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  “Hello, Karen, this is Carl.” It was her former boyfriend, the Johns Hopkins cardiologist to whom she had sent the records of Larry’s biopsy. “I guess it’s an hour earlier out there. Anyway, I received the records and the angiogram from the Conkel biopsy and thought I’d better give you a verbal opinion before I put anything in writing. In my view, this patient’s care was grossly mismanaged by both physicians. For a myocardial biopsy, the cardiologist should have inserted the catheter in the femoral vein. The fact that he used the jugular vein tells me he isn’t familiar with the procedure. Probably never did one before. It also means he probably used the wrong type of catheter. Given his obvious unfamiliarity with the procedure, I’m not surprised he damaged the catheter. After the catheter broke, the surgeon erred in putting the patient on heart-lung bypass. A patient with advanced cardiomyopathy cannot be weaned off of bypass. In my opinion, it would have been far better simply to wait and see. Plastic is inert. Depending on where the remnants of the catheter lodged, he may have had a chance of survival. Probably not, but when he was put on bypass, he was doomed. It’s hard for me to believe the surgeon didn’t know this. Maybe he had bad information from the cardiologist. Anyway, let me know if you want this in writing. Give Jake my regards. Good-bye.”

  “If you would like to hear the message again, press 2. To hear the next message, press 3.”

  “Hi. Annie here. Since Saturday afternoon I’ve talked to every tech and nurse who have anything to do with the cath lab, and nobody admits to having resterilized any catheters since we instituted the policy against it two years ago. Nobody. And nobody is aware of anybody else doing it, either. So I don’t know where to go with that one. Found out one interesting thing, though. One of the cath lab nurses told me that when they did Larry last week, she noticed that there was only one catheter left on the cart. Normally the cath lab cart would be stocked with several. She said it was odd. Who knows if it means anything. If you want me to do anything else on this, give me a call.”

  “If you would like to hear the message again …” Karen pressed 3 to hear the next message.

  “Hello, Mrs. Hayes. My name is Lou Chambers. I’m an attorney representing Dietrich Heiden. He’s the young man who was assaulted in your hospital last Thursday. I’m going to… What? Shaddup, can’t ya see I’m on the phone here? Sorry. I’m going to fax over a consent for release of the medical record. I also want copies of all the incident reports you got. I can subpeenee if necessary. My address is on the fax.”

  “If you would like to hear the message …” Karen pressed 4 to erase, then 3, then 2.

  “Good morning. I’m Harold Wilson, an account executive with Midwestern Mutual Life Insurance …” 4 to erase, 3, 2.

  “Mrs. Hayes, this is Maureen, Larry Conkel’s secretary. I thought I should tell somebody, I wasn’t sure who, I thought maybe Max Schumacher in Security. But you do all the stuff with confidentiality of records and stuff, so I called you. When I got to work this morning, Dr. Herwitz was in Larry’s office, going through Larry’s files.” Karen sat up abruptly. She had just heard from Carl Gellhorn that Dr. Herwitz, the president of the Jefferson Clinic, may have committed an inexcusable and inexplicable error when he put Larry Conkel on heart-lung bypass, an error that had doomed him. Now Herwitz was shuffling through papers in Larry’s office, where Larry kept the record of his investigation into the billing fraud at the Jefferson Clinic. She couldn’t think of an innocent reason for Herwitz to be rummaging around in Larry’s office.

  “There’s boxes and boxes of stuff in there,” Larry’s secretary continued. “I didn’t see how Dr. Herwitz could find whatever he was looking for, so I asked if I could help him find something and he said, ‘No, thank you.’ I asked if it was okay for him to be looking at Larry’s papers and he said it was. I just thought somebody should know. I hope I didn’t do anything wrong. Bye.”

  Karen pressed the reset button and punched the phone number for the head of hospital security, Max Schumacher.

  “Security. Schumacher.”

  “Max, this is Karen Hayes. What kind of authorization would you need to put a lock on Larry Conkel’s office? I think it’s best to secure his office until his family can collect his personal property. He has some valuable things in there.”

  “Yeah, that mug collection. I’ve seen it. Any executive could authorize that. Or Grimes.”

