“Malpractice!” Dr. Brown, clearly shocked, put down the letter, her hand pressed against her chest.
Annie said, “I’ve heard the term used in the newspapers…usually hinting that the doctor had performed an illegal…I mean…”
“No need to mince words. It usually means an abortion,” Dr Brown said, frowning angrily.
“But that can’t possibly be what he means, could it?” Annie replied quickly, not wanting to have offended the doctor.
“Of course not. The dispensary would be closed down in a second if there were the slightest hint we were engaged in that sort of illegal act. The poor woman had ovarian cysts that were retaining so much fluid that she did look as if she were in a gravid state, but Phoebe Truscott was certainly not pregnant, and we did not perform an abortion.”
“Could her husband have actually thought this is what occurred?”
“Good heavens, no! I went over the diagnosis and why we recommended surgery in great detail with both Phoebe and her husband. As did Dr. Harry Granger, Phoebe Truscott’s regular physician. We had been very conservative in our treatment prior to that recommendation. We had her come in multiple times over the previous year so we could express the fluid from the cysts multiple times. But the cysts were growing so aggressively at the end that surgery was the only remaining option. I ended up having to take out the left ovary, it was so diseased.”
“You did the surgery?”
“Yes, although Dr. Granger and several other of our consulting physicians were present.”
“And Mr. Truscott couldn’t have misunderstood what you were doing?” Annie picked up the letter, looking at the exact wording he had used.
Dr. Brown frowned and said, “I can’t believe he could. Although patients, and their loved ones, often only hear what they want to hear when you are explaining something to them. But Mr. Truscott appeared to be an intelligent and rational man. In addition, when his wife left the dispensary, he was effusive in his thanks to us for the care we had taken with her.”
“So this operation wasn’t done without his agreement?”
Annie could imagine a case where a wife might make a decision about her health that went against her husband’s wishes and the husband subsequently lashing out at the doctors and refusing to pay the bill.
“No, no, he was completely behind the decision,” Dr. Brown said with conviction. “He came with Phoebe for each of the initial procedures and appeared to support his wife when she begged for us to do the surgery and not just do another expression.”
“Is there any way of proving that they both understood exactly what was going to happen in the surgery?”
“Absolutely. When we opened the Pacific Dispensary for Women and Children, I insisted that we have a document that a patient—and a relative if appropriate—needed to sign before admission. In the case of a surgical procedure, the document lists the reasons for the operation, the kind of steps we have taken leading up to surgery, the steps we expect to take during the surgery, and our estimation of what kind of aftercare will be required. This document spells out the possible risks that are always associated with this kind of surgery and includes a statement that the dispensary and attending staff will not be liable for any problems that might occur from the operation or aftercare. We also include an estimate of the costs of the procedure and aftercare.”
Annie felt enormous relief hearing this. She said, “And the Truscotts…both of them…signed this document?”
“Oh, yes. I wouldn’t have gone forward with the operation if they hadn’t. The document will be in our medical files, downstairs, and I can assure you those files are in good shape, not like the files in this office. In medical school, my professor of surgery not only encouraged us to follow this practice, but gave us a sample document that I have used as well in my own practice. You would have signed one before I took you on as an obstetric patient. I have insisted that any doctor affiliated with the dispensary use it as well if they perform operations here.”
“I am impressed. No wonder you didn’t hesitate to sign the documents I showed you this morning,” Annie said.
At Nate’s urging, Annie had made a practice of having a similar document prepared for clients to sign that covered her for any liability connected with her auditing or financial advisory activities. In addition, she’d brought a similar document that covered Nate’s legal services, since she had anticipated that the dispensary might need him to compose letters for Annie to send out to people regarding their bills. She now understood why Dr. Brown had needed little explanation before signing both of these documents this morning.
Picking up Truscott’s letter again and rereading the final sentences, Annie said, “So, if Mr. Truscott isn’t referencing an abortion, what do you think he meant by saying that he would sue the dispensary for malpractice?”
“I can’t say without examining Mrs. Truscott. I am concerned that his wife might be experiencing some sort of infection.”
“Would this be likely to be associated with the effects of the surgery?” Annie asked.
“Unfortunately, it might,” the doctor replied. “Any time you cut into a person’s body, there is the possibility of infection. I’m sure you’ve read some of the recent newspaper articles that have reported that the death of poor President Garfield was not due to the assassin’s bullet, but to the system-wide infection he developed from the multiple attempts to probe his wound to remove that bullet.”
Like most Americans, Annie had followed the sad story of how the president’s body had become riddled with infection over the seventy-nine days between the assassination attempt and his ultimate death. And she had personal experience with the ravages an internal infection could cause, as well. Soon after her first husband died, she had helped take care of one of his relatives, who was suffering a painful infection she had contracted in childbirth.
Thinking of this experience, she said, “I hope that infection from the surgery was one of those risks mentioned in the document you had the Truscotts sign.”
Dr. Brown said, decisively, “Yes, yes, in some detail. In fact, there had been some signs of infection immediately after surgery, which is not at all unusual. However, we were successful in combating the infection and only sent her home after she showed all the signs of a complete recovery.”
