Lethal Practice (25 page)

Bufort stood as he resumed speaking. “One of the avenues we have explored to find out why Kingsly was killed and by whom is his hospital records. The other avenues, his personal life, his associations beyond hospital life, haven’t yielded anything so far. Besides, as you probably know, the manner in which he was killed suggests it was done by someone in this hospital, someone with a special skill.”

Hurst was starting to squirm. I wondered if Bufort had questioned him on his ability to needle a heart. The policewoman opposite Hurst watched him for a couple of seconds, then wrote something on her pad.

“In these records,” Bufort continued, “we find what I take it all of you are aware of: The hospital’s finances are in a mess. Every department, it seems, has a debt. It isn’t easy for the auditors we’ve called in to determine who controls what expenditure. People just forward requests for equipment, tests, and supplies, and other people fill those requests from preauthorized labs and medical supply houses. No one at any level seems to know why existing supply and service contractors were chosen. The authority to question alternatives, let alone actually implement any attempt at more cost-effective measures, doesn’t seem to be exercised in any consistent or logical way.”

He paused. Around him a ring of puzzled faces echoed my own confusion. It sounded more like a management seminar than a murder investigation. Riley and his two colleagues watched their sections of the table but wrote nothing down. And Hurst was really squirming now.

“The budget of this place is one hundred and twenty million annually. That’s a great deal of money by anyone’s standards. And Kingsly and the director of finance, Thomas Laverty, alone controlled its allocation.”

Everyone at the table looked around. Laverty wasn’t present. The police officers watched our faces, and I slowly caught on. Bufort and his people were checking for reactions again.

“The opportunity for diddling the till here is immense,” he continued, starting a professorial strut behind the chairs occupied by the policeman and Riley. “Increasingly Mr. Kingsly was ... well, incapacitated. The clerks up in finance kept sending checks to pay the bills as they came in. Overdrawn, why not? A lot of hospitals are these days. The bank relishes racking up interest charges, and loans to the health care system are a cash cow to the moneylenders, so they don’t complain. End of the year, there’s a deficit. The board screams, then approves borrowing the money to pay the interest and further service the debt. The bank now has interest on interest but assumes that even if the hospital is in danger of defaulting, another institution is likely to buy it out and make good on the loan. So for the time being, who even thinks of paying back the principal? After a few years the entire mess becomes such a routine, it gets no more than token scrutiny. The familiarity gives a false sense that it’s all proper, and the diddling continues.”

He had us all now. Hurst looked as if his second heart attack had plugged his pump. His first one, ten years ago, was the reason he’d given up surgery. His hands rolled into fists; his mouth made sucking movements. I leaned forward and took his arm. He wrenched it free. I saw the policewoman write something else on her pad.

“We don’t have many details yet,” continued Bufort, “and we haven’t finished looking at all your departmental salary pools, but we have a pretty good example of wrongdoing. The first oddity was a receipt for etchings and prints from a place called Renaissance Art Gallery. More than two hundred thousand dollars’ worth, labeled as institutional art, that no one knows about. We have no idea where they ended up. There wasn’t a trace of the stuff in Kingsly’s home.”

He paused, surveyed his incredulous audience, and seemed to particularly savor his next revelation. “There is a single account in all the hospital’s bank records and cost centers that routinely holds money. We noticed it because, in contrast, all the other cost centers are continually in deficit. This center, with no designated function, is numbered 0067.”

The absurdity exposed. An account rendered peculiar in our madhouse by the simple deviance of actually having some money in it.

He no longer needed a dramatic pause to get our attention. In fact, he seemed taken aback as, one by one, we reacted to the enormity of what he’d told us. We’d endured shortages year after year. Suggesting we had an embezzler in our midst was a flashpoint. Every person at the table seemed to be getting angry. By now some were standing, leaning in on him. Others remained seated, staring at him, their expressions changing from disbelief into disgust and their hands curling into fists. Riley and his two cops occasionally made a note. Names? Reactions? A lack of reaction?

It was Sean who found his voice first. “Do you mean that creep was siphoning off hospital funds?” he asked, barely controlling the rage in his voice.

