Dr. Werner Ernst: If he's going to die, why should we proceed?
Dr. Butz: Where have you been all your life? It's called revenue!
For those of you that haven't seen it, Critical Care is a dark-comedy that came out in 1997, and centers around Werner Ernst (played by James Spader), a hospital resident in the Intensive Care unit at Memorial Hospital. Due to his questionable ethics, he becomes embroiled in a legal battle between two half-sisters (Kyra Sedgwick and Margo Martindale) who are fighting over the care of their comatose father. One of the half-sisters (Sedgwick) wants him to be put out of his misery immediately, the other (Martindale) wants him to be kept alive as long as possible. However, they aren't really fighting over his care -- as it turns out, that father has an estate worth over $10M, and depending on when he dies, one of the sisters will inherit everything. There's also an interesting side-story -- Werner must contend with his alcoholic and nutty supervisor, Dr. Butz (Albert Brooks), who insists that he only care for patients with full insurance. My favorite line by him is the one above.
Follow me after the fold for a partial transcript of my favorite dialog from the movie:
The movie is kind of hokey, and there's no getting around this fact. It was not a box-office smash for many reasons. BUT -- there is a speech that Spader's character gives at the end (in a legal hearing) that sums up the situation we're in today from a health-care perspective -- 12 years after the movie was originally released.
Judge Fratelli: Felicia A. Potter, on behalf of herself and her comatose father, Plaintiffs, versus Memorial Medical Center and what looks to be like every doctor on staff, plus a couple of John Does just to be safe. Does everybody have a copy of this (holds up the pleading) . . . Mr. Hatchet, why don't you get us going?
Mr. Hatchet: Thank you, Your Honor . . .
**Dr. Ernst (James Spader) Enters**
Dr. Ernst: Excuse me . . .
Judge: Yes, what is it?
Dr. Ernst: I'm Dr. Ernst, one of the defendants
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(basically, the judge asks him to take a seat . . . he refuses, saying he'd like to address the whole group and speak because "something is very wrong". The hospital's counsel indicates that they feel he's been hiding something since the beginning, and since they don't know what he's going to say, they can't continue to represent him under the terms of their Joint Representation Agreement. The Judge makes sure that Dr. Ernst understands this, and advises him to speak with an attorney first. Dr. Ernst indicates he does understand (and has consulted counsel), and requests again to speak to the group. Though this is quite unusual, the Judge and lawyers all finally agree.
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Dr. Ernst: Um . . . I wanted to speak here . . I . I NEEDED to speak here, because there's a man, in bed 5 on the floor 9 intensive care unit, and we're the people that should care, here. Here are his daughters, and they both should care. That's why there's this lawsuit, right? Each daughter has a lawyer, I assume. And so, what we have here are two daughters with completely different ideas on what is the best way to care for their father, right? No, that's not the dispute going on here. The fight between these sisters is about who gets to inherit 10 million dollars.
Lawyers: (unintelligible grumbling)
Judge: Sit down, and let him finish!
Dr. Ernst: And here, here we have this man's doctors, and the hospital in which he is a patient. The doctors and hospital have a lawyer, and they also should care about the patient, but what they really care about is patient turnover, occupancy rates, expensive tests and PROFITS.
Hospital Lawyer: See, your honor, we had concerns about him from the beginning, I knew he was hostile to our side . . .
Judge: (waves him off), I understand, I understand . . . (nods to the doctor to continue)
Dr. Ernst: And here we have . . . I'm sorry, who are you?
Man at end of table: I'm the lawyer for the insurance company.
Dr. Ernst: Insurance?
MaEoT: Malpractice and Liability . .
Dr. Ernst: Of course. I almost forgot about the insurance companies. But I don't really need to say anthing about them because no one ever believes that an insurance company cares about anything except getting paid their premiums and honoring as few claims as possible. (pauses) I see you don't object.
MaEoT: (shrugs)
Dr. Ernst: And then there's me -- one of his doctors -- who is concerned with making money, and getting a new car, and meeting women, and becoming a big-shot doctor when I should have been concerned and should have cared about this patient -- MY patient. So, here we are -- family, doctors, lawyers, insurance men -- each of us only concerned about OURSELVES. Each of us pursuing our own goals. The only one missing here is the patient! The only one here without a voice is the patient! And, all of us together, are the healthcare system, a system as collapsed, and as comatose, as the patient upstairs in bed 5, floor 9 ICU and we should CARE. We should care. .
Judge: Thank you Dr. Ernst. While the patient does not have a voice here, it is the court's responsibility to protect his interests. Though to be honest, I'm not sure whether we hurt or help that situation.
Lots of details I'm leaving out -- including that he was blackmailed by one of the sisters (Sedgwick) but he gets out of the situation in an ingenious way -- he asks the sisters to meet in private, and asks them to sign a release agreeing to 1) split the money in half 2) release the doctors and hospital, and 3) give him power of attorney over his care. If only one signs, he makes sure that person gets all the money over the one that doesn't. If neither sign, he asks how each of them can trust the other not to sign later behind their back. They are angry at first but both sign the forms, and they drop the lawsuit. I won't ruin the conclusion of the story (it's quite good!) but that provides me a segue into my OWN conclusions:
- The healthcare system has been broken for a long, long time. Movies aren't made unless they can connect with audiences, and this was made in 1997. The fact that it's still relevant today indicates just how little progress has been made.
- The healthcare system -- even at the nurse/doctor level -- revolves around making money, and the profession attracts people who work in the industry for this purpose. Though there are many good doctors out there whose sole purpose is to take care of patients and keep their patient's best interests at the forefront, the system by design is profit based. This may have a tendency to corrupt otherwise caring or good-intentioned individuals because it's far more difficult to stand against the entire system than it is to just play ball. And student loans aren't cheap. My dad one remarked about one of his dentists (who had just recommended a bunch of services): "He's really, really good at the business of dentistry. It remains to be seen how good he is at its practice." As the old adage goes, "Power corrupts, and absolute power corrupts absolutely". We already refer to physicians "playing God" -- who is to say that this power over people wouldn't corrupt at least some of them?
So what is the solution? I think the clear answer is to remove the profit factor from the decision of care.
I got my undergraduate degree in business. I believe in many forms of free trade and capitalism, but (unlike Republicans) I don't see it as an absolute, moral imperative. There are just some things that are off-limits to profit (and processes in which to acquire that profit), in my opinion, and healthcare is one of them.
Will government ran healthcare improve things? I belive it will but there will always be improvements to make, and even if we get universal healthcare, we will need to stay vigilant to make sure that the patients are the ones whose interests are protected. Otherwise, expect more scenes like the one above to be played out -- except, instead of an insurance company representative, replace him/her with a government bureaucrat.