Doctored Evidence Read online

  “We’ll see about that one, Ms. Hayes. Also, I wish to notify you of another matter.”

  Karen heard Chambers belch. “My services have been retained by one Steven Linder to bring an action for damages resulting from an assault upon his person whilst he was a patient in your facilities.”

  Damn, thought Karen. There goes any chance of keeping the second sexual assault victim from finding out about the first one and using it against the hospital.

  “How did Mr. Linder happen to select you as his attorney?”

  “That would be privileged, Ms. Hayes.”

  “You know the hospital has no involvement in Mr. Linder’s claim, Mr. Chambers. The alleged assailant was another patient whom Mr. Linder invited into his room.”

  “Well see about that one, too, Ms. Hayes.”

  Karen tried to put Lou Chambers and his lawsuits out of her mind so she could make some headway on her report to the Inspector General. Before she had typed a single sentence, she received another call, this one from the hospital’s outside attorney, Emerson Knowles. As Karen had instructed, he had delivered requests for Larry Conkel’s medical records to St. Peter’s Hospital and Larry’s first cardiologist. He would call Karen Friday to let her know if those records provided any new information.

  Within a minute after Emerson hung up, Karen’s work on the letter to the Inspector General was again interrupted, this time by her secretary. Margaret stood nervously in the doorway clutching a long document covered with tiny print.

  “Mrs. Hayes,” she said meekly, “I need your help on a legal matter. A personal legal matter.”

  “What is it?” asked Karen, cutting herself off before she added “this time.” Over the years, Margaret had come to her for help on small legal matters so many times Karen felt like she had two clients, the hospital and Margaret.

  “My lease,” said Margaret, stepping quickly to Karen’s desk and handing her the document. Margaret settled her emaciated frame into a guest chair without waiting for an invitation. “I just renewed it for a year, but now my boyfriend wants me to move in with him. I don’t think I should have to pay rent if I’m not going to be living in my apartment anymore, but the landlord says I’m obligated for the whole year even if I move out. Is that right?”

  Karen did not relish helping someone break a lease for no good reason, another of the distasteful legal favors Margaret often requested. Once, Karen had persuaded a department store owner not to press shoplifting charges against her secretary, even though the storeowner had Margaret on videotape shoving a handful of string bikinis into her sweatpants. On another occasion, Karen settled a dispute between Margaret and a college student who was upset to learn that the odometer of the secondhand Plymouth he had bought from Margaret had been tampered with. Karen had helped Margaret beat several traffic tickets, including one for drunk driving. Karen always had misgivings about helping, but it was hard to say no to someone who could make Karen’s job a lot harder. Margaret was not above using the subtle art of secretarial blackmail. If Karen resisted Margaret’s requests, Karen’s correspondence would be typed more slowly and less accurately and Karen’s guests would be received even less politely. “I should have fired her long ago,” Karen thought.

  When she had first encountered Margaret’s passive-aggressiveness, she dealt with it head-on, reporting instances of poor performance on Margaret’s evaluation form. The Director of Human Resources discussed the evaluation with Margaret, and Margaret retaliated by misfiling several important documents. Karen was up all night finding the papers needed for a 7:00 A.M. closing. Unless she was prepared to fire her secretary, and it seemed too late now, Karen realized she would have to continue to accommodate Margaret.

  Karen always made something of an attempt to avoid giving Margaret free legal services by instead giving her advice on how to live her life so she wouldn’t need the legal help. Pay the shoplifting fine and stop shoplifting. Give the college kid his money back and sell the Plymouth with an accurate mileage statement. But her advice fell on deaf ears. Margaret apparently suffered from some congenital, systemic condition that disabled her from dealing off the top of the deck. Telling Margaret to play it straight did no more good than telling her to eat better or change her eye color. Her deviousness seemed to be hardwired.

  Karen gave it another try, anyway. “Are you sure you want to give up your apartment?”

  “Sure, I’m sure. I can save a lot of money splitting rent with Marty.”

  “How long have you been seeing Marty?” Margaret went through boyfriends like pantyhose.

  “Long enough.”

