Richard Mabry - Medical Error

When there was no answer to her knocks, Anna called, "Mrs. Hatley?"

The door opened to the limit of the safety chain, and an eye peered out. "Who are you?" The voice was a husky contralto, the words without inflection, as though the speaker were reciting them from a script.

"I'm Dr. Anna McIntyre. Remember, we met briefly at the hospital? I was with your son when he… when he died."Anna shifted uneasily from side to side. "May I come in for a moment?"

The door closed. As she waited, Anna tried without success to recapture an image of Mrs. Hatley from their only other conversation.

A rattle, a couple of clicks, and the door swung open. Mrs. Wanda Hatley stood a head taller than Anna's five feet six. Stick-thin arms and legs protruded from a shapeless flowered housedress. Flyaway brown hair liberally streaked with gray topped a gaunt face. Red-rimmed eyes with amber irises burned a hole through Anna.

"What do you want?" The words were delivered as a challenge, not a question.

"May I come in? I want to talk with you about Eric."

The woman nodded once, then turned and walked away. Anna stepped inside and closed the door behind her. She followed Mrs. Hatley into a living room that contained pieces selected with care. There had probably been a time when this woman took pride in her home. If so, it was long past. Now there was a film of dust on the furniture. The covers on the backs of two upholstered chairs-what were they called? Antimacassars, Anna recalled. These were skewed and wrinkled.

Mrs. Hatley dropped into one of the chairs and picked up a cigarette that smoldered in a half-full ashtray on the end table beside her. "Eric's dead."

Anna eased into the chair opposite. "I know. I was with him when he died. We tried to save his life. We tried everything we could, but it wasn't enough. And I wanted to tell you how sorry I am."

The woman waved away the apology as though waving away the smoke that wafted around her. " 'Sorry' doesn't bring him back."

So much for sympathy. Time to move on. "Mrs. Hatley, was Eric allergic to any medicines?"

For the first time, Anna thought she saw a spark behind that dull facade. "Uh-huh. He almost died a couple of years ago. He went to our family doctor for a Strep throat. Eric had four or five of them a year ever since he was real young. Doc Mercer always gave him a shot of penicillin. Cleared them right up. But this time he had one of those whatchamacallit… those allergic things… epileptic reactions."

"Anaphylactic," Anna said softly, afraid to break into the narrative now that the woman was talking.

"Yeah, that. Made him swell up like a toad. Doc had to give him two or three shots of that adrenalin stuff. And some cortisone."

In Anna's mind, the pieces dropped into place. A previous severe reaction to penicillin was a warning flag to every doctor who treated the patient after that. Never give penicillin or any of the drugs that might produce a similar reaction. Like Omnilex, the antibiotic the fake Eric Hatley received in the emergency room. The drug that undoubtedly killed this woman's son.

"Mrs. Hatley, do you have any family? Do you have anyone who can be with you right now?" Anna asked.

The woman shook her head, and the curtain of listlessness descended once more. "No family. My husband passed last year. Eric was my only child."

"Do you have brothers or sisters?"

She shook her head.

"Was Eric married?"

Again, the head shake. "No, he lived alone-had a bachelor apartment-but he spent a lot of time here. He took care of me. Bought groceries, ran errands, drove me to doctors' appointments. He was such a good son." She sobbed softly."Now I don't have anybody."

"Would you like me to get something for you? Can I do anything?"

"Not unless you can bring Eric back." Mrs. Hatley looked up, and Anna felt the eyes bore into her. "A man came by yesterday. Lawyer. Said Eric shouldn't have died. I signed the papers to sue all the doctors and the hospital and everybody. Won't bring Eric back, but it will pay for somebody to take care of me."

"Mrs. Hatley. One of those doctors you're suing is me."

The woman almost spat her response. "I know."

Anna scanned the faces of the group assembled in the department chairman's office and tried to count the allies among them. Unfortunately, other than the chair, Dr. Fowler, she wasn't sure there were any. Laura Ernst, dressed in a tailored navy suit and plain white blouse, frowned and tapped a yellow pencil on the legal pad she balanced on her lap. Dr. William Dunston, the Dean of Clinical Affairs, brushed a fleck of lint offthe vest of his gray pinstripe suit.

Fowler leaned back in his chair and polished his rimless glasses with the tail of his white coat. "Anna, why don't you tell us what you've learned about the death of your patient, Eric Hatley?"

Anna cleared her throat. "To recap, Mr. Hatley died from a massive allergic reaction during the final phase of his emergency laparotomy for multiple gunshot wounds. We'd given him antibiotic prophylaxis in the form of Omnilex, after confirming he received that drug without incident during an earlier emergency room visit. The pathologist rendered a cause of death as anaphylaxis due to a reaction to Omnilex. Regretfully, I have to agree."

Dunston clasped his hands over his ample belly. "So there appears to be a conflict between the man's prior tolerance of the drug and the massive anaphylaxis he experienced more recently. What do you make of that?"

"I began looking into it." Anna passed Dunston the emergency room record she'd been holding. "The identifying data on this visit matches what we got from Hatley's wallet. However, if you look at Dr. Fell's note, the patient is described as a 'young, African-American male.' Hatley was a middleaged Caucasian."

Dunston scanned the record, then passed it on to Ernst, who read it and frowned. "Can you explain the disparity?" the lawyer asked.

"I believe I can." Anna said. "Someone used Hatley's medical insurance information to get treatment. Maybe he didn't want a venereal disease reported to his own insurance company. More likely, he didn't have insurance but was able to steal Hatley's information and use it. I think that identity theft eventually cost Eric Hatley his life."

"And did you later confirm that Eric Hatley had a history of drug allergy?" Fowler's tone was more neutral than Anna might have liked. Was he going to stand behind her?

Anna described her visit with Wanda Hatley. "Had we known of her son's sensitivity to antibiotics of that class, we could have chosen a different drug, and the odds are that he'd be alive today. But we were unable to contact her while Hatley was in surgery. Instead, we relied on the ER record. In hindsight, I think we made the best possible decision under the circumstances. But he died."

"I believe I asked you not to make contact with this patient's family." There was ice in Ernst's voice. "Now I understand that the mother is taking steps to file a malpractice suit against the medical center and all the doctors involved in her son's treatment."

"She talked with that lawyer before I ever contacted her."Anna regretted her sharp tone as soon as the words were out of her mouth. She might not like Laura Ernst, but she needed her as an ally, not an enemy. "I'm sorry. I'm still trying to figure out why Hatley died. I thought maybe I could learn something from his mother that would shed light on the situation. Obviously, I was wrong."

Dunston looked directly at Anna. "Well, the issue here of someone posing as the patient and leaving false information on his medical record certainly muddies the waters. I'll have to leave it to Laura to sort out the legal ramifications of that." He pursed his lips. "From a medical standpoint, it appears that you acted appropriately, but on flawed information. We don't know how this is going to play out, but I'd like to be kept informed of the progress in this case." He shifted his gaze to Fowler."Please send me a summary of the M amp;M discussion." Then he swiveled toward Ernst. "I want to be copied on all communication regarding any legal actions." With that, he eased himself upright and left the room.