Doctored Evidence Page 11

  Anne spoke. “A disagreement in the family increases the risk of a lawsuit if the mother dies.”

  Dr. Bernard broke in. “Miss Hayes and Miss Delaney are both out of order. The committee has not been asked about discontinuation of life support. Miss Beauchamp, who’s the surgeon?”

  “Dr. Whitman.” Dr. Whitman was a Jefferson Clinic physician.

  “Miss Hayes did make one valid point,” said Dr. Bernard. “The consent of one daughter is sufficient. The surgery is medically necessary, or Dr. Whitman would not have ordered it. We can’t cut off necessary health care to someone just because of her age or the quality of her life.” He wagged a long, bony index finger. “That’s a slippery slope.”

  Karen’s sore neck throbbed. Her worst suspicions seemed confirmed. Dr. Bernard was pushing the Ethics Committee toward putting a patient and her family through a pointless ordeal in order to bring a nice fee into the Jefferson Clinic. She decided to challenge Bernard.

  “Dr. Bernard, we’re not talking about exterminating the mentally challenged here. We’re talking about an elderly patient who has lived a full life and at this point doesn’t even know she’s living. If you call that living. It’s an easy distinction to make.”

  Dr. Bernard cleared his throat. “The Chair calls the question.”

  Karen felt her face flush with anger. Dr. Bernard was capable of railroading the committee. The social worker and the minister were likely to follow the lead of the only physician in the room. Karen decided to again risk raising a medical issue, although she knew what Bernard’s reaction would be.

  “The patient won’t survive bypass surgery,” Karen said.

  “And how do you presume to know that?” said Dr. Bernard, cocking his head from side to side. “Dr. Whitman is a board-certified cardiothoracic surgeon with twenty-three years’ experience.”

  “And a twenty-four percent mortality rate on bypasses,” rejoined Karen, hoping she hadn’t gone too far.

  Bernard glared at her. “That is because he accepts so many high-risk patients.”

  “And that” said Karen, “is because he has three ex-wives and eight children to support. Otherwise, this case wouldn’t even be under consideration.”

  After a moment of silence, the minister said, “Perhaps a little counseling…”

  “We’ve wasted enough time on this,” declared Dr. Bernard. “The Chair will duly note Miss Hayes’s slander of Dr. Whitman and report it to President Grimes. Now, in case you’ve forgotten, the question has been called.”

  “You can’t call the question,” said Karen sardonically, “until a motion is made. There’s been no motion”

  “You lawyers!” blustered Dr. Bernard, his voice rising. “The motion is that this committee endorse the courageous effort of a qualified, respected surgeon to save the life of a patient!”

  Karen’s pulse fluttered, and her field of vision narrowed momentarily. She was losing it.

  “I’ll tell you what, Dr. Bernard,” she said, “why don’t you just have Dr. Whitman do up an operative report, put it in the medical record, and bill it out? No need to actually do the surgery. It would save everybody a lot of trouble.”

  Bernard’s jaw dropped. Karen regretted her utterance instantly. By yielding to her anger, she had virtually announced to Bernard that she was wise to his billing fraud. Dr. Bernard picked up his agenda with shaking hands and slowly set it back down on the table. “Excuse me,” he said, and strode quickly from the room.

  Anne heaved an audible sigh. “Great. There goes our quorum. Mind telling me what that was all about?”

  Karen slumped down in her chair and raised a fist to her forehead. She smacked herself and felt a jolt of pain in her stiff neck. “I don’t know, Annie. Maybe it’s PMS.”

  The minister smiled nervously. The social worker fiddled with her necklace. Karen closed her eyes. “What else was on the agenda?” she asked.

  Anne picked up Dr. Bernard’s discarded copy and read, “The Chairman of the Medical Research Committee asked two months ago for our advice on a research protocol proposed by our infectious disease specialist, Dr. Donaldson. It’s an experimental treatment for AIDS.”

  The social worker spoke. “I hope it’s not a double-blind study where standard treatments are withheld from one-half of the subjects, who get only an experimental drug. They must know by now it’s unethical to withhold treatment known to be efficacious from human subjects.”

