Quincy M.E. (1976–1983): Season 5, Episode 15 - Cover-Up - full transcript
An autopsy eads Quincy to an ER where an underqualified doctor's ending lives rather than saving them.
You actually left that man
in charge of this place?
Oh, my God!
- What happened?
- I don't know.
All of a sudden, he went.
- You were keeping this?
- Yeah.
Are you telling me that
your emergency room
is being run by an
unqualified doctor?
We don't make
mistakes like this.
Oh, come on! Everybody
makes a mistake!
From what I understand, you
must be getting some of your help
from the want ads.
You could be playing a
very dangerous game.
He was given a lot better
medical care after he died
than before he died.
Gentlemen, you
are about to enter
the most fascinating
sphere of police work,
the world of forensic medicine.
Margaret, I can't believe
it, you're a grown woman!
Last time I saw you, you were
wearing braces on your teeth.
It's been a long
time, hasn't it?
It sure has been.
What's she up to, Chuck?
I think I remember you
wanted to be a deep sea diver.
Then you wanted
to be an archeologist.
Well, I guess you and
Dad had an effect on me.
- I became a nurse.
- Oh, that's terrific.
Nursing's a very
satisfying profession.
Not as satisfying
as being a doctor.
- Oh?
- That's why
we're here, Quincy.
We need a favor from you.
What? Name it and you got it.
All right. Margaret has
decided to enter medical school.
Wonderful. How can I help?
If I write a letter
of recommendation
to her whole alma mater...
They'll think it's
a personal thing.
Yeah, but if you
wrote the letter...
- Consider it done.
- Thank you.
Quince, could you
check... Oh, excuse me.
No, come in, come in.
I want you to meet two
very dear friends of mine.
Dr. Charles Aldred.
His daughter Margaret.
- Sam Fujiyama.
- Hi.
Place would fall
apart without him.
Can I get a written
confirmation on that?
I'm up for a raise and I'd
like to show it to Dr. Asten.
And can you check
these autopsy reports?
Sam, it's nice to be
needed, but not all the time.
The life of a pathologist.
At least a pathologist
doesn't have to worry
about his bedside
manner, Quincy.
If that were the case,
he'd be out of a job.
Nice to have met
you, Doctor. Margaret.
Pleasure.
Out late last night?
Aw, come on, would ya?
Well, it doesn't matter,
it's all right. It's no big deal.
Where are you, at a drive-in
movie, for heavens sake?
- You're
supposed to be bowling.
- Aw, come on.
- Take it easy, will ya?
- Thank you sweetheart.
Come on, just relax.
Ah, boy, am I outta shape.
- Take it easy a little bit.
- What are you kidding?
These guys'll think I'm
an old man or something.
You kid.
You know, I've been
working here for a month,
and I still haven't
met Dr. Danner.
It's because he's
too busy getting rich.
He's got quite a deal.
What with operating
six emergency clinics
plus his nursing home, he hasn't
got time to practice medicine.
Somehow it just
doesn't seem quite right.
Why not? We're
here to do the work.
And that's all that matters,
to him or the patients.
Why aren't you
in private practice?
Ah, too much hassle.
Not enough time for myself.
Once I leave here,
it's behind me.
I don't have to
take night calls.
I don't wear a beeper.
No overhead, pay isn't bad.
Oh. Customers.
Well, well, well. What
happened to you?
I told her to stay
off the skateboard.
I told her one of these days,
it would wind up
in a broken bone.
Hey, I bet that hurts, huh?
We better have a look
at it. Come on in here.
You'll be okay.
Oh, man, am I ever
ready for a vacation.
You're lucky. I just
got back from mine
and I'm shot already.
I don't think I had more
than four hours sleep
in the last two days.
Man, ever since those
cutbacks, it's gotten crazy.
Yeah, before I left I was
working six double shifts a month.
The price we pay
for being heroes.
I love being a hero.
I just wish there
was more of us.
Forty-four.
Yeah.
Gotcha. Let's go.
Some old lady took a
fall down a flight of stairs.
Let's do it.
You okay?
Yeah, yeah, I'm...
I'm fine. I'm okay.
Loose your balance?
- Have another beer.
- I'm all right.
- You all right?
- Yeah, yeah, I just lost
my balance, that's all.
Can happen to anybody.
Honey, maybe ice skating,
but you don't fall down bowling.
Will you knock it off? I'm fine.
Hi, fellas, what
have we got here?
Uh, sixty-seven year old female.
She fell down
some steps. Got a...
Okay, you can fill out the
forms. I can take it from here.
Uh, wouldn't you like
a little history first?
Sure. Give it to the nurse.
- Hey, Doc, don't ya...
- Don't "Hey, Doc," me, buddy.
The name's Ito. Didn't
mean to shake your tree.
Uh, it appears that she has
a simple fracture on the third
and fourth ribs and, with
a possible fractured femur,
all on the left side.
One of these days you might
make a good diagnostician.
Mind if I do my own examination
or would you like to take over?
Hey. We're just doing
our job, Doc. Doctor.
Well, keep doing it.
Like get her to the
emergency room.
Anything you say. Come on.
How's that grab ya?
Hey, you look pretty lousy, Bob.
Sure you don't
want to call it a night?
No, it's just that
stuffed cabbage
Arlene made me for
dinner. It gets me every time.
- Sure you're okay?
- Oh, fine, fine, fine.
Let's finish 'em off right now.
Would you like a cup of coffee?
Oh, boy, yes, thanks.
Hi, Tate.
I was beginning to think
you would never show up.
I'm sorry, I got
stuck with a patient.
- Look, Alan...
- Tate, this is Margaret.
Dr. Edmonds will be
covering for me while I'm gone.
Gone?
I thought you were
on duty all night.
Yeah, I am. But, uh,
I have to get away for
about two or three hours.
- I met this gorgeous...
- All right,
spare me the details.
So you're going to be
covering for Dr. Drew.
It looks that way.
Uh, Alan, can I talk to
you for a moment, please?
You bet. We can go in here.
Alan, are you sure this
is gonna be all right?
What's not to be all right?
Huh, you're a
doctor, just like me.
Not just like you, Alan.
I haven't handled an emergency
case since I was a resident.
- That's eleven years ago.
- What emergency?
The most that's gonna
happen is a broken finger
or a splinter,
or maybe you'll have
to do a few stitches.
It's a piece of cake.
Anyway, I'll be back
in two hours, outside.
Hey, would you get
that look off your face.
It doesn't exactly create
an illusion of confidence.
I did it. I finally did it!
Oh, oh, oh, ah...
Oh, help him. Oh, my God.
Call the paramedics. Please,
somebody call the paramedics!
Oh, Bob.
What is it? Take it easy.
Excuse me, please.
Out of the way, please.
Excuse me. Out
of the way, please.
Stand back, folks.
Out of the way.
Thank you. Step on back, please.
- Okay, fella, how ya felling?
- Lousy.
- Really lousy.
- Where does it hurt?
Okay.
Come on. Let's scope 'em.
- What's the matter with him?
- Just take it easy.
- We'll find out right now.
- Hang on, honey.
- It's gonna be all right.
- I... I know.
As soon as I'm set up,
transmit this to Rampart.
Hang on, Bob. You're all right.
He's gonna take care of you.
Rampart Emergency,
this is Rescue 44.
Do you read us? Over.
Oh, hang on, Bob, honey.
So that's why I
decided to specialize.
It's a pretty easy life.
No night calls, no emergencies.
My brother's an O.B.
You wouldn't believe
the hours he works.
You know, women have
absolutely no consideration
about deciding when
they're gonna go into labor.
Sexist.
Not me, my brother. Without
sex he'd starve to death.
Ten-four, Rampart.
We've got the I.V. going.
We've pushed 100
milligrams of Lidocaine...
The PVC's decreasing.
I'm sending another strip.
It's my fault.
I tried to tell him not to play.
Look, he's gonna be
all right. We got it in time.
Hey, Bains. They
want us to take him
to Danner Emergency.
They're phoning it in.
If you asked me, he'd
be better off at Rampart
than at Danner.
Danner's closer.
Besides, orders are orders.
We'll be waiting.
That was Rampart Base.
Rescue 44 is bringing
in a cardiac run.
Cardiac!
Why couldn't they
take it themselves?
Because we're closer.
Besides, it's a
standard procedure.
I haven't handled
a cardiac in years.
Relax. Rampart wouldn't
have authorized transport
unless he were in
a stable condition.
- Oh, still it's...
- Still you're a doctor.
And the only one
around at the moment.
He looked pretty bad, Doc,
but he's feeling better now,
aren't you, Mr. Keane?
You new here?
Help me get him to
the emergency room.
Here are his vitals,
and the medications
that Rampart ordered.
Thanks.
Lidocaine, huh.
That confirms Rampart's orders.
Let's get him on the table.
One, two, three.
Bag's almost empty, Doc.
Well, we'd better change it.
- Yeah, do it, all right.
- Sure.
What are ya doing?
Hooking him up to your
equipment. What else?
- Okay, okay.
- Hey, hey, Doc,
you want us to kinda
hang around for a while?
Rescue 44. Are you available?
Yeah, this is 44.
What do you got?
A stabbing. Tyler and Vermont.
Can you handle?
