Noble Vision (35 page)

Warren smiled generously and shook the woman’s hand. A news photographer snapped a picture of him in his custom-tailored linen suit with the woman in her polyester dress.

“You look happy, like you just hit the jackpot, ma’am,” the photographer commented.

A sudden fear eclipsed Warren’s smile. He thought of David’s haunting words from their last meeting:
What must my patient do to win a door prize, too?

The next citizen approached Warren, an older man self-consciously shifting his weight.

“Excuse me for bothering you, Mr. Secretary, sir.” He fidgeted nervously. “It’s about my bum knee.”

“It’s no bother at all.” The man’s timidity was like a splash of cool water to refresh Warren’s confidence. “Please have a seat. . . .”

For lunch, the secretary traveled by limousine to a restaurant where his favorite table, overlooking the duck pond, was reserved for him. A glass of Chardonnay was poured ten minutes prior to his arrival so that it would warm to the temperature he desired. Extra tomato wedges were placed on his salad, and his steak was cooked exactly medium rare, as he preferred, without his having to ask. The staff, honored by such an important patron, kept a careful record of his predilections.

Just as Warren was enjoying the chef’s personal visit to his table to check on the meal, a tall man with black hair entered the restaurant, giving the secretary a start. The man resembled David, triggering a sudden guilt in Warren, who felt like a child caught stealing a cookie. David’s image seemed to be following him, sprinkling salt over his sweet pleasures. The secretary was relieved to find that the man was not his son, although he could not explain why. His emotions were like lightning bolts that struck with sudden fury and vanished just as quickly.

Warren returned from lunch to perform what he considered another important duty of his office: conducting hearings against doctors who violated CareFree’s rules. A health care provider could appeal a judgment imposed by CareFree and thus obtain a hearing before an administrator. “A public official must be a role model for his staff,” Warren had said during a television interview. “I conduct the physicians’ hearings myself, as my schedule permits, to set an example of firm justice for my agency.”

Doctors privately snickered at such remarks, for Secretary Lang was known to lean far more toward
firm
than
justice
in his decisions on their cases. No doctor in the state wanted Warren as a hearing administrator. The press, however, reacted differently. “The tireless Dr. Warren Lang sets a new standard for hands-on management,” said a flattering article in a New York magazine. “He runs the huge Bureau of Medicine like a corner grocery store, rolling up his sleeves and jumping behind the counter to lead his staff, a practice more agency heads should adopt.”

Warren held the hearings in a setting resembling a courtroom. Every BOM office in the state had such a chamber. The administrator deciding the case sat at a judge’s bench. The defendant, often accompanied by a lawyer, sat at a table to the administrator’s right, with a CareFree attorney at a table to the left and a podium in between. The public observed from rows of seats behind the tables.

That afternoon Warren sat on the judge’s swivel chair in the hearing room. One aide adjusted the lighting to the level the secretary preferred. Another brought him a glass of artesian well water with two limes. Another laid the file for the first case before him. Dr. Lang scanned the document as dentist Sheldon Fein, a balding man whose direct eyes stared out of his gaunt face, approached the podium.

“Good afternoon, Dr. Fein,” said Warren with cool cordiality. Gone was the grandfatherly warmth displayed earlier in the day toward patients.

“Good afternoon, Dr. Lang.”

“The record shows you’ve been waiving the copayments that you’re supposed to collect from your patients.”

“Yes, I have.”

“You admit to the charge, so we have no dispute, Dr. Fein.”

“We have no dispute over what I did, but I have a great dispute over what your agency made of it. I mean, a ten-thousand-dollar fine! The copayments were my own fees. How can my failure to collect money owed to myself be a crime?”

“Why didn’t you collect your fees?” Warren asked sternly.

“It would cost me more to collect the fees than they’re worth. Nobody thinks they have to pay for anything anymore,” the dentist said resentfully. “Because I’m waiving fees owed to me, why should your agency care?”

“Did it ever occur to you, Dr. Fein, that the purpose of the copayments is
not
to embellish your income but to restrict the public’s demand for your services, and that by waiving those payments, you give patients no reason to exercise restraint on their visits to your office? Do you realize that you are encouraging extra treatment and driving up costs, which are straining the system?”

“I realize that the system is straining me!”

Warren’s eyebrows arched at the impertinence. “The judgment stands.” He closed Dr. Fein’s folder and tossed it to an aide. “Next case, please.”

The dentist’s expression oscillated between shock and anger until the latter prevailed: “I’ll speak to my lawyer about this!”

The next folder appeared before Warren, and the next body appeared before the podium—psychologist Diane Lutz, a petite woman in her fifties with gentle eyes and an intelligent face.

“Good afternoon, Dr. Lutz,” said Warren, flipping through her folder.

“How do you do, Dr. Lang?”

“It says here that you knowingly entered a false diagnosis in order to be paid for unauthorized treatment. You said you were treating a man for depression, which
is
covered by CareFree, but you were really conducting marriage counseling for the man and his wife, which is
not
covered.” Warren peered up from the papers. “The record shows that you collected thousands of dollars of taxpayers’ money under false pretenses, Dr. Lutz,” said Warren accusingly.

“But my patient’s depression has caused the problems in his marriage. Last year when I started treating the couple, CareFree paid for their marriage counseling. This year it doesn’t. But I’m still treating the same couple.”

“So what’s your point, Dr. Lutz?”

“I mean that I couldn’t abandon my patients in the middle of treatment because CareFree changed its rules, could I? No matter what we want to call it, depression or marriage counseling, it’s the same case.”

“But it’s a different diagnosis. You switched the diagnosis.”

