Quincy M.E. (1976–1983): Season 8, Episode 2 - Ghost of a Chance - full transcript

Come on, come on.

The operation was a
success, but the patient died.

What exactly are
you accusing me of?

Ghost surgery.

When one doctor performs
an operation for another

without the patient's knowledge.

I was not responsible
for his death.

Maybe Doctor Royce is
just extremely efficient.

I think he killed him.

I don't understand it. The hospital's
always cooperated in the past.

Doctor Royce is very valuable to this
hospital and I don't want to lose him...



What about his patients? You
don't seem to mind losing them.

Gentlemen, you
are about to enter

the most fascinating
sphere of police work,

the world of forensic medicine.

The aorta and atrium are cannulated,
he's ready to go on to bypass.

Going on bypass.

There's one of the culprits.

I can feel a plaque at the
marginal branch of the left anterior

descending coronary.

The venous blood's a little dark,
better increase the blood flow.

Increasing flow to five
liters. I'll send a blood gas.

Let's administer cardioplegia
and stop the heart.

- Is the iced saline ready?
- Yes.

Well, you made that
look simple enough.



It was a little more
complicated than we expected,

but a relatively
simple procedure.

Mr. Markham shouldn't
have any problems now.

He should be able to run a four minute
mile with what you did for his heart.

You know, when I was a kid, my
brothers used to call me "hands"

because I could
never catch a football.

Good morning, Mr. Markham,
how're you feeling today?

Not too good.

Were you able to
sleep last night?

No, I feel too bad.

The Doctor told me the
operation was going to be a breeze

and I was going to
have an easy recovery.

Well, it hasn't even been
a day. Give it a little longer.

Okay, but the operation was
supposed to take away the tightness,

but compared with the pain in my
chest now, the tightness was nothing.

I'll tell Doctor Royce
you're not feeling well.

Thanks.

I'll be bright back,
Mr. Markham.

We better find Doctor
Royce, right away.

What's wrong?

Mr. Markham, he
has a pain in his chest,

his color's pale,
skin cool and clammy

and his blood pressure
is down to eighty over fifty.

- We've got bleeding. Sponge!
- Pressure's down to sixty.

There's leakage on the left anterior
descending. Let's get him on bypass.

- Give me the heparin.
- He's arrested V-fib.

It must be an
infarction. Epinephrine.

C'mon, dammit.

C'mon.

Asystole.

We lost him.

Would you both please sit down.

The clerk said you wanted
to see me, Mr. Markham.

No, he wanted you to see me.

I guess I lost my
temper with him.

He doesn't seem to think my
brother was worth an autopsy.

It isn't that, Mr. Markham.

It's just that since your brother
was under a doctor's care

the last twenty days,

the doctor will certify his death,
an autopsy isn't required by law.

He was under a
doctor's care, all right.

That's why we want
this investigation.

The clerk was just
trying to save you money,

but if you're
willing to pay for it,

there's is no reason why your
application shouldn't be approved.

How much will it cost?

Five hundred seventy five
dollars and eighteen cents.

Ted, it's an awful lot of
money. Especially now.

Don't worry. I'll
take care of it.

I don't know if I have
the strength for all this.

Sarah, listen to me.

It's not just for you and me.

If that doctor killed Hal, I don't
want him to do it to anybody else.

All right.

Come in.

Sorry I didn't know
you were busy.

Oh, Quincy, come in. I was
just going to call you anyway.

This is Mrs. Markham and her
brother-in-law, Ted Markham.

How do you do?

I've reviewed their reques t for an
autopsy on Mrs. Markham's late husband.

It's not a coroner's case
but I'd like you to handle it.

Okay.

Mr. Markham died following
complications from heart surgery.

That's what the doctor
said, but I think he killed him.

That a pretty strong accusation,
Mr. Markham. Who's the surgeon?

Doctor Stanley Royce.

Royce? He's one of our best.

That's why we went to him,
even though he was expensive.

He promised us everything'd be fine
and there was nothing to worry about.

Then forty eight hours later, he tells
us they lost him due to "complications."

The operation was a
success, but the patient died.

Sometimes it is unavoidable.

That's all we want to
find out, Doctor Quincy,

because my brother was too
good to lose if it was avoidable.

How did you come to
choose Doctor Royce?

Our family doctor
referred us to him.

He said that even though
Hal didn't feel that bad,

we should take care of it
before it became a big problem

or it might be too late then.

He said he could take care of
it more easily and safely now.

So we listened

and my sister-in-law's a widow
with two teenage kids to support.

