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COO Carl Palanco, who looked to be in a state of continual surprise.
    â€œGood evening, everyone,” Angela said as she sat down. She again glanced around the room. “First, let me apologize for keeping you waiting. I know it is late and you are eager to get home to your families, so we will make this short. The good news is that we are still in business.” Angela glanced at the three presidents, all of whom nodded in a restrained fashion. “The bad news is that our cash-flow problem has gone from concerning to critical. Of course, we felt the situation was critical a month ago, but it has gotten worse.”
    Angela gestured toward Bob Frampton, who shook his head slightly as if to wake himself. He leaned forward, putting his elbows on the table with his beefy hands together and fingers interlocked. “We are rapidly approaching, if not violating, our eighty percent margin on our loans with the Manhattan Bank and Trust. We had to sell some bonds to make a payment to our cardiac stent provider. They were threatening to cut off our supply.”
    â€œConsidering how tight finances are, I want to personally thank you for doing that,” Dr. Niesha Patrick said. She was a young African-American woman with light skin and a scattering of freckles in a butterfly pattern across her nose and cheeks. Like Angela, she had an MBA in addition to an M.D. Angela had recruited her from a large West Coast managed-care company to run Angels Heart Hospital. “With our ORs intermittently closed, our only dependable source of income has been from invasive angiography and cardioplasty. Without stents, even that revenue would be severely impacted.”
    â€œInvasive angiography and Lasik have probably been responsible for keeping us afloat,” Angela said. She nodded in appreciation toward both Niesha and Dr. Stewart Sullivan. Stewart was the president of Angels Cosmetic Surgery and Eye Hospital.
    â€œWe are all doing what we can,” Stewart said.
    â€œAs much of a gold mine specialty hospitals are in the current reimbursement milieu,” Angela said, “they are at a particular disadvantage when their operating rooms close.”
    â€œBut the operating rooms are now all open,” Dr. Cynthia Sarpoulus said defensively. Cynthia was a medical-school classmate of Angela’s who’d gone on to specialize in infectious disease and epidemiology. Angela had hired her when the current nosocomial infection problem started three and a half months previously. Cynthia was a dark-complected, raven-haired woman with a bit of a temper. Angela had been willing to put up with her thin-skinned and often caustic style because of her training, dedication, intelligence, and reputation. She’d been the reputed savior of several institutions with infection-control problems.
    â€œThey might be open, but they aren’t being utilized except by a fraction of our medical staff,” Dr. Herman Straus said. Angela had recruited Herman from a Boston community hospital, where he’d been a well-respected assistant administrator. A big, athletic man with an outgoing personality, he had a particular affinity for dealing with orthopedic surgeons. That quality combined with his Cornell Hospital administration training made him an ideal president of Angels Orthopedic Hospital, and his record was proof of it.
    â€œAnd why is that?” Angela asked. “Surely they know we have been on top of this problem right from the beginning. Cynthia, remind everyone what has been done.”
    â€œJust about everything possible,” Cynthia snapped, as if she was being challenged. “Every OR has been cleaned with sodium hypochlorite and fumigated at least once with a product called NAV-CO 2 . It’s a nonflammable alcohol vapor in carbon dioxide.”
    â€œAnd not without considerable expense,” Bob interjected.
    â€œAnd why that particular agent?” Carl questioned.
    â€œBecause