Chapter 67: No Comment

December 11, 1989, McKinley, Ohio

On Monday afternoon, I received permission from Loretta to attend the Board of Inquiry for Doctor Mark King, though if the ED was slammed, I'd be paged and have to return. I wasn't surprised to see Carl Strong in the room and sat down next to him.

"How does this work?" I asked.

"They've all read Doctor Rhodes' investigative report, which is the primary evidence. King can make a statement, then call witnesses, both to facts and to his character. The Board could also call witnesses."

"Does he have any chance?"

"Five or ten years ago, it would be a sure thing; times have changed. I'd say he has no chance unless he can offer some kind of new evidence that he didn't sleep with Krista Sandberg or can somehow prove there wasn't a quid pro quo. That said, the only evidence they have is from Krista, and she's a known liar, which you demonstrated convincingly."

"That strikes me as a major problem," I observed.

"We'll see," Carl said as the Board members began taking their seats at a table in the front of the auditorium, which normally hosted M & M Conferences.

"Good afternoon," Doctor Anderson, the Hospital Administrator, said. "A Board of Inquiry has been convened to address a request for reinstatement by Doctor Mark King. The members of the Board are Doctor William Bielski, Doctor Paul Gilquist, Doctor Michelle Lindsay, Doctor Leila Javadi, and Doctor Marcie Baxter. Legal counsel for the Board is Mr. Leland Crowe. The Board has read the reports issued by the Medical School and the Medical Director following separate investigations.

"The findings of both investigations lead to the same conclusion — Doctor Mark King solicited sex from a medical student, Krista Sandberg, in exchange for improving her grade for her clinical rotation in Internal Medicine. These findings were supported by statements made by Miss Sandberg, as well as Nurse Nancy Rodgers, Nurse Karen Black, and medical student Patsy O'Meara. Per the rules for Boards of Inquiry, those individuals are here and may be questioned by Doctor Mark King. I'll now turn this over to Doctor Bielski, who is serving as chairman."

"Thank you, Doctor Anderson," Doctor Bielski said. "Doctor Mark King, would you please come forward and present your request?"

Mark King stood and moved to the lectern to address the Board members, and I turned to look behind me and saw that Krista was in the auditorium, sitting in the last row.

"Good morning, Doctors," Mark King said. "Thank you for hearing my petition for reinstatement. My request is based on one simple fact — the person making the accusations has proven themselves to be completely untrustworthy. It is also the case that her grade for her Medicine rotation was commensurate with her performance. And, while this is not an admission, sexual relations between students and doctors were not a violation of hospital policy or the medical school ethics guidelines at the time of the alleged conduct.

"With regard to the witnesses besides Miss Sandberg, the evidence is mere hearsay with regard to the specific reason for my suspension from the Residency program. None of the witnesses gave testimony about the alleged relationship with Miss Sandberg, and the actions they reported were not a violation of hospital policy or medical school ethics, as they stood at the time. I'll now address each of the witness statements.

"First, Nurse Nancy Rodgers. She has stated that we had a sexual relationship, and assuming for the sake of argument that is true, it did not violate any hospital policy. She was, at the time she claimed we were involved, assigned to Cardiology, not Internal Medicine. Second, Nurse Karen Black made a similar statement. Again, assuming for the sake of argument that is true, it did not violate any hospital policy. She was assigned to Pediatrics at the time she claimed we were involved."

"Doctor King," Shelly Lindsay interrupted, "are you denying you had relationships with those nurses?"

"I'm neither confirming nor denying those claims, as if they did happen, they were not violations and, as such, have literally no bearing on the matter. According to both reports, their statements were used to corroborate Miss Sandberg's claim that she and I engaged in sexual relations. Even if ALL of that is true, none of it was a policy violation."

"If you wish this Board to take you seriously," Doctor Javadi interjected, "dissembling is not the correct approach. Did you have intimate relationships with those two nurses?"