And a malpractice
suit would help.

Listen.

Look, I know a lot of people might try
to take advantage of a situation like this.

But all I want is the truth
about my brother's death.

Of course.

We'll let you know the results as
soon as we've completed all our tests.

When will that be?

We should get the
initial report in a few days.

- Thank you very much.
- Thank you.

Doctor Quincy. What'd you think?

I can understand their grief,

but I'd be very surprised if Stan
Royce lost a patient due to negligence.

He's one of the best
cardiac surgeons around.

I agree with you.

You remember he operated on
Monahan's wife a few years ago?

She had a bad ventricle

two other doctors wouldn't even
risk surgery and he saved her life.

Well, they made the application and
they're willing to pay for an autopsy,

so we'll do one.

I'll get on it as soon as
we can pick up the body.

Quincy, what did you
want to see me about?

Oh.

I forgot.

The pericardium is
clear and unremarkable.

Valves intact, give
me the small scissors.

There are two
bypass grafts, Sam.

There's some minor
bleeding on this one.

Look at the size of that plaque

that obstructed that vessel.

That must have significantly
restricted the blood flow.

There's no doubt about
it. Doctor Royce was right.

Mr. Markham definitely
needed that operation

and it doesn't look like it
was a difficult procedure.

And it looks like he
did a good job too.

Hal Markham could have
lived for many more years

without any heart trouble
after this correction.

It looks like the heart
muscle's a lighter color here

on the apex of
the left ventricle.

It's an early infarct.

The muscle just didn't get enough
blood and died. Probably from a blockage.

You think a clot formed
and blocked the artery?

- It looks like it.
- But what do you
think caused it.

We'll find out as soon as we
can look at the micro sections.

Here it is, Quince.

A blood clot where they attached
the bypass graft to the coronary artery.

Well, that's what killed him.

There was bleeding where they
attached the graft to the artery,

a blood clot formed, blocking the
artery and killing the muscle it fed.

So that's when he started having the
pain and they took him back into surgery.

But we still don't know why there
was bleeding after the surgery.

Take a look.

This is a section
right at the attachment.

You can see the sutures attaching
the graft to the coronary artery.

They look tight. Where was
the bleeding coming from?

Watch.

There's a tear in the graft
vessel next to this suture.

I see it. But it's sealed now.

They must have sealed it when
they took him back into surgery

and removed the torn suture.

I suppose the vessel they used for the
bypass graft had a weakness in the wall.

But why didn't
they catch the leak?

They attached the graft
while he was on bypass.

The blood was being pumped around
the heart through the heart lung machine,

so there was no blood
pressure in the coronary arteries.

Then, when the surgery was
finished, they went off bypass

and sewed him up. The blood pressure
returned to normal and, while he was

in intensive care, the suture ripped
through the weak spot in the graft vessel.

So he bled internally, a clot
formed at the site of the bleeding and

blocked the coronary
artery, causing a heart attack.

If that's what happened,

it's just an
unfortunate accident.

Nothing anybody could have done.

I think I'll pay
Doctor Royce a visit.

Excuse me, I'm looking
for Doctor Stanley Royce.

- He just finished surgery.
- Thanks.

Dr. Royce,

that was the finest bypass
procedure I've ever seen.

It was outstanding. I think I learned
more today than I did in medical school.

Stan. May I talk to
you for a minute?

It's good to see
you again, Quincy.

How's Claire Monahan feeling?

Great, thanks to you. She's
jogging three miles a day,

still asking the
lieutenant to join her.

Too bad they can't
all turn out that well.

I was informed the Markham
family requested an autopsy from you.

Yeah.

- We're doing everything
we can to cooperate.
- I appreciate it.

Why don't you come to my
office with me while I change.

I'm scheduled tighter than
the President these days.

Of course.

- I feel bad about being here.
- You couldn't
feel worse than I do.

When the symptoms showed we
rushed him back into emergency surgery,

but it was too late the heart
was too severely damaged.

Our micros showed a
tear in the graft vessel

where you attached it
to the coronary artery.

That's where it was bleeding.

You know, this is the kind of thing
that happens once in a million times.

There was a weak spot
in the wall of the graft vein.

The sutures were all tight,
but when we went off bypass,

one of the sutures
pulled through.

That's what I figured happened.

Didn't you notice any bleeding
before you closed him up?

Nobody would have seen
it while he was on bypass,

it probably started
several hours after surgery

when his blood
pressure began to rise.