  “Put the lock on immediately. I’ll sign whatever you need.”

  Karen’s vague suspicions about Larry’s death were growing stronger. Could Larry’s death be connected to his fraud investigation?

  Karen got out the report of the tests done on the catheter by Jefferson Engineering. She read again that sentence with the disturbing implication:

  OUR CONCLUSION IS THAT THE SAMPLE MATERIAL HAS BEEN SUBJECTED TO HIGH TEMPERATURES RESULTING IN A BREAKDOWN OF POLYMERS.

  She called the telephone number on the letterhead and asked for Gilbert Austin.

  “My conclusions are quite definite, Mrs. Hayes.”

  “I mean, Mr. Austin, could the breakdown have been caused by somebody leaving the catheter near a radiator or in direct sunlight? Would it have to be from sterilization?”

  “I see. Now that you mention it, I guess the report wasn’t specific on that point. No, this wasn’t just left in the sun, Mrs. Hayes. The type of changes that the spectroscopy and calorimetry showed, with that type of material, could only have resulted from extremely high temperatures, for a long duration.”

  “As would be used in sterilization?” Karen asked.

  “Actually, much more extreme than would be necessary for sterilization. The catheter was really cooked.”

  Karen felt a chill. This was why the Jefferson Engineering report had given her the creeps. It was telling her in so many words that someone had intentionally damaged the catheter.

  “Do you need any further tests performed, Mrs. Hayes?”

  “I’ll let you know. Thank you, Mr. Austin.”

  Her consternation and curiosity having moved up several notches, Karen dialed Anne Delaney’s extension. The two women swapped stories about Larry’s funeral, including Karen’s exchange with Lisa Fuller, Paula Conkel’s nurse friend.

  “Annie, did you know Larry kept a separate apartment?”

  “Yeah, I did. In fact, I know where it is. It’s in that old brick apartment building right across the street from the hospital, called the Traymont. You can see it from your window. Wanted to save the commute, I guess.”

  Karen walked to the window and looked at the building Anne had described. It was four stories, flat-roofed, somewhat dilapidated. “Was Larry really having an affair? He never told me about it.”

  “Me neither, I have no idea,” Anne professed.

  “Annie, I need something else on this. I’d like you to find out who had access to the cath lab cart from the last time it was stocked before Larry’s biopsy until they set up for his procedure on Monday morning. I need to know where the cart was kept, how it was secured, and who got near it. I mean anybody and everybody.”

  “I’ll get right on it. But, Karen, if any hospital employee resterilized the catheter, we’ve blown the warranty and the hospital is on the hook. How does this help?”

  “I’m not sure it does,” Karen said. “I’m not sure it does.”

  Karen was not ready to tell Anne what she was just barely able to admit to herself: with what she had learned that morning, she was now investigating a possible murder.

  CHAPTER

  11

  Early Monday afternoon Karen was at her computer terminal composing a memorandum to Joe Grimes, when a man in a dirty trench coat appeared at the door of her office with a Summons and Complaint from the offices of Benjamin H. McCormick. It was Paula Conkel’s wrongful death lawsuit. “Sign the back of the copy, ma’am,” the process server instructed Karen.

  “Do an affidavit of service,” replied Karen. “I’m not signing anything.”

  She continued to work until 3:00 P.M. on the memor
andum to Grimes. Given the gravity of her suspicions, she needed to at least alert the hospital’s Chief Executive Officer. In the memo, she reported the lab test results on the catheter and Anne’s statement that no one admitted to resterilizing the catheter. She asserted that “serious consideration should be given to involving law enforcement authorities in the investigation of this matter, in light of the complex and suspicious circumstances.” She sent the memorandum by electronic mail, through the hospital’s computer system.

  After sending the memorandum to Grimes, Karen tried to restore her sense of normalcy by working on some routine matters. She drafted a patient consent form for transfer of a patient with a spinal cord injury to a hospital in Chicago, after confirming with the discharge planner that Shoreview Memorial was not illegally dumping the patient because he had poor insurance. She said a silent prayer that the patient would not be jostled during the helicopter flight to Chicago and end up a paraplegic, recognizing that was all she could do about that potential risk.

