Brain surgeon Allen Wyler has written a thriller on the bleeding edge of new-millennium hospital technology.
When a brain surgeon discovers that a revolutionary computerized medical-records system is responsible for a series of patient deaths-and threatens many more-he must navigate a treacherous maze of conspiracy. And risk his life to expose it.
* A comatose man is given a fatal dose of insulin in the Emergency Room-even though he isn't diabetic.
* An ulcer patient dies of hemolytic shock after receiving a transfusion-of the wrong blood type.
* A recovering heart patient receives a double dose of the same medication-triggering a fatal cardiac arrest.
When the doctors and nurses at Seattle's prestigious Maynard Medical Center start making preventable drug and treatment errors that kill their patients, neurosurgeon Dr. Tyler Mathews suspects that something is murderously wrong with the hospital's highly touted new "Med-InDx" electronic medical record. But when he airs his concerns to the hospital's upper management, he's met with stonewalling, skepticism-and threats.
Millions of dollars, and the future of Med-InDx, are at stake. And powerful corporate forces aren't about to let their potential profits evaporate. Tyler soon finds that his career, his marriage, and his very life are in jeopardy-along with the lives of countless innocent patients.
|Publisher:||Doherty, Tom Associates, LLC|
|Edition description:||First Edition|
|Product dimensions:||4.10(w) x 6.70(h) x 1.00(d)|
About the Author
Dr. Allen Wyler is an internationally renowned brain surgeon with over thirty years of experience and is recognized for his pioneering work in the field of neurosurgery. He is currently medical director of Northstar Neuroscience, a biotech firm in Seattle, Washington.
Read an Excerpt
By Wyler, Allen Tor Books
Copyright © 2008
All right reserved.
November, Seattle, Washington
Trauma Room Three, Maynard Medical Center
“Is this how you found him?” Robin Beck, the doctor on call, asked the paramedic as she quickly ran the back of her fingers over Tyrell Washington’s skin. Warm, dry. No fever, no clamminess. Black male. Age estimated in the mid-sixties. Half-open eyes going nowhere. Findings that immediately funneled the diagnosis into the neurologic bin.
“Exactly as is. Unresponsive, pupils mid-position and roving, normal sinus rhythm. Vital signs within normal limits. They’re charted on the intake sheet.” Breathing hard, the paramedic pulled the white plastic fracture board from under the patient, unofficially consummating the transfer of medical responsibility from Medic One to Maynard Medical Center’s Emergency Department.
“History?” Beck glanced at the heart monitor as the nurse pasted the last pad to the man’s chest. Heart rate a bit too fast. Was his coma cardiac in origin?
A respiratory therapist poked his head through the door. “You call for respiratory therapy?”
She held up a “hold-on” palm to the paramedic, told the RT, “We’re going to have to intubate this man. Hang in here with me ’til anesthesia gets here.”
The tech nodded. “You called them yet?”
“Haven’t had time. It’s your job now.”Without waiting for an answer she rose up on tiptoes and called over the paramedic’s head to a second nurse plugging a fresh line into a plastic IV bag, “Glenda, get on the horn to imaging and tell them we need a STAT CT scan.” Better order it now. The scan’s status would be the first question out of the neurologist’s mouth when asked to see the patient. Nervously fingering the bell of her stethoscope, she turned to the paramedic. “I need some history. What have you got?”
“Nada.” He shook his head. “Zilch. Wife’s hysterical, can’t give us much more than she found him like this.” He nodded at the patient. “And, yeah, he’s been a patient here before.”
A phlebotomist jogged into the room, gripping the handle of a square metal basket filled with glass tube Vacutainers with different colored rubber stopper, sheathed needles, and alcohol sponges. “You call for some labs?”
“Affirmative. I want a standard admission draw including a tox screen.” A screen blood test for coma-producing drugs. Then to the paramedic, “Did the wife call 911 immediately?”
He shrugged, pushed their van stretcher over so his partner standing just outside the door could remove it from the cramped room. “Far as I know.” He paused a beat. “You need me for anything else?”
“That’s it? Can’t you give me something else to work with?” She figured that under these circumstances a hysterical wife was of little help in giving her the information needed to start formulating a list of possible diagnoses.
His eyes flashed irritation. “This was a scoop and scoot. Alright? Now, if you don’t need me for anything else . . .”
She waved him off. “Yeah, yeah, thanks.” She wasn’t going to get anything more from him now. At least knowing the patient had been treated here before was some help.
She turned to the monitor. Blood pressure and pulse stable. For the moment.
She called over to the lead nurse. “We got to get some history on him. I’m going to take a look at his medical records.”
