The Bouncing Buns Gentleman's Club

Chapter 5

"We're already starting to have the usual rash of Friday cancellations. If you add in the no-shows we're likely to have, it might be a pretty good, uh...I mean, light day," Sue said as she tried not to appear overly happy that no one was likely to show up.

"What about Dana Martin, Sue? Remember, that evaluation I need to finish from yesterday?"

"They haven't called, so there isn't any indication they aren't going to show up, doc, but you know how it goes. I guess we'll just have to wait until two and see. If they call in to cancel before then, I'll let you know. By the way, your eight o'clock didn't show up so you might as well grab some coffee and relax awhile."

Beverly took Sue's advice and spent the time as she suggested, sucking down a cup of black coffee. It hadn't been sitting long and actually tasted pretty good for clinic brew.

Thank God for legal stimulants, she thought.

Not only did her eight o'clock not show up, but neither did her eight-fifteen, eight-thirty or eight forty-five. Although an unfortunate waste of time, the four no-shows gave Beverly an opportunity to relax a bit and get coffee'd up before the mandatory nine am, Friday staff meeting chaired by the clinic director, Max Bollard.

Max was a former college football player turned administrator after a short stint as a car salesman. Unfortunately, Max came off as too aggressive to be successful in that line of work and was, as he would say, "laid off." Rumor had it that after allegations of customer intimidation and subsequent loss of business came to the attention of management, he was encouraged to seek some other line of work.

Max was usually the first one to arrive, an obvious indication of the importance he placed on these meetings, and the relative lack of importance most of the others in the room did. He usually wore a tattered sport coat and outdated paisley tie. His shirt was white poplin with a buttoned-down collar. Max usually wore heavy wing tip shoes so stiff they didn't bend when he walked. This caused him to make two sounds with every foot step. The first was a clunk as the heel hit, followed immediately by the slap of his lead-like shoe sole against the floor.

Max was no longer an attractive man, if he ever had been. He'd long since pulled most of his hair out coping with the many frustrations of trying to run a mental health clinic in an environment of ever-decreasing funding, and the reluctance of his psychiatrists to do things his way. The muscular physique of a former athlete had long since softened and had been infiltrated with fat, as seems to happen with most muscle not constantly attended to with vigorous exercise. He did maintain his testosterone-enhanced voice, however, and was always the dominant figure at the head of the table.

The professional staff of five psychiatrists was quite large by community clinic standards, and they all seemed to have their assigned seats. It was almost as if there were name placards at each place, although no formal assignment of seating had ever been imposed.

As the newest member of the staff, Beverly was easily able to recall her first meeting. She had avoided sitting down too soon so as not to take one of the unnamed, but reserved seats which happened to be situated as close to the door as possible.

It seems almost like an adversarial relationship... him against us, Beverly thought as she settled into what she knew was an unclaimed spot, now with her invisible placard reserving it.

As her colleagues slowly came in, Beverly thought about Max and the fact that, from her perspective, he ran a pretty tight and efficient organization for its type. It was necessary, given the minuscule funding available for mental health services these days and left no room for waste or inefficiency in the system.

Agencies such as his had to operate on a shoestring and there wasn't always enough money to pay and keep good people on staff. She could empathize with Max's problems making everything work and had something of an appreciation for his ability to do so. Beverly wasn't overly concerned about her own salary at the moment. She'd been in the mental health system long enough to know that community psychiatry wouldn't pay well, but there were other benefits.

Beverly's job enabled her to live where she wanted and was sufficient to pay her bills with a little to spare. This gave her cause to wonder about the other doctors at the clinic though, ones that had been there much longer with families to support and other responsibilities. So far, she liked the work and most of the people there, but was concerned about them and how they were able to make ends meet.

The meeting hadn't been in session long when Max said, "Beverly, I wanted to ask you to watch your diagnoses. We've been getting some evaluations from you with diagnoses we can't bill for and if we can't bill for them, we can't serve them."

Max had already come by to remind her that a patient did not qualify for services with the diagnosis she had given; perhaps he or she could qualify for something that actually would pay us something?

"Thanks for reminding me Max, and I understand your position, but these administrative coding problems have nothing to do with medicine. It puts us in the position to either leave someone without needed services, or to lie and give them an inflated diagnosis in order to try and help them. As a result, they get a psychiatric diagnosis on the books that could cause them work-related issues and other stigmas later."

"I feel your pain, Beverly, but that's the way it is. We can't serve everyone. Our funding is just for the major mental illnesses, you know, the big four: major depressive disorder, bipolar disorder, schizophrenia, and schizoaffective disorder. I don't like it any more than any of you do."

"Another thing, Beverly," said Max.

Oh boy, this is certainly my day... what else? She thought.

"I understand you've scheduled an hour and a half to do a psychiatric evaluation. You realize we can only bill one hour for initial evaluations. Do you know how much that will mean in unrecoverable cost to the clinic?" Max asked, visibly tired of the same old battles.

"Yes, but it couldn't be helped, Max. I had the child, her irresponsible mother and her stepfather in the room all complicating and dragging the evaluation out. There were family relational issues that slowed things down as well as it being a very complex case to start with. These things just happen once in awhile, Max. The kid was obviously intimidated by the stepfather and I needed more time to flush things out. There are likely even some abuse issues to worry about."

"I just want you to be aware of the repercussions these sorts of things have on our ability to stay afloat, Beverly. Too much of this and the doors have to close for everyone!"

"Believe me I do, Max, but to have done it any other way would have been irresponsible and unprofessional. These things are going to happen, not very often thankfully, but they will happen. By the way, you won't like this either but we had to schedule her return visit during the latter part of our meeting. I have to get back to the office now."

Max sighed, rolled his eyes and motioned for her to go. The others remained in their seats, all of them smiling and looking a bit envious while wondering how much longer Max's meeting would drag on this time.