I tell you, everything humanly
possible was done, but we aren't perfect.

How do you explain
that to the next of kin?

You can't.

All the explanations in the world
aren't going to help his family.

Doctor Royce did
the best he could.

You know, I'm actually relieved.

At least Hal didn't die
needlessly from a mistake.

That would have
been harder to live with.

I wish there was some way you
could be compensated for your loss,

but any lawyer will tell
you it wasn't malpractice.

It's all right. Even with
Ted standing behind me,

I don't know if I could have
taken a long legal case.

I wish there was
something I could do.

Don't worry. We'll
manage somehow.

Hal was a congenital optimist

and you can't live with a man
like that for twenty five years

and not have some
of it rub off on you.

- Well, did you do the autopsy?
- Yes, I did.

- And?
- There were no
signs of negligence.

Why did I know you
were going to say that?

Well, you wanted
the truth, didn't you?

What is the truth,
Doctor Quincy?

There was nothing unusual or
unacceptable about his procedure.

Tell me something, Doctor,

if he never had the operation,
would he be alive today?

Most likely.

So how can you say
there was no negligence?

These procedures sometimes
appear to be very simple,

but some hidden danger that
it is almost impossible to detect

makes complications
that can be fatal.

My brother was not a car that
you can send back to the mechanic

if what he fixed didn't work.

He was a human being and he deserved
more care than you give an automobile.

One shot that's all Doctor
Royce had, one shot at my brother

and he was not allowed to make a
mistake or not see any hidden dangers.

He told us he had a new kind
of operation that he developed

and that he guaranteed, yes, he gave us
a guarantee that my brother would make it.

How many mistakes is he
going to be allowed to make?

You know, Doctor Quincy,

I remember when doctors
gave comfort instead of excuses.

Sam, get me the autopsy
file on the Markham case.

Marc, where are the
articles on cardiac surgery?

Top drawer, the
file on the left.

Did you get a
description of the heart?

- Sure, but what's going on?
- I'm not sure.

I need to know where the plaque
was in the descending coronary artery?

It was located right here, where
the marginal artery branches off.

Right there.

But the bypass graft was hooked in
further down the artery, beyond the plaque.

That's the way
it's usually done.

But not with Royce. Markham's brother
said Royce was using a new procedure that

he had developed
for cases like this.

That when I remembered the
article. Royce got a lot of publicity

a couple of years ago for it.

He was one of the doctors involved in
the development of a procedure for cases

where a plaque is located right where
a side branch divides off an artery.

Like this one.

Exactly. In the old procedure, the vein
graft was connected here, just as it is.

But Royce developed a technique

where you cut right in
the middle of the plaque.

Then you clean it and
attach the graft here.

You get full blood flow
back to the heart here

and here. Two for
the price of one.

That's a much better procedure.

Yes, it is.

Maybe there was some reason
why he didn't do it that way.

There's only one man who
knows the answer to that one.

Come in.

Quincy, what is this?

You lied to me about
the Markham case!

- What're you talking about?
- This!

You wrote about the technique that was
designed for cases just like Mr. Markham.

Why didn't you use it?

Look, Quincy. It couldn't be done.
There was too much calcium in the plaque.

You can't clean them
out when they're like that.

That's bunk, Doctor. I examined the
plaque remember. It was cholesterol.

There wasn't enough calcium
to interfere with anything.

Quincy, I don't like
the third degree.

I used the old technique
because it was a simple case.

Or were you in a hurry to
get to your next procedure?

Don't be ridiculous. I just did
so many procedures that day.

And this wasn't one of them.

- What?
- You weren't even there,
were you?

Then who do you
think did the operation?

I don't know yet, but
I'm going to find out.

Quincy, please, as
one doctor to another, I'll

forget about this
foolishness if you will.

No, I don't want
to forget about it.

And I don't want you
to forget about it either.

Look, I'm a reasonable man
but you are trying my temper.

What exactly are
you accusing me of?

- Ghost surgery.
- I'm not even
going to answer that.

Now, if you'll excuse me.

You know, you can be guilty of
malpractice not only for what you do,

but also for what you don't do.

First finger here, second
finger here, third finger here.

Okay.

I think I've got it.

Are you ready?

- No guts, no glory right?
- Right.

Down in the valley,

valley so...

Oh, my goodness.

Hang your head over,

hear the wind blow.

That's wonderful. I
love to hear you sing.

I'm pretty shaky on the guitar,

but I'll get there. It a
beautiful instrument.

A friend of mine was leaving town
and gave it to me for safekeeping.

