Chapter 39 — Ohio State Medical Licensing Board

_August 23, 1989, Columbus, Ohio_

{psc} After lunch on Wednesday, I took Rachel to stay with her aunt, then drove to Columbus to meet Tom Kirkland in advance of the hearing later in the afternoon. I met him at a coffee shop down the street from the Medical Licensing Board offices on East Broad street.

"I think they're going to come at you hard," Mr. Kirkland said. "From their perspective, you're the most dangerous witness, so they're going to do everything they can to put your future at risk."

"Why me, rather than Doctor Mercer?"

"They can't hurt her; they _can_ hurt you. You'll come before the board for your license and they're going to try to poison the well."

"I'm not going to run away."

"I was positive that was true, or I wouldn't have listed you as a witness. For you to withdraw would strengthen their position,. The key to surviving this is not falling for any of their traps. No matter what they ask, or how they ask it, you're testifying as Angie's friend, not as a doctor. I'll emphasize that all of this occurred before you graduated from medical school."

"So how do you want me to answer."

"All you need to do is corroborate what Doctor Mercer and Mrs. Stephens say. Don't let Doctor Greenberg's attorney lead you off that path. No matter how you think the hearing is going, it will go worse if you deviate. Our argument is simple — Angie had a clear picture of the future, had put together a long-term plan, and was implementing it. When Doctor Greenberg became aware of that plan, he acted contrary to best practices. But remember, YOU can't say that last part."

"Understood."

"Then let's go."

We left the coffee shop and walked down the sidewalk to the building, which housed the medical licensing board. Mr. Kirkland gave our names, and we were directed to the hearing room, where Lara and Clarissa were waiting. I also saw Doctor Mercer, and to my surprise, Doctor Lawson.

"That's the Psych Chief from my hospital," I said quietly to Mr. Kirkland. "We need to talk."

"We have a few minutes, let's step out into the hallway."

We did and moved a short distance from the door to the hearing room.

"He's not on the witness list," Mr. Kirkland said. "But the board will probably allow it. What's he going to say?"

"He'll likely describe an incident with a mentally ill patient who I treated. I felt the best approach was to humor him, and I was having success. The Psych Resident rejected my plan and that resulted in an agitated patient who had to be medicated. He'll say I'm a cowboy, or something similar. On the flip side, he threatened my career if I testified today."

"Will you say that on the stand?"

"If he tries to assassinate my character, yes."

"I'll make a judgment on whether we need to raise the issue or not. You answer my questions, and you don't go beyond where I lead you."

"OK."

We returned to the hearing room, and I sat down next to Clarissa, noting that Mr. and Mrs. Stephens had arrived, as had Doctor Underwood, who had first treated Angie when we were at Taft.

"You OK?" she asked quietly.

"I'm not going to be intimidated."

"Good."

"Uh-oh," I said as Doctor Paul Forth walked into the room.

I got up and moved to where Mr. Kirkland was sitting.

"That's Doctor Paul Forth," I said. "He and I had in-depth conversations about Angie."

"What can he say that will hurt us?"

"That, at the time, I agreed Doctor Greenberg made a clinical decision based on the usual standard of care. My response was more nuanced, but that's how he'll spin it."

"He's also not on the witness list," Mr. Kirkland said. "When was that conversation?"

"During my Third Year, sometime in March last year."

"That might actually work in our favor. One late addition would probably be allowed, as I said. But given the conversations weren't in the last few weeks, these are not 'unavoidable circumstances'. Thanks for letting me know."

I returned to my seat just as the members of the Review Board entered the room. They all took seats at a long table in front of the room, and the Chairman banged his gavel to call the meeting to order.

"In the matter of Doctor Jules Greenberg," the Chairman, Doctor Brewer, announced.

The five-member panel was introduced, all of whom were active, practicing physicians, none of whom were psychiatrists. I wasn't sure if that was a good thing or a bad thing.

"Is counsel for the complainant here?"

"Tom Kirkwood on behalf of Mrs. Joanna Stephens, natural guardian of Angela Marie Stephens, and Laura Bragg, next friend of Angela Marie Stephens."

"And counsel for Doctor Greenberg?"

