Cell (11 page)

AMALGAMATED HEALTHCARE HEADQUARTERS

CENTURY CITY, LOS ANGELES, CALIFORNIA

TUESDAY, JULY 1, 2014, 12:11
P.M.

B
radley Thorn's office was on the top floor of the tallest building in Century City. It was both extravagant and massive. His ego demanded it, as did his sense of inferiority, instilled in him at a young age by a domineering, sadistic father. Bradley heard “the hospital must have switched babies” routine too many times to count. It was mean and abusive on his father's part. But then his father's personality had enabled him to rise to the top of the health care game. The father had been ruthless, developing a computerized method of paying doctors as little as possible and delaying the payment for as long as possible, which had amassed him a fortune and ultimately the leadership of Amalgamated Healthcare.

Bradley inherited control of the company just two short years earlier, after the senior Thorn suffered a massive stroke. It was a tragedy for the previously robust Robert Thorn. For his son, it had been a godsend.

Bradley was physically fit and in excellent health. He was confident women found him attractive, although he was never sure if that was enhanced by thoughts of his money or not.

At the moment, Thorn was meeting with Marvin Neumann, a celebrated hedge fund genius who was thinking of putting some $500 million into Amalgamated to take iDoc international. His money would also help with the acquisition of more hospitals. Thorn had told him that's where the big profits were, especially since Amalgamated would be paying itself for hospital services.

Neumann in turn told Thorn he had some demands to go with his money. He wanted a seat on the board of either Amalgamated or iDoc. Which one, he hadn't decided. Neumann also cited medicine's tendency to overemphasize the good and ignore the bad in their testing results. He wanted to be absolutely certain that iDoc's beta test had been as well received as Thorn had reported at the presentation.

“Absolutely!” Thorn protested. “If anything, we have been conservative in our appraisal. Please be assured that I'm not about to risk my reputation or the company's for a short-term gain.”

“That's comforting to hear,” Neumann said. What he didn't say, though he was pretty sure of it, was that Thorn would likely risk everything to be regarded as a hero. The guy was both pretentious and insecure, and everyone knew the stories of him and his father. But family and personal failings aside, the hedge fund guru felt Thorn had stumbled upon something big, and he wanted a piece of it. He just needed to have a position to be able to watch the company's progress and steer it away from trouble if need be. Health care in the United States was a notoriously politicized arena. That's why he would eventually insist upon seats on both boards. But in these preliminary negotiations he would suggest that one would suffice. He'd demand both board seats when Thorn was about to lay hands on the cash. It was a ploy Neumann had used to great effect in the past.

“The beta test has been a fantastic success far exceeding our most optimistic predictions,” Thorn bragged. “As we said, the patients love it and it is going to truly solve the primary-care shortage worldwide. And lower costs. What more can you ask?” Thorn jabbed his finger at Neumann, “And iDoc is going to revolutionize addiction treatment. Whatever the addiction, iDoc will offer immediate, real-time feedback when a client-patient indulges—”

“Okay, okay, I get it,” Neumann interrupted. He didn't need to hear a repeat of what had been said at the presentation.

“Well, I'll get back to you about a board seat,” Thorn said. “It'll have to be brought up with the current board.”

“Of course,” Neumann said, standing.

“Thanks for coming in.” Thorn stood as well and shook hands with Neumann, escorting him out of his office.

Neumann paused at the office door. “Say hello to your father for me. We used to play tennis on occasion on our Sun Valley trips. I hope he's doing well.”

“I will. I will,” Thorn replied with a smile plastered on his face.

As Thorn waved his good-bye to Neumann he glimpsed Langley stretched out in a club chair in the anteroom, leafing through a magazine. Thorn shot a glance at his secretary.

She gave him a shrug, mouthing the words: “He just showed up.”

Irritated, Thorn beckoned Langley into his office. Thorn had a built-in distaste for creative types like Langley.

Thorn pointed to a chair and walked around behind his desk.