  Next, Karen reviewed a memo from the Director of Medical Records. The father of an eight-year-old girl, who had been a patient in the hospital’s psychiatric unit when she was six, had requested a copy of his daughter’s medical record. At the time of her therapy, the girl’s parents were separated and she was living with her mother. During treatment, the girl had described in some detail how her father had sexually abused her when her parents still lived together. The state had never prosecuted the father, due to an absence of evidence corroborating the girl’s description and the wishes of the girl’s mother and psychiatrist that the girl not be subjected to testifying against her father in a criminal proceeding. The mother, who was Roman Catholic, never sought a divorce. Two years after the girl was discharged from the hospital, the father obtained a legal separation from his wife and joint custody of the child. Now he wanted to see what his daughter had told the psychiatrist about him. The psychiatrist said it would be a “calamity” for the child if the father were to be given the record. State law said a parent had a legal right to receive a copy of his child’s medical record. Karen dictated a response to the Director of Medical Records: “No dice. If he wants the record, he can take us to court.”

  After forty-five minutes of such “normal” work, Karen returned to reviewing Larry Conkel’s secret fraud investigation files. In the file numbered “2,” she found a parenthetical reference that piqued her curiosity. Amid the records of clinic patients for whom services had been billed but not actually rendered was the hand-printed statement: “J.C. FRAUD. BILLED PATS.— HOSP. BILLING CONSP.—SEE FILE 3.” Karen had already determined that “J.C.” meant the Jefferson Clinic, and “FRAUD. BILLED PATS.” meant fraudulently billed patient accounts. She supposed that “HOSE BILLING CONSP.” referred to a billing fraud conspiracy involving hospital charges.

  But this supposition created a serious dilemma. She had assumed that she would eventually turn Larry’s files over to the federal agency charged with enforcing the laws against fraudulent Medicare billing, the Office of the Inspector General. But now she needed to find out what was in the missing file, file number 3. Did it contain evidence that the hospital was involved in a billing fraud conspiracy with Jefferson Clinic? If it did, she would be ethically bound as the attorney for the hospital to maintain the confidentiality of the information and protect the hospital. It would be irresponsible, a violation of her ethical duty, as well as a catastrophic career move, for her to charge ahead and to turn files over to the feds that might be damaging to the hospital. Especially when she had no idea what those files showed.

  On the other hand, if the file did not incriminate the hospital, Karen was free to obey the dictates of her conscience and report the crime. This was what she wanted to do. The Jefferson Clinic doctors who had bilked the system for millions while putting their patients through a lot of misery were monsters. Who would subject elderly people to unnecessary chemotherapy or cardiac catheterization just to inflate already huge incomes?

  To sit idly by, watching the perpetrators enjoy their ill-gotten gains, keeping patients in the dark about how they had been used by their doctors, infuriated her. Her impulse was to blow the whistle. But what if the files were damaging to the hospital? Karen needed the contents of file number 3 to extricate her from her quandary. She had two guesses as to the location of file number 3: Larry’s apartment at the Traymont and the locked room at his home.

  She called Jake to tell him she would be a little late, that she had an errand to run.

  The mailboxes in the lobby of the Traymont Apartments revealed that Larry Conkel had rented Unit 207. Karen’s footsteps echoed in the long, terrazzo-tiled hallway of the second floor, which was lit dimly by deco wall sconces. The building had a musty smell, suggesting a wet basement and deferred maintenance.

  Karen reached into her coat pocket and removed the steel key that she had found in the mug in Larry’s office. She started to raise it to the lock on the heavy wooden door to Unit 207, when she was stopped by a soft female voice emanating from inside the apartment. Quiet laughter, then a male voice, then more laughter. A TV sitcom. Someone was in Larry’s apartment, watching television. Someone was in Larry’s apartment, apparently making himself or herself right at home, so soon after Larry’s death. Karen immediately recalled Lisa Fuller’s comment at the funeral that Larry was having a serious affair. She put her eye to the concave glass peephole. A faint, fuzzy glow flickered from within. She replaced the key in her pocket and rapped, unassertively, on the door. The sitcom was muted. The flickering glow at the peephole vanished, but the door remained closed and no one spoke. An eye had arrived on the other side of the peephole, and someone was looking out at her silently. She walked briskly away, keeping to the same side of the hall as Larry’s apartment to avoid being watched through the peephole.

