Homeland Elegies(94)
Here’s the Thom Powell part: Dumachas’s patients were now Chiroh customers; Chiroh owned this problem. For a publicly traded company, disclosure of such an indefensible travesty would have wiped out the stock price, to say nothing of the potential billions in settlements the company would owe if it somehow survived that initial hit. It was of paramount importance to Chiroh that no word of Dumachas’s crimes got out.
Powell was a corporate generalist—a tax lawyer who’d found his way to litigation and later into administration by way of business school. He’d managed operations and logistics for a cable company in Tennessee and helped steer a multistate food services operation through bankruptcy before going to Chiroh to work in risk management. Here was the strategy Powell developed to manage the crisis: An unexpected round of layoffs was announced, a position or two from every level of the organization, including doctors; this was the shot across the bow intended to sow fear and set the stage for later compliance. Separately, Rex Dumachas was quietly offered a generous severance, contingent on his leaving the profession for good. (The last thing Chiroh wanted was for him to start up with his shenanigans somewhere else, get discovered, and have the trail lead back to them.) As another condition of his severance, Dumachas furnished a list of everyone in the organization he knew to be aware of his conduct. Not only were these employees not fired; to a person, they were also offered signing bonuses on contract extensions—but only after signing ironclad NDAs. In short, Dumachas retired early in Arizona, and those aware of the harm he’d done to his patients were rewarded for their silence. The crisis was managed; the stock price continued to rise; Powell got a promotion. It was shortly after all this that Reliant Health poached Powell away, and it was during the Powell years that Reliant grew into the juggernaut that would purchase Father’s group and eventually go public.
Father learned of the Dumachas crisis from an enemy Powell had at Reliant, a fellow administrator worried about—what else!—his job. At that point, there was no love lost between Father and Powell, and the tattling administrator was trying to shore up support for his own position with doctors in the group. In Father, he found a sympathetic ear, for though Father had been an early advocate of being bought out by Reliant, it hadn’t taken him long to change his mind. Powell ran the company the way he’d handled the crisis at Chiroh: with ruthless focus on the twin corporate values of increasing share price and limiting liability. Medical care was almost an afterthought. And yes, Father had dealt with corporate, nonmedically trained administrators his whole career, but Powell and his crew were different. This was a new breed he saw coming into the profession: the in-house counsel elevated to decision maker, the bean counter ennobled by an MBA, the resident financial functionary whose contributions to staff meetings included advice on ways for employees to help the company avoid excessive tax depreciation on fixed assets. These were corporate zealots—“fanatics of the data” was Father’s coinage—as fixated on spreadsheets as he thought they should have expected doctors to be on patients, but it was clear that patients, like stationery expenses, were just another line item. “Quality care”—like the company’s name itself—was just copy, an advertising slogan to be plastered across the billboards and brochures that showed multicultural, multigenerational families smiling at sun-soaked kitchen tables.
Now, Father had been complaining about Powell and the corporate medical model for years, and I’d long since concluded—ungraciously—that his problems were mostly about his ego. After all, he’d been the group leader before the corporate buyout, and now he was just another employee. He had taken the money; what did he expect? But hearing him unload about Powell on the way to Wonewoc, I started to see a different picture, a bigger picture, one that showed him in a more generous light and began to make new sense of his plight in that La Crosse courtroom. He’d insisted on doing the job as he believed it should be done. If patients everywhere were more and more discontent, it was—he thought—because doctors like him had ceded autonomy to managers like Powell, who apparently didn’t care, fundamentally, whether their patients lived or died—as long as the company wasn’t sued.
As we rolled off the dirt road and onto the asphalt byway that led into town, I asked why he hadn’t gone public with what he knew about Dumachas and Powell’s cover-up. “It was leverage,” he said with an evident hint of defensiveness. “I wanted to make things better for us, the doctors. So we could do our job.”
“But what about all those patients?”
“It’s terrible.”
“But I’m guessing they still don’t even know what happened to them.”
“How could they?”
“Didn’t you think they deserved to know?”
“You think I should’ve told them? How?”
“I don’t know. Talk to a journalist. The authorities. Somebody.”
“With what evidence? Patient records are private. Everybody signed nondisclosures.”
“There’s ways around that stuff. Subpoenas, litigation. Whistle-blowing.”
“—Subpoena? From who?”
“I don’t know, Dad. A grand jury, I suppose.”
He glared at me with visible disgust: “I start creating that kind of trouble? Powell would have buried me. Buried. Who benefits from that?”