"Arthur Braun, of Volstead and Braun representing Doctor Greenburg. With me is my colleague, Evan Miller."

"We've all read the complaint. Mr. Kirkwood, you may begin."

"Doctor Brewer and members of the committee. The matter before you is straightforward. I will present witness and expert testimony that Doctor Greenberg callously disregarded clear contraindications to his treatment of Miss Stephens. May I call my first witness?"

"You may."

"I call Doctor Michael Peter Loucks."

I got up and moved to a chair that Mr. Kirkwood indicated.

"Doctor, would you raise your right hand, please?" Doctor Brewer asked.

"Doctor, I request my right to affirm rather than swear."

"Do you affirm that the testimony you give before this committee will, to the best of your knowledge, be true and accurate."

"I do."

"Mr. Kirkwood?"

He had me state my name, address, and current employment.

"Mr. Chairman, despite his recent graduation from medical school, Mr. Loucks is not testifying as a physician, but as close friend to Miss Stephens, to events that occurred before he completed medical school. As such, he is not providing medical judgment, and I ask that he be treated as a layman for the purposes of this hearing."

"Mr. Braun?"

"_Doctor_ Loucks is a physician, and is subject to the rules of this committee, including discipline for any statements he might make. I ask the committee to take official notice that he is a practicing physician."

"Mr. Kirkwood?"

"None of the events which occurred, nor any statements made about Miss Stephens to anyone, occurred or were made as an MD. In fact, many of them were made before Doctor Loucks even entered medical school, and the majority of them before he entered his clinical rotations. There is no witness that Mr. Braun can call, and no evidence that he can present, which shows any statements about Miss Stephens made _as a physician_. No testimony given today will cover any events which occurred after May 25th, 1989, the date of the McKinley Medical School graduation."

The Chairman turned off the microphones and consulted with the doctor on either side of him, who each asked the doctors on the end of the table, with the answers communicated in voices too low for any of us to hear.

"The committee will consider any statements made by Doctor Loucks about events before May 25th to be those of a layman. Doctor Loucks, I caution you to keep your answers factual, and not diagnostic, or this decision may be reconsidered."

"Yes, Mr. Chairman," I acknowledged.

"Is it OK to call you Mike?" Mr. Kirkwood asked.

"Yes."

"Mike, would you describe your relationship with Miss Stephens, beginning with when you first met her?"

I spent fifteen minutes describing how I'd met Angie, how our relationship had progressed, and the series of incidents which had led to her being diagnosed with schizophrenia.

"What happened after that?"

I described marrying Elizaveta, our friendship with Angie, then Elizaveta's death, and how Angie had changed.

"You observed Miss Stephens making long-term plans, with specific goals, and then executing those plans?"

"I did."

"Did you have an occasion to discuss her actions with her?"

"Yes."

"What were those interactions?" Mr. Kirkwood asked.

"When she first put her plan into action, she stopped taking her medication. She confided in me that she had done so, and I insisted that she adhere to the treatment plan established by Doctor Greenberg and Doctor Mercer, a clinical psychologist, and that she discuss the situation with Doctor Mercer."

"Did she comply?"

"To the best of my knowledge, yes."

"What happened next?" Mr. Kirkwood asked.

"She confided to her priest, outside of confession, that her goal was not just her driving license, but marriage to me. Because of direction from our bishop, her priest notified Doctor Mercer about Angie's statements. Doctor Mercer communicated those to Doctor Greenberg. The next thing I knew, Angie was in the hospital under sedation."

"Then what?"

"Her care was moved from Doctor Greenberg to Doctor Hoffman. Doctor Greenberg challenged that move, but was unsuccessful."

"As Miss Stephens's closest friend, what can you say about her behavior just prior to her final meeting with Doctor Greenberg?"

"That she was very much like the Angie I met at Taft in late 1981 — a normal, but quirky eighteen-year-old. I and my closest friends were all quirky, so she fit right in. In other words, Angie was, in layman's terms, back to normal. She was working, taking classes, practicing Aikido, and going to church. She knew what she wanted, and she was, within the restrictions placed on her by the State of Ohio, taking steps to accomplish her goals."

"When did things change?" Mr. Kirkland asked.

