Deadly Care, page 16
part #3 of Joanna Blalock Series
“What do you mean by ‘managed care’?”
Joanna took his cigarette and puffed briefly, then handed it back. “It’s really cost containment. At the present, doctors can charge patients whatever they wish. In a managed care situation, the doctor has to deliver his services at a set price.”
“Give me an example.”
“Let’s say you have a sore throat. You go to the doctor and he examines you and does a laboratory test.
The bill is sixty-five dollars. But if you are a member of an HMO and that doctor has a contract with that HMO, the bill would be only thirty dollars regardless of what tests were done. In other words, the contract limits the amount that can be charged.”
Jake let the information sink in before he spoke. “So the doctors can’t be too happy about that.”
“They’re howling like stuck pigs.”
Jake grinned slightly. “And I’ll bet your surgeon friend, Phil Weiderman, is screaming the loudest.”
“He’s an outstanding surgeon and he does wonderful work,” Joanna said, an edge to her voice.
“Well, he can continue doing great work. He’ll just get paid less for doing it.” Jake went over to the wet bar and poured himself another brandy. He brought the bottle over to Joanna and refilled her snifter. Their hands touched lightly. She pulled her hand away, turning a shoulder to Jake. He exhaled loudly and started pacing again. “Do you think people would kill to destroy managed care in this country?”
Joanna forced a big laugh. “You’re talking about an eight-hundred-billion-dollar-a-year industry. That’s eight hundred billion with a big B. You’re talking about one seventh of the Gross National Product.”
“So some doctor could be doing it.”
“But who? And how? I’ve reviewed the charts of the dead women over and over again. They were looked after in different clinics by different doctors at Memorial.”
“Were they given any shots or medicines?”
“Not in the clinics. I even checked to determine if they had their blood drawn on the day of their deaths.
Two did. Lucy O’Hara and Sally Wheaton. The other patient didn’t. Just to cover all the bases, I talked with the venipuncturist at length. She struck me as being tough and easy to dislike. And she became defensive as hell when I started asking her questions about the dead patients. But she had all the right answers and, besides, what motive would she have to kill? Unless she was a cuckoo.” Joanna slowly sipped her brandy, holding it on her tongue for a moment before swallowing.
“Sudden and death are the words that keep going through my mind. Sudden - death. That’s the key here.
But there was nothing on autopsy to account for it. No strokes or heart attacks or blood clots or hemorrhages.
Nothing.”
“What about poisons?”
“We’ve checked their body fluids with the most sensitive tests available and found nothing. A big zitch.
I-I’ve even sent pieces of their livers to colleagues in San Francisco to see if they can extract anything unusual from the tissue.”
“It sounds like you’re really up against it.”
“Tell me about it.”
There was a sudden thumping sound from the ceiling. The whole room seemed to shake.
“What the hell is that?” Jake asked.
“It’s two guys who just moved in above me. I think they play for some college football team. God, they’re noisy!”
Another loud thud. A small piece of plaster came off the cottage-cheese ceiling and floated down.
Jake looked up. “Have you asked them to quiet it down?”
“About a dozen times.”
Now the stereo came on. Loud. The bass vibrating.
“Hey!” Joanna shouted up at the ceiling. “How about turning it down?”
“Fuck off!” a voice yelled back.
Jake spun around angrily and started for the door.
“They’re just kids, Jake,” Joanna said, grabbing his arm.
“They’ve got big mouths, don’t they?”
“Just kids,” Joanna said and pulled him back. Two more years, she thought, and all of her bank loans would be paid off. Then she’d start looking for a house to buy.
Outside the rain picked up again and beat against the side of the building. There was a distant crack of lightning, then a boom of thunder. Joanna nestled her head against the back of her chair and stared into the fire.
