Original subtitles

What do you got, Will?

9 -1 -1. Female, maybe four years old.

Severe respiratory distress.

Asthmatic? Oh, no. She's got a hell of a fever. 105 .6. Well, let's get her on

exam one. Anyone with her? Her mother should be right behind us. Hey, get an

ambu bag and start the O2.

One, two, three.

Where's she? Where's Wendy? Where'd they take her? Are you her mother?

What are you doing with her?

Where's Wendy? Listen, my name is Dr.

Travis, and your daughter is right in there. She's receiving emergency

care, okay?

I want to be with her. I know, I know. Who's your attending physician?

What? Your regular doctor.

I don't know. They changed it.

I think it was Grossman. Grossman?

No, it was something like that. Did you call him before you came in?

No, I just called 911.

There's not going to be any trouble, is there?

I mean, I have my insurance.

See, here's the card.

Triax MultiCare Incorporated.

It's through my job. I know I'm covered. Okay.

Dr. Travis? Be right with you. Could I have a word with you now?

Ms. Pearson, you can bother me about administrative paperwork later. Right

I have a patient in respiratory distress. You can't just go on.

What? It's a 911 call. No attending physician on record.

What does that have to do with anything?

She signed with an HMO.

We need pre -authorization from them before we can treat the child. We can't

even go beyond emergency breathing care without their approval.

I'm the physician in charge of the ER, right? I know, I know, but you have to

make the call.

I have to call them?

Stop wasting time and make the call now.

I tell you what, you get them on the phone and I'll talk. Right now, a little

girl needs my help.

So your gunshot victim hasn't told you anything yet?

The doctors in ICU say you'll probably never regain consciousness, but I've got

to stick around just in case. In that case, I'll buy you a cup of coffee. So I

paged you. It has been more than two hours since I called. Now, I've got a

patient here. I'm sorry, sir. I've already left a message on the voicemail.

if you'll just be patient.

No, no. I'm not going to wait. Now, you put on one of your damn managed doctors

now, or I will be calling every ten minutes until I speak to one.

What's wrong, Debbie?

I've got a patient in there.

A four -year -old girl. But Betty here says that I cannot... Central

administrative problem. It's been two hours. The procedure is very clear. The

patient is no longer in a life or death situation.

Let me be the judge of that.

I'll have to owe you that coffee. Put it in my ledger. What do you got? When she

arrived, she was febrile and cyanotic. We put her on O2 and bronchodilators.

She was brought in at 11 .10? Yeah.

What the hell with it?

Bring her in, admit her from ER, and start her on definitive treatment right

away. Blood cultures, antibiotics, chest x -ray. Dr. Sloan, I'm sorry. We can't

do that. The patient is signed with Triax Multi -Health, Inc. We have to

permission to treat.

Let's have a look at her.

Well, her temperature's still over 103.

Maybe she has a secondary infection.

Could be another septic focus is going into bronchospasm.

Excuse me.

She's my little girl.

I'm her mother.

Please, doctor, do something.

Do something.

I've got Dr. Holbein, the M .D. from Triax Multihelf Inc.

Let's see if we can clear this up.

Yes, Dr. Holbein, this is Mark Sloan, the community general.

Dr. Sloan, M .D.? Yes.

Why didn't the subscriber call her primary care physician first?

I don't know. Probably because her little girl was turning blue and she was

scared to do anything but dial 911.

Well, in any case, the patient should be at the Triax Multi -Health Contracted

Facility. That would be Greenlawn Hospital.

Well, Doctor, she's not at Greenlawn. She's in my ER.

And we're going to admit her into pediatrics and start a course of

I'm afraid not.

Hello?

Ah, Mr. Turner.

I'm afraid this little confusion is your mistake.

You know, you should have called your primary care physician, Dr. Grossman.

And he would have arranged for the patient's admission to the proper

But I didn't know.

I was scared. I called 911.

What I think you should do now is correct your mistake.

I don't understand.

Do you have your car there at Community General?

Yes. Then I suggest you simply bring the patient over to Greenlawn now.

That way, everything will be back in the proper order with the least trouble to

everyone. What did you say?

I beg your pardon? It's 20 miles across town to Greenlawn. Now, the child was

suffering acute respiratory distress two hours ago.

You want us to throw her in the backseat of a car before we even know why?

