Deadly Errors (15 page)

“You just had a serious complication on one of your patients, didn’t you.”

Tyler dropped his voice to almost a whisper and bent forwards. “How’d you know about that?”

Ferguson nodded. “A kid’s brain’s rotted away because of Med-InDx, didn’t it.”

“Why didn’t you call me on the telephone? Why did you go through all this charade to talk to me?”

Ferguson stood, handed Tyler a card. “You familiar with Lowell’s Café in the Market?”

Tyler accepted the card without looking at it.

The FBI agent gave a sharp nod. “Meet me there at five o’clock. My cell phone’s on the card if something comes up, but I think it’s in your best interest not to stiff me on this, if you get my drift.”

“No, I don’t get your drift.”

Ferguson smiled, “Be there,” and walked out of the exam room.

“S
HE’S BUSY.”

Tyler craned his neck to the left for a straight shot through the open door into Jill Richardson’s office. She sat at her desk facing the computer monitor. Raising his voice he said, “Is that right Ms. Richardson? You’re too busy to see me?”

She turned and smiled. “No, of course not.”

To Tony, Tyler said, “See? She’s not too busy to see me,” as he walked past.

The red-faced secretary shot back an expression that could only be interpreted as angry embarrassment.

Tyler dumped himself into one of the two chairs facing her desk. “I reported Larry Childs’s death to the project PI.”

“So soon?” Her brow furrowed. “Was that wise, considering we have no idea what the cause of death was?”

“We know exactly the cause of death. Radiation necrosis.”

“You know what I mean. We haven’t completed the root cause analysis yet.” She studied him a beat. “Don’t tell me you’ve finished it.

“Look, a patient in a federally funded research protocol had a complication and died from radiation necrosis. I’m obliged to notify our own Institutional Review Board as well as the study principle investigator who then has the responsibility to notify the chairman of the Data Monitoring and Safety Board. There’s no controversy here.” He said this with a tone of conviction that did not invite rebuttal.

Before she could say anything he added, “What NIH plans on doing with the information is their business and remains to be seen. They have the choice to stop the study until the committee reaches a decision on whether to shut it down entirely. I have no doubt this is a grave enough complication for them to seriously consider that option.”

She cleared her throat and straightened her posture. “I didn’t mean to imply you did the wrong thing. I guess I’m still shocked that your patient died, that’s all.”

“And another thing. The on-site technician, Jim Day, says there’s absolutely no evidence that someone messed with the data field. Basically, he says the treatment dose is exactly what was entered into the computer. I called Nick Barber, the PI who ordered the dose, and had him check his records. They’re the same as mine. Ten gray. I could conceive of one of us possibly making a typo, but both of us? Not a chance. On top of that, the computer would have to accept the 200 gray dose. And since it’s way out of range that couldn’t happen without an override by the treating physician. And that didn’t happen either. Bottom line? There’s no other explanation—someone had to change the dose after it was inputted.”

She cocked her head to the right. “And Jim Day says that’s impossible?”

“Correct.”

“So what you say must be correct. The dose was changed. The question is how?”

“How much do you know about computers?”

She considered this a moment before answering, “The sum total of my knowledge is how to turn them on and off and use email.”

“Well the only way I can see this happening is a hacker.”

“But that’s what I don’t understand,” she continued, “I thought you said Day said that was impossible.”

“Look, I’m no computer expert but there are a few things I do know. I know that a good hacker can exploit just about any system that’s connected to an outside phone or fiber optic line. If the system can accept incoming connections, it’s vulnerable to intrusion. And everyone who knows about Med-InDx knows it’s being touted as having impenetrable security. Man oh man, making a claim like that, that your system’s uncrackable … and making a huge public deal about it, is a direct challenge to any self-respecting hard-core serious cracker. Do that and you’re sure to be hit.”

“But how could someone change the record and not leave any evidence?”

“That takes work, but obviously it’s not impossible because that’s the only reasonable explanation for what happened.”

“But you said Jim Day said that can’t happen.”

“You know what source code is?”

“No.”

“It’s the original program written in whatever language the software is written in. Once you get a copy of the source code, you can figure out any number of ways to work around the security. You know what a trap door is?” He added, “In reference to software programming, not cellars.”

“No. But how do you know all this?”

“My college roommate used to code game software. He was also a hacker, but just not as devoted as the real ones. He told me about how coders leave trap doors in programs for easy access. The idea is, if you’re debugging a complicated program, you want access to advanced segments without having to work through all the prior steps that take you up to that particular point. When they finish the product they usually leave them in, for when they need to revise or trouble shoot the software later. Maybe the same thing applies to an application as complex as our medical record.”

She frowned. “So you’re suggesting if a hacker knew about one of these trap doors and had the source code he might be able to change a data field without leaving a any evidence of being there?”

“Absolutely. What other explanation is there?”

She stopped taking notes and started tapping her Mont Blanc pen against the paper. “That’s all very interesting, Dr. Mathews, but where is this going?”

“I’ve always figured if one person can’t give you the answer you’re looking for, go to the next person up the line. Maybe we should go directly to Day’s boss at Med-InDx, see if he or she is more receptive to the idea that their system’s been breached.”

She set the pen down, tapped both thumb nails against her lower teeth, apparently pondering this. “For what it’s worth, let me make a suggestion. Before going to someone in Med-InDx, why not talk to our CIO. After all, if we’re dealing with a security issue, our IT department needs to know about it too. I think this approach would be more politically advisable and if you want, I can arrange an appointment today.”

Her suggestion made sense. “Go ahead, phone him.”