So I figured I'd learn to play.

How about another song?

Quincy, my fingers are sore.
I haven't built up calluses yet.

- Come on just one?
- Quince.

- Okay, what's up?
- Nothing's up, why?

You're avoiding
talking about something.

Not necessarily.

Come on Quince,
get it off your chest.

What're you a
psychiatrist or a psychic?

Okay.

- All right,
you know Stan Royce?
- Royce? No, I don't think so.

He's a cardiac surgeon,
one of the best in his field.

He's letting residents perform
some of his procedures.

He's operating in absentia
which endangers patients' lives.

And you want to understand why
he persists on doing it, anyway?

Yeah.

You know, I once
dated a thoracic surgeon.

He had this real macho
super-human type personality.

He thought he was infallible
he could do anything.

He became so wrapped up in proving
that, I had to break the relationship.

He was a very boring man.

I don't think it was just ego.

I mean, there's nobody more
highly thought of than Royce is.

He's got all the money he needs.

Quince, you used to
be a practicing surgeon.

So you know what
Royce went through.

Those hundred hour
a week internships,

the abuse from staff doctors,

the almost inhuman competition
for that first year's residency.

He's paid his dues, he
served his apprenticeship.

And now, like most surgeons, he's
probably caught up with the rewards.

Come on, Emily, I don't buy it.

I burned the midnight oil, too, but I
don't think I lost my objectivity like.

But Royce has saved
hundreds of lives.

Patients, families, even
doctors come to him every day.

Worshipping his procedures.

Idolizing his techniques, they put
him on a four hundred foot pedestal.

You're saying that adoration
like that has to affect the person.

Cloud their objectivity.

I'm saying that after a while,
people begin to believe that idolatry.

Stan Royce may be a
fine and dedicated surgeon.

But after having elevators
doors held open for him

and hospital concessions made,

it's hard to remain immune to
people's unshakable image of you.

Well that's fine
if you're a God.

Not if you're a human being
entrusted with people's lives.

I'm not going to let go of this.

I didn't think you would.

So, what's up now.

Tomorrow I'm going to go the
Board of Medical Quality Assurance.

Somehow, I knew
you would do that.

Okay, now that I
got it off my chest.

Can I have another song?

You're a glutton for
punishment. You really are.

Angels in heaven

know I love you.

- Ghost surgery?
- That's right.

When one doctor performs
an operation for another

without the patient's knowledge.

We don't condone that.

Good. Then you'll
do something about it.

About what?

What I just told you. This is the Board
of Medical Quality Assurance, isn't it?

All you've given us
is a journal article,

and some dubious assumptions a
about a highly respected surgeon.

We can't challenge someone of Doctor
Royce's standing without a solid complaint.

This isn't evidence, we get crank
calls that make more sense than this.

I am not a crank, I know what I am
talking about, why won't you believe be?

Because there are laws that make
it extremely difficult for doctors to

get away with ghost surgery.

We've had informed consent
in this state since 1975.

Every patient has to sign a form

which lists who's going
to be doing the surgery.

Patients don't always
know what they're signing.

And how do they know who's holding
the scalpel once they're under anesthesia.

What you're talking about would
have to go on with the knowledge of

the other doctors and nurses.

Well, it wouldn't be the first time they
covered up for each other, would it?

Believe me, it isn't
that common a problem.

I ought to know.

Isn't it common for surgeons to let
assistants start operations for them,

- and finish up
after they leave?
- Yes!

But why should an eminent specialist
have to waste his time doing routine work

when he can be
helping someone else?

He shouldn't leave
the operating room

because the operation
is still not over.

The trouble is, once you allow
this standard, accepted practice,

it's easy to start abusing it. Who's
to stop them from leaving too early,

- or never showing up at all?
- I think you're exaggerating.

Am I?

There are eighteen million
operations in this country every year,

who knows how many are being
performed by ghost surgeons?

What about that Watson case,

where an obstetrician left a difficult
birth to an intern under his own name.

The parents didn't know
about it until it was too late.

And they sued for
malpractice and won.

But the Watson's lost a child!

And you didn't do anything
to stop him from practicing.

We wouldn't take away
his career after one mistake.

How do you know
he won't do it again?

Listen, doctors
are not criminals

and can usually be taken at their
word besides, we can't be everywhere,

looking over everyone's
shoulder all the time.

Look, maybe you can't
solve the whole problem.

But you can do
something in this one case.

If Doctor Royce knows
you won't do anything,

he'll think he can keep
on getting away with it.

