Chapter 8 Section VII

At nine-thirty in the evening, Malachy Ross was still in his office, sitting in a faux-leather Eames chair with a cold cup of coffee on the glass table in front of him.Next to the mug sits a tape recorder.Jeff Elliott sits opposite Ross in a swivel chair with a yellow notepad on his lap.At this moment, Rose was looking at the reporter opposite.Through floor-to-ceiling shutters, this office on the seventeenth floor can see the downtown area outside.But he didn't pay attention to the bright lights on the "North Shore" outside the building, nor the twinkling stars in the clear sky.From breakfast to now, he hasn't had any water or rice, but he still doesn't feel hungry.

They were here for about half an hour.Rose talked about his own background.How he joined Parnassus' board as a physician, essentially working to provide medical legitimacy to the company's profit-driven business decisions.It dates back to the days of the initially controversial managed care system, and Ross told Elliott that he was the initiator of the requirement that primary care physicians be assigned in hospitals, who would be the gatekeepers of what patients needed, thereby controlling medical care. The castle functions as a sort of gatekeeper.This concept has now become the standard widely adopted by health maintenance organizations across the country.

"But it wasn't a popular idea," Elliott said. Rose leaned forward in his chair, met the reporter's gaze and said, "If you give me a better route, I'll take it tomorrow. But basically, it works." "Although the patients don't accept this practice?" Ross shrugged nonchalantly. "Then let's talk about that, Mr. Elliott. It's hard to please people. I think most patients want to see the hospital perform. That's what makes them happy." He had I also want to talk about his point that people are too picky.The body is a machine, and a mechanic is someone who knows how to fix this machine when it breaks down.This so-called human factor has been greatly underestimated.But he couldn't say that to Elliott. "It's really better for the vast majority of patients."

"And why?" the reporter asked. "Doesn't that exclude people from all decision-making?" "Yes, that's a valid question, I think. I have a question for you too, even though you may not like to hear it: Why should they be involved in the decision?" He continued, blocking Elliott's response with his hand again. "It's not easy for experts who know how to keep this boat afloat, and if patients had the final say, they'd sink it financially. I'm not saying We shouldn't be keeping patients informed and involved, but..." "But people are going to demand all the expensive checks, even though they don't have to have those checks."

Rose smiled sincerely. "You're right. Healing takes time, Mr. Elliot, and you'd be surprised to be told how many health problems they cause from their own causes." After speaking, he got up and walked to the small refrigerator in the corner, took out two bottles of water from it, gave one bottle to the reporter, and then sat back in his chair. "Look," he said, leaning forward, insincerely, "I know that sounds impersonal. There's no objection to losing money on tests if patients need them. It's an insurance thing. But if fifty guys come in month after month and everyone gets the checks they want, and only five of them actually need them, then Parnassus isn't losing two $15,000 in insurance premiums, but lost $250,000. To make up for those losses, we had to raise our premiums and hitchhike $10 on prescription drugs. No one can afford that. Then the whole system breaks down and no one gets health care."

Elliott took a sip of water and said, "Let's talk about the fifty people who want the checks. What's wrong with them if it's actually ten people who need those checks instead of five?" What will happen?" "They themselves will understand what's going to happen, Mr. Elliot, sadly belatedly. No one will deny that, and I admit that it will be difficult for them to make the right choice. Personally, I would Sincerely hope that no one has to suffer any pain, that's what I've come to do as a doctor. But it's my job to not sink this ship, and at the same time, if we do all that patients want regardless of what they really need checks and we'd be sinking like a rock, that's the hard truth. No one would get any checks that way because no one could afford those checks. Do you think it's better?"

"Let me ask you a question," Elliott replied, "I've heard rumors out there that you're not paying some of your doctors. Would you mind commenting on that?" Rose's face froze all of a sudden, and he remained expressionless.Elliot knew the situation, and it alarmed and troubled him.He thinks Elliott knows who's behind it—the always-difficult Dr. Eric Kenson who took baby Emily in, and suspects that this guy has become Elliott's A source of heartbreaking stories.But all he said was, "I don't know where you heard that, it's not accurate."

This clearly pleased the reporter. "Inaccurate but true?" Ross leaned back in his chair, trying to look as relaxed as possible. "We did ask our doctors to take out a loan to the company, the extra was deducted from their retained wages, it was completely voluntary, and we have repaid the loan to those who asked for it." Jeff Elliott had sat there for over an hour listening to Malachy Ross' apology and explanation.At the moment, the medical director is talking, literally speaking, on the rationale for Parnassus' drug prescription, perhaps expecting that Jeff will turn his self-righteous nonsense into good advice for his column Go midway, to win some public support for the Parnassus group in Rose's upcoming battle with the city.