Uh, yeah, we'll,
we'll take it, Dispatch.
I sure don't know where
they find them these days,
but if you ask me, that
doctor doesn't know
his stethoscope
from his left ear.
Where's my husband?
Is he all right?
He's doing just
fine, Mrs. Keane.
The nurse inside
can help you out.
- Oh, thank you.
- We have another call.
I sure hope Drew gets here soon.
I don't need this one bit.
He's stable. I'll get it.
Hello. Hello, is somebody here?
- May I help you?
- Oh, yes.
They told me that
my husband's in here.
Oh, he's resting in
the back just now,
if your Mrs. Keane, that is.
Yes, I'm Mrs. Keane.
I'd like to see him.
Please, I just
want to be with him.
I'm sorry. It's better
if you don't right now.
Well, I just want
to be with him.
Oh, my God.
He's dead, isn't he?
Now Mrs. Keane,
he's not dead. He's fine.
He's not dead, Mrs.
Keane, sit down here.
I'll be right back.
Oh, he's dead, I know it.
It's his wife. She's very upset.
I'm going to give her
something to calm her down.
Margaret!
- Well, what's the matter?
- Nothing. It's all right.
Here. Just take some of this.
Take these pills.
You'll feel much better.
- What happened?
- I don't know.
I don't know. All of
a sudden, he went.
We better defibrillate.
Clear.
No conversion.
What the hell am I
gonna tell his wife?
Hi.
- What's happened?
- Cardiac arrest.
Thank God you're
here. I can't handle this.
How long has he been like this?
- Twenty minutes.
- He went into V-fib.
We tried to convert him
six times, but nothing!
Margaret, go see to
his wife. I'll take over.
- But...
- Do it!
Yes, Doctor. Whatever you say.
- You gave him this?
- Yeah.
Why, what's the matter?
The matter is, we got a lot
of work to do here and fast.
Hey Quince, wanna
grab some lunch?
Soon as I finish here,
I'll be right with you.
What are you doing?
I'm breaking down a food sample.
Food poisoning? I
didn't know we had one.
Now this is off the record.
Do you know
Danny's secret sauce,
you that spaghetti sauce
he's always bragging about?
He bet me ten dollars
I couldn't duplicate it.
Well, with this
equipment I can't miss.
Where'd ya get the specimen?
Where else? Off my tie.
Do you know what this machine
cost to operate and maintain?
Do you know what your
time is worth, and you spend it
analyzing spaghetti sauce.
Is nothing sacred? Are
you bugging this room?
I told Danny, I said
Dr. Quincy would never use
county facilities for
personal reasons
like analyzing spaghetti sauce.
It's against regulations.
Right?
He's all heart, that guy.
Come on, I'll buy you lunch.
- At Danny's?
- Where else.
Hi, Carol. What's the matter?
It's Dr. Danner.
He's in the office.
- Here?
- Uh-huh.
He said he wanted to see
you as soon as you came in.
Me? Why?
I don't know. But you'd
better get in there right away.
- Well, okay.
- Okay.
- See ya tomorrow.
- Sure.
- Dr. Danner?
- Uh, come in, Miss...
Aldred. Margaret Aldred.
Of course.
The nurse who wants
to go to medical school.
That's right, Dr. Danner.
- I applied last August.
- Good.
Good. Sit down,
Miss Aldred, sit down.
Thank you.
Now you may not know
it, but I happen to be
on the entrance
evaluation committee.
And since you work for me,
perhaps I can be of some help.
I sure hope so, Doctor.
I'm certain of it.
We must talk of it sometime.
Uh, by the way, Miss Aldred,
you were on duty
last night, weren't you?
Yes, sir.
Then you handled this
unfortunate cardiac arrest
with Dr. Drew, didn't you?
Is anything the matter?
No, no, not at all.
It's just that we have a
reputation to maintain.
And in cases like this,
where a death is involved
well, I always like to
be certain that, well...
Well, you understand
what I mean.
I think so.
Now, Drew is a very good man.
Excellent, as a matter of fact.
And I'm sure that you
both did everything possible
for the patient.
It's just that case
files don't always give
one a totally complete picture.
So, I would like you to tell me
in your own words
exactly what happened.
Well, it was about 11:00
when we got a hot line
call from Rampart Base
that Rescue 44 was
bringing in a cardiac case.
I see. The paramedics
had handled the
case in the field, then?
That's right.
They had been in radio
contact with Rampart
and had stabilized him on
Lidocaine before he came in.
- Than what happened?
- Well,
we brought him into the E.R.
and then Dr. Edmonds and I...
Dr. Edmonds? Who's Dr. Edmonds?
Don't you know
who Dr. Edmonds is?
Well, of course, now
that you mention it.
He must be Dr. Drew's
authorized replacement.
Well, it's just that I have so
many people working for me.
I think I can get
the rest of this story
from Dr. Edmonds or Dr. Drew.
Thank you. That'll
be all, Miss Aldred.
Marinara or clam?
Marinara?
It's neither, it's tissue.
I've learned my lesson.
That'll be the day.
Let me take a look.
- Don't you trust me?
- Let me take a look!
All right. You can look,
but if you do, I'm gonna
take it personally. Go ahead.
What would you think
if I told you I trust you?
- Then why look?
- Well,
you said it was tissue...
Listen would you work on these?
- There are four of 'em!
- Quincy, it's routine.
- It'll take you a few hours...
- Few hours?
You know how long.
Why don't you take two?
You never keep
your hand in anymore.
How can you say that to me?
You realize I've a pile
of paperwork that...
Oh, gotta return a call. Sorry.
Robert Keane, age forty-two,
five feet, eleven inches tall.
You mean to tell me that
you let this, uh, this Edmonds
cover for you? That you actually
left that man in charge of this place?
I don't believe
what I'm hearing.
Look, it was only for two hours.
And besides, the man's
a fully qualified M.D.
Fully qualified! Is he an
emergency physician?
Is he certified in
coronary care?
There's a big
difference, Doctor,
between a case of
acne and a heart attack.
According to the law,
he has as much right
to work here as I do.
- Or you.
- I know that.
I am not talking about the law,
I am talking about
simple common sense.
And my county contract.
I've put a great deal of blood
into building my operation,
and I don't need it jeopardized
by your irresponsible behavior
in leaving a totally unqualified
doctor in charge here.
All right, look,
maybe I was wrong,
but there was no harm done.
I got here just as
the patient went sour.
I worked on him
myself for an hour.
There wasn't anything
anyone could have done
to save the guy.
These things happen.
Not to me, they don't.
Not when I can't justify
why a Dr. Edmonds
could happen in my clinic!
My clinic!
I'm afraid, Dr. Drew,
that you and I
have come to a
parting of the ways.
If you say so, Doctor.
But is it wise to fire
me, just like that?
What are you getting at?
It would be an admission that
something was wrong here...
Wouldn't it? Think about it.
I signed a report for the
Medical Examiner's Office,
So who's to know that
Edmonds was ever involved at all?
Just you and I.
And Dr. Edmonds.
Is he gonna want
to talk about it?
What about Margaret Aldred?
What about her?
I'm gonna take a
section of his heart, Sam.
Gimme a petri disk, will you?
Well, the heart shows signs
of acute myocardial infarction.
Otherwise he appears to be okay.
Well, according to the report,
it looks like they did
everything they could.
Sure looks that way.
Well, the tox results will give
us some more information.
Results should
be routine, I guess.
Yeah. I wanna take another look.
Right.
Anyway, as long as I'm here
I thought we might
into the matter
of your medical school
application more thoroughly.
Is this in the order
of an oral interview?
Not officially.
I see that your father
is Dr. Charles Aldred.
He's a fine physician.
Has an excellent reputation.
I also notice a letter
of recommendation
from a Dr. Quincy,
who's a Deputy Medical
Examiner for the county.
- It's a glowing note.
- Thank you.
He's an old friend.
I suspect that you've seen
him recently. Am I correct?
Yes, I have, but it was only
to ask him to write that letter.
Is there something wrong?
Of course not.
This is just routine.
Well, it doesn't seem
very routine to me.
I mean, it isn't very often
that a medical applicant
is called in for a private,
informal, oral interview.
Calm down, Miss Aldred,
you're a bit nervous.
Of course, that's expected.
Going from a nurse to
a doctor it's a big step,
and I gather it's
important step for you.
Very.
And it does seem that
you're eminently qualified.
It would be a pity to
have come all this way
with your work and studies,
and then get rejected
at the last moment.
May I call you Margaret?
There are certain sacrifices
that one makes for a career.
That's a fact of life.
Now I would like to help
you get into medical school.
That would mean that you and I
were working side
by side as colleagues.
I can't follow you, Doctor.
Well, I'm referring
to the excellent work
that you did with Dr. Drew
together as a team last night.
You and Dr. Drew.
You and Dr. Drew.
But not Dr. Edmonds?
I knew you'd understand.
You're an intelligent
young woman.
You know where you're heading,
and you're gonna get there.
So the Captain says, what
with these new cutbacks,
we have no overtime
authorization anymore.
We should be so lucky.
And so the Lieutenant
here says to him,
"Hey, that'd work out just fine.
"Now all you have
to do is get the crooks
"to work out the same deal."
Hey, listen, it's no joke.
