Every Fifteen Minutes (18 page)

“Yes, I have.”

“Then I don't see how you could have any doubts about Rostatin.”

“Really?” Eric turned to his laptop and scrolled through the notes he'd taken from the papers. “Even in the papers you sent, the data shows that Rostatin correlates with increased incidence of muscle atrophy, and on the macro level, I'm not sure I approve of the treatment goals for this drug. In my field, we know that the brain needs cholesterol for proper function. Yet here comes another drug company that decides cholesterol has to be lowered from 200 to 190, so they can count on the market share expanding. It's cholestrol points for dollars. They know the algorithm. It's only about the money.”

Morris shook his head. “One can hardly fault Wacher for trying to make money. They have shareholders to answer to, as a public company. The only question before us is should we carry Rostatin, which was approved by the FDA with flying colors.”

Eric knew that FDA approval didn't go far enough, in terms of safety. “Morris, we both know that only two positive studies are required for FDA approval, and an article I found, which I emailed to you all, said in a footnote that Wacher got two negative studies, as well.” Eric gestured at the packet. “I didn't see anything about the negative studies in here, and all four of the studies were commissioned by the drug company in the first place. Why didn't they show us those negative studies?”

“That's proprietary information. It contains trade secrets and the like.”

Morris pressed his reading glasses onto the bridge of his nose.

“If so, then why aren't the positive studies also proprietary information? In any event, they should produce them to us before we approve Rostatin for the HGH pharmacy. I'll warrant to them I'm not going to form a competing drug company.”

Everybody except Morris laughed, and Eric was beginning to wonder if the gossip about Morris was true, that he was in Wacher's pocket—literally. The Cardiology Chief had just built a vacation home in Myrtle Beach and he was putting three kids through private school. Everyone at the table knew how much Morris made at the hospital and also that his wife didn't work. Nobody could say with certainty where the extra money came from, but they couldn't say it didn't come from big pharma, either.

Eric continued, “We all know that data can be manipulated. In my field, for example, when studies showed a few years ago that certain antidepressants created suicidal ideation in adolescents, the FDA required black box warnings on them. More recently, the drug companies who manufactured the antidepressants studied the impact of the black box warning, and it should come as no surprise that they concluded the black box warnings are a disaster because fewer antidepressants are being prescribed and more teenagers are dying from suicide. It's a superficially persuasive study, but it's totally manipulated data. When you look at data underlying the studies, it shows that the suicidal patients included heroin addicts. That's just a faulty proxy.”

“I don't see how that's relevant.”

Eric let it go. He had made his point, and he could see heads nodding around the table. He would be damned if they'd get steamrolled into approving an unsafe drug and he loathed the corruption in the drug-approval process. Physicians at HGH ordered only those drugs stocked in the hospital pharmacy, and patients preferred to continue whatever medication they were on, after discharge. HGH was only one of the hospitals being lobbied to carry Rostatin, as the first wave of the drug's rollout across the country, and hospital approval could make or break a drug in the marketplace.

Dr. Sharon McGregor, Chief of Orthopedic Surgery, looked over. Her eyes were grayish behind wire-rimmed glasses, which set off her silvery hair, clipped in chic layers around her ears. “Morris, I agree with Eric. I feel as if we're rushing to trend on this drug. I don't want to approve it merely because it's the latest and greatest. It's not a Chanel jacket. It's okay if it's last season's.”

Eric smiled. “What she said. Something about Chanel.”

Everybody but Morris laughed again, even the three committee members who never said anything.

Sharon continued, growing serious. “Morris, do you need me to remind you that we did the right thing when we voted no on Calcix, that new osteoporosis drug? You see now, reports are coming out that it encourages excessive bone growth. Women are showing up with tumors in their jawbones. It's unconscionable. This committee is the last line of defense for HGH.”