  “Then why did you renew your lease?”

  “The opportunity to move in with Marty just came up, right after I signed my renewal.”

  “How?”

  Margaret narrowed her eyes and looked at Karen as if she was about to say “none of your goddamn business,” but stopped herself. Instead she said, “His … brother was living with him, but he suddenly moved out.”

  “So why the rush? Why not wait a couple of months before making such a big change?”

  Margaret tossed her waist-length hair and repositioned her bony hips in the chair. “Marty can’t swing the rent by himself,” she said. “I’ll miss the opportunity if his … brother wants to move back in.”

  Karen could tell Margaret was lying. Probably met this Marty about a week ago. But nothing could be accomplished by continuing the cross-examination, except inducing Margaret to go on one of her impromptu strikes. And she knew the files more accurately than Karen ever would.

  Karen scanned the lease. It took her less than a minute to find a way to break it.

  “This lease is unenforceable,” she said. “It contains a cognovit provision.” This provision was not only unenforceable, but its use prevented the landlord from enforcing the entire lease. Karen was amazed that some landlords continued to use it, apparently out of habitual nastiness.

  She handed Margaret a ballpoint pen and a pad of lined paper. “Take a letter,” she instructed and proceeded to dictate a letter to the landlord that told him where to mail the security deposit and, in polite legal language, where to put his lease. “You can kiss your security deposit goodbye, Margaret,” she said, “but you can stop paying rent. The landlord won’t take you to court. Just get your stuff out before he gets this letter, or he’ll probably lock you out. Good luck with the move.”

  Margaret thanked Karen a bit offhandedly and darted from the room. Karen felt the same prickly remorse she always felt after helping her secretary.

  At 10:00 A.M., Karen brushed out her hair, touched up her makeup, grabbed a pad of paper and a pen, and walked the length of the hall to Joe Grimes’s office. When she was ten feet from the door, she detected the putrid odor of cigar smoke. Ed Bernard was there.

  “C’mon in, Karen,” announced Joe, “we’re just getting started.”

  Joe was behind his desk, wearing a black suit, a gray dress shirt, and a solid black necktie. The monochrome look, very trendy, very Joe. Ed Bernard and Leonard Herwitz were seated in the two upholstered guest chairs in front of Joe’s desk, Bernard in wrinkled blue surgical scrubs and Herwitz in a crisp white lab coat. Karen was relegated to an odd little Frank Lloyd Wright-type teak chair that appeared to be designed to be occupied by a rhesus monkey. As she arranged the skirt of her gray dress and awkwardly sat down, a glimpse of the clay urns sent a shudder through her.

  The three men appeared to be in good spirits. Karen noticed three empty, plastic champagne flutes on Joe’s desk.

  “Getting an early start on New Year’s Eve?” asked Karen.

  Joe chuckled. “I thought a little celebration was in order. Karen, I want you to start drawing up contracts for the three radiologists from the clinic, and Drs. Bernard and Herwitz, to provide consulting services to the hospital on the selection of the MRI equipment, for $10,000 each.”

  Karen’s face flushed and her left foot started to tap involuntarily on the tile floor. Joe was going full speed a
head with the illegal plan that Karen had overheard him describe to Dr. Herwitz while she was hiding in the urn. Joe wanted her to phony up some consulting contracts for the clinic to provide funds to seed its account with Dean Williams at Jackson, DeSalle. Then the clinic would receive fifty percent of the profits from the MRI acquired by a new hospital subsidiary, which would make a series of “unlucky” investments using Dean Williams as its broker. The investments in the clinic’s account, on the other hand, would be stellar performers, and the whole scheme would be papered over with backdated confirmation slips.

  The amazing thing was that giving the doctors a financial incentive to refer patients to the MRI would make the MRI so profitable that the hospital would come out way ahead, even though it was giving away half its profits up front. The only losers would be the patients who got MRIs they didn’t need, and the people who would foot the bill—taxpayers and those paying health insurance premiums.

  It wasn’t just that Joe’s plan was legally risky for the hospital. The deception and corruption involved, and the doctors’ apparently gleeful acceptance of it, disgusted Karen, reminded her of a butcher surreptitiously adding sawdust to ground beef.