"Doctor Javadi and Doctor Lindsay, with all due respect, I was taught that a gentleman never discusses that topic."

"He's not doing himself any favors," I whispered to Doctor Strong. "He should just admit it."

Carl nodded.

"While it's certainly true that I would not want a paramour revealing intimate details," Doctor Javadi replied, "the nurses in question have come forward to say that they had an intimate relationship with you. Please either confirm or deny their statements, or I will assume you have something to hide and take that into account during our deliberations."

"Yes, Doctor Javadi, I was involved with both nurses," Doctor King admitted. "May I continue?"

"Yes."

"During the time Miss O'Meara says that we were involved, she was assigned to Psych. Again, that was not against hospital policy, nor was it a violation of the student ethics code."

"Just to be clear," Doctor Lindsay asked, "you admit to having sex with a medical student and two nurses?"

"Yes, Doctor Lindsay."

"And with Miss Sandberg?"

"I'm involved in a civil lawsuit with Miss Sandberg, and on the advice of my attorney, I have to decline to answer that question."

"A criminal case would have delayed this inquiry until it had been completed," Doctor Bielski said. "But it's a civil case, so I think, Doctor King, that you have a stark choice. If you decline to answer our questions, we will decline to act on your petition with the result that the suspension would be confirmed, and you would be subject to dismissal from the Residency program."

I so wanted to turn to see if Krista was smiling, but I felt it was better not to do so.

"May I have two minutes to consult with my attorney, please?"

"Yes, of course."

Doctor King moved from the lectern to a woman sitting in the front row of seats and spoke quietly to her for about a minute, then returned to the lectern.

"Doctor Anderson," Doctor King said. "My attorney would like to speak with Mr. Crowe. We'd like a twenty-minute recess, please."

Doctor Anderson consulted with Mr. Crowe and then agreed to the recess.

"I wonder what that's about," I said.

"I suspect they intend to try for an injunction to prevent dismissal until he can answer the questions without risking anything in his civil suit. I'm no expert, but I'd say from what he's focused on — that nothing he did broke the rules and that Miss Sandberg received an accurate evaluation — he'll get it and likely have cause to sue the hospital for wrongful dismissal."

"From what I've seen," I countered, "a court isn't going to order them to take him back."

"No," Carl said, "but his suit for several million dollars would likely play well in front of a jury if he asserts he didn't break any rules and didn't raise her grade. He'd claim lost wages and a ruined career."

"I think you might be right," I observed, "given there have been several complaints about unfair evaluations from Medicine in the past four years. But what if she says he threatened to fail her? I haven't seen the actual complaint."

"Me, either. Do you know anything about the settlement she made with the hospital and medical school?"

"No," I replied. "But one thing I'm sure of — no reinstatement, given she lied in a sworn statement."

"There's no way she's coming back here, that's for sure," Carl said.

"She might have a chance at restarting medical school at another institution," I said. "A lot would depend on what the medical school agreed to in the settlement."

"What's your bottom-line assessment of her?"

"She's not cut out to be a physician," I replied. "I was leaning that way before the false accusation and before her other lies were exposed. I was giving her an absolutely fair shake, but I was suspicious that it was a wasted effort. She might have surprised me the way Felicity Howard did."

After about five minutes, Mr. Crowe consulted with Doctor Anderson, who stood up.

"This hearing is continued to a future date," he said. "I will provide appropriate notice as to when we'll reconvene."

"I suspect a deal was just struck," Carl said quietly. "And they need to put it down on paper. I have ten bucks that say he's back to work by the end of next week."

"Shelly and Leila are going to be pissed," I observed. "And I'm not particularly happy."

"I hear you, but her claims were seriously weakened by trying to trap you. Had she not done that, you'd have testified on her behalf and made the hospital look VERY bad. You would also have lent credence to her claims against Doctor King. Now, he can portray her as a liar; without that, he couldn't have. I bet any deal they strike will require him to settle with Miss Sandberg."

