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  “And I meant what I said.”

  Her eyes widened. “You mean you’ve decided not to contribute?”

  “That’s right.”

  “Why, if I may ask? Is it a matter of money?”

  “The problem isn’t money,” I replied. “The problem is safety.”

  She had heard the word before, and not in a pleasant context. “I see.”

  “You hear things about the blood supply these days. About it being risky.”

  “Alarmists, I assure you. As the form indicates, we test our product thoroughly before distribution.”

  “You mean for AIDS and stuff.”

  “AIDS. Hepatitis A, B, and C. HTLV I. We run tests for things you’ve never heard of. The fact is, the blood supply in this country is as safe as it can be.” She lowered her voice and leaned forward. “Besides, you’re forgetting something.”

  “What?”

  “Any risk that remains in the blood supply lies with the recipient of the product. You, sir, will simply be a donor.”

  “You can’t get AIDS from donating blood?”

  She summoned the full force of her vocation. “There is no record of such an instance.”

  “You’ll pardon me if I say that’s less than entirely reassuring. I wonder if I could talk to the boss around here, maybe get some more—”

  A noise behind me indicated my blood buddy had finally finished his form and was impatient to deliver it. I decided to let him finish his business before I fenced with Ms. Glad some more. “I think I need to think it over,” I told her.

  Ms. Glad looked at me and then at the transient. “Very well. But there will be no fee; we never negotiate.”

  I returned to the table to wait for a chance to probe the operation further, mainly so I could get a line on the Dracula character, who was apparently acquainted with both Nicky Crandall and Lex Chadwick.

  As I sat down, I heard the other man ask if head lice were a virus. Ms. Glad blanched, then glanced at the form, then shook her head with increasing vigor and said something I couldn’t hear.

  “You mean I flunked?” the man protested with as much injured outrage as his battered psyche could muster.

  “I’m afraid at the moment you don’t meet our requirements,” Ms. Glad answered kindly. “You shouldn’t regard it as an affront.”

  “Dracula said I’d pass for sure.”

  Ms. Glad grew stern. “Dracula, as you call him, is not qualified to render that opinion.”

  “He works for you, don’t he?”

  “I believe he occasionally performs services as an independent contractor.”

  “Indep—” The man lacked the energy to complete the phrase. “So I’m out.

  “I’m afraid so.”

  “If I don’t get paid, he don’t get paid. Right?”

  “I’m afraid no one gets compensated at this institution,” Ms. Glad pronounced primly. “We are a nonprofit organization.”

  The man squinted at her with a sudden flash of brotherhood. “Me, too.”

  Ms. Glad smiled despite herself. “I wonder, have you seen a physician recently, sir? There’s a clinic down on Ellis Street, I’m sure they—”

  The man held up a hand. “I been there before—all they want is to stick me with a needle. I used to be a junkie; I had all the needles I can stand.”

  “But you seem … ill.”

  The man shrugged. “I’m better than I used to be,” he said, and shuffled off to the bosom of the Tenderloin, leaving Ms. Glad and me regarding each other in a mix of amazement and thanksgiving.

  I joined her at the desk. “They come in several times a week, some of them,” she murmured, her thoughts still on the transient. “They’d sell a pint a day if we let them.” She sighed, then blinked at her sorrow. “Have you reached a decision?”

  “I have.”

  “And?”

  “I’m too chicken.”

  “It’s virtually a pain-free procedure.”

  “It’s just that I had a bad experience once.”

  “With a transfusion?”

  “With a trained technician.”

  I had decided to ask if Nick Crandall was one of their regulars when a finger poked me on the shoulder. I turned to see the taller of the Healthways paramedics who’d confronted me at Jan and Nick’s apartment.

  “Catch him?” I asked affably.

  He glowered and shook his head. “No trace. Which makes us think maybe he wasn’t there at all. We think maybe you were playing games with us.”

  “Why would I do that?”

  “That’s what Don and me were wondering.”

