Authors: Daniel Palmer
Julie held her stony expression, knowing the bad news was yet to come.
“He sustained numerous injuries due to the high-speed impact of the crash,” Dr. Benton continued. “Ortho cleaned up the wound from the open fracture. They plan to set it in a day or two, when he is more stable. His wrist and elbow are splinted, and will also need pinning. We’ll try to have two ortho teams in the OR to minimize time spent in surgery.”
That’s not it … there’s something else. I can see it in her eyes.
“He also suffered a pelvic fracture, and is in traction now.” Dr. Benton reached across the table for Julie’s hand.
Oh, no … here it comes …
A pit opened in Julie’s stomach.
“The major concern now is that the burst fracture of C4 splintered into the spinal column.”
Julie visualized fragments of bone moving with enough velocity to shear the delicate strands of nerves embedded in the spinal column, the way shrapnel can shred flesh.
“Dr. Weinstein has been involved, and Sam is on the spinal cord trauma protocol.”
High-dose steroids to try to help the swelling, Julie knew. It was like using aspirin to try and cure a cancer.
“Now we want to give him some time to stabilize and give you time to see him before we take him for an MRI.”
“What’s the prognosis?” Julie asked.
“We don’t know yet.”
“Give her your personal opinion, Wendy,” Lucy said in a stern voice.
“I’m sorry, Julie,” Dr. Benton said. “The injury was bad, as bad as I’ve ever seen. There’s no easy way to break this news gently. My personal opinion is the accident is going to leave Sam permanently quadriplegic.”
Romey arrived at Duxbury Country Club at about one o’clock and changed into his golf outfit, khaki pants and a navy polo shirt. He had paid the pro for all the starting times between one and three, ensuring that he and Allyson would not run into anyone, especially not anyone he knew. A meeting between two rival hospital executives—on a golf course, of all places—could start rumors that might make others aware of the business potential. Like Warren Buffet, Romey saw opportunities others missed.
He was sitting on the veranda when Allyson Brock pulled up in her brand-new Lexus. The car was such an obvious choice for an executive. Romey drove a late-model, but not brand-new, Honda Accord. It was a sensible choice, and told his employees he was just one of them. While he was not about to surrender his spacious corner office, Romey thought his car made him appear more approachable. He knew how to play it smart.
As a boy, Romey had been blessed with a gift for numbers, but it did not take a math genius to know his chances of fitting in would have improved greatly were he more athlete than mathlete. A lonely only child growing up in a nice New Jersey suburb, Romey had been small and skinny back then. He was pragmatic about such matters. He did not wallow in self-pity and focused instead on his strengths rather than his weakness. He studied hard, honed his analytic skills, and after graduation went to Rutgers on an academic scholarship, where he excelled at accounting.
He trusted numbers more than people. Board members did as well, which explained why many hospital CEOs and administrators were numbers people and not trained physicians.
Allyson walked toward Romey, pulling her clubs behind her. She was wearing beige capris that accentuated her athletic body. Her white knit shirt clung to her torso and was open just enough to show cleavage. With what he was about to reveal, Romey had no doubts he could get Mrs. Brock into bed. He thought he could juggle it even with his two current mistresses.
Allyson waved and flashed Romey a smile, but he sensed a slight air of superiority in her gesture and the way she carried herself.
Romey was shorter than Allyson by three or so inches. His belly was a bit soft, his ears too big for his head, his hair thinning. She was the sort of woman who equated appearance with power, and for that reason alone was blind to the threat he posed. A man who loved power and money as unconditionally as Romey did not need Kevin Costner’s jawline—or a good handicap, for that matter—to have the upper hand.
Romey took Allyson’s clubs and put them in the back of a golf cart. “I figured we’d drive, no need for a caddy. Is that all right with you, Allyson?”
“Sure. This is just a friendly game. If I can give you any pointers, I will.”
Allyson placed her tee in the grass and with a driver hit an amazing shot that flew about two hundred yards, landing smack in the middle of the fairway.