At the workstation, Beck typed Tyrell Washington’s social security number into the computerized electronic medical record. A moment later the “front page” appeared on the screen. Quickly, she scanned it for any illness he might have that could cause his present coma. And found it. Tyrell must be diabetic. His medication list showed daily injections of a combination of regular and long-lasting insulin. Odds were he was now suffering a ketogenic crisis caused by lack of insulin.
Armed with this information, Robin Beck hurried to the admitting desk where Mrs. Washington was updating insurance information with a clerk.
“Mrs. Washington, I’m Dr. Beck . . . has your husband received any insulin today?”
Brow wrinkled, the wife’s questioning eyes met hers. “No. Why?”
Suspicions confirmed, Beck said, “Thank you, Mrs. Washington. I’ll be right back to talk to you further.” Already calculating Tyrell’s insulin dose, Beck hurried back to Trauma Room Three.
“I want fifteen units of NPH insulin and I want it now.” She figured, Let him start metabolizing glucose for an hour before titrating his blood sugar into an ideal level. For now she’d hold off calling for a neurology consult until assessing Washington’s response to treatment.
“Mama, what’s happened to Papa?”
Erma Washington stopped wringing her hands and rocking back and forth on the threadbare waiting-room chair. Serena, her oldest daughter, crouched directly in front of her. She’d called Serena—the most responsible of her three children—immediately after hanging up the phone with 911.
“I don’t know, baby . . . I just don’t know.” Her mind seemed blank, wiped out by the horror of what life would be like without Tyrell.
Her daughter reached out and took hold of both her hands. “Have the doctors told you anything yet?”
“No baby, nothing.”
“No, wait . . .” Amazed that she’d completely forgotten. “A lady doctor came, asked had Papa been given insulin today.”
“Insulin? Why’d she ask such a thing, Mama? Papa doesn’t take insulin!” “Dr. Beck, come quick. Room Three’s convulsing.”
Robin bolted across the hall to Washington’s room. The man’s limbs were locked in extension, pressing the stretcher side rails out, jaws clamped shut, saliva bubbling out between upper front teeth. From across the room she heard the raspy stridor of a compromised airway. Luckily, the nurses had left the center restraining strap pulled snugly across his belly. A pool of sickening acid settled in Beck’s stomach. She’d missed something. Either that or she completely miscalculated the insulin dose.
She yelled to the closest nurse: “Ten milligrams Valium. Now,” then muttered, “Shit, where’s respiratory when you needed them?” To a nurse just entering the room, she yelled, “Get some nasal oxygen on him.” She looked at the suction to assure herself it was hooked up and functional. All she needed now was for the patient to vomit and aspirate. The best thing, she knew, was to turn a seizing patient on his side so fluids would run from the mouth instead of down the trachea into the lungs. But with his arms rigidly straight this would be impossible.
The cardiac monitor alarm rang with a slicing shrill.
Beck saw a flat green line streak across the screen and yelled, “Get a crash cart in here.” She slapped the red “Code 199” wall button, scrambling the medical center cardiac arrest team from whatever parts of the hospital they were presently working.
Oh, Christ, not again, thought Gail Walker. Two migraines already this month and the spots in her vision that signaled her typical onset were dancing again. She believed they were triggered by the recessed fluorescent ceiling lighting throughout the Intensive Care Unit. She’d considered requesting a transfer to another nursing service but loved the action of this Surgical Intensive Care. There were other ICUs in Maynard Medical Center, of course. Neonatology and Cardiac, for example. But she hated seeing newborns and preemies in heated incubators, with four to five tubes sticking out of their wrinkled little bodies. The Cardiac Care Unit depressed her, reminding her of her own mortality and the incremental age each day checked off of her life. From the fanny pack around her waist she dry-swallowed a pill. Catch those suckers soon enough, chances were you could abort them.
The centrifuge beside her stopped. She removed the small capillary tube and placed it against a chart. The deathly pale thirty-two-year-old real estate broker—one of Dr. Golden’s stomach bleeders—now had a hematocrit of eighteen. Too low. Not unexpected. Especially since a half hour ago he had discharged a large amount of foul-smelling black tar into a bedpan.
From the little ICU lab she stepped into the nurses station and found a free computer terminal. On the wall above her left shoulder hung the white board—in spreadsheet format—listing each room, each row stating the patient’s name, admitting physician, and assigned nurse. She double-checked the patient’s orders on the electronic medical record. Just as she thought: she was to give him two units of packed red blood cells if his hematocrit dropped below twenty.
With another few keystrokes she ordered the two units of red blood cells from the blood bank and marveled at how much more efficient this sort of task had become since MMC had installed the new Med-InDx Computerized Information System—or CIS, as the Information Technologies techies called it. The electronic medical record, or EMR, was just one component of the entire CIS system.