"No bet," I replied. "That would make perfect sense. He pays her off and is allowed to finish his Residency."

"On probation, most likely," Carl added. "And he won't be offered an Attending role here."

"With two years in Medicine, he could apply for his license and hang out a shingle, so he wouldn't be completely screwed. I need to get back."

I got up and walked towards the back of the auditorium, noticing that Krista had left and was relieved she didn't try to talk to me. Unfortunately, my relief was short-lived.

"Doctor Mike, could I talk to you?" she asked as I walked out of the auditorium.

"My attorney said that's a bad idea," I replied.

"I'm not suing you," Krista protested, though her voice was calm.

"I know, but at least until all of this is over, I have to follow my attorney's advice. And right now, I need to get back to the ED."

"I am sorry," Krista said.

"I know," I replied. "I do need to go."

I walked away from her, turned left at the main corridor, walked quickly to the ED, and found Doctor Gibbs in the Attending's office.

"How did it go?" she asked.

"Doctor King's attorney spoke with Mr. Crowe, and Doctor Anderson agreed to suspend the Board of Inquiry. I suspect there's a deal of some kind in the works."

"That's going to go over like a lead balloon," Doctor Gibbs observed.

"Sure, but is Krista a reliable witness? And is the hospital willing to risk a lawsuit that has actual teeth?"

"So he gets away with it?"

I shrugged, "I have no idea what kind of deal they might cut. Carl Strong speculated they'll reinstate him on probation and not consider him for an Attending position. I suspect he might bail after PGY2 and open his own practice. If you think about it, that could work for the hospital because they've already settled with Krista. Maybe they work out a multi-way deal with her to end the fiasco."

"Wait!" Loretta protested. "She might be back?!"

"I don't see that happening," I replied. "I was thinking more along the lines that King pays her off, and everyone signs non-disclosure agreements. If she's smart, she takes the cash, gets a Master's and PhD in biochem and becomes a researcher. That is literally perfect for her. She was a terrible clinician."

"AHA! You agree with me!"

"I always agreed with you, Lor. The difference was, I felt she deserved a chance to prove it conclusively."

"Then why didn't you say something?"

"Because the one thing I won't ever do is prejudge a student. Yes, I checked to see why her procedure book was light, but that led me to think about what I could do to give her a final shot at success, not decide she was hopeless and relegate her to scut. That's not my style, which you know, and yet she was assigned to me. So..."

"You won that one, too," Loretta replied. "Per Cutter, effective January 1st, nobody is to be assigned pure scut except for short periods. That's to be left to candy stripers and nursing students in most cases."

"That's good for students, and it also protects the hospital," I observed. "The other good change is the one the medical school instituted in rating Residents on their ability to teach."

"You would like that, given you received perfect scores on that, too."

"Have I received a less-than-perfect score on anything?"

Loretta smirked, "Clarissa Saunders outscored you on Step 2 of the MLE."

"Yeah, yeah," I chuckled. "By a point."

"Mike?" Ellie said from the door to the office. "Paramedics four minutes out with a fire victim."

"Burns or smoke?" I asked.

"They didn't say."

"Let my students know. Which nurse?"

"Becky."

"Thanks."

"Go heal the sick," Loretta said.

I left the office, put on a gown, gloves, and goggles, and headed to the ambulance bay, where I was joined by John, Kelly, and Becky.

"We don't know what we're getting beyond they're bringing someone in from a fire," I said. "John, be prepared to intubate; Kelly, EKG and monitor, though if the victim is burned, you might not be able to place the EKG leads; Becky, stat ABG, CBC, and Chem-20. I'll call out any changes if necessary."

The EMS squad turned into the driveway and, a few seconds later, pulled up in front of us. Bobby jumped out.

"Doc, it's Jim Greer," he announced. "Thirty-two-year-old male; floor collapsed during a rescue. Smoke inhalation and a fractured right leg; PO₂ 90% on ten litres; BP 130/70; pulse 80. Couldn't intubate; leg is splinted."