Frankly, I'm reluctant to authorize the expense of an ambulance when the error

is obviously that of the subscribers.

Are you out of your mind? The regulations are clear.

A patient must be treated in the HMO contracted facility unless there are

legally binding, obvious, immediately life -threatening circumstances.

Doctor, I just told you. Simple breathing difficulties that respond to

treatment do not qualify.

over from Greenlawn. It should take, ooh, perhaps an hour.

An hour? My God, man.

I'm terribly sorry. I have another call. If you wouldn't mind waiting, I'll get

right back to you.

Wait a minute. Thank you for calling Triax Multi -Health Incorporated. Your

is very important to us.

Please stay on the line.

Admit her.

Dr. Snow. I'm not holding off treatment any longer. I'll get back to Relia for

pediatrics. The hospital directives are very clear.

With HMO patients, we must get permission before undertaking any

treatment. What do you want to do, Betty? Wait an hour for their ambulance?

She's having a seizure.

Get into ICU.

I'll get Vaccarelli.

Let's roll her on her side. Take her airway. Get that oxygen mask back on.

an IV valium. Now. Vaccarelli, please call ER immediately. Dr. Sloan, line

Dr. Sloan, line two. Sloan.

This is Dr.

Arthur Holbein here again.

I'm afraid the ambulance will be slightly delayed.

There is a backup at Greenlaw. Don't worry. It'll arrive. The patient will be

appropriately cared for at the proper facility.

Dr. Baccarelli. Dr. Baccarelli, call ER immediately.

Dr. Baccarelli.

I don't know.

I find that hard to believe. What exactly don't you know?

Those phone calls.

Betty, when I was a young intern, if you were sick, you were taken care of. If

you had money, you paid. And if you didn't, you were a charity case.

I remember I served three, four years in a free clinic for the poor.

Now with the docs, it was a very poor neighborhood.

Mostly condos now.

Do you remember how long someone had to wait to be seen in a clinic like that?

I do.

I grew up in a very poor family.

My father was a pants presser when he could get to work.

Health insurance.

He couldn't afford an aspirin.

I think, Dr. Sloan, your memories of those days are a bit skewed.

In those days, if you were poor, you might not be treated at all.

I remember my Aunt Sophie dying of pneumonia all alone in her room.

There's something to be said for today.

Medicare, Medicaid, HMOs, managed care.

They are a lot better than nothing.

About 25 minutes after we got the little girl into the ICU, she went into

cardiac arrest.

Stan Vagarelli did all he could, but, uh... She died within 15 minutes.

Anybody tell the mother?

I did.

Four hours since she came in here and the ambulance from Greenlawn just

Mark, there's no way of knowing if we had admitted the child any sooner, if we

could have saved her.

We did the right thing. We had no choice. We had to follow the protocol.

Yeah.

And our call was obviously very important to them.

We did everything we were authorized to do.

You won't have any real answers until they do the post -mortem.

I know we'll be vindicated.

I think it was murder.

Dr. Sloan?

Here. Melvin Pinter, attorney at law.

I got your name from Mrs. Andrea Turner.

What are you doing in my house?

I'm representing Mrs. Turner in a suit for damage involving the death of her

daughter, Wendy.

I haven't heard about anything like that.

Nobody has.

What I mean to say is the case hasn't actually been filed yet, which is why I

wanted to talk with you.

I understand that you were present when the child was brought into Community

General Emergency Room. Not what you brought in later.

Close enough. The point is you took part in telephone negotiations with Tri -X

Multi -Health, the HMO.

I spoke to someone over there, yes. An Arthur Holbein, M .D.? That sounds

Good. Well, what I'd like to do informally is go over with you exactly

happened before actually deposing you in the case. Just exactly who are you

suing? Oh, everybody.

But not you, personally.

Who?

Tri -X Multi -Health Incorporated, of course.

The Turner's primary care physician under the HMO, Dr.

Arthur Holbein, and Community General Hospital. I'm particularly interested in

those in charge of the ER. Goodbye, Mr. Fender.

Dr. Sloan.

A four -year -old child is dead.

You know she died because of negligence, malpractice, and greed.

Which side are you on?

Was he killed with an 8 -inch Phillips screwdriver or not?

