“Here come the experts.”

“Which ones?”

“All of them.”

A month after the subpoena, new faces were everywhere. ULS, Moynihan, and the plaintiff’s team each seized a conference room, carpeting tables with banker’s boxes, binders, and laptops. Navy pinstripes, red ties—an assembly line of certainty.

Employees were ushered in one at a time—histotechs first, then lab assistants, secretaries, transcribers. They emerged tight-lipped, “advised” not to share. Naturally, they compared notes in the back lot on smoke breaks.

“The pathologists mixed up the slides and pinned it on the typist,” a lab assistant huffed.

“Yeah, now they’re scapegoating Audrey,” a histotech added, happy to return fire after years of being on the receiving end.

“They always blame us,” a transcriber chimed in.

Doris Stanley, Client Services supervisor—never called, never shy—couldn’t resist: “They bring in residents who look like high-schoolers, then pretend attendings review every word. My money says a resident signed it out and somebody rubber-stamped it.”

The corner office calculus

Inside, the temperature was just as hot. Bryce Collins, the white-haired lab manager, spoke in his familiar, measured cadence, worn down by years of budget cuts. “Gene, our internal review shows overtime up by fifteen percent and productivity per FTE down.”

Next to him, CFO Bryston—Wall Street exile, Reagan-yellow power tie—clicked through three charts. “We warned against academic prima donnas. Memorial promised residents wouldn’t sign out cases solo. Now look.”

Collins piled on. “We’ve documented slow response times to client complaints. Nomura and the Memorial group don’t care about our physicians.”

Carlisle thumbed pages, noncommittal. “Last thing we need is another lawsuit.”

“We got hammered on the liver-function overbilling,” Bryston said. “First biopsy suit, though.”

“Nomura hasn’t helped,” he pressed. “He’s passive-aggressive. Won’t return calls. Counsel is livid.”

Carlisle frowned. “Bernstein told me the investigation was on schedule.”

“Trust me. He punts until it explodes and blames others.” Bryston softened his tone, pivoting. “Remember Saxon before Nomura? Class act. Signed Christmas cards, karaoke in the lobby, stockings with U-L-S candy. Staff loved them.”

Carlisle smiled despite himself. “Class act.”

“And business,” Bryston nudged. “Ladue’s surgeons are gone—two million in revenue. Riverside’s Hartman is picking up surgicenter and oncology work. He’s hungry.”

Carlisle’s eyes narrowed. “Maybe we’re chasing the wrong volume. Nomura’s derm work is forty percent of our outpatient slides, but he barely orders IHC. Haas is heme—every case triggers panels, sometimes molecular. One hematopath case can generate thirty to fifty times the revenue of a skin shave.”

Bryston brightened. “So we lean heme, like Riverside.”

“Pushing glass, but profitably,” Carlisle said. “Think about it.”

Sand in the gears

Reassigned to ULS for the investigation, Nomura found a different lab. He buzzed transcription. “Sally, I need the prior slides on Richardson.”

Silence.

He stepped around the corner. Three transcribers hunched over headsets, avoiding his eyes.

“Sally, did you hear my page?”

She slid off her headphones. “Sorry, Doctor. We’ve been told to focus on transcription. You’ll have to pull slides yourself.”

Two colleagues melted out of sight. Complaints to Collins went nowhere. Evenings stretched to 9 p.m., split between experts and scavenger hunts through metal files.

Jake Thompson—Moynihan’s information systems expert—was done being polite. “This LIS is a museum piece,” he muttered, tracing the path of the surgical report. Clinical chemistry flew through the system; anatomic pathology limped. Today, though, he had something bigger than clunky workflows.

“I wanted to run this by you before I tell Collins and corporate counsel,” Jake said, closing Nomura’s door. “Are you aware transcribers can alter finalized reports?”

Nomura nodded. “Clinics call with left/right changes. We issue a corrected report. I sign those.”

Jake set two photocopies on the desk. “Report A is your original. Report B shows a handwritten note—‘Pearl from Ladue called, site should be left’—and a corrected site. There’s no record you approved it.”

Nomura stared. “These aren’t the copies I reviewed. The corrected report should be flagged and routed back to me with slides.”

“It wasn’t,” Jake said. “And the original requisition? Missing. Collins and I tore through that month. Nothing.”

Nomura exhaled. “I once found a req in the trash next to Audrey’s desk. Filing here is a joke. If they’d pulled the slides with the correction, we would have caught this.”

Jake nodded. “These are serious breaches. I’ll keep digging. If anyone duplicated content or resumed a dictation against the wrong requisition, I’ll find the footprint.”

“I know you will,” Nomura said. “There’s a joint meeting tomorrow. Bring it.”

Conference room theatre

Carlisle convened Collins, Bryston, Moynihan, and ULS counsel on a Nashville speakerphone. Introductions. Summaries. Then the bomb.

“Our IT consultant traced the report pathway,” Carlisle said evenly. “There was a protocol breach. A corrected report issued without pathologist approval.”

Ten-minute recess. In the hallway, Moynihan leaned toward Nomura. “Good for us, bad for them. Let me feel them out.”

They reconvened.

“Dr. Nomura,” ULS counsel began, “has anyone considered that you may have reviewed the same slide twice and dictated the same report?”

Nomura traded a quick glance with Moynihan. “Even if I tried, I couldn’t reproduce my wording verbatim—seventy-eight words, exact punctuation—hours apart.”

“Still possible?” counsel pressed.

“No,” Nomura said, voice steady. “DCIS has many patterns. My descriptions vary case to case. Word-for-word duplication is functionally impossible.”

“Who can issue a corrected report?”

“Transcription, with my sign-off. Possibly information systems.”

“What about you?”

Nomura’s eyes hardened. “Pathologists do not have system privileges to alter finalized electronic reports.”

“I see,” counsel said. “That’s all for now.”

Carlisle stood. “Thank you, everyone. We’re making progress.”

In the library next door, Moynihan’s brow knotted. “I don’t like their angle. Get me your written protocol for corrected reports. I’m also calling a developer who worked on a sister LIS. If they’re going to dance the ‘same dictation twice’ waltz, I want him in the room.”

Nomura nodded. “I’ll also talk to Gene. He won’t tip his hand, but he needs to hear how deep this runs. When this is over, we need real change.”

“Send me the protocol by morning,” Moynihan said. “We’ll keep them on defense.”

Quiet hands at James’s back

Back at Memorial, Wilma slid a Post-it onto James’s desk: Back-lot gossip is ugly. Keep your head down. I’ve got your blanks cut early for Haas. —W

Deanna called between frozens. “Moynihan says you won’t be deposed until they finish with ULS staff. Breathe. Tonight: food, then mock-questions. No trick answers, no speculating. Just what you saw, what you did.”

“Copy,” James said, steadier than he felt.

Across town, Nomura drafted the corrected-report protocol he had written years earlier, the one the system—and the culture—had quietly learned to ignore.

He printed it, signed the bottom, and slid it into a folder for the morning.

Next Chapter: Chapter 28-Divided We Fall