SEATTLE– In a statement issued
today, Maynard Medical Center CEO Arthur Benson reported
a twenty fold decrease in medical errors since becoming a
beta test site for the highly-touted Med-InDx electronic
medical record (EMR). This makes it by far the safest West
Coast hospital according to JCAHO, the accrediting organization
for hospitals. “This is a remarkable improvement in
patient safety,” said Sergio Vericelli, chairman of
JCAHO committee charged with selecting a benchmark EMR within
the next year.
Vericelli added, “In November 1999, the Institute of
Medicine concluded a study entitled, To Err Is Human: Building
A Safer Health System. It focused attention on the issue
of medical errors and patient safety by reporting that as
many as 44,000 to 98,000 people die in hospitals each year
from preventable medical errors. This makes preventable medical
errors this country’s eighth leading cause of death—higher
than motor vehicle accidents, breast cancer, or AIDS. About
7,000 people per year are estimated to die from medication
errors alone.”
In support of its mission to improve
the quality of health care provided to the public, JCAHO
reviews a hospital’s response to sentinel events in
its accreditation process. A “sentinel event” is
an unexpected occurrence involving death or serious physical
or psychological injury. Such events are called "sentinel" because
they signal the need for immediate investigation and response.
AUGUST
“...the needle, sponge and cottonoid counts were correct.
The estimated blood loss was 350 ccs with no blood or blood product
replacement. This has been dictated by Tyler Mathews.”
Finished dictating his operative report,
neurosurgeon Tyler Mathews, returned the beige dictation telephone
to its cradle and leaned his weary body against the acoustical
tile wall of the small dictation booth. The sweat-dampened scrub
shirt chilled his back but he was too exhausted to move to a
more comfortable position. For an uncharacteristic moment he
savored the professional satisfaction and pride his work gave
him. The benign brain tumor, a meningioma, had been a particularly
nasty one involving a fifty–year-old woman’s nerves
for sight and eye movement. He’d spent the past six hours
peering through a surgical microscope, picking bit by bit at
the knobby, cream colored, grape-sized hunk of tough fibrous
tissue until every visible nubbin was removed. A total removal
was one thing. But the real trick—and the thing that made
this case so satisfying—was getting out of there with the
surrounding nerves functioning perfectly.
It was meticulous, demanding work. He loved
the challenge.
With a deep breath he palm-wiped his face.
Ignoring the familiar fatigue created by
six hours of continuous mental exertion, he pushed off the bar-height
stool and headed for the recovery room to once again check his
patient’s progress recovering from anesthesia.
“Doctor Mathews, there’s a man
wants to see you.” Matilda, the ever-smiling unit clerk
nodded towards the automatic doors leading to the rest of the
hospital. The man appeared to be close to Tyler’s 38 years
and perhaps two inches shorter, maybe 5’9”. He wore
a summer weight dark gray suit, white shirt and abstract black
and white tie.
Tyler thought, FBI, without knowing exactly
why.
“What does he want?” By now the
man was approaching with a self-assured strut Tyler recognized
as characteristic of law enforcement or military types.
“Doctor Mathews?”
“Yes?” The questioning stares
of nurses and anesthesiologists tingled Tyler’s back, their
interest already sharpened by a stranger in street clothes in
a restricted area.
The stranger glanced around. “Not here.
Let’s move this out into the hall.” His tone carried
an irritating edge of authority.
Tyler didn’t move. “Not until
you tell me what this is about. I’m wrapping up a case.
Who are you?”
The man pointedly surveyed the room again. “I
think it’s better we continue this discussion in the hall.”
Tyler told the clerk, “I’ll be
back in a minute,” as his gut tightened into a square knot.
Out in the hall the automatic doors slid
shut at their backs. The man studied Tyler a moment before his
hand appeared holding a wallet. “Agent Dillon, DEA.” The
wallet dropped open exposing official looking identification.
The square knot in Tyler’s gut began
to send sharp stabbing pains up through his diaphragm. “Yes?” He’d
wondered about reprisals from his chairman and how they might
come. Was this the beginning?
“Mind if I have a look-see in your
locker?”
Tyler’s heart started galloping. “Why
would you want to look in my locker?”
Legs spread in military at ease, Agent Dillon
hooked both thumbs over his belt, throwing open his suit coat
just enough to flash a shoulder holstered firearm. “And
why would this be a problem, Doctor?”
Tyler spread his legs too, folded both arms
across his chest. “The problem’s your attitude. It
sucks. I want to know what you’re looking for and why.”
Dillon laughed. “Hey, not my problem.
And I will look in your locker... One way or another.”
Tyler shook his head. “There’s
nothing in my locker that would interest the DEA. Period.”
“Hey, have it your way. But, we can
do this one or of two ways. Either you open it for me, or I’ll
have security do it.” As he spoke, his right hand replaced
the ID wallet with a folded paper from his inside breast pocket. “This
is a signed order to search your locker.” A shrug. “Your
call, Doc.”
Seeing no other option, Tyler marched towards
the dressing room, anger constricting his chest. “What’s
the deal, you guys don’t have enough to do in The War On
Drugs? You have to get your jollies now by bullying doctors?”
As they rounded the corner to the narrow
passageway between rows of identical gray metal lockers he came
face to face with two security guards, one leaning against his
locker, the other one blocking the aisle, telling a joke. Their
conversation stopped abruptly when Tyler appeared.
Tyler turned to Agent Dillon. “What
are they here for?”
Dillon flashed irritation. “Just open
the fucking locker.”
Tyler glanced at the guard leaning against
his door. “Mind?” The guard moved away with an embarrassed
grin.
Tyler’s mind started racing as he reached
for the combination lock. What if someone placed something in
there? How long ago had he opened the locker to change into scrub
clothes? He checked his watch. Six hours. A long time. Long enough
for anything to have happened.