You know, he could have been killed by a long -range X -ray beam from a flying

saucer, but I won't know until I can complete my autopsy, which I can't do

you hovering and pestering me. Come on, Amanda, it was sticking out of his

chest. I've got a witness and I've got the weapon. What's the mystery?

Amanda?

I'm sorry, were you in the middle of something?

No, this gentleman was just looking for a spot for his screwdriver.

Don't ask.

Oh.

Listen, do you remember doing an autopsy on a four -year -old girl about three

weeks ago?

Yeah, that was Wendy Turner.

Right. Do you remember the post -mortem findings?

I believe that she died from cardiopulmonary arrest due to

and that was complicated by bacterial pneumonia.

I was thinking more of the time question.

Do you think further treatment, say, two, three hours earlier would have

her? What I mean is, was delay the cause of death.

In a general way, earlier treatment is always best. I'd need to pull the file.

It's tough to say what brought on the cardiac arrest. There are always

variables. Okay.

All right, thanks.

Dr. Cohn, report to administration.

Dr. Cohn, please report to administration.

What was that all about?

He keeps thinking about that kid's death.

I'd take him out to dinner Tuesday night.

You took him out to dinner? That was a special occasion.

Yeah, but he didn't eat a thing.

Just kept asking himself if he could have done more to save her.

I wasn't much help.

Neither was I.

Look, I can pull that file and take another look, but that's about it.

So, what can I do for you, Harold?

Hal. Just Hal.

Uh, I think you said for me, Hal.

Yes. Well, as a matter of fact, I was just wondering.

There's a bit of a rumor, you know, just a wispy sort of thing.

Somebody was looking for you, a certain Melvin Pinter.

Is Pinter suing Community General, I mean, directly?

You didn't actually say anything to Pinter, did you?

Not yet.

Because, as a matter of fact, legal says there's very little chance he can sue.

And as a matter of fact, it wouldn't even be a suit per se. Well, you know, a

lot of these HMOs have a contractual bar in their contract against court action.

So most of the time, an arbitration is the first and sometimes the only

recourse. But Pinter couldn't actually win. I mean, there's so many, you know.

intangibles, variables, and I can't... After all, we didn't do anything,

right? Oh, that's right. We didn't do anything. We just let that child lie

in the ark.

Mark, you provided emergency care and you stabilized her. After that, any

delay is the HMO's fault.

Nearly. Four hours went by before anything happened beyond initial

therapy. Well, that's inexcusable. It's inexcusable.

If anybody asks me about this in court or anyplace else, I've got to tell the

truth. Of course.

Just be careful.

That's all.

You know, we have certain interests of our own in this, right?

I don't understand.

The HMO doesn't own us. Why do we have to do what they say?

The HMO may not own us, Mark.

But HMO -approved doctors send us patients.

They send us money that we badly need.

I mean, look, if they continue to like us and send us cases, we can pay

for what? Research projects? We can pay for experimental services, teaching, my

salary, your salary. It can't be so bad that we let them tell us what to do.

The old days of Norman Rockwell -type family doctors with charity

clinics and even federal payments like Medicare and Medicaid. It just wasn't

working. Something had to happen to control costs.

What about the patient, Al?

Mark, Mark.

been looking into this Pinter. I don't like the way he does things.

Please, don't... don't talk to him anymore.

Okay?

Dr.

Sloan. Hi, auntie. Something wrong?

I need a minute.

In private.

She's in her 40s, Lena Rizzoli, in room 114.

She was admitted this morning for a routine removal of lipoma on her back.

She was admitted for a fatty tumor removal?

I thought that was all outpatient these days.

Well, it would be, but this one's too deep for drive -through surgery, and it

interferes with her arm movement, a lot of pain. She was admitted for two days.

I wish you'd speak to her.

Why? Well, the routine admissions blood test came up from the lab. Now, it could

be severe anemia, but when I was getting her settled, she was feeling very

faint. It was abdominal pain.

The admitting doctor came in. Well, naturally, I asked him about it. He told

to forget it.

You know him? No. His name is Gould.

Leonard Gould.

He really snapped at me. He told me that the patient was fine and everything was

under control.

Implied that I should know my place.

I see.

Mark, you know, I put in a lot of time and the...

Outpatient cancer service.

I had that lumpectomy myself five years ago.

I remember.

Is Gould still here?

No.

You didn't tell him you were going to talk to me or anyone else, did you? No,

no. You know you could get fired.

