Two nurses at a hospital reception desk complain about a whiny patient who keeps buzzing them with requests. One goes to take care of her latest request, but is interrupted by a man yelling for help and saying that a patient, Michael Jones, is on the floor. As they run, the man says that Michael isn't breathing. The nurse enters the room to find Michael being cradled by his mother Ashley. Ashley screams for help. Both nurses have come in by now, and one calls a Code Blue and requests a crash cart. Michael is given air as his mother screams, but the nurses are unable to save him. Green and Cassidy talk to the first nurse to enter the room. She says that the only people present besides Michael were his mom, Ashley, and the man, Ashley's publicist. The nurse thinks that foul play was involved, since Michael was healthy right up until he died. Cassidy says that people die despite being previously healthy all the time, and cites an Uncle Harvey who had a heart attack. The nurse says that this is unlikely, since Michael was young and in his prime. The nurse leads them to the room, which is a mess, and says that no one touched anything since Michael was pronounced dead. Cassidy notes that the boy was spitting up blood, and the nurse says that his lungs filled up with blood — which is a symptom of some poisons. Green asks for Ashley, and the nurse says that she's sedated down the hall. Green finds her bag, which includes a change of clothes, books, and a cell phone. Cassidy asks who else was in the room, but the nurse doesn't think that anyone besides the staff would have been around. The detectives find a hospital dinner sitting on a table. Then Green realizes, from the change of clothes, that Ashley was the patient, not Michael. Cassidy wonders if Ashley was supposed to be the victim. In a room, Ashley swears she knows who killed Michael.
"That son of a bitch killed Michael! Now, what are you going to do about it?"She says that her stepson, Miles Foster, and his sister Hillary are contesting the will of their father William. William's will left everything to Ashley, but his children want a share. The will is for forty-six million dollars. Ashley breaks into tears, complaining that they never had any time together. Cassidy says that it's possible that she, Ashley, was the target, and she's stunned. Green asks if Foster has threatened her before, and Ashley says that he's threatened her repeatedly and had people follow her. She also says that, right now, the will is tied up in probate, but if she dies, the Fosters get it all. At his luxurious home, Miles Foster complains about being accused of murdering Michael.
"Well, we believe that someone intended to poison her."He claims that he was about to win the lawsuit and so had no reason to kill Ashley or Michael. Green asks how Ashley got a claim to his will in the first place, and Miles says that Ashley married William when William was already ninety-two and becoming ill. She, Miles says, tricked William into amending his will. Cassidy says that William might have just loved her, but Miles disagrees and says that Ashley schemed endlessly to get the money.
"Well, I applaud them for the effort, but I assure you I had nothing to do with it, detective."
—Ed Green and Miles Foster
"Knowing her, she probably killed her own son just to accuse me."Asked about the threats and stalkers, Miles says that he and Hillary hired a private investigator to document her lifestyle. He refers them to his attorney. The attorney and her private investigator, Frank Simon, say that William Foster was senile, and Ashley manipulated him until the prenuptial was abolished and the will amended.
"That's not gold-digging. That's grave robbing."Green points out that Miles appears to have a very strong motive, but the lawyer says that they're going to win the lawsuit. She has an affidavit from Ashley's personal trainer that the two of them were having an affair. Cassidy asks why the trainer told Simon, and Simon says that Ashley abandoned the trainer after William died. Green asks if there were any more people like the trainer, and the lawyers says that there were many. Green asks where Michael fits into this, and Simon says that he's been raised by relatives his whole life and barely interacted with his mother. The detectives wonder why Michael returned in the first place, and Simon says he was hitting up his mother for money. He shows them photos of Michael buying drugs with the money. Green approaches Van Buren and says that the toxicology report was negative — the food wasn't poisoned. Cassidy is at narcotics trying to track down Michael's dealer, and Medical Examiner Rodgers doesn't have a definitive cause of death yet. Van Buren says that he needs to ask Rodgers again so they can make some progress, but Green says that Rodgers is tired of talking to him.Van Buren is about to when Cassidy comes in, having identified the dealer as a low-level criminal named Marco Penzler. Reading his rap sheet, Van Buren sees a bench warrant on a drug charge, and Cassidy points out an attempted murder charge as well. There wasn't enough evidence to charge him, but he was once suspected of selling poisoned drugs that hospitalized a kid. The cops wonder if Penzler poisoned Michael. Green remembers that Michael's cell phone had a call they couldn't trace; it could connect to Penzler. Van Buren authorizes Penzler's arrest. Penzler, in interrogation, wonders why the Homicide department is interested in him. They ask about Michael. He denies poisoning the other victim, and says that he didn't sell Michael any drugs that day because he was out. He says that models from Fashion Week cleaned out his whole supply. He predicts that Michael got contaminated drugs elsewhere and died from those. Green says that he thinks that Michael owed him and wasn't paying up, so Penzler gave him bad drugs. Penzler says that Michael never had money problems. Cassidy wonders who Michael hooked up with if not Marco, but Penzler doesn't know. Green gets a message on his pager that Rodgers is ready.