“Well? You going to open it?”
Tyler spun the dial and missed the third
number. He started over and missed again. By the third time his
fingers, trembling from anger, hit the combination and the lock
dropped open. He stood aside. “Go ahead, knock yourself
out,” and drilled the closest security guard a questioning
look. The guard glanced away.
Agent Dillon snapped on a latex glove, stepped
up, opened the door and stood there a moment before reaching
up to the single shelf above Tyler’s hanging clothes. “My
oh my, what have we here?”
“What the hell—” Tyler
reached out but the DEA agent slapped his hand away.
“Don’t touch a thing.” Dillon
pulled down a vial from the shelf. The label read Morphine Sulfate.
He turned to one of the security guards. “Open one of those
plastic bags for me, will you. And neither one of you two is
touch anything before I drop it in a bag. Understood?”
OCTOBER
Attorney, Mary McGuire’s richly appointed office occupied
the southwest corner of the fifteenth floor, and commanded a
magnificent view of San Francisco's industrial district. The
morning sky was so dark with late October fog and drizzle that
cars snaking along the streets below had headlights on at nine
o'clock in the morning. It would rain soon. Tyler was sure of
this.
“You have a choice. You can accept
their offer, which by the way, I think is extremely generous
under the circumstances, or you can take your chances in court.
I shouldn't have to reiterate the consequences should you lose
the case, but just for the record, I will. In this state, as
is the case in most states, a felony conviction would mean loss
of your professional license. Bottom line, you lose the case
and you will never practice medicine again. Ever.”
“Goddamit,” Tyler said, his frustration
and fury building. He continued to stare out the window, fists
shoved deeply into his pockets, shoulders hunched as if protecting
his body from the chilly, foggy, autumn gusts outside. “Say
we got to trial, what do you estimate my chances of winning?’
His lawyer sighed. They’d been over
this how many times this morning? “If you hadn’t
come up with a positive urine test, well, I would’ve said
pretty good. But, considering that particular bit of ammunition...”
“Goddamnit, just give me the odds.”
“They haven’t changed from the
last time we went over this,” she said testily. “My
guess, you have about a ninety percent chance of losing.”
Typical. He’d asked for his chances
of winning. She’d given his risk of losing. He grunted
sarcastically and continued staring at the street below.
“Just so I understand this completely...so
I have an informed consent...” His jaw muscles were aching
again, producing tight throbbing across his forehead. He paused
to work out the tenseness. “Tell me again exactly what
the deal is.” He glanced over his shoulder at her.
Peering back at him over the tops of her
half-height reading glasses, sending him her stern-faced lawyer
expression, she said, “First, you must complete a drug
rehab program here in San Francisco. One that is certified by
the California Medical Society’s impaired physician program.
Only after being fully discharged from such a program can you
practice again. Second, when you do practice again, it must be
outside the state of California.”
“This was the part that baffles me.
Can they really do that? Dictate which state I practice in?”
“Under the circumstances of this particular
deal they can, yes.”
“Final question. How long do I have
to consider this?” He turned to fully face her.
She reached up, took off her reading glasses,
her face deadly serious now. “What’s to consider?
It’s a no brainer, far as I see. But, to answer your question,
no time at all. They expect an answer from you today.”
He knew what he had to do. He thought of
Nancy, how he still had her in spite of losing everything else
that mattered in his life. He drew in a deep breath, and gave
his answer.
LATER THAT DAY
The moment Tyler opened the front door to their one-bedroom apartment,
a bolt of intuition warned of something wrong. He hesitated,
hand still on the doorknob, then shrugged it off as residual
paranoia from a very bad day.
He turned into the living room and saw Nancy
push up from the couch, fists clenched, cheeks streaked black
from mascara. Confused, Tyler stopped. Two pieces of luggage
stood neatly aligned to each other a few feet from the couch.
She moved to them.
His heart stumbled, a knot of fear encasing
it. “Something happen to your Mother?”
Fresh tears trickled down her cheeks. “No,
Tyler, she’s fine but I’m not. I’m moving out.
I’ve contacted a lawyer. I’m filing for divorce.”
He placed a hand on the wall for support
as his legs weakened. “I—”
She shook her head. “It’s not
debatable, Tyler. I’ve made up my mind.”
“Not debatable? Who said anything about
a debate?” He found himself unable to think clearly.
“I know how you are, that’s all.
I just don’t want to discuss this.”
“Jesus, I come home from a very bad
day and you tell me we can’t even discuss this... that
you’re leaving me? Why?” He pointed at the suitcases. “Christ,
we’ve always been able to talk things out...that’s
been one of the really special things about our relationship...being
able to communicate.”
“Well, not this time, Tyler. I just
don’t want to be pressured out of my decision.”
He straightened his legs back up. “As
I remember, the vows went something like, ‘for better or
worse.’ Were we both on the same page that day?”
Before she could react, he held up a hand. “Hold
it. I take that back. Let me start over again.” He inhaled
deeply. “Isn’t there something we can do to work
this out? I mean, why are you doing this?”
“It’s the drug thing, Tyler.
I just can’t handle it. I believed in you. I really did.
I was willing to stand by you if it went to a trial because I
believe that innocent people win.”
“But I am innocent. I’ve been
framed.”
“Then what are these?” She held
up an amber prescription bottle.
“I have no idea. Here, let me see.”
She handed it to him. “I know what
they are, Tyler. They’re oxycontin.”
“But—”
“I found them in the back of your nightstand.
I...I just can’t deal with the fact that you lied to me.” New
tears began flowing down her cheeks making glistening new trails. “I’m
not going to live with a drug addict.”
She grabbed the bags and walked to the door. “Don’t
try to contact me. My lawyer will contact you.”
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