Critical (4 page)

"But Mom," Michelle whined. "All the girls have them."

"That's hard to believe. You and your friends are only ten years old and in the fifth grade. I'm sure many parents feel the same as I do."

"Dad said I could. You are so mean. Maybe I should go live with him."

Angela gritted her teeth and resisted the temptation to respond to her daughter's hurtful comment. Instead, she swiveled in her chair and glanced out the window of her corner office. Angels Healthcare was located on the twenty-second floor of the Trump Tower on Fifth Avenue. Her private office faced both south and west, with her desk oriented to the north. At the moment she was looking south, down the length of Fifth Avenue, chockablock with traffic. The receding red taillights appeared like a thousand radiant rubies. She knew her daughter was responding to her own anger about life with divorced parents and was trying to use Angela to get her way. Unfortunately, such hurtful comments about her ex-husband had worked several times in the past and had gotten Angela furious, but Angela was determined to try to keep it from happening. Especially under the strain she was, she had to keep herself calm for her upcoming meeting. Parenting and running a multimillion-dollar business were often at odds, and she had to keep them separate.

"Mom, are you still there?" Michelle questioned. She knew she'd crossed the line and already regretted her comment. There was no way she wanted to live with her father and all his crazy girlfriends.

"I'm still here," Angela said. She swung back around to face her sparsely furnished, modern office. "But I did not like your last comment one bit."

"But you are being unfair. I mean, you let me pierce my ears."

"Ears are one thing, but belly-button rings are something else entirely. But I don't want to talk about it anymore, at least at the moment. Have you had supper?"

"Yeah," Michelle said dejectedly. "Haydee made paella."

Thank God for Haydee,
Angela thought. Haydee Figueredo was a gracious Colombian woman Angela had hired as a live-in nanny right after Angela had separated from her husband, Michael Calabrese. Michelle was only three at the time, and Angela was six months away from finishing her internal medicine residency. Haydee had been like a gift from heaven.

"When are you coming home?" Michelle asked.

"Not for a couple of hours," Angela said. "I'm going into an important meeting."

"You always say that about meetings."

"Maybe I do, but this one is more important than most. Do you have homework?"

"Is the sky blue?" Michelle said superciliously.

Angela wasn't happy about the disrespect Michelle's comment and tone suggested, but she let it go.

"If you need any help with any of your subjects, I'll help you when I get home."

"I think I'll be asleep."

"Really! Why so early?"

"I have to get up early for the field trip to the Cloisters."

"Oh, yes, I forgot," Angela said with an exaggerated grimace. She hated to forget events that were important to her daughter. "If you are asleep when I get home, I'll sneak in, give you a kiss, and then I'll see you in the morning."

"Okay, Mom."

Despite the conversation's earlier tone, mother and daughter exchanged heartfelt endearments before disconnecting. For a few moments, Angela sat at her desk. But the phone conversation with her daughter had reminded her of a time and an episode that had been equally as challenging and distressing as the current situation. It had been when she had to deal with both divorce proceedings and the bankruptcy of her inner-city primary-care practice, and the fact that she had survived them gave her confidence in her current circumstance.

With slightly more optimism than she had had earlier that afternoon, Angela pushed back from her desk, picked up her notes, and emerged from her office. She was surprised to see her secretary, Loren Stasin, sitting dutifully at her desk. Angela had not given the woman a thought over the previous three hours.

"Why are you still here?" Angela questioned with a touch of guilt.

Loren shrugged her narrow shoulders. "I thought you might need me."

"Heavens, no. Go on home! I'll see you in the morning."

"Do I need to remind you of your meeting tomorrow morning at the Manhattan Bank and Trust, followed by your meeting with Mr. Calabrese at his office?"

"Hardly," Angela said. "But thank you anyway. Now, you get out of here!"

"Thank you, Dr. Dawson," Loren said while surreptitiously putting away a novel.

