The Corporation

CHAPTER ELEVEN

THEY HAD JUST dumped the car Jay O’Rourke had stolen in St. Louis and were on the turnpike heading to the house when Donald’s cell phone rang.

He answered it, keeping his attention on the road. “Hello.”

“Donald. It’s Eric.”

Donald recognized Eric Brown’s voice immediately. Eric was the medical director of the group he worked at, Crossroads Family Practice. Dr. Brown occasionally called Donald on the weekends to catch up with his patient load and shoot the breeze. He was a good physician and a great manager—Donald liked him immensely. For some reason, though, Donald detected an inflection in Eric’s voice that raised warning signs with him. Something was wrong. “Eric! What’s up?”

“I have some bad news for you, Donald.” Eric’s voice sounded strained, like he was under stress. “I hate to do this… God knows this isn’t coming from me, okay? It’s Pete’s decision more than it is mine, and Pete is certain the medical board will back him up on this.”

“What’s wrong?” His stomach felt queasy.

“I have to relieve you of your duties with the medical group,” Eric said. Despite the sense of hesitancy in Dr. Brown’s voice, Donald was shocked. He felt his body tighten and he had to force himself to pay attention to his driving as he took the news in. “It isn’t my decision. I went to bat for you before the Medical Board and the Business Administrators of the medical group, but they were adamant.”

“Why? What for? I don’t understand?” Donald did a quick lane change and merged into the slow lane, looking for an exit. He couldn’t have this conversation without it affecting his driving.

“Red Rose got into a tizzy over the Brennan case,” Dr. Brown said, and at the mention of Michael Brennan’s name Donald felt his stomach flutter with worry. “I’m happy his diagnosis was made early and that Dr. Schellenger performed the procedure. But Red Rose is furious that the decision was made to perform the procedure without their approval and they’re demanding we let you go or they’ll completely sever all business ties with us.”

“What?” Donald couldn’t believe what he was hearing. He was furious. “That’s… that’s,” he stammered.

“Outrageous? Yeah, I agree with that, buddy. That’s really outrageous.”

The exit to Elizabethtown was coming up and Donald gestured toward the change compartment on the middle island of the front seat of the vehicle. Jay grabbed a handful of quarters and the toll-booth ticket and waited while Donald got in line at the exit to the turnpike. “You read my report on Brennan. Dr. Schellenger and I both believe he had first stage testicular cancer and the lab results from the biopsy clearly indicated nonseminoma testicular cancer. Where the hell do they get off on making diagnostic decisions on my patients?”

“I’m completely on your side in this, Donald,” Dr. Brown said, his voice apologetic. “The medical board is as well, and so is Isabel Frank and Pete Barker.” Isabel and Pete were the Business Administrators of Crossroads Medical Group. “But Pete says he has no choice—if we don’t let you go, Red Rose will cease doing business with Crossroads, and with their market share as a health insurance provider in Central Pennsylvania, we’ll be out of business very quickly.”

“Jesus Christ.” Donald approached the toll-booth and Jay reached over and handed the ticket and change to him. Donald passed it over to the attendant, who nodded and waved them through. Donald piloted the car down the exit ramp and headed toward a Chevron station. “I can’t believe this.”

“If it makes you feel any better, I’m told Drs. Schellenger and Royer were dismissed from Lancaster Urological Group this morning, too.” Eric paused. “This hasn’t been easy on myself or Dr. Westerman.” Dr. Jerry Westerman was the Medical Director at Lancaster Urological Group.

“Red Rose made the same threat to them?”

“Yes, they did.”

Donald opened his mouth to talk but he was speechless. Somehow he steered the car into the Chevron station and parked next to a Cadillac on the side of the building. Jay O’Rourke was sitting in the front passenger seat, looking concerned. Donald put the car in Park. “Can they really do this?” he asked.

Eric sighed. “I’m afraid they can, Donald. They’re our biggest insurance group, they provide the largest patient pool in the area. If we lose them, our patients will defect to other medical groups. You know that.”