"Okay," Ross said, "let's talk about the Genesis Group developing a drug called Nocomus to treat cancer. This project started from the development of the drug before FDA certification By the time it gets to clinical trials, a billion dollar budget has gone into it. All of a sudden, it's available for cancer and everybody wants it. Patients are willing to pay. And if Genesis is going to be commercially neutral It needs to recoup its investment if it is invincible and develops other extraordinary drugs. As a result, it charges a hundred dollars on each prescription. It has been many years since Nocons has been on the market. , it's all selling well.

"But in the end another drug company came out with their own version of Nocons, perhaps with a slight twist to avoid patent issues..." "But some changes might cause side effects?" The displeasure on his face made Rose's eyelids droop. "Very little, Mr. Elliott, really, very little. Going back to the topic just now, those drugs that also treat cancer are only sold for ten dollars in order to gain market share. In response, the price of Nocons has been reduced. It's fifty dollars." "That's much higher than ten dollars, too." "That's right, once we lead people and tell them the truth, everyone will stop using Nocons and buy that cheap stuff. You can think about that, can't you?"

"Would they do that?" "Absolutely not. Probably absolutely not from a statistical point of view. Even when given the chance to choose, patients continue to choose Nocoms. It is a brand that people recognize. This is the confidence that the product itself brings to consumers .” "It's like Bayer's aspirin." "That's right!" Ross put his hands together silently, as if applauding, "so that's the point, even though it's supplying us with Nocons for over forty dollars, if we take it And put it on the drug list, then it will be sold to the patient at its usual price, which is fifty dollars, which is where the ten dollar drug ride-hailing fee comes from. So we crossed it off the list .” "Nocons?" "That's right." "But right now it's a hypothesis. You're saying it's a good thing, but you don't let your patients get it." "They can get it, but we're not going to pay for it. If we did, it would destroy us. We're doing it for the survival of the company and making a small profit. You gotta get this. Stein isn't the only drug that works. That's what I'm trying to get you to understand. The off-brand drugs work, too." Elliott himself had a very detailed knowledge of the prescriptions.He has had multiple sclerosis for more than two decades, and at the advice of his doctor, he sometimes thinks he has tried all the off-brand drugs in the world for different and changing symptoms.The situation has not changed much, but several times, at least made him suspicious of off-brand brands, because he experienced first-hand the side effects and physical discomfort caused by different drugs.But when he returned to brand-name drugs, the problem disappeared.Therefore, Ross would never sell him off-brand drugs. "So from the standpoint you've stated," Elliott said, "you see this lowering of barriers and cost reductions, from controlled treatments to generic pharmaceuticals, that you're doing with the practice that you're doing. The oath is consistent. The oath emphasizes harmlessness first and recovery second." "Basically," Ross seemed content with the statement, but Elliott knew he wouldn't last long. "We're talking about medicine, Mr. Elliott," he continued. "The goal is to benefit the people on the widest possible scale." "Is there no conflict between your commercial interests and your patients?" "Of course there is." Ross leaned back, crossed his legs comfortably, "but we try to minimize this conflict. It's just a matter of degree. The company itself needs to survive in order to continue to function. " "Also make a profit, let's not forget that. You have to make a profit, right? To please your investors?" Ross laughed, spreading his palms apologetically. "Yeah, we're not doing too well at that." "That's what I heard." Elliott moved the wheelchair forward and said in a friendly tone, "Have any of your investors expressed dissatisfaction with the salaries of your executive officers and department heads?" Ross blinked a few times, but quickly brushed the question over if he found it annoying. "Not often. Our board members are seasoned businessmen. If the pay isn't attractive, they'll look elsewhere. Good people aren't easy to find, and when you do, you have to pay a lot for it. Price." "Just this good helper, what does it do? Run a company?" "Exactly." "But you're all about to go bankrupt." It wasn't a question, but Elliott brought it up just to knock Ross off the hook. It's confusing. Isn't it?" Fisk and Bracco may have been recognized by other homicide investigators as a well-matched pair, but as human beings, it is really impossible for them to be too different from each other.What this means is that they are also police officers, but of a different kind. At five o'clock, Harlan Fisk asked his partner if he could drop him off at the Dardich, the oldest restaurant in town.Although his children and pregnant wife were waiting for his return at this time, he was going to meet his Aunt Cathy and some of her followers, and then had dinner and chat with them until midnight. Finish.He didn't invite Braco to join them, and he didn't do it on purpose to annoy Braco or embarrass him.The truth is, Fisk is a political animal, and his eyes are always on long-term political payoffs. Bracco, by contrast, is the son of a cop, and even after he was promoted to homicide, he didn't figure out how much his father's relationship with the mayor affected