Act of Darkness(46)
“Well, there was a rider to a bill that came up around that time, a Medicaid funding thing about prescription drugs. It would have prevented Medicaid from paying for any prescriptions that weren’t handled through a full-fledged M.D., no matter what those prescriptions were—”
“I thought that was the definition of a prescription drug,” Gregor said, “a drug that can only be obtained on doctors’ orders.”
“Mostly that’s true. But there’s a gray area, a whole line of drugs that have emergency uses or that can be prescribed by nurse practitioners. And that’s the point. The rider would have made it impossible for nurse practitioners to prescribe drugs they’ve been prescribing for many years, these sort of low-level prescriptive drugs, and have them paid for by the government. The rider was Dr. Debrett’s idea.”
“Are you sure?”
Clare shrugged. “Dr. Debrett’s or theirs.” She waved her hand in the direction of Stephen Fox and Dan Chester, taking in Patchen and Bennis in the process, although she didn’t mean to. “Senator Fox brought the rider to the floor.”
“So what?” Dan Chester said. “It was a damn good rider, and you know it. It only made sense. Considering what happened later—”
Clare smiled a stiff December smile. “It’s what happened later I’m talking about. The rider didn’t pass, by the way, Mr. Demarkian, but it almost did. Have you ever heard of a woman named Caroline Bell?”
“No,” Gregor said.
“Well, maybe the news wasn’t as big outside Washington as it was in. Or maybe you had your mind on other things. Caroline Bell was a nurse practitioner in one of those free clinics that operate in storefronts in the poorer parts of Washington. One of those places where they do birth control and prenatal work and that sort of thing. She had a patient named Debra Tescowitz—”
“I remember Debra Tescowitz,” Gregor said. “She was a—”
“Sort of a poster girl for homeless people,” Bennis said.
“You could call it that.” Clare nodded. “She had three children and then her husband left her, just got himself a no-fault divorce and disappeared. He took all the money with him—they hadn’t been rich, but they hadn’t been poor—and then just didn’t bother to pay her any support. She ended up in a shelter with all three children in tow. Some reporter from the Post found out about her and talked his editor into putting her on the front page. Whatever. She used Caroline Bell’s clinic, and one day she went in for a refill on some blood pressure medication she was taking. It’s not legal, but the nurse practitioners in these clinics write a lot of prescriptions like that, refills, where they’ve already talked to a doctor and know the refill would be automatic anyway unless the patient reported problems. Quite frankly, if they didn’t do that, those clinics would be financially impossible. So Debra came in and got her refill prescription. Then she went over to the Debrett Clinic—”
“How could she have done that?” Gregor asked. I thought Dr. Debrett’s services were—expensive.”
“They’re unconscionable,” Victoria Harte said. “Even the insurance companies refuse to pay the total bill.”
“Kevin had taken on Debra’s youngest daughter as a charity case,” Clare Markey plowed on, “after all the publicity came out. It got him a lot of publicity, too, of course. It was very good for his image. Anyway, she went there, and her daughter did her motor coordination therapy for the day, and then she left. She went straight to a pharmacy on Avenue C and had her prescription filled. She was dead less than twenty-four hours later.”
“Of what?” Gregor said.
“A stroke. It was the wrong prescription. Instead of being medicine to lower blood pressure, it was the kind that raised it in patients who have problems after surgery and that sort of thing. If she’d gone to a pharmacy where they knew her, it would never have happened. But she didn’t have a pharmacy that knew her. She hadn’t had a permanent address in three years.”
“They were sure it was the prescription that was wrong and not a mistake on the part of the pharmacy?” Gregor said.
“Absolutely. They got hold of the prescription. Caroline Bell lost her nurse practitioner’s license—she would have lost that even if Debra Tescowitz hadn’t died. After all, she wasn’t supposed to be prescribing that particular kind of drug under any circumstances. It was all over the papers. And all over the television news, too. And Congress got a lot of pressure to pass that rider, of course. They almost did it. And in the meantime—”