“I had Brennan’s report and our request for approval to cover his treatment already written out,” Donald said, still shocked by this sudden news. “I explained to Michael what we were doing, that we were going to word the request in a manner that the claim would be impossible to deny.”

“You made the mistake in authorizing the procedure to take place prior to Red Rose’s final approval,” Eric said.

“They were denying it on the grounds that they didn’t feel it was medically necessary! They would have kept denying it until Michael’s cancer advanced to third or fourth stage and metastasized!”

“I know. I saw your reports.”

“They wanted Michael to wait until it got worse, until blood work positively ruled in their favor that it was testicular cancer. You know that by the time the T-Cell counts show those kind of numbers it’s usually in the fourth stage by then! Those bastards simply didn’t want to shell out money for the procedure at this early a stage! Had we waited it would have not only jeopardized Michael’s health, Red Rose would have wound up paying a hell of a lot more to cover his treatment.”

“You’re preaching to the choir, Donald,” Eric said, his voice still troubled but trying to be soothing. “Trust me, I’ve been saying the same thing to Pete and he’s been saying the same thing to Red Rose, but they’re adamant. They’re furious that you over-stepped their authority on the manner. Their decision to deny coverage for this procedure, at this particular time, was final.”

“Those bastards.” Donald was furious.

“I’m sorry,” Eric said. “I didn’t want to do this, but I had to.”

The thought of being suddenly unemployed didn’t bother Donald; it was the extreme stupidity of the reason for his dismissal. He had taken the Hippocratic Oath to heal people, to provide the best health care and medical services he was capable of. To have his work overruled by faceless corporate suits who didn’t have medical training and who were motivated more by preserving the corporate bottom-line infuriated him. “My patients,” he said. “I can think of several off the top of my head who will be upset. Some of them might want to go with me to whatever medical group I wind up at.”

“Perfectly understandable,” Eric said. “Come in Monday morning and we’ll talk. I’ll help clear your files out and we’ll have a letter of recommendation ready for you as well.”

After agreeing to be in the office at nine a.m. on Monday to collect his things, sign some paperwork and pick up his final check, Donald pressed disconnect on the cell phone. He was still stunned by the suddenness of the events, so overwhelmed by what happened, that he didn’t notice Jay O’Rourke in the seat beside him.

Jay leaned forward, his features concerned. “What’s going on? You got fired?”

“Yeah,” Donald said, snapping out of his reverie briefly. He quickly recapped his conversation with Dr. Brown. “Those bastards at Red Rose insisted that Crossroads and Lancaster Urological fire me, Pete, and Bill or they’d sever ties with them.”

“Tell me about this guy Michael,” Jay said. “He the guy you told me about last night? The one who had testicular cancer?”

“Yes.” Donald gave Jay a brief synopsis of Michael Brennan’s diagnosis and his struggle to get Red Rose to approve the procedure necessary to properly diagnose and treat Michael’s cancer. “I’ve never run across an HMO who denied this procedure. I’ve had a few approve it and then later question me on it, asking if it was really medically necessary, but the claims adjusters who do that are usually the new guys in the office, the ones eager to look good to their superiors. Even then, the treatment is always approved at some point.”

“But these guys never approved it,” Jay said. “Are they like this with all your cases?”

“Pretty much,” Donald said. He placed the cell phone back in his breast pocket. “And especially lately. They’ve been denying a lot of things they used to pay for without any question.”

“They have a new CEO or something? New management?”

At this question, Donald’s mind flashed back on something Michelle had told him a few weeks ago… that Red Rose was one of Corporate Financial Consultancy’s clients. “No, but get this.” He quickly told Jay what Michelle mentioned to him. Jay looked grim. “This is just too weird to be a coincidence. I mean… Corporate Financial Consultants begins working with Red Rose and suddenly their whole business structure changes, becomes more bottom-line oriented. More ruthless.”

“Same as what’s been happening with Building Products,” Jay said. “This patient, Michael Brennan. What’s going to happen to him now?”

Donald sighed. “Red Rose will deny payment to his providers and the hospital and Michael will be stuck with the bill.”

