"Oh, no!" Angela lamented. "I hadn't heard. I'm crushed. We'd been spared for more than a week."
"Like all the previous cases, we're trying to keep it quiet," Herman said. "As I said, it unfolded late this afternoon." For a few moments, silence reigned.
All eyes switched to Cynthia. The expressions ranged from anger to dismay to inquisitiveness: How could this happen after all that Cynthia had just told them was being done, with considerable funds that they did not have?
"It hasn't been confirmed it was methicillin-resistant staph," Cynthia snapped defensively. She'd been called by the hospital's infection-control committee chair and briefed on the case just prior to coming to the current meeting.
"If you mean it hasn't been cultured, you're right," Herman said. "But it was positive by our VITEK system, and my lab supervisor says she's never had a false positive: false negatives yes, but not false positives."
"Good Lord," Angela said, trying to keep her composure. "Was the patient operated on today?"
"This morning," Herman said. "Anterior cruciate ligament repair."
"How is he doing, or shouldn't I ask?"
"He died while being transferred to the University Hospital. For obvious reasons, once it was clear he had septic shock, he would have been far better treated over there."
"Good Lord," Angela repeated. She was devastated. "I hope you realize that was a bad decision. Sending two patients in as many days to a regular, full-service hospital raises the risk the media might get ahold of the story. I can just see the headlines: Specialty Hospital Outsources Critical Patient. That would be a PR nightmare for us and do what we are trying desperately to avoid: negatively affect the IPO."
Herman shrugged. "It wasn't my decision. It was a medical decision. It was out of my hands."
"How has the Jeffries family taken it?" Angela asked.
"About the way you would expect," Herman responded.
"Have you spoken with them personally?"
"I have."
"What is your sense; are they going to sue?" Angela asked. At this point, damage control had to be a priority.
"It's too early to tell, but I did what I was supposed to do. I took responsibility on behalf of the hospital, apologized profusely, and told all the things we have been doing and will do to avoid a similar tragedy."
"Okay, that's all you can do," Angela said, more to reassure herself than Herman. She made a quick note. "I'll inform our general counsel. The sooner they get on it, the better."
Bob spoke up: "If there had to be another postoperative infection, as tragic for everyone as it is, it's best the patient passed quickly. The cost to us is considerably less, which could be critical under the circumstances."
Angela turned to Cynthia. "Find out if the procedure was in one of the operating rooms that had just been cleaned. In any case, see that it is again taken care of, but don't shut the whole OR. And find out when all the involved personnel had been cultured and if any of them had been a carrier."
Cynthia nodded.
"Isn't there some way we can get our physician owners to up the census?" Bob asked. "It would be enormously helpful. We have to have revenue. I don't mind billing Medicare in advance if it is only for a couple of weeks."
The three hospital presidents looked at one another to see who would speak. It was Herman who spoke up: "I don't think there's any way to increase census, especially with this new MRSA case today. I don't know how my colleagues feel, but orthopods are very infection-adverse, because bone and joint infections have a tendency to stay around for a long time and eat up a lot of the surgeon's time, even in the best of circumstances. I've spoken about this issue with my chief of the medical staff. He's the one who clued me in."
"I've spoken with my chief of the medical staff," Niesha said. "I got essentially the same response."
"Ditto for me," Stewart added. "All surgeons are risk-averse when it comes to infections."
"It's probably too late, in any case," Angela said, trying to recover from this new blast of bad news. "But Bob's question gets to the heart of the reason I called this meeting. First, I wanted you all to hear about everything Dr. Sarpoulus has done concerning our MRSA problem. Of course, I wasn't aware there had been a new case. I'd truly hoped we were in the clear. Be that as it may, we have to somehow weather the next few weeks."
Angela then turned to Cynthia. "Angels Healthcare thanks you for your continued efforts, today's events notwithstanding. Now, would you mind leaving us for our boring financial discussion?"
Cynthia didn't respond at first. Her coal-dark eyes regarded Angela briefly, then swept around at the others. Without a word, she pushed back from the table and left the room. The door closed with a definitive thump.
For a moment, no one spoke.
"Rather headstrong," Bob commented finally, breaking the silence.
"Headstrong but dedicated," Carl said. "She's taken this whole problem and its persistence personally. I bet she thinks we are going to talk about her negatively especially with this new case."
"I'll assure her tomorrow,"Angela said. "But now let's get to the crux of the matter. As you all know, the closing of our IPO is two weeks away. The trick is how we are going to get there without any would-be investor or SEC official finding out about our ongoing cash-flow disaster. We've been lucky so far, despite the malpractice suits. We're also lucky that the problem with the staph occurred after the external audit, so its impact is not reflected in our IPO prospectus. I know you have all made enormous personal sacrifices. No one in the top echelon has taken any salary over the last two months, and that includes me. We've all maxed out our personal credit. I thank you for that. I can assure you we have begged and borrowed from all our investors to the maximum, including a quarter of a million from our lead angel investor syndicate.
"The irony of this desperate situation is that if the IPO goes as planned, the underwriters have recently guaranteed us five hundred million dollars, meaning we all will be rich and the company will be swimming in cash. Equally as important, our three hospitals proposed for Miami and our three hospitals proposed for Los Angeles will start construction. We are poised to be the first specialty hospital company to go public after the lifting of the United States Senate moratorium on specialty hospital construction, and we are involved in all the most lucrative specialties. The timing could not be more perfect. The sky is the limit. We just have to get there."
Angela paused and engaged the eyes of each of the people in the room to make sure there was no dissent. No one moved or spoke. Angela briefly glanced down at her notes.
"There is no blame in this situation," Angela asserted. "None of our spreadsheets that we used for forecasting even worst-case scenarios predicted such a catastrophe, where all our ORs would shut down essentially simultaneously. With revenue at near zero and fixed costs high, the burn rate on our emergency capital was enough to leave us here in the home office breathless. But you know all this, and with your help, we have survived. We've limped along, withholding payment to our suppliers until it was critical. We're continuing to do that, but still, it might not be enough. Bob, tell everyone how much capital we would need to get us through the IPO."