Otto Vinki, the diminutive Russian-born Chief of Internal Medicine, closed his laptop, which was what he did when he reached a decision. Otto was the oldest member of the committee, close to seventy-something, but his eyes retained their acutely brilliant blueness, though his bald head was covered by a network of fine white strands that looked more like bacterial spores than hair. “I also share Eric's doubts,” Otto said, in a Slavic accent that would've sounded authoritative even ordering take-out pizza. “I believe that we're jumping the gun and I have an issue with the underlying theory. Statins don't treat a disease, they treat a
risk factor
for a disease. We can convince people that if they lower cholesterol, they have fewer heart attacks, but I quarrel with that treatment goal, too. I have my vote.”

Everyone at the table turned, as, at the far end, the hospital pharmacist motioned for attention, raising an elegant hand with slender fingers. Mohammed Ibir was one of the most talked-about pharmacists in the system; African-American, hard-working, and only in his thirties, he was already developing ways to save HGH money. “The merits of Rostatin aside, I can tell you that it is much more expensive than Rosuvastatin and Atorvastatin. It's a third more costly, and I might add, that's typical for Wacher Labs. For example, the prices for their chemo agents are completely out of sight, and they have a new hep C drug in the pipeline that is projected to cost $84,000 per treatment cycle for one year.”

“For one patient?” Eric recoiled, appalled.

“Yep.” Mohammed lifted his dark eyebrows comically.

Sharon chuckled. “They have no shame!”

Morris pursed his lips, unhappy. “We're not discussing the hep C drug today, Mohammed. We have an agenda for a reason. Let's follow it.”

Otto started shaking his head. “I've heard enough, and my patients await me. Shall we put this to a vote?”

“Yes,” Eric answered.

Morris shook his head. “No, this is an important decision, and we allotted three meetings to discuss it before we vote.”

Otto scoffed. “We don't need three meetings, Morris. We should vote.”

Morris caught Mike's eye. “Mike, legally, we can't put it to a vote yet, can we? Donna's not here.” He gestured to an empty chair, and Eric realized for the first time that the Chief of Pediatrics was missing.

Mike shook his head. “You're right, Morris. We can't vote without a full committee. People, we have to table discussion until next week.”

Otto rolled his eyes.

Sharon groaned.

Eric sighed inwardly, then Morris turned to him.

“Eric, I hope you keep an open mind and review the studies in the meantime.”

“Fine,” Eric answered, wondering about that house in Myrtle Beach.

 

Chapter Twenty-one

Eric had just returned to the unit and tossed his messenger bag on his office chair when Amaka came to his door, with a frown. “Good morning, is something up?”

“Yes. Trouble. Perino's wife is here and she wants to take him home.”

“Oh boy.” Eric had been concerned there would be fallout with Perino after yesterday's incident. He headed with her down the hall toward Perino's room. “Where's Sam?”

“With Perino and the wife.” Amaka fell into step beside him.

“Good. Did he call the wife after yesterday?”

“I don't know.”

“Did he call Mike in Legal?”

“Yes, and they're standing by.”

“Okay.”

“I called security just in case, and they promise they'll be quicker this time.”

“Security, really?”

Amaka shot him a confident smile. “No more instant replays of yesterday, not on my watch.”

“Thanks.” Eric arrived at Perino's room, immediately taking in the scene. Sam stood on the near side of the bed, looking relieved to see him, and Mr. Perino sat on the edge of the bed in his hospital gown, leaning forward slightly, staring down at the floor. His wife Linda was a short, round woman whose bleached-blonde hair was pulled back into a bristly ponytail, and she had on wide jeans and a pink sweatshirt with an iron-on dreamcatcher. She whirled around when Eric entered the room.

“Oh, here comes the big muckety-muck,” Linda said, her brown eyes flashing with anger. Her forehead furrowed, and wrinkles lined her thin lips like a lifetime smoker. Her features were somewhat coarse, and she frowned in anger, stepping forward, holding Perino's streetclothes and sneakers.

“Good morning, Mrs. Perino.” Eric extended his hand, but Mrs. Perino scoffed.

“You want me to shake your hand? I don't think so. You're the one who attacked my husband. I'm getting him out of here. He's not staying another minute.”

