Pennsylvania's Finest, page 25
The following morning was bitterly cold in the city. Despite being New Year’s Eve, there was no festive atmosphere surrounding the PGH family. The death of Helga Cox cast a mournful spell upon the entire surgical department. Phil drew the short straw amongst the interns and was on call that night. Rick Polk was planning on hosting a New Year’s party in his lounge that evening. However the only confirmed guest for the event was Phil himself. Jenna had wanted to attend, but after much discussion declined, in light of the recent events at the hospital. Rick invited a select group of nurses from the floor, but there were no takers.
By noontime, Dr. Barnes had arrived in his PGH office in preparation for the afternoon meeting. Like Dr. Knight, he had suffered through a restless prior evening. He was distraught over not alerting the legal authorities earlier with regards to the whole matter at hand. Like his associate, he had also received heat from his wife, regarding a social event supporting the Bryn Mawr Hospital that evening.
CEO Rineman appeared in his hospital office two hours later. Rineman was unaccustomed to working a holiday, and it felt strange to enter the hospital that day. Absent was the usual hustle and bustle outside the facility. Rineman had slept well through the night, not concerned about the series of events. A true businessman, he was comfortable with the earlier recommendations from the legal department. As a matter of protocol he had documented their advice in a series of internal memos, thus protecting his role in the matter. His wife didn’t care about the meeting, since he was always at some important meeting or affair every night of the week.
Twenty minutes prior to the meeting, the two men met as Dr. Barnes arrived early in the CEO’s office.
“Good afternoon my friend,” said a smiling Rineman to the arriving Barnes. “Plans for tonight?”
“Good afternoon and yes” said Barnes. “Hor d’oeuvres at 5 PM sharp with the wife, otherwise our marriage is in trouble,” said Barnes with a forced smile. “Hopefully the predicted bad weather will hold off until I get home.”
“I agree,” said Rineman as he looked out the window. “From what I hear a nasty storm front is headed into town.” Rineman paused while continuing to peer out the window towards the sky. He then continued, “Tough time for a meeting but we have to hear from Asher with legal present. He didn’t get into town until just recently, and promised to head right over to the hospital.”
Then, at that very moment, James Asher walked into the room. He was disheveled, having just taken a taxi from the airport. In tow was a roller suitcase with a broken rear wheel that rhythmically clicked behind him. Wearing his trademark white socks, the I.T. guru carried a laptop in his right hand.
“Salutations,” was his hello to the team.
Greetings were exchanged and superficial chat occurred regarding the great weather on the West Coast. All three men had a deeper sense of concern about the meeting, albeit at separate levels of gravity. Asher excitedly discussed promising updates to the computer world that he had heard about at the national meeting.
Ten minutes later, legal arrived at the meeting. The figurehead of this entourage again included Rineman’s close personal friend from the downtown firm. However this time he was accompanied by four junior attorneys, each dressed in an obligatory dark suit with conservative shirt and tie. The group of understudies included three males and one female, each billing time and a half in honor of the holiday. A smile was on legal’s face as he shook Rineman’s hand in preparation for the financial plundering about to be performed.
As the grandfather clock within the office chimed three times, there was not a sign of Dr. Knight. No concern arose until fifteen minutes later when legal, in a show of expense, checked his wristwatch directly in front of Rineman. The CEO then went to call Knight on the phone, only to be told by Barnes that he never carried a cell. Rineman then suggested the meeting start without Dr. Knight.
“Gentlemen, thank you for meeting here today,” said Rineman in opening. “We have gathered to discuss a matter of critical importance that has come to our attention.”
Dr. Barnes then spoke saying, “Yes, this is a follow-up meeting to our earlier discussions regarding the possible breach of our computer systems by an unauthorized entity.”
“We have asked our I.T. expert, Mr. James Asher to again be present with regards to this topic,” said Rineman as he looked towards the legal team. “Earlier this week we did experience an apparent illegal entry into our system.”
There was a pause in the room as CEO Rineman looked around at the group slowly. Suddenly the room was very quiet and only the methodical tick of the clock could be heard. Rineman continued with, “This activity was then followed by the sudden and unexpected death of a hospital patient.”
A sudden rustle occurred amongst the pack of attorneys. Several of the younger members were writing down notes on a yellow pad, not daring to speak. The head legal eagle then cleared his throat to speak, and then said, “This violation was picked up by the monitoring system that we agreed to just last month?”
“Yes,” said Asher. “At approximately noontime yesterday, east coast time, my alarm tripped. I was in Los Angeles at the time.”
“What exactly triggered your alarm?” asked the attorney.