"Perfect. Well, Marco, in about ten minutes we'll know if you're on the level."Rodgers says that Michael had heroin and prescription medication in his system, but he actually died from a brain tumor. Cassidy recalls that Michael complained of a headache before collapsing and probably had a major seizure. Green asks if Michael had cancer, but Rodgers says she's still calling it a homicide. She says that the prescription drugs in his system were immuno-suppressents, so that his body wouldn't reject foreign organs — in his case, new legs. Rodgers shows them x-rays of his legs, which have extensive bone grafts. Green realizes that Michael got cancer from the grafts.
"…first class surgery with third-rate donor material."Cassidy wonders how this could have happened, and Rodgers say that no legitimate tissue bank would have let this happen. Green is disbelieving. Rodgers then says that the cancer Michael got was ovarian cancer — obviously impossible for him to get naturally. He definitely died from cancerous bone grafts. Green tells Van Buren that the surgery was legitimate but the bones themselves weren't. Van Buren wonders if the bones were stolen from dead people, and Green says that it's likely. Cassidy warns that there will be a health crisis if the contaminated body parts wind up in general distribution, but Van Buren cuts her off. Van Buren asks who else knows about it, and Cassidy reports that the health department is contacting area hospitals. Van Buren asks for leads, but Green says they have none. They do have a very rough timeframe of when the bones were grafted into Michael's body — about eighteen months ago. Cassidy points out that Michael was a heroin addict living on the street then and was likely uninsured. Van Buren doubts that any real hospital would help him without insurance. Cassidy notes that someone must have really wanted to help Michael, since the bone graft was extremely expensive. Van Buren tells them to talk to Ashley again. Ashley says that Michael admitted he'd been homeless and on drugs, but she forgave him. She admits to being a poor mother due to a drug problem of her own, but says she was trying to be better. She doesn't know anything about the surgery. The only thing she can tell them is that Michael had a girl named Natasha over a few weeks ago. Natasha's shirt had the name 'Delaney's.' At Delaney's Restaurant, Natasha Clayton tells the cops that she and Michael met when they were homeless junkies. She quit drugs and lost contact with him until a few weeks prior, when she tried reconnecting with him. However, he was still using, so she left. Cassidy asks how Michael injured his legs, and Natasha says that they were stealing an airbag from a car when they were spotted. Michael took off across a busy road and got run over by a taxi. The paramedics wouldn't let Natasha go with him, and she never found out which hospital he went to — the nearest hospital, which she checked, didn't have him listed as a patient. Green asks if Michael was admitted under another name, and Natasha recalls that Michael did have a stolen ID, which he got from another car. She gives the name as Hubby W Ilson. Dr. George Amiri reads a chart for Wilson's name, and it says that the patient had two shattered femurs. Green asks if the hospital gave him the bone grafts, but Amiri says no — the man with Wilson's ID, Jones, didn't have health insurance. Green asks what would have happened next.