  “No,” said Anne, “that isn’t the question. The question the Research Committee was asking is whether there’s any ethical problem with allowing one of the physicians cosponsoring the protocol to serve as a subject.”

  Karen’s eyes popped open. She grasped the implications of the Research Committee’s question instantly. “One of our docs? Somebody on our medical staff has AIDS? Who is it?”

  Anne looked Karen in the eye and shook her head, as if warning Karen to drop the subject. “Doesn’t matter. It’s moot. We didn’t have a quorum last month. When we didn’t get back to them, the Research Committee approved the protocol subject to our review today. If we don’t get them an adverse recommendation today, the protocol goes ahead. With no quorum now, we’re out of the loop. I move we adjourn. Karen, could you stay a while longer? I need to talk with you on another matter.”

  The minister and social worker left the room. Karen shook four ibuprofen tablets from a small plastic bottle and downed them with a gulp of lukewarm coffee. The heat came on, and the radiators clanked. Karen touched her cervical collar and groaned.

  “You really should have stayed home today, Karen,” said Anne. “Why kill yourself to make it to Ethics Committee?”

  “Because,” said Karen, “if I don’t stop him, Bernard will have them carting respirators down to the morgue and hooking up corpses—after checking to make sure the corpses have adequate insurance coverage, of course. What was the other matter you wanted to talk about? Have you got the details on who had access to the cath lab cart before Larry’s biopsy?”

  “Not yet. I expect to have it tomorrow. What I wanted to talk about was another alleged sexual assault on a patient.”

  Anne described to Karen a complaint made the previous night by a surgical patient named Steven Linder. Mr. Linder claimed that another patient he had met on the floor came into Mr. Linder’s room, talked with him for over an hour, and then proceeded to fondle his genitals. Mr. Linder also claimed that he felt drugged at the time. The floor nurse confirmed that Mr. Linder was receiving a narcotic postoperatively for pain, but the patient said he felt a surge of drowsiness and a “buzz” right before the assault. Mr. Linder claimed to be familiar enough with the effects of drugs to know he was feeling something more than his post-op pain med.

  “That’s interesting,” remarked Karen. “A similarity to the Dietrich Heiden complaint. Heiden said he was drugged, too, before the alleged assault by Carson Weber.”

  Anne chewed on the knuckle of her left index finger. “Uh, there’s another similarity.”

  “And that would be…?”

  “Linder identified Dr. Weber as the assailant.”

  Karen blinked twice. The radiator groaned. “I thought he said he was attacked by another patient.”

  “He did. Dr. Weber was a patient on the same floor as Mr. Linder last night. They were next-door neighbors, in fact.”

  “Whoa!” Karen exclaimed. “Well, that about does it. No way this is a coincidence. Damn! We blew it on the Heiden complaint.” Members of the medical staff were not employees of the hospital, so even if Dr. Weber had assaulted Dietrich Heiden, the hospital probably would not be liable. However, the hospital was much more likely to be responsible on a second assault, if it failed to deal effectively with the first assault.

  “Not your fault, Annie. It was a good investigation. The parking garage videotapes just made it seem more likely that Heiden was confused, or lying. The only thing we’ve got going for the defense of this Linder complaint is that Weber was a patient at the time of the assault. He wa
sn’t on duty as a physician. By the way, what was he in the hospital for?”

  Anne’s gaze dropped to her lap. “He’s the physician who’s one of the subjects in Dr. Donaldson’s research protocol He signed himself in to start the tests.”

  Karen pulled off her cervical collar and threw it across the conference table. She rubbed her painful neck with both hands. “So the doctor who’s been sexually assaulting our patients has AIDS. Isn’t that special?”

  Upon returning to her office, Karen called Joe Grimes and reported the second allegation of sexual assault against Dr. Weber. She requested that Grimes contact Leonard Herwitz, Chief of the Medical Staff, to convene a special meeting of the Medical Executive Committee, for the purpose of suspending Dr. Weber’s medical staff privileges. Karen felt remorseful that she had reached the wrong conclusion about the first complaint against Weber, but she had little doubt that the Medical Executive Committee, which was charged with the responsibility for disciplining wayward medical staff members, would suspend Dr. Weber. From her experience with the committee she had gleaned a general principle: if the members of the committee could imagine themselves committing the same infraction as the errant physician, they would go easy on the culprit; if not, they’d throw the book at him. This general principle, combined with the overt homophobia that prevailed in the culture of the medical staff, boded ill for Carson Weber.