A
RTHUR BENSON LEANED forward in the desk chair, combing fingers through the shock of white hair just to the left of his widow’s peak. His other hand he held the telephone to his ear. He said into the mouthpiece, “We can’t take that chance.”

The man on the other end of the line responded, “So, what do you propose?”

Behind the desk, above the matching credenza, hung an oil portrait. The piercing eyes of a distinguished, serious faced man in a three-piece suit stared through round wire rim glasses at anyone who cared to look at him.

This isn’t rocket science
, Benson thought.
Not even close. Why do I have to spell it out like this?
“Way I see it, we have only two options. Pay the sombitch off or off the sombitch. My vote? The latter.”

“Did he say how much he would settle for?”

“That is not the point.” He drummed his fingers and reconsidered his answer. “The point is, we can’t let him hold us up like this. It’s extortion, blackmail. It’s going against a fundamental rule. It’s not right. It’s bad business. It puts us in a position to be hit up again. It’s the reason the Israelis don’t deal with terrorists. We can’t let this pissant hold a gun to our heads. How else can I explain this to you? What is there you don’t understand about this?”

“Got your point the first time. Just answer the goddamn question. How much does this pissant terrorist blackmailing sombitch—as you call it—want?”

“What difference does it make? We’re not paying it.”

“Just give me the figure instead of a headache.”

Benson exhaled, exasperated. “He didn’t give an exact figure. But the general tone of the conversation came in at around two million. Not exactly what you’d call chump change.”

“But only a fraction of what we’ve sunk into this.”

“So what are you saying? It’s the cost of doing business?”

“Could be.”

He squeezed out a sarcastic laugh. “Fat chance.”

“So what are you saying? Off him?”

“Yes.”

“And just how is that going to play to the feds? A couple weeks before the committee’s report is due the committee chairman has a goddamn automobile accident? That’d be just what Prophesy is looking for.”

“I have it from a very good source that our amigo has a heart problem. It could be made to look like a heart attack. Anybody gets suspicious enough to do a post, they’ll find a good enough reason for him to croak.”

The other man admitted, “It
would
solve a few problems.”

Y
USEF KHAN STOOD outside his opened office door, hand extended. “I am glad to meet you, Doctor Mathews.”

A slender man Tyler pegged for 5’9” and mid to late forties, his black hair and flawless dark complexion accented strikingly chiseled, handsome facial features. He wore a gray herringbone tweed sports coat, blue Brooks Brothers button-down oxford, maroon tie patterned with a blue, green, and gold school crest of dubious authenticity, navy Dockers, cordovan penny loafers.
A Dartmouth assistant professor could not have done it better
, Tyler thought. Then considered that his dad, the professor, dressed pretty much the same.

Khan ushered him and Richardson into his office. “Please forgive my office, it is a mess,” and shut the door behind them, confining them into a room cluttered with computer printouts, computer journals, overflowing book cases, and stacks of CD jewel cases on the floor. The room smelled faintly of paper and printing ink, reminding Tyler of a second hand bookstore.

From the mix of accents, Tyler guessed Khan had been schooled in Pakistan by the Brits before immigrating to the States.

The Chief Information Officer bent to remove a pile of computer journals and print outs, from a chair in front of his desk. “What may I do for you?” He stood for a moment looking for a free spot to place the pile.

Richardson reached out to stop him. “Don’t go to the bother. I know you’re busy, so we won’t take up much of your time.”

Setting the stack back down with an embarrassed blush, he said, “I do not receive many visitors in my office.” He straightened, brushed off his hand, his gaze turning to Tyler. “This is about your unfortunate patient Larry Childs, yes?”

“How did you know?” He turned to Richardson. “Did you say something I didn’t hear?”

Richardson stiffened. “No. You were right there when I called.”

Khan gave Tyler a quizzical smile. “You act surprised. You do not know that Doctor Golden from the NIH contacted me and asked me to verify this alleged error?”

Tyler’s fists tightened. “Alleged?”

Khan’s face became more puzzled. “This is not the correct word?”

“Nothing’s alleged. It happened. I can prove it.” But since Khan apparently knew the punch line, Tyler decided to skip the preliminaries. “There was a dosage error. I checked Childs’s medical record the evening he was admitted. The intended dose was ten gray. He received 200 gray.”

Khan’s face wrinkled in apparent confusion. “But I found no evidence of this alleged error.”

“What!” Tyler glanced at Richardson. She was studying him with a strange, almost bemused expression. Was Khan’s English so bad that this represented a massive communication problem?

“Apparently you don’t understand. Let me go through it again. The other day the record showed Childs received 200 gray of radiation to his brain. Two hundred gray is a massive overdose, I guarantee you.”

Khan flashed a puzzled smile, “Come,” beckoning while moving to his desk. “I will show you.”

Khan typed a command. Larry Childs’s chart popped up on the monitor.

Khan said, “I will open his chart,” and moused the tab for radiation treatments. The radiation dose showed 10 gray.

Tyler blinked, looked again. “That can’t be.” He checked the name on the chart. Correct—Larry Childs. The treatment date was also correct.

Richardson asked, “What?” and craned her neck to see over his shoulder.

Tyler straightened up, bumping her out of the way in the process. “Goddamnit! Day must’ve changed it.”

She shot him a funny look. “Why would he do that?”

“He’s on the company payroll, for Christ’s sake. He was the last one to open the chart. He’s had every opportunity.”

“But are you forgetting,” Khan piped in before Richardson could respond, “such orders can only be changed
before
a medication or treatment is being given. This one,” tapping the flat panel screen with a pencil eraser, “cannot be changed, not now.” He shook his head adamantly.