"Well, if you can't pay, you get the blue-light special. In this case, double amputation."Cassidy is stunned, but Amiri blames bureaucrats. Green asks how Jones could have gotten bone grafts, and the doctor says that he probably transferred out. Wilson's chart is missing some pages, so the doctor doesn't know where Michael was taken. He tells the detectives about a clinic in Manhattan that sometimes does charity bone grafts. The program is run by a Dr. Adam Vaughn. Then an alarm goes off and Amiri rushes to tend to another patient. Vaughn tells the detectives that he highly doubts that the bones he used caused Jones's death. He says his clinic uses several tissue banks and the bones could have come from anywhere. Cassidy asks how the uninsured patients are covered, and Vaughn responds that grants and donations make up the difference. His clinic has an annual budget of fifteen million dollars, and most of that subsidizes patient care. Green asks if Vaughn occasionally cuts corners, but Vaughn says no. Vaughn says that the odds of Jones contracting cancer from bones is minute and that Jones must have gotten the cancer from some other source; as for the bones, he doesn't know the source. All he has is the donor's death certificate, which does show that the corpse — Karen Kendall — didn't die of cancer. Karen's parents, Alexis and Thorn, talk to the detectives about Karen's death. She was driving home from college when she was hit by a truck. She was proncouned brain-dead and was taken off life support shortly thereafter. Her organs and tissue were not donated — the family couldn't bear to part with her remains. The Kendalls say that the hospital they used was Chase General. The parents are stunned to hear that someone donated Karen's bones regardless. Cassidy asks if Karen had cancer, but Alexis says no.
"She was in peak health. She ran marathons!"The detectives say they'll need to look at Karen's remains, but Alexis says that Karen was cremated. Cassidy asks for the cremation service, and the Kendalls direct the cops to Tony Bicks and Bicks Funeral Home. Bicks says that the cops should talk to the hospital morgue. The cops say they know Bicks signed out Kendall's body two hours after Kendall died. Bicks denies taking the body until the cops say they have the sign-out sheet from when Bicks took the corpse, at which point Bicks admits to taking it. Cassidy asks what the rush was, and Bicks says he was probably at the hospital for another run. Cassidy says that Kendall was the only body that day. Bicks is annoyed and asks what Cassidy is getting at, and the cops say they think Bicks took the body so quickly so that her remains could be harvested. Bicks says that the cops are making unfounded accusations, so Green asks to see Bicks's records. Bicks says that his attorney will need to be notified. Cassidy threatens to get a warrant, so Bicks tells them his attorney's firm. He goes to leave, but Green tells him that he should call his attorney himself. Green and Cassidy tell Rubirosa that Bicks got 278 bodies over the past few years; 213 gave no consent for donation, but many of their names are showing up on donor lists regardless. However, no one is willing to admit that they bought directly from Bicks. Rubirosa is concerned that the harvested body parts could be scattered across the country. Cassidy notes that Bicks called Vaughn's clinic frequently, but that doesn't meant that Vaughn necessarily knew what was going on — Bicks was forging death certificates and consent forms. Green adds that Vaughn was unhelpful when talking to them. Rubirosa asks how much money was involved, and Green begins reading off a price sheet. One body is worth more than $200,000 without even counting organs. Bicks doesn't have enough money in the bank to indicate that he was selling the parts at market value. Cassidy is sure that Bicks is hiding the money, but Rubirosa says that, regardless, he's not responsible for Jones dying. Green asks if they can get Bicks for larceny and forgery, but Rubirosa says they first need to prove that Bicks robbed the corpses himself. Cassidy comments that not all the bodies were cremated; the bodies can still be examined. Rodgers shows the detectives a couple of bodies.
"This was pure slice-and-dice."Rodgers say that bones, tendons, and veins are missing. One corpse has plumbing pipes in its legs to maintain the shape of the body so that nothing would be noticed at the funeral viewing. Bloody gloves and aprons were sealed up inside the corpses too. Cassidy asks if they can trace any of it to Bicks, and he says that they got some fingerprints off of the pipes in a leg, and CSU matched them to Bicks. Later, at Bicks's Funeral Home, Bicks is arrested during a viewing. In court, Bicks is aranged for grand larceny and forgery. His attorney, Ms. Prescott, pleads him not guilty. Rubirosa wants remand, arguing that since Bicks forged death certificates, he could forge his passport. Prescott points out that the charges are relatively light, so bail shouldn't be significant. Rubirosa says they're still investigating additional charges while they exhume bodies. Judge Janice Goldberg asks if all the victims were already dead, but Rubirosa says that Bicks's actions implicate him in Jones's murder. Goldberg says that it's a very tenuous connection between Bicks and Jones. Rubirosa argues that a murder charge may be filed, so Prescott says that they can revisit bail if the charge is actually submitted to the court, but in the meantime, low bail seems appropriate. Goldberg sets bail at $300,000.