Angela continued down the stark interior hallway. For a multitude of reasons, she wasn't looking forward to tomorrow's meetings. She always found it somewhat demeaning to try to raise money, and now, in such a desperate situation, it would be that much more humiliating. Even worse was that one of the people she would be asking for money was her ex-husband. Whenever she met with him, regardless of the reason, it almost never failed to evoke all the emotional turmoil of the divorce, not to mention the vexation she felt toward herself for having married him in the first place. She should have known better. There had been too many subtle suggestions that he would turn out like her father, challenged by her success to the point of encouraging bad behavior.

At the closed door to the boardroom, Angela paused, took a fortifying breath, then entered. Similar to her private office, the interior was aseptically modern, and dominated by a striking central table composed of a two-inch-thick piece of glass placed on the top of a white marble Ionic capital. The floor was white marble tile. Each of the side walls to the right and left had imbedded flat-screen television monitors for PowerPoint presentations. The far wall was glass, overlooking Fifth Avenue. The gilded and illuminated top of the landmark Crown Building immediately across the street filled the starkly modern room with a reflected warm glow.

The round table had been Angela's idea. Her management style emphasized teamwork rather than hierarchy, and the round table was more egalitarian than the usual boardroom fare. Although there were chairs for sixteen people, only six were occupied at the moment. The CFO was by himself at the opposite end, his back to the window. The three hospital presidents were to Angela's left. The COO was a few chairs away from the CFO, to Angela's right. The infection-control professional was next to the COO.

Purposefully, none of the department heads of Angels Healthcare, such as those from supply, laundry, engineering, housekeeping, public relations, personnel, laboratory services, and nursing, medical staff, or outside members of the board, were present. In fact, none had even been notified that the meeting was scheduled, much less invited.

Angela smiled cordially as she quickly glanced around at individual faces and acknowledged each person. The expressions were mildly apprehensive, except for CFO Bob Frampton, whose fleshy face had an ever-present sleep-deprived appearance, and for COO Carl Palanco, who looked to be in a state of continual surprise.

"Good evening, everyone," Angela said as she sat down. She again glanced around the room. "First, let me apologize for keeping you waiting. I know it is late and you are eager to get home to your families, so we will make this short. The good news is that we are still in business." Angela glanced at the three presidents, all of whom nodded in a restrained fashion. "The bad news is that our cash-flow problem has gone from concerning to critical. Of course, we felt the situation was critical a month ago, but it has gotten worse."

Angela gestured toward Bob Frampton, who shook his head slightly as if to wake himself. He leaned forward, putting his elbows on the table with his beefy hands together and fingers interlocked.

"We are rapidly approaching, if not violating, our eighty percent margin on our loans with the Manhattan Bank and Trust. We had to sell some bonds to make a payment to our cardiac stent provider. They were threatening to cut off our supply."

"Considering how tight finances are, I want to personally thank you for doing that," Dr. Niesha Patrick said. She was a young African-American woman with light skin and a scattering of freckles in a butterfly pattern across her nose and cheeks. Like Angela, she had an MBA in addition to an M.D. Angela had recruited her from a large West Coast managed-care company to run Angels Heart Hospital. "With our ORs intermittently closed, our only dependable source of income has been from invasive angiography and cardioplasty. Without stents, even that revenue would be severely impacted."

"Invasive angiography and Lasik have probably been responsible for keeping us afloat," Angela said. She nodded in appreciation toward both Niesha and Dr. Stewart Sullivan. Stewart was the president of Angels Cosmetic Surgery and Eye Hospital.

"We are all doing what we can," Stewart said.

"As much of a gold mine specialty hospitals are in the current reimbursement milieu," Angela said, "they are at a particular disadvantage when their operating rooms close."