Romey stepped up to the tee and with way too much effort, sliced the shot into the rough, about a hundred yards from the tee. His short torso and thick waist made it difficult to get the club around the ball. He gave Allyson a sheepish grin. “I told you I was just learning.”
Allyson came up behind him and explained how he had to hold his hips steady, spin from the waist, and remember to follow through.
“The ball goes where you tell it to.”
“Wish it were that easy with physicians,” said Romey.
“Don’t we know it,” she said. “Some days I feel like I go into work just to do battle with my medical staff. They all want to become employees of the hospital, and they give me and the board such a song and dance about their productivity. We both know that they don’t want to work the way the old guard did. They don’t want the hassle and expense of owning their practice. They’d rather work four days a week, take no on-call, and sign their inpatients over to hospitalists. And for this they want a quarter of a million, and threaten to leave on an almost daily basis.”
Romey had heard all this before. It was the administrator’s lament, the theme song of those running hospitals in the early part of the twenty-first century. Physicians and hospitals used to have a more symbiotic relationship: the hospitals provided physicians a place to admit and serve their patients, and physicians, in turn, provided the hospitals with paying customers. In that model, many of the docs ran private practices and billed patients separately for their time and expertise, while the hospitals charged for inpatient stays, including room, board, and ancillary services: lab work, radiology, use of the operating rooms, physical therapy.
It worked fine until the government and other insurers changed the way they paid hospitals and physicians. After the change, it made financial sense for physicians to become hospital employees. The docs would no longer have to fight with the insurers, and the hospital would take over most of their expenses. With the physicians under the control of the hospital, administrators could force doctors to deliver competing services like lab, radiology, or even surgery centers through the hospital and generate larger profits for their institutions. It should have worked well for both parties, but an employee’s mindset is different from that of an independent owner of a medical practice. The doctors wanted more and more perks for less and less work. At least, that was how the administrators saw it.
By the third hole, it was obvious that Allyson was feeling her most powerful. Romey knew she loved playing golf with male colleagues, especially since she was so much better than most of them.
She came up behind Romey and placed her hands on his hips. “Do you mind?” she asked.
“Not at all,” said Romey.
Allyson moved his hips through the correct range of motion. The tutorial paid off. Romey’s next swing was a straight, albeit relatively short, drive.
“That’s right,” she said. “If you keep your hips in line, it will give you the straight line you want.”
“Who taught you this insidious game in the first place?” Romey asked.
“My father was a fanatic,” Allyson said. “I was on the course with him when I was six, and by twelve I was playing eighteen holes. Good golfers wanted me to caddy for them because I was something of a natural and I gave great advice.”
Romey might not have known how old Allyson was when she began to play, but he did know she got a golf scholarship to the University of Southern California, where she studied occupational therapy. Upon graduation she was able to join the LPGA tour. He knew other things about her, too. Things she would not want anyone to know.
They played through the hole and climbed in the cart to head for the fourth tee.
“So tell me, Allyson, how are things at Suburban West?”
Allyson gave him the party line. “Pretty good,” she said. “We had a tough time last year, but we put in place some cost-savings measures that should turn things around. We’re also in the process of recruiting two new orthopedists and a podiatrist that will really help us establish our sports medicine department.”
She hopped out of the cart and sent her first drive right down the center.
“You are good,” said Romey as he put his tee in the grass and addressed the ball. His shot was picture perfect and hit the fairway dead center, about fifty yards ahead of Allyson’s ball.
Allyson watched Romey’s shot, mouth agape.
“Never believe what you see,” said Romey. “Just like I don’t have to believe you and your ‘everything’s just perfect’ routine.”
A shadow crossed Allyson’s face. “What’s that supposed to mean?”
“It means, I know you’re facing a seven percent loss for the past year. Not the kind of financial position that can be corrected with a sports medicine program, especially since I can assure you those two orthopedists are not coming near your hospital.”