"December 1987, after the communication from Angie's priest."

"And how is Angie now?"

"Similar to how she was after her diagnosis."

I wanted to add 'due to medication', but I had to be VERY careful about that.

"Which means?"

"Barely able to care for herself and unable to work."

"And that changed in December 1987, after her intentions were communicated to her doctors?"

"Yes."

"Thank you. I have no further questions of this witness, Mr. Chairman."

"Mr. Braun?"

"Good morning, Doctor Loucks. It's good to see you again."

I'd expected that, so I was ready to tell a 'little white lie' of social convention, despite being under oath.

"And you as well," I replied.

I made sure to keep my tone light, but all I could think of was that I now fully understood what the Holy Apostle Paul meant by a 'thorn in his side', and it did not appear that God would remove this particular thorn any time soon.

"_Doctor_," he said, emphasizing the word, "did you have occasion to speak to Doctor Paul Forth and Doctor William Lawson about Miss Stephens?"

"Objection, Mr. Chairman," Mr. Kirkland said.

"On what grounds?" Doctor Brewer inquired.

"Both doctors are employed at Moore Memorial, a teaching hospital, and any conversations were of a didactic nature. Medical students are not only requested, but instructed to ask wide-ranging questions and explore non-traditional responses with the aim of education. To attempt, years later, to hold a medical student accountable for questions he or she asked would do a grave disservice to medical training.

"I will also point out that neither Doctor Forth nor Doctor Lawson appear on the witness list submitted by Mr. Braun. The fact that he led with that question indicates an attempt to sway the committee to allow him to sandbag both Doctor Loucks and Miss Stephens' guardian and next friend by relying on what amounts to trickery to bring in their testimony without depositions or interviews."

"Mr. Braun?"

"It's a legitimate question that will show that _Doctor_ Loucks admitted that the actions of Doctor Greenberg were warranted and justified by the standard of care."

And he'd managed to get the testimony in, even if his witnesses were disallowed, which I had to tip my hat to, despite feeling the thorn dig deeper into my side.

"The questions and speculations of a medical student during clinical rotations," Mr. Kirkland countered, "are not only privileged but also, as I said, an expected, even required, part of medical training. I'm going to raise my objections now to Mr. Braun calling those two physicians who do not appear on any witness list, nor are their names listed in any responses by Mr. Braun on behalf of Doctor Greenberg."

"Doctor Loucks," Doctor Brewer said, "these conversations, were they diagnostic in nature?"

"Yes, Doctor," I replied.

"Then I'm not going to allow this line of questioning. Mr. Braun, you may continue."

"But, Mr. Chairman…"

Doctor Brewer held up his hand, "Mr. Braun, would you like to be called before the Bar and have every word uttered in law school examined to see if you might have said something which was legally in error and have that used to disbar you for unlicensed practice of law?"

"No, but…"

"I'd say that answers my question. Do you have further questions?"

He frowned, but I knew that wasn't the end of it.

"_Doctor_ Loucks," he said.

"Excuse me," I interrupted, "but we all know I'm a doctor as of May 25th. You can say the word without emphasizing it every time."

I was hoping he'd say something to the Chairman about me being uncooperative or whatever, but to his credit, he didn't, and continued.

"You testified that you advised Miss Stephens about proper use of her medication, did you not?"

"Not," I replied. "I advised her to follow the directions of her physician, which I was required to do by my oath as a medical student."

"Did you or did you not instruct her to take medication?"

"I instructed her to follow the prescription she had been provided by her treating physician. I also instructed her to report her non-compliance to Doctor Mercer, again, as I was required to do by my oath as a medical student to not practice medicine in any way."

"Did you communicate with Doctor Fran Mercer about Miss Stephens' treatment?"

And this line of questioning didn't fall under medical training, so there was no way I'd be able to avoid answering.

"I did, at her invitation."

"And in the course of those conversations, did you object to Miss Stephens' treatment program?"

"I did, and sometimes quite insistently, to a clinical psychologist, who is not an MD, who asked my views."

"When did those conversations take place?"

"After Angie was hospitalized."

"Never before?"

"Before that, Doctor Mercer provided advice on how my deceased wife and I could best support Angie and her parents. I also saw Doctor Mercer for pre-marital counseling."