The phone rang. Joanna stared at it, wishing that she had unplugged it. She wasn’t on call at the hospital and wanted an evening of peace and quiet. Not tonight. On the fifth ring she picked up the phone. It was Jake’s partner, Lou Farelli. She handed Jake the phone and watched him stoke the fire while he spoke. His conversation consisted of “Right…… Yeah,” and “Good.”
“Anything wrong?” Joanna asked as he put the phone down.
“Naw,” Jake said and lit another cigarette. “I had Farelli talk with the officers who found your man with no face.”
“Did they have anything to add?”
“Not much. They found the body nude in a shallow grave that was covered with a few rocks. The killer left nothing behind. The cops searched the area looking for the weapon he used to bash in the victim’s face. Nada.
Nothing. Our guy is real careful.”
“But why did he dig such a shallow grave? Why didn’t he make it six feet deep? That way the body would never have been found.”
Jake smiled at her. “Have you ever tried to dig a hole six feet deep and three feet wide?”
Joanna shook her head.
“It would take a lot of time for one man to do it.
Hours and hours.” Jake put his arm around Joanna and drew her close. “Too many things could go wrong. A hiker or a camper might have spotted him. Maybe a forest ranger. No, it would have been too risky. It was better to make the grave shallow, get the hell out of there and take your chances.”
Joanna nodded at the logic. Jake was so good at putting the pieces of a crime together. So good. Too bad he wasn’t as talented when it came to relationships. “And the reason he only put a few rocks atop the grave was that a pile of rocks might have drawn the attention of a passerby.”
“Right. And a few good-sized rocks would stop the rain from washing the ground away and would probably discourage coyotes if they detected the scent of the corpse. But even if the coyotes nudged the rocks aside, all they’d do is eat the remains and that would be fine with the killer too.”
“Christ.” Joanna winced, her stomach turning briefly. “The killer thought of everything, didn’t he?”
“That’s what pros do.” Jake started to light another cigarette but resisted the urge. “But there’s something not right here. Something is out of place.”
“What?”
“I’m not sure,” Jake said, his voice raspy. “It’s on the tip of my tongue, but I can’t reach it. My mind is working in slow motion right now.”
“Maybe it’s the jet lag after your trip back from Greece.”
“Maybe.” And the word Greece brought a picture of Eleni back into his mind. They were in a taverna that overlooked a magnificent harbor just outside Athens.
Eleni was dancing by herself, running her hands through her hair, beckoning to Jake to come and join her. It was the last time they were in Athens together.
Until her funeral.
Joanna was watching his face, seeing the faraway look in his eyes and knowing what he was thinking about. Jake was doing his best to hide his sadness, but it still showed. She wondered why men went to such great lengths to conceal their grief. It accomplished nothing except to increase the pain. “Do you want to talk about Eleni?”
“There’s really not that much to talk about.”
“Yes, there is.”
Jake exhaled loudly. “I once loved her and now she’s dead. And it hurts like hell.”
“Maybe deep down you still love her, Jake.”
“Naw, it’s over.”
“Well, if it’s over, why did you fly all the way back to Greece for her funeral?”
Jake hesitated, wanting to be very careful with his answer. He ‘had the feeling of a man about to walk through a minefield. “It was the right thing to do.”
Bullshit, Joanna thought, keeping her expression even. “It was more than that.”
Jake felt his blood pressure rising. “You just can’t accept the truth, can you? You have to turn this whole thing into some kind of melodrama.”
“Is that what you think this is? A melodrama?”
“Damned right.”
“Let me tell you about a real melodrama,” Joanna seethed. “It’s about a stupid cop who flies back to Greece looking for a lost love that died years ago. And he can’t seem to remember that this great love of his threw him out and divorced him and went on with her own life, never once looking back. Now, how does that sound to you?”
“It sounds like something a real jealous bitch would say.
“I’M way past the point of being jealous,” Joanna said stonily. “But I’ll tell you what I’m very close to.”
“What’s that?”
“Not giving a damn about you or your past.”
Jake waved a hand disgustedly. “I knew I shouldn’t have come here tonight.”