Ten minutes later two clear plastic bags of red blood cells arrived on the unit. With a scanner similar to those used by grocery clerks, she verified the bags as those typed and cross-matched for her patient. Before the advent of the Med-InDx CIS, this job would have required another nurse to cross-validate the blood. Now the task could be done in a fraction of the time with absolute accuracy. God bless technology.
She entered the room and asked, “How you feeling? Still short of breath?”
The pale man turned his head to her. “Man, oh, man, it seems like it’s getting worse.”
“That’s because you’re anemic.” She held up the bags of red blood cells for him to see. “Once I get these into you you’ll be feeling much better.”
With both bags of packed cells dripping into the patient’s IV, Walker checked on another patient—a post-op open heart who’d probably thrown a blood clot to his brain during a coronary artery bypass operation to unclog three Big Mac–encrusted arteries—where she ran through a NIH stroke assessment and recorded it into the chart.
An alarm from a cardiac monitor shrieked.
She glanced at the row of nursing-station slave monitors, did a double take. What the hell? Her patient. Golden’s GI bleeder. Shit, what happened?
She raced around the corner of the desk to join the flock of nurses and doctors funneling into the room.
January, the Following Year
“It’s been the shift from hell. I’m outta here.”
William Thornton threw a mock salute to the nurse he was replacing. “Have a good one.”
Walking past sliding-glass doors to a string of patient rooms in the MMC Cardiac Care Unit, Thornton began mentally organizing the next sixty minutes of his ten-hour shift. He stopped outside room 233. As an RN he had responsibility for three CCU patients instead of two—a thin staffing pattern brought about by the nursing shortage. A staffing pattern the administration deemed acceptable because of using nursing assistants as extenders. A practice Thornton knew the nurses union intended to make a hot issue during the next round of contract negotiations.
Might as well start by making rounds on the patients, he decided. Tablet computer in hand, he entered room 233.
“Hello, Mr. Barker, I’m Bill Thornton.” He reached out to feel the fifty-five-year-old man’s pulse, an unnecessary move since he could read it off the monitor, but one he knew personalized the contact. “How are you feeling?”
“Bored. Why the hell can’t I have a TV in here?”
Thornton scanned the patient’s vital signs. Heart in normal sinus rhythm, blood pressure 144/76, pulse 78. Color good, patient responsive.
“Don’t want to get you excited. Not for a day or so.” He already knew Barker’s story but asked, “Tell me, what happened to you?” to test his memory.
“It was the damnedest thing, I’m down in my basement workshop—I do woodworking, you know . . . furniture, pretty good stuff too, if I do say so myself—when I get this chest pain.” His right hand massaged his left breast. “Just like what they tell you? Ya know, like a fucking elephant stepping on my shoulder. Well, hell’s bells, I knew exactly what it was. Scared the bejesus outta me too. I didn’t want to move so I called my wife and she called 911. Doc says two of my arteries were almost completely shut down.”
Thornton nodded approval at the story. “But that’s all taken care of, right?”
“Except for the fact you’re still having some irregular heartbeats.” An understatement. Barker was still on high-dose IV medications for life-threatening arrhythmias.
With his notebook computer, Thornton logged into the EMR and checked Barker’s medication schedule. To his shock he noticed the nurse he just relieved had neglected to give a critical anti-arrhythmic medication. Horrified, he moused the pharmacy tab, double-clicked on the medication, then clicked stat.
“Matter of fact,” he said, trying to mask any anxiety from his voice, “you’re due for another dose of medication right now. I’m having it sent up right away.”
Ten minutes later Thornton returned.
“You’re in luck, Mr. Barker,” he joked. “The pharmacy still carries this.” He held up a syringe of clear colorless fluid, squeezed out a drop of air, and injected the drug into the IV port.
Finished, Thornton dropped the empty syringe in the wall-mounted “sharps” container just as the cardiac monitor began shrieking. He turned to see the tracing go flat-line.
January, One Week Later
For the first time since starting their discussions, second thoughts began eroding Sergio Vericelli’s confidence. It wasn’t the proposal evoking the toenail nervousness that had started creeping in waves from his feet up to his chest, filling his gut with a tightness. It was the man sitting across the small bistro table from him.
He realized the man had asked a question. “Sorry, I became distracted. You will repeat it?”
A flicker of irritation in the man’s penetrating dark eyes broke the emotionless mask he wore so effectively. “How would you like to receive the money? I suggest it be wired to an offshore account. I assume you have one?”