“How much?”

Donald shrugged. “Hard to tell. Twenty grand maybe.”

“Shit. No wonder the medical profession is getting a bad rap.”

“I share your concern about the runaway cost of healthcare in this country, but now’s not the time to vent your opinion on what you may feel are the overrated prices of healthcare,” Donald said, struggling to keep the anger out of his voice. “The basic cost for such a procedure is around fifteen thousand dollars, which is a relatively low figure when you compare it with the fees of other surgeries. And if you think Dr. Schellenger received that entire amount for his fee, you’re mistaken. That fee covers those assisting him including the assistant physician, surgical nurses, and the equipment used. There’s also risk involved—there’s always risk involved when you put somebody under general anesthesia and operate on them. Anything can go wrong. Operating on a human being isn’t like fixing the transmission of your car or tinkering with the motherboard of a computer. You screw up, the patient dies. You can replace a car or a computer, you can’t replace a human being.”

“I hear you,” Jay said. He was fidgety. “I didn’t mean to criticize.”

Donald buried his face in his hands. “I’m sorry if I snapped. It’s just… I can’t believe this is happening!”

“Do you know where Michael lives?”

Donald turned to Jay, who looked concerned. “Why?”

Jay’s dark eyes reflected more than a concern for Michael Brennan’s financial ruin. “I think… I can’t really describe it, but… I just have this feeling he might be in danger.”

And when Jay revealed this to him Donald felt a shiver pass through him. First Red Rose’s repeated denials to cover treatment for a potentially life-threatening disease, then their hardball tactics to have Michael’s providers dismissed from their respective medical groups due to their willingness to save his life… and Red Rose’s continued refusal to cover treatment in similar cases the past six months while green-lighting other cases. It didn’t make sense. Donald remembered a case a month ago when Red Rose green-lighted plastic surgery for the patient of a colleague, which was definitely not medically necessary. The patient in question simply didn’t like the way her nose looked. Red Rose paid seven thousand dollars, the total fee, for a relatively minor procedure that shaved tissue off the tip of her nose. Last he heard, the Plastic Surgeon in question was planning further surgeries for the woman—liposuction to remove fatty deposits along the face, belly and thighs, some nips and tucks to smooth the brow. He’d never heard of any HMO approving Plastic Surgery for vanity’s sake. It had been the hot topic of conversation at work when Donald mentioned it in passing to one of the other doctors on staff, Jon Sneller.

Yet other procedures… denying coverage for the sixteen-year-old girl with a clear case of appendicitis and having the appendix burst—the medical group was still fighting with Red Rose for the emergency surgery necessary to save the girl’s life; the forty-four year old woman with pneumonia who was admitted to Lancaster General and was now on life-support after Red Rose initially denied the antibiotics that were recommended in the early stage of the illness that would have staved off the condition; the traffic accident victim who almost lost his leg when a drunk driver crossed the center divider and smashed head on into his car—Red Rose’s claim was that the surgery performed on the patient’s leg in order to save it was denied due to a pre-existing condition, one that existed in the driver that caused the crash. The driver in question was an alcoholic, a medical condition that had been documented in his history before. Never mind that the victim wasn’t an alcoholic and was simply in the wrong place at the wrong time, it didn’t matter to the Red Rose governing board.

Their verdict, when rendered, had caused a ripple of concern among Crossroads and Lancaster General, who had performed three procedures to save the victim’s leg, procedures which had so far amounted to seventy-five thousand dollars in medical expenses. Had they simply amputated the leg, Donald had no doubt Red Rose would have paid for that procedure and the follow-up care since they would have wracked up around twenty-five grand in fees all totaled. But now? With three surgeries already under their belt and with more to follow? The fees would be astronomical. The patient in question was fully covered through his employer, and most HMOs would have been bound to cover the cost of the treatment minus deductibles and co-pays. What Red Rose was doing was not only unprecedented in Health Care but unethical and, in Donald’s opinion, highly illegal.

