sounds demeaning, the word ‘sexpert’. To me, it sounds demeaning to both Nadine and Angie."
Jack looked forlorn. He hated it when Alex corrected him or seemed disappointed. "Okay, okay, okay, you got it. I didn't mean to sound disrespectful," Jack said quietly as he rose to leave.
Alex smiled at him and teased, "It's okay, Jack. I'll forgive you this one time, but only this one time. Now get your butt moving over to the Pavilion and then get it back over here for lunch."
Jack stood and said, "Will do. See you shortly." He saluted her on the way out.
8
After placing her tray on the rack, Alex headed towards her office but decided to stop in hospital administration on the way.
Latetia, Don Montgomery's secretary, was working quietly at her desk. She looked up at Alex sadly and said, "Ms. Alex, how are Bridgett and Angie? I just heard a little while ago and it's just awful. Do you think Angie will be okay? I just know Bridgett must be terribly upset. Is there anything that I can do?" Latetia's liquid brown eyes were kind and reflected deep concern for her friends.
"Latetia, Angie's in surgery and you're right, Bridgett is beyond herself with grief. I wish there was something that we could do to help her and her family, but right now I think it's just a game of waiting and watching and praying." Alex watched Latetia's eyes overflow with tears as she moved from behind her desk to give her a hug.
"Sure, sure. I know you're right. We’re planning to send food to Bridgett's mom's house for the next week or so. Check the Meals to Go in your email so you can participate. I'm sure that Bridgett and Angie's mom will be keeping the baby. I would imagine that Bridgett, her husband, and Angie's husband will want to be at the hospital."
"The food is a great idea and I'm happy to participate. Love the idea of the Meals to Go. By the way, do you think you can find me a temp while Bridgett is out? I would anticipate she will be out for several weeks."
"Sure. Want me to try for Mona again?"
Alex nodded in approval and said, "Yeah. That would be great. She was pretty good during those several weeks last month when Bridgett and her family were vacationing on the Gulf Coast. And she knows me. That's half the battle right there."
"I'll do my best, Ms. Alex," Latetia said, reaching for her temporary staff file.
"Thanks. By the way, what's Don doing? Does he ha
ve anyone in his office?” Alex added, as she inclined her head towards the executive's office.
Latetia glanced at her phone. "He was on the phone, but now he seems to have hung up. By the way, you may want to think twice about going in there. He's in a pretty foul mood, so you might want to be careful. The July revenue projections came in and they were low, much lower than we expected." Checking out the look on Alex's face, Latetia added, "Are you sure you want to go in? I wouldn't if I didn't have to. I'm actually thinking about taking the afternoon off to get away from him," she smiled, rolling her eyes. "I know you. You're always up for making him mad,” she teased.
"Yeah, I'm going in. He doesn't scare me anymore. It'll only take a minute and will make his day much worse," Alex added as she moved towards the door and knocked.
"Oh, that's just great. Thanks a bunch, Alex." Latetia groaned, as Alex knocked on the CEO’s door.
"Enter." Don Montgomery was seated behind his massive, walnut desk, his head buried in computer printouts. He looked surprised and irritated at Alex's interruption.
"Alex, do we have a meeting?" He quickly scanned his Outlook calendar on his computer. "Nope, we don't. I didn't think so." He looked smugly at his legal counsel, always happy to be right and one up on the lovely attorney. "What do you want? I'm busy." Don glanced at Alex briefly and returned to his papers, a blatant act of dismissal. When Alex didn't reply, he looked at his watch and said angrily, "Really, Ms. Destephano! I’m very busy, and don't have time for you to stand there and gawk at me."
Anger creeped up Alex’s spine and she said, "No, Don. We don't have a formal meeting scheduled, but we do have a situation we must discuss."
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