American Greed: Killers in White Coats and Executives in Dark Suits

By Eliezer Nussbaum, MD

Jonathan Campbell is dead.

Jonathan was eight years old. He was a normal, healthy boyuntil the night he died of spinal meningitis in the Pediatric Intensive Care Unit. Jonathans death could have been prevented, if not for a string of events and choices that led to his untimely end. His doctor has blood on his hands . . . but hes not the only one. In the wake of Jonathans death, a firestorm is brewing, and at its bloody heart is Northwest Health Care, arguably the most powerful HMO in the United States. For Northwest, everything has a costincluding every life. If the cost of that life gets too high, theyll end it.
But not if attorney-at-law Joe Sharp gets there first.

American Greed is a story about profits, hypocrisy, and the killers in white coats.

• Language: English
• Publisher: AuthorHouse
• Release date: Nov 30, 2015
• ISBN: 9781504963473

Eliezer Nussbaum, MD

Dr. Nussbaum is a Fellow of the American Academy of Pediatrics, American College of Chest Physicians, and the Society of Critical Care Medicine. He is a member of prestigious national societies, including the Society of Pediatric Research, American College of Physician Executives, and American Thoracic Society. Dr. Eliezer Nussbaum has been actively involved with the health care industry for more than 35 years. He is currently a Professor of Clinical Pediatrics Step VIII at the University of California, Irvine (UCI), and Chief of Pediatric Pulmonary Medicine and Medical Director of Pediatric Pulmonary and Cystic Fibrosis Centers at Miller Children’s and Women Hospital of Long Beach Memorial. Dr. Nussbaum played an integral role in developing one of the first Pediatric Intensive Care Units (PICU) in the state of California, and was listed among the top doctors in the nation by US News & World Report from 2011, and Best Doctors in America from 2003 through 2015. He has authored six books, including American Greed (three novels and three medical books) and over 200 scientific pieces.

Book preview

CHAPTER 1

A PLASTIC TUBE snakes from the boy's mouth and connects to a respirator. Multiple lines are anchored to his right and left forearms, skin bruising where they meet. Nurses hold him down as he flails and struggles. Jonathan is only eight years old, with skinny brown arms and sun-yellow hair, but he is strong.

Doctor O'Conner! a nurse shouts. Code Red! He's in cardiac arrest. Nurses swarm around the gurney, a flutter of green scrubs. One snaps the boy's shirt open; another begins rubbing gel on the shallow hollows of his chest.

Jonathan seizes again, teeth biting a bloody strip into his lips. His eyes are open but foggy and distant, lost in the orange and yellow leaves painted on the ceiling. It is an overly bright and cheery mural painted there years ago: an enchanted forest with fairytale heroes playing under the boughs. A single, giant tree represents each of the four seasons, limbs spreading around the walls of Pacific Memorial Children's Hospital Pediatric Intensive Care Unit in San Francisco, known as the PICU.

Doctor Karen O'Conner bursts into the room, her wild mane of hair threatening to slip from her cap. She is joined by the PICU attending, Doctor Rosen. Give me EPI one to ten thousand! O'Conner orders. Zero point five CC EPI, 50 cc bicarbonate! Up the IV dopamine to twenty micrograms, and get his arterial blood gases.

Her golden eyes dart around her nurses. She moves like a cat, fluid and practiced, and grabs the defibrillator paddles from their case. "We're losing him," O'Conner shouts, and she pounces. The paddles find their marks, thumping into place as the machine jolts to life.

Jonathan convulses. His legs jerk. His blue eyes flutter and find the doctor.

Look at the forest, Jonathan, she says. His eyes drift back to the autumn leaves, and the three blind mice climbing the tree. Jonathan's eyes are calm, the quiet place in the hurricane of his convulsions, as if they've already passed beyond.

He's flatlining, O'Conner thinks, her mouth cottony dry despite her many years of experience. We're losing him!

It is the controlled panic of a pediatric intensive care unit. Oxygen monitors hum; the defibrillator thumps. O'Conner can hear everything, her senses attuned to every nuance: the nurses' haggard breathing, the creak of tubes and wires.

Patient deceased, Doctor O'Conner. Time of death---

The doors swing open again. A barrel-chested man in flannel with a belt buckle as big as a saucer pushes through the staff. In vain the nurses try to hold him back. A proud woman, black hair in a tight bun, eyes stern and cold, follows her husband.

Get them out of here, Karen whispers, turning to close Jonathan's eyes, interposing her body between the boy and his parents.

Brent Campbell, Jonathan's father, is begging, pleading, gasping in unimaginable pain. You've made a mistake, doctor. He's okay, I can tell. We did everything we were told. He's okay! I know it ... please ...

The father's pleas fade as the hospital staff crowds him out of the room. The nursing staff leaves as the machines grow quiet, but a cold malice remains.

You killed my son.

Brandi Campbell's voice is low, like a distant storm on the horizon. The words were a whisper, but they found their mark.

Your son was referred to the Pediatric Intensive Care Unit too late, Mrs. Campbell. Karen O'Conner unstraps her mask, pale green against her coffee-colored skin. Anger trembles in her voice, the force of it threatening to break every word.

We gave him cold baths, aspirin, Brandi says. "He had a fever. A fever."

Your son had spinal meningitis, Karen snaps. There was a very narrow window where we could have saved him, and he wasn't brought to us in time.

