Finally Laurie had called the Joint Commission on Accreditation of Healthcare Organizations. Cheryl had not been able to get her a specific person to talk with, and after Laurie had been switched around numerous times, each time being given the name of someone else who could supposedly help her, she had given up, defeated for the moment by the bureaucratic mind-set.

Arriving at her destination, the taxi pulled up to the curb and stopped, and Laurie handed over the fare and the tip. As she climbed from the cab, she looked up at an impressive, modern highrise of green-tinted glass held in place by vertical ribs of green granite. The name, Angels Orthopedic Hospital, was inscribed into a pediment-shaped marble lintel over the front doors. A liveried doorman stood on the sidewalk. A sloping driveway led to a receiving dock, a service entrance, and a multistory parking garage in the rear.

The interior was even more impressive. It was more like walking into a Ritz-Carlton than a hospital, exactly as Jack described that morning. The floor was a mixture of hardwood and marble, and the information booth looked like a concierge desk, with two uniformed men sitting side by side in suits and ties. But what caught Laurie's eye more than the decor was the lack of people. There was no hustle and bustle like a normal hospital. Other than the two men at the information booth, there were only two people in the large lounge area sitting opposite each other on opposing, elegantly upholstered couches.

Laurie went up to the information booth and received the full attention of both gentlemen. She asked for Loraine Newman, mentioning her name and that she had an appointment.

"Certainly, ma'am," one of the men said. He picked up the phone, and after a brief conversation directed Laurie to a pair of interior doors to the left of the bank of elevators. "Miss Newman is waiting for you in administration."

Laurie followed the directions and pushed through the designated doors. The administration area was more utilitarian than the lounge area but still sumptuous compared to any hospital Laurie had ever been in. It was a wide, long room with glass-enclosed offices on either side, each fronted by individual secretarial desks. Most all the desks were occupied, but it didn't appear that much work was being done. Only a few of the secretaries were typing into their monitors, while most were chatting in subdued tones.

One of the secretaries caught sight of Laurie and asked if she could help her, but before Laurie could respond, a glass door to an office opened and an energetic woman wearing a white coat over a brown turtleneck sweater and skirt called out to her. She introduced herself as Loraine Newman before ushering her inside.

"Let me have your coat!" Loraine said. She was Laurie's height and build and even approximate age but had different coloring compared to Laurie's blond complexion. "Please take a seat," she said, as she placed Laurie's coat on a hanger and hung it inside a small closet.

Laurie sat down, and Loraine went behind her desk and did the same.

"I've never met a medical examiner," Loraine said with a smile. "I'm awed by what you guys do."

"We don't get out much," Laurie said. "Most of our scene work is done by our forensic investigators." She inwardly winced, recognizing Bingham would surely not appreciate what she was doing.

"How can I help you?" Loraine asked. "I suppose you are here because of yesterday's unfortunate MRSA death."

"That and more," Laurie answered. "I did the autopsy on Mr. Jeffries this morning. The extent of his infection was dramatic, to say the least, especially how quickly it consumed him."

"You have no idea how upset we are, and not only about the tragic loss of a life of an otherwise healthy man but also because it has occurred despite our making maximum effort to prevent it."

"I heard from one of my colleagues the efforts that you have been making. I imagine it must be discouraging, especially since you have apparently had eleven such cases."

"Discouraging is not a strong enough word. Did you find out anything at autopsy that might help us? When you called, I was hoping that was going to be the case."

"I'm afraid not," Laurie admitted.

"Then why did you come over?"

Laurie squirmed in her chair. Although the tone of the question was far from hostile, Laurie found herself questioning exactly why she was compelled to make the visit, and for a moment felt foolish.

"I didn't mean to put you on the spot," Loraine said, sensing Laurie's discomfiture.

"It's okay," Laurie said. "After I did the autopsy this morning, I found out essentially by accident about all the other cases occurring over the last three and a half months. I just felt I had to do something. I'm afraid the OCME has let you and the rest of the city down by not being aware of the outbreak. It's part of our job not to let something like this fall through the cracks."

"I appreciate your sense of responsibility, but in this case I don't think it matters. We certainly have been aware, and believe me, we have done everything possible. And when I say everything, I mean everything, including the hiring of a full-time infection-control professional. And as the chairperson of this hospital's interdepartmental infection-control committee, I personally jumped on the problem from day one. We've had input from everyone, including our medical staff, nursing, engineering, laboratory, you name it.

Our committee has met just about every other week since the first MRSA case. We even shut down our ORs for a time and halted all surgery and invasive procedures."

"So I heard," Laurie said. "I don't have much training in epidemiology, but there are several things about this outbreak that bother me."

"Such as?"

Laurie took a moment to organize her thoughts. She was afraid she might sound naive, since she truly only had the basics in epidemiology. "For one thing, it has continued despite all your efforts at control; secondly, many of them are, like Jeffries, primary pneumonias, which I believe is unique for staph; third, they have apparently been occurring in only Angels Healthcare facilities. You do know that your sister hospitals are experiencing cases as well?"

"Of course. I've had multiple meetings and frequent communication with my counterparts at our heart hospital and at our cosmetic surgery and eye hospital. I was also the one who strongly encouraged Angels Healthcare's CEO, Dr. Angela Dawson, to hire the M.D./Ph.D. infection-control professional to coordinate our efforts, specifically because the problem was happening in all three of our institutions."

"Is that Dr. Cynthia Sarpoulus?"

"That's correct. Why do you ask?"

"I recall one of my ME colleagues mentioning her name. He spoke to her a month or so ago."

"She's one of the leaders in our specialty, and coauthored a major text on hospital-infection control programs. I was sure that, when I heard she'd been hired, we'd be out of the woods."

"But it hasn't happened."

"It hasn't happened," Loraine agreed.

"Well, back to my amateur concerns," Laurie said.

"I'd hardly call you an amateur, doctor," Loraine said with a smile. "Please, continue!"

"An hour or so earlier, I talked with a doctor at the CDC. She'd had the opportunity to subtype the staph from two of your cases that occurred more than a month ago at different hospitals. Using rather sophisticated genetic typing, they proved to be the same. She promised to confirm that with tests of even higher specificity and get back to me. To my informally trained epidemiological brain and contrary to what she thinks, it suggests to me a carrier is involved: a carrier who visits both hospitals. Do any of the Angels Healthcare personnel regularly visit all your hospitals?"

"Wow," Loraine remarked. She laughed in a fashion that indicated she was impressed. "Are you teasing me about not having epidemiologic training?"