The Good Nurse: A True Story of Medicine, Madness, and Murder (18 page)

26

July 8, 2003

T
he conference call with the Somerset Medical administrators was set for nine o’clock, pushed by increasingly heated calls from the New Jersey Poison Control director.
¹
This was Somerset risk manager Mary Lund’s second call with Dr. Steven Marcus; the first conversation hadn’t gone so well. This time, it was her bosses’ turn to catch a direct blast.

“You see, my problem here is that you’ve put us in a… a ticklish bind,” Marcus boomed over the conference room speaker. “And that’s why my comment to you last night was that—look. If there is somebody out there, that is
purposely
doing this to individuals at your hospital, we have a
legal obligation
to report it!”

“Um, okay…,” Cors said.

“And not just as an adverse drug reaction!” Marcus continued, working himself up. “I mean, this is a forensic thing. And I sure as heck don’t want to get involved in—get caught with my pants down, like they did on Long Island a few years ago. Or Michigan, you know, five or ten years ago, when they had somebody that was going around, doing in patients!”

Marcus’s blunt language seemed to have stunned the room. Several awkward seconds passed before Lund filled the gap.

“We’re listening to you,” she said finally. “We do understand your concerns. And as I said yesterday, we’re struggling with these same questions and what our responses need to be.”

Now Ruck jumped in. “And there’s supposedly two other patients with very strange glucoses, as well?”

“Um, yes. I think
Nancy
discussed these with you?”

Ruck had promised Nancy Doherty that he would protect her, and so instead of giving up his source, Ruck answered Lund’s question with
a question, one he already knew the answer to. “Did you guys ever run C-peps and insulin levels and all that on these patients?”

Again, there was a protracted silence. Ruck had asked the critical question. The C-pep tests would have indicated whether the insulin in their patients had come from their own bodies, or from some other, outside source. If it was an outside source, they obviously had a real problem.

Finally, Cors and Lund both answered, barely audible:

“Yeah.”

“Yep.”

“And…?” Ruck led.

Silence.

“Um, did they come back in correlation?”

“Yes,” Lund said finally. “They did.”

“Well,” Cors began, “the endocrinologist on the case… he, um, felt that, um… at least in one of the cases… um…. I’m trying to remember which one, I don’t have the charts just right in front of me, but um… he would be hard-pressed to explain what happened to the patient, absent an….” Cors paused to think, then finally remembered the word he was looking for. “… an
exogenous
source of influence.”

“Well, hey!” Marcus said. Cors had said it. Their own physicians had concluded that someone must have injected these patients with overdose levels of the drug. “That—yeah, that is our worry about this
whole thing
!” Marcus boomed. “Because my gut feeling is that, they’re all victims of the same thing!”

“Well, we have gut feelings, too,” Cors admitted. “And what we’re wrestling with is, um, you know, throwing the whole institution into chaos, versus, you know, our responsibility to, you know, to keep patients from further harm. And, um, that’s what, that’s what we’re, that’s what we’re wrestling with, right now.”

The Poison Control end of the line was silent, waiting to know the outcome of Cors’s wrestling.

Finally, Cors continued. “We have been trying to investigate this. To get some more information before we made any kind of rush to, you know—judgment. Part of that investigation involves an expert opinion. Which we solicited from you. And now puts you in an unfortunate position.”

“Yeah!” Marcus snorted. “You see, the problem is that in
every single report
like this in the literature in years gone by, there was
significant delay
in the hospitals instituting any sort of a legal investigation. You know, physicians—I don’t care how good your background is, they are really infamously poor at doing forensic investigation. And, the problem, in the past, has always been that somebody then moves on—and, and, you have trouble tracking them.”

“Yeah,” Cors said. “Who does do good forensic investigation?”

“This is a police matter,” Ruck blurted. He’s said it a half dozen times over the past two days.

“Yes, it’s a police matter,” Marcus said.

“Um, oh-kay,” Cors said.

“Okay, I mean, quite honestly,” Marcus said, “if you
don’t
report it to the police, and
somebody else
dies, and then it comes up that you
stonewalled
it—you’re really going to look terrible!”

“Well, oh-kay.” Cors chuckled. “We’re looking at protecting
patients
.”

“No no, no,” Marcus said. “Obviously I’m concerned in protecting all of the patients in your hospital as well. But I’m also concerned that, that we’ll all be caught with our pants down, and we’ll all look like morons!”

Cors listened, then cleared his throat. “One of the reasons we called you was to determine if there’s really any further benefit, at this point, with you coming in and taking a look, um, through the, the actual records,” he said. “And, maybe we should defer… maybe what we should do is maybe kind of,
end this call
at this point, so that we can confer with our legal counsel and, uh, get some advice—just lay out all the facts and, um, make sure we do the… right thing.”

Marcus sighed wearily. “Well I…. sure. We’d be more than happy to come look at it. My gut reaction, having been doing this for, you know, a number of years, being involved with the police investigation of several, other…
situations
over the last twenty years, is that, yeah, you need to get your legal people on board—but I would
not waste time
.”

Marcus knew of several cases in which hospital staff members had poisoned patients, some in the literature, others that he had worked on personally. They called these killers Angels of Death. All of those cases shared a simple but disturbing pattern; each time, the doctors treated the rash of crashing patients like a disease to be studied, while the administration and the lawyers treated them as a potential lawsuit. The institution dragged its feet before calling in the cops. And while they dragged, people died. That was the pattern he saw repeating itself at Somerset.

