Fatal Cure

EPILOGUE

David knew he was late as he pulled up to a modest house on Glenwood Avenue in Leonia, New Jersey. He jumped out of the car and ran up the front steps.

"Do you know what time it is?" Angela asked. She followed David into their bedroom. "You were supposed to be home at one and here it is two. If I could get here on time I think you could have too."

"I'm sorry," David said as he quickly changed his clothes. "I had a patient who needed extra time." He sighed. "At least now I have the freedom to spend more time with a patient when I think it's called for."

"That's all well and good," Angela said. "But we have an appointment. You even picked the time."

"Where's Nikki?" David asked.

"She's out on the sun porch," Angela said. "She went out there over an hour ago to watch the '60 Minutes' crew set up."

David slipped on a freshly laundered dress shirt and did up the buttons.

"I'm sorry," Angela said. "I suppose I'm anxious about this TV thing. Do you think we should go through with it?"

"I'm nervous, too," David said as he selected a tie. "So if you want to cancel, it's fine with me."

"Well, we've cleared it with our respective bosses," Angela said.

"And everyone has assured us that it won't hurt us," David said. "And we both feel the public ought to know."

Angela paused to think about it. "Okay," she said at last. "Let's do it."

David tied his tie, brushed his hair, and put on a jacket. Angela checked herself in the mirror. When they both felt they were ready, they descended the stairs and walked out onto the sun porch, blinking under the bright lights.

Although David and Angela were nervous, Ed Bradley quickly put them at ease. He began the interview casually, getting them to relax, knowing he would be editing heavily as usual. He began by asking them what they were currently doing.

"I'm taking a fellowship in forensic pathology," Angela said.

"I'm working with a large medical group at Columbia Presbyterian Medical Center," David said. "We're contracted out with several HMO organizations."

"Are you both enjoying your work?" Bradley asked.

"We are," David said.

"We're thankful we've been able to put our lives back in some sort of order," Angela said. "For a while, it was touch and go."

"I understand you had a difficult experience in Bartlet, Vermont," Bradley said.

Both David and Angela chuckled nervously.

"It was a nightmare," Angela said.

"How did it start?" Bradley asked.

David and Angela looked at each other, unsure of who should begin.

"Why don't you start, David?" Bradley said.

"My part of it started when a number of my patients began to die unexpectedly," David said. "They were patients with histories of serious illnesses like cancer."

David looked at Angela.

"It started for me when I began to be sexually harassed by my immediate superior," Angela said. "Then we discovered the body of a homicide victim entombed under our cellar steps. His name was Dr. Dennis Hodges, and he'd been the administrator of the hospital for a number of years."

With his usual clever questioning, Ed Bradley pulled out the whole sordid story.

"Were these unexpected patient deaths instances of euthanasia?" he asked David.

"That's what we thought initially," David said. "But these people were actually being murdered not through some misguided gesture of mercy, but to improve the hospital's bottom line. Patients with potentially terminal illness often use hospital facilities intensively. That translates to high costs. So to eliminate those expenses, the patients themselves were eliminated."

"In other words, the motivation for the whole affair was economic," Bradley said.

"Exactly," David replied. "The hospital was losing money, and they had to do something to stem the red ink. This was their solution."

"Why was the hospital losing money?" Bradley asked.

"The hospital had been forced to capitate," David explained. "That means furnish hospitalization for the major HMO in the area for a fixed fee per subscriber per month. Unfortunately, the hospital had estimated utilization at too low a cost. The money coming in was much less than the money going out."

"Why did the hospital agree to capitate in the first place?" Bradley asked.

"As I said, it was forced," David said. "It had to do with the new competition in medicine. But it's not real competition. In this case the HMO dictated the terms. The hospital had to capitate if it wanted to compete for the HMO's business. It didn't have any choice."

Bradley nodded as he consulted his notes. Then he looked back at David and Angela. "The new and current administrator of the Bartlet Community Hospital says that the allegations you're making are, in his words, 'pure rubbish.' "

"We've heard that," David said.

"The same administrator went on to say that if any patients had been murdered, it would have been the work of a single deranged individual."

"We've heard that as well," David said.

"But you don't buy it?"

"No, we don't."

"How did the patients die?" Bradley asked.

"From full-body radiation," Angela said. "The patients received overwhelming doses of gamma rays from a cobalt-60 source."

"Is that the same material that is used so successfully for treating some tumors?" Bradley asked.

"In very carefully targeted areas with carefully controlled doses," Angela said. "David's patients were getting uncontrolled full-body exposure."

"How was this radiation administered?" Bradley asked.

"An orthopedic bed was fitted with a heavily lead-shielded box," Angela said. "It was mounted under the bed and contained the source. The box had a remotely controlled window that was operated by a garage door opener with radio waves. Whenever the port was open the patient was irradiated through the bed. So were some of the nurses tending to these patients."