And there may be more
innocent victims like Mr. Markham.

Bring us a valid complaint,

give us something to go
on and we'll investigate.

You promise?

I promise.

Okay. You're a doctor so
I'll take you at your word.

Come in.

You wanted to see me, Herb?

Yes. Thanks for coming,
Stan. I know you're busy

but Doctor Quincy's been calling
me about the Markham case

and I've been avoiding him

- until I could talk to you.
- Is anything the matter?

Well, probably not, but I
wanted to hear your side of it first.

My side of it! You've
seen the reports.

Doctor Quincy conducted a postmortem
and couldn't find any proof of negligence.

But he's such a fanatic, he'd probably
find fault with Doctor Schweitzer.

Unfortunately, I'm
caught in the middle.

Well, if push comes to shove, I'll
expect you to back me up 100%.

Of course. But Stan,

but could you do me one favor?

What's that?

Could you cut back on
your procedures for a while

and stay closer
to the residents?

I stay close to the residents?

Are you saying there was something
wrong in the Markham case?

No. We just don't want
a whole investigation.

Even if we're vindicated
and I'm sure we would be.

The bad publicity would
embarrassing to the hospital.

I happen to have a certain
stature as a cardiac surgeon,

and I don't appreciate someone
else telling me my responsibilities.

I'm just asking you
to ease back a bit.

And waste time watching a
resident put in some final sutures

when, in my judgment,
it isn't necessary?

I'm only trying to do
what's good for this hospital.

I'm good for this hospital. I
bring a lot of patients here,

and I make it possible for
you to attract the best staff.

And don't forget that surgery
is your biggest profit maker.

All those procedures I do,
help pay for the scanner,

and for that expensive
testing equipment

we need to offer the
highest quality medical care.

I work my tail off being
the best doctor I can,

and I'd never knowingly
put my patients in jeopardy.

I'm not questioning that.

I respect your position
here and I know what

a difficult job it is
running a hospital.

So if I become an
embarrassment to you,

I could always go
someplace else.

Don't even talk that way.

I didn't mean to
offend you, Stan.

And don't worry, you've
got my full support.

Thanks, Herb.

Sorry it took so long. Department
of Health Services is all backed up.

What'd you get, Sam?

The death
certificates of patients

who died under Doctor
Royce's care in the past year.

How many are there?

Six, with the reputation he has,
he must treat a lot of patients.

That's an excellent record.

If one of those patients died needlessly
as Markham did, it's a terrible record.

And that's what
I'm gonna find out.

Well, these don't have
anything to do with surgery.

Ventricular fibrillation, congestive
heart failure, ruptured aortic aneurism.

But these three
could be questionable.

"Cardiogenic shock, congestive
heart disease, myocardial infarct."

All complications
following surgery.

One of the leading causes
of death, complications.

I guess it's a catch all when
things don't go as planned.

Where you going?

I'm going back to the hospital
to find more about these cases.

I have been trying to see the
administrator for two days now.

I gotta give the Board of Medical Quality
Assurance something specific enough.

I want 'em to act.

Can I help you?

Yes. I'm Doctor Quincy from
the Medical Examiner Office.

I'd like to see the records
on some former patients.

Well, you know that
information is confidential.

I'm sorry, but we can't release
records without a patient's permission.

The patients I'm
talking about are dead.

Then you'll need the
consent of the next of kin.

Could you give
me their addresses?

We aren't allowed
to disclose that either.

Did Doctor Royce tell
you to be so cooperative?

Doctor Quincy, I don't like
this any more than you do.

Maybe you should talk to our
administrator, Doctor Marden.

I've been trying to do that, but I
haven't been able to connect with him.

He doesn't seem to
want to cooperate either.

Dr. Quincy.

Let me see what I can do.

I'm sorry for all the delays in
getting to talk to you, Doctor Quincy.

We've all been so
busy around here.

So I understand.

How can I help you?

By giving me access
to the medical records

of some of Doctor
Royce's former patients.

I'm afraid that'll
be a little difficult.

Why? You've got the authority.

But you know how sensitive doctors
are about revealing patients' records

and being second-guessed.

I could make it part of an official
investigation and subpoena them.

Then that's what
you'll have to do.

I'm not going to go behind
Doctor Royce's back and insult him,

either professionally
or personally.

Why are you so
afraid of offending him?

Frankly, Doctor Royce is very valuable to
this hospital and I don't want to lose him.

What about his patients? You
don't seem to mind losing them.

That's uncalled for.