his career, and To what extent those ordinary people with mediocre backgrounds gritted their teeth at him.At the same time, he never asked for any special treatment, even if it was only a small matter within the scope of power.Some people in the bureau who are good at making money think that if they treat Bracco kindly, they will win the favor of the mayor and everything will be fine for them, but they are really wrong. When Fisk told Bracco that he was considering complaining to his aunt, the City Overseer, about the injustice they were being treated on the fourth floor of the police building, he talked Fisk out of it.One thing he'd learned from his father was that cops weren't the ones to cry and yell at.It will always be like this.He told Fisk that he should talk to Griski about it, ask directly and discuss the answers he gave: There was probably no element of homicide in the hit-and-run, so there was nothing to investigate. Bracco believed that to be the case, but the other thing was, how was he going to spend the rest of the time? So, after he dropped Harlan downtown, he spent hours chasing down the clues they'd collected about the vehicle during the investigation.He doesn't expect any results, but he will never know the results if he doesn't do it.He had learned from his experience dealing with vehicle hit-and-runs that, in most cases, the driver would sit around for a while until he parked the car out of sight and closed the garage door.After a month, they'll take the car to a car wash or body shop for cleaning and touch-ups, and that's when it's done. But maybe this time things will turn around and things will be different.During this period of time, they have received 11 clue calls from outside patrol police.According to the patrol report, the vehicles matching the characteristics of the vehicles involved in the accident were parked on the side of the road or in the in and out lanes of the city.Fisk hated doing this kind of investigation, but Bracco spent hours scrutinizing every clue.The kind of impact that knocked Markham into the air would leave a crash mark on an old-fashioned heavy-plate American car, and by the light of the street lights next to the driveway, the driver knew whether to back the car back and restart. Roll it once to be sure.But the result of the investigation was that none of the cars had similar traces. He didn't know why, so he wandered aimlessly in the parking garage of Portola Hospital for another half an hour, but there wasn't a dark car here.At this moment he felt like an idiot, his mind was blank, so he went back to his car and wrote some things to do tomorrow in the car in case he forgot - check the cars with bruises, don't forget those Citizens interested in tip-offs offered by city inspectors call the Hit-and-Run Investigation Unit's tip-off line -- $10,000 for providers of information that could lead to arrests and convictions. Finally, on his way home on Nineteenth Street, he stuffed himself with sandwich pies and decided to turn around and head back to Markham's waterfront place.As Griski said, he was going to start his investigation at the Markham home and keep an eye on the cars parked outside.He was a traffic cop after all, he reminded himself unpleasantly. "Do you need help?" Hearing the sound, Braco straightened up suddenly, and swept the beam of the flashlight from the hood of the white Toyota car he was inspecting, and shot it at the front seat.It was the rearmost of the twenty-three cars parked on the street facing the Markham home.Under the beam of light, an extremely tall man raised a hand to block the light, and said another sentence nervously in a high-pitched voice. "What the hell are you doing?" Braco noticed the man was putting his other free hand into the pocket of his coat, and he warned, "Stay still. Police." That was all he could think of at the moment. "Don't move." Braco didn't know whether he should flash his police badge or pull out the gun from the holster on his shoulder.He decided to take the latter approach and drew his gun to face the guy in front of him. "I'm doing business with this car." He warned again, bleeding faster, "Stay there." "I didn't move." "Okay, now slowly take your hand out of your coat pocket and put it where I can see it." "This is ridiculous." The man murmured and complied. Braco stepped forward to pat his coat, reached out and took out a mobile phone, and returned it after searching. "Listen, I'm a doctor," the man said. "A patient of mine died today and his family lived here. I just came out of his house to pay my respects when I saw someone with a flashlight checking my car. I Just trying to use my phone to call the police." After a while, Braco returned the phone to the doctor and put his gun back in the holster.If he had felt like an idiot wandering in the hospital parking lot, he was humiliated by his behavior, even though he didn't mean to show his gun. "Can you show me your ID?" The man turned his head and looked in the direction of the Markham house for a moment before turning his gaze to the investigator. "I don't understand, I..." Finally, he sighed and pulled out his wallet. "My name is Eric, Kenson. I'm the doctor on duty today in the ICU at Portola Hospital." "The place where Mr. Markham died?" "Yes, he's me... my boss, I think. Why are the police outside his house now?" Bracco revealed his true purpose of coming here. "I'm looking for the car that caused the accident." Kensen yelled impatiently: "Can I take my wallet back?" Before Braco could answer, he stuffed the wallet into his pocket, and asked unexpectedly, "Are you really Think Tim's acquaintance bumped him on purpose and came here to visit his