“A malware that through a series of corrupt commands entered the blood laboratory pathway of the PGH. This penetration seemingly altered the blood value of a patient within the hospital.”
Again, silence engulfed the room as all eyes were on the head proxy. No one moved in his amen corner behind him. Legal then spoke asking, “Did the blood value involve one of Dr. Knight’s …?”
“Yes,” answered Asher quickly.
“Was it the patient that expired after the infraction?” asked legal.
“I don’t know,” said Asher. “I am unaware as to who died, but I do have the patient’s name whose blood work was altered.”
“What would be that name?” asked legal.
Asher scrolled down on this screen and squinted a bit. He then said, “The patient’s name, or should I say her name, was a Helga Cox.”
“That’s who died,” said Dr. Barnes shaking his head back and forth with a suddenly pale face. “Richard was right. He was right all along.”
Suddenly the door to the room burst open and in walked Dr. Knight. He was wearing a black tuxedo with a bow tie and his cheeks appeared reddened, as if he ran up a few flights of steps. Subdued anger was upon his face, as was an ever so slight stench of vodka on his breath. He approached the group in a frenzied fashion, as if he were already late for another meeting.
“Sorry I’m late,” was Knight’s feinted apology. “Troubles everywhere, what did I miss?”
“We were just discussing with Mr. Asher the recently identified computer intrusion within the hospital,” said Rineman immediately realizing that he had a bull in a china shop.
“You were right Richard,” said Barnes in disgust, “Somebody altered Cox’s labs right before she died.”
CEO Rineman tried to respond but was cut off by the still charging Dr. Knight.
“Of course I was right!” screamed Knight. “I knew it months ago when I talked to this fool from the computer department.” The irate surgeon was pointing directly at Asher when speaking.
“Gentlemen, let’s discuss the facts rationally,” said legal.
“Who the hell are you?” said Knight in anger looking at the group of suits from across the Schuylkill River.
“Richard, take it easy,” said Rineman. “Present besides me are the attorneys who have skillfully represented this institution since I have been chief executive officer.”
“Have they been a part of your little secret society monitoring my patients over time?” said Knight. “The same patients that have been getting murdered right under our noses?”
“Howard, we need to settle this down or I’m afraid this meeting will be adjourned shortly,” said legal.
CEO Rineman then successfully calmed down Dr. Knight for the time being, as he begrudgingly took a seat. As order was restored more detailed questions were presented to James Asher. While Asher responded, Knight listened attentively while staring directly at the floor, not making eye contact with anyone in the room.
“The value that was altered was the potassium level,” said Asher.
“I don’t understand,” said legal. “Please explain to me how someone changing a lab value within a computer system then results in the death of a patient?”
“Its quite obvious now,” said Barnes. “If someone, or should I say some twisted person, decided to change the potassium level of a patient, it would immediately alter their care.” Barnes then looked at Asher asking, “What exactly happened to the potassium level in this case?”
Asher again stared at his computer screen and typed in a series of commands. While scrolling down a column of numbers all eyes in the room were upon him, except Knight’s.
“Here it is,” said Asher. “The true potassium value was 6.1 mEq. The corrupt value which the computer system relayed to the floor was a lower number. Let’s see, that number was 2.3 mEq.”
“Oh my God,” said Barnes. “Oh my God.”
“Explain your concern,” asked legal in a matter of fact fashion.
“Don’t you see?” said Barnes. “A low potassium is no big deal, it won’t kill a person. However, a high potassium level is a medical emergency, it can kill a patient in a matter of minutes if given rapidly.”
Silence again gripped the room as the nonmedical attendees tried to digest the information.
Dr. Barnes then continued, “If a resident identifies an elevated potassium level over the computer, he or she will take actions to lower it, not increase it. However if the information provided identifies a low potassium, then the knee jerk response of the house staff is to pour more potassium into the patient.”
“I see,” said legal. “So in this described scenario a patient with an already elevated potassium level, gets even more potassium pumped into their system by the unsuspecting resident.”
“Exactly,” said Barnes. “Because the resident received the corrupt lab value stating the potassium level as low, instead of high.”
“So the dangerously high potassium level goes even higher,” said Rineman, “Even that is clear to me.”
“Right,” said Barnes. “It will rise rapidly, to a point of triggering a cardiac arrhythmia.”
“Dr. Knight, what are your thoughts?” asked legal.
Knight slowly looked up from the floor and scowled at the group of hospital advocates in front of him. He despised attorneys of all walks of life, regardless of race, color or creed. He looked down again to seemingly gather his thoughts but did not speak.
“Richard, we need your input,” said Rineman. “This is a problem that we all share, not just you.”