And for Liz's situation, but I wasn't going to bring that up.

"What specifically did you say?"

"What I've said here — Angie had shown self-awareness, was making detailed, long-term plans, and was taking the steps to achieve them."

"Did you claim Doctor Greenberg had committed malpractice?"

"Yes, and that was borne out by the settlement reached by his insurance company."

"No liability was admitted," Mr. Braun said quickly. "And that is not relevant because it was settled."

"You brought up malpractice," I said with a grin. "I simply noted what occurred."

"Did you, at any point, propose a treatment plan for Miss Stephens?"

"No. I pointed out the negative outcome and expressed my belief that Angie's behavior was not properly taken into account."

"So you made a diagnosis?"

"No, I reported observed behavior to Doctor Mercer and pointed out to her that it had, in my opinion, not been taken properly into account."

"You obviously felt Doctor Greenberg was wrong. What would you have done differently?"

"It wasn't my place to make that decision," I said.

"I'm asking what you would have done had it been up to you?"

"And that's a question I cannot answer. I wasn't aware of Doctor Greenberg's actions until after the fact. All I can say is that inside of twenty-four hours after her statement to her priest, she went from working, caring for herself, practicing Aikido, and being able to carry on normal conversations, to being medicated in the hospital. At that point, there was nothing _to do_, except hope for recovery."

"You're saying you never proposed a course of treatment, nor gave an opinion on how to proceed?"

"Never. All my comments to Doctor Mercer, and to the doctors who helped train me, were all after the fact, and thus, purely hypothetical, similar to case studies."

"Did you have an affair with Miss Stephens?"

"Angie and I spent a lot of time together, but we were never a couple, and beyond a single kiss during Freshman year at Taft, there was no intimate behavior."

"Isn't it true that the other residents of your dorm called her 'Mrs. Loucks'?"

"Yes, that's true."

"And you would have us believe that there was no intimate behavior when the average person would assume a married couple was engaging in intimate behavior?"

"They called her that because, as my sister put it, Angie and I went to church together, prayed together, ran together, practiced karate together, and acted as if we were married, minus sex. My friend and colleague, Clarissa Saunders, made the same observation. I offered, at one point, to get engaged, reserving sexual intimacy for after our marriage, and Angie couldn't even take that step."

"But you wanted to have sex with her?"

"As a college Freshman with strong feelings for a pretty red-haired girl with green eyes, absolutely. But her reaction to that solitary kiss changed everything, and as I said, I set that desire aside because of her reaction."

"And after you lost your wife?"

"Angie was a ward of the state, and was declared incompetent, and as such, could not consent. One of her goals, before she was hospitalized, was to get her driving license, which she saw as her first step to have her found competent, and then to marry and have children. She clearly expressed that to me before she said it to her priest. I made it clear that she had to take one step at a time, and that no promises could be made."

"So you gave her advice on how to overcome the state's determination of incompetency?"

"I did, in the sense that I referred her to an attorney who specializes in such things and advised her to follow his instructions. I defer to professionals, Mr. Braun. I never once took matters into my own hands."

"Does that include treating patients in ways that go counter to the instructions of Attending physicians?"

"Objection," Mr. Kirkland said. "First, Doctor Loucks cannot discuss any patients without their consent or an order from this board for a review of records. Second, any such incident, if it occurred, would have occurred after May 25th, and is not relevant to this inquiry."

"I think I'd like to hear it," Doctor Brewer said. "Doctor Loucks?"

"If Mr. Braun will specify the case to which he is referring, I'll answer in a way that protects patient privacy."

"Mr. Braun?" Doctor Brewer inquired.

"Specifically, a patient with delusions who you chose to treat outside protocols."

"Well," I said, "as an Intern in trauma surgery, I'm subject to the policies of the Emergency Department, which I didn't violate. I did make a suggestion to the Psych resident about a preferred way forward, but they rejected that suggestion."

"Doctor Loucks, would you be more specific, please?" Doctor Nelson, one of the other Board members requested.