If the criminals in this city,
would form a union,
we could negotiate reasonable
working hours for everyone.
Quince, did you figure out
the recipe for my sauce yet?
I'm working on it.
I'm working on it.
Save the wardrobe, Quincy. Here.
All the sauce you need.
Take it home, play
with it, take it to the lab.
But you'll never find
out the secret ingredient.
Pretty cocky, huh?
Margaret, what
are you doing here?
They told me in your
office that I'd find you here,
- Can we... Be alone?
- Sure, sure, sit.
- That's my niece.
- You're niece?
Yeah, my niece. What
kinda guy do you think...
- You want anything?
- No.
Oh, this isn't a
social visit, is it?
- It isn't.
- What's the matter?
Something happened
the other night
at the emergency
clinic where I work
that has me all mixed-up.
Oh, you're too smart to
be mixed-up about anything.
What happened?
Well, the other night
we had a heart case.
And we lost the
patient, Robert Keane.
Robert Keane... Robert Keane?
Do you work at the Danner
Emergency Clinic, South L.A.?
Yeah, how did you know?
Well, I did an autopsy
on him yesterday.
Did you find
anything, uh, unusual?
No, I don't think so.
Of course, the tox results
won't be back until later today,
but I don't think there was
anything out of the ordinary.
Well, I guess I was wrong.
Wrong about what?
Well, it's just that
the doctor in charge
was totally incompetent.
I mean, it was if he had
never seen a heart case before.
Are you telling me that
your emergency room
is being run by an
unqualified doctor?
Well, not exactly.
Dr. Drew, who I usually
work with, is very good.
What'ya mean usually work with?
Well, that night he took
a couple of hours off,
and Dr. Edmonds
was standing in for him.
- He was the unqualified one.
- That's right.
Well, what specifically
did he do or not do
that made you think he'd put
the patient's life in jeopardy?
Well, nothing, I...
I guess, it's just that...
Were you with him all the time?
Well, it was more
like he was with me.
I mean, it was like I was
handling the case for him.
Well, did you do
everything by the book?
Absolutely.
And I'm a fully certified
emergency room nurse.
Margaret, I want you to
understand that I think it's a crime
that a doctor with no training
in emergency medicine
is allowed to take over
an emergency clinic.
I know why you're upset.
I'm glad you're upset.
It means you care.
But I don't understand
what the problem is here.
Well, after a while I started
to think it was my imagination,
until Dr. Danner tried to
get me to forget about it.
He intimated that I would
have a very hard time
getting into medical
school if I reported it.
Now why would he
try and blackmail me
unless there was
something really wrong?
Do you mind not getting
into medical school,
and you still want to report it?
Yeah, but I'm really scared.
You're gonna need me, Sam.
I wanna take another
look at Robert Keane.
- Right now?
- Right now.
I suppose you want to
rush the tox on him, too?
- You got it.
- Something wrong?
I don't know, but if there is,
I want to find out
about it, and fast.
Same, come here.
Take a look at the
body. Use the glass.
What am I looking for?
The forth and fifth
costal cartilages.
Here? Where the
fourth and fifth ribs
- attach to the sternum?
- Yeah, what do ya see?
Well, it appears that the
cartilage has separated.
It doesn't appear,
it has separated.
Now only tremendous
pressure put on the chest
could have done that.
Yeah, but didn't the report say
that the doctor applied CPR?
That would do it.
Yeah, with that much pressure,
there would hemorrhaging
around the fat,
if he were alive at the time.
This thing's beginning not
to make too much sense.
Quincy, about the Keane case.
I understand you
may want an inquest?
Maybe, I'm not sure.
Well, the file looks
pretty routine to me.
Well, it doesn't
look routine to me.
Yeah.
Really?
Oh, send him in. Send him in.
It's beginning to look
less and less routine,
- as a matter of fact.
- What do you mean?
That was George Danner.
He came to see me.
And?
Well, if a busy guy like that
takes off the time to come
and visit me, he
must want something.
I wonder what it is.
I better go.
Quincy, before you
ask for an inquest,
you better give
me more than this.
- Come in, sir.
- Dr. Quincy?
- Yes, sir.
- I'm Dr. Danner.
How do you do? Sit down please.
Thank you.
What can I do for you?
Terrible thing about Mr. Keane.
These things happen, but
somehow I feel personally involved.
- Are you?
- Am I what?
Personally involved.
Absolutely not.
I assume you've
already done the autopsy.
That's right.
Find out anything?
Well, we found
nothing irregular so far.
Then there should be no
reason for an inquest. Am I right?
Well, that's not necessarily so.
See, we haven't gotten
the tox results back yet.
They may prove that
Dr. Edmonds panicked.
Dr. Edmonds. There is no
Dr. Edmonds working for me.
Dr. Alan Drew was
the physician in charge.
He signed the report.
See that's one of the
things that bothers me.
You can't be
running a tight ship
if you don't know
who's in and who's out.
Your name is on top of
everyone of your clinics,
so you're responsible
for what goes on inside.
Look here, Dr. Quincy,
are you accusing me of
running a shoddy operation?
Oh, no, no, no, no, I'm not
accusing you of anything.
No, sir.
You could be playing a
very dangerous game.
I'm not playing games.
From what I understand,
you must be getting some of
your help from the want ads.
There is no need for me to
respond to that statement,
but for your information
every single one of them
is an E.R. physician.
I insist on it.
Even though there's nothing
in the law that requires me
to hire specialists.
Dr. Edmonds doesn't
fit that description.
And I've already told you,
there is no Dr. Edmonds
in my employ.
Then you got
nothing to worry about.
But if he was working for you,
you'd better start
checking your insurance.
They know that Edmonds
was there that night,
and that alone may be enough
to give Quincy an excuse
for an inquest.
So there'll be an inquest.
What can they prove?
All the right things were done.
Edmonds might not be totally
up on emergency procedures,
but, uh, the law's so loose
they can't fault him or us
on those grounds alone.
Besides, I worked with the guy,
trying to bring him
back, as I told you.
And my qualifications
can't be questioned.
Let's hope you're right.
I don't need any more
problems with this one.
- Hey, Dr. Quincy.
- Yeah.
There's a Miss Boling
from County Health
waiting to see
you in your office.
Thanks. I've been expecting her.
Mark.
Tell Sam to let me know
the minute he gets the tox
results on Keane, will you?
All right.
I can understand your
feelings in this matter, Doctor.
But, in spite of the fact
that this Dr. Edmonds
may not have
been totally qualified
is not in itself
grounds for any action.
Are you telling me that any
doctor who wants to practice
emergency medicine
can do it just like that?
Well, just about.
Under Title 22, Section 70415
of the California
Administrative Code,
an emergency room is
supposed to be staffed
by doctors who are, and I quote,
"experienced in emergency
medical procedures."
Well, how much
experience is necessary?
Well, there's no
operable definition.
Well, that's scary.
It's also ironic in a way.
What do you mean, ironic?
Well, on the one hand we
have very rigid certification
and periodic re-certification
procedures for Paramedics
and emergency room nurses,
but for the doctors themselves,
there's nothing.
What about controls?
Who insures that the
care will be quality care?
Well, if an emergency
room has a county contract
and we have sufficient grounds,
we can revoke their contract.
Then you can do
something about it.
Well, it's usually
handled by medical ethics.
It's just like any
doctor's office.
But it is not a doctor's office.
There's no steady clientele.
It's a transient population.
I mean, suppose there was
a complaint against a doctor
while he's in the
emergency room.
What can be done about it?
Then they'd go to the Board
of Medical Quality Assurance.
And that's it?
I'm afraid so.
Boy.
Well, of course the
picture isn't that black.
Most emergency rooms
staff highly qualified,
highly skilled doctors.
I mean, percentage-wise,
we get very few complaints
about the quality of the service.
But there is no specific legal
requirements to guarantee it.
Are you speaking
of the Keane case?
Yes, I am.
Without additional evidence
there is nothing
further anyone can do.
- Yeah.
- Quince.
The toxicology's complete.
I'll be right there.
Thank you very
much for coming out.
Alcohol, Lidocaine, Epinephrine.
That all conforms to the report.
Wait a minute... Isoproterenol?
Is that on the report?
No, according to the
report, it wasn't used.
- Who are you calling?
- Fire Department.
I think I'm finally
on to something.
Just got a call
from headquarters.
You guys are supposed
to report to a Dr. Quincy
at the Medical Examiner's
office right away.
- What for?
- How would I know?
But when a downtown
chief says so, you go.
I guess.
Would you call Dispatch and
put us out of service, Captain?
Right.
Okay, lemme get this clear.
You contacted Rampart Base
and you sent them a strip, right?
That's right, Doc. Just
like it says on the run report.
Okay. You mind if
I here it from you?
Check this out. It
says after the EKG
you started a IV drip of D5W
and gave him a dose
of Lidocaine in a bolus.
Just what they told us to do.
And that's all the
medication you gave him?
That's all that Rampart
ordered, so that's all we did.
All right. Let's
drop the hostility.
I just want to find out what
happened. That's my job.
Sure it is.
It's just that we can smell a
bum rap from a fair distance.
It goes with our job.
Nobody's accusing you of
anything. At least I'm not.
Then why are we here?