house?" "Not really, but we'd be really stupid if we didn't take a look, wouldn't we?" "That reason sounds far-fetched to me, but if that's you guys..." He didn't finish his thought before changing the subject, "Listen, are we done? I want to leave now .My car didn't hit him. Do you see where I hit him? Do you want to double check to make sure? I interrupted you while you were doing it." The arrogant and impatient tone revealed in the man's words hit Bracco's momentum.He knows that people react in different ways to the police, but he believes that sometimes a casual reaction can reveal something unusual, perhaps a sense of guilt.Kenson was about to reach for the car door handle when Bracco realized instinctively that he was going to leave him to say something. "You said Mr. Markham was your boss? I didn't know he was a doctor too." Kenson straightened up by the car door and sighed again. "He's not. He runs the company I work for, Parnassus Health Group." "Then you know him pretty well, don't you?" The conversation paused for a moment. "That's not the case." He turned his head again, his gaze passed over Bracco's shoulder, and landed on the Markham's house, "If our business is over, now..." "What's in the house?" Braco asked without waiting for him to finish. "What do you mean? Nothing." "You keep looking back at it." "Did I?" He shrugged noncommittally. "I didn't realize it. I guess I was worried about them. It's such a tragedy that they're out there grieving." Bracco picked up a post-it, which may have been asking for guilt, but there may be additional gains.If he managed to get the right tone, he could turn his question into an interrogation. "I thought you said you didn't know him well." "yes." "But you're still worried about his family?" "Do you think there's anything wrong with this? I've already answered this question before. It's not a sin to care about a victim's family." Kenson raised a hand and swung it heavily in front of his forehead, quickly The street glanced around, "Officer, do we have to dig into this issue to find out what I've missed?" Bracco didn't answer that, instead, he asked his own question: "So, you don't have any deep friendship with him?" The doctor turned his head aside and said, "What do you mean? As a boss?" "No matter how you look at it." This time the doctor was silent for a long time before speaking again. "Officer, can you give me your name if you don't mind? I want to know who I'm talking to." "Bracco, Detective Darrell Braco, of the Homicide Squad." As soon as the words came out of his mouth, Bracco knew that he had made a mistake.Kenson jumped up in shock. "The homicide squad?" "Yes, sir." "So you're investigating Tim's death? Why? Does anyone think he was murdered?" "A hit-and-run vehicle doesn't have to be a homicide. It's just routine." "Routine? Check the car that came to his house?" "Yeah. You just called him Tim." "And what does that mean? His name is Tim." "You don't know him very well, but you still only call him by his first name?" Kenson shook his head wordlessly.Later, he let out a long breath. "Look, Detective, I don't know what to say. This man died in my department today in my care. I've known him for fifteen years, and I'm here to pay his respects. Further condolences from wife and family. It's almost ten o'clock. I was up at six o'clock in the morning and I was dying of exhaustion by this time. I don't understand what else it means to call this man by his first name, and if If you don't mind, you can call me again tomorrow morning. If you make an appointment in advance, I will be very happy to talk with you in the hospital." Bracco realized that perhaps he had taken his so-called interrogation too far.What Kenson said, both in tune and out of tune, are very humane, there is really no need to bother this well-behaved doctor at this moment, in fact, he has already taken the initiative to open the way for tomorrow's interview Door.The detective knew that he had gone too far and couldn't go any further. "You're right, but I may have to call you back in a few days." "That's fine," Kenson said, "I'm not going anywhere." The two of them stood on the street in relative silence for a while before Braco said goodbye to Kenson and headed for the house in Markham.Griski had told him to start with his family, and he might discover something, get some valuable first-hand information.But before he took two steps, he heard Kenson's voice coming from behind him again. "You're not going to the house, are you?" He stopped and said over his shoulder, "I think I'll go." The doctor hesitated, seemingly debating whether to say anything more.Finally he said aloud: "Well, then, you do what you want, Agent, but you might consider leaving them alone tonight and coming back tomorrow. They've had bad enough today, Everyone is devastated. I guarantee that none of them were behind the wreck you're looking for. Is there anything you can't wait to ask them?" Bracco is a little sleepy even now.He turned to look at the house in Markham. The lights were still on.He needed to find something to do with Tim Markham's death to prove his worth to Grisky, so he pressed ahead with his work.He had made some illusions about the case and had questioned Kenson wrongly, right here, right now. Talking to Markham's family face-to-face, when he hadn't planned anything in advance and really didn't know what to ask, would surely make the same mistake.He should have left them alone, exhausted and grief-stricken.Things might get better tomorrow. Bracco nodded and said, "Good reminder, but you and I should talk again as soon as possible." "I'm looking forward to it." Kenson replied, reaching out and opening the car door.