Reviewed by Lawrence R. Huntoon, M.D., Ph.D., Jamestown, NY

Sutton's Law is a frighteningly realistic novel about where managed care might very well lead us. Or, as one of the main characters, Dr. Milton Silber aptly describes it, a system "designed by thieves for thieves."

Written by Jane M. Orient, M.D., Executive Director of the Association of American Physicians and Surgeons (AAPS) and co-author Linda J. Wright (Lauren Wright Douglas), Sutton's Law will no doubt take its rightful place alongside Samuel Shem's The House of God and Mount Misery, and Michael Palmer's Silent Treatment. A mix of medicine, mystery, murder, and intrigue with a little high finance, drugs, and romance - Sutton's Law ultimately is about greed and simple justice.

Yes Toto, intern Maggie Altman isn't in Kansas anymore. She's in the big city at the Texas University Regional Preventive Health Center, otherwise known as TURPH. As a new intern in medicine, Maggie counted on major stress and a hectic lifestyle, but in her profession, she never envisioned that anyone would try to kill her. Coming from a background in basic science training in a research lab, Dr. Altman had a natural curiosity about things...things like why certain patients' charts were missing...and why certain patients who weren't seriously ill ended up dead. What could it all mean? And, curiously, the patients' computerized data frequently didn't match the clinical data as Maggie remembered it. Was she crazy, incompetent, or just losing it all in her sleep-deprived state? Was it a simple glitch in the hospital's computer system or was someone manipulating the data, or worse, altering the patient's outcome for profit? And what does this new managed care experiment known as EquaCare have to do with these suspicious discrepancies?

Dr. Milton Silber, former professor of medicine, was fed up with it all. DRG profiles, UR/QAC harassment and EquaCare. Now a financial analyst and publisher of the prestigious Silber Report, who can argue with his plain truth assessment of medicine under managed care: "Treating illness is not very profitable...If you want to make some money, try not treating illness, after collecting the insurance premiums in advance." But Dr. Silber, who wanted nothing more to do with TURPH and EquaCare, kept showing up in the hospital at odd hours, sneaking downstairs to meet his old friend and chief pathologist, Dr. Metzenbaum. Was he a hypocrite or hero? Was he hot on the trail of the bad guys or coldly conspiring with the pathologist?

And, what about Pit Boss, senior level resident and "gate-keeper" extraordinaire, Dr. Brent Stemmons? He seemed to have it all under control as "captain of the bridge" in the ER. He had the clinical skills of the "Fat Man" (The House of God, by Samuel Shem) and knew his way around the DRGs and computer printouts which he dutifully provided to the chief resident, Dr. Stephen Blaine, on a regular basis. Keeping track of residents' DRG profiles and cost-effective management was a high priority for EquaCare and TURPH as it is for real life managed care companies. Those residents who had the misfortune of getting stuck caring for the sickest patients ran the risk of deselection from the program, or in Maggie's case, being sent back to the research lab. Maybe Brent Stemmons, being a fellow resident, would understand Maggie's plight and help her solve the puzzling discrepancies at TURPH; besides, he was handsome, and Maggie owed it to herself to pursue a life outside of the day to day drudgeries of the hospital.

This intriguing and delightful novel weaves in and out of various people's unusual lives both inside and outside of TURPH. The reader is intrigued and tantalized by titillating and convincing conversations between mysterious persons whose true identities remain hidden until the end. Little hints here and there, and cryptic clues throughout are present, just enough to keep the reader hopelessly hooked. The pages turn quickly and the chapters are short. Maybe the next chapter holds the key? Maybe the key is in the relationship between Sutton's Law and Law Number IX? But what exactly is "Law Number IX," and just who was Willie Sutton anyway?

Sutton's Law

Reviewed by Fr. James Thornton

Sutton's Law, a murder mystery, is written by janem M. Orient, a medical doctor and executive director of the Association of American Physicians and Surgeons, and Linda J. Wright, a successful mystery author. The combination is a winning one. This novel is, in large measure, the story of the changes now taking place in the field of health care in the United States, and so some background is apropos.

Changes during the last several years in medicine have had the effect of eliminating much of the traditional care and and treatment that placed emphasis on close personal harmony between doctor and patient--a wholly private relationship--and replacing that with socialist-style assembly-line mass medicine. I say socialist-style rather than socialist, because this new type of medicine is imspired by the big-corporation mentality, acting in concert with big government, and thus is not the unadulterated state socialism of the Soviet kind. The end product, however, is not all that dissimilar.

In the final analysis, the mindset in many giant corporations often resembles the mindset common in the dank caverns of the government behemoth. Both are highly bureaucratic, impersonal, collectivist-oriented, and anonymous. We are reminded here of the writings of economist Wilhelm Roepke, the most perceptive of the theorists of the Austrian Schol, who perpetually warned against the "Cult of the Colassal," which he defined as an intoxication with social gigantism in which quality is defined by quantity.

When the "Cult of the Colassal" holds sway, as it increasingly does, Roepke observed that "life becomes de-humanized and man becomes the plaything of unhuman, pitiless forces." In time, these forces become ever more unhuman and ever more pitiless, as henchmen strive to  make efficient and workable systems that are fundamentally inefficient and unworkable, and uncongenial to real human beings leading real human lives. Inevitably, it becomes necessary to "crack eggs to make omlets" (as the Bolsheviks like to say)--that is to "liquidate" entire categories of human beings for the sake of the "greater good" of continuing social and technological "progress." Right now, our country "liquidates" millions of unborn children, because they are, for one reason or another, inconvenient. But the killing machinine, which reaps a "bonus" in the form of huge profits from this commerce in death, will certainly not stop there.

Already, decisions of a life-or-death nature are made by these new semi-socialistic "health-care systems," without giving the slightest consideration to the patient's wishes, and with a a primary accent on the fiscal "bottom line" as opposed to to the patient's actual medical needs. It is, in other words, a form of health-care rationing, inspired by today's equality-mania, in which all but the most affluent are made dependent on the decisions of nameless paper-pushers, mostly without medical degrees, and are forced to compete with vast numbers of the welfare recipients that government is either creating or importing. Furthermore, a patient whose health, in the opinion of a bureaucrat, is harmed by some form of "politically incorrect" living, such as eating an excessively fatty diet, driving without seat belts, or somking cigarettes, may soon be denied full access to life-saving care--punishment for failure to conform to the dictates of the government and corporate "experts," who tell us what is good for us and demand obedience.

In Sutton's Law, internist Dr. Maggie Altman, practicing at an immense "managed care" facility in Texas, becomes alarmed when patients under her care, and patients moreover without life-threatening conditions, die inexplicably. She is led to the conclusion that they are murder victims. Soon, the realization comes to her that murder is being committed by someone in the "system" who, seeing patients as mere financial pluses or minuses on some computerized ledger sheet, is determined to maximize the economic viability of te organnization by "managing" the delivery of health-care through homicide. The killer soon learns that Dr. Altman is on her trail and decides to eliminate her, too. It is an entertaining and most enlightening thriller, a fictional story woven through with some of the more sovering realities of our time.

Sutton's Law is another expression of the appropriate concerns that arise when we rush to turn medical are into a business first and a community resource second.