"A patient came into the ED complaining his body had been infested by aliens. Upon exam, he stated that aliens had inserted tracking probes into his brain via his nasal passages. He had wrapped aluminum foil around his head to block the signals. In order to be able to perform a primary exam, I explained that I'd leave the foil in place, and once I'd completed my exams and run appropriate tests, I'd call the hospital's alien expert."

There was laughter in the room from everyone except Doctor Greenberg, Doctor Lawson, and Mr. Braun. Even Doctor Forth laughed.

"The patient expressed surprise that I believed him, and I stated that I needed to take him seriously so I could treat him. He asked if the alien expert was a secret, knowing we were a government, that is county, hospital, and compared it to the alien spacecraft and bodies housed at Wright-Patterson Air Force Base in Dayton."

"Allegedly housed, right?" Doctor Wilson, the only female on the Board inquired.

"Of course," I chuckled. "But the point is, Hangar 18 in Area B _is_ rumored to have those things, and not everyone who believes that, or the rumors about Area 51, is diagnosable mentally ill. I put them in the same general category as people who believe Erich von Däniken's theories that extraterrestrials influenced modern technology. It's quirky, but not necessarily a sign of mental illness.

"That said, I was reasonably sure he either was suffering from a mental illness or perhaps had a tumor, be under the influence of mind-altering drugs, or have some other condition which might cause paranoid delusions. I ordered a CBC, CHem-20, glucose panel, and a tox screen.

"He protested about the tox screen, saying he wasn't on drugs and I suggested the aliens might have injected him with something. He accepted that, saying they were crafty, and complied with the exam and blood draws. He was completely compliant, calm, awake, and oriented times three. My nurse observed that I'd been unconventional, but that it had worked because the patient was calm.

"At that point, I presented my plan to the Chief Attending, Doctor Loretta Gibbs, who asked questions, suggested that Psych was going to be unhappy that I'd humored him. but agreed I'd done no harm, and probably some good. She reviewed my plan and signed the chart."

"So you had a signed chart from your Attending, which reflected your actions and approved your plan?" Doctor Brewer asked.

"Yes. The chart, if you were to request it, would show my notes about humoring the patient with the goal of completing the exam and obtaining test results. When I received the results, I discussed them with the patient. Literally nothing was outside normal parameters. The patient proposed that was because the aliens were using technology we could not detect. As a fan of _Star Trek_, I agreed an advanced alien race could certainly do that. At that point, I informed the patient I was calling a specialist to see him."

"Meaning Psych, right?" Doctor Brewer asked.

"Yes. I assumed, and that assumption was borne out later, that the patient would not react well to a psych consult. The on-call Psych Resident came down, I presented the case outside the room so I could explain my somewhat unconventional approach. I noted that I had followed all ED protocols with regard to H&P, then suggested that because the patient was calm and cooperative, the Psych Resident should continue the kabuki play.

"The Psych Resident objected, saying that wasn't protocol. I replied that my goal was to provide the best possible care, and if that meant going along with his hallucinations and delusions in the short term, I felt that was the best course of action. The Resident made it clear that their Attending would not agree, then expressed frustration that the ED Chief Attending had signed off on my approach.

"I countered that we had a docile, cooperative patient who believed we were going to help him, as opposed to one who thought we were in league with his enemies. The Resident insisted that she had to follow protocol and at that point I asked my nurse to prepare five of Haldol because I was positive we were going to need it.

"I pleaded with the Psych Resident to simply introduce herself as a specialist and she responded that I shouldn't have fed his hallucinations or delusions. At that point, I was positive about what was going to happen, so I asked the Resident to wait until I could have my medical student and an orderly available.

"The orderly and my student stood outside the treatment room, and I made a final attempt to continue my charade by introducing the Psych Resident as 'the specialist I mentioned'. I was pleased when the Resident simply gave their name and title, without stating they were from Psych, but her language and tone of voice after that made it clear she was skeptical.

"That caused the patient to become agitated, and claim that the Psych Resident didn't believe him. The Psych Resident stated that there were no such thing as aliens, which caused the patient to lose control, and begin screaming about a coverup and how the Psych Resident was 'one of them'. It quickly got to the point where safety required administration of Haldol, which I ordered. I noted that on the chart, along with the fact that the patient had been docile and cooperative prior to the Psych consult. The patient was admitted at that point."