"And both of you saw this bed?" Bradley asked.

David and Angela nodded.

"After we found the source and shielded it as best we could," David explained, "I tried to figure out how my patients had been irradiated. I remembered that many of my patients had been in hospital beds that malfunctioned. They'd wound up being transferred to an orthopedic bed. So after we left the conference room we went looking for a special orthopedic bed. We found it in the maintenance shop."

"And now you contend that this bed was destroyed," Bradley said.

"The bed was never seen again after that night," Angela said.

"How could that have happened?" Bradley asked.

"The people responsible for the bed's use got rid of it," David said.

"And you believe the hospital executive committee was responsible?" Bradley said.

"At least some of them," David said. "Certainly the chairman of the board, the administrator, and the chief of the medical staff. We believe the operation was the brainchild of the chief of the medical staff. He was the only person who had the background necessary to dream up such a diabolical yet effective scheme. If they hadn't used it so often, it never would have been discovered."

"Regrettably, none of these people can defend themselves," Ed Bradley said. "I understand that all of them died of severe radiation sickness despite some heroic measures to save them."

"Unfortunately," David admitted.

"If they were so sick how could they have destroyed the bed?" Bradley asked.

"Unless the dose of radiation is so great that it is immediately lethal, there is a variable latent period before the onset of symptoms. In this case, there would have been plenty of time to get rid of the bed."

"Is there any way to substantiate these allegations?" Bradley asked.

"We both saw the bed," David said.

"Anything else?" Bradley asked.

"We found the source," Angela said.

"You found the source," Bradley said. "That's true. But it was in the conference room and not near any patients."

"Werner Van Slyke essentially confessed to us both," David said.

"Werner Van Slyke is the man you believe was the worker bee behind this operation," Bradley said.

"That's correct," David said. "He'd had nuclear technician training in the navy, so he knew something about handling radioactive materials."

"This is the same Werner Van Slyke who is schizophrenic and is now hospitalized with severe radiation sickness," Bradley said. "He's also the same Werner Van Slyke who's been in a psychotic state since the night the hospital executive committee got irradiated, who refuses to talk with anyone, and who is expected to die."

"He's the one," David admitted.

"Needless to say, he's hardly the most reliable corroborating witness," Bradley said. "Do you have any other proof?"

"I treated a number of nurses with mild radiation sickness," David said. "They had all been around my patients."

"But you thought that they had the flu at the time," Bradley said. "And there is no way to prove that they didn't."

"That's true," David admitted.

Bradley turned to Angela. "I understand you autopsied one of your husband's patients?" he asked.

Angela nodded.

"Did you suspect radiation sickness after the autopsy?" Bradley asked. "And if you didn't, why not?"

"I didn't because she'd died too quickly to manifest many of the symptoms that would have suggested radiation," Angela said. "She'd received so much radiation that it affected her central nervous system on a molecular level. If she'd had less radiation she might have lived long enough to develop ulceration of her digestive tract. Then I might have added radiation to the differential diagnosis."

"What I'm hearing is that neither of you has any hard evidence," Bradley said.

"I suppose that's true," David said reluctantly.

"Why haven't either of you been called to testify?" Bradley asked.

"We know there have been some civil suits," Angela said. "But all of them were quickly settled out of court. There have been no criminal charges."

"With the kind of accusations you've made it's incredible there have been no criminal charges," Ed Bradley said. "Why do you think there haven't been any?"

Angela and David looked at each other. Finally David spoke: "Basically we think there are two reasons. First, we think that everybody is afraid of this affair. If it all came out, it would probably shut the hospital, and that would be disastrous for the community. The hospital pumps a lot of money into the town, it employs a lot of people, and it serves the people medically. Secondly, there's the fact that in this case, the guilty, in a sense, have been punished. Van Slyke took care of that when he put the cobalt-60 cylinder on the conference table."

"That might explain why there hasn't been any local response," Bradley said. "But what about at the state level? What about the state's attorney?"

"Nationally, this episode cuts to the quick of the direction of health-care reform," Angela said. "If this story were to get out, people might begin to reevaluate their thinking on the route we seem to be taking. Good business decisions don't always equate with good medical decisions. Patient care is bound to suffer when the powers that be are too focused on the bottom line. Our experience at Bartlet Community Hospital may be an extreme example of medical bureaucrats run amok. Yet it happened. It could happen again."

"Rumor has it that you could profit from this matter," Bradley said.

David and Angela again exchanged nervous glances.

"We have been offered a large amount of money for a made-for-TV movie," David admitted.

"Are you going to take it?" Bradley asked.

"We haven't decided," David said.

"Are you tempted?"

"Of course we're tempted," Angela said. "We are buried under a mountain of debt from our medical training, and we own a house that we have not been able to sell in Bartlet, Vermont. In addition to that, our daughter has a medical condition and might develop special needs."