We did what our doctor told us to do. Now Brandi's whispers are spears, each syllable dripping with malice.

Your doctor didn't understand the seriousness of Jonathan's condition. I don't know more or I'd---

Doctor Benson, Brandi hisses. I never trusted him. Brent did. Brent trusted him.

Benson? Now the anger is breaking through the seams of Karen's practiced calm, the name a fissure in her armor. I'm sorry, Mrs. Campbell. You and your husband should have a moment with your son.

Karen rushes from the room, flipping through the boy's charts. Each page makes another surge of hatred well in her heart. Head pounding, golden eyes crackling, she throws the clipboard across the hall. It hits the wall hard enough to leave a crack.

This is the last time, Karen whispers, a promise she will not break. This is the last time Benson gets away with this, so help me God.

CHAPTER 2

KAREN WAITS ACROSS from Doctor O'Brien's empty desk. It is neatly ordered, with files and papers in tidy rows, two different calendars, and a vintage sea-green phone in immaculate condition. The wood-paneled walls behind the desk are equally ordered, framed awards, diplomas, and certificates arranged in gilded rows. No photos, she notices. Just a collection of ostentatious trophies, the sort of trophies a pompous ass like O'Brien would have.

O'Brien is the chief medical officer---or CMO---at the hospital, so this is the last place in Pacific Memorial Hospital that a doctor wants to find herself. When a doctor is brought down here by the board of directors or the supervisory staff, it usually means there is a problem, with O'Brien happily delivering bad news. The room has always felt to Karen like a principal's office, and she the naughty student.

Karen sees her face reflected in the mosaic of diplomas. The lines around her eyes make her look older than she is, a fact that has ceased to trouble her the way it once did. Still, it won't help anything if Doctor O'Brien sees her anger seething so close to the surface. She tries to unknot the rage in her brow.

Two manila envelopes stuffed with case files are balanced on Karen's knees. Files going back seven years, before she ever came to Pacific Memorial. Long before she packed up her belongings and her cat from her tiny Los Angeles apartment and drove up the Pacific Coast Highway to the hilly streets of San Francisco, seeking a new beginning.

The case files in the envelopes are Benson's patients, not Karen's. These files point to a clear pattern of recklessness, poor diagnosis, and an unsettling string of patient deaths. Evidence, Karen thinks. Undeniable evidence that Benson has violated the oath every doctor takes before he enters the practice of medicine: do no harm. This is the Hippocratic oath, and it embodies all the duties and obligations of a physician. But Benson has broken it, Karen muses, time and again.

The door swings open and O'Brien strides in. He's aging but handsome, with perfectly manicured gray slashes over his temples and horn-rimmed glasses. A few pounds heavier every year, he still moves with vigor and purpose.

Karen, good morning.

Doctor O'Brien---

He cuts her off with a raised hand. You fucked up again, Karen. He shrugs his medical coat on, shakes his head. I'm sorry for my language, but you understand. I've not even had a cup of coffee this morning, but I do have a dead boy in the PICU. His mother is threatening to sue us. Did you know that?

She doesn't seem like the type to make idle threats.

She's also from Oakland. She couldn't afford to sue us, but she can afford to make my life a living nightmare. What's that? O'Brien motions toward the envelopes.

"What I want to talk about. Benson."

O'Brien presses the wrinkles from his lab coat, sits, and opens one folder, then another. His eyes rise above his thick glasses. This must be the last thing you see before the board pushes you out, Karen thinks.

Benson is with Northwest Health Care, O'Brien says, slowly, deliberately. As if Karen is a stubborn and asinine child. Northwest Health Care is the major referral company to Pacific Memorial. Without their patients, the hospital will end up in the red.

So what? Karen says. "He's a bastard. Look at his patient files. Seven years, seven years of questionable diagnoses. This is the third patient of his who has died in my PICU."

"I wouldn't count on it being your PICU for long, Karen. Not with your record of patient deaths."

What? Karen's eyes flash back from the gilded wall of trophies. Jonathan Campbell died of spinal meningitis. There was nothing I could do to save him. His doctor---Benson---should have properly diagnosed him. A first-year resident should be able to diagnose spinal meningitis, for God's sake.

Karen. O'Brien closes the envelopes and leans back in his chair. Have you written the boy's cause of death report?

No. Karen's words could cut cloth. I've been a little busy this morning, Doctor.

Busy pulling case files? You need to fill out the death note and death certificate too. You should be good at this by now, Karen.

I'll be sure to make it clear how he died, she says through gritted teeth. "And who denied his early transfer to the PICU."

No. O'Brien stands, hands behind his back. You'll write that Jonathan Campbell died of cardiac arrest. I'll review the case myself before it goes to the board, but the paperwork that you sign won't mention spinal meningitis.

Karen leaps to her feet, outrage coursing through her. This is indefensible. This is beyond what even someone like O'Brien is capable of.

I won't, she says.

"You will, or I'll find something very different when I get to the case. The board will find something very different. Your contract with Pacific Memorial will become very different. He thrusts the heavy folders across the desk. The Medical Board of California will find a very different report. Sign the fucking papers, Karen."

Hospitals are no longer physician-friendly, Karen murmurs to herself, and she wheels around and stomps out of the office, slamming the door behind her so hard that a framed diploma falls and the glass in its frame shatters on the floor. She smiles at the sound of splintering glass. She