The Society

corporate cost-cutting had left her floor woefully short of registered nurses, and she had been picking up extra shifts and performing extra duties on those shifts. Do you think she or the family of the dead patient want to hear about statistics and dollars saved by substituting LPNs and aides for RNs?”

There was no movement at all among the hundreds in the audience. No sound. Will cleared his throat, then took a sip of water. Seated in the center of the fourth row, Gordon Cameron made eye contact and almost imperceptibly nodded. Will plunged ahead, feeling like a halfback who had broken through the line and was now running free in the open field.

“Last week a fifty-three-year-old loving, caring internist by the name of Mark White was chastised and threatened by a non-MD managed-care official for ordering excessive diagnostic tests on his patients. That call was the final straw for this physician, who had never been sued, who did volunteer work at a free clinic, who was a past chief of medicine at his hospital, and whose filled-to-overflowing practice was as totally devoted to him as he was to it. He spoke briefly to his staff and to the patients in his waiting room. Then he put on his coat and left. . Quit. . Just like that. . Good-bye, Dr. White.

“A survey by the Western Journal of Medicine recently reported that the average primary-care physician spends forty minutes a day dealing with managed-care hassles, mostly around referral and prescription issues. Since there are around one hundred thirty-seven thousand primary-care docs with managed- care contracts, that translates into more than twenty-one million hours of patient-physician interaction lost to those hassles. Using the average three visits per patient per year, and an overly generous twenty minutes per visit, more than twenty-one million patients could have had access to a primary-care physician during the time those docs are now spending on managed-care issues.”

Will paused to let the notion sink in. He still had no clear idea how he was going to wrap things up, but he sensed that desperation had led him to the path he should have been traveling all evening-that medicine must be, at its core, always and ever, about each individual patient. He caught movement out of the corner of his eye, and initially thought that either Roselyn Morton was coming over to give him the hook or Boyd Halliday was about to turn the forum into a free-for-all. Instead, Tom Lemm approached and handed him a typed sheet.

“I think this might be just what you need,” he whispered.

Will scanned the paragraph and immediately understood.

“So, where does this leave us?” he asked the crowd. “Fee-for-service has been deemed too expensive, and managed care is too, well, managed. Under the one system, lots of doctors were felt to be making too much money. Under the other, managed-care executives are pocketing tens if not hundreds of millions, while searching daily for ways to further cut services and payments, as well as ways to weed out from their coverage those who are most in need of proper health care-the old, the infirm, and the poor. In Europe and Canada, nationalized health care has been at least as successful as the system we have in place. If nothing else, all of the citizens of those countries have access to care. Whether it is their system, or a hybrid of theirs with our own, changes are needed and needed desperately.

“I want to close with this note that we received at the Hippocrates Society and that my trusted cohort Dr. Tom Lemm just produced for me. It’s from a man who works in an auto-body shop north of Boston-one of those regular guys I was talking about. I seriously doubt we’ll ever be seeing Vic Kozlowski in any promotional videos. He doesn’t suffer from a dramatic, life-threatening illness. But believe me, Vic has something to say to all of us gathered here tonight. So here he is, in his own words.”

For emphasis more than any physical need, Will cleared his throat again and took another sip of water.

“I don’t think it’s really appropriate for my doctor to do, Vic writes, but every time I visit him he tells me about how the HMOs are dictating every move he makes and ruining his practice. Then he tells me he shouldn’t even be saying such things because he might get in trouble. It makes me so sad. He is a wonderful doctor, but he’s scared to speak up against the HMOs.

“It’s bad for me, too. I can’t get an antibiotic that I need because it’s not on the HMO-approved formulary, but the ones that are in there either don’t work or make me so sick they don’t stay in my body. So, if I do what’s best for me and get the medication that works, the payment is more than fifty dollars. Well, I don’t have to tell you that to a family of four with one income, that is a hard chunk.

“We already pay sky-high rates, and they keep rising while our copays keep rising as well. The bottom line is I feel I might as well be uninsured. The doctor doesn’t make me feel confident and the circle is never-ending. The patient is the butt of the whole thing. I truly believe that America is helpless. I am so nervous every time I get sick. This probably seems totally trivial to you, but believe me, most of the patients in this country feel the same way I do. Thanks for reading this.”

Will walked back around the podium and replaced the microphone. “And on behalf of myself, Dr. Lemm, and the Hippocrates Society, thank you all for caring enough to attend tonight.”

The huskiness in his voice was as surprising as it was unintentional.

Several silent seconds passed. Then the applause began, building like the sound of a river churning downstream toward a falls. Then, with Gordo leading the way, slamming his huge hands together, most of the crowd rose, cheering out loud. Thoroughly drained, Will nodded sheepishly and returned to his seat. Still the clamor continued. Roselyn Morton took the microphone and thanked the audience and participants, but it was doubtful anyone heard through the noise. The forum was over. Will sat for a time until he felt reasonably confident his legs would hold him, then descended the steps to the main floor, where he was mobbed. Gordo, Jim, and their wives hugged him. Susan squeezed him tightly and whispered something about his making the whole profession proud. Several members of the Society pumped his hand and said no one had ever done so much for their cause so quickly.

As the crowd began to disperse, Will’s attention was drawn to a woman standing off to the side, wearing tight-fitting jeans cinched with a heavy-buckled belt, a tan silk blouse, and a black vest. Her face was fascinating- vibrant and intelligent-with scattered freckles across the bridge of her nose and wide, emerald eyes that seemed possessed of their own light. For a time, she just stood there, eyeing him curiously until the last of the well-wishers had departed. Then, her gaze still fixed on him, she approached and handed him a business card.

“Please give me a call,” she said, punctuating the request with the tiniest wink.

Before he could speak a word, she turned and was gone. Her jeans highlighted an athletic, totally appealing behind. She moved with confidence and perhaps even a bit of swagger. Will watched until she had disappeared down the stairs. The vacuum she created in front of him was immediately filled by a few lingering fans, each anxious to tell him how his spontaneity and emotional sincerity had snatched victory from the jaws of defeat. When at last he was alone, the woman’s face still dominating his thoughts, he took a look at her card.

Patricia Moriarity

Detective Sergeant

Massachusetts State Police

CHAPTER 8

Patty woke from a troubled sleep at ten after three. Her dream this time-what she remembered of it-featured multiple burned and bloodied body parts interspersed with varying images of Dr. Willard Grant. The two homicides she had handled before the managed-care murders were exercises in police and crime-scene procedure, not in detective work. In the first, the victim had taken out a restraining order against her violent boyfriend, and half an hour after she had returned from court he kicked in her door and stabbed her twenty-five times. The second, a lover’s quarrel between two gay men, had ended in a single impetuous gunshot to the heart.

The shooting death of Ben Morales, CEO of Premier Care, was the first murder she had been assigned where the suspect wasn’t ready-made. Now, that one case had grown to three, and no one doubted that a serial killer was at work. On paper, she was still part of the team from Middlesex working the case, but thanks to Wayne Brasco, she was justifiably feeling more and more like an outsider. Meetings were being held that did not include her and were called nothing more than impromptu discussions when she found out. Consultants were being called in without her knowing about them. The profiler she had originally lined up-a young, talented woman-had been replaced by a more experienced, though in her mind far less capable, man.

Tired of having her ideas demeaned and brushed off, Patty had decided on her own and on her own time to