Jammersreviews

Notices, 11/14/00:

(I) Apologies for this being so late; I've been busy with some other things.
I'm trying to get back on track with the Andromeda reviews.

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you want to e-mail me, send mail to jamahl@... until further
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check the site for an all-clear update on my real address, because the
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instead.


--
Warning: This review contains significant spoilers for Voyager's "Critical
Care." If you haven't seen the episode yet, beware.


In brief: An effective but not fully realized allegory on the bureaucracy of
medical care.

Plot description: The Doctor is abducted and sold to an alien hospital that
uses twisted ethical practices for determining the nature of treatment for
its patients.

-----
Star Trek: Voyager -- "Critical Care"

Airdate: 11/1/2000 (USA)
Teleplay by James Kahn
Story by Kenneth Biller & Robert Doherty
Directed by Terry Windell

Review by Jamahl Epsicokhan
Rating out of 4: ***

"I'm going to expose you!"
"To whom? The people who employ me? They brought me here to make the hard
choices they don't want to make."
   -- The Doctor and Chellick
-----

In "Critical Care," Doc wakes up one morning (figuratively speaking, of
course) and finds himself in the most chaotic wing of an alien hospital.
He's thrust into an extreme situation which is written very consciously by
the Voyager writers to be extreme. In the spirit of shows like last season's
"Memorial" and "One Small Step," this outing goes down as another effective
Voyager "message show" -- the story emerges from a premise that is telling a
story specifically to make a point.

Is the story's message in your face? Well, not to a point that makes it
remotely unpalatable. But like "Memorial" and "One Small Step," the point is
*not* going to escape you, because it's right there, front-and-center. It's
just as well. "Critical Care" is an allegory that works on its story terms
and also as something that wants to be a Classic Trekkian Commentary. After
last week's awful "Repression," which wasn't about anything at all,
"Critical Care" is a relief in that it turns out to *be about something*.
And it's about it well. It plays like a good, substantive episode of The
Original Series.

The allegory targets the bureaucratic corporate-ness of HMOs (Health
Maintenance Organizations), which too frequently seem more interested in the
bottom line than in serving their customers (patients) efficiently. No, HMOs
aren't The Devil, and they aren't anything remotely approaching what's
depicted in "Critical Care," but there are points here that echo the
bureaucratic nonsense that patients (customers) must sit through in dealing
with some HMOs, as when Dr. Voje (Paul Scherrer) tells Doc that his request
must be made by filling out and submitting a form in triplicate.

Quick story. One of my coworkers injured her wrist on the job last December.
That was nearly a year ago, yet today she still suffers from significant
pain that interferes with simple daily activities. She probably should've
had surgery long ago. The case is long and complicated, but I can assure you
that the insurance companies and medical providers haven't been particularly
helpful in resolving the case in any way that would avoid her stress.
Perhaps the biggest kick in the head came when she got a letter saying she
was suspected of making the whole thing up. Believe me, if I'd been put
through the amount of nonsense she has endured, I'd probably be doing
research into these companies and setting fire to their headquarters by now.

In "Critical Care," the writers turn up the heat and make the consequences
more dire. Reducing patients to impersonal numbers isn't simply a side
effect of inefficient corporate operation; it's an intentional means to
reach a rather cynical end that has been deemed necessary by the societal
Powers That Be. And the consequences extend far beyond the mere
decomposition of one's patience and peace of mind, and instead lead straight
into death.

The plot point used to drop Doc into this situation is that he has been
stolen by a scheming opportunist named Gar (John Kassir) and sold to a
medical facility on a troubled world. This facility -- indeed the entire
society -- is lacking in resources when it comes to medical treatment. This
particular area of the hospital is depicted as an understaffed, overwhelmed,
dim, dank, chaotic ER. With the priority of the Hippocratic Oath taking
over, Doc puts aside the fact he has been abducted and quickly lends his
medical talents.

The hospital administrator, Chellick (Larry Drake), witnesses Doc's
abilities firsthand and decides he would be better utilized in another
section of the hospital known as Level Blue. Doc is moved out of the chaotic
Level Red wing up to Level Blue ... which looks to be about as advanced as
Voyager's sickbay.

It's here where the story unleashes its allegory-via-absurdity approach.
Level Blue treats patients who, quite simply, do not require the treatment
they're getting. Crucial medicine that would save lives on Level Red is
wasted on Level Blue to proactively treat possible medical conditions that
do not yet exist in these patients, and may never exist. "It increases life
expectancy" is about the best justification Doc is supplied by Chellick and
Level Blue Dr. Dysek (Gregory Itzin). Medicine is rationed by "The
Allocator," the pre-programmed hospital computer, which was supplied its
inflexible directives by Administrator Chellick. Doc is outraged. His
outrage is irrelevant. Chellick tells him in no uncertain terms that This Is
The Way It Is.

