“I’m too busy right now,” David said. He turned back to his consults.
“I’m afraid I must insist,” Kelley said. He tapped David on the shoulder. David brushed his hand off. He did not like Kelley touching him.
“This will give me a chance to examine the patient,” Dr. Mieslich said. He stood up and left the nurses’ station.
“I’ll use the time to write up my consult,” Dr. Hasselbaum said. He took his pen from his jacket pocket and reached for Jonathan’s chart.
“All right,” David said, standing up. “Lead on, Mr. Kelley.”
Kelley walked across the corridor and stepped into the patient lounge. After David entered the room Kelley closed the door.
“I presume you know Ms. Helen Beaton, the hospital president,” Kelley said, “and Mr. Michael Caldwell, the medical director.” He gestured toward both people, who were sitting on the couch.
“Yes, of course,” David said. He remembered Caldwell from Angela’s interviews, and he’d met Beaton at several hospital functions. David reached out and shook hands with each. Neither bothered to stand up.
Kelley sat down. David did likewise.
David anxiously glanced around at the faces arrayed around him. He expected trouble from Kelley, thinking this meeting had to do with the autopsy on Mary Ann Schiller. He guessed that was why the hospital people were there. He hoped this didn’t spell trouble for Angela.
“I suppose I should be forthright,” Kelley said. “You probably wonder how we’ve responded so quickly to your handling of Jonathan Eakins.”
David was flabbergasted: how could these three be here to talk to him about Jonathan when he’d only just started investigating the man’s symptoms?
“We were called by the nursing utilization coordinator,” Kelley explained. “She had been alerted by the floor nurses according to previous instructions. Utilization control is vital. We feel the need to intervene. As I’ve told you before, you are using far too many consults, especially outside the CMV family.”
“And far too many laboratory tests,” Beaton said.
“Too many diagnostic tests as well,” Caldwell said.
David stared at the three administrators in disbelief. Each returned his stare with impunity. They were a tribunal sitting in judgment. It was like the Inquisition. He was being tried for economic medical heresy, and not one of his inquisitors was a physician.
“We want to remind you that you are dealing with a patient who has been treated for metastatic prostate cancer,” Kelley said.
“We’re afraid you’ve already been too lavish and wasteful with your orders,” Beaton said.
“You have a history of excessive use of resources on three previous patients who were clearly terminal,” Caldwell said.
David struggled with his emotions. Since he’d already been questioning his competence as a result of the three successive deaths, he was vulnerable to the administrators’ criticism. “My allegiance is to the patient,” David said meekly. “Not to an organization or an institution.”
“We can appreciate your philosophy,” Beaton said. “But such a philosophy has led to the economic crisis in medical care. You must expand your horizons. We have an allegiance to the entire community of patients. Everything cannot be done to everybody. Judgment is needed in the rational use of limited resources.”
“David, the fact of the matter is that your use of ancillary services far exceeds norms developed by your fellow physicians,” Kelley told him.
There was a pause. David wasn’t sure what to say. “My worry in these particular cases is that I’m seeing an unknown infectious disease. If that is the case, it would be disastrous not to diagnose it.”
The three medical administrators looked at each other to see who would speak. Beaton shrugged and said: “That’s out of my expertise; I’m the first to admit it.”
“Mine too,” Caldwell said.
“But we happen to have an independent infectious disease consult here at the moment,” Kelley said. “Since CMV is already paying him, let’s ask him his opinion.”
Kelley went out and returned with both Dr. Martin Hasselbaum and Dr. Clark Mieslich. Introductions were made. Dr. Hasselbaum was asked if he thought that David’s three deceased patients and Mr. Eakins might have been afflicted by an unknown infectious disease.
“I sincerely doubt it,” Dr. Hasselbaum said. “There’s no evidence whatsoever that they had an infectious disease. All three had pneumonia, but I feel the pneumonia was caused by generalized debility. In all three cases the agent was a recognized pathogen.”