Noble Vision (42 page)

“If I may remind you, the people of this state elected Governor Burrow democratically. The people
want
CareFree, Ms. Hudson. As a citizen, don’t you feel an obligation to respect society’s laws?”

“No, Mr. Harkness, I can’t say that I feel an obligation to respect a law that’s destroying me.”

“All right, Ms. Hudson.” Years of practice raised Harkness’s voice to a high pitch of moral condemnation. “It’s understandable, granted your history of antisocial behavior and fugitive activities, that you are rebellious and arrogant toward the law!” As David’s attorney rose to object, Harkness sat down. “I have no more questions. Thank you, Ms. Hudson.”

Nicole felt lost in a dark tunnel echoing with the shouts of Brian Harkness. She lowered her head and sighed as two familiar warm hands covered her cold ones.

“It’s over, Nicole. No one’s going to ask you any more questions,” said the hushed voice that she needed to hear.

“David, I don’t know how to talk to these people,” she whispered. “They don’t speak my language.”

“The language you spoke was beautiful.” She felt the familiar squeeze of hands telling her this moment was important. “Don’t be afraid of them. Here, I’ll help you down.”

Attuned to the subtle movements of her guide, Nicole needed no verbal cues as David escorted her to the gallery. They looked not like a blind patient and a doctor but more like a young couple, arm in arm, strolling through a park.

When Nicole was seated, Warren nodded to David’s attorney to continue.

“I call Dr. David Lang,” said Green.

The man taking the witness stand did not look like an outlaw. The clean lines of the starched white shirt, silk tie, and deep green suit had an elegant simplicity. The suntanned face formed a bronze backdrop for the light green eyes that glowed like gemstones. The tall, trim form with the subtle waves of hair cropped closely around the face was serenely classic. The hands with the long, sensitive fingers looked exquisitely carved by a master sculptor. David leaned back in the chair and related his story.

“I broke the law because I can’t work with CareFree in the OR with me. To diagnose an illness, to interpret a brain scan, to decide when to operate, to remove a tumor—all require that I analyze the case at hand and apply the sum of my medical knowledge to make a decision. It is profoundly important that I be able to think unencumbered, because a patient’s life can rest on my actions.

“To treat a patient, I must examine the person, diagnose the problem, and determine how to fix it. Because the human body is complex, there are no pat answers—only countless combinations of symptoms, conditions, and treatment options. Medicine is not a connect-the-dots puzzle.

“With CareFree, the scientific inquiry I have to make stops. Instead of deciding what are the best tests to run in a particular case, I have to ask: What tests am I
allowed
to run? Someone behind a desk miles away who never met my patient will make that decision.

“Instead of asking what treatment is best in a given situation, with CareFree I have to ask: What treatment am I
allowed
to use? A clerk in an office and a book of regulations can override my judgment. That’s what CareFree is—the incompetent ruling the competent, the faceless bureaucracy superseding the individual doctor and patient.

“If it takes an average of six hours to remove a certain kind of tumor, that’s what CareFree bases my fee on. Because the human body doesn’t confine itself to CareFree’s surveys, you may have a tumor that will take me twelve hours to remove, but I’ll get paid for only six. What do I do? Remove it completely and work for nothing? Or follow an utterly arbitrary ruling, quit after six hours, and leave you with a vestige of tumor that will regrow in ten years? CareFree rewards the short-term, the mediocre, the shoddy, the unconscientious and penalizes the doctors who are above average.

“With CareFree, instead of deciding what pill is best to prescribe, I have to ask: What pill am I
allowed
to prescribe? My judgment is superseded by an arbitrary third party. If you multiply this kind of humiliation by thousands of cases, and by the chronic fear doctors have of punishment if they break the rules, you’ll know why the best ones are quitting medicine, and you’ll also know why the American standard of care, once the finest in the world, is deteriorating. The doctors who survive, the ones who play by the rules, give up the thing that makes them good healers: their free, inquiring minds.