Bufort clearly hadn’t expected this level of fury and still seemed astonished by what he’d unleashed. “We don’t know much yet,” he said cautiously, “but I’m asking anyone who does to come forward. We’re especially interested at the moment to hear from anyone with any information on cost center 0067.”

I got my own brain functioning again. “How much do you figure went through this center?” I asked.

“More than a million a year,” Bufort said carefully, as if each word were nitro.

I swung on Hurst. “That’s the cost of closing fifty beds. Were you aware of this?”

He had a lock on the table’s edge that turned his knuckles as white as his face. “Of course not!”

I didn’t believe him.

“Is this why you were so hell-bent on attacking the deficit and ordering such excessive bed cuts? Were you planning to use the extra savings to cover some embezzled shortfall of Kingsly’s?

At my accusation his lips trembled so violently that I was sure he’d have attacked me if we’d been alone.

“Well, get this. Hurst,” I said before he calmed down enough to speak. “Patients in emergency aren’t going to play victim to cover Kingsly’s dead ass, incompetent, crooked, or both. Your court order’s dead in the water as of now.”

I hadn’t planned to use that fact this morning. I pulled a rolled fax of legal-size text from my lab coat pocket. It was confirmation that our malpractice insurance group in Albany would assign a legal team to quash Hurst’s court order. But I unscrolled to an even more pertinent section. Against the sounds of Hurst’s sputters and the counter-protests of Carrington and Watts telling him to “stuff it,” I started reading aloud. “ ‘Specifically forbidden is any action on the part of the county, hospital, or any individual representing the hospital who attempts to coerce a physician to work in conditions unsafe for patients or contributing to patients being subjected to substandard care. Our company deems the long waiting times for emergency patients to get beds as unduly dangerous to their well-being and, as such, a breach in the standards of acceptable hospital practices. Adherence to such standards is the basic tenet under which we grant malpractice policies, and any failure to adhere to them automatically renders our contracts null and void. The probability of costly lawsuits is too great, and we refuse to underwrite in such a high-risk situation.’ “

Everyone was looking at me now with very confused expressions on their faces. Even the cops.

Sean asked, “What’s that mean?”

“It means if a hospital doesn’t have the integrity to shut down emergency services that can’t supply timely care, then the insurance company can withdraw malpractice coverage. Without coverage, it’s against our own hospital bylaws for a physician to work.”

“Wow!”

“Finally!”

“Great!”

Lost in this chorus. Hurst went an even paler shade of his usual white. “It’ll never stand!” he snarled at me.

“Then try this,” I said, and handed him another document.

All the side conversations stopped. Every pair of eyes gazed at Hurst as he skimmed my latest offering. Probably, I thought, he was going to say we should meet privately later and discuss the matter, try to bury the ruling without the other department heads finding out. I blew that option off the table.

Not letting my eyes off Hurst, I raised my voice. “Gentlemen, what I’ve shown Dr. Hurst is a letter of intent from our protective agency to defend free of charge any physician subjected to legal action for his or her part in shutting down an unsafe ER. They figure it’s cheaper to prevent the inevitable litigation than to pay for it later. And whatever our own financial woes might be, Dr. Hurst and his bean counters aren’t likely to go into a court of law to argue their right to force doctors into unsafe practices just to balance their books.”

Now I looked at my colleagues. Four days ago they had been cool, outright hostile to any action on our part against the bed closures. A few had probably welcomed the injunction.

Arnold Pinter hesitatingly tried to rekindle their opposition. “Uh, Earl, surely this is completely inappropriate at this meeting, don’t you think? I suggest you forget this ridiculous idea of shutting down emergency. Why, the—”

“Shut up, Arnold!” Sean Carrington shouted. “And I’ll be raising this same principle of standards with the department of surgery.”

The other chiefs came to Carrington’s and my support.

“Right.”

“Agreed.”

“Bravo!”

A few even gave me a slap of congratulations on the back. Their smiles lightened the mood, but only for some.

