Primitive Secrets by Deborah Turrell Atkinson

other than what the HMO offered him.
    The organization had both O’Toole and Sakai by the short and curlies. O’Toole was stuck between being a bouncer, maintaining his income and reputation, and being the patient advocate the Hippocratic oath commanded. Sakai fought for his life and depended on O’Toole, as his primary physician, to refer him for the treatments he needed.
    Storm let her head flop back on the seat and tried to read between the lines in the letters she held. O’Toole had approached Hamasaki because he trusted Hamasaki’s confidence, but probably also because O’Toole needed some muscle behind his words. Hamasaki had enough clout with local law firms and state organizations to influence the employee health plans that would be chosen.
    O’Toole’s request for more extensive therapy for his patient had been rejected once already. The letter Storm held was a second try. Storm imagined that O’Toole had come to Hamasaki before he mailed the second letter. In his favor, he just couldn’t stand to stay silent and watch the young man die. But Unimed could ruin O’Toole. They could curtail his pay, fire him, sue him, or smear his reputation if he spoke outside of the HMO. As for Sakai, no other health insurance establishment would take him on. The HMO could hold him to the treatment they wanted. Storm shuddered. Poor Tom Sakai.
    She wasn’t sure if O’Toole or Sakai legally had a chance. Sakai, when he joined the HMO as a healthy thirty-year-old, had signed a contract with them for the medical care they offered. Even if he had read the small print, he probably wouldn’t have cared that the HMO didn’t offer bone marrow transplants. What thirty-year-old believes that he’ll need one? What sixty-year-old does?
    Storm swallowed hard. Still, tens of millions of dollars would be at stake if Sakai started a lawsuit. Juries like to side with people like Sakai. Sadly, if Sakai died in the middle of the proceedings while being refused treatment by the HMO, the family could get even more for the anguish they’d endured.
    If they knew about it, the executive board had to be very nervous. Storm had a bad feeling that they did.
    She looked again at the letter. O’Toole wrote that the palliative treatments, the methotrexate for chemotherapy and rodding of the bone fractures, were not working. Sakai was in pain and growing weaker.
    The next couple pages in the file were photocopies of Sakai’s medical history. He was thirty-five. Storm’s stomach flip-flopped; he was so young. He had gone to see a general practitioner at the HMO, the one running the clinic that day, because he had recurrent pains in his thighs. It had grown so bad that he couldn’t continue to throw a ball with his seven-year-old son. The GP punted Sakai to O’Toole, who was the next level up in terms of specialists. O’Toole called in the oncologist.
    O’Toole and the oncologist supervised a round of chemotherapy for a year with decent results. Then Sakai relapsed. His wife was three months pregnant.
    Storm checked the date on that note. Eight months ago, so she’d had the baby. O’Toole’s last written comments were that the patient was seeking traditional Hawaiian therapies. O’Toole was encouraging it, as long as Sakai also continued his chemotherapy.
    The final paper in the file was a confidential letter from the HMO board to O’Toole. He was reminded not to discuss the possibility of treatments not offered by the organization with Sakai or his wife. The bone marrow transplant was out of the question. The last sentence said that perhaps when the HMO underwent their planned expansion and had their own cancer treatment center, they would be in a position to help Sakai.
    Storm shook her head sadly. Except that Sakai would be dead. A bunch of MBAs had handed down a death sentence to a thirty-five-year-old father. The file drooped in her grip while