Because I've got a problem.
The tox results came back.
There was
Isoproterenol in his blood.
I don't know how it got there.
I wanna find out if you
guys administered it.
Look if it wasn't
ordered, there is no way
we would have given it to him.
In his condition,
throwing PVC's like he was,
I wouldn't have given it to
him even if it was ordered.
Even by mistake?
Look, Doc, we don't
make mistakes like that.
Oh, come on, everybody
makes a mistake.
That bum rap is getting
closer by the minute.
Yeah, tell me about it.
I can feel it breathing
down my neck right now.
Talk to ya later.
Look, Doc.
We never gave him
Isoproterenol, period.
But there's no way
we can prove it.
I know you can't.
Maybe I can.
My secretary left me a
note saying it was urgent
for me to see you?
It's about the Keane case.
I'm afraid there's gonna
have to be an inquest.
Well, don't I have
something to say about that?
With what I've got, the only
thing you have to decide is when.
What have you got?
Now having heard
from the two paramedics
who had initial
contact with the patient,
and from Dr. Rogers,
who was handling the run via
radio from Rampart Emergency,
before recess, I would like
to proceed with Dr. Alan Drew,
the attending physician
at Danner Emergency
where the deceased was taken.
Dr. Drew, please.
Raise your right hand.
Do you swear to tell
the truth, the whole truth,
- and nothing but the truth?
- I do.
Be seated.
Will you give your full name
and spell you last name, please.
Alan Drew. D-R-E-W.
Now, were you the
physician on duty at the time
Robert Keane was brought in?
I was not.
Your name is on the report
as being the physician on duty.
I'm aware of that,
however, I was not present
when the patient first came in.
Why did you sign the report?
Because I was present
at the time of death.
Were you the physician
in charge or not?
You'll permit me to explain...
Well, I'd like to know
who was in charge
at the time the
patient was brought in?
Dr. Tate Edmonds.
Thank you. You may
step down Dr. Drew.
Please don't leave.
Dr. Edmonds,
please take the stand.
I trust we can
straighten this out now.
Dr. Edmonds, you were
the physician in attendance.
- Yes I was.
- Fine.
Can you tell us
exactly what happened?
The patient was brought in
suffering from a heart attack.
The precise nature wasn't known.
- We applied...
- I would caution
you to be specific.
Who else was there, Dr. Edmonds?
A nurse.
Margaret Aldred.
She, uh, assisted me.
Thank you. Go on.
Well, we proceeded normally,
using standard life
support techniques.
Did the patient exhibit
cardiac arrhythmia?
Yes, sir.
Ventricular Tachycardia,
then Ventricular Fibrillation.
Please outline
exactly what you did.
I administered a bolus of
100 milligrams of Lidocaine.
Unfortunately,
even after we applied
CPR, Defibrillation,
Epinephrine and Sodium
Bicarbonate, the patient died.
Does Dr. Edmonds' counsel
wish to ask any questions?
- No questions, Your Honor.
- Thank you, Dr. Edmonds.
Would you please take your
seat at the table with counsel?
Well, so far the procedures
outlined seem to, uh,
be well within the
parameters for care of this kind.
Would Margaret
Aldred please come up?
Miss Aldred, did Dr. Edmonds
give an accurate account?
Dr. Edmonds panicked
when Mr. Keane came in.
Your Honor.
The witness is giving a
highly subjective opinion,
not testifying as to facts.
Point is well taken, Counselor.
Would you tell us
exactly what did happen?
Well, after the paramedics
brought the patient in,
we replaced the IV bag,
but did not apply any
further medication.
Why not?
Because the patient
was stable at the time.
I see. Continue.
After the patient went
into Ventricular Fibrillation,
we performed CPR
and tried to defibrillate
several times, but nothing else.
You're quite certain?
Quite certain.
Well, we seem to have a
severe difference of opinion here.
I think at this time I would like
to call the Medical Examiner,
- Dr. Quincy.
- Uh, Your Honor.
The witness has implied
that Dr. Edmonds' testimony
was inaccurate, and
as Dr. Edmonds' counsel
I would request the opportunity
to cross-examine this witness
before she is dismissed.
I appreciate your
position Counselor,
but I think it would be
more helpful to everyone
if you held your cross-examination
after Dr. Quincy's findings.
Then if you wish I
will call both witnesses
for your cross-examination.
Very well, Your Honor.
Thank you, Miss Aldred.
Dr. Quincy, would
you come forward?
Dr. Quincy, you performed
the autopsy on Mr. Keane?
- Yes, I did.
- Would you give
us your findings?
I first became involved in this
matter when Margaret Aldred
came to me, because
of what she considered
improper treatment of
a patient, Robert Keane.
You Honor, I object.
Dr. Quincy is giving us
his opinion of her opinion,
neither of which is fact.
Her opinion is based on
several years' experience
as a qualified
emergency room nurse.
Dr. Edmonds is not experienced
in emergency medicine.
His practice is limited
and highly specialized.
That is the real problem here.
Your Honor, Dr. Edmonds
is a licensed physician.
There is nothing in the law
that states he must be a
specialist in emergency medicine.
Dr. Quincy, although
you point is well taken,
we are not here to discuss
the overall state of
emergency medicine.
We're here to discuss what
occurred in this particular case.
It does apply to this case.
If a qualified emergency
physician had been on duty,
the chances are Robert
Keane would be alive today.
- In your opinion.
- In my expert opinion, yes,
I'm not sure I follow
you, Dr. Quincy.
You heard the testimony
of Dr. Edmonds.
Would you say what
Dr. Edmonds described
is accepted procedure
in Mr. Keane's case?
Yes, I would.
But I'm sure that Dr. Edmonds
is not telling the whole truth.
You Honor, Dr. Quincy
wasn't even there.
How could he be so sure?
I didn't have to be there.
Robert Keane, the deceased,
told me everything I needed to know.
Would you explain that, please?
When I examined the
body it was apparent he died
of an acute
myocardial infarction,
A heart attack.
It also showed that Lidocaine
had been administered,
along with Epinephrine,
and Sodium Bicarbonate.
But that's exactly what
Dr. Edmonds told us.
What he didn't tell you
was that Isoproterenol
was also administered.
- Isoproterenol?
- That's right.
Considering the symptoms,
it would increase the likelihood
of cardiac arrhythmia and failure.
So I have to assume the
administration was done
either through
ignorance, or by mistake.
Your Honor, I
must protest again.
Dr. Quincy is conjecturing.
All right, counsel,
your objection is noted.
Dr. Quincy, what else
did your findings show?
The Lidocaine was used both
before and after death occurred.
And of the other medications
except for the Isoproterenol,
we also administered some
considerable time after death.
- After death.
- That's right.
Will you clarify that
for the jury, and for me?
The paramedics an initial dose
of Lidocaine at the bowling alley.
Now that would have
calmed down the heart.
However, after
about thirty minutes
the Lidocaine would
have metabolized to a level
where it would no
longer be effective.
I see. Then what
would have happened?
The autopsy showed it
was sufficiently damaged,
that it needed more
Lidocaine to remain stable.
But no more Lidocaine was
given until after he was dead,
Instead at this point,
someone administered
Isoproterenol in the emergency room.
Your Honor, how we be sure
that the paramedics didn't
give it to him by mistake?
Because it wouldn't
have been possible.
And why not?
Isoproterenol is broken
down by the body very quickly.
And based on the level
found in Mr. Keane's blood,
it could not possibly
have been administered
more than five minutes
before his heart arrested.
By which time the paramedics
were long gone from the clinic.
So from the time
sequence I just described,
only Dr. Edmonds
could have given him
the injection of Isoproterenol,
which in effect killed him.
I see.
Would you explain how
the other medications
- came into the picture?
- Yes.
Based on the
toxicological reports,
it is my opinion that he
and Dr. Edmonds together
administered the
other medications,
in an attempt to make it
look as if everything possible
had been done for
Mr. Keane before death.
Wasn't Miss Aldred
a witness to all this?
No.
Before the procedure, Dr. Drew
ordered her out of the room.
Is there any
additional proof of this?
Yes.
In an attempt to circulate the
medications through the blood,
excessively heavy chest
compressions were used.
As a result the fourth and fifth
costal cartilages were fractured.
This would have
resulted in hemorrhage
at the fracture points
on a living person.
There were no such bruises
evident on Keane's body,
In other words,
he was given a lot better
medical care after he died,
than before he died.
You know, Quincy,
you did another fine job.
Sam, after Quincy
gave his findings,
that jury didn't have
any trouble bringing in
a "death due to negligence"
against Edmonds.
Yeah. He's going to
spend a lot of time wishing
he hadn't done his
buddy Drew a favor.
And after the State,
and the County,
and the Board of
Medical Quality Assurance
and the District Attorney get
through with Danner and Drew,
they're gonna be
in a lot of trouble.
Quincy, how's the
spaghetti sauce?
Oh, it's terrific.
Did you figure out the
secret ingredient yet?
- Yes, I did.
- You did, eh?
What is it?
Crushed rice husks found
only grown in the Po Valley
in Northern Italy.
How'd you find that out?
Just give me the ten dollars.
- How did you find that out?
- I'm a scientist.
Don't monkey
around with science.
How did he find out?