Why are patients on Level Blue afforded such better treatment than those on
Level Red? Simple: It comes down to something called the "TC" -- "Treatment
Coefficient" -- a formula essentially derived from a patient's current value
to society (engineers who work on projects important to society have a
higher TC than, say, expendable mine laborers). Patients with a higher TC
get the priority for medical resources, even if they don't really need them.

What's amazing is how close to plausible Chellick is able to make his
reasoning seem. There's a potent scene where Doc confronts Chellick's cold,
numeric approach to patient treatment, to which Chellick responds that this
once-dying society has improved dramatically under such measures. I liked
that Larry Drake's performance wasn't one of a villain so much as a cold,
inflexible pragmatist who has been given a job to do and is determined to do
it  ("They brought me here to make the hard choices they don't want to
make") even if it means the lower tiers of society may be paying with their
lives.

This doesn't for one second wash with Doc, however, who makes it his new
mission to save the lives on Level Red, which he does by stealing medicine
from Level Blue and taking it to Level Red. While on this mission he
recruits reluctant Level Red Dr. Voje, who is a wonderful example of a
decent guy trying to do his job within the confines of a system much bigger
than him. Doc pushes at Voje to bend and eventually break the rules to give
better treatment to the patients of Level Red (manipulating the TC of
patients and later administering them stolen medicine). Voje is
understandably reluctant and annoyed; when you've been brought up on an
ethics system as screwed up as this one, turning around and risking your
career to oppose it isn't necessarily the first thing to come to mind.

The Level Red situation is reduced via microcosm to a teenager named Tebbis,
who is played fetchingly -- almost to a fault -- by Dublin James. He's a
Sick Boy and a Nice Kid, and thus might as well have "Dead Meat" scrawled
across his forehead in a story like this. I liked the doctor/patient
relationship established between Tebbis and Doc, even if Tebbis ends up as
the episode's thematic equivalent of the proverbial drowned kittens.

Indeed, one of the real strengths of "Critical Care" is the way it portrays
Doc completely in the role of a healer. He takes pleasure in his work, where
the highest reward is in making the sick get well. And when Tebbis
unexpectedly dies and Doc learns that Chellick sat by and let it happen
because the rules said so, there's a scene where Doc stares at Chellick with
a look of disbelief that is conveyed about as well as surprised disgust can
be. (Picardo, as usual, puts in stellar work.)

There are other really good moments here, like when Doc cleverly uses the
backwardness of the system against itself, convincing Dysek that using more
resources on Level Blue will lead to *getting* more resources (which Doc
then steals and routes straight into Level Red). I also liked the riff on
automated bureaucracy in the recorded message that greets Janeway when she
tries to hail the medical facility.

What only worked kinda-sorta for me, however, was the ending. It seemed kind
of ... anticlimactic. The idea of making Chellick a patient in his own
hospital is appropriate enough, but what happens in the final act lacks a
certain follow-through and ends up being pretty simple. And it doesn't
really come to any resolution: By having Chellick cave in to Doc's demands
at the last moment, we're not really solving any problems. Perhaps we're not
*supposed* to be solving anything, but the story's mistake, I think, is that
it doesn't really commit to a larger picture for the ending, one way or the
other. Do things get better after Doc's intervention, or worse? Is any
change effected? Should there be?

I also didn't quite understand Dysek's motives in going along with Doc's use
of this "leverage" over Chellick. Early in the episode Dysek seems to buy
completely into Chellick's way of doing things as a matter of necessity, but
by the end he flip-flops without much in terms of motivation.

I guess it doesn't much matter, because the episode is about this isolated
case involving Doc, and it keeps the focus on him. By the end, it indicates
a certain growth on Doc's part, permitting him to infect a man with a
disease in order to save a dozen others. It's an ironic situation, and it's
good that the episode -- and Doc himself -- realizes this is the case. For
Doc it's a conflict that shouldn't be permitted by his programming, because
his ethics are clear: Do no harm. But something else -- call it necessity --
takes over in him by the end of "Critical Care." Interesting.

--
Next week: Lt. Barclay as a pawn to ... Ferengi?

-----
Copyright 2000 Jamahl Epsicokhan. All rights reserved.
Unauthorized reproduction or distribution of this article is prohibited.

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