“Nobody invited you.”
The stereo in the apartment above suddenly blasted.
The bass was so strong that everything began to vibrate. Then came a loud thumping noise. People jumping up and down dancing.
Jake jumped atop a footstool and pounded on the ceiling with a closed fist. “Hey up there! Hold down the racket!”
The music blasted on, the thumping noise even louder.
Jake pounded on the ceiling again. “Hey, goddamn it! It’s almost midnight.”
“That’s too bad. And if you knock on the ceiling again, I’m going to come downstairs and we’re going to have a little talk. Asshole!”
Jake grinned down at Joanna. Then he banged the ceiling with powerful blows over and over again. He heard footsteps racing across the floor above. A door opened. Now they were on the stairs coming down.
Jake hurried into the bedroom and came out holding his .38-caliber police special, checking the chamber, making certain it was loaded. He moved toward the apartment door. Joanna grabbed at him, trying to restrain him. “No, Jake! They’re only kids.”
There was a forceful knock on the front door. Then an angry voice said, “Open up, asshole, or I’ll knock this door down.”
Jake opened the door and assumed the firing position, arms extended and holding the weapon in front of him. He pointed the .38 special at the head of a huge man in his mid-twenties with crew-cut blond hair and a square jaw. The man had to weigh 250 pounds and was at least six five.
“You wanted to talk to me,” Jake said hoarsely.
“Now’s your chance.”
The big man stared at the gun, his eyes bulging. His mouth came open, but he couldn’t form words. Just behind him was another huge man, every bit as big, with long, shaggy hair that fell to his shoulders. Both were heavily muscled, wearing T-shirts and jeans. Off to the side a young blond woman was watching, more fascinated than frightened. She had on short-shorts and an opened shirt, its ends tied in a bow across her midriff. She was showing plenty of breasts that were too big and too well formed. Implants, Jake thought, his gaze now on the cigarette she was smoking. It had the characteristic sweet odor of marijuana. In the other hand, she held a can of beer.
“Can’t talk, huh?” Jake took a step out into the light rain. The man quickly backed up. “Well then, I’ll do the talking. First, I’m licensed to carry this weapon because I’m a cop. Secondly, I spend a lot of nights here and I’m a light sleeper. Thirdly, if you ever piss me off again it’s going to be the worst day of your life.
Am I coming across?”
The man in front of Jake nodded rapidly and said in a quiet voice, “We’ll keep it down.”
“You’d goddamn well better.”
“Wait a minute,” the cute blonde blurted out, “they pay rent here too. You can’t just order-”
“Yes, I can,” Jake cut her off, now staring at her marijuana cigarette. “And I can also call my buddies on the narc squad and have them come over and check out your apartment. How does that sound?”
“There’s no need for that,” the huge man said quickly. “We’ll keep it down. I promise you.”
“I don’t want to hear another sound, not even a peep,” Jake said hoarsely. “Now get the hell upstairs and be real quiet.”
The rain started pouring down again with big drops.
There was a flash of lightning and the sky turned blue.
Jake and Joanna hurried back into the living room.
Joanna slammed the door and glared at Jake. “Goddamn it, Jake! Are you crazy? Pulling a gun like that.”
Jake’s eyes narrowed, not believing what he was hearing. “He was going to kick your door in, for Chrissakes!”
“They’re just kids, trying to act tough. You could have talked to them rather than pull your gun.”
“Sometimes you can be so damn dumb,” Jake growled, trying to control his rage. “Suppose that son of a bitch had a gun when I opened the door. We would both be dead, quicker than you can blink.”
“People in this building don’t have guns, and if they did they wouldn’t aim them at one another.”
“Yeah, and people in this building don’t kick down doors, do they?” Jake hissed, his neck veins bulging.
“You just don’t get it, do you?”
“No, you don’t get it,” Joanna hissed back. “Now everyone in this building will think they’d better not knock on my door or they’ll end up looking down the barrel of a gun.”
