August 14, 2014

‘Code Black’ is a startling call to action

Documentary begins as a look at ER heroics, then asks us to re-examine health care.

Nobody knew what the “C” stood for in the name “C-Booth” at the old Los Angeles County Hospital. Maybe “central,” because the 520-square-foot space was the often-bloody heart of that public facility. Maybe “critical”; one administrator claims more people were saved and died here than in any comparable spot in America. Maybe even “chaos,” off which physicians seemed to feed while trying to work miracles.

The fascinating “Code Black” begins in that facility in 2008, though most of it takes place in a new county hospital built because the old one stood too near an earthquake fault line. Just as the change in venue forced doctors to re-examine the way they worked, it changes the film midstream from a tribute to a cry for help.

Ryan McGarry, a resident physician at the hospital, co-wrote the documentary with Joshua Altman and directed it himself. He tells his own story to illustrate why he feels so connected to emergency medicine: The one-time track star, whose race times dipped unaccountably, asked a family physician for help; the doctor rushed him that afternoon to an oncologist, whose treatment subdued McGarry’s lymphoma.

Like his fellow physicians, he’s frustrated by huge new piles of paperwork, much of it instituted to satisfy government regulations that may not be helpful or protect him and the hospital against malpractice suits. He wins our sympathy there.

Yet he and the other doctors (some of whom served as executive producers on the movie) save their outrage for our health care system itself. All hospitals must treat patients who bring life-threatening conditions to emergency rooms, whether or not they can pay. But after those patients get discharged, many hospitals’ responsibilities end.

So millions of poor or inadequately insured patients flood emergency rooms such as this one. McGarry and his colleagues aren’t making a case for or against the Affordable Care Act, frequently called “Obamacare.” They’re arguing that providing a diabetic man with regular doses of insulin makes more financial sense than having him show up at the hospital with a heart attack, thus costing taxpayers tens of thousands of dollars.

Many faces in this overcrowded waiting room belong to Latinos. (The title refers to a designation when the emergency room is at its worst, so full that wait times exceed 18 hours.) Whether documented or undocumented, these working poor consider McGarry’s ER a place to come with all conditions, critical or otherwise, and the hospital treats them. (We watch more than one of them die in front of us, sometimes not easily.)

On the other hand, McGarry includes an attorney who says she lost her firm through embezzlement and now lives out of her car; this 58-year-old white woman, articulate and well-dressed, contradicts expectations.

We can ignore her problems, attributing them to bad luck or bad judgment, just as we can ignore the countless people who come to public hospitals with too little money and too many problems. But “Code Black” appeals to our better natures while remaining aware of the money needed to let those better natures reign. It makes a strong case.

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