  Grimes said he would try to get the meeting scheduled at the end of the day. Then he said he had something else to discuss with Karen.

  “Good news on the MRI,” he said exuberantly. “You can stop worrying about private inurement and illegal kickbacks and all that stuff. I think I’ve found a donor who will make a large gift to a new hospital subsidiary to acquire the MRI, and the clinic doctors have agreed to voluntarily send their patients here to support the program. I’ve been using my legendary powers of persuasion on Dr. Herwitz.”

  Joe’s mention of the MRI deal brought back a memory of the interior of the clay urn, and Karen’s stomach jumped. Her sore neck ached. Joe was moving forward with his plan to sneak the hospital’s money to the clinic by corrupting the stockbroker into phonying up confirmation slips showing stock transfers that never took place. Using a “donation” Joe may have gotten his hands on by arranging Larry’s death. She gritted her teeth.

  “Gee, Joe, how do you do it? All taken care of, just like that. And a week ago, we were stymied.”

  “I still need some help from you, Karen. Think about how much we can pay the clinic for consulting on selection of the MRI equipment and so forth. Estimate on the high side.”

  Great, she thought and stuck out her tongue at the telephone. It’s not enough the clinic is getting half the MRI profits from the hospital. Now they’re squeezing consulting fees out of it, too. What might they cook up next?

  CHAPTER

  15

  Leonard Herwitz, accompanied by the sound of the ever-present clanking of the radiators, called the special meeting of the Medical Executive Committee to order at 6:00 P.M. Tuesday in sweltering old Conference Room I. Dr. Herwitz’s svelte figure and erect posture looked as straight and sharp as one of his scalpels.

  The committee ate fried chicken and french-fried potatoes from plastic plates on cafeteria trays. The hospital dietician had made prior attempts to serve low-fat fare at committee meetings, but the healthier food had received bad reviews from the doctors.

  Karen helped herself to a serving of soggy green beans, a dry dinner roll, and skim milk. At the long fruitwood table across from her, Dr. Bernard avoided eye contact. The smell of his cigar smoke, suspended in the air of the stuffy conference room like cobwebs, did little to enhance the cafeteria meal. She nodded at Dr. Herwitz, who nodded back, smiling. He was almost her father’s age, but Karen had to admit that Herwitz was a good-looking man. He always seemed to show more interest in her than most of the other doctors did.

  Dr. Caswell, the oncologist who figured prominently in Larry Conkel’s fraud investigation files and who Karen thought looked like an undertaker, was present. Two other committee members attended—an anesthesiologist named Futterlieb, whom Karen had heard referred to by other doctors as a “frat boy,” a euphemism that meant he had a drinking problem, and an internist who was young, clean-cut, and new to the committee. Joe Grimes was there as a guest.

  “Why don’t we start the meeting while people eat,” suggested Dr. Herwitz, “That way we can get out of here at a reasonable hour.” He paused for a bite of fried chicken. “Joe, why don’t you tell the committee what you told me earlier.”

  Joe described the complaints against Carson Weber: one allegation of assault involving nonconsensual oral sex and a subsequent allegation involving fondling. Joe explained the similarity of the allegations, the dates and times, and why Weber was a patient in the hospital at the time of the second sexual assault.

  “That would put the first incident on the night of Thanksgiving,” Dr. Herwitz observed.

  “Correct,” said Joe.

  “I guess,” said Dr. Caswell, “Carson has his own idea of Thanksgiving dinner.” A couple of the doctors chuckled.

  “Maybe he thinks that’s what the term ‘drumstick’ means,” said the anesthesiologist. The committee members laughed.

  “Do you suppose,” the internist interjected, “he prefers light meat or dark?” More laughter.

  “I bet,” said Joe, “what he really goes for is stuffing!”

  Dr. Herwitz interrupted the subsequent chortling after several seconds. “Now, gentlemen, let’s not forget we have a lady present.”