Fernandez was staring into space. He gave no sign of following what was going on around him. Instead, as white as Hurst, he got to his feet and made for the door. I was startled to see his hand shake as he reached for the handle. I don’t think anyone else in the room noticed him leave. Except the policewoman. I saw her watching his departure and making a note on her pad.

I turned back to the table.

Saswald was desperately oiling his sensors to gauge the political swing unfolding too fast for his usual self-serving calculations.

I enjoyed putting him on the spot. “Where are you now, Sas?”

He started weaving the air with his hands. “Well, I... of course, I must raise any such serious matters for careful study within my anesthesia department, and I’ll make a motion—”

“Forget it, Sas.” Gotcha! I knew I was being petty, but it felt good.

In my mind I fancied a perversion of one of those righteous bumper stickers: I DON’T BRAKE FOR POLITICIANS, EVEN IF THEY PRETEND TO BE PHYSICIANS. LET ‘EM BE SMEARS ON THE ROAD. Then I remembered that I’d nearly been dispatched to that status myself and sobered up. I turned from the stillblustering Saswald and faced Hurst.

“Forty-eight hours. Hurst, or we shut down. Open the goddamn beds!”

He glared at me but said nothing. I glared right back at him. I was pretty certain now that he’d gone as far as crippling the hospital to cover up a scandal over Kingsly. Was he also capable of killing for it? I still didn’t know, but clearly we were now on a different footing about the beds.

Arnold sank morosely into his chair.

Riley broke my second of triumph with a quiet cough, then deferred to Bufort and thus duly returned us to the business at hand. We all sat back down and stopped muttering to one another. Riley and the two uniformed police resumed watch on their respective sections of the table. I don’t think anyone else noticed we were being observed so systematically.

“We are questioning the director of finance.”

That explained Laverty’s absence.

“We are
not
sure yet of me extent of his involvement. Nor do we know how these events led to your former executive director’s murder. But we’re very sure there is a connection.”

I saw the policewoman look at Hurst and make yet another note. I wondered if because of my outburst he’d be questioned now about covering up the embezzlement.

Bufort made his next disclosure very quietly. ‘Two days ago, as I mentioned, we had to completely change our thinking and the scope of our investigation. That’s when we learned from Dr. Watts that there may have been a second murder with a cardiac needle.”

While everyone else at the table gasped in surprise, Watts grimaced at this belated acknowledgment of the inconvenient find and leaned back with his arms folded.

Bufort gave him a wary look, then said, “A derelict DOA in your emergency had evidence of an unexplained intracardiac needle stab. We are looking into other explanations, but given how Mr. Kingsly died, we have to keep the possibility of a connection open, though what the connection could be, we’ve no idea.”

More silence—until he added what I wished he’d left out. “Yesterday morning both Dr. Garnet’s house and his office here in the hospital were broken into, and he was the target of a hit-and-run attempt.”

It was my turn to stare at the center of the table. I heard horrified exclamations of shock from all around me. “Oh my God!” “How awful!” “Good Lord!” Beside me, I sensed Watts tense up.

“The attack,” Bufort explained, “was vicious, and barely failed. Again we haven’t the slightest idea how the attempt might be tied in with Kingsly’s killing. Not even Dr. Garnet has a clue as to what has made him so vulnerable.”

Arnold and Saswald nodded readily—probably in agreement to the judgment that I was “clueless.”

“For the moment,” continued Bufort, “we must assume these extraordinary events are linked somehow. Please contact me if you think of anything that might help us. In the meantime, I would like all of you to be careful.”

As the meeting broke up, I got some more patronizing looks from Arnold and Saswald. They made me feel I could have avoided my own misfortune had I just paid attention. They were obviously not going to make the same mistakes I’d made—whatever the hell those mistakes were. What pompous asses.

Sean stood up and gave my shoulder a hearty squeeze as he went by me on his way to the door. A few of the others mumbled words of sympathy while they pushed away from the table, but I got the distinct impression the danger I was in made them feel uncomfortable. I felt a flash of impatience and almost blurted out that it wasn’t catching, but I had to admit they had a point. I probably wasn’t the healthiest guy to be around right now.