  The three men smiled smugly and glanced at one another conspiratorially. Karen willed her nervous toe to stop tapping.

  “So, Joe,” she said, “that would be an even $50,000 going to the clinic, more or less simultaneously with the acquisition of the MRI. That about it?”

  Joe confirmed. Dr. Herwitz asked, “Is there a problem with that, counselor?”

  Karen explained that an IRS audit or Medicare investigation of the MRI program would undoubtedly sweep together all contemporaneous transactions between the hospital and clinic. Overpayment for consulting services would be easily exposed.

  Dr. Bernard chewed on his cigar. “Don’t you lawyers have anything better to do than make trouble for people who are trying to save lives? For Christsake! If it gets an MRI into this hospital, that should be enough.”

  “Well, it’s not enough,” responded Karen. “I’m not trying to make trouble, I’m trying to avoid it. I’m just telling you what the law is.”

  Dr. Bernard uncrossed his legs and recrossed them. “The law, which is created by a bunch of other lawyers! Why do we have lawyers telling us what we can and can’t do? It’s ruining the practice of medicine. Why don’t you pass some laws that make it harder for lawyers to make a living for a change?”

  “Dr. Bernard, I’m not in the legislature. I don’t make the laws.”

  Joe intervened. He said it was nothing to get excited about. The doctors would each document forty hours of consulting services, and a rate of $250 an hour could easily be defended.

  “You’ve told us the law, Karen,” said Joe. “That’s your job. We can make the business decision to accept the risk. It’s not much of a risk, if you ask me. So just do the documents. We’d like drafts before Christmas.”

  Karen clenched her jaw. She had explained the legal problems, Joe understood them, and he was plunging ahead. She was out of ammunition.

  Dr. Bernard regarded her through narrowed eyes and cigar smoke. “I’d like to know if she’s found any time between her attacks on the medical staff to do anything about this bullshit Conkel lawsuit. I thought the hospital was going to keep the doctors out of the case. That so?”

  “So far, only the hospital has been served,” said Karen. “I’d be surprised if it stayed that way. Ben McCormick usually sues everybody who is within a hundred yards of the plaintiff at the time of the injury.”

  “But in this case,” insisted Dr. Bernard, “there’s no way anybody can fault the doctors. How can we be responsible if the hospital furnishes us with defective catheters?”

  Joe played with his vertical-blind remote control while Dr. Herwitz pretended to read the label on the champagne bottle. It was in French. Karen knew Bernard’s question was rhetorical, but she elected to answer it anyway.

  “For starters, you might be responsible if you mishandled the catheter, or if you mismanaged the care of the patient after the catheter broke.”

  Dr. Bernard wrinkled his brow. Veins stood out on his neck. “No one could possibly suggest any such thing.”

  “Sorry,” Karen corrected him. “A cardiologist from Johns Hopkins reviewed the record and said exactly that.”

  Bernard and Herwitz sat bolt upright in unison and looked at Grimes. Joe fumbled the remote control for a moment. He rotated his desk chair to face Karen.

  “I expressly instructed you not to bring in an outside expert on this case. This is insubordination.”

  Karen felt her momentum building. She relished rattling the conspirators a little.

  “Relax, Joe,” she said. “It was just a college friend of mine. There’s nothing in writing. One thing he said, Dr. Bernard, is that he suspected you had never done a myocardial biopsy before. Is that true?”

  Bernard dropped his cigar in a huge onyx ashtray on Joe’s desk. His upper lip dewed. “I’ve done thousands of catheterizations,” he muttered, his eyes darting about.

  “I’m sure you have, doctor,” said Karen, “but was Larry your first myocardial biopsy?”

  Dr. Bernard looked back and forth from Grimes to Herwitz. There was a tremor in his hands. “What is this, a cross-examination? Why am I being subjected to this?”

  Joe admonished Karen to drop the discussion, but Dr. Herwitz continued it.

  “Did your friend say anything about the surgery?”

