John Lescroart - The Oath

Now he sat on a low filing cabinet in the cubicle that was Elliot's office on the ground floor of the Chronicle building. His frustration with Kensing surfaced in an over-formal tone. "I confess to being somewhat surprised to learn at this late date that he has a girlfriend. We talked last night on the phone for hours. I asked him to tell me everything important about his life he could think of, and he never mentioned her."

"Judith," Elliot said. "Really pretty. But maybe it's not an important relationship. Maybe it's one of those modern things where they just have incredible sex every couple of hours, but otherwise don't even like each other. Wouldn't that be horrible?"

"Awful." Hardy remained somewhat distracted. "Do you know when they got together?"

"No. Why?"

"Because it'd be nice to know if she was in the picture before he and Ann separated. Maybe his wife leaving didn't break his heart after all."

"You should ask him."

"I will, but it'd be swell if he volunteered some of this stuff. I didn't even know he was the leak on Baby Emily."

"Was he?" Jeff's open face was the picture of innocence.

But Hardy hadn't stopped by the Chronicle to talk about his client. He wanted to know if Elliot had heard any rumors about a rash of unexplained and unexpected deaths at Portola.

"No." But the thought of it, of the story in it, lit up the reporter's eyes. "How big a rash?"

"I don't really know. My source wasn't sure of the details, or really even of the bare facts. But she seemed pretty levelheaded, and she was definitely scared."

"So what did she say?"

Hardy gave him a fairly accurate recounting of his talk with Rebecca Simms. About halfway through, Elliot pulled a pad around and began taking a few notes. When Hardy had finished, Elliot said he'd like to talk to her.

"I can ask her," Hardy replied, "but I got the feeling that even talking to me made her nervous. Evidently the administration at Portola likes to keep a tight lid on their internal affairs. People who talk become unemployed pretty quick."

"Okay, so help me. Where do I look?"

They both came up with it at the same time. "Kensing."

Jeff closed the door to his cubicle and put on the speakerphone. Kensing told him that yes, Judith was still there, but she'd worked the night shift at the clinic and had gone in to bed. He was just hanging out, he said, windows open, reading a book. It was the first one he'd read in maybe a year. Max Byrd's Grant. Fantastic. The best first sentence he could remember reading anywhere. "'Start with his horrible mother.' Isn't that great?"

Elliot agreed that it was a fine line. But he'd called because Dismas Hardy was here with him in his office and they wanted to ask him about something. When Hardy had finished with Rebecca Simms's story of unexplained deaths at Portola, Kensing was silent long enough for Elliot to ask him if he was still there.

"Yeah. I'm thinking." Then, "I can't say the idea hasn't crossed my mind. But people are always dying in the ICU. I mean, they don't get in there until they're critical to begin with. So what you're asking, I take it, is whether people died who shouldn't have died, right? Are we off the record here, Jeff? I don't need any more bad press right now."

"Okay. Sure." Jeff wasn't crazy about agreeing, but under the circumstances there was nothing else he could do.

"While we're being formal," and Hardy no longer had any intention of being anything but formal in his relations with this client, "this conversation isn't privileged, either. Just so you know."

"All right. So what are you suggesting? Some kind of rampant malpractice? Or something more serious?"

"I'm not suggesting anything," Hardy said. "I'm asking if anything has struck you."

"Well, I'd be surprised if we've filed many eight-oh-fives. I'll go that far."

"What are those?" Hardy asked.

"Reports to the state medical board. When a doctor screws up seriously enough for the administration to suspend his clinical privileges for more than thirty days, then the hospital's supposed to file an eight-oh-five with the state. They're also supposed to forward it to the National Practitioner Data Bank, which is federal-and never goes away. You get listed in the data bank, your career is toast."

"So why don't these things get turned in?" Hardy asked.

"You're a lawyer and you're asking me that? You're a doctor and some hospital writes you up, what do you do? You sue the bastards, of course. You're a patient who finds out your hospital hired a bad doc, you sue the hospital. Everybody sues everybody."

Elliot couldn't resist. "I always assumed you lawyers loved that part," he said to Hardy.

But Hardy was hearing something else altogether. "Are you telling me, Eric, that Portola's got these doctors, and knows it , and they're not filing these reports?"

"Let me answer that by saying that we have people on the staff whom I would not personally choose as my own physician."

"So what really happens when some doctor messes up?" Hardy asked.

"Couple of things. First, you notice I mentioned the magic thirty-day suspension from clinical privileges. So instead you get grounded for twenty-nine days. Ergo no eight-oh-five, right? You're within the guidelines. And no national database."

"Are there any Portola doctors on this database?" Jeff was always chasing the story. "How can I find out?"

"You can't." Kensing's voice was firm. "The public can't get access to it, for obvious reasons. Although prospective employers can. In any event, there's another way reporting doesn't happen. It's probably more common."

"And what's that?" Hardy asked.

"Well, the eight-oh-fives are based on peer reviews."

"Other doctors," Elliot said.

"Right. And there's some feeling among doctors, especially now at Portola, that we're all in this shit storm together, so we better protect one another. If one of our colleagues isn't making the right medical decisions, okay, you go have an informal discussion, mention the standard of care we all strive for. But we're all under this intense financial pressure, we're all working too hard all the time, the bottom line is we're not ratting one another out."

"Never?" Hardy asked.

"Maybe with some egregious lapse-I'm talking inexcusably gross fatal error-and maybe even more than one. But anything less, you're not going to get a peer review at Portola that recommends an eight-oh-five. Most hospitals in the country, I'd bet it's close to the same story."

In the cubicle, Elliot and Hardy looked at each other. "What about other causes of death?" Hardy asked. "Maybe intentional deaths?"

This gave Kensing pause. "What do you mean, intentional?"

"Maybe pulling the plug early, something like that." Hardy considered, then added, "Maybe something like this potassium."

"You're talking murder, aren't you?" No answer was called for. "Do I think that's been going on at Portola?"

"Do you?" Hardy asked.

"Only in my most paranoid moments."

Elliot jumped in. "Do you have many of those, Eric?"

Kensing sighed audibly. "There was another patient in the ICU at the same time as Markham. Did you both know that?"

"I thought there were several," Hardy said.

"That's true. What I meant was that there was another patient who died."

"Who was that?" Hardy's every instinct knew that he was on to something, and that this was part of it.

"His name was James Lector. Seventy-one, never smoked. He'd developed some complications after open-heart surgery and we had him on life support for a couple of weeks, but he was off that and responding to treatment. His vital signs had been improving. I was thinking of moving him out in a few days."

"And he died?" Hardy said.

"Just like that. No reason I could see. Just…stopped."