"But the operating rooms are now all open," Dr. Cynthia Sarpoulus said defensively. Cynthia was a medical-school classmate of Angela's who'd gone on to specialize in infectious disease and epidemiology. Angela had hired her when the current nosocomial infection problem started three and a half months previously. Cynthia was a dark-complected, raven-haired woman with a bit of a temper. Angela had been willing to put up with her thin-skinned and often caustic style because of her training, dedication, intelligence, and reputation. She'd been the reputed savior of several institutions with infection-control problems.

"They might be open, but they aren't being utilized except by a fraction of our medical staff," Dr. Herman Straus said. Angela had recruited Herman from a Boston community hospital, where he'd been a well-respected assistant administrator. A big, athletic man with an outgoing personality, he had a particular affinity for dealing with orthopedic surgeons. That quality combined with his Cornell Hospital administration training made him an ideal president of Angels Orthopedic Hospital, and his record was proof of it.

"And why is that?" Angela asked. "Surely they know we have been on top of this problem right from the beginning. Cynthia, remind everyone what has been done."

"Just about everything possible," Cynthia snapped, as if she was being challenged. "Every OR has been cleaned with sodium hypochlorite and fumigated at least once with a product called NAV-CO2. It's a nonflammable alcohol vapor in carbon dioxide."

"And not without considerable expense," Bob interjected.

"And why that particular agent?" Carl questioned.

"Because methicillin-resistant staphylococcus aureus, or its more common designation, MRSA, is highly sensitive to that particular preparation," Cynthia shot back, as if it were a fact everyone should know.

"Let's not get testy," Angela said. She wanted to keep the meeting friendly and, she hoped, productive. "We are all on the same page here. No one is casting aspersions. What else has been done?"

"Every hospital room that has seen an infection has also been similarly treated," Cynthia said. "More important, perhaps, as you all know, every member of the medical staff and every employee of the hospitals are cultured on a recurrent basis, and those who test positive as a carrier are treated with mupirocin until they test negative."

"Also at great expense," Bob added.

"Please, Bob," Angela said. "We are all aware of the expense side to this disaster. Cynthia, continue! Do you think culturing and treating the staff and employees is critical?"

"Absolutely," Cynthia said. "And we might consider the same for patients as a prelude to admission. Both Holland and Finland had a particularly bad problem with MRSA, and the way that they brought their problem under control was by treating both staff and patients: anyone who tested positive as a carrier. I'm beginning to wonder if we might have to do the same thing. Yet my real concern is that the MRSA is occurring at all three of our hospitals. What does that say? It says that if a carrier is responsible, then that carrier must routinely visit all three hospitals. Consequently, I have as of today ordered the testing and treating of all employees from even here at the home office who regularly visit all three hospitals, whether they have actual patient contact or not."

"Anything else?" Angela asked.

"We have mandated aggressive hand-washing after each patient contact," Cynthia said, "particularly with the medical staff and nursing personnel. We've also instituted strict isolation for all MRSA patients, and more frequent changing of medical staff clothing, such as white coats and scrub outfits. We also require more alcohol cleaning after each use of routine equipment, like blood pressure cuffs. We've even cultured all the condensate pans of all the HVAC air handlers in all three hospitals. All have tested negative for pathogens, especially the strain of staph that has been plaguing us. In short, we are doing everything possible."

"Then why haven't the doctors been admitting patients?" Bob questioned. "As they are all owners, they have to be aware they are taking money from their own pockets by not doing so, especially if we go bankrupt."

"I don't want to hear that word," Angela said, having already been through that demeaning experience.

"It's clear why they are not admitting," Stewart said. "They are terrified of their patients getting a postoperative infection despite all the infection-control strategies. With reimbursement solely based on DRGs, or diagnostically related groups, patients getting a postoperative infection directly cuts down on their productivity, and it is productivity that determines their income. Besides, there's the malpractice worry. Several of our plastic surgeons and even two of our ophthalmologists are being sued over these recent staph infections. So it's pretty simple. Despite being equity owners, it makes economic sense for them to go back to University or the Manhattan General, at least in the short run."