Sergio studied the man’s face for a hint of what disturbed him so. Chiseled, rugged features that he supposed women found handsome. From his perspective the only mar was a shock of white from the widow’s peak—a contrasting streak against black hair combed straight back. A flaw Sergio would have taken care of if it were his. Maybe there was nothing sinister there at all, he decided. Maybe his nervousness was nothing more than the muffled voice of his conscience shouting to be heard above the cacophony the hundred-thousand-dollar offer caused. An additional fifty thousand, if all went as planned.
“No, but I will open one tomorrow.”
Sergio realized he’d just moved one step closer to consummating the deal. Did he really want to do this? He thought of childhood stories of men who made pacts with the devil. But this is not the devil, he reminded himself.
Are you very certain of this? Do you know this to be fact?
Sergio Vericelli felt a shiver snake down his vertebrae only to be chased away by the thought of what one hundred thousand dollars would buy.
“Excellent. Then we are agreed?”
Sergio swallowed only to find his mouth dry. “Agreed.”
The man with the shock of white hair held out his hand.
A primitive gut-level fear caused Sergio to hesitate a beat before clasping the dry warm flesh. But the moment the other man’s fingers wrapped around his, dreams of further riches smothered those fears.
Copyright © 2005 by Allen Wyler. All rights reserved.
Excerpted from Deadly Errors by Wyler, Allen Copyright © 2008 by Wyler, Allen. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Ransom Notes Interview with Dr. Allen Wyler
Paul Goat Allen: Dr. Wyler, first off, congratulations on a fantastic novel. I literally couldn't put it down once I began reading it and stayed up until the wee hours finishing it in one sitting. The obvious question is: What motivated an accomplished neurosurgeon to write a thriller about preventable medical error?
Allen Wyler: Being a neurosurgeon, it's not unusual for me to run into weird situations that cause me to pause and think, Hmmmm, now there's a potential kernel for a story. Usually what happens is I kick the idea around for a few days until it's been thoroughly trashed and deserves discarding. However, on rare occasions the idea stands up to scrutiny and may even grow into something more interesting. When that happens it gets dropped into my computer's hard drive "IDEAS" folder.
When I came up with the idea for Deadly Errors, in addition to my surgical practice, I was medical director for the neuroscience institute at a large private Seattle hospital. Being part of the hospital administration, I was frequently tapped to serve on various committees. One turned out to be the team charged with selecting the electronic medical records (EMR) system the hospital needed to purchase.
So, one dreary afternoon as I sat in one EMR committee meeting listening to a droning description of a software system's bulletproof security precautions, I started thinking, What might happen if a hacker was able to penetrate the system? Better yet, what if a hospital's EMR software was really flawed and no one knew about it? The idea completely captivated me as the start of an interesting plotline. I worked it over, and it turned out to be the plot kernel for Deadly Errors.
PGA: The statistics in the novel were absolutely chilling -- between 44,000 and 98,000 people die in hospitals every year due to preventable medical error. How does this figure compare to other countries, and what are the major causes? Understaffing? Lack of training? Antiquated equipment?
AW: The numbers are indeed chilling and were quoted directly from the November 1999 study by the Institute of Medicine study entitled "To Err Is Human: Building a Safer Health System" (www.iom.edu/report.asp?id=5575). The major cause of these errors is miscommunication. The majority of hospitals, clinics, and ambulatory surgeries maintain medical records in an antiquated handwritten form (regardless of the country). I recently had surgery at the hospital where I used to practice. I was amazed when, during my admission, I was asked the same question about my medical history six times within the two hours between entering the admission area and talking to the anesthesiologist. And I don't know that they really got it recorded. In addition to not having a centralized record system, errors occur from erroneous communication that is the result of handwritten notes. For example, a well-intentioned physician might prescribe a medication to a patient who is highly allergic to that drug. Or take, for example, a ward clerk confusing a prescription Lamictal (a strong anticonvulsant) with Lamisil (an antifungal) when transcribing it to the pharmacist. The list goes on and on, but you get the idea. Broken down to its most basic element, the majority of these errors result from erroneous communication between health care workers. Almost all such errors could be prevented with the proper use of EMRs. This, by the way, is the reason Senators Hillary Clinton and Bill Frist recently joined forces in sponsoring a bill to require a broader use of these computer systems.
PGA: If you had a magic wand, what would you do to alleviate this problem?