"As you say, unconventional," Doctor Brewer said. "But I don't believe anything you did violated standard emergency medicine protocols. Mr. Braun?"

It was all I could do to keep from smiling because that one statement by Doctor Brewer defanged the entire argument.

"Doctor Loucks," Mr. Braun said. "Would you tell us about being defrocked by your church?"

"Objection," Mr. Kirkland said. "That has no probative value here."

"I'd like to answer," I said quickly, before the Chairman could rule.

"Go ahead, Doctor," Doctor Brewer said.

"I was not 'defrocked', I requested to be returned to the order of the laity, which is comparable to a military officer resigning their commission. The Orthodox Church ordains married men, but men who have been ordained may not marry. My wife reposed — that's the word we use for a loved one who dies — and that meant I was, in effect, forced into a vow of chastity, as clergy not permitted to marry, nor are twice-married men ordained.

"At the time, I had an infant daughter to care for, on my own, as my wife had reposed only hours after giving birth due to a congenital condition. I felt, very strongly, that she needed a mother, and that was not possible so long as I was a deacon. In addition, I had not made a vow of chastity, and was not prepared to make one, directly or indirectly, at age twenty-four.

"That led me to approach my bishop and ask to be returned to the order of the laity. There was no discipline of any kind, and I remain an authorized catechist, and I'm a lay chaplain with a prison ministry. So, to put it simply, your information is in error. I can provide the necessary documents and testimony to back that up if need be."

"Doctor Loucks," Doctor Wilson asked. "My condolences. Would you mind sharing the cause of your wife's passing?"

"She suffered an intraparenchymal bleed, due to a congenital arteriovenous malformation. A slight rise in blood pressure was enough for the nidus to expand and bleed. Per the pathologist at Moore Memorial, because it was proximal to the medulla oblongata, it is 'routinely fatal'."

"Thank you," she said.

Mr. Braun was frowning because his foolish question had garnered me sympathy from the panel, which couldn't help him. I actually hoped he'd ask more questions, but instead, he wisely declined. I was allowed to return to my place near Clarissa and Lara, and Mr. Kirkland called Doctor Mercer as his next witness.

Under questioning from Mr. Kirkland, she confirmed my testimony about Angie's behavior, and said something I wasn't able to say — that Angie's behavior was indicative of improvement, and should have been encouraged, and intervention had been contraindicated. I was happy with everything she said, though I knew the cross-examination would be where the problems occurred.

"You're not an MD, correct?" Mr. Braun asked.

"That's correct," Doctor Mercer said. "As I said to Mr. Kirkland, I have a PhD in psychology, and I'm licensed to practice in Ohio."

"As such, you are not qualified to make medical judgments, is that correct?"

"I'm not permitted to prescribe medication, but otherwise, I am permitted by my license to diagnose and treat all forms of mental illness, as well as provide behavioral counseling."

"So you were not the treating physician in this case?"

"No."

"And you concurred with Doctor Greenberg's medical judgment?"

"Initially, yes."

"And you were the one who, after consultation with Doctor Greenberg, delivered the message to Miss Stephens?"

"Yes."

"And at that point, you agreed with him?"

"I did."

"And at the time, you believed his actions conformed to the usual standard of care for patients with schizophrenia?"

"Yes, at the time."

"And you communicated that to Doctor Loucks?"

"I did."

"What led you to change your mind?"

"A conversation with my mentor, Doctor Laura Paulus."

"Is she a medical doctor?"

"No, she, too, is a PhD psychologist."

"And it was because of her, not because of influence from Doctor Loucks?"

"Doctor Loucks challenged me, and after hearing his challenges, I went to my mentor, Doctor Paulus, to discuss what he had said."

"And what did she tell you?"

I nearly broke up laughing, because he'd just walked into a buzz saw.

"She said, after hearing the facts, that she felt a suspension was warranted, and if it were her, that she'd revoke Doctor Greenberg's license because he ignored clinical signs of which he was completely aware, and that Mike, that is, Doctor Loucks, was correct and I should apologize, which I did."

"Did Doctor Paulus ever examine Miss Stephens?"

"No."

"So, she made that determination based simply on your reports?"