It doesn't matter.

The woman needs our help.

You know, I wouldn't ask anybody else.

I wouldn't say yes to anybody else either.

Well, let's see.

It must have been almost a year ago.

I just felt, I don't know, completely blah.

Did you call a doctor then? My insurance company signed up with LifeSuits

Incorporated five years ago.

That's the HMO.

And you were complaining of?

I'd feel weak.

Then I'd feel faint.

I actually passed out a few times.

I lost a lot of weight and...

I had this pain in my stomach.

Did you report that to the doctor?

I couldn't get an appointment with Dr. Gold for almost six weeks.

The people at the LifeSys Inc. walking clinic gave me pills.

They said I had psychosomatic arthritis brought on by tension and depression

over my recent divorce.

They prescribed an antidepressant and iron supplements.

Standard procedure.

And Dr. Gould agreed.

He said my anemia was improved.

But I just didn't feel well.

So I called people at the HMO about a specialist.

But they kept sending me back to my primary care physician.

The gatekeeper.

Yes.

That's how they called Dr. Gould. The gatekeeper.

So these problems continued, huh? I asked him if I shouldn't have some other

test. I don't know what they called them.

MRIs, CAT scans.

But he said they were unnecessary.

So for six months, I was on iron supplements and Prozac.

And now this thing.

This thing on my back, the lipoma, grew.

And really hurt.

And that's what I'm here for.

I see.

Mr. Zoli, have you ever had a mammogram?

As a matter of fact, I asked about that as well.

But Dr. Gould said it was HMO policy that it was unnecessary for a woman

the age of 45.

With all those presenting symptoms, it's hard to understand how a doctor could

treat someone for that long and not order any further tests.

Capitation.

You're talking about Rizzoli, Nancy's patient?

It's okay. I told her.

What does capitation have to do with Lena Rizzoli?

LifeSys, Inc. is like other HMOs.

They pay doctors so much per month, per patient, $15, $20 per head.

Capitation.

If the doctor orders tests, medication, anything over the $20 that comes out of

his own pocket.

To stop doctors from doing unnecessary procedures.

That's the theory.

It sounds like rationing a medical care to me.

Point is, anyone who stays well is a profit.

Anyone who requires treatment is a loss.

And further tests on Lena Rizzoli would definitely be a loss.

How could a doctor deny care simply because of a few dollars profit or loss?

I love you, Dr. Sloan. You are a sweet breath of innocence in a bottom -line

world.

Some HMOs offer big bonuses to doctors who have a reputation of keeping the

down.

You've heard of the gag rules.

A doctor is prohibited from even mentioning to a patient any treatment

HMOs won't authorize.

I thought the state and federal regulations pretty well took care of

Technically. Is there any chance that Gould can still order those tests? I

she is his patient.

I don't think so. When I suggested it, he blew up. He pointed out that an RN is

not in a position to lecture an MD.

Threatened me with strong disciplinary action.

But she needs those tests.

The protocol is clear.

Permission for any procedure has to come from the primary care physician.

And that means LifeSys, Inc.

What are we going to do?

We'll do exactly what we did in the case of Wendy Turner.

And if Lena Rizzoli dies, that'll be murder, too.

Not this time.

I want to know who's responsible for this.

I am.

Do you realize what you've done?

There is no excuse for this kind of unauthorized activity.

You're going to get community general in deep, deep trouble. We've already heard

from the legal department of LifeSys, Inc. You have opened us to all kinds of

charges of financial irresponsibility. Why did you do this?

Because I'm a doctor, Hal.

I swear by Apollo and Aesculapius, first do no harm to Hippocratic Oath. You

remember that?

Don't patronize me, Mark.

If you were anybody else, I would have you fired.

I demand you get Sloan in here right now. Already done, Doctor.

You may be Chief of Internal Medicine, Sloan, but you've overstepped your

authority.

Ordering tests on my patient? Tests you should have ordered yourself.

I don't have to admit my patients here, you know. I can always take them to...

To another HMO facility.

Well, you are the gatekeeper after all.

Oh, so that's what this is all about, huh? You think this is about HMO

procedure, do you? Well, you're wrong.

This is bottom line doctor -to -doctor medical ethics.