“CareFree’s rules don’t represent any judgment superior to mine—just the opposite. They represent political decisions and statistical averages that have nothing to do with your case. If you can’t get the tests or the surgery you need for your condition, it means that your tax money went to buy something else for someone else. The state tells you it’s giving you something for nothing, but there’s no such thing. What CareFree really does is tax your money, which you can’t spend as you choose, so the state can spend it—or not spend it—as it chooses. Not only are you still paying through taxes for your medical care, which is now grossly inflated by the cost of running a huge bureaucracy, but you’re also paying a hidden and deadly price—the price of giving up your right to make your own medical decisions. He who pays the bill sets the terms; therefore, there’s no method of improving CareFree so that you and I can be autonomous. Any variant of CareFree would be and always has been the same. So do you really want medicine to be ‘free’ of charge?

“No airline would ever have a clerk in an office miles away telling your pilot how to fly your plane. No hospital or doctor would ever give you cookbook medicine. None of us would give you a distant administrator to decide your treatment on the basis of a statistical average or on the basis of who’s trading favors with whom among the politicians. Medicine and politics don’t mix. Everyone in medicine knows this. CareFree is like an elephant in the house of medicine. We pretend it’s not there, we walk around it, and we try not to get trampled.

“You, the public, seized medicine from the doctors and gave it to the politicians because you wanted your treatment to be free. It’s
not
free. You want the providers to shun material rewards and to work primarily for your benefit. I reject that. I practice medicine because I love it. I help others, which gives me great satisfaction, but it’s not the thing that can fuel a life’s dedication to a grueling profession. I didn’t endure the poverty and grind of med school and residency so that I could do a good turn for you without personal gain for me, and that includes material rewards beyond what I could achieve in a job not requiring ten post-college years of training.

“Besides controlling the material rewards that I obtain for my work, CareFree also controls something else that is vital to me and my patients. Nicole Hudson’s case demonstrates the issue clearly. It’s not about bogus research. I showed that I have grounds for the action I took. It’s not about costs. Her surgery can be paid for without taxpayers’ money. It’s not about the patient’s safety. The patient is doing fine. It’s about one issue only: my judgment or CareFree’s power?

“What’s really on trial here? If you want to save not only my patient and me but also medicine itself, you must recognize that you can’t straitjacket the doctors; you can’t force us to serve you. If you build houses for a living, I don’t have a right to march the state in to control your business so that you can provide me with a house for free. That would amount to holding you as my slave. You can’t do that to the doctors. It’s a fact that in the days when insurance was not controlled by the state, private policies—the good kind that didn’t interfere with treatment decisions—were affordable. It’s a fact that before the passage of licensing laws, lobbied for by the medical profession, there was a greater supply of doctors and auxiliary personnel, which kept fees low. And it’s a fact that before the state’s meddling, private charity abounded for those who couldn’t pay. The freer, happier, and more prosperous the doctors were, the more generosity they showed to the needy. You tell me whether you’d be in a mood to give private charity after you performed twelve hours of surgery but got paid for only six.

“I tried to give charity to Nicole Hudson, but her treatment was prohibited by law, even though I charged no fee. You tell me the motives of your so-called benefactors who claim they want to help the unfortunate yet condemn a young woman at the pinnacle of her life to a future of misery. I say
CareFree
is on trial here, and I urge you to give it the sentence it deserves. Your own life may depend on your decision.”

When he finished, David was looking at Warren.

“Thank you, Dr. Lang,” said his attorney. Then Green nodded to Harkness, signaling that it was his turn.

“Dr. Lang,” said Harkness, rising from his seat, “your dedication to medicine is admirable, I’m sure. However, from the information I have, it also seems as if you’re dedicated to other things, as well. Is it true, Dr. Lang, that before CareFree, your office pulled in several million dollars in billings each year?”

