27 of 30 people found the following review helpful:
5.0 out of 5 stars
Power Corrupts...In Medicine, It's The Money, September 2, 2007
This review is from: Critical (Hardcover)
Corporate fraud has not involved an attractive female doctor turned CEO until now, with Robin Cook's "Critical." This is a great book...a fast, page-turning ride of intrigue involving the health care system, a development stage company going IPO (an Initial Public Offering), organized crime, and Washington lobbyists.
Angela Dawson, MD/MBA, a divorced single parent, doctor turned CEO is facing the challenge of a lifetime for any CEO. The company she founded, Angels Healthcare, LLC, is about to go public but is experiencing a mini-epidemic of nosocomial methicillin-resistant staphylococcus aureus (MRSA) infections. A number of patients have died at three of their New York City based hospitals resulting in the shutdown of their surgical suites, a cash crunch and the potential delay of the IPO. This delay may mean insolvency and the loss of millions not only to the founders but also to key investors, one of NYC's crime bosses.
Key figures include Jack Stapleton, forensic pathologist in NYC Office of Chief Medical Examiner who is scheduled for knee surgery at Angels Orthopedic Hospital; Stapleton's wife, Laurie Montgomery, who is also a forensic pathologist at OCME; Walter Osgood, MD, Department Head of Clinical Pathology for Angels Healthcare; Michael Calabrese, Dawson's ex-husband who helped raise the start-up capital for Angels from childhood friend and crime boss, Vinnie Dominick; Adam Williamson, a killing machine who worked for healthcare lobbyists in Washington, DC; and Angelo Facciolo, hitman for Dominick.
Montgomery who becomes increasingly concerned with her husband's scheduled surgery as a result of post-mortems on a stream of patients operated at Angels' facilities initiates an unofficial investigation of the cause. Dawson, Dominick, and the DC lobbyists, concerned with "overenthusiastic medical examiner" take matters into their own hands to silence Montgomery. Dominick had already murdered Paul Yang, Angels' Chief Accountant, and Amy Lucas, Yang's administrative assistant.
"Critical" bobs and weaves between stories of the key figures then lurches to an unexpected and satisfying outcome. The book also raises and details some issues of the day, including:
* The rise and shortcomings of specialty hospitals in the US - They "don't have the resources for serious problems and have to outsource them, are interested in the cream of patients (healthy, well insured), like quick procedures that require no overnight stay (in and out), and have no ER or ICU. They are money making machines."
* Conflicts of doctors and the business of medicine - "Success from business as measured by wealth and its trappings had trumped altruism, charity, and the pleasures of interpersonal intimacy.
* Hospital infection rates - Hospital acquired infections affect about two million patients per year resulting in 90,000 deaths per year in the US alone.
* Nosocomial methicillin-resistant staphylococcus aureus (MRSA) infections - one of the greatest healthcare concerns we have today as bacteria mutate and become resistant to available antibiotics.
As one who is not a big reader of fiction, I found "Critical" to be an excellent book. It is a great story that also outlines some critical issues of the day, raising questions about today's morality. As someone who has worked in healthcare for more than thirty years, I agree with Cook's final assessment, "In politics, power corrupts and absolute power corrupts absolutely. In medicine, its money, not power." We - doctors, the delivery system, the regulatory system and payors, which includes the federal government - have lost sight of the patient.
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15 of 17 people found the following review helpful:
3.0 out of 5 stars
Bad Medicine, August 23, 2007
This review is from: Critical (Hardcover)
The delivery of medical care in the United States is a subject of great public and private debate. The economics of medicine are quite unlike other economic models because neither pure competition nor governmental regulation will ever produce affordable quality health care uniformly. Coupled with the fact that health care is controlled not by physicians but by corporations the opportunity to exploit niche markets creates both risk and reward.
So here we examine, in the context of a medical thriller, the issue of specialty hospitals. Specialty hospitals are apparently organized in such a way relative to government set reimbursement rates for procedures. Because they do not have emergency rooms, ICU units, etc like general hospitals they can be very profitable. This creates a class of winners-specialy hospitals and losers general hospitals. And in all business situations the winners want to maintain their advantage and the losers want to "level the playing field."
So a business war breaks out and unlike most business wars this one produces real casualties. When Assistant Medical Examiner Laurie Montgomery starts noting strange fatal nosocomial infections (hospital acquired) plaguing three corporately related specialty hospitals she launches an investigation. Her motives are a bit personal since her husband, also a medical examiner is scheduled for surgery at one of them.
Now someone has decided to make this really a thriller something more than a bunch of deaths caused by pneumonia is needed. Here Critical strays. Cook is not content with a mysterious virus and possible serial killer on the loose. He enlists not just the Mafia to bump off executives and Laurie, he also gets a ex-Delta Force mercenary into the same act.
When you go from Quincy, MD to Don Corleone and Rambo in a book, you can be assured that it will lose credibility. This is a shame since the original premise has enough tension to sustain it as a medical thriller.
Hopefully, Robin Cook will find a new editor who knows how to properly utilize his great talent.
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11 of 12 people found the following review helpful:
4.0 out of 5 stars
Another Robin Cook medical thriller!, August 11, 2007
This review is from: Critical (Hardcover)
Author Robin Cook continues to pound out his brand of medical thrillers. In Critical, a struggling private medical surgical company, Angels Healthcare, has financial problems compounded by a mysterious series of lethal infections occurring in patients throughout Angels Healthcare's system of clinics. Involved are investors, the Medical Examiner's office, the police, the mob, and others. Bad guys are really bad, and folk at the ME's office work hard to understand what's going on, for a variety of personal reasons.
Being "critical" myself, Critical probably moved slower than what I expect from a Robin Cook novel. The twist at the end is so unexpected that it almost reads as an afterthought, as in "I don't want the reader to have any chance at all to guess who's doing this, so I better throw another person in." At least Cook had an explanation for this person's involvement.
Still, I've enjoyed every "Cook Book" I've read, beginning with Toxin. I hope his next one is back on track.
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