Mrs. Rizzoli is admitted for routine minor surgery, a lipoma excision, and

you and Community General Hospital move in with the obvious motivation of

running up enormous bills by a lot of unnecessary procedures.

is the grossest kind of ethical lapse, Dr. Gould. I am sure that we can settle

this without any kind of... What, you're going to let him get away with this?

Because I'm not.

We'll just see what the county medical society and the state licensing board

will do.

Got anything to say, Sloan?

You tell me, what excuse can you make? What possible justification can you

Microcytic anemia.

Positive occult blood in the stool.

Mark, TEA elevation 65 .8.

Excuse me, what the hell is going on here?

The results of the test on Lena are so late. The endoscopic report shows her

without question advanced colon cancer.

The pathology report in the biopsy makes it very clear that cancer has been

developing for at least eight months, widespread beyond the colon.

Had the symptoms, the continuous anemia, the weakness, the unexplained weight

loss, pain in the abdomen, been interpreted to call for tests, when she

it, the early stages could have been spotted, and the prognosis would have

a lot different at this point. As it is, Cascan shows widespread metastases to

the liver.

We'll have to call in an oncologist.

You know Malcolm McAuliffe?

Good man.

Probably call for cryotherapy or a possible removal of the lesions.

Neither one is very successful very often. Of course, chemotherapy.

I, um... Excuse me, please. I think I should go downstairs and see my...

Mrs. Rizzoli.

You think this started eight months back?

Well, the natural history of colon cancer suggests it's been at least that

Eight months.

How long has she got?

Well, I have no specialist help. Six months a year.

Well, talk to McAuliffe.

See what you can do for her.

Six months to a year of chemotherapy. You think Life Cis Inc. is going to pay

for that one?

It's all right.

You'll be okay now.

It's the chemo. There's always some nausea.

Three days.

She's under pretty heavy sedation.

Dr. Slott. Yes.

How are you feeling? Any better?

I thought it was Dr. Gould.

He came to see me.

I actually sort of laughed.

I was thinking, where were you eight months ago?

It might have done some good.

Dr. McCullough did everything that should be done.

I know.

Dr. Gould said he was sorry.

He apologized.

I didn't have the strength to feel anything particular.

I told him I... I forgave him.

Isn't that silly?

Forgave him?

What difference does it make?

Hi. We've got some company.

Dr. Leonard Gould.

I didn't see a car out there. He came up from the beach about an hour ago.

I think he's a little bombed.

He said he wouldn't leave until you got here, so I left him in the house with

his bottle.

Well,

you better make some coffee.

High octane. All right.

You're back from the hospital.

Mm -hmm.

How's the patient doing?

Oh, you know, standard reaction to chemo, nausea, that kind of thing.

I haven't been there for ten days. I transferred the case over to Malcolm

McAuliffe. Yes, I know.

Did you know that a suit has been filed by Melvin Pinter, counselor -at -law

against Life, CIS, Inc., HMO, and Leonard David Gould, M .D.?

For five million dollars damages.

I will drink to life, sis. Ink.

Of course they won't get five mil.

Judges tend to throw out huge jury awards.

Have to settle for maybe 700 thou.

On the other hand, my own malpractice insurance has been cancelled.

What I can do next in...

Medicine is an interesting question.

Doctor, I'm not sure you should be talking to me. Oh, I think I should talk

you. I think I have to.

There's nothing I can do. I mean, the malpractice action is out of my control.

It's out of my control, for God's sake.

But you can at least listen.

All right, all right.

The implication, The accusation is to pile up nickels and dimes out of my per

capita HMO payment. You know about that. I know about capitation.

All right. To make an extra buck here and there, they say I purposely withheld

treatment to the sick.

That isn't true.

I think... I mean, take...

Take managed care.

And I did.

You have to look at the social gains, the economic necessity.

See, the point is, without it, there's waste, terrible waste.

Now, in the old days, unnecessary treatment was the way a lot of doctors

their money, right?

Right. Well, probably.

In some cases, a few of those. Oh, you're romantic, Dr. Sloan. You know

true. We have to control costs, make sure...

Nobody is misusing our resources. Otherwise, the world's best health care

will destroy itself.

Doctor, past abuses are no justification for inexcusable actions in the present.

Don't you think this is enough for now? No, no, no. You've got to understand.

I cannot. I will not believe that a payment system geared to keeping

down would have influenced my medical judgment.

I refuse to believe that I would let myself be used to increase some...

