Deadly Errors (23 page)

Using Bill’s password, he signed into Med-InDx. Once there, he pulled up the record of Tyrell Washington, the first of three patient names Jill had given him. His fingers froze over the mouse. The admitting physician was Robin Beck. Michelle’s image flashed through his mind along with their conversation in the cafeteria the night of Larry Childs’s admit. This had to be the incident Michelle had mentioned.

He punched the left mouse button, moving the screen deeper into the record. Washington had been admitted to the Emergency Department last November in coma. Robin Beck made the diagnosis of diabetic coma based on the history in the record. She had treated him with a large dose of insulin and charted the reason as being the suspected diagnosis of ketoacidoses due to lack of insulin. Problem was, the chart now showed that Washington wasn’t diabetic and certainly wasn’t taking insulin. Washington died in cardiac arrest only minutes after being treated.

The telephone rang. Tyler jumped, his heart rate racing. He picked it up.

Click.
Then dial tone.

The caller ID was already blank by the time he thought to look. A chill snaked down his back. Coincidence or simply a wrong number? Another chill nudged a sense of urgency into his work. He picked up the paper and typed in the second medical record number.

The next case was just as interesting. Later that same month a second case had been reported to Risk Management. A GI bleeder in the Intensive Care unit had been transfused with mismatched blood resulting in a massive transfusion reaction resulting in fatal cardiac arrest. It took a few mouse clicks to find the nurse of record, Gail Walker.

How could this possibly happen
, he wondered.
This is exactly the type of screw-up electronic medical records eliminate.
He knew before even checking what the record would show. Sure enough, it appeared that Walker had never scanned the bar coded label on the bag of red cells before hanging it. Clearly Walker’s error. Or at least, that’s how it looked to anyone investigating the complication.

Tyler paced nervously around the cramped office, his need to move fueled by restlessness and a gnawing anxiety in the pit of his stomach.

He dropped back into the chair and entered the last of the three names, hit enter.

This case occurred just last January. A nurse injected a patient in the Cardiac Care Unit with a potent antiarrhythmia medication less than an hour after a prior dose of the same drug had been given. The second nurse, the one responsible for the mishap, swore that the prior injection had not been recorded on the medical record. In fact, upon review of the record, the pharmacy portion clearly showed the drug being prepared and delivered to the CCU twice in less than an hour, a finding directly supporting the nurse’s assertion. The nurse responsible for the first injection also swore she had given and charted the injection—a claim the chart clearly supported.

“This isn’t right,” Tyler muttered. He stood and paced, trying to figure exactly what didn’t set well with this case.

Then it hit him. If, as the first nurse claimed, the first dose had been ordered, filled by the pharmacy, and injected—as the chart claimed—a second could
not
have been given unless specifically ordered by the physician. This is because safeguards embedded in the software would have alerted the pharmacist that a second dose was being ordered during the period when a second dose would have been lethal. So, if all were working properly the managing physician would have had to overwrite the system with a detailed explanation to justify a second dose within this short time frame. Clearly, that step hadn’t happened.

Whoever was behind the cover up had done an elegant job hiding the first two cases. Not so for this third case. This was exactly the type of information Ferguson was looking for and exactly the type of proof Tyler needed to exonerate himself.

Tyler burned a copy of all three cases to a CD.

Finished, he removed the silver disk. For a moment he sat still, rocking it back and forth slightly, staring at the rainbow dancing across the disk’s shiny surface. Another idea hit. He slid the disk back into the still open bay and pressed it home.

In the search field he typed Torres’s name, hit enter. A moment later his brain abscess patient’s chart appeared on the screen. He moused the Laboratory tab, then the microbiology section.

This time, instead of gram-negative rods, the gram stain reported gram-positive cocci. Next, he checked Torres’s pharmacy records. Changed also.

Tyler fought off a faint smile of satisfaction.
Just like surgery
, he thought,
when you get too sure of yourself, that’s when a complication jumps up and bites you in the ass. Be careful now, pal. Don’t let your guard down.

He burned Torres’s information to the CD also.

Task finished, he removed the silver disk from the computer and glanced around the office for a place to hide it.

Y
USEF KHAN’S COMPUTER emitted a series of beeps like a robin chirping. They drew his attention away from the work at hand. A glance at the 19” LCD screen immediately focused his eyes to a red flashing dialog box. This general alarm was programmed to trigger for events of a security nature as well as any number of other contingencies a person holding his administrator level privileges chose to set. During any given day he might monitor for any number of incidents, such as if any of his technicians were sneaking time on porn sites. As Chief Information Officer he also spent some time each day spot checking the work of his system administrators—those people who made sure the hundreds of Maynard Medical Center PCs continued to function seamlessly across a network of numerous servers and storage unit.

He moused the cursor onto the box and clicked.

The computer responded with: 191.90.26.05 ACTIVATED.

His interest in the message perked up. This was the medical center internal network address for Tyler Mathews’s computer. But all the number told Khan was that the computer in Mathews’s office was logged into the network. It did not reveal its user. Keeping the present window active, Khan queried another program for the password used to log onto the system.

It did not match Mathews’s password.

Next, he ran the password through the database and found it belonged to a William Leung. A quick scan of the user directory showed Leung was a neurosurgeon, one of Mathews’s partners.

This left two possibilities. Leung could be using Mathews’s machine. Or, Mathews had borrowed Leung’s password. There was a good way to settle it question.

Khan dialed Mathews’s telephone. It rang once before Mathews answered with, “Mathews here.”

Smiling, Khan hung up. Persistent fellow, that Mathews. Sly too.

