An interview with the author

by Lara Moore.

April 11, 2012

What inspired you to write this book?

It is my first novel. So I am a bit shy and afraid of the reaction it may bring. It is as if I was sharing a first born with some imperfections. I hope they are not too important as I work extensively to present a topic that is not easy to illustrate. It took more than nine months to produce this account.

What inspired me to write the book is the shortage of physicians. As I researched the topic, I realized the profession suffered an undue burden in the past ten years. I constructed the narrative around the issue. While, I realize that the profession is not without some bad apples, I wanted to show the danger of using people as scapegoats. The innate risk is that it will be causing a crisis far worse than financial.

How did you write this story?

My goal was to bring readers behind the scene. To take a closer look at situations, they could not witness in real lives. The tough part is to show without telling and let readers come to their individual conclusion.

I attempted to illustrate the destructive power of misapplied justice. It seems as if we have repeated the same pattern in many centuries. The hysteria of the Witch of Salem caused by a time of a financial downturn did not resolve issues of that time. The German Nazi regime killed six million Jews, did not resolve ills of that time.

They created both shameful acts and dark history. It will be forever present and attached to horrible disgrace. While, I do not deny that some abuses have occurred in the medical profession. However, after reviewing records and listening to providers, I was shocked. Neither the victim nor their patients who have suffered a loss will forget this injustice. It is the beginning of deep doubt about a government they trusted.

Is it your main concern?

My concern is the shortage of providers. Pamela Wible, a family physician. She has written about an increase in suicide in the profession and presented an interesting fact. ‘Given that a typical doctor has about 2,300 patients, under his or her care, that means more than a million Americans will lose a physician to suicide this year.’ The same applies for losses of licensing or criminalization. This aggressive approach has been causing discouragement for years.

The witch-hunt has caused mistrust in the profession. It is hurting every physician as well as patients. It has dishonored the profession rather than improved it. In what I have researched, I am not sure the approach is working. Something is amiss. Again, I am concerned that one day it will be recalled in the same shameful way we now remember the Salem Trials or the Nazi regime.

Is the main character Anna someone you know?

I made Anna up to tell the story, young women I have known and stories I overheard.

Dr. Quaile?

Dr. Quaile is also a made-up character. She is a combination of cases I have read about as well as many doctors I interviewed.

The Judge?

He is also a fictional person. I wanted the judge to be a good guy who was blinded by circumstances. I studied court records and used portions of actual hearings.

The Prosecutor?

Errors had to be caused by someone rather than procedures. They were manipulated to attain a goal for selfish reasons. I wanted to show, how easily our system can be apparently maneuvered.

I believe that we need to be aware of damages an unrestrained legal profession can cause.

The prosecutor is portrayed as a bad guy and villain. Is this actually possible?

In the same way, a physician could victimize patients; his achievement and personal issues preoccupy him. He found the perfect victim: A physician who was on a sick leave. He has another agenda interfering with his work. Yes, this can happen. Look at all the “Innocence Projects” across the country. Victims have spent 20-40 years behind bars for crimes they did not commit.

All participants present at these hearings played an important role in the demise of Dr. Quaile. They fail to see a true picture of the situation. They are presented only with one side of the equation.

Wasn’t the crucial point the absence of anyone for a defense?

Yes, of course. Due process and a right to representation is a very important fundamental right. I believe, given what happened, the system must have serious flaws. Consequences of depriving someone of his or her rights to a defense can be potentially devastating for anyone. Apparently, it is not unusual in these cases, and we need to revisit and understand; possibly, simply discipline those who use this loophole. Here, the depravation of right is recurring.

What do you think of the witnesses, Dr Quaile’s former patients? I hope that the individuals depicted here are rare.

I agree. However, these were word-for-word out of hearings I found. From my research, it seems that we are underestimating the financial losses due to that sort of fraud. I wanted to illustrate some of the issues physicians are facing. They are not law enforcement. Dr. Quaile was in an unusual situation since she served corporate clients and was astute to the issues of fraud. Most physicians are almost likely as vulnerable if not more. I am thinking here also of physicians treating pain and probably the target of disguised drug dealers. While I am not discussing the issue at length in this book, I described the situation with a drug dealer who sent his so-called “girlfriend” for pain medicine. Was this girl paid to post as a patient? No one will ever know, but these are real stories physicians have shared with me.

From my research, it seems that there aren’t enough resources for the profession to protect them or stop these abuses. On a larger scale, this may account for far more losses than realized. For authorities, the results may not be as directly lucrative. How can you control it? Physicians are trained to avert death, treat illnesses. They are not trained to fight fraud or drug abuse. The insane part of that story is that Dr. Quaile had recognized the problem since she had discharged them from the practice. She did what she had been instructed to do and followed the advice of the malpractice insurance’s attorney. Despite her following procedures, the authorities used these troubled individuals to demote her professional license. It does not make sense; a provider, I interviewed, shared this situation.

At this time, the main goal of our government has been to get money back. They feel that prosecuting doctors because they have perceived deep pocket is the fastest way to resolve their objective. This situation seems wrong and unjust. Especially, in the case of Dr. Quaile; she represents a majority of primary-care physician, not adequately remunerated. The approach does not make sense. Rather than assisting the profession in fighting the issue, they used disguised actual culprit of fraud to do so. I could see disciplining a doctor for failing to recognize such behavior. They are oblivious to the actual witnesses’ deceit themselves.

One could turn the table and construe it as organized crime against hard-working providers and innocent victims. Doctors need to receive more assistance in addressing these issues. Obviously, I portrayed Dr. Quaile as diligent in averting fraud. Despite efforts exerted on an area of care where one sees potential risks, her office is blindsided and has no one to turn over these issues. Apparently, the malpractice attorney’s actions may have aggravated, rather than protect the doctor.

How much did you know about this before you wrote this book?

I had an idea that there is something going on in health care and wanted to examine and write about the subject.

I investigated many cases and chose a combination to write the book. It took a lot of research.

How do your friends and peers feel about your writing this book?

Most are proud of my writing this book, but of course, you also have odd ones who don’t like to disturb the comfort of what they have heard and would like to believe. Lastly, others are puzzled. I wanted to bring a thought-provoking story to steer some thought process into how to address these issues. There is a true concern for the approach to criminalizing medicine by many. More scholarly articles have been published on the issue. I wanted a story the general public could understand. A list of recommended readings and articles is available at the end of the book.

Could you share a few words about your writing process?

After my research, I did not know where to begin. Nothing was coming, but eventually I started writing and was surprised to find out that my characters became alive in the course. As I wrote, the character began to act in front of my eyes. I could not stop writing for fear I would miss a piece. It was as if someone was dictating the script. If there is something resembling a “Genie,” it felt as if I had one. I assume; it was all the anecdotes of people I had interviewed blending in one narrative. Have you ever started doing something you did not know you could do and wondered where you had learned it?

First, I wrote the main story. Then I went back and relived time and again, adding colors, sounds, other people or animals, birds, etc. The process of writing is like painting in a way.

Who are your favorite authors?

I like authors that tell a story with a subject matter. In that style, Jodi Picoult has a great ability to bring us into the lives of people dealing with various real-life issues.

Thank you for presenting your book.

Thank you, it was an honor to bring you to the inside of the making of this elaborate project.