Pennsylvania's Finest, page 21
Later that evening Dr. Knight sat alone in his residence. The clock on his study mantle slowly clicked away each audible second. The chart of Katherine McDuff sat atop his antique desk. He had just completed a detail review of her treatment during that unforgettable day. While looking outside a window he noticed some fine snow flurries starting to fall. A fir tree in front of a brick wall peacefully gathered snowflakes upon its frozen branches. Knight’s mind began to churn through a long list of personnel associates and medical colleagues. He wondered what Jennifer Ranier was doing at that very moment. A grim picture of Phil Drummer compressing the chest of Katherine McDuff entered his mind. The snickering face of pathologist Falcon peering over the lifeless body of Katherine McDuff only added to his mental angst.
Knight reached for a phone to the right of his seat. He slowly picked up the receiver and methodically dialed a number jotted down in front of him. The time was 11:50 P.M. After hearing a sleepy voice politely answer his call, Knight identified himself with a late night apology. Mr. James Asher was startled and surprised by the urgent call from the physician. He did however agree to meet with him early the following morning.
CHAPTER 19 A Matter of Security
Three days passed before Mr. James Asher walked into the office of CEO Rineman. Asher had arranged the meeting and requested that an attorney for the hospital system be present. Waiting in the office with Rineman was Dr. Barnes. Sitting along side them was an attorney from a prestigious and expensive Philadelphia law firm. The legal counsel was a close friend of Rineman, and like the CEO, was the figurehead of his firm. The parties had predetermined not to invite Dr. Knight to the discussion. Knight was completely unaware of the gathering that morning.
Introductions were made and Asher was invited to sit down in a plush chair facing Rineman’s massive desk. Behind his desk was a large window overlooking the city. The desk was littered with photographs of his family and high profile dignitaries in his presence. A photo of the CEO with his arm around the president of the United States caught Asher’s eye. Sitting to the right of Rineman was Dr. Barnes and the legal counsel for the hospital system. Behind their antique Chippendale chairs stood a massive oaken grandfather clock. The timepiece expectedly announced nine o’clock with a calculated series of sharp, yet pleasing pings.
As soon as Asher sat down he sensed power in the room. Despite being in the hospital complex itself the office was comfortable and deathly quiet. The hustle and bustle of a major medical center surrounding the confines had somehow been kept out of the quarters. A soft hum surrounded the room. Asher suddenly felt as if he was on the bridge of the Starship Enterprise. His favorite Star Trek episode titled Balance of Terror entered his mind. An exact star date of 1709.2 arose from his memory banks. The computer genius could remember the snowy December day in 1966 when he first watched the episode. As Rineman began to speak Asher tried to picture the CEO as Star Trek’s Commander James T. Kirk. Unfortunately, Rineman had the physical attributes of the crafty Romulan leader who met his death in that memorable episode.
“To what do we owe this pleasure?” said CEO Rineman after introductions were made.
“Thank you for meeting with me,” said Asher. “I will try to make this brief since I know we all have busy schedules.”
The pricey Philadelphia attorney shifted in his chair rather hoping for longevity. Despite charging a thousand dollars an hour he was glad that his firm included travel time in the fee. He noticed a picture of Rineman teeing off at the Augusta National Golf Club. He wondered how the CEO was able to get on the course while his efforts three years ago failed. The word “unfair” registered in his wealthy mind.
“As you may know I spoke at length with Dr. Knight about two days ago,” said Asher. “Dr. Knight had some troublesome concerns that I believe warrant your attention.”
Doctor Barnes then stared out the window. It was a blustery November day in the city. A group of pigeons rapidly flew with the wind in a downward direction just outside. Barnes was still getting over the shock of the McDuff death. Grave concerns about the well being of his cardiothoracic colleague occupied his mind. A sorrowful feeling entered his gut while thinking of Knight and the upcoming Philadelphia Chronicle article. Looking at CEO Rineman he wished he had washed his hands completely of Knight’s plan to ramp up the surgical volume.
Asher continued saying, “First of all, Dr. Knight raised concerns about the validity of our blood testing laboratory.” Asher then proceeded into a detailed description of Knight’s discussion with the head of laboratory services. Asher confidently assured the group that all laboratory values were valid. After answering a few questions he then informed the group that this was not the main reason for the meeting.
CEO Rineman then spoke again saying, “We all know that Dr. Knight has been under an immense amount of pressure lately.” He paused to look at the attorney and chairman next to him, then continued, “Certainly this can explain his intense concerns regarding patient care.” Rineman then again looked at his legal counsel hoping that the I.T. guru was not wasting his precious legal time. The attorney reflexively shook his head in agreement while still stewing over Augusta National’s rejection of him.
Rineman then looked back at Asher and while cocking his head to one side said firmly, “Well then please tell us Mr. Asher, what is the urgent topic that prompted you to gather us together?”
“Dr. Knight is convinced that some computer virus is altering the laboratory values of his patients,” said Asher bluntly. His comment was followed by silence in the room.
“What do you mean?” said Rineman with a wrinkled forehead and frown, “I don’t understand.”