"Trauma 2!" I declared. "Kelly, find Doctor Gibbs! John, I'll handle the intubation; get the EKG hooked up. Becky, I need that ABG faster than stat!"

We rushed Lieutenant Greer into Trauma 2, moved him to the table, and Bobby and Sam retreated to the corner of the room rather than leave. Lieutenant Greer was wearing bunker gear, but someone had opened his jacket, which allowed John to cut away his shirt to affix the EKG pads. I grabbed an intubation kit myself and moved into position just as Loretta and Kelly returned to the room.

"I have soot around the nose and mouth," I said. "Intubation attempt in the field failed. Run it, Lor, while I try to get the tube in."

She began her examination while I removed the oxygen mask, placed Lieutenant Greer into the sniffing position, and inserted the laryngoscope. I placed the tube in the groove of the scope and began advancing it, but both visually and by feel, I could tell his airway was partly occluded. I tried twice but couldn't manage to advance the tube.

"Constricted airway," I said. "Lor, switch places and give it a try. I haven't done a crike!"

"PO₂ down to 87%!" John announced. "86%!"

"No time, Mike," Doctor Gibbs declared. "Do you know the procedure?"

"Yes, but I'm not signed off. Kelly, call for a surgeon!"

"PO₂ down to 85%!" John announced.

"Becky, crike kit to Mike!" Doctor Gibbs ordered. "Mike, I'm authorizing it!"

Technically, that wasn't permitted, but there was no way I was going to allow Lieutenant Greer to die or have permanent brain damage while waiting for a surgeon. I put the oxygen mask back on him and moved to the side so I could perform the procedure which I'd seen twice, had never performed, but had studied extensively.

"Kelly, assist, please. I need the neck hyper-extended."

She moved to where I'd been standing and adjusted Lieutenant Greer's head.

"PO₂ 88%," John called out.

Which meant that some oxygen was making it into Jim Greer's lungs, giving me a bit more time to think through the procedure. With the open tray next to me and Becky standing to my left, I first tested the cuff of the tracheal tube balloon for leaks by using a syringe to inflate it with air. Once I was sure it would hold air, I deflated it.

"Becky, lubricate the dilator and balloon cuff, please," I requested. "John, I need you to sterilize the neck with Betadine, then drape!"

While that was happening, I filled a syringe halfway with saline. As soon as the drape was in place, I identified the cricothyroid membrane by moving my finger from the laryngeal prominence until I felt the step-off between the caudal end of the thyroid cartilage and the cricoid cartilage.

"Lidocaine!" I ordered.

Becky handed me the pre-filled syringe, and I made two injections near my planned incision site, then handed back the syringe. Using my left hand, I stabilized the larynx.

"Scalpel!" I ordered.

Becky handed it to me, and I made a 2.5cm midline longitudinal incision in the skin and subcutaneous tissues over the cricothyroid membrane.

"Needle catheter!" I ordered. "Attached to the syringe."

Becky did as I asked and handed it to me. I inserted it through the cricothyroid membrane, aiming caudally at a 45-degree angle, and kept back-pressure on the syringe plunger as I advanced the needle and catheter. I felt a bit of resistance and pop as the needle entered the trachea.

"Air bubbles in the syringe," I announced.

"PO₂ 86%!" John called out.

"Get a move on, Mike!" Doctor Gibbs ordered.

Having seen the air bubbles, I quickly removed the syringe from the needle, advanced the catheter, and withdrew the needle.

"Guidewire!" I requested.

Becky handed it to me, and I threaded the flexible tip through the catheter and into the trachea. Once it was in, I removed the catheter, then carefully guided the dilator over the guidewire, ensuring it passed properly through the dilator. As I tried to advance it, I felt some resistance, so I rotated the unit slightly back and forth until the hub and flange of the airway catheter were flush against the skin.