Film's Medical Director Discusses 'John Q'
March 7 -- A true story. The call came in after midnight. The urgency in the voice of the referring cardiac surgeon catapulted me out of bed towards my notepad.
"I operated on a 51 year-old male in the midst of his MI (heart attack). He is not going to make it without one of your heart assist devices. Can you take him?"
Within six hours he was in my hospital. By 9 a.m. he was in our operating room. Only the obligatory call to the insurance company separated me from the inside of his chest. Their representative's response was confounding.
"Well, we have an interesting situation." In medicine, one strives to avoid being interesting.
"Mr. B is fully employed but just moved from Maryland to New Jersey. Although the policy in Maryland covered transplantation, a clause in the New Jersey version appears to prohibit this."
"Since putting a mechanical heart into the patient will allow him to survive to receive a heart transplant, you cannot proceed."
What were my options? The patient did not know the policy was revised, and even if he did, should he have received the death penalty.
To muddy the waters further, my hospital was in New York City, so was I obliged to follow New Jersey rules?
In fact, if I removed him from the operating room, would I have violated my Hippocratic oath to do no harm? Could I ethically have done this? What about the malpractice liability of letting a salvageable patient die?
The hospital administrators supported surgery, but they cautioned that these operations cost $200,000 and if the program went bankrupt and closed, hundreds of future patients would not have the chance to be saved. Should I save one, but risk the future of many? What would you do?
Transplanting Medicine to the Big Screen
John Q, played by Denzel Washington, faces a similar conundrum to that of Mr. B when seeking a heart for his dying son and in desperation takes the ER hostage.
When the movie's producer Mark Burg brought me the script to review, he had already been warned that many Americans were so angered by our nation's inability to address the financial challenges in health care that the film might catalyze violence.
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