“He stated to me that several of his patient’s have died unexpectedly over the past few months,” replied Asher. “Two of these patient’s had rapid changes in their electrolyte levels that he couldn’t explain from a medical standpoint.”
Barnes immediately thought back upon the M & M rounds discussion regarding a patient’s potassium level. The pitiful feeling in his stomach became more intense.
Asher paused to look around at the now very attentive group. He then continued, “Simply put, he could not explain to me the rapid change in lab values from a scientific standpoint. He told me that no known law of pharmacology or medicine could explain the sudden shift in lab values.”
“What are you suggesting?” asked legal counsel.
“I’m not suggesting anything,” said Asher. “I’m just bringing a serious concern to your attention.”
“Let me get this straight,” said Rineman. “Knight thinks that something or someone is altering the lab values of his patients while they are in the hospital?”
“Correct,” said Asher.
“There must be a logical explanation,” said Barnes. “Do you realize what you, I mean he, may be implying?”
“That someone is trying to harm his patients,” said the Philadelphia attorney now with a very serious look on his face. “Some illegal entity I presume,” was his follow up line.
“He didn’t put it that bluntly,” said Asher. “But that was the concern that I took away from the conversation.” Asher paused to look around at the puzzled faces surrounding him. He then said, “His speech was very rapid during the conversation. He looked as if he hadn’t slept all night.”
The attorney continued, “I mean, I’m assuming that when laboratory values come back erroneous, subsequent medical care can be detrimental.”
“Of course it will be detrimental,” said Barnes. “All of our treatment protocols are centered upon objective laboratory and clinical findings. For every action occurring on the surgical floor, this in an appropriate reaction.” Barnes paused, then continued saying, “Assuming the original information is accurate.”
“What proof does he have?” asked the attorney.
“None that I am aware of,” responded Asher. “Just a rash of deaths with unexplained lab shifts.” Asher paused and continued while recalling additional facts, “Oh yea, he threw in some talk about pathology reports and peculiar cell wall findings. Lost me a bit on that stuff,” said Asher with a quirky grin.
“We need to call the police,” said Chairman Barnes.
“Whoa, whoa!” said Rineman holding the palms of his hands up to Dr. Barnes. “Let’s not go crazy here.” Rineman looked at the group and then continued, “We don’t want mass hysteria here. Certainly not based upon the hunch of a surgeon who frankly in my opinion, is overworked and overstressed.”
“This whole thing is going too far,” said Barnes staring directly at Rineman. “We need someone with experience in this type of matter involved.”
“We do have someone with experience in this matter Michael,” replied Rineman as he held his arm out in the direction of the attorney. “Our esteemed friend sitting next to you is the head of the most storied law firm in Philadelphia.” Rineman paused to gather his composure. He did not like Barnes’ terminology of “this whole thing.” Once settled he continued saying, “That’s why we invited him to this meeting. Now let’s hear what he has to say about the matter.”
The legal eagle stared at the floor gathering his thoughts. All eyes in the room were upon him. He then spoke in a calculated fashion saying, “Mr. Asher, have any other physician’s or department chairs voiced a similar concern?”
“No” was the response.
“Has there been any known breach into your information system?” was the next question addressed to Asher. “I mean a breach from a computer security standpoint.”
“No” was his response once again.
“I see,” said the attorney, again pausing for effect while formulating his next expensive question. “Can you please explain to us how each physician or medical worker accesses your system?”
“Surely,” said Asher who then proceeded to succinctly summarize the process of logging into the EMR system. A brief tutorial was given regarding the two-step log in process required from outside the confines of the hospital. The crucial role of the authentication token was then explained. Asher kept the terminology simple, yet soon travelled beyond their level of comprehension.
The medical system proxy then spoke again, “The way I see it is that we have a state of the art EMR system that is the gold standard for hospitals around the country. The system has never been knowingly violated. Our I.T. department is top notch and they constantly monitor the system. Our only concern at this point is the belief of one, and only one surgeon, that the entire system is being breached solely for the purpose of harming his patients.” The attorney looked at the party and then asked, “Is that a clear description of the scenario at hand?”
“That’s the way I see it,” said Rineman.
“I would agree,” said Barnes.
“How knowledgeable is Dr. Knight with computers and the EMR?” asked the attorney.
Some subtle chuckles went through the crowd. “No knowledge whatsoever,” said a smiling Asher with a grin on his face. Asher recalled setting up Knight’s home computer system being amazed by the absolute lack of technological savvy displayed by the surgeon.
“Then I agree that we have to proceed slowly here,” replied the attorney. “Very slowly. To release any portion of Knight’s concerns to the press would be poison to the system.” He paused, then spoke again, “I mean Dr. Knight may be a bit over paranoid at this point in time. Allowing his concerns to run out of control would be Armageddon to the PGH system.”
“I fully agree,” said Rineman. “But we do need a plan.”
“Why didn’t he come to us?” asked Barnes still skeptical of the entire situation. “I mean we are his most trusted confidants.”
“Pride, anger, disappointment,” said Rineman. “Take your pick. You know Richard, he is a bit of a rogue. Once he sets sail in a certain direction an unalterable course is usually set.”