So is letting ghost
surgeons operate on them.

Or don't you know what's
going on in your own hospital?

I know that Doctor Royce is one of
the finest surgeons we've ever had here.

And this happens to be a
teaching hospital, Doctor Quincy.

In case you've forgotten,
surgeons aren't born,

they're created by doing
procedure after procedure.

Do you know how many
brilliant doctors he has turned out?

Add up all the
lives they've saved.

It still doesn't make up for the one he
lost by letting a resident operate alone.

What you're talking about
is a question of judgment.

And I trust Doctor Royce's.

So you're part of
the conspiracy too.

The only conspiracy
here is to help our patients.

How? By letting
inferiors operate on them?

Who can tell a man like Doctor Royce
when he can come and go in the OR?

There better be some body,

or more of your patients are
going to end up on my table.

Well, I'm sorry too.
Thank you anyway.

You see?

No. I couldn't get the hospital to
release the patient records either.

You're the old master, you
always know the right strings to pull.

I'm afraid I just pulled my last one.
Doctor Royce has some influence, too.

He's stonewalling.

And I need those records or the Board of
Medical Quality Assurance won't do a thing.

I don't understand it. The hospital's
always cooperated in the past.

Apparently they've
had a change of policy.

Wait a minute! You just
said the magic word policy.

The insurance investigator?

Medical insurance investigator.
Almost everything Doctor Royce

does must be billed through
health insurance companies.

And all the insurance companies
share information through their computers.

That's brilliant, Quincy.

I'm glad I thought of it.

Quince, how are you?

Thanks for seeing me
on such short notice, Al.

My pleasure, Quincy.

You've helped us before,

and it's good business to return
the favor. What can I do for you?

You've heard about
ghost surgery, haven't you?

I sure have. We had a case a
while ago that cost us a bundle.

I know the doctor in
question didn't perform

the surgery, but
we couldn't prove it.

We lost the malpractice suit
and don't even know if the doctor

who really did the
surgery is insured by us.

Fortunately, most
surgeons are responsible

enough not to take chances
with their patients' lives.

But for some,

the temptation's too great to squeeze
in a few more procedures a day.

Each one's worth
thousands of dollars.

That's what makes
ghosts so appealing.

How do they get around
the informed consent

that's supposed to guarantee
the patient's right to know?

Sometimes the doctor lists his
name and associates on the form.

Others come and go without
the patient knowing whether they

were there the
whole time or not.

I want to stop that practice.

But how, Quincy, a resident's
got to get hands-on experience.

- But under supervision.
- But where do
we draw the line?

The surgeon has to be present.

How far from the table five feet,
ten feet in the same building?

By the resident's side!

From your lips to the AMA's ears.
I'm sure it would save us a fortune.

But it's easier said
than done, Quincy.

Who're you going after?

- Stanley Royce.
- Doctor Royce.

I find that hard to believe.

That's what helps
him get away with it.

Can you get me the records of all Doctor
Royce's billings over the past three years?

Sure I can get 'em.

I'll start on them right away.

Thanks, Al.

I'll need a wheel barrow to get
them over to your office though.

Hello, Max. Listen get me
the records on Doctor Royce.

For the last three years.

- More?
- Remember, that's
only three years' worth.

Would you look at this, Al.

The simple process of opening
a mitral valve that went wrong.

Two operations were
necessary to correct it.

Let me see that.

Wow! You're right. Royce never would
have let this happen. He's too good.

He would have known there was a
problem right there in the operating room.

This is that case
I told you about.

Listen to this. On April 12th,

Royce billed for two valve replacements
and three bypass procedures.

On June 2nd, he did a
triple coronary bypass,

an aortic aneurysm, and
three aorta endarterectomies.

- I can't believe
he would do that.
- Well you better believe it.

Each of these
procedures takes hours.

Royce would have to be in two
places at once to do all of these.

Either that, or he's got the
fastest hands in the West.

Well, with this information,

the Board of Medical Quality Assurance
is going to have to slow him down.

So? Doctor Royce
did a lot of operations.

That's not unusual for
a surgeon of his quality.

Come on! He'd have to be twins

to have done all these
procedures by himself.

This isn't the Board of Medical
Quantity. The word is "Quality."

But if residents are filling in
for him without supervision,

it's bound to
affect the quality.

Isn't this proof enough that
ghost surgery is going on?

But, Quincy, what residents?

What lack of supervision?
Give me a specific case.

Maybe Doctor Royce is
just extremely efficient.

You're going to
ignore this right?