"He can't make that, Your Honor."Rubirosa tells McCoy that Bicks will post bail the next day and Prescott won't talk about a plea. McCoy says that Prescott is waiting on the murder indictment to see if the charges are really filed. McCoy says that he finds it hard to believe that Vaughn didn't know where the bones came from. Rubirosa says that it's circumstantial, and that the phone calls between Bicks and Vaughn could be argued to be related to fundraising. Bicks often donated to the clinic, and Bicks's illegal profits could have been sent to Vaughn as donations — there's still no indication where the money from the bodies went. McCoy wonders what Vaughn had to say, but Rubirosa says that Vaughn lawyered up, and his attorney, Dave Seaver, is a criminal law attorney (and not a malpractice one). McCoy says that this is telling. Rubirosa sighs that they have no proof of Vaughn's knowledge unless Bicks rats him out. McCoy says that they need the clinic's records. Rubirosa doubts that they can get a subpoena, but McCoy notes that many of the judges have had transplants themselves, and will be nervous about a possible source of contamination int the organ and tissue banks. Rubirosa approaches a boy named Jason Carter, playing basketball, and compliments him on his skills. Jason smiles and says that he's got a basketball scholarship to Georgetown. Rubirosa confirms that he's really Jason.
"Maybe he's got something he can sell."
—Mr. Prescott and Janice Goldberg
"Man, I must be dreaming you came here looking for me."Rubirosa identifies herself and says she needs to talk about Dr. Vaughn. Jason confirms that Vaughn gave him knee surgery. At his home, his mother Tanya says that Jason smashed his knee badly at the end of his junior year of high school. She is surprised to hear that the bone they used to heal Jason was stolen, and possibly carcinogenic — the bone was also from Karen Kendall. Jason doesn't believe that Vaughn would do something like give someone a cancerous bone. Tanya asks why Rubirosa is there, and Rubirosa says that they have to be able to prove that the cancer came from Karen. Thus, they need to take a biopsy from Jason's knee. Tanya is unwilling.
"I understand this is an unusual request."Rubirosa says they need the biopsy for the case, but Tanya refuses and says she'll call Dr. Vaughn. Rubirosa tries to dissuade her, but fails. Rubirosa finally says that she's willing to go to court to get a judge to order a biopsy to be taken. Tanya is still not willing to volunteer Jason to have the biopsy. Tanya's lawyer argues that the state has no right to take the biopsy, and Jason has no obligation to give it. McCoy says that, logically, the state must have some recourse when investigating cases involving stolen body parts. The lawyer says that Jason is an innocent third party and should not be compelled to undergo the biopsy. McCoy says that Jason might be a victim.
"Unusual. You comin' in my home, telling me my son might have cancer?"
—Connie Rubirosa and Tanya Carter
"Maybe he'd like to know!"Tanya's lawyer says that it's a fourth amendment issue, and that this is an unreasonable search. McCoy cites a precedent from the Supreme Court saying that that the state can compel minor surgery to obtain evidence of a crime, but the other lawyer says that the procedure is not minor. The operation could destroy Jason's knee all over again. Judge Dorothy Parnell says that the precedent concerned a patient who was also a suspect in the crime; Jason isn't a suspect in anything. McCoy says that distinction was not mentioned in the ruling in the precedent case. The other lawyer points out that the precedent actually resulted in the state's motion for a surgery being denied because of the level of intrusion, but McCoy says that the precedent still allows for the possibility of such a surgery in cases where the public interest outweighs the intrusion. He says that the Health Department and Center for Disease Control are already involved, and that there's a risk of a major health crisis. Parnell asks if there's any other way, but McCoy says no. She then asks what the biopsy will prove, and McCoy says it will establish that it was the bone graft that killed Jones. In the audience, Tanya and Jason look nervous. Parnell grants the request for the surgery, apologizing to Jason as she does so. Tanya looks distraught. Later, Tanya is in tears — Rubirosa and McCoy have just told her and Jason that Jason also contracted ovarian cancer from the graft. Jason is stunned; he feels fine. McCoy says that the cancer is still early, and he can be treated and beat the cancer. Carter says they can't afford that. Rubirosa says they'd have a great case against anyone they convict, and could get a lot of money. McCoy says that he knows it must be hard for Jason, and asks him to testify against Vaughn. Jason agrees. He asks if Vaughn meant to do it. In jail, Bicks is irate at the suggestion that Vaughn was ignorant of what was going on.