Eric remained calm. He wanted to set the record straight, but he also understood how she could be upset. “Mrs. Perino, I didn't attack your husband. Here is what happened—”

“You did, too! He's got a big bump on his head because you
tackled
him. You're supposed to be taking care of him. We came here because we thought you would take care of him.”

“We are taking care of him and we will continue to do so.”

“He's only been here three days, and this happens? I'm taking him out of here.”

“It would be against my medical advice for you to try and leave with him—”

“What do you know? You're not even his doctor. He is.” Mrs. Perino pointed at Sam, who came forward, holding up a calming hand.

“Mrs. Perino, Dr. Parrish is my boss and he's fully up to speed on your husband's case.”

“Oh yeah?” Mrs. Perino spun on her sneakers to face Eric again. “What were you doing when he hurt himself on the table? How did that happen?”

“I'm sorry, Mrs. Perino,” Eric said, though Legal had told him that he should never apologize, because it could be construed as an admission of liability. “You're right, that shouldn't have happened—”

“How do you explain it then? Everybody here's asleep at the switch. Nobody's paying any attention to him. You just stick him in the room and ignore him.”

Sam interjected, “Mrs. Perino, I explained it to you on the phone last night. You said you understood how this came about. It was your husband's reaction to an unfamiliar nurse.”

Eric joined in, “Mrs. Perino, I assure you that we are giving him the treatment he needs. He wasn't being ignored, and he never would be. We work in teams and his team is absolutely dedicated.” He turned to Perino, who slumped on the edge of the bed and still hadn't looked up. “Mr. Perino, how are you feeling?”

“I want … to go home,” Perino answered, still staring at the floor. “You're not … helping me. Nobody here is helping me. I want to go home.”

“Mr. Perino.” Eric touched Perino's shoulder gently. “I'm sorry about what happened yesterday, but I can't let you go home, not until—”

“My wife wants to take me home … and she'll take good care of me, like before we started all this, in and out of hospitals, and I can go back to work—”

“Donnie, you don't have to talk to him.” Mrs. Perino stepped closer, backing Eric away with a steady glare. “Doc, don't you dare speak to him. You're the one who could've broken his neck. He could have split his skull!”

“Mrs. Perino, please, listen to me.” Eric faced her, undaunted. He could see that she was angry but underneath that, concerned for her husband's welfare. “As I've explained to your husband, his abrupt withdrawal from his meds can cause adverse and even violent reactions. That's why he hit his head on the tray, and we had to subdue him before he could hurt himself any further. That's why he needs to stay here—”

“No way,” Mrs. Perino shot back, waving the streetclothes at him. “Now get out of this room so I can get him dressed and out of here.”

“I can't do that, Mrs. Perino. Neither can you—”

“You can't tell me what I can and can't do! Who the
hell
do you think you are?
God
?”

“No, not at all.” Eric kept his cool.

“I brought him to the hospital. I can take him out of here anytime I want. You can't stop me.”

“Mrs. Perino, your husband was admitted under Section 201, after we evaluated him in the emergency room and decided to admit him. That's considered a voluntary admission, but that doesn't mean that the discharge is voluntary, as well.” Eric had been unhappily surprised to learn that as a doctor, he spent too much time acting like a lawyer. The admissions and discharges of mental health patients were governed by a myriad of state laws, on top of the rules and regulations that the hospital imposed.

“What are you talking about? How could it
not
be? If I got him in, I should be able to get him out.”

Eric knew it was counter-intuitive and Mrs. Perino wasn't in a listening mood. “If you recall, you were asked to sign a form agreeing to give seventy-two hours' written notice before leaving the hospital, if you are leaving against medical advice—”

“I don't have to follow your rules!”

“It's not our rules, it's state law. It says you can't take him out of the hospital today, and it's designed for your husband's well-being. You signed the form and—”

“I don't remember that! It musta been in the fine print! I didn't think I wasn't gonna be able to get him out again!”