You're going to pretend,
I was never here.

I could never forget
you were here.

You see these, Doctor Quincy?

They're all complaints about
malpractice clear-cut cases of negligence.

No phantoms no
assumptions or speculations.

That's the trouble
with ghost surgery.

Nobody sees anything nobody knows
anything and nobody can do anything.

I'll tell you what.

I'll call the hospital
and put them on notice

that we do not approve of
unethical practices like these

and we'll be watching
them. Will that be enough?

Only time can answer that
one. It'll put Royce on notice.

I really appreciate, that. One
thing you'll find out about me,

when you really get
to know me better.

I don't make too many demands.

Yeah.

May I talk to you for a minute?

Sure.

You're working
overtime, as usual.

I have to, with all the running
around I've been doing lately.

Mind if I have a cup of coffee.

Help yourself.

Quincy, why did you go to the
Board of Medical Quality Assurance

and have them put me on notice?

To try and make sure that
what happened to Markham

doesn't happen to any
of your other patients.

I told you that
couldn't be helped.

I don't buy that, Stan.

All you're doing is creating
a tempest in a teapot.

If that all I'm doing, then what're
you doing here at this hour?

You're a good doctor,
Stan, and a good man.

And way down deep you know
you're doing something wrong.

You're here because you want me to
accept what you're doing and approve of it.

I can't do that.

All right, you want
to hear me say it.

I didn't perform that operation
because an emergency came up.

But a very talented young
surgeon who was fully capable did.

But he didn't have your
experience and your knowledge.

That's what the Markhams
were paying you for, your skill.

How do you think I
learned those skills?

A brilliant doctor taught me and then
gave me my first chance to operate.

I lost cases too.

Was he by your side?

Yes.

Then you weren't
responsible for their

deaths. Of course
you've got to teach, Stan.

But it should only be when you're
there, and with the patient's permission.

Come on, Quincy. If we
tell patients everything,

they'll go to another doctor
who'll let a resident operate.

That can't become your standard.

How much money do you need?

I am sick and tired of you trying
to make me feel like a murderer!

I was not responsible
for his death.

Everything possible that could
have been done for him was done.

That's not true.

How can you equate your
ability with that of a resident?

You're making it sound like that resident
is some kind of inexperienced butcher.

Do you know how many lives he's saved
using the procedure he used on Markham?

And Mr. Markham would
have been saved too

if it weren't for the abnormal
weak spot in the wall of his vein.

Which you might have
detected with your experience.

Quincy, your scare tactics aren't
going to accomplish anything.

I'm going to continue to
do exactly what I'm doing.

We'll see.

You know something, Stan, I
have more faith in you than you do.

Quincy, why are you
riding Royce's back?

- He's a good doctor.
- I want him to stay that way.

Whenever I see you
my ulcer starts acting up.

You got anything good
for acid indigestion?

Here, try these.

Thanks.

You better take
a couple yourself,

because I don't think
you have a case here.

What?

You mean a doctor can say
he's gonna be the surgeon

and then have someone else do it

and the District Attorney
won't prosecute him for fraud?

Why? No crime's been committed.

- What?
- Not in the eyes of the law.

You see, criminal fraud
is the intention of taking

someone's money
without providing a service.

As long as the doctor
provides the service,

no matter how bad
it is, it's not fraud.

But sometimes he doesn't
provide the service himself.

It doesn't matter as long
as the service is provided.

It's a practice that
goes on every day.

I just bought a book

I thought was written
by a well-known author.

It turns out he has four other guys,
ghostwriters doing all his writing.

He just puts his name on
and sells a million copies.

Even though I bought it just
because of his name, it still isn't fraud.

We're not talking about books,

we're talking about lives and
he shouldn't get away with it.

According to the law, he can.

It's strictly a civil case.

The patient's family could claim
the doctor misled them and sue.

They don't have the money for that.
Besides, it'd take years to get to court.

Sorry, Quincy, it doesn't
fall under our jurisdiction.

You've got tougher laws about false
advertising than you do for medicine.

It is hard for us to
make laws for doctors.

They fight it through their
lobbying and tell us we don't

know enough about medicine
to start setting rules for them.

What are we supposed to do?

Then maybe it's time we wrote
some new laws with the doctors' help.

Maybe it's time we said a
surgeon has to be in the operating

room from the first
cut to the last stitch.

I'm with you, Quincy. But don't
look for it to happen tomorrow.

Tomorrow? I want
it to happen today.

Hold on to these, you're
going to need them.

