Robin Cook - Fatal Cure

"That reminds me," Traynor said. As chairman, he felt he had the right to interrupt. "What is the status of the old cobalt-60 machine that the linear accelerator replaced? Have there been any inquiries from the state licensing division or the nuclear regulatory commission?"

"Not a word," Beaton answered. "We informed them the machine is in the process of being sold to a government hospital in Paraguay and that we are waiting for the funds."

"I don't want to get involved in any bureaucratic snafu with that machine," Traynor warned.

Beaton nodded and turned to the last page of her notes. "And finally, I'm afraid I have some additional bad news. Last night just before midnight there was another attempted assault in the parking lot."

"What?" Traynor cried. "Why wasn't I informed about this?"

"I didn't hear about it until this morning," Beaton explained. "I tried to call you as soon as I heard, but you weren't in. I left a message for you to call back but you never did."

"I was in Montpelier all day," Traynor explained. He shook his head in dismay. "Damn, this has to stop. It's a PR nightmare. I hate to imagine what CMV thinks."

"We need that garage," Beaton said.

"The garage has to wait until we can float a bond issue," Traynor said. "I want that lighting done quickly, understand?"

"I've already talked to Werner Van Slyke," Beaton said. "And he's already gotten back to me that he's been in touch with the electrical contractor. I'll follow up on it so that it's done ASAP."

Traynor sat down heavily and blew through pursed lips. "It's almost mind-boggling what running a hospital today entails. Why did I get myself into this?" He picked up the current meeting's agenda, glanced at it, then called Richard Arnsworth, the treasurer, to give his report.

Arnsworth got to his feet. He was a bespectacled, precise, accountant type whose voice was so soft everyone had to strain to hear him. He started by referring everyone to the balance sheet each had received in his information packet that morning.

"What's immediately obvious," Arnsworth said, "is that the monthly expenses still significantly outstrip the monthly capitation payments from CMV. In fact, the gap has expanded relative to the increase in admissions and lengths of stay. We're also losing money on all Medicare patients not enrolled in CMV as well as all indigents who are not enrolled in any plan. The percentage of paying patients or those with standard indemnity insurance is so tiny we cannot cost-shift enough to cover our losses.

"As a result of this continued loss, the hospital's cash position has deteriorated. Consequently, I recommend switching from one hundred and eighty days investing to thirty days."

"It's already been taken care of," Sherwood announced.

When Arnsworth took his seat, Traynor asked for a motion to approve the treasurer's report. It was immediately seconded and carried with no opposition. Traynor then turned to Dr. Cantor to give the medical staff report.

Dr. Cantor got to his feet slowly and leaned his knuckles on the table. He was a big, heavyset man with a pasty complexion. Unlike other presenters he didn't refer to notes.

"Just a couple of things this month," he said casually. Traynor glanced over at Beaton and caught her eye, then shook his head in disgust. He hated Cantor's jaded behavior at their meetings.

"The anesthesiologists are all up in arms," Dr. Cantor said. "But of course it's expected now that they have been officially informed that the hospital is taking over the department, and they're to be on straight salary. I know how they feel since I experienced the same situation during Hodges' tenure."

"Do you think they'll sue?" Beaton asked.

"Of course they'll sue," Dr. Cantor said.

"Let them," Traynor said. "The precedent's been well established with pathology and radiology. I cannot believe they'd think they could continue with private billing while we're under capitation. It doesn't make sense."

"A new utilization manager has been chosen," Dr. Cantor said, changing the subject. "His name is Dr. Peter Chou."

" Will Dr. Chou cause any problems for us?" Traynor asked.

"I doubt it," Dr. Cantor said. "He didn't even want the position."

"I'll meet with him," Beaton said.

Traynor nodded.

"And the last item concerning the medical staff," Dr. Cantor said, "involves M.D. 91. I've been told he's not been drunk all month."

"Leave him on probation just the same," Traynor said. "Let's not take any chances. He's relapsed before."

Dr. Cantor sat down.

Traynor asked if there was any new business. When no one moved, he asked for a motion to adjourn. Dr. Cantor eagerly "so moved." After a resounding chorus of "yeas," Traynor struck the gavel and ended the meeting.

Traynor and Beaton slowly gathered up their papers. Everyone else trooped out of the conference room, heading for the Iron Horse Inn. When the sound of the outer door closing behind the departing group drifted back to the room, Traynor's eyes met Beaton's. Leaving his briefcase, Traynor stepped around the table and passionately embraced her.

Hand in hand they hurriedly left the conference room and retreated across the hall to a couch in Beaton's office as they had so many times before. There in the semi-darkness they made frenzied love just as they had after each executive committee meeting for almost a year. It was a familiar scenario and didn't take long. They didn't bother to remove their clothes.

"I thought it was a good meeting," Traynor said as they rearranged their apparel after they were through.

"I agree," Beaton said. She turned on a light and went over to a wall mirror. "I liked the way you handled the lighting issue for the parking lot. It avoided needless debate."

"Thank you," Traynor said, pleased with himself.

"But I'm worried about the financial situation," Beaton admitted as she reapplied her makeup. "The hospital has to break even at the very least."

"You're right," Traynor admitted with a sigh. "I'm worried too. I'd love to wring some of those CMV people's necks. It's ironic that this 'managed competition' nonsense could very well force us into bankruptcy. That whole year of negotiations with CMV was a lose-lose situation. If we hadn't agreed to capitate, we wouldn't have gotten the contract and we would have had to close like the Valley Hospital. Now that we did agree to capitate, we still might have to close."

"Every hospital is having trouble," Beaton said. "We should keep that in mind, although it's hardly consolation."

"Do you think there is any chance we could renegotiate the contract with CMV?" Traynor asked.

Beaton laughed scornfully. "Not a chance," she said.

"I don't know what else to do," Traynor said. "We're losing money despite our DUM plan that Dr. Cantor proposed."

Beaton laughed with true mirth. "We have to alter that acronym. It sounds ridiculous. How about changing from Drastic Utilization Measures to Drastic Utilization Control. DUC sounds a lot better than DUM."

"I kind of like DUM," Traynor said. "It reminds me that it was dumb to set our capitation rate so low."

"Caldwell and I have come up with an idea that might help significantly," she said. She pulled a chair over and sat down in front of Traynor.

"Shouldn't we be getting down to the Iron Horse?" Traynor said. "We don't want anybody getting suspicious. This is a small town."

"This will only take a moment," Beaton promised. "What Caldwell and I did was brainstorm about how the consultants we hired came up with a capitation rate that has proved to be too low. What we realized was that we'd provided them with hospitalization statistics that CMV had given us. What no one remembered was that those statistics were based on experience CMV had with its own hospital in Rutland."