"Damn right he knew!!"He doesn't want to be convicted of murder. Rubirosa says that Bicks knowingly gave Vaughn the body parts for an illegal operation. Prescott wants a deal before Bicks talks, but McCoy insists that Bicks talk first. Prescott concedes to that. Bicks says that he didn't take anything out of the bodies; he just got a finder's fee and fixed the paperwork. He clarifies that Vaughn had to do the harvesting, since Bicks has shaky hands which could destroy the tissues that were extracted. Rubirosa asks how many bodies were involved, and Bicks says that five hundred bodies or more were used.
"He said his patients couldn't afford anything else."McCoy asks if the parts were only for the clinic, but Bicks says no, Vaughn did sell some of the parts to tissue banks around the country. Prescott asks for the murder charges to be dropped, and McCoy says he'll do even better and offer concurrent sentences for the remaining charges, so long as Bicks does at least ten years in prison. Bicks agrees, and later, Vaughn is arrested in his clinic. On his way out, he asks a nurse, Valerie Miller, to call Seaver. In McCoy's office, McCoy says that Bicks will testify against Vaughn. Seaver says that Vaughn might have illegally gotten body parts, but there's no murder case. McCoy says that Vaughn knew the risks but ignored them, showing a depraved indifference towards their life. Vaughn disagrees.
"I gave my patients consistenly excellent care."Rubirosa points out that Jones is dead and Carter has cancer. Seaver says it's a civil malpractice case, but McCoy disagrees. He offers a fifteen year sentence, contingent on Vaughn surrendering his license to practice medicine. Seaver says that Vaughn couldn't have known about Karen's cancer since she was undiagnosed when she died. McCoy points out that Vaughn didn't have Karen's medical records because the harvest was illegal — he couldn't have known anything about Karen's condition. Vaughn says that he was justified. He says that Jones would have lost his legs had he not helped him.
"People like Karen Kendall have so much to give, and they don't. I did what I had to do for my patient."Vaughn won't take the plea. Branch wonders if Vaughn was making profit off of the organ and tissue sales, but Rubirosa says that Vaughn doesn't have any suspicious accounts. The only explanation she has is that Vaughn must have put the money he got from selling the parts right back into his clinic. McCoy says that they don't need a motive. Branch points out that the defense will cite the statistical risk inherent in any surgery and argue that Vaughn can't be held responsible for the death, since surgeries always carry that risk. McCoy says it's about consent; Jones wasn't aware that the bones hadn't been tested for diseases. Rubirosa thinks there's something else going on.
"No pun intended, but I think the doctor has another bone to pick."She thinks that Vaughn will use the trial to excoriate the insurance companies, who would let poor patients die or have horrific care (such as amputations) over money. She points out that, statistically, one in six people are uninsured; if one of them gets on the jury, they could be inclined to support Vaughn. Branch says that they have to make having Vaughn as a doctor seem worse than not having a doctor at all. In court, Jason testifies as to what happened. Vaughn never told him of a risk of cancer, and didn't say anything about where the bone came from. Jason testifies that he feels scared and angry.
"I just sort of thought that Dr. Vaughn was more on top of it."He says he's started chemotherapy, and he just wants to be cured. On cross-examination, Seaver asks if Jason could have had his knee fixed without Vaughn, and Carter says no since they didn't have insurance. Vaughn treated him for very little money, and Carter has to admit that he wouldn't be playing basketball for Georgetown without Vaughn's care. Seaver asks if Jason cares about playing, and Jason says that he does care. Seaver asks what Jason would have done if he'd known the risks, and Jason has to admit that he'd still have had the operation. Seaver then asks if Jason blames Dr. Vaughn.