  Joe, seeming a little intoxicated at having gotten a laugh from the doctors, said, “That’s no lady, that’s my shyster!” He was rewarded with another laugh. Smiling pleasantly, Karen thought to herself, What a bunch of assholes, and interrupted the laughter.

  “We need a committee member to make a motion to summarily suspend Dr. Weber’s medical staff privileges.”

  “So moved,” said the internist.

  “Seconded,” said Futterlieb, the anesthesiologist.

  “Hold your horses,” said Dr. Bernard. “Let’s not rush to judgment. All we have is stories from patients who by their own admission were on drugs.”

  Leave it to Bernard to try to use the fact that Weber’s victims claimed they were drugged to discredit them, thought Karen. Was there no limit to this man’s disregard for patients?

  “That’s not quite all we have,” she said. “Dr. Weber admitted the second assault to the floor nurse. Anne Delaney got a written statement from her. In addition, we did a drug screen on the patient. Somehow, this patient received a drug other than the one ordered by the attending physician.”

  “You’re jumping to conclusions,” said Dr. Bernard, wagging his index finger. “Maybe the nurse screwed up the medication, then fabricated Dr. Weber’s confession to cover her own ass.”

  Karen cast her eyes to the ceiling. God, how he rankled her.

  “That’s ridiculous,” she said. “The nurse didn’t even know about the first assault, and she didn’t know we would do a drug screen. The drug screen came after Weber’s confession.”

  Dr. Bernard furrowed his brow and leaned forward. “I don’t know what’s going on here. Isn’t a man innocent until proven guilty in a court of law? That’s what the Constitution says!”

  Karen felt fatigued and frustrated at the same time. “No, Dr. Bernard, the presumption of innocence is not in the Constitution. More to the point, this isn’t a criminal prosecution. We’re not going to put Dr. Weber in jail, we’re just deciding whether he can exercise his medical staff privileges in this hospital.”

  “No,” asserted Dr. Herwitz, “we are not. Mrs. Hayes, the standard for summary suspension is that the physician poses an immediate danger to patients. That standard is not met. No suggestion has been made that Dr. Weber is not practicing competent medicine. We cannot discriminate against a physician based on sexual preference. Now, I know Dr. Weber has AIDS, but as long as he uses universal prec
autions there is no significant danger to patients.”

  “Dr. Herwitz,” Karen asked, “don’t you yourself refuse to perform surgery on AIDS patients?”

  “That’s an entirely different matter. The risk of transmission from patient to physician is well established. There is no established risk of transmission from physician to patient if universal precautions are followed. The Chair will entertain a motion that Dr. Weber be required to enter an impaired professionals program under the auspices of the County Medical Society.” If the physician adhered to the program, he could continue to practice while he received treatment.

  “Let me get this straight,” interjected Karen. “A physician with AIDS who is sexually assaulting patients does not pose an immediate danger to patients?”

  “So moved,” said Dr. Bernard, ignoring Karen.

  “Seconded,” said Dr. Caswell.

  The motion passed by a vote of three to two. Karen was astonished that Herwitz would want to keep Weber on the medical staff, and that Bernard and Caswell would go along with him. It was the first time in years that she had been wrong in her prediction of a Medical Executive Committee vote. Was she losing her touch? Why were the Jefferson Clinic doctors protecting Weber? What was happening in this hospital?

  After Dr. Herwitz adjourned the meeting, Dr. Caswell regaled the committee with a story he had heard about Dr. Weber. Occasionally emergency room physicians saw male patients, especially late at night, who came to the ER with foreign objects lodged in their rectums.

  “A few weeks ago,” said Dr. Caswell, “Weber sees a patient who’s got a cucumber stuck in his ass. It takes Weber fifteen minutes to remove the thing. When he gets it out, he says to the patient, ‘You know, you really should chew your food more thoroughly’.” The doctors filed from the room doubled over. Joe Grimes asked Karen to stay for a minute.

  “Dr. Bernard was in my office this afternoon, Karen,” he said. “Your behavior at the Ethics Committee meeting this morning was way out of line. And you were contradicting him just now. It’s not your job to alienate the medical staff. I know you’re a good lawyer, Karen, but if I hear any more about you harassing Dr. Bernard …”