Shortly after the child’s death, he learns that Robert’s mother had been discouraged from seeking medical help by her HMO, Brama. They indicated that if the child’s condition did not merit hospitalization or emergency medical care, they would not pay the medical costs. Garnet feels that this attitude on the part of health care providers, while saving money for them and the hospitals is not worth the trade off for the loss of human life.

Mounting his own campaign against Brama and other HMOs produces negative response from some fellow physicians as well as hospital administrators because patients are being diverted to other hospitals that are more supportive of the HMO’s policies. Garnet is also concerned about a fellow physician, David Pearson, whom he has treated for alcoholism. David has signed up for a new treatment, which will be administered in Mexico at the suggestion of his HMO (you guessed it), Brama.

Then the Chief of Anesthesia at his hospital, Hector Saswald, is found in the physicians’ parking lot with his throat cut. The police find a pertinent clue, written in blood, presumably by Saswald as he lay dying. Getting involved in police investigations is nothing new for Dr. Garnet, but this time his own life may be at stake.

Peter Clement always delivers a first rate novel as is evidenced by his previous successes, Lethal Practice and Death Rounds. The Procedure is of equal quality, perhaps even better. The author, himself a physician, gets the technical part absolutely correct, and manages to convey this knowledge to the lay reader in language that is readily understood. The excitement and drama of the emergency room is vividly portrayed, not only describing what is done, but why such treatment is appropriate.

The pace of the action is worthy of a thriller of the highest quality; yet calling this book a thriller would be doing it an injustice. The author’s way with words is realistic, yet almost poetic at times. Witness Clement’s description of a crime scene. “ ... strips of police tape warning a passerby not to cross over. Except here the wind, roaring off Lake Erie, then accelerating through the concrete canyons of the downtown core, was much gustier than it had been in the suburbs, and the strength of it had ripped apart the yellow strands, turning them into streamers... like some tentacled creature made of giant ribbons.” <.i>It is easy to imagine our hero’s desperate situation here -- “Dirt grated against my chin. A salty metallic taste filled my mouth as tiny stones pulled my lip into a sneer and abraded its inner lining. Bristly tufts of underbrush and other potential handholds slid tantalizingly under my palms.”

Clement has developed realistic characters and given them intriguing moral problems to grapple with. His lead character, Garnet, by taking on the HMOs has put his physician wife’s career in jeopardy. One of Garnet’s flamboyant and impulsive friends from medical school days, Jack MacGregor, has placed himself in a position where his cause, about which he is absolutely passionate, will not be achieved except by his own death.

If the above comments do not entice you to read this book, read it anyway. There is much more to recommend it than what I have inadequately tried to convey. Dr. Clement’s writing is far superior to mine.

--Andy Plonka