This all flashed in Donald’s mind quickly as he considered Jay’s concerns. He felt afraid too, and he didn’t know why. Everything was spinning out of control; he didn’t know what to think about the situation. “I know Michael lives somewhere in the Denver area. I don’t remember his address or anything.”

“We need to find him,” Jay said. “I don’t know why, but we have to. I just have this feeling.”

Donald nodded and put the car into reverse and backed up. “So do I,” he said, and they pulled out of the Chevron station and headed out.

VICODIN WAS THE best drug in the world next to morphine. Michael Brennan was sure of this as he lay in the bed he shared with his girlfriend Jenny. It not only completely erased the pain in his lower groin, it produced the same numbness he felt the few seconds before he went under completely yesterday during surgery. He had been lying on the operating table surrounded by doctors and nurses at Lancaster Hospital, feeling very calm and confident that he was going to be well taken care of. There was an IV inserted in the vein of his left hand and the anesthesiologist was at his side, telling him he was going to start administering a drug that would put him to sleep very shortly. “You’re going to feel very calm, very relaxed, and then you won’t feel anything,” the Anesthesiologist said through his surgical mask. Sure enough, Michael felt very relaxed and calm, and then for approximately five seconds he experienced the best high he ever had in his life. It was wonderful, like floating on a cloud and having your body feel… well, so relaxed, so calm, so good. His friend Bobby told him the night before that Anesthesiologists used something morphine-based to put you under. Now Michael knew why people did heroin, which was derived from opiates, same as morphine. He didn’t know if Vicodin was an opiate but it sure felt like it. It wasn’t as strong as the morphine high he’d felt for five seconds before he dropped off like a rock and woke up suddenly in the recovery room, coming awake in a rush, crying in relief that it was over finally, but it was pretty damn close. Vicodin was great. It was so great he was thinking about replacing it with salt and pepper in his meals, maybe replacing it with sugar and cream in his coffee.

Aside from a brief bout of nausea when he came home from the hospital last night, he felt fine. He’d slept like a log all night, Jenny being careful not to bump into him as she slept on her side of the bed, her back to him. She’d gotten up this morning to go to work—she worked as a cashier at Wal-Mart in Ephrata—and his mother was supposed to come over later this afternoon to help out around the house. Jenny had made him a ham and cheese sandwich and placed it, along with a banana and a pear, in his lunch box and placed it by the bed. He had a bottle of water with him, which he drank from constantly. He could hobble out of bed to the bathroom easy enough, although he had to take it slow. He was still rather stiff. He’d inspected himself briefly this morning; the doctors had dressed the wound with gauze and bandages and then bundled his private parts in a jock-strap and a cloth-like diaper. They wanted him to keep the jock strap and diaper on as much as possible for the next five days, then Dr. Schellenger would take a look at him Wednesday during his follow-up appointment. Michael was relieved the first time he felt his dick at the hospital when he took his first piss. He hadn’t dared touch his scrotum yet to see what it felt like after the surgery, but at least his dick was still there. Dr. Beck told him the day before that he would be able to function just fine sexually, but of course there could be side effects to the surgery. Michael didn’t care; he just wanted the cancer out of his body. Still, in a few days when he felt better, he wanted to make sure everything worked, see if he could get an erection (and if he was able to pop a woody he was going to jack off to see if the pump still worked). But he was going to take these things one step at a time.

He was lying in bed now, watching TV, his mind wandering, when there was a knock on the front door. His mother. “Hey ma!” He called out. “Key’s under the doormat! Come on in!”

A moment later he heard the key slip into the lock and the front door opened. He heard footsteps and he frowned. There was more than just his mother showing up to help out around the house. If she brought his grandmother and his Aunt Becky over he was gonna be pissed. “Ma, who else did you bring?”

The footsteps headed down the short hallway of the trailer, and when the well-dressed men stopped in front of the doorway to his bedroom Michael’s heart leaped into his throat. He sat bolt upright in his bed, unmindful of the surgical wound in his groin. “Who are you?” His voice squeaked in surprise and sudden fear.

