What did it matter? he remembered thinking. The whole brouhaha would blow over in a couple of days.
But he was wrong.
His auto-da-fe' at the hands of the Guidelines committee continued with unflagging zeal. Apparently the members thought they'd found a particularly tasty bone in Duncan Lathram and wanted to keep gnawing away at him. Then the Alexandria Banner picked up the story, followed by a patient's rights group demanding an investigation, so the State Board of Medical Examiners got involved, and soon Medicare had a team of pettifogging auditors formicating through his office records, pawing through his files, and swarming in the hospital records room, sifting his charts for pecuniary indiscretions. To hell with patient confidentiality. Those weasel-faced bureaucrats would know all the secrets of everyone he'd operated on in the past few years. But what did that matter? Spurred by the Guidelines committee, the government had declared jihad on Duncan Lathram.
Duncan was angry and embarrassed, but not too worried. His medical records were impeccable, and he'd match his morbidity and mortality stats against anyone in the country. Let them investigate. He'd come up smelling like a rose.
He just wished they'd hurry and get the whole mess over and done with.
But it dragged on, and in the ensuing months Duncan began to notice a hint of coolness from some of his colleagues at the hospital. He was getting fewer requests for surgical consults. He understood their predicament, worrying about guilt by association. They were waiting till things cooled down.
Still, he was in for a nasty shock one day as he began one of the surgical consultation requests he did receive. When he entered the patient's hospital room and introduced himself, the patient bolted upright in bed. Duncan still remembered his words.
"Oh, no. Forget it. No way I'm gonna be operated on by some knife-happy, money-grubbing quack! " Duncan was mortified, angry enough to punch a hole in the wall. And dammit, hurt. He consoled himself that most likely he had just experienced the nadir of the whole affair.
It couldn't get any worse.
The only way he could go from there was up.
Again, he was wrong.
Because all the bad press was having a devastating effect at home.
Duncan Lathram, MD, was the talk of the town . . . including the high school.
And so in retrospect it seemed inevitable that he would come home one night to find Lisa sobbing in her mother's arms. She and Kenny had had a fight and broken up. The cause of the fight? What the kids were saying about Lisa's father, saying to Kenny behind Lisa's back.
Kenny's parting shot? "Forget the prom! Forget everything! I ain't going' anywhere with the daughter of no crook! " Devastating for any teenager, but to Lisa it seemed like the end of the world.
Barely able to speak through her sobs, she wanted to know why her father hadn't said anything, why he hadn't come out and defended himself.
Duncan remembered the scene as if it had occurred only a moment ago.
He knelt before his daughter and gripped her hands. "Honey, these are lies from spotlight-hunting buffoons. The way these things work, the louder I proclaim my innocence, the guiltier I look."
"But you haven't said anything! " "I'm letting my records do the talking. I've got nothing to hide, Lisa.
When the bureaucrats finish their investigation, I'll be vindicated.
And they'll be the fools."
"But meanwhile they're making you look like a crook! And making everybody hate me! And you don't care! " "Of course I care." He realized then that he'd misread the whole situation. He'd treated it as a brief but unpleasant interlude, another in a long series of fleeting Capitol Hill cacophomes that would die down as soon as Congress, in tune with its well-earned reputation for a short attention span, moved on to the next hot topic.
So he'd done nothing to counter the accusations leveled. That had been a mistake.
Another mistake was thinking it would involve only his practice. He should have seen that his professional obloquy would have a ripple effect on his private life as well. He'd always separated the practice and the family, but there was no way of insulating the latter from the ravages upon the former, not with an assault of this magnitude.
He hurt for Lisa.
"But what could I have done, Lisa? What can I do to make this better?
' "I don't know, something. You could plea bargain or whatever they call it. Something, anything to make them shut up and get off our backs."
"Plea bargain? " He was stunned. "You don't plea bargain when you're innocent." Lisa tore her hands from his and ran upstairs, screaming, "Thanks!
Thanks for nothing! My life is over! And all because of you! I might as well have AIDS! " Diana followed her, glaring back at him. "She's right, you know. You could have done something! " This was vintage Lisa, always taking everything too hard, seeing everything in the worst light. With her history, though, that kind of outburst could not be laid off to hyperbole and histrionics.
They increased her therapy sessions and kept an eye on her day and night. But a week later, when it became clear, at least to Lisa, that she and Kenny were through for good, she dug out a hoard of old pills she had squirreled away over the yeats, a potentially lethal combination of antidepressants like Elavil, Parnate, Desyrel, Sinequan, Norpramin, Tofranil, Nardil, and lithium, and took them all.
And then she fell. Over the railing. Down to the hard, cold foyer floor. Where Duncan found her.
And then she died. And Diana blamed him.
And Duncan blamed himself.
He had never realized what grief could mean, never imagined he could mourn the loss of another human being the way he mourned Lisa. And he knew it was all his fault . . . all his fault . . .
Until the audits and investigations were completed. Then he knew who was really to blame.
The rasorial crew of Medicare auditors finished their quest for any improprieties that might grease his path to the gibbet, always in full view of his steadily diminishing patient flow, and the worst they could come up with were a few errors in the coding of certain procedures.
The quality assurance examiners found no cases, not one! , of unnecessary surgery. Every single procedure met or exceeded recommended . . . .
Indications.
No apology, though, from the Guidelines committee and their fugleman, McCready. They'd moved on to other hatchet jobs.
Except for a few loyal patients who wrote letters on Duncan's behalf, no one had come to his defense throughout the entire ordeal. His colleagues had kept their heads down. Even some A.M.A paper-pusher was quoted as saying the amount Duncan billed was "excessive." Duncan learned the meaning of alone.
The long-delayed reports finally got forwarded to the State Board of Medical Examiners. The "coding irregularities" did not result in any net gain on Duncan's part, actually he lost money, but still he was issued a warning to be more careful in the future. Since there was no evidence of fraud or negligence, or of performing even a single unnecessary procedure, -the board exonerated him.
But where was that publicized?
In a small paragraph buried deep in the Banner. But the Washington Post, which had broken the original story that started this nightmare, never mentioned it.
The public flogging was over, but it had dragged on too long. Referral patterns had changed. Generalists who used to feed his practice had found new surgeons.
His practice was ruined. He'd been held up to national scorn and then cleared. But his reputation remained tainted.
He could have shrugged it off, all of it, if Lisa still were alive and Diana still behind him.
But Lisa was gone. Dear, dear Lisa, who left without a goodbye, blaming him for all her pain.