"I know he didn't mean for it to happen. I actually feel bad he's in trouble, you know?"Later, Rubirosa says that Seaver did well in court. McCoy says he won't offer a deal. Rubirosa argues that Carter said he'd be willing to endure chemotherapy to play basketball, but McCoy doesn't think this changes anything about Jones. Rubirosa points out that informed consent is beginning to sound pointless; Carter didn't give it but even he doesn't want Vaughn to be in trouble. Then McCoy sees something. He asks what date Rubirosa has for Michael's surgery. Rubirosa says that she has April 28th. McCoy says that the medicine registry has Michael getting the drugs on the 23rd, days before the transplant. Rubirosa says that it could be a clerical mistake. McCoy notes that the same nurse, Valerie Miller, signed all the relevant paperwork. Rubirosa says that they should ask Miller which date the surgery really happened. Miller says that she must have made a mistake on the medicine registry and that Michael had his surgery on the 28th, but Rubirosa says that she checked with the dispensary and that the drugs were delivered on the 23rd. This is strong evidence that the surgery really was on the 23rd. Rubirosa asks again when the surgery was, and Miller says that she was just following orders. She doesn't want to be involved, but Rubirosa says that she already is. In court, Miller testifies that Vaughn asked her to change the dates in the files after he heard that Jones had died. This was because Karen Kendall was still on life support on the 23rd; she was not the real donor. The real donor was a woman named Tina Sodowsky. McCoy asks Miller to read Sodowsky's death certificate. Sodowsky died on April 22nd. McCoy asks for the noted cause of death, but Miller first apologizes to Vaughn. Judge Duncan Harvey orders the jury to disregard the apology, and Miller testifies that Sodowsky died of ovarian cancer. In the audience, Ashley Jones looks angry. Seavel waves his cross-examination. Vaughn testifies that he was told that the hospital was going to amputate Jones's legs; after Vaughn treated him, Jones could walk again. He testifies that there is risk in medicine, and says that even for something as common as penicillin, a small number of those treated will always die from a reaction. He points out that no one questions penicillin despite this. He testifies that he used two half-foot pieces of bones that he harvested, without consent, from a donor. Seaver asks why, and Vaughn says that the insurance companies ensure that there are always organs and tissues for the wealthy and insured, but there's nothing for the uninsured. The rich rarely become donors themselves, though.
"I took an oath to care for my patients. I had to do everything I could to help."He argues that, while it looks reckless to harvest bones from someone who died of cancer, the odds of the bones actually having the cancer were so small he felt it was worth it. McCoy asks if Vaughn stole human remains from people who hadn't consented, but Vaughn says that the remains were needed. McCoy asks Vaughn to confirm that he had no way to determine the suitability of the remains, or to look at the medical histories. Vaughn says that he did the best he could and believes that he chose good candidates. McCoy points out that Vaughn sold the extra body parts to other tissue banks, but Vaughn says that the money was put back into his clinic. McCoy then say that Sodowsky died of cancer but Vaughn chose her anyway, and Vaughn responds by again saying that the risk was minute.
"Except in this case you were wrong!"Vaughn says that he regrets what happened to Michael and Jason. He argues that he still gave his patients better care than they would get elsewhere.
"So, in other words, you're saying you didn't think you were risking much?"McCoy points out that Vaughn never told his patients what the risks were. Vaughn says that Jones wouldn't have chosen to lose his legs. In a perfect world, he admits, he might be guilty, but in the real world, he can't always ask for consent. McCoy says that Vaughn is bound by laws, but Vaughn says the laws support a corrupt and classist medical system.
"I'm saying I weighed the risks against those who desperately needed it."
—Jack McCoy and Adam Vaughn
"It's dictated by money! Or, more often in my patient's case, a lack of it!"McCoy says that the system isn't on trial; rather, Vaughn is, since he gambled on Michael's life and lost. Vaughn begins to rant.
"What would you have me tell patients like Michael Jones? Too bad? As a doctor who swore an oath to help my patients, that's not acceptable! He depended on me to save his legs, so I did."McCoy says that Vaughn is worse than any disease. Seavel objects, Harvey sustains, and McCoy ends his cross-examination. Later, Vaughn is found not guilty. Ashley Jones is upset; Seavel is thrilled and somewhat surprised. McCoy is stunned. Vaughn hugs Tanya Carter on the way out. It takes McCoy a while to get up. That night, Branch says they can take comfort in the fact that Vaughn's license is being revoked. Rubirosa says that she doubts people like the Carters feel happy about that. Branch tells McCoy that he was right on the law.
"You saved his legs, you lost the patient!"
"And given the odds, I'd do it again."
—Adam Vaughn and Jack McCoy
"Does that mean that Dr. Vaughn was wrong?"