  “Yes,” Karen acknowledged, “he said the patient never should have been put on heart-lung bypass. He said that was a death sentence for a patient with Larry’s condition.”

  Dr. Herwitz leaned toward Karen, his forearms on his knees, a woeful expression on his face. “You know, Mrs. Hayes, this is a medium-sized hospital in a small city. We’re clinicians here, the physicians in the trenches. Don’t assume we’ve been negligent because some ivory-tower pedant from Johns Hopkins is able to find fault with a snap judgment made in the heat of battle. It isn’t fair.”

  Karen was unprepared for frankness, and it caused her to adjust her attitude slightly. Herwitz was better than Bernard. He seemed to care, and there was some merit to his argument.

  “I’m not assuming anything, doctor,” she said. “I just want us to be prepared for what Ben McCormick is going to make out of it if this was Dr. Bernard’s first biopsy. He’s going to argue that the procedure should not even have been performed here, that we should have sent Larry to a facility that does myocardial biopsies routinely. He’s going to tell the jury that we willfully put Larry’s life in jeopardy because of greed, because we try to hold on to every patient whether he or she belongs here or not. McCormick has used that type of argument before to get punitive damages.”

  Bernard exploded. “You see what I’m talking about? That’s why malpractice premiums are sky-high! That’s why we have to practice defensive medicine. You want to know why health care costs are out of control? It’s you goddamn lawyers!” He jabbed at Karen with the butt of his cigar. She could feel the bile pouring into her bloodstream.

  “You goddamn vultures,” Bernard continued, “will say anything. You cast the foulest aspersions you can think of, the worst possible accusations …”

  “Oh, no, Dr. Bernard,” interjected Karen, “that’s not the worst possible accusation. The worst possible accusation would be…”

  “It’s outrageous,” Dr Bernard continued. “Joe, the hospital better get in front of me on this or …”

  “The worst possible accusation would be that Larry’s death was not an accident,” Karen finished.

  Dr. Bernard stared straight ahead, his mouth agape. “She’s out of her mind. Grimes, your lawyer is a paranoid schizophrenic.”

  Joe clapped his hands together. “All right, enough already. We’re not here to debate the merits of the American legal system. We’re here to do a deal. Let’s get back to business.”

  “Yes, let’s,” concurred Dr. Herwitz.

  “Karen,
any problem getting the consulting contracts for the doctors prepared by Christmas?”

  Karen simmered. She dropped her chin and peered at Joe from under lowered, linear eyebrows. “I’ve got a pretty full plate right now. What’s the rush?”

  “There’s a big price increase in the works for the MRI equipment. If we don’t get the deal done soon, we’ll have to pay more. That will screw up the pro formas and business plan for the program, and we don’t have a replacement Chief Financial Officer yet who could redo them. So you can have until the end of the year, but no longer.”

  Sieg heil, mein Führer, Karen said to herself. “Will that be all?”

  “Not quite,” said Joe. “I’d also like you to do up a simple set of Articles of Incorporation and Corporate Bylaws for a new subsidiary of the hospital. Call it ‘Shoreview Millennium Corporation.’ Keep it simple, just a three-member Board of Directors. I’ll be on the initial board, along with Dr. Herwitz.”

  Karen examined the three men, their self-satisfied smiles restored. Dr. Bernard took a few puffs on his cigar. Dr. Herwitz ran his thumb and index finger along the crease in his pants. Joe tipped back in his swivel chair, clasped his hands behind his head, and propped his feet up on his desk, crossed at the ankles.

  “For the third director,” said Joe, “we should consider someone from outside the hospital.”

  Temptation overtook Karen. A sly smile appeared on her lips. “How about,” she suggested cheerfully, “Dean Williams from Jackson, DeSalle?”

  Joe lost his balance momentarily and struggled to sit up. Dr. Bernard started coughing on his cigar smoke. Dr. Herwitz stared at her.

  Enjoying their discomfiture, Karen couldn’t resist. “Did I read your minds? We paranoid schizophrenics have psychic powers!” Now they knew that at least part of their secret was out, but they would never be able to figure out how she knew.