“Yes.”

“So you admit you made a lot of money before CareFree pulled the plug on that?” roared Harkness accusingly.

“I did.”

“Excuse me, Mr. Harkness,” said Green, rising from his seat, “but why don’t you also ask how many ball players, rock singers, company executives, and, yes, even lawyers, made more money than my client did? And how many lives did they save?”

“Mr. Secretary, this interruption is out of line!” Harkness cried indignantly.

“We’re not bound by legal protocol here. I think Mr. Green can finish his point,” said Warren.

Harkness looked astonished. Green, who was about to sit down, also seemed surprised at being permitted to proceed.

“And what about the years of schooling and residency in which Dr. Lang made little or no income?” Green continued. “And the overhead expenses for his loans, malpractice insurance, office rent, staff salaries—”

David contradicted his attorney. “Well, no, Russ. Even after I paid all the overhead, I still made a pretty good living.”

David ignored the angry look his attorney flashed at him. Harkness beamed. With Green silenced by his own client, Harkness continued his questioning.

“And isn’t it true, Dr. Lang, that you and your brother talked to private investors about creating a research center with venture capital, where you would test your ideas about nerve repair, ideas that the body of reputable scientists say are impossible?” Harkness’s condemning tone made the deed sound terrible.

“That’s right.”

“And you talked to a pharmaceutical company about producing the drugs you discovered for nerve repair?”

“I did.”

David had discussed the matter with his friend, pharmaceutical president Phil Morgan, whose company had several of its drugs removed from CareFree’s formulary when Morgan defended David’s surgery on Nicole.

“And if a company manufactured those drugs, you, as the discoverer, would collect royalties, would you not, Dr. Lang?”

“I would hope so; that was my intention.”

“And if you could launch your research center and get your new drugs manufactured, you could make a great deal of money, couldn’t you, Doctor?” Harkness bellowed reproachfully.

“Perhaps.”

“And it would please you to make a lot of money, wouldn’t it?”

“It would.”

“Ah ha! So, in your overzealous drive to market your new products and to get as rich as you possibly could, you cut a few corners and ignored a few rules, didn’t you? With wild dreams of fame and fortune whirling in your mind to cloud your medical judgment, you pushed a barely developed procedure and untested drugs on a helpless patient to serve as your personal guinea pig, didn’t you?”

“That’s absurd,” said David quietly.

David’s attorney raised his hand to object again, but Harkness prevailed for the final, biting word: “We’ll let the jury decide how proper it is for a healer to be wheeling and dealing with drug company executives and venture capitalists and to be recklessly endangering his patients. I don’t think I need to ask you any more questions, Dr. Lang, because your actions speak for themselves about your character! Thank you.”

Looking pale and distraught, Warren called for the closing statements from both attorneys, and then dismissed the twelve advisors for deliberation. He adjourned the proceeding for two hours. Although it was one o’clock and he had skipped breakfast, he had no appetite for lunch. He retired to his office, staring vacantly out the window for two hours.

When he returned to the courtroom, it was filled. His advisors were already seated in the jury box, and David was staring at him from the defendant’s table. Warren turned to the spokeswoman of the panel, who rose to face him.

“What have the advisors decided, Ms. Farley?”

“I’m afraid we’re deadlocked, Mr. Secretary. Six of us strongly believe that you should lift Dr. Lang’s suspension and allow Ms. Hudson’s second operation. The other six of us feel just as strongly that Dr. Lang should receive the maximum suspension and fine for subjecting Ms. Hudson to an unauthorized procedure. Those six further believe that Dr. Lang should be barred from doing any nerve-repair surgery on humans until the animal experimentation is completed and the proper authorities have reviewed the findings and found the procedure safe. We think it would be useless to deliberate further. We have no dispute about the facts of the case, but we have a profound philosophical disagreement about the role of the state in medicine, and it doesn’t appear likely that any of us will have a change of heart.”