Once seated, Langley cleared his throat. “We've investigated this supposed glitch that I told you about yesterday. At first I thought it was a regression of the bug we'd seen during the first few weeks of the beta test. But it's not. Nor is it actually a glitch in a literal sense, even though we can call it that. The application just made determinations from a different set of criteria and learning points than we would have suspected.”

Thorn was irritated. It seemed to him that Langley was deliberately trying to confuse him. “I'm not following you. What the hell do you mean by a ‘literal sense'?”

“The algorithm is weighting variables differently from how we thought it would. That's the core of the problem, if it is a problem.”

Thorn threw up his hands, exasperated. “You know the key to running a large business like Amalgamated? You delegate. You hire good people and get out of their way. Now you want to drag me into the weeds? Have you considered the fact that if I am consumed with the details of your job, it might hinder my ability to act effectively for the company as a whole? My fund-raising is essential to securing future contracts for Amalgamated. Are you following me?”

“This is not a routine programming problem. And it is spreading.”

“What do you mean ‘spreading'?”

“Exactly what the word means. It started at Santa Monica University Hospital but now has appeared at Harbor University and even at the L.A. University Medical Center.”

“Shit!” Thorn exclaimed, running a hand nervously through his hair. “What kind of numbers are we talking about?”

“Not many yet. Besides the two cases at Santa Monica University Hospital, there have been two cases at Harbor University Hospital and two at L.A. University Medical Center.”

“Have these all occurred since we spoke yesterday?”

“Not the ones at Santa Monica, but the other four, yes.”

“And they all resulted in death?”

“Unfortunately, yes!”

“Are we going to see a surge in this problem or is this going to remain an isolated phenomenon?”

“I can't say for certain; I can only guess.”

“Okay, guess!”

“I don't think we will see a surge. But nor do I think the issue is going to go away. In fact I am sure it is not.”

“All right, you win. I need you to explain to me what is going on, but not in your usual tech-speak.”

Langley leaned forward. “These deaths are a direct outgrowth of the heuristic nature of the algorithm—”

Thorn put his hand up. “What do you mean by ‘heuristic'? You've bantered this term around without really explaining it to me.”

“As I said yesterday and have told you before, the application is capable of learning. We have all seen that iDoc learns. It progressively makes its own decisions, decisions that were not programmed into it per se, but that are based on past outcomes.”

“That means the iDoc algorithm is getting better because of its heuristic nature. Isn't that what you are saying?”

“Exactly. It is learning and getting better faster than we predicted.”

“But still there have been these six deaths.”

“Correct. But remember the algorithm is not aware that it's doing anything
unwanted
. In fact, it is doing what it thinks is best for everyone, the victims included.”

“So how many deaths do you think there will be?”

“As I said, there is not going to be an avalanche. Right now we are seeing an incidence of just over three hundredths of one percent. I don't see it ever going over four hundredths. And as I said, the Independent Payment Advisory Board set up to control costs for Medicare and Medicaid is intrigued by what is happening and is looking more favorably on iDoc as a result.”

“How did they learn about this glitch?”

“As part of their due diligence in evaluating iDoc for Medicare and Medicaid beneficiaries, we allowed them access to our servers. They became aware of the deaths at the same time as we did. They are intrigued.”

“So they don't want us to stop the glitch.”

“Their only concern, and a big one, is that it remain undiscoverable, for obvious reasons. If the media were to get hold of the story, it would be an unmitigated disaster.”

Thorn nodded that he couldn't agree more. “Okay! All this is highly classified; no one gets wind of it. Make a few inquiries; see what ripples resulted from it so far. You said there were a couple of cases at University Medical. Clayton's over there, have him sniff around to make sure no one is suspicious. Tell him I asked for his services specifically. But do not give him the details, just the basics. Again, how many are in the loop as of now?”

“At Amalgamated? The same as before: three. Me, you, and my IT head, Bob Franklin. And Franklin's a team player, so no worries there.”

“Okay. Besides Clayton, no one else here at Amalgamated should know about this. No one! What about at IPAB?”