Corporate profit margin.

Doctor, I don't pretend to understand your motivations, financially or

psychologically or any other way. All I know is the treatment was denied.

Lena Rizzoli has six months to a year.

I must not admit that even unconsciously my concern for my income would make me

responsible for Lena Rizzoli's death. You see that, don't you?

I see advanced colon cancer. I see metastases to the liver.

You're not listening. You do understand.

I mean, you've got to believe me. You've got to believe me.

I'm not guilty of that. I'll take them all. Come on.

You've got to believe me.

Oh, please, please.

My God, you're a doctor, too.

Okay, continue the four tasks.

One gram.

Q8H. Mark.

I didn't know you were working today.

Actually, I came by to say goodbye.

I've been fired.

Nancy, you knew you were risking your job when you questioned Gould's

and came to me. That's only part of it.

I think they also found out I'm the one that tipped off Melvin Pinter.

It's a good thing they can only fire me once.

Let me talk to Mr. Lomax. No, please. There's no point.

In fact, they're offering me a reference and six months' severance pay.

They're buying you off. Oh, I'll let them.

I don't regret what I did, but they might.

I got an offer to teach in a nursing school.

I like the idea of unleashing a few Nancy Rushes on the Lomaxes of this

Oh, we're going to miss you.

I'll miss you.

I'm sorry, Mr. Lomax. I tried to stop him.

Why are you firing Nancy Rush?

She broke protocol.

Come on, Hal.

On top of which, Lex's Inc. became aware that she was instrumental in Melvin

Pinter's malpractice suit against them.

They made it clear she had to go. Why? Because they wouldn't like us anymore?

You know, you are not sitting in this chair, Mark. There are some very large

issues involved here.

For one thing...

Payment on six months to one year of chemotherapy and other treatments in the

Rizzoli case?

Probably in the neighborhood of $250 ,000 or more.

And I'm not even sure that Lycis will pay.

Well, they won't like it even if they do.

You know what the HMOs say, a quick death is a cheap death.

There are legitimate financial issues here, Mark.

20 % of our patients are admitted here and paid for by LifeSys, Inc. and other

HMOs like them.

This is a fair executive decision because, on balance, Community General

their... their goodwill.

Against that, one RN... One RN who has the integrity to put the patients first.

It seems to me the Community General needs her, too.

Lorraine, would you do me a favor?

Call... Melvin, Pinter, please.

Yes, tell him I'd like to discuss with him a malpractice suit he has.

Wendy Turner.

You know, they sent out to the farmer's market for the locks.

No, thanks.

Very fancy offer.

What, this isn't yours?

They won't even let me into the men's room here.

Even the janitor has a degree from Harvard Law.

Now, they just lend out their boardrooms for fancy arbitrations.

Like today.

That's right. For stage and non -binding arbitration.

You mean there's no judge?

An arbitrator.

Well, actually, he's a retired judge. Teaches legal ethics at UCLA Law.

Don't think I'll find too friendly an ear there.

Why not?

This case he sat on, he threw out five out of six charges.

Then cut the amount of damages down from one million to a piddling 100 ,000.

Point is, for a major insurance company or HMO to get out from under for a lousy

100 ,000, it's like finding a bargain at a yard sale.

How much are you asking?

An excess of three and a half million dollars.

Stay away from the onions.

Morning, Harold.

It's Harold.

And I really don't understand your aiding and abetting this hijacking

Pinter, right?

So far, I haven't noticed he's been responsible for anybody's death. Now,

actually, in a way, it's not too late.

For what?

Well, I know you will want to consider your ongoing relationship with

Community General. That is, when you testify.

A little discretion, one way or the other, would make a big difference to

Community General and to you.

Now, Dr. Travis, I just want to get this clear.

During the time you had the patient in the emergency room, Wendy Turner, she

receiving only standard inhalation therapy, which means this was not

a life -threatening emergency situation?

Well, yes, but then she started seizures.

But that was after the telephone conversation with Triax MultiHealth HMO?

Yeah, I guess so, yes.

I see.

That's all the questions.

Any further cross -examination for this witness?

Nay, Your Honor.

Mr. Pinter, you're next, if you please.

Thank you, Your Honor. Dr.

Mark Sloan.

Dr. Mark Sloan.

Your call is very important to us. Please stay on the line for the next

available operator.

