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71[VOY] Jammer's Review: "Critical Care"

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  • Jamahl Epsicokhan
    Nov 14, 2000
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      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.

      (II) E-MAIL PROBLEMS: Since approximately 11:30 a.m. CST (GMT -0500) on
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      --
      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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      Jamahl Epsicokhan - jammer@...