“I’m Matthew Hall, from Red Rose Medical Insurance,” one of the men said. He gestured to another man next to him. “This is Bill Moreau. The rest of the men here are Red Rose Insurance Adjusters. We’re here about your case.”

Michael relaxed a little bit. “Damn, you scared the shit out of me. I thought you were my mother.”

The men entered the room and surrounded him. Bill Moreau was a young man, perhaps a few years older than Michael, and he was carrying what appeared to be a black medical bag. He opened it and began rummaging around for something as Matthew Hall addressed Michael. “We have some papers to give you.” Matthew nodded at one of the other men, who thrust a sheaf of papers at him.

Bill Moreau found what he was looking for and grabbed Michael’s left arm. Michael started. “Hey, what’s up?”

“Relax,” Bill Moreau said as he quickly applied an alcohol swab to Michael’s left arm and deftly gave him a shot from a syringe he was concealing.

“What are you doing!” Michael yelled. He was suddenly being restrained by the other two men in the room as the injection was administered.

When Bill was finished administering the injection, he replaced the syringe in his bag and the men released their grip from them. Michael felt a flare of fear rise inside him. Something’s not right here… something’s not right…

“We’re enclosing bills for your surgery, hospital stay, your consultations with Crossroads Medical Group and Lancaster Urological Group, and Bill Moreau’s house call,” Matthew Hale said, tapping the papers that had been dropped on his chest. “Please remit payment within thirty days as directed.”

“What?” Michael was confused. Bills for surgery? Hospital stay? That was supposed to have been covered! Dr. Beck was supposed to have taken care of all that. And Bill Moreau’s house call? “What did you inject me with?” he asked, rubbing his arm.

“The injection will show up as a separate line item in one of those bills,” Matthew Hale said, his voice crisp and business-like. “Don’t worry, you weren’t injected with any drug. It’s just the cancer cells which were found in the biopsy of your right testicle yesterday in the lab.”

The implication of what Matthew just said hit him like a ton of bricks. Michael felt his face go slack with shock. “You’re kidding.”

“I’m not.” Matthew Hale’s features were stony, completely devoid of emotion. “Red Rose denied your original claim. That was our original business decision. Therefore, the bills for your surgery and hospital stay, as well as pre and post care, not to mention Bill Moreau’s services here today to deliver what was yours in the first place.”

The absurdity of it all was so overwhelming, so wrong, that Michael was stunned. He wasn’t a highly-educated man but he knew that it was unethical for a business, especially a health care business, to jeopardize the health of their members. “This is insane!” It was the only thing he could think of to say.

“No, it isn’t,” Matthew Hale said. “It’s just business.”

“But I’ve got fucking cancer!” Michael screamed.

“And Red Rose denied your original claim,” Matthew Hale said. “Had you and your health care provider operated within the parameters of our contract, this wouldn’t be happening.”

“But I’ve got cancer you nitwit!” Michael was growing frantic; he could feel his face growing hot, his breathing growing heavy.

“Original claim denied.” Matthew looked and sounded more like a robot than he did a human being.

“I—” Michael was at a loss for what to say. Except for the sharp pinprick in his left arm from the shot, he felt fine. He didn’t think Bill Moreau had injected him with any kind of drug, and if he did there was going to be hell to pay.

The well-suited men from Red Rose stepped out of the bedroom. Matthew Hale was the last to leave. “Oh, another thing. Due to the fact that you violated our contract, Red Rose is dropping you as a member. Please pay all claims promptly.”

“Fuck you!” Michael shouted. He threw the mass of bills at Matthew Hale.

Matthew’s features didn’t change. “Regardless, you’re still liable financially for this due to the fact that Red Rose denied this claim. Please pay all bills—”

“Get the hell out of here!” Michael made an attempt to get out of bed and a stab of pain rocked through his groin and lower abdomen.

“—promptly. Thank you.” Matthew Hale stepped out of the bedroom, and as Michael gritted his teeth against the pain in his groin he heard their footsteps receding down the hall and out the door.