  “It’s a puzzle all right. Let me know if you come up with an answer.”

  The paramedic crossed his arms. “What the fuck you think you’re doing here, pal?”

  I looked around. “I’m thinking of giving blood. I’m sure as a healthcare professional you applaud that.”

  “You claim you’re giving blood. Before that you claimed you lived in the same dump as Crandall. I think you’re lying both times.” He looked at Nurse Glad. “He been processed yet?”

  “He changed his mind,” she said tentatively.

  The medic nodded. “He does that a lot. For instance, I bet he’s changed his mind about where he lives.”

  “You’re right. I was confused before.”

  “Yeah, well, what confuses me is why you’re poking your nose in Healthways’ business.”

  I met his bluster with some of my own. “And I’m confused about what Healthways’ business is.”

  The medic started to fence with me again when his partner peeked through the door. “Let’s roll, Ron. Base says they’ll handle it.”

  The tall one started to debate the point but finally yielded. His attention swiveled to Ms. Glad. “Where’s Dracula?” he asked gruffly.

  “I haven’t seen him today.”

  “You tell him to come by the clinic. We need to talk to him.”

  “I’ll give him that message.”

  Ron nodded and headed for the door. Before he reached it, he turned back. “I don’t want to see you again, pal.”

  “Then I better start taking better care of my health.”

  “You do that while you got the chance,” he said, and was gone.

  I looked at Ms. Glad. “They’re more like MPs than paramedics.”

  She wouldn’t engage in gossip. “Healthways has a very aggressive health-services program.”

  “What do you suppose they want with Dracula?”

  She made a face. “He’s such a repulsive creature, I don’t know why anyone would get near him.” She looked at me. “What are you doing here, anyway?”

  I smiled. “You ever hear of a man named Nicholas Crandall?”

  “The name isn’t familiar.”

  “You’d know if he was a regular donor, right?”

  “Probably. Why is he important?”

  “I really don’t know,” I admitted, and not for the first time. “Who runs this place, by the way?”

  “You mean this particular center?”

  I shook my head. “The whole operation.”

  “The Fremont Memorial Blood Bank is a nonprofit corporation, doing business exclusively in San Francisco,” she recited. “We are the second-largest blood bank in the area, next to Irwin Memorial. We were established in 1986, when the Red Cross ceased collecting blood in the city. Our chairman is a man named Norman Glasswell. Our headquarters are on Divisidaro, near Sacramento.”

  “Does Richard Sands have anything to do with Fremont?”

  “Not that I know of.”

  “How about Lex Chadwick?”

  “I believe he’s on our board.”

  “You’d better tell Glasswell that there’s something fishy going on around here,” I said.

  Ms. Glad looked even more worried than when I’d come in. “I think he knows that already.”

  “What do you mean?”

  “I’m not sure. I just know there’s a problem of some kind. The b
lood people in the Bay Area are very concerned. Even the FDA is looking into it.”

  TWENTY-FOUR

  I went back to the office and made some calls, mostly without success. Dr. Marlin wasn’t at Healthways or anyplace else anyone would admit to. Ellen Simmons wasn’t at work or at least wasn’t being allowed to come to the phone. Although I tried half a dozen other numbers, the only one who talked back was my stockbroker.

  Clay Oerter was my broker only in the sense that I’d lost enough money to him playing poker to figure he owed me a favor in the form of some top-of-the-head information from time to time. To give him his due, he seemed to think so, too.

  “Clay.”

  “Marsh.”

  “How’s the market?”

  “Off seventeen. Apparently the war boom is ending except for the run-up on Raytheon. How’s the mayhem?”

  “Bullish as usual. Tell me about Healthways.”

  “Healthways. Hmm. Well, for one thing you can’t get a pure play in it anymore, not that I’d recommend it if you could.”

  “Background, s’il vous plaît.”