“I don't know for sure. Two, maybe three folks. They're a secretive bunch and don't share much because they are not politicos, but rather power brokers who have been appointed without having had to go through congressional confirmation hearings. Their task is to reduce the deficit by reducing Medicare and Medicaid spending. It's all about power. And power is knowledge that no one else has.”

“Well said. At least there is no worry there. And I assume there should be no trouble at the medical examiner's office.”

“Right! No problem there, considering the medical histories of the cases.”

“Good. Thank the Lord for small favors.”

Langley stood up. “All right! I'll get in touch with Clayton and have him make sure there are no problems over at L.A. University. As the premier academic institution in the area, if there is no problem there, it should be smooth sailing elsewhere.”

“I agree. Later, come back here. I want a more complete explanation of what is happening. I presume you know, since the algorithm is your baby.”

“No problem. It will be my pleasure!”

EMERGENCY DEPARTMENT

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

TUESDAY, JULY 1, 2014, 12:58
P.M.

G
eorge was still upset about Sal's horrific death and was glad he didn't have a noon radiology conference to sit through, as it had been canceled for the first day of the new academic year. Such conferences always required a certain amount of socializing, which at the moment George didn't think himself capable of. Passing the time in the ER's isolated radiology viewing room was much less demanding and considerably less stressful.

As he sat staring into the middle distance, he wondered what on earth could have gotten into Sal to make him act so bizarrely. Sal had been a pretty calm individual. Could it have been the Alzheimer's?

While George stayed hidden in the viewing room, he let Carlos do the running around that went with the territory of being a radiology resident assigned to the ER. George was happy to remain secluded, because the ER was still as chaotic as he had ever seen it, with construction workers cleaning up the debris and seeing to the broken windows despite the usual onslaught of patients. Some of the ER's exam rooms could still be used, but the ones close to ground zero were out of commission, so the ER had temporarily taken over a portion of the nearby outpatient clinic building. The trauma rooms had not been damaged, and were still in use. But it wasn't easy. With all of the construction people around, it was difficult to get the major trauma patients out of the arriving ambulances and into the proper rooms. Nevertheless, to her credit, Debbie Waters was making it happen.

Some time later Carlos breezed into the room, saying, “There's a bunch of images that have to be read.” He dropped into the chair next to George and booted up the monitor.

“How is the ER shaping up?” George asked.

“They got rid of the wrecked car already. Most of the debris, too. And they have covered the broken windows with plywood. The scuttlebutt in the media is that the driver of the vehicle was trying to commit suicide.”

George looked at Carlos, shocked.

“They're just speculating,” Carlos said, catching George's expression. “You know the tabloids. Gotta juice everything up.”

George shook his head.

“One of the ER residents told me that they suspected some of the driver's abdominal wounds looked self-inflicted,” Carlos added as he entered the first patient's hospital number into the computer. “They found a utility knife in the car with blood on it. Can you imagine? The guy must have been nuts.”

George shook his head again. He had trouble believing Sal would do such a thing. And how could they tell what was self-inflicted and what wasn't, considering that Sal's body had gone through the windshield before smashing into the LED screen? Suddenly George asked, “How do they know the blood didn't get on the knife as a result of the crash, considering all the gore. The victim had exsanguinated. Blood was over everything.”

“No clue.” Carlos shrugged as he pulled up the first image.

George didn't like the thought of Sal being remembered as a crazy weirdo on a suicide mission, possibly trying to take innocent people to their graves with him. George decided to check things out for himself once he finished up with Carlos.

•   •   •

A
n hour later George emerged from the peacefulness of the reading room. He was impressed that the ER was pretty much back to normal except for all the plywood and the large hole in what had been the wall-size LED screen. After asking around a little with the orderlies he learned that Sal's body had been sent down to the hospital morgue. With all the questions he had, he decided to pay a visit. It was a place he had never before had the occasion or the inclination to visit.

