Chapter Eighteen
A bout forty minutes later, Lee dismounted at the ED entrance and handed the helmet back to Randy. Staff was already transferring Nick from the sled to a gurney.
Maverick’s shoulders drooped as he glanced her way. The sun had set and twilight cast his face in shadows. “I’m headed over to the ambulance garage to water the dogs.”
“I’ll see if folks need help in the ED,” she said, handing him the satellite phone.
“Should I wait for you?” His voice was as flat as the low ambient light around them.
“No. Take care of the babies. I’ll get a ride back later.”
“Sure.” He shook his head. “We were done anyway.” He grasped Kenai’s neckline and slowly trudged across the parking lot with the team and the attached sled.
Her chest ached at the sight of this rugged man, believing that his dreams had been broken in a matter of moments. For a person who fixed problems for a living, she didn’t have an answer to this situation.
As staff wheeled Nick into the building, Lee followed, turning sideways to sneak in the sliding doors. No staff badge on her today.
The doors closed on Randy’s big, gaping mouth. He could stay outside for all she cared. Or he could sit in the waiting area and think about new ways to be a jerk.
She gritted her teeth.
Lee needed to change clothes and assist in the ED. When she had spoken with Amberlyn before leaving the accident site, it sounded like the on-call doc, Paul, was busy with a difficult labor and likely couldn’t break away.
Snagging a generic staff badge from the HUC, she headed into the locker room, shucked off the winter gear, and pulled on fresh scrubs. Thank goodness she kept an extra pair of labor shoes in her locker. The fit of her thick wool-socked feet into the well-worn Danskos was tight, but it worked. Without a hat on, her hair stood up in strange angles, and so she snagged a patterned cloth bouffant cap and shoved all of her hair beneath it.
Shrugging into her lab coat and looping her stethoscope over her neck, she entered the first trauma bay. Lee reviewed the nursing initial assessment. Vitals were all stable. Neuro status reassuring. That was a great start.
“Let’s not move him too much until imaging is done.” She and the nurses unstrapped Nick and eased his arms out of the coat and fleece and unzipped the sides of his snow pants, stopping to remove the SAM splint on the lower leg before replacing it over his base thermal underwear layer. Then they carefully rolled him, allowing Lee to do a proper spine palpation. The nurses eased the garments out from under him with an impressive lack of jostling.
However, that small movement must have hurt. “I need something for my pain!” Nick hollered. “Please! This leg is killing me.”
Fair enough. A broken leg was miserable. “Amberlyn, please place an IV. Let’s give five milligrams of morphine IV. Can you pull rainbow labs?” Rainbow labs meant filling one of every color blood tube to have on hand until Lee knew which orders she wanted. For certain, she would run a tox screen and blood-alcohol level, which could contain key information if litigation occurred. If the lab was drawn after administering morphine, it could result in a false positive flag for opiates. Lee wanted accurate information today. Everything by the books. Nick’s health depended on it.
Maverick’s future depended on it.
“Got the blood.” Amberlyn handed the tubes to the waiting lab tech who stuck labels on and left. Then Amberlyn pushed the morphine dose through the IV hub.
Lee said, “I’d like a CT, head to butt, for a stat tele-radiology read. And an x-ray of that leg.” With Nick’s coat and fleece jacket and snow pants removed, it was easier for her to do a more in-depth exam.
She listened again with her stethoscope. Good air movement in the lungs and a regular heart rate without any rubs to indicate traumatic pericardial effusion. She also pressed on his shoulders, arms, abdomen, and pelvis. No pain.
Then Nick’s breathing sped up.
He waved his hand. “Hey, wait. Did you say CT? Is that the donut thing?” His pitch rose. “I’m claustrophobic. I can’t go in there! I can’t breathe in it!” He clawed at his neck and waved off nursing attempts to hold still as he thrashed. “Where’s Randy? This wasn’t part of the deal.”
Oh boy.
Lee had a choice. Get inadequate imaging and be unable to rule out major internal, spine, or head injuries. Or give a strong antianxiety medication, recognizing that if he had a head injury, it would be difficult to obtain accurate neurologic status assessments.
The twenty-something-year-old patient wailed and thrashed, sitting up on the bed, moving nurses along with him. Looked neurologically intact from here.
Risks versus benefits. “Two milligrams of Versed, please, Amberlyn.”
Within a few minutes of receiving the medication, Nick began to relax, and his breathing evened out. Vitals remained stable.
The nurses and radiology tech wheeled Nick back for imaging, while Lee sat in the work area to chart, draping her white coat on the back of the chair.
Where was the on-call doc, Paul? She called out to labor and delivery only to find out that he was considering a vacuum-assisted delivery, with the OR crew en route for possible C-section if the vacuum wasn’t successful. Nope, he wasn’t coming to the ED anytime soon.
She refreshed the chart on the screen. No uploaded films yet. Lee stared toward the double doors to the waiting area. As much as she disliked Randy, she should give him a quick update. He was probably worried about his nephew.
As she approached the waiting area, she spied him on the phone, pacing. Late afternoon, on this Saturday, only a few visitors drifted in and out through the main entrance doors.
“As long as Nick plays along, we’re golden. Uh-huh. This is gonna be money. Literally.” He glanced at her and continued to walk and talk. Nothing about his expression suggested that he recognized her.
Because she looked like any generic healthcare worker in the same scrubs and surgical cap as everyone else.