  It must have been my accent that made him laugh. “Back in the sixties, Healthways seemed like an idea whose time had come. So thought its founder at least, a man named Eric Rattner. Rattner was a veritable Renaissance man—physician, philosopher, patron of the arts, humanist, philanthropist, even an erstwhile playwright if I remember correctly. He’d made a ton of money in downtown real estate and decided to plow most of it back into his first love, which was health care. Specifically, Rattner wanted to insure the delivery of quality medical services to people who couldn’t afford to pay for them. What he did was put together a vertically integrated HMO funded not by employer contributions or private subscriptions but by the state and federal governments.”

  “An HMO is what?” I asked.

  “Health Maintenance Organization. A privately financed health program, basically. Rattner didn’t originate the concept—Kaiser had been around for years before Rattner started cranking up—but Rattner was the first to try to integrate an HMO from top to bottom and most definitely the first to direct his efforts toward the poor and unemployed rather than the middle class. Basically, instead of having individuals or employers come up with the money to fund the system, Rattner relied on Medicare and Medicaid and MediCal to pay the freight, gambling that the efficiencies of vertical integration coupled with a ruthless program of cost controls could make the concept work.”

  “I know about the clinics. What else does Healthways do?”

  “The clinics were the first step—the walk-in med centers you see in major cities on the West Coast. The next step was to open a string of emergency hospitals smack in the middle of the ghettos—primary care only, very few beds, no long-term treatment. Then Rattner set up an extensive outreach to the surrounding community through a fleet of EMS units.”

  “Ambulances.”

  “Right. But these were ambulances with a difference—the Healthways units not only provided emergency services, they also provided follow-up monitoring and even at-home care in some circumstances—house calls, if you will. They undertook some pretty intensive wellness training, too, through educational and testing programs in the local schools and workplaces and social service agencies.”

  “Sounds like a good deal.”

  “It was a good deal from a medical point of view. From a financial point of view, it was marginal. The kicker was supposed to be when Rattner linked the neighborhood operations to a small drug company he set up to concentrate on manufacturing generic medicines that poor people use a lot—hypertension agents, analgesics, antibiotics, nutritional supplements, stuff like that. At about the same time, he bought up a small hospital-supply business so he could get some control over the outrageous costs of outfitting the operation.”

  “Clever.”

  “More than clever—brilliant. And daring. What Rattner figured was that the last two enterprises—the drug company and the supply outfit—would be profitable enough to absorb the losses generated by the more prosaic elements of the enterprise.”

  “Was he right?”

  Clay sighed heavily. “The Healthways story is a tragedy, pretty much. After he went public, the stock soared for a while—up to forty times earnings back in the early seventies, a real flyer. But it was a dream, mostly—everyone on Wall Street certainly hoped it would work, if only for the reason that if it did then they wouldn’t have to worry so much about all those poor people anymore. But just as Rattner got all his ducks lined up and was ready to subject his concept to the rigors of the market instead of the fantasies of investors, several things happened. The country went into the recession of seventy-two. Plus, benefits and coverage under Medicaid began to decline dramatically as a result of budget cuts—in the beginning the program covered something like three fourths of the people below the poverty line; now it’s less than forty percent. Plus, our kind old Congress decided not to let Medicaid—the poor people’s program—pay as much for certain services as Medicare—the old people’s program—paid for the same procedures. All of which meant Healthways couldn’t keep up with the raging inflation in health costs because its clientele was on the short end of the political stick. And finally, Eric Rattner had a stroke. He lingered in a vegetative state for years while his brainchild crumbled to dust around him. Died about five years ago, I think. Came close to being another Kaiser or Carnegie. Now no one knows his name.”

  “But Healthways is still operating. I was at one of their clinics yesterday.”

  “Right, but it’s not Rattner’s baby anymore. Healthways stumbled along under its own power for a while—it took a few years for the social-service bureaucrats to realize it wasn’t working and to use any excuse they could come up with to deny funding. The stock fell to nothing—Healthways was on the brink of receivership for years. Then a year or so ago the whole kit and caboodle got bought out for peanuts in a not particularly spectacular takeover move.” Clay chuckled dryly. “It probably won’t surprise you to learn that the new owners have slightly different motivations than poor old Rattner.”