Dr. Sloan, do you recall Dr. Holbein's suggestion on behalf of Triax Multi

-Health Incorporated that Mrs. Andrea Turner should take her child in her car

miles across town to the Greenlawn Hospital?

The only place that child should have been taken was our pediatrics unit.

But as soon as the seizures were noted, Dr. Sloan, full emergency care was

immediately instituted.

Yes, but that might not have been necessary if we hadn't been kept waiting

hours for the HMO to give us permission to treat her. But isn't it a fact that

the post -mortem shows no definitive indication that delay was involved in

cause of death?

Common medical practice in the handling of emergency situations calls for the

quickest possible treatment.

Not pointless delays.

Any further cross -examination for Dr. Sloan?

No, Your Honor. No.

Dr. Sloan, you're excused.

Your Honor, I wonder if I might say just a few words.

I object, Your Honor. Your Honor, Your Honor, please.

Please, Your Honor, this is not a forum for personal opinion.

No, it's not.

It's an arbitration.

My arbitration.

And I'll decide who talks and who doesn't.

Now, Dr. Sloan, you've been sitting in that chair for the past hour, and it

seems like you've been a little bit uneasy.

And I, for one, would like to know why.

Thank you.

I'm aware that the post -mortem is indeterminate as to the precise

time in this child's death.

Speaking from the point of view of the doctor, I only remember one thing.

The clock on the ER wall.

It jumped convulsively every second.

Jump. Jump.

Jump.

I can remember the weight of the wristwatch every time I looked at it.

It was four hours before that ambulance would arrive from Greenlawn.

For that, my profession has no excuse.

The key to...

The proper delivery of medical services has only to do with the patient's needs.

The patient's needs.

The profits of a corporation, the rise and fall of its stock in the market, all

of the vast economic problems which have erupted out of the mountain of demands

and expectations, they're all secondary to the actions of the doctor,

the nurse.

The clinic.

The hospital.

And most important to those in danger.

In pain.

At risk.

No hospital is the equivalent of a factory.

Or a bank.

Or a supermarket.

I'm no expert on who's legally responsible here. You're lawyers. It's

ballgame.

The minutes that Dr.

Travis and I spent on the telephone arguing with a computer playing elevator

music, arguing business regulations as to who had claimed that the patient's

billing and control.

All that was a violation of my oath.

Those minutes belonged to that little girl.

Then tell me, Dr. Sloan.

Who is responsible for Wendy Turner's death?

The HMO.

Triax Multi -Health, Inc.

The doctor in their office.

The administrative regulations enforced at Community General Hospital.

And me.

Well, I have some news.

The ruling came down this morning.

How'd it go?

Told you I was afraid of Judge Kesey.

First off, the claims against the hospital have been thrown out. That

make you happy, Dr. Sloan. Not very.

Second, the judge is proposing a settlement.

What kind?

The companies, the insurance, and the HMOs have agreed to pay, but they don't

have to accept any blame for any wrongdoing.

They're guilty of nothing.

Exactly how much is this settlement?

$200 ,000.

How does Mrs. Turner feel about it?

She's not very happy.

Not because of the money. I mean, that doesn't really matter to her.

But Triax Multi -Health Incorporated gets off without acknowledging their

in Wendy's death.

So you think they won? Is that it?

In a way.

Remember what I told you. To a billion -dollar corporation, a few hundred grand

is a cheap insurance premium to let them go on just the way they did before.

How about you, Dr. Sloan? Have you got any backlash from the hospital because

your testimony?

Oh, no, not yet.

It's much easier to get rid of a registered nurse who doesn't have a term

contract.

Although Lomax has stopped asking me to call him Hal.

You all right, Dad?

Yeah, I'm fine.

At least it's over.

This case.

But there'll be others.

Lena Rizzoli.

Now, that one should be easy.

Of course, I'll...

Probably have to subpoena you, Dr. Sloan.

But at least the hospital's in the clear.

That's great for the lawyers and the hospitals, but what about the people who

practice medicine?

I mean, what's the point of becoming a doctor if I can't be a doctor? Some

corporation is going to tell me who I can treat and how to treat them.

Jesse, there's only one rule that applies to what we do, and it hasn't

in the last 2 ,000 years, no matter how much the practice of medicine has.

First, do no harm.

Even though they're not making it easy for us.