Sutton's Law by Jane M. Orient, MD and Linda J. Wright

Reviewed by Lawrence R. Huntoon, MD, PhD
Article Type: 
Book Review
Fall 1997
Volume Number: 
Issue Number: 


Sutton's Law is a frighteningly realistic novel about where managed care might very well lead us. Or, as one of the main characters, Dr. Milton Silber aptly describes it, a system "designed by thieves for thieves."

Written by Jane M. Orient, M.D., Executive Director of the Association of American Physicians and Surgeons (AAPS) and co-author Linda J. Wright (Lauren Wright Douglas), Sutton's Law will no doubt take its rightful place alongside Samuel Shem's The House of God and Mount Misery, and Michael Palmer's Silent Treatment. A mix of medicine, mystery, murder, and intrigue with a little high finance, drugs, and romance - Sutton's Law ultimately is about greed and simple justice.

Yes Toto, intern Maggie Altman isn't in Kansas anymore. She's in the big city at the Texas University Regional Preventive Health Center, otherwise known as TURPH. As a new intern in medicine, Maggie counted on major stress and a hectic lifestyle, but in her profession, she never envisioned that anyone would try to kill her. Coming from a background in basic science training in a research lab, Dr. Altman had a natural curiosity about things...things like why certain patients' charts were missing...and why certain patients who weren't seriously ill ended up dead. What could it all mean? And, curiously, the patients' computerized data frequently didn't match the clinical data as Maggie remembered it. Was she crazy, incompetent, or just losing it all in her sleep-deprived state? Was it a simple glitch in the hospital's computer system or was someone manipulating the data, or worse, altering the patient's outcome for profit? And what does this new managed care experiment known as EquaCare have to do with these suspicious discrepancies?

Dr. Milton Silber, former professor of medicine, was fed up with it all. DRG profiles, UR/QAC harassment and EquaCare. Now a financial analyst and publisher of the prestigious Silber Report, who can argue with his plain truth assessment of medicine under managed care: "Treating illness is not very profitable...If you want to make some money, try not treating illness, after collecting the insurance premiums in advance." But Dr. Silber, who wanted nothing more to do with TURPH and EquaCare, kept showing up in the hospital at odd hours, sneaking downstairs to meet his old friend and chief pathologist, Dr. Metzenbaum. Was he a hypocrite or hero? Was he hot on the trail of the bad guys or coldly conspiring with the pathologist?

And, what about Pit Boss, senior level resident and "gate-keeper" extraordinaire, Dr. Brent Stemmons? He seemed to have it all under control as "captain of the bridge" in the ER. He had the clinical skills of the "Fat Man" (The House of God, by Samuel Shem) and knew his way around the DRGs and computer printouts which he dutifully provided to the chief resident, Dr. Stephen Blaine, on a regular basis. Keeping track of residents' DRG profiles and cost-effective management was a high priority for EquaCare and TURPH as it is for real life managed care companies. Those residents who had the misfortune of getting stuck caring for the sickest patients ran the risk of deselection from the program, or in Maggie's case, being sent back to the research lab. Maybe Brent Stemmons, being a fellow resident, would understand Maggie's plight and help her solve the puzzling discrepancies at TURPH; besides, he was handsome, and Maggie owed it to herself to pursue a life outside of the day to day drudgeries of the hospital.

This intriguing and delightful novel weaves in and out of various people's unusual lives both inside and outside of TURPH. The reader is intrigued and tantalized by titillating and convincing conversations between mysterious persons whose true identities remain hidden until the end. Little hints here and there, and cryptic clues throughout are present, just enough to keep the reader hopelessly hooked. The pages turn quickly and the chapters are short. Maybe the next chapter holds the key? Maybe the key is in the relationship between Sutton's Law and Law Number IX? But what exactly is "Law Number IX," and just who was Willie Sutton anyway?

Sutton's Law is a definite winner. It will keep you at the edge of your seat. This suspense thriller is destined to become a popular classic and is a natural addition to the personal libraries of those physicians and others who have a true appreciation for what managed care is about and how it really operates. It gives hope and an overwhelming sense of true satisfaction to those who believe in simple justice - and perhaps, the triumph of good over evil!

Reviewed by Lawrence R. Huntoon, MD, PhD
Jamestown, NY.

Originally published in the Medical Sentinel 1997;2(4):148. Copyright © 1997, Association of American Physicians and Surgeons.

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(Sutton's Law by Jane M. Orient, M.D. and Linda J. Wright, 299 pp., Hardcover, $21.95, ISBN 0-9461077-1-6, Macon, Georgia, Hacienda Publishing, Inc., 1997.)

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