“That’s crap and you know it. Why do you keep overreacting to everything?”
Joanna clenched her jaw. “That’s the second time I’ve heard that word tonight. I didn’t like it the first time and I like it even less now.”
“It’s a simple fact,” Jake said coldly.
“Well, let me give you another simple fact. You’re going to get your clothes and get the hell out of here. Now!”
Jake stared at her, his face coloring.
“And don’t come back unless you’re invited.”
“Fine!” Jake spun around and stomped into the bedroom, cursing under his breath. He came out carrying his still-wet clothes and hurried past her without a word.
Jake stepped outside, then turned to say something.
But before he could, the door slammed in his face.
Joanna gave the nurse a sharp look. “You tell Dr. Kohler he either sees me now or I’ll have him subpoenaed.”
“What?” the nurse said, taken aback. “I-I’m not sure I understand.”
“Listen carefully because this is the exact message I want you to give to Dr. Kohler.” Joanna kept her voice down so the patients in the waiting room couldn’t hear her. “I need to talk with him about some of his patients who died suddenly. These patients are coroner’s cases, and since I performed the autopsies I represent the coroner’s office. If he refuses to talk with me, I’ll have him subpoenaed. If he ignores the subpoena, a bench warrant will be issued for his arrest. They’ll come in here, handcuff him and drag him out. It will not be a pleasant scene.”
“Let me talk with Dr. Kohler again,” the nurse said quickly.
Joanna watched the woman hurry down the corridor.
As the nurse was turning to enter a room, Arnold Kohler stepped out. The nurse nodded toward Joanna, then spoke to Kohler in a very animated fashion.
Joanna tried to read Kohler’s expression but she could see only his profile.
Kohler handed a chart to the nurse and rapidly came over to Joanna. “I’m sorry, Dr. Blalock. I didn’t know it was you. The nurse mispronounced your name at first.”
“I see,” Joanna said, not believing him for a moment. “Didn’t you receive a call from Dr. Mariner’s office telling you that I was coming here?”
“I get so many messages,” Kohler said evasively.
“One says do this, another says do the opposite. It’s difficult to keep up.”
“Where can we talk?”
“In my office.”
Joanna followed Kohler down a corridor and into a cluttered office. The room was small and windowless, the air stale with the smell of old cigarette smoke. As she sat down, Joanna glanced over at an antiquated examining table with its leather straps. Next to it was a big, bulky EKG machine that was at least twenty years old. Even the stethoscope around Kohler’s neck was outdated with its oversized bell and long tubing.
Joanna rearranged her chair so that she was facing Kohler. In the corner by his desk she saw a withered plant, its leaves yellowed and dying.
“It’s tragic, very tragic. These patients were so close to being given a new lease on life.” Kohler gestured with his hands and shrugged. “What can you do?”
“We can find out what killed them,” Joanna said.
“Your autopsies haven’t turned up anything yet?”
“Not so far.” Joanna took out a stack of index cards and flipped through them. “Before we get to your patients, I want to talk to you about Lucy O’Hara.”
“Who?” Kohler’s forehead furrowed.
“Lucy O’Hara.”
“I don’t know her.”
“Are you sure?”
“Positive,” Kohler said, but he scratched at his ear nervously. “I’ve never seen her.”
“I think you have.” Joanna looked down at an index card and studied it briefly. “Six months ago you hospitalized her.”
“You must be mistaken. It must-”
“There’s no mistake,” Joanna cut him off. “You were listed as her primary physician in her hospital chart. She was a young woman with acute leukemia and a raging pneumonia.”
Kohler stared out into space at length, then slowly nodded. “Oh, yes. I remember now. She was Amanda Black’s patient. Amanda was on vacation and I was covering for her. The patient was terribly ill.”
“You didn’t think so at first. According to a consultant’s note, when Lucy’s father called you and described her symptoms, you told him you thought it was the flu.”