“But the infection could return?” Annie asked.
“Yes, unfortunately, it could. I personally told Mrs. Truscott that she should let us know immediately if she experienced any sort of abdominal pain or fever, because it’s not unknown for there to be a recurrence of infection up to as much as twelve months after this sort of surgery. It’s also possible Mrs. Truscott could be developing some new cysts. We didn’t see any problems with the right ovary, so we left it in. However, that doesn’t mean conditions haven’t changed since November when we operated. I don’t know why we weren’t alerted as soon as she began to have difficulties.”
Annie really needed to have Nate go over the document the Truscotts had signed, make sure the dispensary really was covered, legally. She didn’t know if he had ever dealt with a malpractice suit, so she didn’t know how much work this would entail. When she had volunteered his services, she didn’t think he would need to do anything more complicated than write a letter to get someone to pay their bill.
Annie asked, “Is it possible that Richard Truscott is in financial difficulty?”
Dr. Brown shook her head slowly, saying, “I have trouble believing that’s what is happening. First of all, it was my impression that Phoebe Truscott is the one with the money, and it was my understanding that she was quite wealthy. The operation and aftercare were costly, but neither of them ever expressed any hesitation about the fees.”
Dr. Brown got up and began to pace around the small office. “If she is indeed ill, why didn’t she notify us?”
Annie said, “Sometimes a person’s finances aren’t exactly what they seem, so we do need to keep in mind that this might be a possibility. Perhaps Richard Truscott thinks if he threatens the dispensary he can get some money out of you or maybe free medical care for his wife in compensation? In the letter, Truscott doesn’t say he will take legal action but that he might have to take action. That sounds suspiciously like he wants something from you in return for not going through with the threatened suit.”
“Why would he feel he had to extort help from us? Even if for some reason they couldn’t pay for our services, we would still take care of her and find some way for them to pay the bills off over time. Wouldn’t be the first time we have made some financial accommodations for patients. And if Mrs. Truscott contacted Dr. Granger, the doctor who referred her to us, I can’t believe he wouldn’t have told me if he knew she was in difficulty. It’s so very strange.”
Dr. Brown came and sat back down, again looking at the letter as if it held some explanation.
“And this Dr. Granger hasn’t mentioned anything?” Annie said.
“No. He is our chief consulting physician, and he was here checking on a patient just last week,” the doctor replied. “Oh, Mrs. Dawson, I really don’t know if I should still go tomorrow. Lucy Wanzer could make the trip without me.”
“What exactly could you do if you stayed?” Annie said. “Seems to me if Mrs. Truscott is suffering from some sort of infection, whether caused by the operation you conducted here or not, she has probably turned to someone else for follow-up treatment, don’t you imagine?”
“Yes, yes, you’re probably right. That does happen quite often when a patient is dissatisfied with how they are feeling—hoping that a different doctor will come up with a more effective cure. But we should at least make sure that whoever is treating her now has her full medical history,” Dr. Brown said.
“Can’t Dr. Granger or your resident physician, Dr. Blair, handle that?” Annie said.
“Oh, yes, either of them could.”
“If by some chance Mrs. Truscott did want to come to the dispensary for treatment, would it be a problem that you are out of town?”
“Dr. Blair and our nursing staff can certainly handle a case of infection, if that is what is going on. And any of the consulting physicians would be perfectly capable of advising our staff. But what about Mr. Truscott’s threats about the unpaid bill?”
“Leave that for me and my husband to figure out. There really isn’t anything you can do until I have looked through everything here.”
“Yes, I expect you’re right.” Dr. Brown took a deep breath and said, “In any event, you can always contact Dr. Maria Bucknell, our third attending physician. Normally, she would be spending one morning a week here. But she lives in Oakland, and she is currently taking care of a seriously ill relative. In addition, I will write a note to our board president, Mrs. Stone, to apprise her of what is going on. You can rely on her for sensible advice if you can’t reach Dr. Bucknell.”
“Well,” Annie said, “the contracts you signed should give me the needed authority to contact any creditors, as well as patients who might be in arrears. However, if there is something that needs to be done before you return, I will certainly reach out to Mrs. Stone or Dr. Bucknell.”
Dr. Brown stood up again, looking quite determined. “Yes, I feel quite confident you will do all that can be done over the next two weeks. What I can do is go tell Dr. Blair what we have learned and have her make you a copy of the document the Truscotts signed before the operation. Then I will go straight to Harry Granger’s office and see what he knows, if anything, about Phoebe Truscott’s health. I am sure if he hasn’t heard anything, he will be anxious to stop by and see how she is doing. I will give him your name and address and ask him to report anything he learns to you.”
“Thank you. All that will help. Now, if you don’t object, I am going to take all this material back home with me and see what sense I can make of it all before returning tomorrow morning. Maybe it will turn out that the dispensary’s accounts will balance, and Mr. Truscott’s letter is all based on some sort of misunderstanding that can be swiftly cleared up after my husband sends him a diplomatically worded letter. Nate is really very good at finding a way to settle problems amicably out of court, which would be to everyone’s benefit.”