  “Like what?”

  “Turning nonprofit HMOs into profit-making healthcare corporations is a big deal now—Healthways is only one of several examples. In their last appearance before the analysts, the Healthways people claimed to anticipate earnings jumps of at least twenty percent per year through the rest of the decade.”

  “How are they going to get them?”

  “I don’t follow the stock that closely, but it seems to me there was some talk about additional efficiencies in the hospitals, new drugs in the pipeline, an anticipated growth in their market—the usual bullshit. A great way to invest, when you think about it—a pure play on poverty.” Clay’s laugh was uncharacteristically mordant. “Let’s put it this way: The analysts were underwhelmed. The stock hasn’t made a move in years.”

  “The new owner of Healthways wouldn’t happen to be Richard Sands, would it?”

  Clay whistled. “Your perspicacity never ceases to amaze me, Marsh. If you put that sixth sense to use in the market, you’d make a mint in no time.”

  I laughed. “I’ll start buying stocks when Wall Street stops letting guys like Sands treat the market like a private sandbox.”

  “Hey. That was the eighties. Nowadays guys like Sands are barely hanging on. I hear he left for Toronto this morning, trying to get a bridge loan to take him over his next interest payment.”

  I was surprised: Apparently my client had misled me about the extent of her husband’s fortune. “Sands is really on the edge?”

  “Fingernail City. He’s sold off two subsidiaries in the past six weeks, and rumor has it there’s more to follow. Tidy balance sheets, too; lots of upside potential once we get out of the recessionary psychology we’re into now. Sands let them go for a song.”

  “Why’s he strapped all of a sudden?”

  “Nothing special that I know of, just the credit crunch that’s the handmaiden to the b
ank and S and L crises, in addition to the recession, of course—plus his debt overhang. The Street says his bankers read him the riot act—no more rollovers on the notes; word is they came to the meeting with their foreclosure specialists. Sands countered with his bankruptcy boys, of course, but Sands was the first to blink. So it’s off to Toronto on a shopping spree. I hear if he doesn’t connect in Canada, the next stop is Singapore.”

  “What would it take for Sands to turn it around?”

  “A miracle in the form of several million bucks of cash flow, primarily. Happened every day in the Reagan years—if you needed dough, someone was always there to make some for you. Rights, warrants, junk—all they are is new forms of money.”

  “The Constitution says only the government can print money.”

  “What Constitution?” Clay asked with mock innocence. “Anyway, Sands is scrambling. I wouldn’t bet against him, either: He won’t go down without a fight, and if he does go down, he’ll take lots of people with him. I hear folks are bailing out of Sandstone in droves. And melting their memory chips behind them.”

  “One more thing,” I said.

  “Shoot.”

  “Tell me what you know about blood.”

  “Are you serious?”

  “Yes.”

  “Blood. As in the blood business, you mean?”

  “Right.”

  “Well, it’s big, for one thing. Several billion a year in sales of blood and blood products. A person has a ninety-five-percent chance of needing either a transfusion or a blood product at some time in their life. A pint of blood that’s given for free to the Red Cross can be worth over five hundred bucks when it’s broken down into by-products—plasma, platelets, stuff like that—and sold off to hospitals.”

  “What’s the word on safety?”

  “You mean the AIDS problem, I suppose. Well, there’s no question that the blood banks—the Red Cross and the private banks both—didn’t respond quickly enough to AIDS. Randy Shilts lays this out in his book—basically, between the time AIDS was discovered in 1983 and the time the blood people finally began testing for it, which wasn’t till 1985, a lot of bad blood got into the system. Hemophiliacs were the chief victims since they use so much of it—over half the hemophiliacs who were getting blood back then ended up with the virus.”