“I would make sure you go to the authorities, and make sure that they know that there is this question. And then it’s in their hands, and if they decide not to do anything, then that’s their problem.”

“Oh, I understand,” Cors said. He sounded tired of being scolded, and ready to end the call.

“We
do
hear you,” Lund added.

“And also including the Department of Health!” Ruck reminded them.

“I mean, this is certainly a sentinel event,” Marcus said.
²
He knew the effect of those words on a hospital administrator. A sentinel event is any event in which patient safety is threatened. Marcus had thrown the gauntlet; by law, Somerset had to report such an event to authorities. “They need to know about it,” Marcus added.

“All right,” Lund said… finally, using the singsong tone that signals the end of a phone call.

“Well, we surely appreciate your input,” Cors said. “And, we will, um, indeed get back to you… so… you’ll hear from us one way or the other…”

“Hopefully it was nothing,
inappropriate
,” Ruck said, trying to lighten the murder thing, keep them moving. “Hopefully just an error or whatever.”

“I know!” Cors said. “I just wish somebody would come forward and say, ‘Hey, I screwed up.’ I’d sleep a lot better.”

“Well, you’ve got two patients with dig and two patients with insulin,” Marcus said. “That doesn’t sound to me like it’s going to be a simple screwup.”

B
ruce Ruck knew he was pushing his luck, especially after the bomb Dr. Marcus let off at with the last call, but he needed to check on Nancy. He dialed the number for the Somerset Medical Center pharmacy again, figuring if he got Vigdor, he’d make something up. A female voice answered on the second ring. This time, he didn’t identify himself.

“Hey,” Ruck said. “I’m trying to get in touch with Nancy—”

“Yeah hold on, she’s right here.” The phone at the other end was muffled. “That’s for you.”

“Nancy Doherty, can I help you?”

“Nancy, it’s Bruce.”

“Um, hi,” Nancy said quickly.

“Look,” Bruce said.“I know you can’t talk about the case, and that’s fine…”

“Um-hmm,” Nancy said.

“Nancy,” Bruce said, “the only thing I want to tell you is, if they’re going to try and get you in trouble in any shape or form…”

“Um-huh.”

“The medical director, he and I have talked about it. We will back you five hundred percent, ’cause you did nothing wrong.”

“Okay,” Nancy said.

“Are they giving you a hard time?”

“Ah, there’s some…” Nancy picked her words. “There’s a lot of…
issues
. Floating around…”

“Okay.”

“A
lot
of issues,” she said. “Floating around.”

“Okay,” Bruce said. “But Nancy, Nancy.”

“Yeah?”

“You did nothing wrong.”

“Yeah.”

“And that’s why him and I sat down and discussed it.”

Nancy sounded like she was trying hard to keep it together. “Okay…”

“Because if, God forbid, Nancy, if they try to do anything to you, professionally?”

“Yeah?”

“We will one hundred and fifty
percent
back you up.”

“Okay.”

“I put it together,” Bruce said. “You? You just called for information.”

“Yeah.”

“On how to increase dig levels, or whatever.”

“Okay,” Nancy said. She sounded grateful at Ruck helping her, getting the story straight.

“You should
not
take the brunt.”

“I really appreciate that,” Nancy said. “I do.”

“You know,” Bruce said.

“Yeah,” Nancy sighed. She sounded on the edge of tears. “You don’t know how much that means to hear you say that right now.”
³

T
here would be only one more conference call between Dr. Marcus at Poison Control and the Somerset Medical Center administration. Again,
Marcus told the Somerset administrators in no uncertain terms that they were obligated to report these incidents to the state within twenty-four hours of their occurrence, and they were already out of compliance with their obligations. And again, Marcus was told by Somerset that until they’d mounted a thorough investigation, they were not planning on reporting them to anyone: not the New Jersey Department of Health and Senior Services (commonly known as the DOH), and not the police.
⁴

But this second conversation differed from the first in two crucial aspects. The first was raw volume, most of it from Dr. Marcus. He was, in his own words, “extremely concerned” and “frustrated”; “rude, confrontational, and adversarial in his dealings with Somerset Medical Center employees,” was how Dr. Cors would later characterize Marcus’s phone manner. The poison control director was furious and unmuzzled. He loudly protested that this was a police matter, a matter of patient safety. He gave them twenty-four hours; if Somerset refused to act, Marcus had an obligation to report their problem to the DOH, personally, and he added that it would “look a lot worse if I do it.”

In fact, Marcus had already reported the issues at Somerset.
⁵
Earlier that afternoon he’d called Eddy Bresnitz, MD, the state epidemiologist and assistant commissioner of the DOH, pulling him out of a meeting. Marcus would recall
⁶
telling Dr. Bresnitz of “a cluster of illnesses in the hospital in the state which may be based on a criminal act.” He then dashed off an e-mail to Amie Thornton, the assistant commissioner of health, summarizing both “what appears to be a cluster of four untoward clinical events” at the hospital,
⁷
and Somerset’s unwillingness to report them until after they mounted a thorough investigation themselves.
⁸