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When Dr. Noah Spencer retires from private practice to accept a job offer from his longtime friend and prot g , Steve Nesbitt, Noah can't begin to imagine what's ahead. In his new position as medical director of Salyer Medical Center, Noah discovers shocking irregularities in the hospital's quality-management reporting. And he finds Steve's indifferent attitude toward below-standard performance to be unusual and disturbing.

Unbeknownst to Noah, Steve has been fighting a losing battle with addiction. Steve becomes deeply indebted to a Mafia-owned casino and attempts to climb out of his cash-shortage quandary by accepting kickbacks. The fact that he is blatantly betraying his hospital weighs heavily on Steve's mind. When he is pressured by the Mafia to participate in a money-laundering scheme, he decides to break his ties with them. Now privy to the illicit operation of the Mafia, Steve becomes a target for silencing.

Although he cannot unravel the details, Noah has a strong suspicion that a link exists between Steve's gambling problems and the quality issues at the hospital. Eager to help, Noah and his wife become embroiled in a sequence of events with Steve and his wife that threatens to entangle them in the FBI's testosterone-driven investigation of a corrupt underworld organization.