George rode an elevator down to the sub-basement. The doors opened onto a desolate hallway. It was eerily quiet in contrast to the rest of the hospital. Lines on the concrete floor of various colors gave directions to different destinations: power plant, refuse, recycling, storage for this or that. George followed the black line leading to the morgue. After a couple of twists and turns he found the place. But no one was home. An empty desk sat in the anteroom, where George expected to find one of the attendants.

Opening an inner door, George wandered in to look for someone. It was a lonely place, looking more like a set for a horror movie than a modern medical center. The place smelled weird, too. And quiet. He promised himself he would view Sal's body as quickly as possible, then get the hell out.

The surroundings also reminded him of Pia's visit to the morgue back at Columbia Medical School when she was intent on investigating the death of her research mentor. That had been a very unpleasant experience that had almost gotten him kicked out of medical school.

Suddenly a diminutive man dressed in a long, soiled white coat stepped out of a refrigerated room. Both were startled at their near collision. The man took a step back and momentarily raised his arms as if to defend himself. Apparently he didn't encounter too many live people.

“Can I help you?” The guy's tone wasn't all that friendly, either.

“I'm looking for a body. The deceased's name is Salvatore DeAngelis.”

“You family?” The guy still sounded annoyed. George thought the diener would have been happy to see a living human being.

“No. I'm—we were friends. Neighbors, actually.”

“Then you can't see him. We don't allow ‘friend' visits. Just family members and approved personnel with direct business—”

“I work at the medical center,” George said, pointing to his white coat and name tag. “I'm a radiology resident.”

The man was clearly not impressed. “I have strict orders. No unauthorized visitors view the deceased. HIPAA rules. You should know all this. With all the celebrities in town, we have to be very strict, especially since the debacles over Michael Jackson and Farrah Fawcett. People take photos and sell them to the tabloids.” He looked down at George's hands as if he might have a camera ready to start snapping away. “If I just let whoever in here to see any body they wanted—”

“I don't want to see any body,” George interrupted. He couldn't believe the guy. “Mr. DeAngelis was a close friend, and I'm a doctor on the staff.” George's voice rose more than he intended. He took a deep breath and spoke in a more even tone. “The patient was involved in the auto accident in the ER upstairs this afternoon. I'm sure you heard about it. Well, I was there when he crashed. I helped identify him.”

“Of course I heard of the crash.” He waved as if shooing away a fly. “And that is another reason not to let you see the body. It might be a medical examiner's case, being an accident and all.”

George threw his hands up in disgust. “Okay. Fine. I'm out of here.” It was a lost cause, and he didn't want to hear the guy babble anymore. “Thanks anyway,” he added sarcastically.

George made his way back to the elevator and punched the call button. “What a jackass,” he silently voiced. When the elevator arrived he boarded, irritably pressing the first-floor button.

Just as the doors were about to close, he noticed the doors of the elevator across the way opening. He got a fleeting glance at the passenger stepping off.

Was that Clayton?

George hit the
OPEN
button on his car just in time. The doors retracted back, and George leaned out. It was Clayton! And he was hurrying in the direction of the morgue. What the hell was Clayton doing?

Making a snap decision, George stepped out of the elevator and hurried after the radiology chair. Maybe he was going someplace other than the morgue. But what else was in the sub-basement that might interest him? George had no idea.

George hustled down the hallway and rounded a corner, briefly catching sight of Clayton farther ahead and immediately disappearing as the corridor turned again. He was definitely moving fast, George thought. Was he carrying a package of sterile gloves? That's what it had seemed like from the brief look George got before the elevator doors had closed.

George rounded the final corner in time to glimpse Clayton arrive at the morgue and enter.

George slowed down. His intuition was telling him to leave. But his curiosity propelled him forward.

He approached the morgue's double entry doors and peered through one of the small windows. George noticed that the diener seemed much more accommodating with Clayton. George watched him nod as Clayton spoke to him and then lead the way into the morgue proper while Clayton followed, donning his gloves.

What the hell?

George debated what to do. His intuition was still telling him to get the hell out before Clayton reappeared. This time George listened.