“Don’t give me that crap,” said Knight sharply looking up at Rineman. “Someone has been methodically executing my patients over time. This is my problem. A vendetta against me.”
“You’re right,” said Dr. Barnes. “I mean you are correct with the execution terminology. Potassium is what they give prisoners that are executed.”
“What are you talking about?” asked Rineman.
“I’ve had the pleasure, or should I say displeasure of being a former advisor to our northeast regional court system. Our committee was responsible for helping the judges with decisions involving medical matters. One such matter involved the medications used to execute a prisoner.”
“A lethal injection?” asked counsel.
“Exactly,” responded Barnes. “I quickly became an expert on the medicinal cocktail that the state gives a prisoner during an execution.”
“And potassium is in that mixture?” asked legal.
“Yes,” replied Dr. Barnes. “An execution by lethal injection involves three separate medications given sequentially in a particular order. The first drug administered is sodium pentothal, which renders the condemned unconscious. The second medication given is pavulon, which causes whole body muscle paralysis.”
“How are the medications administered?” asked legal.
“Intravenously, directly into the patient’s vein. The medicine is mixed into a liquid solution so the effect is immediate,” said Barnes.
“Where does the potassium come in?” asked Rineman.
“Potassium chloride is the final medication administered intravenously,” said Barnes. “It is actually the one that kills the patient, or should I say prisoner.”
“How does it work and how fast does it take effect?” asked legal again.
“A bolus, or concentrated dose of potassium immediately affects the heart muscle. It disables the heart at the cellular level, making it unable to generate an impulse,” replied Barnes.
“Therefore I’m assuming it cannot pump blood to the body,” said Rineman.
“Exactly,” said Dr. Barnes. “It cripples the heart on a molecular level.”
A pause again overcame the room as everyone tried to gather their thoughts. During this time Dr. Knight stared at the floor, occasionally shaking his head slowly back and forth with a scowl on his face. His right knee bobbed nervously up and down in rapid fashion. He appeared anxious and ready to leave at a moment’s notice.
“Richard!” said Barnes quickly, “It now all makes sense.” Everyone in the room stared at Dr. Barnes. “Remember the pathology report from M & M rounds, nobody could explain the pathologist’s findings regarding the heart musculature. Don’t you see? It was from the potassium overdose!”
“Of course I see,” said Knight with an incredulous stare at his colleague. “As usual you have a keen grasp of the obvious,” was his next slur directed at Barnes. “Thank god you are the department chairman,” was his final vile comment.
Dr. Knight then turned his gaze upon James Asher saying, “Mr. Asher, can we cut to the chase. Will you please tell us who is the culprit of this crime?”
“Not an easy answer,” said an unfazed Asher to the group.
“Why?” asked Knight quickly.
“I can only give you the authentication token that was used by the perpetrator,” replied the I.T. expert.
“I don’t know what that means,” said Knight in a more agitated tone. “Give us a name. With all the technology at your disposal are you telling me you can’t come up with a name?”
“Exactly,” said Asher in defiance. “I can only give you the token that was used.”
“But from what I understand, every token is specifically authorized to a PGH employee,” said Rineman, recalling their earlier meeting.
“Yes,” said Asher. “Each employee is administered an exact token, which is used to securely and legally enter the system.” He paused before continuing in a lower and more professorial tone saying, “The system is secure, with the assumption that the token not be shared with others, who also have knowledge of the physician’s password. This has been a strong warning our department has made clear from the beginning.”
“Just give us a name to the token,” rumbled Knight. “Do you think we are playing games here? Somebody is killing my patients, and may be doing it again as we speak.”
“All right,” said Asher with a look of disgust at Dr. Knight. He shook his head slowly back and forth to nonverbally voice his disdain for the CT surgeon. Then, as if savoring the moment, he spoke again, while staring directly at Knight, “The authentication code used to violate the system was your token doctor. It was the token administered to one Dr. Richard Knight, from the Department of Surgery.”
Knight only paused momentarily before speaking with an incredulous tone, “What are you talking about? I don’t even know what the hell a token is.”
“You have a token,” said Asher. “Its under your name. That was the token used to alter the potassium value.”
“Are you insane?” said Knight standing up in front of the physically slight I.T. master. “Are you suggesting I’m killing my own patients?”
“No he isn’t Richard,” said Rineman standing up and walking around the desk. He was trying to ease Dr. Knight who appeared to be one step away from assaulting Asher.
“Richard, calm down,” said Dr. Barnes while also standing up. “Of course you are not the perpetrator, but someone is obviously using your token to enter the system.”
