Chapter 5 - The Physician
Lieutenant Commander Ann Howard was thirty-nine years old.
She was a pediatrician. She had done her residency at Walter Reed and her fellowship at Children's National and she had been at Naval Medical Center San Diego for four years. She had a reputation for being careful and thorough and for being willing to argue with her supervising physician when she thought he was wrong.
She was also, according to the official chart, the attending physician who had signed the 08:30 note that said Adrian Vasquez was stable for discharge.
Moreno interviewed her on the third day.
Howard came into the interview room with her hair down and her eyes swollen and her hands folded on the table. She did not ask what this was about. She had, Moreno suspected, already known what this was about before the interview began.
"Lieutenant Commander Howard," Moreno said. "I want to ask you a question and I want you to think carefully before you answer it. Did you write the note in the official chart at 08:30 on the morning of the incident?"
Howard did not answer immediately.
"Lieutenant Commander," Moreno said, "I can read you your rights if you prefer."
"No," Howard said. "I don't need my rights read. I did not write that note."
"Who did?"
"I don't know."
"Lieutenant Commander, the note is signed with your electronic signature. The signature was applied at 08:31 by a credentials token that is registered to you. The token was in your possession. It was not lost. It was not stolen. It was used at 08:31 on the morning of the incident to sign a note that was not written by you. Either you signed it, or you gave your token to someone else and they signed it for you, or your token was stolen. Which is it?"
Howard's hands tightened on the table.
"Ma'am," she said, "I did not write the note. I did not give my token to anyone. And I do not know who wrote the note."
"Then how did your token get used?"
Howard was quiet for a long moment.
"Ma'am," she said, "at 08:15 on the morning of the incident, Commander Whitfield called me into his office. He told me that the patient in Room 4 was stable and that he was going to discharge the patient and that I needed to sign the discharge order. I told him that the patient was not stable. I told him that I had documented two oxygen desaturation events overnight and that I had written a note recommending against discharge. He told me that my note was not in the official chart. He told me that my note had been replaced by a note that said the patient was stable and that the note was in my name and that it was already in the chart and that I needed to sign the discharge order or he would have me relieved."
"Did you sign the discharge order?"
"I did not sign the discharge order. I told him that I would not sign it. And I told him that if he discharged the patient without my signature I would report him to the chief medical officer. And then I left his office."
"And then what happened?"
"And then at 08:31 my token was used to sign a note that I did not write."
"How?"
"I don't know, ma'am. But I know that Commander Whitfield has a master token. Every supervising physician has a master token. It allows them to apply a signature on behalf of a subordinate in a case where the subordinate is unavailable. It is supposed to be used only for emergencies. It is supposed to be logged. It was used on my token at 08:31 on the morning of the incident, and I have never been asked whether I authorized it."
"Did you tell anyone?"
"I told my charge nurse. She told me that Commander Whitfield was a very senior physician and that I should not make a fuss."
"And did you make a fuss?"
"No, ma'am. I did not make a fuss." Howard's voice was very quiet. "I am making a fuss now."
Moreno looked at her.
"Lieutenant Commander," she said, "how many other charts has Commander Whitfield altered?"
Howard looked at the table.
"I don't know, ma'am," she said. "But I have been keeping a list."
She reached into her bag and took out a small spiral notebook.
"I started keeping it in June," she said. "Every time a chart didn't match what I had written, I wrote the patient's initials and the date. There are thirty-one entries. Sixteen of them are on the pediatric ward. The rest are on the other wards that Commander Whitfield supervises."
Moreno took the notebook.
She opened it.
She read the first entry.
She read the last entry.
Then she looked up.
"Lieutenant Commander Howard," she said, "I need to ask you something and I need you to answer it honestly. Why did you keep this list?"
Howard looked at her.
"Because, ma'am," she said, "I am a pediatrician. I have spent eleven years learning how to keep children alive. And I have been watching a man alter charts to discharge children who are not stable because he needed to free up beds for the patients flying in from Okinawa. And I did not have the courage to go to the admiral. But I have a notebook. And the notebook is the only thing I have."
May you like
Moreno closed the notebook.
"Lieutenant Commander," she said, "the notebook is enough."