If Allyson was stunned by Romey’s drive, she appeared in absolute shock at his knowledge of Suburban West’s financial position.
“I also know that HealthSense Insurance is giving you a four percent haircut and Unified is considering dropping you from their network. That could hurt. They make up—what? Twenty-one percent of your patients?”
Allyson was too stunned to speak. Insurance negotiations and rates were highly confidential.
“So, Allyson, you’re in a very weakened position, and my hospital is flush with cash. Unless you work magic, your days at Suburban West are definitely numbered.”
Her body deflated. “How do you know all that?”
“You know that’s a question I can’t answer. But I am here to help you.”
“How?”
“Tomorrow you will find a proposal on your desk for a management contract between White Memorial and Suburban West. You can read it if you like, but suffice it to say the terms are financially favorable for individual board members. In the end, however, White Memorial will have total control. You don’t have the balance sheet to make it and we both know it. You can string the board along for a while, sure, but they’ll see a better way forward in my proposal. So, you’re going to include me in an executive-level meeting and together we’re going to make sure you sell my proposal to your board exactly as it is written.”
“What about me?”
“There will be a transition period where you’ll share CEO duties with someone I select. When the merger’s complete, I’ll have a position open as director of support services at White that just may be right for you.”
“Are you kidding me? I run the hospital. You expect me to take a director’s position?”
“Let’s face it. You haven’t exactly done a very good job, have you? It’s probably less than six months before your board cans you, so I think you’re not in much of a position to negotiate.”
“I’m a damn fine CEO. I climbed my way to the top and worked for everything I got.”
Roman knew this was true. After Allyson’s golf career came to an abrupt and unexpected conclusion, she went to Tufts and got her MS in occupational therapy. Upon graduation she landed a job in a private rehabilitation hospital run by the owner, a neurologist. In a few years she became the director of occupational medicine, and in that capacity implemented a winning strategy for attracting patients. Allyson was so successful she was promoted to COO, where she came to the attention of an executive recruiter looking for someone with panache and cachet to help turn Suburban West from a bleeder into a success story.
“I’m not saying you didn’t work for what you got, Allyson. I’m just saying you were the right person for a time, and times have changed.”
“And what makes you so great, Romey? How is it you’re keeping so high afloat?”
Romey made a
tsk-tsk
noise. “Those are trade secrets, my dear. Let’s just say my board is extremely pleased with my performance because I always hit my numbers.
“Now, here’s how it is going to work, Allyson,” he continued. “You will take whatever job I tell you, and you will do whatever I tell you.”
“Please, Romey. Spare me the alpha male bravado. I can’t be played like that.”
“No? I disagree. Have a look at this.” Romey pulled a folded piece of paper out of his pocket and handed it to Allyson.
Her body shook with anger as she looked at the confidential agreement between her and the LPGA.
“If you don’t support me fully on this, Allyson, I will wait until you are fired by Suburban West—and then I’ll make sure you won’t be able to get a job selling Big Gulps at the 7-Eleven.”
Romey’s face was calm, but his interior glowed. The smell of dirty laundry always intoxicated him.
While Allyson told people she had left the tour because she wanted to pursue a career and family, the truth was far different. She had thrown several matches for a Vegas bookie who had blackmailed her with evidence of her scandalous affair with a tour director. The agreement was that if she left the tour on her own volition, the LPGA would not press charges, because they did not want the bad publicity that would result. If however, this information was ever made public, the tour would come after her personally and press criminal charges. The damages from litigation would be ruinous.
“I assume we have an agreement.”
Allyson stared at the paper.
“I would like to hear it, Allyson.”
“Yes, you prick. We have an agreement.”
“Such language. Not a good way to start off our new relationship,” said Romey, as he swung his clubs over his shoulder and sauntered back to the clubhouse.
Jordan Cobb sat at the kitchen table in the two-bedroom apartment of his next-door neighbor, Ms. Mae Walker, with an algebra book open and a sharpened number two pencil in his hand.