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The Great Chest Tube Mystery
And here’s what a fool I had been, here’s how naïve I was:
A few weeks after receiving Dr. Steven Knapp’s letter assuring us of the impeccable academic standards at the Johns Hopkins University, we received another set of Pam’s medical records from the hospital. It was a complete set. In fact it was the most complete set we’d received so far.
It took me a while to figure out how hospitals deal with unruly patients. If you ask for records while your loved on is still in the hospital, that fact is noted in the patient’s chart. That’s when they hunker down and start being very careful about what they say and what they write. Then they will mete out the victim’s records as slowly as possible. It is part of the overall strategy of delay, to wear the enemy down, or just plain outlive them.
Thus my requests for Pam’s complete medical record yielded meager results at first. I asked for a complete set of records in January of 2003. They sent what they said what was the entire record, 302 pages, in August.
By 2005, I had them up to about 500 pages. Pam being a nurse, we knew with each delivery of the “entire record” that certain things were still missing. She was especially curious as to why there was a certain scar on the side of her chest. She knew it came from insertion of a chest tube, as for draining fluids, but she could find no mention of it in the charts.
I contacted the The Maryland State Attorney’s office, which sent Hopkins a letter reminding them that there were, after all, rules about such things, and a patient was entitled to her records. That’s when Hopkins coughed up 735 pages and an affidavit swearing up and down that that was everything. It was two years after my first request. Pam could find nothing about a chest tube insertion, but I told her that I thought the chest tube scar wasn’t that important to the case. Let it go, I told her.
But Pam would not let it go. Months later, she sent for another copy of the complete record, and in July of 2006 a smiling FedEx man came to my door and handed me a box containing 742 pages. The new material included a three page document from Hugh Calkins labeled “Note to the Medical Chart.” Dated May, 2002, it was written at the direction of Hopkins’s in-house lawyer, a cranky guy named Rick Kidwell. As per the protocol, Kidwell had been notified that someone was grousing about their care and asking for medical records after some unpleasantness down in the EP Lab. He rang up Calkins to ask for a memo. This memo was to be written so as to cast the institution and its staff in a certain light regarding the affair.
And Calkins generally did a masterful job.
If the events had unfolded the way he described, there would be little room for complaint from patient Pam Walter; a malcontent, a sore loser who was upset at a bad outcome. But he made a couple of big mistakes that wound up defeating the purpose. Since the letter was meant to be a privileged communication between attorney and physician, it should have been addressed to Rick Kidwell and delivered to his office. But Calkins dictated it to his secretary as a note to the medical chart and had her fax a copy to the house attorney. He kept the letter in his office, close to his vest, for four years. But when Pam asked for another copy of the entire chart out of the blue—and after the statute of limitations for a malpractice action had passed—someone in his office finally complied with the request.
So it happened that one day in July 2006, I sat cross-legged in a sea of papers in the middle of our living room floor, reading a very well done CYA memo. And at the very end of the memo Calkins writes this: “I should note here that Dr. Richard Wu was manipulating the catheter at the time it became entrapped in the mitral valve.”
And I was innocent enough, when I finally found out that Hugh Calkins had not done the job, to think that if I called Richard Wu and asked him to explain that he’d never met my wife, if I asked him just tell the truth, that he would do it.