AW: Most of these errors can be eliminated by centralizing data in the form of well-programmed electronic medical records. But this solution is extremely costly and difficult to implement. The cost is not just in the software but includes the cost of maintaining the infrastructure to maintain and support it. Moreover, there are huge problems in obtaining software that will "talk to" the various departments within hospitals, clinics, pharmacies, insurance companies, etc. So, if a genie popped out of the bottle and gave me that magic wand, I'd use it to suddenly create a nationwide, seamless, easy-to-use electronic medical records system that would allow a person from New York who suddenly requires emergency medical care in Seattle to have his records accurately and immediately available. Man, wouldn't that be wonderful!
PGA: The comparisons to authors like Michael Palmer and Robin Cook are obvious. Are you a fan of the medical thriller genre, and if so, what are a few of your favorite books? What are you reading now?
AW: I love all the medical thriller authors you mentioned plus the other biggies like Tess Gerritsen. But I also love to read authors outside of the genre. Guys like John Sandford, Robert Cray, Michael Connelly, John Nance, and others. One of my favorites is Nelson DeMille. I just finished Connelly's The Closers.
PGA: Any thoughts of a second novel? And if so, can you give fans a little teaser as to what it might be about?
AW: I plan to stick with novels that deal with the brain and with neurosurgery. My next one is Dead Head, a thriller about keeping a detached head alive because of what the person knows. It's presently on my editor's desk at Tor.
Most Helpful Customer Reviews
Neurosurgeon Dr. Tyler Matthews learns that his boss cheated Medicare so he reports it. Not long afterward DEA Agent Dillon searches his locker and finds drugs there. His lawyer Mary McGuire suggests he accepts the government¿s ¿kind¿ offer though he insists he is being framed over his whistle blowing if he refuses he will lose in court and never practice medicine again. He has already lost his wife Nancy so he reluctantly agrees. Tyler obtains work at the Maynard Medical Center in Seattle where a computerized record keeping system is being tested that is expected to dramatically reduce the annual 44000 to 98000 medical errors. When his patient dies, Tyler conducts a root analysis that leads him to believe the record system is flawed and caused the death he reports his findings. He is threatened with the end of his practice as millions are at stake based on a committee¿s findings of how well the database performed. While other whistle-blowers have died and Nancy is threatened, the FBI, international terrorists, and members of the government-industrial health complex seek him. He trusts no one after San Francisco and with the Patriot Act, they able to bury him. --- This chiller is not for the faint of heart as readers will be stunned by the avarice antics of those who allegedly protect the public health. The story line is action-packed from the moment the DEA disillusioned Tyler and never slows down as the hero feels déjà vu all over again. Interestingly weaving in real world stats such as the eighth most common deaths in America is medical mistakes Dr. Allen Wyler's debut is as tense a medical thriller as there is because the scary supporting stats are real. Six Sigma please. --- Harriet Klausner
Tyler Mathews is a doctor that loses his license to practice medicine in the state of California because of prescription drug use. He also loses his wife and his marriage. He is just now picking up the pieces and working at a hospital in Washington. His ex-wife has contacted him about possibly getting back together and things are looking up at work. Then an emergency room patient dies from an overdose of insulin, Tyler has a patent that comes in and gets an overdose and dies a horribly, and other events start happening. The strange thing is that the new computer system is acting odd. Although the information is being entered correctly, it looks like someone has hacked into the system and changed it causing improper diagnosis, dosage, and treatment. Clearly there is something wrong with the new Med-InDx. When Tyler lost his license in California, he had stumbled over the hospital stealing millions from Medicare. When he brought that to the light, they got rid of him with the drug charge. Because of that history, he is asked to look into the Med InDx. This is going to be hard to do when once again he is framed for drug use. But that is the easy part, now someone wants to silence his findings for good. This is another great story from Allen Wyler. Initially I couldn’t careless with Tyler. He is caught doing drugs, loses everything, and then when he is starting we start with him abusing Ambien. But things look fishy when he loses his patient and it’s because of the dose being wrong in the computer system, I felt for him. The more I got into the story I felt for him. He was just trying to do the right thing and getting grief for it. I loved all the action with the Med InDx program. It’s creepy to think that doctors now use the electronic devices to help with their jobs and the possible outcomes of software issues and such. This is a great medical thriller. If you have not read any of Allen Wyler’s other books, this would be a great one to start with. He is one author that you don’t want to miss. I received this book for free in exchange for an honest review.
Why would u post a reader's synopsis of the book? I was going to buy until I read her review. I kno the book now from start to finish. B&n u should not post these types of reviews it only hurts the author and b&n
This was a new author for me! I really enjoyed this book! It was super suspenseful! I will be buying all of this author's books!
Wow another H.K. mini version of the book. B&N you have just lost a sale, since I know what the book is about, why should I buy it. Save me some money.
Editing was terrible... missing words,misspellings, words out of order. Several instances of pages not turning. Frustrating, to say the least. Less than professional.