How did you find out, Quincy?
I gave the chef twenty-five
dollars and he told me.
That means you lost fifteen.
in charge of this place?
Oh, my God!
- What happened?
- I don't know.
All of a sudden, he went.
- You were keeping this?
- Yeah.
Are you telling me that
your emergency room
is being run by an
unqualified doctor?
We don't make
mistakes like this.
Oh, come on! Everybody
makes a mistake!
From what I understand, you
must be getting some of your help
from the want ads.
You could be playing a
very dangerous game.
He was given a lot better
medical care after he died
than before he died.
Gentlemen, you
are about to enter
the most fascinating
sphere of police work,
the world of forensic medicine.
Margaret, I can't believe
it, you're a grown woman!
Last time I saw you, you were
wearing braces on your teeth.
It's been a long
time, hasn't it?
It sure has been.
What's she up to, Chuck?
I think I remember you
wanted to be a deep sea diver.
Then you wanted
to be an archeologist.
Well, I guess you and
Dad had an effect on me.
- I became a nurse.
- Oh, that's terrific.
Nursing's a very
satisfying profession.
Not as satisfying
as being a doctor.
- Oh?
- That's why
we're here, Quincy.
We need a favor from you.
What? Name it and you got it.
All right. Margaret has
decided to enter medical school.
Wonderful. How can I help?
If I write a letter
of recommendation
to her whole alma mater...
They'll think it's
a personal thing.
Yeah, but if you
wrote the letter...
- Consider it done.
- Thank you.
Quince, could you
check... Oh, excuse me.
No, come in, come in.
I want you to meet two
very dear friends of mine.
Dr. Charles Aldred.
His daughter Margaret.
- Sam Fujiyama.
- Hi.
Place would fall
apart without him.
Can I get a written
confirmation on that?
I'm up for a raise and I'd
like to show it to Dr. Asten.
And can you check
these autopsy reports?
Sam, it's nice to be
needed, but not all the time.
The life of a pathologist.
At least a pathologist
doesn't have to worry
about his bedside
manner, Quincy.
If that were the case,
he'd be out of a job.
Nice to have met
you, Doctor. Margaret.
Pleasure.
Out late last night?
Aw, come on, would ya?
Well, it doesn't matter,
it's all right. It's no big deal.
Where are you, at a drive-in
movie, for heavens sake?
- You're
supposed to be bowling.
- Aw, come on.
- Take it easy, will ya?
- Thank you sweetheart.
Come on, just relax.
Ah, boy, am I outta shape.
- Take it easy a little bit.
- What are you kidding?
These guys'll think I'm
an old man or something.
You kid.
You know, I've been
working here for a month,
and I still haven't
met Dr. Danner.
It's because he's
too busy getting rich.
He's got quite a deal.
What with operating
six emergency clinics
plus his nursing home, he hasn't
got time to practice medicine.
Somehow it just
doesn't seem quite right.
Why not? We're
here to do the work.
And that's all that matters,
to him or the patients.
Why aren't you
in private practice?
Ah, too much hassle.
Not enough time for myself.
Once I leave here,
it's behind me.
I don't have to
take night calls.
I don't wear a beeper.
No overhead, pay isn't bad.
Oh. Customers.
Well, well, well. What
happened to you?
I told her to stay
off the skateboard.
I told her one of these days,
it would wind up
in a broken bone.
Hey, I bet that hurts, huh?
We better have a look
at it. Come on in here.
You'll be okay.
Oh, man, am I ever
ready for a vacation.
You're lucky. I just
got back from mine
and I'm shot already.
I don't think I had more
than four hours sleep
in the last two days.
Man, ever since those
cutbacks, it's gotten crazy.
Yeah, before I left I was
working six double shifts a month.
The price we pay
for being heroes.
I love being a hero.
I just wish there
was more of us.
Forty-four.
Yeah.
Gotcha. Let's go.
Some old lady took a
fall down a flight of stairs.
Let's do it.
You okay?
Yeah, yeah, I'm...
I'm fine. I'm okay.
Loose your balance?
- Have another beer.
- I'm all right.
- You all right?
- Yeah, yeah, I just lost
my balance, that's all.
Can happen to anybody.
Honey, maybe ice skating,
but you don't fall down bowling.
Will you knock it off? I'm fine.
Hi, fellas, what
have we got here?
Uh, sixty-seven year old female.
She fell down
some steps. Got a...
Okay, you can fill out the
forms. I can take it from here.
Uh, wouldn't you like
a little history first?
Sure. Give it to the nurse.
- Hey, Doc, don't ya...
- Don't "Hey, Doc," me, buddy.
The name's Ito. Didn't
mean to shake your tree.
Uh, it appears that she has
a simple fracture on the third
and fourth ribs and, with
a possible fractured femur,
all on the left side.
One of these days you might
make a good diagnostician.
Mind if I do my own examination
or would you like to take over?
Hey. We're just doing
our job, Doc. Doctor.
Well, keep doing it.
Like get her to the
emergency room.
Anything you say. Come on.
How's that grab ya?
Hey, you look pretty lousy, Bob.
Sure you don't
want to call it a night?
No, it's just that
stuffed cabbage
Arlene made me for
dinner. It gets me every time.
- Sure you're okay?
- Oh, fine, fine, fine.
Let's finish 'em off right now.
Would you like a cup of coffee?
Oh, boy, yes, thanks.
Hi, Tate.
I was beginning to think
you would never show up.
I'm sorry, I got
stuck with a patient.
- Look, Alan...
- Tate, this is Margaret.
Dr. Edmonds will be
covering for me while I'm gone.
Gone?
I thought you were
on duty all night.
Yeah, I am. But, uh,
I have to get away for
about two or three hours.
- I met this gorgeous...
- All right,
spare me the details.
So you're going to be
covering for Dr. Drew.
It looks that way.
Uh, Alan, can I talk to
you for a moment, please?
You bet. We can go in here.
Alan, are you sure this
is gonna be all right?
What's not to be all right?
Huh, you're a
doctor, just like me.
Not just like you, Alan.
I haven't handled an emergency
case since I was a resident.
- That's eleven years ago.
- What emergency?
The most that's gonna
happen is a broken finger
or a splinter,
or maybe you'll have
to do a few stitches.
It's a piece of cake.
Anyway, I'll be back
in two hours, outside.
Hey, would you get
that look off your face.
It doesn't exactly create
an illusion of confidence.
I did it. I finally did it!
Oh, oh, oh, ah...
Oh, help him. Oh, my God.
Call the paramedics. Please,
somebody call the paramedics!
Oh, Bob.
What is it? Take it easy.
Excuse me, please.
Out of the way, please.
Excuse me. Out
of the way, please.
Stand back, folks.
Out of the way.
Thank you. Step on back, please.
- Okay, fella, how ya felling?
- Lousy.
- Really lousy.
- Where does it hurt?
Okay.
Come on. Let's scope 'em.
- What's the matter with him?
- Just take it easy.
- We'll find out right now.
- Hang on, honey.
- It's gonna be all right.
- I... I know.
As soon as I'm set up,
transmit this to Rampart.
Hang on, Bob. You're all right.
He's gonna take care of you.
Rampart Emergency,
this is Rescue 44.
Do you read us? Over.
Oh, hang on, Bob, honey.
So that's why I
decided to specialize.
It's a pretty easy life.
No night calls, no emergencies.
My brother's an O.B.
You wouldn't believe
the hours he works.
You know, women have
absolutely no consideration
about deciding when
they're gonna go into labor.
Sexist.
Not me, my brother. Without
sex he'd starve to death.
Ten-four, Rampart.
We've got the I.V. going.
We've pushed 100
milligrams of Lidocaine...
The PVC's decreasing.
I'm sending another strip.
It's my fault.
I tried to tell him not to play.
Look, he's gonna be
all right. We got it in time.
Hey, Bains. They
want us to take him
to Danner Emergency.
They're phoning it in.
If you asked me, he'd
be better off at Rampart
than at Danner.
Danner's closer.
Besides, orders are orders.
We'll be waiting.
That was Rampart Base.
Rescue 44 is bringing
in a cardiac run.
Cardiac!
Why couldn't they
take it themselves?
Because we're closer.
Besides, it's a
standard procedure.
I haven't handled
a cardiac in years.
Relax. Rampart wouldn't
have authorized transport
unless he were in
a stable condition.
- Oh, still it's...
- Still you're a doctor.
And the only one
around at the moment.
He looked pretty bad, Doc,
but he's feeling better now,
aren't you, Mr. Keane?
You new here?
Help me get him to
the emergency room.
Here are his vitals,
and the medications
that Rampart ordered.
Thanks.
Lidocaine, huh.
That confirms Rampart's orders.
Let's get him on the table.
One, two, three.
Bag's almost empty, Doc.
Well, we'd better change it.
- Yeah, do it, all right.
- Sure.
What are ya doing?
Hooking him up to your
equipment. What else?
- Okay, okay.
- Hey, hey, Doc,
you want us to kinda
hang around for a while?
Rescue 44. Are you available?
Yeah, this is 44.
What do you got?
A stabbing. Tyler and Vermont.
Can you handle?
Uh, yeah, we'll,
we'll take it, Dispatch.