  Karen got into her car and headed for the other likely location of file number 3, the Conkels’ house, about a twenty-minute drive. Paula might be home and refuse to allow her in the house; the house might be empty; or one or both of the children might be home while their mother was out. If Paula was home and let Karen in, Ben McCormick would have a fit, even though Karen had no intention of discussing the Conkels’ claim against the hospital. She was merely attempting to recover a missing file on an unrelated matter. Could anybody connect the file missing from Larry’s office with the Conkels’ claim against the hospital? More to the point, could anybody prove that Karen suspected a connection?

  When Karen’s car was about one hundred and fifty feet from the Conkels’ house, she hit the brakes hard enough to make the tires squeal. Here was a possibility that she had not considered: in the Conkel driveway was a black BMW convertible. Karen pulled forward slowly, and read the car’s vanity license plate: “MEM CEO.”

  “The private inurement mobile!” Karen said, out loud. “What the hell is Grimes doing here?”

  Karen stopped fifty feet past the Conkels’ driveway and turned off the engine. The Conkels’ house was decorated for the season with icicle lights along the gutters and a garish plastic wreath on the front door. As she watched the front door of the house in her outside wing mirror, the interior of her car got colder until she could see her breath and her fingers started to ache. Eventually, two bright floodlights illuminated the driveway, and the door opened.

  Joe Grimes backed out through the door. Joe was hatless, wearing his Burberry coat. Paula was wearing a red knit dress, oddly formal for a weekday evening at home. Joe held the aluminum storm door open with his left hand, while briefly holding one of Paula’s hands with his right. Karen couldn’t see around Joe’s broad back to tell whether he held Paula’s right hand, as in a businesslike handshake, or her left, which would have suggested something more intimate. Paula was smiling. Not just smiling. Beaming. Joe closed the storm door, waved, and walked to his car. Karen slumped down in her seat. She heard the sound of Joe’s engine, then slumped lower as his headlights lit up the interior of her car. When Joe’s car was a block away, K
aren sat up. She grabbed her cellular telephone and dialed her home number.

  “Y-y-yello.”

  “Jake, it’s me,” whispered Karen.

  “Why are you whispering?” asked Jake.

  “I don’t know,” said Karen in her normal voice. “Jake, I’m going to be home later than expected. Hold dinner.”

  “Sacré bleu,” said Jake, “ze soufflé will be ruined.”

  “What are we really having?”

  “Soy burgers and canned vegetarian beans. Where are you? Sounds like the car phone.”

  “I’m in front of the Conkels’ house. I drove over to look for a file missing from Larry’s fraud investigation. When I got here, guess who I found visiting Paula?”

  “Uh, the Chicago Bulls?” guessed Jake.

  “No. Joe Grimes.”

  “Velly intelesting. He and Paula having a little assignation? A little tête-à-tête?”

  “I don’t know,” said Karen, “but Jake, today I talked to the guy who tested the catheter that broke up in Larry. And I got an independent opinion on the performance of the docs. And Annie talked to the cath lab personnel. In a nutshell, it doesn’t look like Larry’s death was the result of negligence.”

  “Well,” said Jake, “it wasn’t the result of old age. You’re saying Larry was murdered?”

  “I’m trying to avoid saying it. I sent Grimes a memo this afternoon saying I think we need to bring in the police. Then I find a reference to a file that might implicate the hospital in the clinic billing fraud. Now I see Grimes huddling with Paula Conkel. I don’t want him to get that memo.”

  “I dig,” said Jake. “The hospital may be in bed with the clinic, and the hospital’s CEO may be in bed with the victim’s wife. If Grimes was involved in murdering Larry, telling him you’re going to the cops could be hazardous to your health. You’re going to get the memo you sent him back before he reads it.”