Ed Bradley smiled at Nikki who immediately smiled back. "I hear you were a hero in this affair," he said.

"I shot the shotgun at a man who was fighting with my mom," Nikki said. "But I hit the window instead."

Bradley chuckled. "I will certainly keep my distance from your mother," he said.

Everyone laughed.

"I'm sure you two are aware," Bradley said, resuming a more serious tone, "that there are people who contend that you have dreamed up this whole story to make the TV money and to get back at the hospital and HMO for firing you."

"I'm sure that those who don't want the true story out will do what they can to discredit us. But they really shouldn't blame the messenger for the bad news," Angela said.

"What about the series of rapes in the hospital parking lot?" Bradley asked. "Was that part of this plot?"

"No, they weren't," Angela said. "At one point we thought they were. So did the private investigator who lost his life investigating this episode with us. But we were wrong. The one indictment that has come out of this unfortunate episode is for Clyde Devonshire, an emergency-room nurse. DNA testing has proved he was responsible for at least two of the rapes."

"Have you learned anything from this experience?" Bradley asked.

David and Angela said yes simultaneously. Angela spoke first: "I've learned that as health care is changed, doctors and patients better know all the rules of any supposed cost-cutting plan so they can make appropriate decisions. Patients are too vulnerable."

"I've learned," David said, "that it is dangerous to allow financial and business people and their bureaucrats to interfere in the doctor-patient relationship."

"Sounds to me as if you two doctors are against health-care reform," Bradley said.

"Quite the contrary," Angela said. "We think health-care reform is desperately needed."

"We think it's needed," David said. "But we're worried. We just don't want it to be a fatal cure like that old joke about the operation being a success but the patient dying. The old system favored over-utilization through economic incentives. For example, rewarding a surgeon according to how frequently he operated. The more appendixes or tonsils he removed, the more money he made. We don't want to see the pendulum swing in the opposite direction by using economic incentives to under-utilize. In many health plans, doctors are being rewarded with bonuses not to hospitalize or not to treat in some specific way."

"It should be the patient's needs that determine the level and type of treatment," Angela said.

"Exactly," David said.

"Cut," Bradley said.

The cameramen straightened up from their equipment and stretched.

"That was terrific," Bradley said. "That's plenty of material and. the perfect place to stop. It was a great wrap. My job would be a lot easier if everyone I interviewed were as articulate as you folks."

"That's sweet of you to say," Angela said.

"Let me ask you guys if you think the entire executive committee was involved," Bradley said.

"Probably most of them," David said. "All had something to gain from the hospital if it thrived and a lot to lose if it shut down. The board members' involvement wasn't as altruistic as most people would like to think, particularly Dr. Cantor, the chief of staff. His Imaging Center would have folded if the hospital went under."

"Damn!" Bradley said after he'd skimmed his notes. "I forgot to ask about Sam Flemming and Tom Baringer." He called out to the cameramen he wanted to do a little more.

David and Angela were puzzled. These names were not familiar to them.

As soon as the cameramen gave him the cue that the tape was rolling, Ed Bradley turned to David and Angela and asked them about the two men. Both said they could not place the names.

"These were two people who died in Bartlet Community Hospital with the exact same symptom complex as David's patients," Bradley said. "They were patients of Dr. Portland."

"Then we wouldn't know anything about them," David said. "They would have expired before we started working at the hospital; Dr. Portland killed himself shortly before we moved to town."

"What I wanted to ask," Bradley said, "is whether you believe that these two people could have died from radiation sickness as you allege your patients did."

"I suppose if the symptoms were the same in type, degree, and time frame, then I would say yes," David said.

"That's interesting," Bradley said. "Neither one of these two people had terminal illnesses or any medical problem other than the acute problem they'd been admitted with. But both had taken out multimillion-dollar insurance policies with the hospital as the sole beneficiary."

"No wonder Dr. Portland was depressed," Angela said.

"Would either of you care to comment?" Ed Bradley asked.

"If they had been irradiated, then the motive was even more directly economic than it was in the other cases," David said. "And it would certainly make our case that much more convincing."

"If the bodies were exhumed," Bradley asked, "could it be determined unequivocally whether or not they had died of radiation?"

"I don't believe so," Angela said. "The best anyone could say would be that the remains were consistent with radiation exposure."

"One last question," Bradley said. "Are you happy now?"

"I don't think we've dared ask ourselves that question yet," David said. "We're certainly happier than we were several months ago, and we're glad we're working. We're also thankful that Nikki has been doing so well."

"After what we've been through it will take some time to put it all behind us," Angela said.

"I think we're happy," Nikki said, speaking up. "I'm going to have a brother. We're going to have a baby."

Bradley raised his eyebrows. "Is that true?" he asked.

"God willing," David said.

Angela just smiled.