I sure don't know where
they find them these days,
but if you ask me, that
doctor doesn't know
his stethoscope
from his left ear.
Where's my husband?
Is he all right?
He's doing just
fine, Mrs. Keane.
The nurse inside
can help you out.
- Oh, thank you.
- We have another call.
I sure hope Drew gets here soon.
I don't need this one bit.
He's stable. I'll get it.
Hello. Hello, is somebody here?
- May I help you?
- Oh, yes.
They told me that
my husband's in here.
Oh, he's resting in
the back just now,
if your Mrs. Keane, that is.
Yes, I'm Mrs. Keane.
I'd like to see him.
Please, I just
want to be with him.
I'm sorry. It's better
if you don't right now.
Well, I just want
to be with him.
Oh, my God.
He's dead, isn't he?
Now Mrs. Keane,
he's not dead. He's fine.
He's not dead, Mrs.
Keane, sit down here.
I'll be right back.
Oh, he's dead, I know it.
It's his wife. She's very upset.
I'm going to give her
something to calm her down.
Margaret!
- Well, what's the matter?
- Nothing. It's all right.
Here. Just take some of this.
Take these pills.
You'll feel much better.
- What happened?
- I don't know.
I don't know. All of
a sudden, he went.
We better defibrillate.
Clear.
No conversion.
What the hell am I
gonna tell his wife?
Hi.
- What's happened?
- Cardiac arrest.
Thank God you're
here. I can't handle this.
How long has he been like this?
- Twenty minutes.
- He went into V-fib.
We tried to convert him
six times, but nothing!
Margaret, go see to
his wife. I'll take over.
- But...
- Do it!
Yes, Doctor. Whatever you say.
- You gave him this?
- Yeah.
Why, what's the matter?
The matter is, we got a lot
of work to do here and fast.
Hey Quince, wanna
grab some lunch?
Soon as I finish here,
I'll be right with you.
What are you doing?
I'm breaking down a food sample.
Food poisoning? I
didn't know we had one.
Now this is off the record.
Do you know
Danny's secret sauce,
you that spaghetti sauce
he's always bragging about?
He bet me ten dollars
I couldn't duplicate it.
Well, with this
equipment I can't miss.
Where'd ya get the specimen?
Where else? Off my tie.
Do you know what this machine
cost to operate and maintain?
Do you know what your
time is worth, and you spend it
analyzing spaghetti sauce.
Is nothing sacred? Are
you bugging this room?
I told Danny, I said
Dr. Quincy would never use
county facilities for
personal reasons
like analyzing spaghetti sauce.
It's against regulations.
Right?
He's all heart, that guy.
Come on, I'll buy you lunch.
- At Danny's?
- Where else.
Hi, Carol. What's the matter?
It's Dr. Danner.
He's in the office.
- Here?
- Uh-huh.
He said he wanted to see
you as soon as you came in.
Me? Why?
I don't know. But you'd
better get in there right away.
- Well, okay.
- Okay.
- See ya tomorrow.
- Sure.
- Dr. Danner?
- Uh, come in, Miss...
Aldred. Margaret Aldred.
Of course.
The nurse who wants
to go to medical school.
That's right, Dr. Danner.
- I applied last August.
- Good.
Good. Sit down,
Miss Aldred, sit down.
Thank you.
Now you may not know
it, but I happen to be
on the entrance
evaluation committee.
And since you work for me,
perhaps I can be of some help.
I sure hope so, Doctor.
I'm certain of it.
We must talk of it sometime.
Uh, by the way, Miss Aldred,
you were on duty
last night, weren't you?
Yes, sir.
Then you handled this
unfortunate cardiac arrest
with Dr. Drew, didn't you?
Is anything the matter?
No, no, not at all.
It's just that we have a
reputation to maintain.
And in cases like this,
where a death is involved
well, I always like to
be certain that, well...
Well, you understand
what I mean.
I think so.
Now, Drew is a very good man.
Excellent, as a matter of fact.
And I'm sure that you
both did everything possible
for the patient.
It's just that case
files don't always give
one a totally complete picture.
So, I would like you to tell me
in your own words
exactly what happened.
Well, it was about 11:00
when we got a hot line
call from Rampart Base
that Rescue 44 was
bringing in a cardiac case.
I see. The paramedics
had handled the
case in the field, then?
That's right.
They had been in radio
contact with Rampart
and had stabilized him on
Lidocaine before he came in.
- Than what happened?
- Well,
we brought him into the E.R.
and then Dr. Edmonds and I...
Dr. Edmonds? Who's Dr. Edmonds?
Don't you know
who Dr. Edmonds is?
Well, of course, now
that you mention it.
He must be Dr. Drew's
authorized replacement.
Well, it's just that I have so
many people working for me.
I think I can get
the rest of this story
from Dr. Edmonds or Dr. Drew.
Thank you. That'll
be all, Miss Aldred.
Marinara or clam?
Marinara?
It's neither, it's tissue.
I've learned my lesson.
That'll be the day.
Let me take a look.
- Don't you trust me?
- Let me take a look!
All right. You can look,
but if you do, I'm gonna
take it personally. Go ahead.
What would you think
if I told you I trust you?
- Then why look?
- Well,
you said it was tissue...
Listen would you work on these?
- There are four of 'em!
- Quincy, it's routine.
- It'll take you a few hours...
- Few hours?
You know how long.
Why don't you take two?
You never keep
your hand in anymore.
How can you say that to me?
You realize I've a pile
of paperwork that...
Oh, gotta return a call. Sorry.
Robert Keane, age forty-two,
five feet, eleven inches tall.
You mean to tell me that
you let this, uh, this Edmonds
cover for you? That you actually
left that man in charge of this place?
I don't believe
what I'm hearing.
Look, it was only for two hours.
And besides, the man's
a fully qualified M.D.
Fully qualified! Is he an
emergency physician?
Is he certified in
coronary care?
There's a big
difference, Doctor,
between a case of
acne and a heart attack.
According to the law,
he has as much right
to work here as I do.
- Or you.
- I know that.
I am not talking about the law,
I am talking about
simple common sense.
And my county contract.
I've put a great deal of blood
into building my operation,
and I don't need it jeopardized
by your irresponsible behavior
in leaving a totally unqualified
doctor in charge here.
All right, look,
maybe I was wrong,
but there was no harm done.
I got here just as
the patient went sour.
I worked on him
myself for an hour.
There wasn't anything
anyone could have done
to save the guy.
These things happen.
Not to me, they don't.
Not when I can't justify
why a Dr. Edmonds
could happen in my clinic!
My clinic!
I'm afraid, Dr. Drew,
that you and I
have come to a
parting of the ways.
If you say so, Doctor.
But is it wise to fire
me, just like that?
What are you getting at?
It would be an admission that
something was wrong here...
Wouldn't it? Think about it.
I signed a report for the
Medical Examiner's Office,
So who's to know that
Edmonds was ever involved at all?
Just you and I.
And Dr. Edmonds.
Is he gonna want
to talk about it?
What about Margaret Aldred?
What about her?
I'm gonna take a
section of his heart, Sam.
Gimme a petri disk, will you?
Well, the heart shows signs
of acute myocardial infarction.
Otherwise he appears to be okay.
Well, according to the report,
it looks like they did
everything they could.
Sure looks that way.
Well, the tox results will give
us some more information.
Results should
be routine, I guess.
Yeah. I wanna take another look.
Right.
Anyway, as long as I'm here
I thought we might
into the matter
of your medical school
application more thoroughly.
Is this in the order
of an oral interview?
Not officially.
I see that your father
is Dr. Charles Aldred.
He's a fine physician.
Has an excellent reputation.
I also notice a letter
of recommendation
from a Dr. Quincy,
who's a Deputy Medical
Examiner for the county.
- It's a glowing note.
- Thank you.
He's an old friend.
I suspect that you've seen
him recently. Am I correct?
Yes, I have, but it was only
to ask him to write that letter.
Is there something wrong?
Of course not.
This is just routine.
Well, it doesn't seem
very routine to me.
I mean, it isn't very often
that a medical applicant
is called in for a private,
informal, oral interview.
Calm down, Miss Aldred,
you're a bit nervous.
Of course, that's expected.
Going from a nurse to
a doctor it's a big step,
and I gather it's
important step for you.
Very.
And it does seem that
you're eminently qualified.
It would be a pity to
have come all this way
with your work and studies,
and then get rejected
at the last moment.
May I call you Margaret?
There are certain sacrifices
that one makes for a career.
That's a fact of life.
Now I would like to help
you get into medical school.
That would mean that you and I
were working side
by side as colleagues.
I can't follow you, Doctor.
Well, I'm referring
to the excellent work
that you did with Dr. Drew
together as a team last night.
You and Dr. Drew.
You and Dr. Drew.
But not Dr. Edmonds?
I knew you'd understand.
You're an intelligent
young woman.
You know where you're heading,
and you're gonna get there.
So the Captain says, what
with these new cutbacks,
we have no overtime
authorization anymore.
We should be so lucky.
And so the Lieutenant
here says to him,
"Hey, that'd work out just fine.
"Now all you have
to do is get the crooks
"to work out the same deal."
Hey, listen, it's no joke.
If the criminals in this city,
would form a union,
we could negotiate reasonable
working hours for everyone.