"Yes."

"And you acted on that completely uninformed advice and wrote your statement?"

"It wasn't uninformed," Doctor Mercer said. "She had all the information she needed to give me advice."

"But she never saw Miss Stephens, so she had only third-hand information, correct?"

"Yes," Doctor Mercer admitted.

He had no further questions for her, and Mr. Kirkland called Doctor Mark Edmonds, a psychiatrist in private practice in Columbus, who was serving as an expert witness. His testimony covered the standard of care for schizophrenia. He confirmed everything that I'd observed and made an unequivocal statement about it.

"I believe Miss Stephens showed clear indications of recovery, which is seen in a small number of patients. The DSM makes this clear, as does the literature. When such behavior is observed, the only correct course of treatment is to support the patient, and if warranted, attempt to wean them from all medication. What should never be done is tell the patient that they can _never_ recover, as that is not only harmful, but completely inaccurate."

"You're saying," Mr. Kirkland asked, "that the standard of care was different because of her behavior."

"Yes," Doctor Edmonds confirmed. "A diagnosis of schizophrenia is based only on observed behavior, therefore cannot be supported when a physician observes behavior which shows long-term planning and thinking 'outside the moment'."

"Could this be merely a difference of opinion?"

"No. I've reviewed all the records, and it is inarguable that she showed signs of recovery. While that does not mean she had recovered, the treating physician must take every possible step to support the patient in their endeavors. In this case, it would have been to do whatever was possible to allow her to continue working, going to school, practicing martial arts, and guide her in her attempt to obtain her driver's license."

"Thank you, Doctor," Mr. Kirkland said.

Arthur Braun stood and began his questioning.

"How much are you being paid to appear?" Mr. Braun asked.

"My usual expert witness fee is $500 for one day," Doctor Edmonds said. "I waived it in this case."

'BOOM!' I thought. I hadn't been aware of that, and hoped against hope Mr. Braun would be foolish enough to ask 'why', as I could only imagine that would hurt his case.

"You're receiving no fee for your testimony?"

"Correct."

"Are you related to or friends with anyone in this case?"

"No, though I have been an expert witness for Mr. Kirkland in other cases."

"How many cases have you testified in?"

"About two dozen."

"And always for the patient making a complaint?"

"Yes."

"Going back to waiving your fee, was there any _quid pro quo_?"

"No. I found the case to be so egregious, I offered to testify without my usual fee."

Another 'BOOM!' moment. Barring some kind of recovery by Mr. Braun, I felt there was a very good chance Doctor Greenberg would have his license suspended.

"Did you have a chance to examine Miss Stephens before her most recent hospitalization?"

"No."

"So you are relying only on second-hand or third-hand information?"

"I was asked to examine the records in the case, which I've done, and I'm providing my analysis based on those records."

"So, as I said, you do not have first-hand information, correct?"

"I was not the treating physician, so that would be the case."

"Thank you, Doctor."

Mr. Kirkland had no further witnesses, which surprised me a bit, as I'd expected at least one of Angie's parents to testify. The Chairman called for a fifteen minute comfort break so Clarissa, Lara, and I went to use the facilities, then bought soft drinks from a machine.

"Lara, what's a 'next friend'?" I asked.

"The person who acts on behalf of someone with some sort of disability to bring their own suit. It applies to the inability to retain legal representation as well as what you would normally think. In this case, I'm paying Tom Kirkland, so he felt it was best to include my name on the complaint to take away any avenue of attack."

"And you can be sure Arthur Braun would find it," I said.

"What is it with you and that guy?" Clarissa asked.

"The Biblical 'thorn in my side'," I replied. "I swear, he has to be looking for cases where I'm involved!"

"Possible," Lara said. "But his firm is the premier criminal defense firm in Cincinnati, with a strong reputation throughout the state. If you can afford them, you go to them, even if you're from Cleveland or Toledo. Each case has been someone with money, right?"

"I suspect so," I replied. "The only one I don't know for sure was Jack Strickland, but I believe his dad is a doctor in the Cincinnati area."

"So that fits," Lara said. "What's your take?"

"A couple of bad moments for Mr. Braun, and I think we're on course for some kind of suspension. A reprimand is certain."