He checked another program he’d set to monitor all keystrokes from Mathews’s computer. It was functioning well.

Out of curiosity, Khan downloaded what had been recorded so far this morning. One by one he issued the same commands and was pleased with what he found. Tyler had called up the medical record system and then a patient’s chart. A bit more searching perked up Khan’s interest further. The record of interest was of a patient who had died last November. Not only that, Mathews had never been involved with the patient case. Interesting.

He cross checked the patient’s record number with a list he kept hidden in the top drawer of his desk. It matched a number on the list.

Khan picked up the phone again and dialed a number from memory. A moment later a man answered. Khan said, “It’s me, Khan. Just as we suspected, our friend is snooping again.”

T
YLER DECIDED TO hide the CD in a plane manila business envelope and leave it in clear sight on his desk, figuring something out in the open wouldn’t draw any attention if someone came looking for it. He couldn’t shake the feeling of being watched—either directly or electronically.

You’re losing it, pal. That was totally paranoid.

The telephone rang.

“Mathews here.”

“Tyler, Steve Rolfson.”

Tyler exhaled a deep breath and relaxed. “Hey Steve, did you just try to call me a few minutes ago?”

“No. Why?”

“Nothing.” The chill returned. “Wrong number, I guess.”

“What I’m calling about, I just finished the brain cutting on your patient Childs. Thought you might want to hear what I found.”

Tyler picked up a pen and pulled over a piece of scratch paper. “Shoot.”

“You already had it nailed. Clear cut case of radiation necrosis. Not a doubt about it. Want to come down and view the specimen before I sign off on the case?”

He started drumming the pen against the desk. “No, Steve, but thanks for asking.”

“Anything else you want to know?”

Yeah, but you can’t help me with those questions.
“No. That was all. Thanks again.” Tyler hung up with a sense of anticlimax.

For a long time he sat staring at the manila envelop, wondering what to do with the information inside. Without a doubt it verified Ferguson’s claim of a problem with the Med-InDx system. He considered calling him but immediately rejected the idea. Before turning anything over to the FBI he wanted a tangible assurance of immunity from repercussion. Not only that, he wanted it in his lawyer’s hands. Once bitten… .

Talk to Jill about it? Ferguson’s warning to trust no one in the MMC administration popped into his consciousness again.

Nancy. If there was one person he needed to talk to, it was Nancy. He glanced at his watch. She should be back sometime this evening. He dialed Alaska airlines to check arrivals from San Francisco.

“W
HAT DO YOU mean it’s finally over?”

Still dripping sweat from a five-mile jog, Tyler stood in his apartment kitchenette toweling his face with one hand while pressing the phone to his left ear with the other.

Nancy said, “Just what I said, Tyler. It’s over between us. I’ll call my attorney and have her file the papers.”

“D
ON’T I AT least deserve to know why you’re having this sudden change of heart? The other night when we went out, I got the impression things were going well between us. What changed all that while you were in California?” A thought suddenly hit: did she have some guy in San Francisco? Maybe she’d come up to Seattle to test their relationship. And maybe she’d gone back to San Francisco to cut things off with him but it hadn’t worked out that way. A huge empty hole suddenly opened up below his diaphragm.

“Oh Tyler, don’t play innocent with me. You know how that pisses me off.”

He threw the towel against the wall. “I’m not
playing
innocent, I
am
innocent. I don’t know what the hell you’re talking about.” Maybe the-other-man-fantasy wasn’t the operative problem here. If not, what? He kicked the towel away from where it had landed.

“Well then, let me spell it out for you. You swore to me you were clean and sober. Today I learn that isn’t quite true, that you were hiding narcotics in your locker, just like last time.”

A jarring numbness engulfed him. “Who told you that? Believe me, that isn’t true.” He ran a mental list of possible candidates and immediately stopped at Ferguson. He was the only one who knew about Nancy. And he was the only one to have a motive. Then again, how in hell would Ferguson know about the drugs? Didn’t make sense.

“Oh Tyler, how can you say that? This is exactly like the last time.” She sighed exasperation. “Why in the world would someone lie about something like that?”

He slammed his hand on the counter top. “Listen to me, I’m being framed because of what I know about the medical record system!”

“And who’s behind this?” sounding blatantly skeptical.

“I don’t know, but I have some suspicions.” He considered mentioning the FBI, but quickly decided with her probing it would only lead to more problems.

Another doubtful sigh. “This is sounding way too familiar. Just like last time.”

He knew better than to argue any further. Nancy would just dig in deeper. Best to let her vent, decompress, and try to reason with her later. “Who called and told you? At least tell me that.”

“What difference does it make?”

“It could help me a lot.”

“To get off of drugs?” This said with barbed sarcasm.

“Please.”

“Tyler, I don’t know. I received a phone call. That’s all I know.”

“Male or female. What exactly did they say.”

“This conversation is going nowhere. I’m going to hang up now.”

“Just one last thing. Please.”

A pause, then, “What?”

“Don’t file those papers just yet. Give me one last chance to prove myself. Give me a week. Please?”

She hung up.

E
VEN AT THIS time of morning the outside temperature hung at a muggy 78 degrees Fahrenheit, the air cloyed with Lake Michigan humidity. Tangible air, the kind you could sweep off your arm one minute after stepping out of air conditioning. The back side of a 175-unit condo complex faced a park bordering a river. A path for strollers and joggers meandered though the greenbelt kissing the river bank every now and then. Two stocky men in black long-sleeved mock-tees and black jeans left the path and crossed the lawn toward the building. Both men wore black nylon fanny packs.