Back at the house and on the trail, he hadn’t seen her face.
Mav had implied that she was an EMT. Not a hospital worker.
There was no receptionist on duty this Saturday to identify her. She considered the ring-bell-for-nurse sign next to the ED registration desk, close to where Randy paced.
Lee’s heart jumped, but she ducked her head and walked with purpose through the waiting area to the empty nurse triage room and sat at the desk like she worked there.
Activating the intercom button, she listened intently. Randy’s voice drifted back to her. “Yeah, with the lawsuit, we’re going to get it this time. When I’m done, it’ll be pennies on the dollar. From there on out, it’ll be pure profit.”
A wave of ice worked through her veins. No way. Lee must have misheard. Must be imagining a connection.
They couldn’t have faked the injury for litigation. Keeping the intercom open so that she could hear the conversation, she did her best triage nurse impression and acted like this room was her entire job. She logged into the computer on the desk and moved the mouse around. Then she pulled up the x-ray. Yep. Midshaft tibial fracture. Nothing fake about that finding.
“Oh, he’ll be fine.” Randy’s voice came though the intercom.
He was one of those people who didn’t realize how loudly they were talking or didn’t care because they thought that it made them sound important. Too bad she would use his loud mouth to her advantage.
“It was more damage than we planned, but that’s even better.” He paused and sniffed. “Sure, we’ll give him a little extra for his trouble. Nick’s my nephew. I’ll make it his birthday gift.”
Lee studied the ceiling at the fisheye that hid the security camera for the small room in which she sat. There was at least one camera in every area of the hospital, recording images and audio 24/7. Even in the waiting room. Could she request footage? Or record Randy?
Doing so might be a crime.
Thanks to her ex’s false claim against her to her previous employer, Lee had next-level knowledge regarding patient privacy law. In Georgia, digital images with security cameras could be recorded, but it was a felony to record a private conversation in a private place. There was a recent case involving a hospital where the court interpreted that felony to include recordings of private conversations on medical facility premises.
Problem was, Lee didn’t know Alaska’s law, and now wasn’t the time for legal research.
If she obtained any sort of recording of Randy and it was a crime in this state, she risked being charged with a felony and the evidence thrown out. Also, doctors convicted of a felony couldn’t participate in Medicare and state Medicaid programs and couldn’t obtain hospital privileges, which would effectively end her ability to work as a physician.
She froze, heart hammering beneath her ribs.
Flashbacks of being called up to the chief medical officer’s office back in Georgia, along with the HR director, and the hospital’s CEO raced through her mind. She hadn’t done anything wrong then, and still Preston had almost gotten her fired because of the HIPAA violation claim.
She walked a tightrope without a net here in Yukon Valley. If she ran afoul of HIPAA law, there would be no do-overs. No more locums assignments. No income.
Over the intercom, Randy kept bragging.
God, she hated bullies.
But she needed her job.
Damn it.
Her palms sweated. So. What could she do that was legal?
Lee sat up straighter and looked at the answer right in front of her on the computer screen. The medical record.
She was the treating physician. She could document into the medical record any information regarding her patient that pertained to the condition being treated.
Documenting a history of present illness complete with relevant quotes from the patient or others who were present during the injury wasn’t a crime. Lee grinned, even as adrenaline zipped heated jolts through her. Careful documentation was not a crime at all—it was part of thorough medical care.
Hate to miss any details that could help my patient, right?
Nearly breathless with her plan, Lee pressed a finger to her lips and listened in as Randy continued his conversation. The topic had changed to travel logistics down to Anchorage. She took in a few slow breaths, waiting for him to cycle back to Nick’s part in the scam.
If she recorded damning information in the patient chart, then what?
Nothing that could harm her but also nothing she could share . Legally, she could not pass along her knowledge that the patient was going to sue Maverick. Doing so would violate HIPAA.
Lee knew those HIPAA rules far too well. Only the staff who were officially assigned to care for Nick could discuss details of his case without his explicit permission. No other healthcare worker was allowed to access the chart. Including Maverick, because he was not acting as an official EMS provider.
She drummed her fingers on the laminate tabletop. However.
If Randy’s lawsuit went forward, its success would hinge on the medical record. Any mention of an injury depended on the doctor’s exam as evidence. Sometimes even a doctor’s testimony in court. She knew that fact from working on patients’ disability claims over the years.
Her palms sweated.
She had to remain objective. First and foremost, she had to care for her patient and make sound clinical assessments and provide high-quality care. His health came first. She double-checked the CT images. Not ready to view yet.
Time to return to the chart documentation basics. She smiled to herself. Intro to Clinical Practice, first year of medical school, day one—history of present illness.
Lee would take a complete history from her patient. Very complete. She would document his responses to her medical questions in the chart. As a physician caring for a trauma victim, she should add pertinent clinical information relevant to this patient’s case.
Pertinent clinical information, such as direct quotes from other witnesses regarding the accident. Mitigating factors.
Factual statements could help better understand what led up to the accident. The mechanism of injury. The mental state of the patient and those around him. This entire process was just Lee being a thorough physician, really.
Out in the waiting area, Randy continued talking, voice lower but still coming through the intercom perfectly. He’d circled back to his original bragging, as she suspected he eventually would do. “Yeah, this is great news. We’re so close, I can almost taste it.”
Lee picked up a scrap piece of paper and a pen.