Quince, did you figure out
the recipe for my sauce yet?
I'm working on it.
I'm working on it.
Save the wardrobe, Quincy. Here.
All the sauce you need.
Take it home, play
with it, take it to the lab.
But you'll never find
out the secret ingredient.
Pretty cocky, huh?
Margaret, what
are you doing here?
They told me in your
office that I'd find you here,
- Can we... Be alone?
- Sure, sure, sit.
- That's my niece.
- You're niece?
Yeah, my niece. What
kinda guy do you think...
- You want anything?
- No.
Oh, this isn't a
social visit, is it?
- It isn't.
- What's the matter?
Something happened
the other night
at the emergency
clinic where I work
that has me all mixed-up.
Oh, you're too smart to
be mixed-up about anything.
What happened?
Well, the other night
we had a heart case.
And we lost the
patient, Robert Keane.
Robert Keane... Robert Keane?
Do you work at the Danner
Emergency Clinic, South L.A.?
Yeah, how did you know?
Well, I did an autopsy
on him yesterday.
Did you find
anything, uh, unusual?
No, I don't think so.
Of course, the tox results
won't be back until later today,
but I don't think there was
anything out of the ordinary.
Well, I guess I was wrong.
Wrong about what?
Well, it's just that
the doctor in charge
was totally incompetent.
I mean, it was if he had
never seen a heart case before.
Are you telling me that
your emergency room
is being run by an
unqualified doctor?
Well, not exactly.
Dr. Drew, who I usually
work with, is very good.
What'ya mean usually work with?
Well, that night he took
a couple of hours off,
and Dr. Edmonds
was standing in for him.
- He was the unqualified one.
- That's right.
Well, what specifically
did he do or not do
that made you think he'd put
the patient's life in jeopardy?
Well, nothing, I...
I guess, it's just that...
Were you with him all the time?
Well, it was more
like he was with me.
I mean, it was like I was
handling the case for him.
Well, did you do
everything by the book?
Absolutely.
And I'm a fully certified
emergency room nurse.
Margaret, I want you to
understand that I think it's a crime
that a doctor with no training
in emergency medicine
is allowed to take over
an emergency clinic.
I know why you're upset.
I'm glad you're upset.
It means you care.
But I don't understand
what the problem is here.
Well, after a while I started
to think it was my imagination,
until Dr. Danner tried to
get me to forget about it.
He intimated that I would
have a very hard time
getting into medical
school if I reported it.
Now why would he
try and blackmail me
unless there was
something really wrong?
Do you mind not getting
into medical school,
and you still want to report it?
Yeah, but I'm really scared.
You're gonna need me, Sam.
I wanna take another
look at Robert Keane.
- Right now?
- Right now.
I suppose you want to
rush the tox on him, too?
- You got it.
- Something wrong?
I don't know, but if there is,
I want to find out
about it, and fast.
Same, come here.
Take a look at the
body. Use the glass.
What am I looking for?
The forth and fifth
costal cartilages.
Here? Where the
fourth and fifth ribs
- attach to the sternum?
- Yeah, what do ya see?
Well, it appears that the
cartilage has separated.
It doesn't appear,
it has separated.
Now only tremendous
pressure put on the chest
could have done that.
Yeah, but didn't the report say
that the doctor applied CPR?
That would do it.
Yeah, with that much pressure,
there would hemorrhaging
around the fat,
if he were alive at the time.
This thing's beginning not
to make too much sense.
Quincy, about the Keane case.
I understand you
may want an inquest?
Maybe, I'm not sure.
Well, the file looks
pretty routine to me.
Well, it doesn't
look routine to me.
Yeah.
Really?
Oh, send him in. Send him in.
It's beginning to look
less and less routine,
- as a matter of fact.
- What do you mean?
That was George Danner.
He came to see me.
And?
Well, if a busy guy like that
takes off the time to come
and visit me, he
must want something.
I wonder what it is.
I better go.
Quincy, before you
ask for an inquest,
you better give
me more than this.
- Come in, sir.
- Dr. Quincy?
- Yes, sir.
- I'm Dr. Danner.
How do you do? Sit down please.
Thank you.
What can I do for you?
Terrible thing about Mr. Keane.
These things happen, but
somehow I feel personally involved.
- Are you?
- Am I what?
Personally involved.
Absolutely not.
I assume you've
already done the autopsy.
That's right.
Find out anything?
Well, we found
nothing irregular so far.
Then there should be no
reason for an inquest. Am I right?
Well, that's not necessarily so.
See, we haven't gotten
the tox results back yet.
They may prove that
Dr. Edmonds panicked.
Dr. Edmonds. There is no
Dr. Edmonds working for me.
Dr. Alan Drew was
the physician in charge.
He signed the report.
See that's one of the
things that bothers me.
You can't be
running a tight ship
if you don't know
who's in and who's out.
Your name is on top of
everyone of your clinics,
so you're responsible
for what goes on inside.
Look here, Dr. Quincy,
are you accusing me of
running a shoddy operation?
Oh, no, no, no, no, I'm not
accusing you of anything.
No, sir.
You could be playing a
very dangerous game.
I'm not playing games.
From what I understand,
you must be getting some of
your help from the want ads.
There is no need for me to
respond to that statement,
but for your information
every single one of them
is an E.R. physician.
I insist on it.
Even though there's nothing
in the law that requires me
to hire specialists.
Dr. Edmonds doesn't
fit that description.
And I've already told you,
there is no Dr. Edmonds
in my employ.
Then you got
nothing to worry about.
But if he was working for you,
you'd better start
checking your insurance.
They know that Edmonds
was there that night,
and that alone may be enough
to give Quincy an excuse
for an inquest.
So there'll be an inquest.
What can they prove?
All the right things were done.
Edmonds might not be totally
up on emergency procedures,
but, uh, the law's so loose
they can't fault him or us
on those grounds alone.
Besides, I worked with the guy,
trying to bring him
back, as I told you.
And my qualifications
can't be questioned.
Let's hope you're right.
I don't need any more
problems with this one.
- Hey, Dr. Quincy.
- Yeah.
There's a Miss Boling
from County Health
waiting to see
you in your office.
Thanks. I've been expecting her.
Mark.
Tell Sam to let me know
the minute he gets the tox
results on Keane, will you?
All right.
I can understand your
feelings in this matter, Doctor.
But, in spite of the fact
that this Dr. Edmonds
may not have
been totally qualified
is not in itself
grounds for any action.
Are you telling me that any
doctor who wants to practice
emergency medicine
can do it just like that?
Well, just about.
Under Title 22, Section 70415
of the California
Administrative Code,
an emergency room is
supposed to be staffed
by doctors who are, and I quote,
"experienced in emergency
medical procedures."
Well, how much
experience is necessary?
Well, there's no
operable definition.
Well, that's scary.
It's also ironic in a way.
What do you mean, ironic?
Well, on the one hand we
have very rigid certification
and periodic re-certification
procedures for Paramedics
and emergency room nurses,
but for the doctors themselves,
there's nothing.
What about controls?
Who insures that the
care will be quality care?
Well, if an emergency
room has a county contract
and we have sufficient grounds,
we can revoke their contract.
Then you can do
something about it.
Well, it's usually
handled by medical ethics.
It's just like any
doctor's office.
But it is not a doctor's office.
There's no steady clientele.
It's a transient population.
I mean, suppose there was
a complaint against a doctor
while he's in the
emergency room.
What can be done about it?
Then they'd go to the Board
of Medical Quality Assurance.
And that's it?
I'm afraid so.
Boy.
Well, of course the
picture isn't that black.
Most emergency rooms
staff highly qualified,
highly skilled doctors.
I mean, percentage-wise,
we get very few complaints
about the quality of the service.
But there is no specific legal
requirements to guarantee it.
Are you speaking
of the Keane case?
Yes, I am.
Without additional evidence
there is nothing
further anyone can do.
- Yeah.
- Quince.
The toxicology's complete.
I'll be right there.
Thank you very
much for coming out.
Alcohol, Lidocaine, Epinephrine.
That all conforms to the report.
Wait a minute... Isoproterenol?
Is that on the report?
No, according to the
report, it wasn't used.
- Who are you calling?
- Fire Department.
I think I'm finally
on to something.
Just got a call
from headquarters.
You guys are supposed
to report to a Dr. Quincy
at the Medical Examiner's
office right away.
- What for?
- How would I know?
But when a downtown
chief says so, you go.
I guess.
Would you call Dispatch and
put us out of service, Captain?
Right.
Okay, lemme get this clear.
You contacted Rampart Base
and you sent them a strip, right?
That's right, Doc. Just
like it says on the run report.
Okay. You mind if
I here it from you?
Check this out. It
says after the EKG
you started a IV drip of D5W
and gave him a dose
of Lidocaine in a bolus.
Just what they told us to do.
And that's all the
medication you gave him?
That's all that Rampart
ordered, so that's all we did.
All right. Let's
drop the hostility.
I just want to find out what
happened. That's my job.
Sure it is.
It's just that we can smell a
bum rap from a fair distance.
It goes with our job.
Nobody's accusing you of
anything. At least I'm not.
Then why are we here?
Because I've got a problem.
The tox results came back.
There was
Isoproterenol in his blood.
I don't know how it got there.
