Robin Cook - Crisis

"I understand that your style of practice changed at that point."

"It changed dramatically. I was approached by an older, revered physician who was practicing concierge medicine but who was having health issues. He offered me a partnership."

"Excuse me for interrupting," Randolph said. "Perhaps you could refresh for the jurors the meaning of the term 'concierge medicine.'"

"It's a practice style in which the physician agrees to limit the practice size to offer extraordinary accessibility for an annual retainer fee."

"Does extraordinary accessibility include house calls?"

"It can. It's up to the doctor and the patient."

"What you are saying is that with concierge medicine, the doctor can tailor the service to the needs of the patient. Is that correct?"

"It is. Two fundamental principles of good patient care are the principle of patient welfare and the principle of patient autonomy. Seeing too many patients per hour threatens to violate these principles, since everything is rushed. When the doctor is pressed for time, the interview has to be forced, and when that happens, the patient's narrative is lost, which is tragic, since it is often within the narrative that the critical facts of the case are hidden. In a concierge practice, like mine, I can vary the time I spend with the patient and the location of the service according to the patient's needs and wishes."

"Dr. Bowman, is the practice of medicine an art or a science?"

"It is definitely an art, but it is based on a bedrock of proven science."

"Can medicine be appropriately practiced from a book?"

"No, it cannot. There are no two people alike in the world. Medicine has to be tailored for each patient individually. Also, books are invariably outdated by the time they come on the market. Medical knowledge is expanding at an exponential rate."

"Does judgment play a role in the practice of medicine?"

"Absolutely. In every medical decision, judgment is paramount."

"Was it your medical judgment that Patience Stanhope was best served by your making a visit to her home on the evening of September eighth, 2005."

"Yes, it was."

"Can you explain to the jury why your judgment led you to believe this was the best course of action?"

"She detested the hospital. I was even reluctant to send her to the hospital for routine tests. Visits to the hospital inevitably exacerbated her symptoms and general anxiety. She much preferred for me to come to her home, which I had been doing almost once a week for eight months. Each time it had been a false alarm, even on those occasions when I was told by Jordan Stanhope that she believed she was dying. On the evening of September eighth, I was not told she thought she was dying. I was confident the visit would be a false alarm like all the others, yet as a doctor, I could not ignore the possibility she was truly ill. The best way to do that was to go directly to her home."

"Ms. Rattner testified that you told her en route that you thought her complaints might be legitimate. Is that true?"

"It is true, but I didn't say that I considered the chances to be extremely small. I said I was concerned because I noted slightly more concern than usual in Mr. Stanhope's voice."

"Did you tell Mr. Stanhope on the phone that you believed Mrs. Stanhope had had a heart attack?"

"No, I did not. I told him that it would have to be ruled out with any complaint of chest pain, but Mrs. Stanhope had had chest pain in the past that had proved to be insignificant."

"Did Mrs. Stanhope have a heart condition?"

"I had done a stress test several months previous to her demise that was equivocal. It wasn't enough to say she had a heart condition, but I felt strongly that she should have more definitive cardiac studies by a cardiologist at the hospital."

"Did you recommend that to the patient?"

"I strongly recommended it, but she refused, particularly since it involved going to the hospital."

"One last question, doctor," Randolph said. "In relation to your office's PP, or problem patient, designation, did that signify the patient got more attention or less attention?"

"Considerably more attention! The problem with patients so designated was that I could not relieve their symptoms, whether real or imagined. As a doctor, I found that a continual problem, hence the terminology."

"Thank you, doctor," Randolph said as he gathered up his notes. "No more questions."

"Mr. Fasano," Judge Davidson called. "Do you wish to redirect?"

"Absolutely, Your Honor," Tony barked. He jumped to his feet and rushed to the podium like a hound after a rabbit.

"Dr. Bowman, in relation to your PP patients, did you not say to your then live-in girlfriend while riding in your new red Porsche on the way to the Stanhope home on September eighth, 2005, that you couldn't stand such patients and that you thought hypochondriacs were as bad as malingerers?"

There was a pause as Craig fixed Tony with his eyes as if they were weapons.

"Doctor?" Tony asked. "Cat got your tongue, as we used to say in elementary school?"

"I don't remember," Craig said finally.

"Don't remember?" Tony questioned with exaggerated disbelief. "Oh, please, doctor, that's a too convenient excuse, especially from someone who has excelled throughout his training at remembering trivial details. Ms. Rattner certainly remembered as she testified. Perhaps you can remember telling Ms. Rattner on the evening you were served your summons for this lawsuit that you hated Patience Stanhope and that her passing was a blessing for everyone. Is that possibly something you can recall?" Tony leaned forward over the podium as much as his short stature would allow and raised his eyebrows questioningly.

"I said something to that effect," Craig reluctantly admitted. "I was angry."

"Of course you were angry," Tony exclaimed. "You were outraged that someone, like my bereaved client, could possibly have the gall to question whether your judgment was in keeping with the standard of care."

"Objection!" Randolph said. "Argumentative!"

"Sustained," Judge Davidson said. He glared at Tony.

"We are all impressed with your rags-to-riches story," Tony said, maintaining his disdain. "But I'm not sure what that means now, especially considering the lifestyle your patients have provided you over the years. What is the current market value of your home?"

"Objection," Randolph said. "Irrelevant and immaterial."

"Your Honor," Tony complained. "The defense presented economic testimony to attest to the defendant's commitment to become a physician. It is only reasonable for the jury to hear what economic rewards have accrued."

Judge Davidson pondered for a moment before saying, "Objection overruled. The witness may answer the question."

Tony redirected his attention at Craig. "Well?"

Craig shrugged. "Two or three million, but we didn't pay that."

"I would now like to ask you a few questions about your concierge practice," Tony said, gripping the sides of the podium tightly. "Do you believe that demanding an annual, up-front payment of thousands of dollars is beyond some patients' means?"

"Of course," Craig snapped.

"What happened to those beloved patients of yours who either could not or did not for whatever reason come up with the retainer fee that was financing your new Porsche and your sex den on Beacon Hill?"

"Objection!" Randolph said. He stood up. "Argumentative and prejudicial."

"Sustained," Judge Davidson barked. "Counsel will restrict his questions to elicit appropriate factual information and will not word his questions to float theories or arguments better left for summation. This is my last warning!"

"I'm sorry, Your Honor," Tony said before turning back to Craig. "What happened to those beloved patients whom you had been caring for over the years?"