Seated before him were Barton Sherwood, vice chairman; Helen Beaton, president and CEO of the hospital; Michael Caldwell, vice president and medical director of the hospital; Richard Arnsworth, treasurer; Clyde Robeson, secretary; and Dr. Delbert Cantor, current chief of staff.

Strictly following parliamentary procedure as specified in Robert's Rules of Order, which he'd purchased after being elected to the chairmanship, Traynor called on Clyde Robeson to read the minutes of the last meeting.

As soon as the minutes had been read and approved, Traynor cleared his throat in preparation for his monthly chairman's report. He looked at each member of his executive committee in turn, making sure they were all attentive. They were, except for Dr. Cantor who was, typically, bored and busily cleaning under his fingernails.

"We face significant challenges here at the Bartlet Community Hospital," Traynor began. "As a referral center we have been spared some of the financial problems of smaller rural hospitals, but not all of them. We're going to have to work even harder than we have in the past if the hospital is to survive these difficult days.

"However, even in these dark times there is occasional light. As some of you have undoubtedly heard, an esteemed client of mine, William Shapiro, passed away last week of pneumonia coming on after knee surgery. While I very much regret Mr. Shapiro's untimely passing, I am pleased to announce officially that Mr. Shapiro had generously designated the hospital as the sole beneficiary of a three-million-dollar insurance policy."

A murmur of approval spread through the people present.

Traynor lifted his hand for silence. "This charitable gesture couldn't have come at a better time. It will pull us out of the red and push us into the black, although not for long. The bad news for the month is the recent discovery that our sinking fund for our major bond issues is considerably short of its projected goals."

Traynor looked directly at Sherwood, whose mustache twitched nervously.

"The fund will need to be bolstered," Traynor said. "A good portion of the three-million-dollar bequest will have to go to that end."

"It wasn't all my fault," Sherwood blurted out. "I was urged to maximize return on the fund. That necessitated risk."

"The chair does not recognize Barton Sherwood," Traynor snapped.

For a moment, Sherwood looked as if he might respond, but instead he remained silent.

Traynor studied his notes in an effort to compose himself after Sherwood's outburst. Traynor hated disorder.

"Thanks to Mr. Shapiro's bequest," Traynor went on, "the sinking fund debacle will not be lethal. The problem is to keep any outside examiners from getting wind of the shortfall. We can't afford to have our bond rating change. Consequently, we will be forced to put off floating a bond issue for the parking garage until the sinking fund is restored.

"As a temporary measure to forestall assaults on our nurses I have instructed our CEO, Helen Beaton, to have lighting installed in the parking lot."

Traynor glanced around the room. According to the Rules of Order, the matter should have been presented as a motion, debated, and voted on, but no one moved to be recognized.

"The last item concerns Dr. Dennis Hodges," Traynor said. "As you all know, Dr. Hodges disappeared last March. During this past week I met with our chief of police, Wayne Robertson, to discuss the case. No clues as to his whereabouts have surfaced. If Dr. Hodges did meet with foul play, there has been no evidence of it, although Chief Robertson allowed that the longer Dr. Hodges is missing, the more likely it is that he is no longer living."

"My guess is he's still around," Dr. Cantor said. "Knowing that bastard, he's probably sitting down in Florida, laughing himself silly every time he thinks of us wrestling with all this bureaucratic bullshit."

Traynor used his gavel. "Please!" he called out. "Let's maintain some order here."

Cantor's bored expression changed to disdain, but he remained silent.

Traynor glared at Dr. Cantor before resuming: "Whatever personal feelings we may have about Dr. Hodges, the fact remains that he played a crucial role in the history of this hospital. If it hadn't been for him this institution would be merely another tiny, rural hospital. His welfare merits our concern.

"I wanted the executive committee to know that Dr. Hodges' estranged wife, Mrs. Hodges, has decided to sell her home. She relocated to her native Boston some years ago. She had held out some hope that her husband might resurface, but based on her conversations with Chief Robertson, she has decided to sever her connections with Bartlet. I only raise this matter now because I think that sometime in the near future the board might wish to erect a memorial befitting Dr. Hodges' considerable contributions to Bartlet Community Hospital."

Having finished, Traynor gathered up his notes and formally turned the meeting over to Helen Beaton so that she could give her monthly president's report. Beaton stood up in her place, pushing her chair back from the table. She was in her mid-thirties with reddish-brown hair cut short. Her face was wide, not unlike Traynor's. She wore a businesslike blue suit accented with a silk scarf.

"I've spoken to several civic groups this month," she said. "My topic on each occasion was the financial plight of the hospital. It was interesting for me to ascertain that most people were generally unaware of our problems even though health-care issues have been almost constantly in the news. What I emphasized in my talks was the economic importance of the hospital to the town and the immediate area. I made it very clear that if the hospital were to close, every business and every merchant would be hurt. After all, the hospital is the largest employer in this part of the state. I also reminded everyone that there is no tax base for the hospital and that fundraising has been and will remain key to keeping the doors open."

Beaton paused as she turned over the first page of her notes. "Now for the bad news," she said, referring to several large graphs illustrating the information she was about to relay. She held the graphs at chest height as she spoke. "Admissions for April were twelve percent over forecast. Our daily census was up eight percent over March, and our average length of stay was up six percent. Obviously these are serious trends as I'm sure our treasurer, Richard Arnsworth, will report."

Beaton held up the last graph. "And finally I have to report that there has been a drop in utilization of the emergency room which, as you know, is not part of our capitation agreement with CMV. And to make matters worse, CMV has refused to pay a number of our ER claims, saying the subscribers violated CMV rules."

"Hell, that's not the hospital's fault," Dr. Cantor said.

"CMV doesn't care about such technicalities," Beaton said. "Consequently, we've been forced to bill the patients directly and they are understandably upset. Most have refused to pay, telling us to go to CMV."

"Health care is becoming a nightmare," Sherwood said.

"Tell that to your representative in Washington," Beaton said.

"Let's not digress," Traynor said.

Beaton looked back at her notes, then continued: "Quality indicators for April were within normal expectations. Incident reports were actually fewer than in March and no new malpractice actions have been initiated."

"Will wonders never cease," Dr. Cantor commented.

"Other disturbing news for April involved union agitation," Beaton continued. "It was reported to us that both dietary and housekeeping have been targeted. Needless to say, unionization would significantly add to our financial problems."

"It's one crisis after another," Sherwood said.

"Two areas of under-utilization," Beaton continued, "are the neonatal intensive care unit and the linear accelerator. During April, I discussed this situation with CMV since our fixed costs for maintaining these units are so high. I emphasized it had been they who demanded these services. CMV promised me that they would look into ferrying patients from areas without these facilities to Bartlet and reimbursing us accordingly."