we can’t take time to locate a vein and probe with a needle every time a medication needs to be provided to a patient. That is one of the functions of the IV line, which has the two ports that allow the insertion of a syringe and the introduction of whatever medication has been ordered. Now, if I want a medication to take immediate effect, as I said, I will order it given quickly in one shot. That is known as a bolus and is given in the port close to the vein in the back of the patient’s hand or arm.”
Wu said, “Okay, I got it now. So the higher the port where the medication is injected, the longer it takes to reach the patient. In your case with Mr. Wallberg you wanted to give it fast so the port next to the vein was used. Right?”
“Correct.”
Wu followed the explanation. “Okay, so in this case there might be a lag of at least fifteen minutes and as much as thirty minutes before the overdose of heparin caused the rapid heartbeat and evidence of bleeding that brought Wallberg back to the operating room.”
“That’s reasonable.”
“Let me ask this,” she said in a thoughtful tone, “after surgery you saw Wallberg in the ICU, gave written orders to the nurses there, and spoke briefly with Mrs. Wallberg, right?”
“That is correct,” Cliff replied wondering where all this was going.
“How long did all that take?”
“I don’t know. Five or ten minutes at the most.”
“Then you went down to the surgeon’s locker room and had some orange juice before you received the call from Intensive Care, right?”
“That’s right.”
Wu leaned forward staring intently at Cliff. “From the time you left the ICU until the call how much time had expired?”
Cliff thought for a moment. “I’d say twenty to twenty-five minutes.”
Wu leaned back in satisfaction and said, “Here’s another way it could have happened; someone administered the heparin to Wallberg after you left the ICU.”
Cliff reeled back slightly in amazement. “You’re saying one of the ICU nurses gave Wallberg the overdose?” His face registered extreme disbelief.
“Somebody did,” Wu said with certainty. “If it wasn’t a nurse, who was it?”
Vehemently, Cliff protested, “But I left no orders for heparin to be given to Wallberg! There’s no way a nurse could have misunderstood.”
Wu remained unperturbed, “What exactly were your orders?”
“Morphine as needed for pain, an antibiotic every six hours, continued gastric suction and of course nothing by mouth. As with any patient, I would check back after my surgery schedule the next day to see if any change in the orders was warranted. That was it.”
Wu pressed on, “Were these handwritten orders you issued?”
“Yes,” Cliff replied, “and I see where you’re going with this. Unlike many doctors, I have always prided myself on the legibility of my handwritten orders. In fact, they’re printed, not written, so there can be no possible misunderstanding. There is no way anything on those orders could have been interpreted as calling for heparin.”
Wu was not dissuaded. “Is it possible one of the nurses made a mistake?”
“What kind of mistake?” Cliff asked defensively.
“Is it possible that a nurse gave Wallberg a shot of heparin instead of morphine?”
Cliff was outraged, “She would have had to be dead drunk to make a mistake like that. The vials in the drug cabinet are clearly marked. How could she read a label that says morphine and think it was heparin?”
“I don’t know,” Wu replied calmly. “All I know is that someone gave an over dose of heparin to Wallberg and if it wasn’t Madhava then one of the nurses looks like the most likely suspect.”
Cliff shook his head in disagreement. “I just can’t see that happening.”
“All right, how about this? Could the vial of heparin been mislabeled as morphine?”
Cliff thought for a moment. “I suppose that’s possible but I have to tell you, it is highly unlikely. The vials are labeled by the manufacturers and it is hard to imagine that on an assembly line in a pharmaceutical plant one vial could receive a wrong label. I suppose it’s possible that an entire run of vials could be mislabeled but if that had happened, all the hospitals that received a shipment from that run would have been notified.”
Wu smiled complacently. “Dr. Harris, we’re talking about human beings here and any time humans are involved, errors are not only possible, they are inevitable.”
“I can tell you this, there were no reported instances of mislabeled vials, either before Wallberg died or after. So the scenario you outlined was only possible if one vial was mislabeled and that seems extremely unlikely.”
“Dr. Harris, everything about Wallberg’s death seems most unlikely. We only know two things for sure, he’s dead and an overdose of heparin killed him.”
Harris could not reply and they stared at one another for a few seconds before Betty Wu said, “I’m sorry, there are three things we know for sure. The third thing is that a jury will find the hospital negligent. Even if it is never determined exactly how the heparin got into Wallberg’s body, there is no way it could have happened without someone in the hospital doing something wrong somewhere along the line. I’d say you’re in the clear and the hospital is going to have to pay and pay big.”
CHAPTER 11
Vincent Barbutti could not keep a smile of victory from his face as he explained the autopsy report to Marilyn Wallberg and Richard Spehn in his office. Spehn grasped the import of the autopsy immediately. “The hospital has to be at fault!” he exclaimed.
Barbutti nodded in agreement. “You are absolutely correct, Mr. Spehn. It doesn’t matter how the heparin got into Mr. Wallberg’s body. Whatever the cause, the hospital is at fault, either a nurse or some other hospital employee made a fatal mistake.”
He turned to Marilyn and said, “Mrs. Wallberg, I doubt if this case will even go to court. The insurance company for the hospital will make an offer of settlement once they have digested the impact of this autopsy and realize they have no defense.”
Marilyn’s response was more subdued. “That’s certainly good news, but it’s all hard to believe,” she said in a quiet voice. “I’ll be glad when this is all over and my children and I can start to build a new life.”
Still excited, Spehn turned to Barbutti, “How soon do you think an offer will be made, Mr. Barbutti?”
“That’s hard to say. Sometimes, these insurance companies take a long time to face up to unpleasant facts. One thing I do know, your sister will see a substantial amount of money in what should be months instead of years.”
Marilyn perked up