"I agree," Clarissa said. "There doesn't seem to be any way out for them. Maybe they can do damage control, but what really concerns me is Forth and Lawson, who can hurt Mike pretty badly."

"I don't think so," I countered. "By keeping everything before May 25th, the _worst_ they can do tarnish me, but do you think Doctors Gibbs, Casper, Nielson, Gabriel, or Taylor are going to care? And I know what Cutter, Roth, and Lindsay think of Psych! And I let Mr. Kirkland know what Doctor Williams told me about Lawson."

"What's that?" Lara asked.

"He failed to Match for surgery and had to Scramble. The only Residency he could find that would accept him was psych. He had applied to eight surgical programs and was rejected by all of them. According to Brent, the hospital in Detroit where he served his Residency wouldn't hire him as an Attending."

"Holy shit!" Clarissa exclaimed. "Now we know his problem!"

"And Mr. Kirkland will use that if Lawson tries to come gunning for me."

"Does Lawson know you know?"

"He does not. And I bet he doesn't remember calling _me_ for a consult when I was a Fourth Year for my friend Jenny."

"Jesus, Petrovich!" Clarissa said. "You have HIM over a barrel!"

"So it would seem. Shall we go back in?"

We downed the remainder of our Cokes, then headed back to the hearing room. When the Chairman reconvened the hearing, Mr. Braun did what I expected, and tried to call Doctor Forth.

"Objection," Mr. Kirkland said. "Despite these proceeding being less formal than court proceedings, neither witness appears on the list submitted last week, nor were any supplementary filings made in advance. I contend that neither Doctor Forth nor Doctor Lawson, who I expect to be called, have any testimony that is of probative value.

"At best, they would attempt character assassination by implying that statements made in a didactic setting are material to this hearing. They are not. Nothing they have to say is about the actual case, only about Doctor Loucks, whose testimony was not medical in nature, and was confirmed by Doctor Mercer and by written statements submitted by Mrs. Stephens, Miss Lara Bragg, and Miss Anna Wilson."

"Mr. Braun, do your witnesses have anything to say about Miss Stephens or about the case?"

"Mr. Chairmen, we're allowed to impeach witnesses," Mr. Braun said. "Given the relationships between Doctor Loucks and all the witnesses who gave statements, impeaching him, impeaches them."

"I'll allow you to call them, but you may not ask any questions related to statements or questions Doctor Loucks might have said or asked during his clinical rotations. That is strictly off limits."

Mr. Braun frowned, then said, "I withdraw Doctor Forth, but call Doctor Lawson as an expert witness."

"Mr. Chairman," Tom Kirkland said. "May I have two minutes to confer with counsel?"

"Yes."

I leaned over so both Lara and Clarissa could hear and said, "Hammer time."

They conferred, and I suppressed a laugh when Mr. Braun went to Doctor Lawson, whose face hardened. He turned to glare at me, then spoke to Mr. Braun, who went back to the table where he had been sitting.

"Mr. Chairman, may I have fifteen minutes to confer with my client?"

"We're adjourned for fifteen minutes."

Lara, Clarissa, and I went into the hallway, and this time Mr. Kirkland and the Stephens joined us.

"I take it you explained life to him?" I asked.

"Yes. I made the point that I would get all of that on the record, and paint it as personal animosity against you. That would hurt Doctor Lawsons' reputation more than he could hurt yours. I also have, in my possession, a statement from Doctor Shelly Lindsay to that regard."

"Really?!"

"She got in touch with me, offered to write the statement on the condition that I only use it if Doctor Lawson was called and attempted to, in her words, 'throw you under a bus'."

"Somebody loves you, Petrovich!" Clarissa declared.

"She's been looking out for me since we lost that patient in the OR," I replied.

"You know it's not your fault, right Petrovich?"

"I know, but that doesn't change how I feel about the situation."

"What could you have done?"

"Nothing. It's emotional, not intellectual, which is why Shelly has been talking to me. I'm sure you remember my reaction to the autopsy case with the young girl who was raped and murdered."

"Warranted. And you certainly wear your heart on your sleeve."

"Tom, may I speak with you?" Arthur Braun asked from a few feet away.