“But the pain is the same!”

“Excuse me?” Warren asked threateningly.

Dr. Lutz looked down timidly, and a subtle satisfaction glimmered on Warren’s face, as if he had won some kind of battle.

“But Mr. Secretary, if I had dropped the case when marriage counseling was no longer covered, then couldn’t I be charged with patient abandonment? That’s an infraction, too, isn’t it?”

“So instead you decided to be charged with fraud?”

The comely psychologist did not protest, which seemed to permit the secretary to soften his tone.

“Next time,” he added kindly, “call our office if you have questions about diagnoses and changes in our coverage. After all, we’re here to help you.”

“Well, I . . . uh . . .”

“I think the fine is justified. Now do you have any other questions?”

“I guess not,” Dr. Lutz said disappointedly.

The secretary looked pleased with the dispatching of Dr. Lutz and signaled to his assistant for the next case. His aide approached, but this time without a new file, whispering something in Warren’s ear, as a distinguished gray-haired man approached the podium.

“Good afternoon,” said Warren to the tall man in a business suit.

“Good afternoon, Dr. Lang. I’m Kenneth Viceroy, the director of cardiology at Pace Memorial Hospital.”

“I understand that we have no case against you, Dr. Viceroy.”

“That’s right, and CareFree has
never
had a case against me or any member of my department. We pride ourselves on following the law.” The surgeon raised his right hand to his heart as if taking an oath.

“So what brings you here today?”

“An urgent request. We’ve applied for CareFree’s approval to perform heart transplants at Pace Memorial, and we’re told it will take thirty days more to obtain authorization. Yesterday a patient was admitted who is an excellent candidate for a transplant. With Whittier Medical Center having closed last month, the nearest hospital that can perform this procedure is fifty miles away, and the patient is too unstable to be moved. I came to ask your permission to perform this surgery immediately, or the patient could die. You see, we’ll be using the same transplant team that worked at Whittier before it closed.”

“Dr. Viceroy, your group may perform the surgery—”

“Wonderful!”

“—when you have met your regulatory burden.”

“Dr. Lang, really!”

“We have a responsibility to ensure public safety.”

“I recognize that, of course. But everyone on our team has experience performing transplants safely. Isn’t there anything you can do?”

“There are reasons for the laws we have. If we could take on face value everyone who stands here and says he’s okay, then we wouldn’t need any regulations, would we? We’ll just let anyone who says he’s okay loose on the public. Is that what you’re advocating?”

“Of course not. But can’t you expedite the approvals?”

“We can’t cut corners with public safety.”

“But if we don’t operate, the patient could die!”

“But if we make an exception for you, then others who have pending applications will want us to do the same for them. This undermines our system, Dr. Viceroy. We have the lives of millions of patients to consider. That’s why we must focus on a wider context than one individual patient, and we must follow the proper procedures.”

“I respect those procedures, of course.”

“Yet you want me to disregard them?”

“But in this case—”

“Especially in the case of a complex, risky operation such as yours, it’s even more important to ensure that society is protected. I’m confident the public can count on you, Dr. Viceroy, to continue your commendable record of regulatory compliance.”

The cardiologist bristled, about to disagree, when Warren dismissed him by calling the next case.

*
  
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*
  
*

Later that afternoon Warren’s chauffeur drove him up the winding hill to the fragrant front garden of the governor’s mansion. Disturbing thoughts of his last encounter with David lingered, marring the secretary’s usual rush of excitement on visiting his ardently wished-for future home. On his way to Burrow’s office, he walked through the picture gallery of governors, reaching the empty place on the wall beyond Burrow’s portrait where the next governor’s picture would hang. As was his habit, he visualized his own likeness in the spot. But instead of feeling his usual thrill, the aftertaste of his bitter meeting with David intruded to evoke a pervasive, unnamed guilt. His son’s acrid words seemed to echo ominously through the hall:
Before this matter is over, one of us will be finished.

Warren recalled the people he had encountered that day who gave his life legitimacy: the patients who revered him as their only hope; the restaurant staff members who treated him like royalty; the doctors who, despite their frustrations with the system, respectfully accepted his authority. With the endorsement of all these people, how could one man make him avert his eyes from the portraits like an impostor undeserving of greatness?

In the opulent Victorian parlor outside the governor’s office, an aide offered Warren a seat. While waiting for his appointment, the secretary observed the Burrow administration in action. The governor’s personal secretary was telephoning a candy shop in Glens Falls to order a specific kind of truffle that Burrow craved. A writer composing Burrow’s memoirs worked at a computer. One advisor left the inner office and another entered it, while many others waited. Warren had never known the governor to be alone. Like favorite pets, Burrow’s aides followed him everywhere—in his bedroom while he dressed, in his bathroom while he shaved. Burrow constantly called meetings with aides, then wasted hours of their time by making them wait to see him. The governor was never punctual, Warren thought irritably, feeling like a boy at the dentist’s office. Burrow seemed to take a peculiar pleasure in having a throng of people queuing to see him.

Before being appointed to his current post and establishing a home in Albany, Warren was an advisor to the governor and a frequent overnight guest at the mansion. Burrow, an early riser, had an odd fear of being alone and a reputation for waking anyone available for companionship. Warren remembered the governor’s early morning wanderings into his room to talk. The pajama-clad, aging, somewhat helpless looking Burrow jarred with the persona of the commanding politician, masterful at playing special-interest groups against each other. Burrow could persuade the unions to back a bill and big business not to oppose it, all the while creating a universe of obligations, favors, and fears that he used to run the state. Warren wondered why such a man could not bear loneliness.