Page 89 of I’ll Be Watching You

“How?” she asked.

“The medical records department are the only ones who can actually delete anything of importance. Some nurses, like the charge nurse or a nurse in the IT division, can delete something added in error, or an encounter that was coded wrong, things like that, but only the medical records department can delete anything permanently. Still, if the entire record was deleted, there would still be a note in the system and, theoretically, the chart can be rebuilt using archived data. But if a patient’s record is merged with another patient, then it’s as if that first patient doesn’t exist at all in the system.”

“Why would anyone do that?” Nate asked.

“Take Mr. Novak. His name is James Charles Novak. That’s on all his official records, that’s the name he enlisted under, it’s the name we’re going to have for him, though we might include a nickname of ‘Jim.’ But maybe he goes to a clinic after he separates from the Navy and he’s having issues like he had last night, and tells the nurse he’s Jim. Doesn’t give his full name, is uncommunicative. She’ll create a record for Jim Novak, and later medical records or the charge nurse will do research and based on a variety of data, hopefully find his actual medical records. This new encounter with ‘Jim’ would be merged with his official records and ‘Jim’ would cease to exist in the system.”

“Is there an approval process?” Nate asked. “I know in the military, redundancy is built into the system and you don’t do anything without orders.”

“No, not that I know of, but not anyone can merge records. Only the medical records office, and I can’t see why they would do it without a reason.”

Lu knew the reason: money. If someone unscrupulous worked in the medical records department, they might have been bribed to merge records to “delete” Jim Novak.

“Can we find out what records have been merged in the last week?” she asked.

“That’s very specific,” Peggy said.

The nurse was getting suspicious, and Nate said, “On Monday, we know that Jim went to the VA hospital and met with a nurse practitioner, Liz Swanson. She called our firm because she was suspicious that something odd had happened to his medical file. She said specifically that a year in his chart was missing. She suspected someone deleted the encounters, because she saw there was a hole, or a note that wasn’t attached to a specific encounter.”

Luisa was surprised at how easily Nate picked up the nurse’s own jargon. She tried not to be impressed.

Nate continued. “She went back to research the file at the end of the day, and it was gone. She had just seen the patient. What would she do at that point?”

“Call Medical Records with an IT request,” the nurse said automatically.

Lu knew in her gut that was exactly what happened. She called Medical Records and that was why someone knew she was looking at Jim Novak’s file.

They were covering their ass. They’d killed two people to cover their ass.

She was angry.

“Can you explain the merge process?” Lu asked. “Like, do they need a similar patient file? Or can they merge with anyone?”

“Well, technically, they can merge with anyone, but there would be a lot of red flags if a forty-year-old male was merged with a seventy-year-old female.”

“If you were going to merge records because you wanted to hide a patient’s file, how would you do that?”

At first, Peggy didn’t want to answer, but Nate said, “It would really help us out, and help Jim.”

She softened. “Well, I don’t spend a lot of time thinking about ways to get around the system, but if I wanted to make a record disappear as completely as possible, I would merge it with a recently deceased individual with the same basic characteristics as the patient so that there would be no red flags during an audit.”

“And what would that look like in the system?” Nate pressed.

“All the encounters for the two patients would be on one record. The patient who is merged into the deceased record would, for all intents and purposes, cease to exist. His name, address, birth date, would be converted to the original record, but there would be a list of encounters with him merged with the records of the deceased. It would be near impossible to know which encounter was for which individual, even if you were able to find out the records used.”

“And it can’t be done accidentally?” Nate asked.

“Absolutely not.”

“And only someone in Medical Records can do this?” Luisa confirmed.

“Yes.

“This is very helpful,” Nate said. “Thank you. We’ll be back tomorrow to talk to Jim.”

They walked out.

“Medical Records,” Lu said. “You drive—I need my computer.”