How are you feeling, Mary Ann?

I think I've got
terminal butterflies.

Now don't you worry about a
thing. It's natural to be a little nervous,

but you don't have a
thing to worry about.

I brought you a new best seller
to read while you're recuperating.

Thank you, Doctor.

The only reason I've got the
courage to have this operation

is because of you.

Now, you just try to relax,
and before you know it,

you'll be back holding hands
with this fellow over here.

I can't tell you how
grateful I am, Doctor Royce.

You're the only one who ever could've
convinced her to go through with this.

It took you six months
to psych her up for it.

I want you to know
how much I appreciate it.

Time is very important to her.

It's never a moment too
soon in a case like this.

Thanks again, Doctor.

Don't you worry,
either. Everything's fine.

Doctor Royce, 726 please.

Doctor Royce, 726 please.

This is Doctor Royce.

What do you mean, they moved it
up to three? I can't be there in time.

I'm scheduled here.

All right. Tell them I'll be there
after I talk to Doctor Marden.

You can't put me in
this situation again.

It isn't my fault. They moved
General Walters up to three.

His case isn't life threatening.
Can't they reschedule him?

He needs five days recuperation

and he's got an important
series of meetings

at the Pentagon next week.

Why doesn't someone
else operate on him?

Let Central Hospital have
that headache for a change?

You're talking about
Brigadier General Walters.

One of the most important
military men in this country.

He won't let anyone operate on him
except me and I consider that an honor.

I owe my reputation
to people like him.

Stan, I went along with you
before, but I can't anymore.

If anything should happen.

Are you telling me what I
can or cannot do, Doctor?

Yes, I am.

Well to be perfectly frank, I
didn't expect this kind of reaction.

What did you think
I'd do? Jump for joy?

I didn't even have to tell
you. I did it out of courtesy.

But don't worry. You won't be caught in
the middle. I'll take full responsibility.

- Yeah.
- Doctor Quincy?

Something just happened that
I think you should know about.

Yes?

Doctor Royce is scheduled to operate
on a patient named Mary Ann Fisher

who's going into
surgery in fifteen minutes.

So?

I just saw him
leave the building.

I'll be right over.

- What is it?
- Royce. He's doing it again.

I was wrong. I thought I reached
him, Sam, but I was wrong.

- Two-oh polyester.
- Blood gases are looking good.

Just two more stitches and
she'll be good as new. Suture.

You've got the same
dexterity as Doctor Royce.

If I just knew what
Doctor Royce knows.

Okay, Tom, let's
come off bypass.

We've got some bleeding. Sponge.

Clamp. I've clamped
the atrial appendage.

Damn, the edge of the suture line
tore open. Suction, damn it, suction!

I can't see what I'm doing.
Clear the blood away.

- Pressure's dropping
it's down to fifty.
- What're you going to do?

- I'll suture across the tear.
- No, put her back on bypass.

You've got to do this right.

Heparin.

You can't repair a tear like
this with the heart pumping.

No matter how much
time it looks like you'll save,

it'll take you longer. Sponge,

some suction over here.

Give me some polyester
and a Dacron patch.

This tear requires
some careful stitching.

The tissue is very fragile because
of her previous heart disease.

You need to reinforce
it with a Dacron patch

so it won't tear again when the
blood pressure returns to normal.

Give me another suture.

Without the heart
pumping, it's easy to repair.

You can't sew up an inflated
balloon especially if it's moving.

She's going to be fine now.

I was never so glad to
see anyone in my life.

I thought I was
going to lose that girl.

The time it takes to go back onto
bypass will save you time in the long run.

You're right. All I could think
of was stopping that bleeding.

But I'll never make
that mistake again.

That's what I'm here for.

But what happened to
your other procedure.

I gave him a choice, postponement
or another excellent surgeon.

- What did he choose?
- He should be
out of surgery now.

What's the matter, Quincy?
You look like you saw a ghost.

All's well that ends well?

What about the Markham family?

Royce's insurance company
made a private settlement with them,

so they won't lose their house.

Hey, I didn't order
pastrami on rye.

And I wanted ham.

I said without mustard.

What is this? You've
got everything wrong.

Sorry, fellas, but Mario
the cook is out sick

and we've got a
substitute in the kitchen.

Well, you tell the chef
we'd like to see him?

Right away.

I ordered hamburger and
I get a turkey sandwich.

What about me, I want fried
scallops and look what I got?

Any complaints, gentlemen?

I've heard of ghost surgeons,
but never a ghost chefs.