“I bet there are a lot of students at the college who are looking to make some fast money.”

“Some of my indigent patients enroll in study after study. It’s the only thing that keeps them from starving. But it’s big business if you work it right. There are websites for professional guinea pigs. They fly around the country raking in sixty, eighty grand a year.”

“The doctors don’t track the patients to make sure they’re not gaming the system?”

“All you have to show is your license, sometimes not even that. They stick your name in a file. From then on, you’re a number. Everything they collect on you is self-reported. You can tell them you’re a stockbroker with insomnia and acid reflux when you’re really a homeless wino looking for pocket money. They’re not running background checks. There’s no central database of names.”

“So, Tommy answers an ad and tries to enroll in one of these trials. Then what?”

“They would screen him both medically and psychologically. There’s different criteria for each study, and each participant has to meet the guidelines, or protocols. If you’re really smart, you can fudge your way onto a study.”

“Tommy wasn’t really smart.”

“No, and he wouldn’t have passed the psych evaluation if it was properly administered.”

“Wouldn’t the doctor be in charge of that?”

“Maybe, maybe not. There are good doctors out there who do it right, but the bad doctors never see the trial participants. They’re just paperwork that has to be signed off on. They usually go in on a Sunday and ‘review’ all three hundred cases before the enforcement rep gets there Monday morning.”

“Who takes care of everything then, nurses?”

“Sometimes, but it’s not required that they have any medical training. There are CROs, Clinical Research Organizations, that offer temp staffing for doctors running studies. At least they have some training. There was a doctor in Texas who had his wife doing everything. She accidentally switched the trial drug with medication for her dog. One doctor had his mistress in charge. She told the participants to double up on missed doses and half of them ended up with permanent liver damage.”

“Okay, so Tommy makes it through the psych evaluation. Then what?”

“He goes through the medical workup. He was healthy; I’m sure he passed that. Next, he gets the pills. He has to keep his journal. He goes in to give blood and urine or just to check in, probably once a week. The person who talks to him takes his journal and her report, what’s called source notes, then enters them into the case report. The doctor only sees the case report.”

“Where would the system break down?”

“Exactly where you said. Tommy obviously had a reaction to the medication. He was getting into arguments with people, which we know from the police incident reports. His altered mood would have shown up in his journal. Whoever interviewed him during his office visits would immediately know something was wrong.”

“And if this person wanted to hide the fact that Tommy was in trouble?”

“They could lie on the case report form. It’s entered into the computer and transmitted directly to the drug company. No one would know anything was wrong unless they compared it to the source material, which gets boxed and put into storage as soon as the study ends.”

“Would it ruin the study if Tommy was wigging out?”

“Not necessarily. The doctor could classify him as a protocol violation. That means he doesn’t meet the guidelines for being enrolled in the study. Which, with his disability, he didn’t belong in anyway.”

“What about Allison?”

“Her suicide attempt should’ve exempted her, but if she didn’t self-report, they wouldn’t know.”

“Who gets in trouble for Tommy being enrolled in the study?”

“No one, really. You can always plead ignorance to the ethics committee. By law, every study has to have an internal review board that’s in charge of maintaining ethical standards. They’re comprised of people from the community. Doctors, lawyers, local businessmen. And always a priest or a minister, for some reason.”

“The ethics committee gets paid by the drug company, too?”

“Everybody gets paid by the drug company.”

“What about Tommy? When does he get his money?”

“At the end of the study. If they paid them ahead of time, most of them wouldn’t come back.”

“So, if the trial was nearing the end, then Tommy had a payday coming. And Allison, too. Maybe Jason Howell.”

Sara didn’t want to think about who had the biggest money motivation in this sordid mess. “For a three-month trial, it wouldn’t be out of the question that they would each be looking at around two to five thousand dollars for their participation.”

Will pulled into the parking lot of the clinic. He put the gear in park. “So, where’s the problem? We’ve got doctors making lots of money. Participants getting paid. Tommy shouldn’t have been in the study but it’s not like he was going to bring the whole thing down. Why would anyone kill two people over this?”

“The key is going to be finding out how many more participants were experiencing mood alterations like Tommy. Allison was depressed. You can read that in her journal. Tommy was acting out lately, getting into arguments when he never had before. He killed himself in jail. I don’t want to let Lena off the hook, but he could’ve been suicidal from the medication. In a study, if you get clusters of adverse events, it’s immediately shut down.”

“So, it would be in the doctor’s best interest not to have one of these adverse clusters. Not if he stood to make a lot of money on the trial.”

Sara pursed her lips, thinking of Hare. “Right.”

She stared out the window at the clinic. The front door was illuminated by the headlights. She could see the familiar layout of the lobby.

Will got out of the car and walked around to get the door for her. “I probably shouldn’t go inside with you. I know you’re the rightful owner and I’ve got your permission and all that, but the law is very strict about me looking through medical records. You’re going to have to play the concerned citizen and tell me what you find.”

“It’s a deal,” she agreed, though it occurred to her that he wouldn’t be much help reading the records anyway.

Sara walked to the front door with her keys in her hand. She couldn’t remember the last time she had been inside the building, but she didn’t have time to reflect. Just as she slid the key into the lock, she turned toward the police station. The movement was natural, something she had done every morning because Jeffrey usually waited across the street to make sure she got safely inside.

The streetlights were bright, the night air crisp, finally clear of rain. She saw a shadow standing by the window to Jeffrey’s office. The man turned. Sara gasped. Her knees started to give.

Will got out of the car. “Sara?”

She ran without thinking, pushing past Will, going down the hill toward the station. “Jeffrey!” she screamed, knowing it was him. His broad shoulders. His dark hair. The way he walked like a lion ready to pounce. “Jeffrey!” She stumbled as she reached the parking lot. The asphalt ripped her jeans. Her palms were scraped.