I wanna find out if you
guys administered it.
Look if it wasn't
ordered, there is no way
we would have given it to him.
In his condition,
throwing PVC's like he was,
I wouldn't have given it to
him even if it was ordered.
Even by mistake?
Look, Doc, we don't
make mistakes like that.
Oh, come on, everybody
makes a mistake.
That bum rap is getting
closer by the minute.
Yeah, tell me about it.
I can feel it breathing
down my neck right now.
Talk to ya later.
Look, Doc.
We never gave him
Isoproterenol, period.
But there's no way
we can prove it.
I know you can't.
Maybe I can.
My secretary left me a
note saying it was urgent
for me to see you?
It's about the Keane case.
I'm afraid there's gonna
have to be an inquest.
Well, don't I have
something to say about that?
With what I've got, the only
thing you have to decide is when.
What have you got?
Now having heard
from the two paramedics
who had initial
contact with the patient,
and from Dr. Rogers,
who was handling the run via
radio from Rampart Emergency,
before recess, I would like
to proceed with Dr. Alan Drew,
the attending physician
at Danner Emergency
where the deceased was taken.
Dr. Drew, please.
Raise your right hand.
Do you swear to tell
the truth, the whole truth,
- and nothing but the truth?
- I do.
Be seated.
Will you give your full name
and spell you last name, please.
Alan Drew. D-R-E-W.
Now, were you the
physician on duty at the time
Robert Keane was brought in?
I was not.
Your name is on the report
as being the physician on duty.
I'm aware of that,
however, I was not present
when the patient first came in.
Why did you sign the report?
Because I was present
at the time of death.
Were you the physician
in charge or not?
You'll permit me to explain...
Well, I'd like to know
who was in charge
at the time the
patient was brought in?
Dr. Tate Edmonds.
Thank you. You may
step down Dr. Drew.
Please don't leave.
Dr. Edmonds,
please take the stand.
I trust we can
straighten this out now.
Dr. Edmonds, you were
the physician in attendance.
- Yes I was.
- Fine.
Can you tell us
exactly what happened?
The patient was brought in
suffering from a heart attack.
The precise nature wasn't known.
- We applied...
- I would caution
you to be specific.
Who else was there, Dr. Edmonds?
A nurse.
Margaret Aldred.
She, uh, assisted me.
Thank you. Go on.
Well, we proceeded normally,
using standard life
support techniques.
Did the patient exhibit
cardiac arrhythmia?
Yes, sir.
Ventricular Tachycardia,
then Ventricular Fibrillation.
Please outline
exactly what you did.
I administered a bolus of
100 milligrams of Lidocaine.
Unfortunately,
even after we applied
CPR, Defibrillation,
Epinephrine and Sodium
Bicarbonate, the patient died.
Does Dr. Edmonds' counsel
wish to ask any questions?
- No questions, Your Honor.
- Thank you, Dr. Edmonds.
Would you please take your
seat at the table with counsel?
Well, so far the procedures
outlined seem to, uh,
be well within the
parameters for care of this kind.
Would Margaret
Aldred please come up?
Miss Aldred, did Dr. Edmonds
give an accurate account?
Dr. Edmonds panicked
when Mr. Keane came in.
Your Honor.
The witness is giving a
highly subjective opinion,
not testifying as to facts.
Point is well taken, Counselor.
Would you tell us
exactly what did happen?
Well, after the paramedics
brought the patient in,
we replaced the IV bag,
but did not apply any
further medication.
Why not?
Because the patient
was stable at the time.
I see. Continue.
After the patient went
into Ventricular Fibrillation,
we performed CPR
and tried to defibrillate
several times, but nothing else.
You're quite certain?
Quite certain.
Well, we seem to have a
severe difference of opinion here.
I think at this time I would like
to call the Medical Examiner,
- Dr. Quincy.
- Uh, Your Honor.
The witness has implied
that Dr. Edmonds' testimony
was inaccurate, and
as Dr. Edmonds' counsel
I would request the opportunity
to cross-examine this witness
before she is dismissed.
I appreciate your
position Counselor,
but I think it would be
more helpful to everyone
if you held your cross-examination
after Dr. Quincy's findings.
Then if you wish I
will call both witnesses
for your cross-examination.
Very well, Your Honor.
Thank you, Miss Aldred.
Dr. Quincy, would
you come forward?
Dr. Quincy, you performed
the autopsy on Mr. Keane?
- Yes, I did.
- Would you give
us your findings?
I first became involved in this
matter when Margaret Aldred
came to me, because
of what she considered
improper treatment of
a patient, Robert Keane.
You Honor, I object.
Dr. Quincy is giving us
his opinion of her opinion,
neither of which is fact.
Her opinion is based on
several years' experience
as a qualified
emergency room nurse.
Dr. Edmonds is not experienced
in emergency medicine.
His practice is limited
and highly specialized.
That is the real problem here.
Your Honor, Dr. Edmonds
is a licensed physician.
There is nothing in the law
that states he must be a
specialist in emergency medicine.
Dr. Quincy, although
you point is well taken,
we are not here to discuss
the overall state of
emergency medicine.
We're here to discuss what
occurred in this particular case.
It does apply to this case.
If a qualified emergency
physician had been on duty,
the chances are Robert
Keane would be alive today.
- In your opinion.
- In my expert opinion, yes,
I'm not sure I follow
you, Dr. Quincy.
You heard the testimony
of Dr. Edmonds.
Would you say what
Dr. Edmonds described
is accepted procedure
in Mr. Keane's case?
Yes, I would.
But I'm sure that Dr. Edmonds
is not telling the whole truth.
You Honor, Dr. Quincy
wasn't even there.
How could he be so sure?
I didn't have to be there.
Robert Keane, the deceased,
told me everything I needed to know.
Would you explain that, please?
When I examined the
body it was apparent he died
of an acute
myocardial infarction,
A heart attack.
It also showed that Lidocaine
had been administered,
along with Epinephrine,
and Sodium Bicarbonate.
But that's exactly what
Dr. Edmonds told us.
What he didn't tell you
was that Isoproterenol
was also administered.
- Isoproterenol?
- That's right.
Considering the symptoms,
it would increase the likelihood
of cardiac arrhythmia and failure.
So I have to assume the
administration was done
either through
ignorance, or by mistake.
Your Honor, I
must protest again.
Dr. Quincy is conjecturing.
All right, counsel,
your objection is noted.
Dr. Quincy, what else
did your findings show?
The Lidocaine was used both
before and after death occurred.
And of the other medications
except for the Isoproterenol,
we also administered some
considerable time after death.
- After death.
- That's right.
Will you clarify that
for the jury, and for me?
The paramedics an initial dose
of Lidocaine at the bowling alley.
Now that would have
calmed down the heart.
However, after
about thirty minutes
the Lidocaine would
have metabolized to a level
where it would no
longer be effective.
I see. Then what
would have happened?
The autopsy showed it
was sufficiently damaged,
that it needed more
Lidocaine to remain stable.
But no more Lidocaine was
given until after he was dead,
Instead at this point,
someone administered
Isoproterenol in the emergency room.
Your Honor, how we be sure
that the paramedics didn't
give it to him by mistake?
Because it wouldn't
have been possible.
And why not?
Isoproterenol is broken
down by the body very quickly.
And based on the level
found in Mr. Keane's blood,
it could not possibly
have been administered
more than five minutes
before his heart arrested.
By which time the paramedics
were long gone from the clinic.
So from the time
sequence I just described,
only Dr. Edmonds
could have given him
the injection of Isoproterenol,
which in effect killed him.
I see.
Would you explain how
the other medications
- came into the picture?
- Yes.
Based on the
toxicological reports,
it is my opinion that he
and Dr. Edmonds together
administered the
other medications,
in an attempt to make it
look as if everything possible
had been done for
Mr. Keane before death.
Wasn't Miss Aldred
a witness to all this?
No.
Before the procedure, Dr. Drew
ordered her out of the room.
Is there any
additional proof of this?
Yes.
In an attempt to circulate the
medications through the blood,
excessively heavy chest
compressions were used.
As a result the fourth and fifth
costal cartilages were fractured.
This would have
resulted in hemorrhage
at the fracture points
on a living person.
There were no such bruises
evident on Keane's body,
In other words,
he was given a lot better
medical care after he died,
than before he died.
You know, Quincy,
you did another fine job.
Sam, after Quincy
gave his findings,
that jury didn't have
any trouble bringing in
a "death due to negligence"
against Edmonds.
Yeah. He's going to
spend a lot of time wishing
he hadn't done his
buddy Drew a favor.
And after the State,
and the County,
and the Board of
Medical Quality Assurance
and the District Attorney get
through with Danner and Drew,
they're gonna be
in a lot of trouble.
Quincy, how's the
spaghetti sauce?
Oh, it's terrific.
Did you figure out the
secret ingredient yet?
- Yes, I did.
- You did, eh?
What is it?
Crushed rice husks found
only grown in the Po Valley
in Northern Italy.
How'd you find that out?
Just give me the ten dollars.
- How did you find that out?
- I'm a scientist.
Don't monkey
around with science.
How did he find out?
How did you find out, Quincy?
I gave the chef twenty-five
dollars and he told me.
That means you lost fifteen.