Chapter Thirty Luisa Angelhart
Chapter Thirty
Luisa Angelhart
Luisa insisted on driving to Honor House Cave Creek. She didn’t want Nate with her, but there really wasn’t a better option.
He’d made the connection to Jim Novak.
They drove onto the grounds, which, though not gated, had ample security cameras, and the building itself was secure. A sprawling
one-story structure that blended in well with the desert environment. Lu had read up about the facility. They specialized
in thirty-, sixty-, and ninety-day drug and alcohol rehab programs for veterans only. They transitioned homeless vets who
had successfully completed the program into one of the other Honor House facilities until they were fully back on their feet.
A doctor was on-site 24/7 as well as many nurses, orderlies, and counselors. The difference with this facility was that the
individual had to commit themselves for a minimum of thirty days; they couldn’t just leave because detox became difficult.
Lu thought the quiet, peaceful environment lent itself to healing.
She didn’t talk much to Nate during the forty-minute drive from Tess’s house. She had nothing to say. Fortunately, he kicked back in the passenger seat and closed his eyes so she didn’t have to shut down any small talk.
Once they were allowed inside, a nurse—Peggy Vargas—came to talk to them. The first thing she said was that they wouldn’t
be allowed to see Jim today. He was getting a complete physical, followed by a two-hour IV treatment for dehydration and malnutrition.
“But, Mr. Lorenzo, I talked to the night nurse and she told me what you did to get Mr. Novak here, and I’m sure Mr. Novak
would like to see you. If the doctor clears it, we can arrange a meeting in the morning.”
“Were you able to get his medical records from the VA?” Luisa asked.
Peggy hesitated, then said, “No, we haven’t. Both the head of admitting and I have been working on it, but they claim there
are no records for him. I suppose it’s possible he has never been in the facility, but highly unlikely considering the injuries
he sustained that led to his discharge from the Navy.”
“He had an appointment there Monday,” Luisa said. After working through the worm she’d installed and talking to Dr. Pierce
again last night, she had some knowledge about how electronic health records were handled. “How can a record just disappear?”
“It can’t. Sometimes a record may be accidentally altered—an encounter deleted—but it will show up in a records audit. There
would also be a record to audit! But there appears to be nothing for Jim Novak. Fortunately, he had his VA card and identification in his
wallet. There’s probably a logical explanation, such as a transposed number or letter. We’ll get it straightened out, I’m
sure.”
“Can a record be deleted?”
“No. Well, except . . . but no.”
Lu’s instincts twitched. “Except what?” she pushed.
“Well, it’s the only explanation I can think of, but it would be difficult and doesn’t make much sense in this case. I don’t want to make assumptions that might get someone in trouble.”
“Run it by us,” Nate said, using his most charming smile. “We’re not going to get anyone in trouble, but Lieutenant Commander
Novak needs his records. We want him to get healthy, and not go down the same path I got him off of last night.”
Peggy, an attractive brunette of at least fifty-five, fluttered her eyelashes and smiled shyly. Lu resisted the urge to roll
her eyes or punch Nate. Everyone loved him. The strong, silent former sailor with the dreamy brown eyes.
Not dreamy. Boring, bland brown eyes.
“It’s near impossible to delete a record, and there would actually be a record of the deletion. But—and I’m just making a
guess here—someone could merge two records.”
Luisa’s instincts did more than twitch, they jumped. This was it. This was why she kept running into a brick wall in the VA
data.
“How?” she asked.
“The medical records department are the only ones who can actually delete anything of importance. Some nurses, like the charge
nurse or a nurse in the IT division, can delete something added in error, or an encounter that was coded wrong, things like
that, but only the medical records department can delete anything permanently. Still, if the entire record was deleted, there
would still be a note in the system and, theoretically, the chart can be rebuilt using archived data. But if a patient’s record
is merged with another patient, then it’s as if that first patient doesn’t exist at all in the system.”
“Why would anyone do that?” Nate asked.
“Take Mr. Novak. His name is James Charles Novak. That’s on all his official records, that’s the name he enlisted under, it’s the name we’re going to have for him, though we might include a nickname of ‘Jim.’ But maybe he goes to a clinic after he separates from the Navy and he’s having issues like he had last night, and tells the nurse he’s Jim.
Doesn’t give his full name, is uncommunicative.
She’ll create a record for Jim Novak, and later medical records or the charge nurse will do research and based on a variety of data, hopefully find his actual medical records.
This new encounter with ‘Jim’ would be merged with his official records and ‘Jim’ would cease to exist in the system. ”
“Is there an approval process?” Nate asked. “I know in the military, redundancy is built into the system and you don’t do
anything without orders.”
“No, not that I know of, but not anyone can merge records. Only the medical records office, and I can’t see why they would
do it without a reason.”
Lu knew the reason: money. If someone unscrupulous worked in the medical records department, they might have been bribed to
merge records to “delete” Jim Novak.
“Can we find out what records have been merged in the last week?” she asked.
“That’s very specific,” Peggy said.
The nurse was getting suspicious, and Nate said, “On Monday, we know that Jim went to the VA hospital and met with a nurse
practitioner, Liz Swanson. She called our firm because she was suspicious that something odd had happened to his medical file.
She said specifically that a year in his chart was missing. She suspected someone deleted the encounters, because she saw
there was a hole, or a note that wasn’t attached to a specific encounter.”
Luisa was surprised at how easily Nate picked up the nurse’s own jargon. She tried not to be impressed.
Nate continued. “She went back to research the file at the end of the day, and it was gone. She had just seen the patient. What would she do at that point?”
“Call Medical Records with an IT request,” the nurse said automatically.
Lu knew in her gut that was exactly what happened. She called Medical Records and that was why someone knew she was looking
at Jim Novak’s file.
They were covering their ass. They’d killed two people to cover their ass.
She was angry.
“Can you explain the merge process?” Lu asked. “Like, do they need a similar patient file? Or can they merge with anyone?”
“Well, technically, they can merge with anyone, but there would be a lot of red flags if a forty-year-old male was merged
with a seventy-year-old female.”
“If you were going to merge records because you wanted to hide a patient’s file, how would you do that?”
At first, Peggy didn’t want to answer, but Nate said, “It would really help us out, and help Jim.”
She softened. “Well, I don’t spend a lot of time thinking about ways to get around the system, but if I wanted to make a record
disappear as completely as possible, I would merge it with a recently deceased individual with the same basic characteristics
as the patient so that there would be no red flags during an audit.”
“And what would that look like in the system?” Nate pressed.
“All the encounters for the two patients would be on one record. The patient who is merged into the deceased record would, for all intents and purposes, cease to exist. His name, address, birth date, would be converted to the original record, but there would be a list of encounters with him merged with the records of the deceased. It would be near impossible to know which encounter was for which individual, even if you were able to find out the records used.”
“And it can’t be done accidentally?” Nate asked.
“Absolutely not.”
“And only someone in Medical Records can do this?” Luisa confirmed.
“Yes.
“This is very helpful,” Nate said. “Thank you. We’ll be back tomorrow to talk to Jim.”
They walked out.
“Medical Records,” Lu said. “You drive—I need my computer.”
“What are you going to do?”
“You don’t want to know.”
“Maybe I do.”
“Maybe I don’t want to tell you.”
Nate grinned at her and she ignored him as she pulled out her laptop and logged into the program she had running in the background
of the VA network.