“Here is what I recommend,” said the PGH head attorney as he checked the time on his Rolex Day Date Presidential watch. The medical system’s lead attorney then proceeded to formulate a plan in response to the concerns of Mr. Asher. He firstly informed CEO Rineman that several other members of his legal team would need to be involved. Rineman readily consented to this blunt warning of a future financial plunder. Next, he asked Asher to immediately commence electronic and computerized surveillance on all of Dr. Knight’s patients. Asher agreed to personally supervise this task, which sent his mind into a frenzied state of energy. He then requested that all parties in the room meet once a month to discuss the progress of this matter of security.
“All agree?” asked counsel.
“Agree,” said Rineman and Asher.
“Agree with one caveat,” said Barnes. He then looked first at Rineman, then at legal counsel before saying, “That we immediately notify the police if any known unauthorized trespass of the system occurs.”
“Of course,” said counsel. “Dr. Barnes, let me be clear. We aren’t trying to cover up anything. Rather we are making an appropriate response to a concern brought to us by the hospital’s I.T. team. If, at any moment an illegal action is suspected, the authorities will be notified at once.”
Dr. Barnes then agreed to the plan. A brief exchange occurred regarding paralegals and secretaries responsible for lines of communication. Asher assured the team that an internal alarm system would be in affect by one week at the latest. Legal counsel then questioned Rineman on Augusta National and his contacts there. A series of handshakes transpired as the group broke up and headed towards the door. Asher told Rineman to “live long and prosper” but received no Trekkie response to the comment.
“Oh, one more thing,” said Barnes. “What about Dr. Knight? Shouldn’t he be aware of this plan?”
“I was wondering who would ask that question,” said legal.
A brief pause occurred as everyone gathered a measured response to the question. Then, a unanimous decision was made not to alert Dr. Knight of the surveillance plan. The consensus being that Knight was under enough duress at the moment. All agreed that Knight would be made aware of the plan if he ever voiced direct security concerns to either Rineman or Barnes. Then the meeting ended, sending each man in separate directions.
James Asher headed directly to his office to commence his assigned task. By Monday of the following week the entire EMR system, as it related to Dr. Knight, was under his surveillance. Anyone logging into the data of a Knight patient would be tracked with regards to their actions. This included floor nurses, laboratory personnel, interns, residents and ancillary services. All EMR access from outside the hospital setting would also be monitored. Specifically, the access token used to enter the system would be documented alongside any patient care orders given. Lastly, Asher installed sophisticated antiviral software linking the laboratory data on all of Knight’s patients to his personal communication network. This spyware would identify any external corruption attempting to alter the blood work values of Knight’s patients. He specifically adjusted the software to be vigilant in relation to the electrolyte values transported through the system. This tweak of the system was based upon Knight’s original conversation with Asher. The entire system was set to trigger a personal alarm to Asher immediately upon sensing a breach. This included Asher’s work computer, home computer and smart phone. James Asher was the only employee within the I.T. system aware of the settings. It was his brainchild.
Fortunately, for all involved parties, Asher failed to detect any paranormal activity throughout the month of November. The month was marked by a somber mood on the cardiothoracic team. Dr. Knight took three full days off after the death of Katherine McDuff. Considering the fact that he only took one day off for the birth of each of his children, this was a major event. The McDuff name was never again mentioned to Knight directly. However, upon his return the surgical volume remained heavy. The team of Larson and Polk became one of Knight’s favorite combinations and their efficient work was well appreciated by the demanding mentor. Knight never lost sight of the fact that a Philadelphia Chronicle article would hit the newsstand in January of the following year. He remained obsessed with surgical numbers and a soon to be published mortality rate. A cold, surgeon’s mentality allowed him to churn without emotion through a heavy surgical load. Thanksgiving week was marked by a flurry of so called emergency cases. The ramped up volume prompted three surgeries to be performed the Friday after Thanksgiving.
“How was your Thanksgiving,” asked Nurse Frey to Dr. Knight.
“Pathetic,” said Knight as he finished the first case of that Friday morning. “Absolutely pathetic. Another wasted work day for the American laborer.” Knight then looked around at his staff saying, “Thank God we are all back to work. Normalcy has been restored.”
No one dared to interject. The O.R. staff in general was upset about being there that morning. No other surgical rooms were running that Friday morning. A skeleton crew of employees was originally scheduled for the day, which was not open for elective surgery. However a phone call from CEO Rineman mandated duty for the C.T. team that Friday. His reasoning was based on the best interest of the public.
“I love Thanksgiving,” said nurse Frey realizing that her good will with Knight allowed her to speak. “Mmmmm, turkey is my favorite.”
“Why don’t you try the hospital’s turkey dinner,” said Polk as he helped suture close the chest. “That will change your mindset.”
A collection of light laughter followed Polk’s line. Polk knew that Knight appreciated him living downstairs in the hole. It reminded Knight of happier days as a resident himself. Whenever possible he hinted to his current PGH residence in conversation. Over the past month Dr. Polk had solidified his position on Knight’s very short A-list.
