Hospital emergency rooms have been publicly alleged to provide “adequate” alternatives to nationalized health care. If one believes both ex-President George W. Bush and presidential candidate Mitt Romney, the non-exclusive admittance policies of such public facilities supposedly ensure commensurate health care services for patients lacking medical insurance. Viewers of Peter Nicks’ San Francisco International Film Festival multiple award-winning documentary “The Waiting Room” will come away with a far more realistic impression of what passes for health care for the uninsured. The film’s titular room is located in Oakland’s Highland Hospital. Over an often hectic 24 hours, the mostly indigent and uninsured clientele wait hours to get treated for everything from drug addiction to testicular cancer. Meanwhile, Highland’s medical staff tries to both stretch scant resources and deliver the best care they can to their financially strapped patients.
The film deliberately avoids naming onscreen the patients or the hospital staff. Rather than making the film’s subjects anonymous, Nicks’ choice gets the viewer to see these people as everymen and –women whom one can develop emotional connections with via the circumstances that brought them to Highland’s waiting room. One feels the helplessness of the divorced and unemployed father who seeks treatment for his badly feverish daughter. The doctor who got inspired by “ER” to work in a real-life emergency room shines with his idealism and true concern for his patients.
Visually helping to immerse the viewer in the world of Highland Hospital’s Emergency Room is the film’s cinema verite style. It captures both the mundane nature of this world and its symbolic embodiment of the badly frayed social safety net.
The soundtrack consists only of conversations, subject monologues, and the typical background noises of a hospital at work. Since the film never visually takes the viewer out of the waiting room’s world, the viewer feels part of this composite cinematic day in the life of Highland’s ER.
Nicks’ cinematic chronicle takes a decidedly partisan-free approach to its subject. Voice-over editorializing is eschewed in favor of letting viewers see first-hand how those who can’t afford America’s for-profit medical system must make do. That said, one can’t help noticing that Nicks’ camera repeatedly witnesses the tremendous gulfs between pro-insurance company rationalizations and the experiences of the people stuck in the waiting room.
The long waits for emergency room care turn out to be a consequence of triage of scarce hospital resources. It is humane to give priority to treating the more seriously injured or sickest patients first. But what happens when everybody waiting for treatment is there because their medical problems become critical? How does one prioritize who gets treated and when?
Telling behind-the-scenes footage show how Highland Hospital’s staff deals with these problems. Air traffic controller-like scrambling is needed to determine which patients are well enough to be released so their beds can be made available for new patients. Treating a seriously wounded gunshot victim may take priority. But such trauma cases tie up anywhere from 12-15 hospital staffers and increases the waiting time for those suffering from less life-threatening conditions.
Triage may make logical and efficient sense. Whether the triage system makes everyday human sense is a different matter. None of the patients seen in the film enjoy hours of suffering in pain and stress as they wait for treatment. One particularly frustrated dialysis patient actually prefers having his life-saving tubing removed rather than endure further runarounds and waits for non-existent care. The doctor who listens to this particular patient can think of nothing to alleviate the man’s anger.
That incident captures the larger problem of finding a fair balance in public health between delivering efficient service and ensuring mass accessibility to healthcare. Over-emphasizing organizational efficiency often comes at the cost of choosing who will not be served or at least served less quickly than others. Yet over-emphasizing access for all can mean misallocating resources in pursuit of equity.
Nicks’ film shows that Highland’s medical staff tries to do their best to reach that balance for the 250 patients they serve daily. The scenes of ER administrator and Registered Nurse Liz Lynch trying to juggle available bed space with waiting room denizens’ growing impatience catch the difficulties of this task. Making Lynch’s task easier is the wonderfully charming Certified Nursing Assistant Cynthia Y. Johnson. Whether she takes pride in correctly spelling the names of her multinational clientele or defusing her scolding of a patient’s cussing by asking if he’s a Scorpio, Johnson’s appearances onscreen prove to be one of “The Waiting Room”’s delights.
Less delightful are the sequences where the patients have to deal with paying for their ER services. An accounting clerk’s joking makes the process of figuring out payment less stressful for a homeowner with an underwater mortgage. Viewers will sympathetically tense up with worry for the college student with testicular cancer as he obviously has scant financial resources.
While the viewer may cheer whatever medical victories are achieved onscreen, Nicks reminds the viewer that the patients seen here carry intractable problems that can’t be solved with painkillers. A floor layer gainfully employed by Sherwin Williams keeps his job by unwillingly taking both a severe pay cut and a reduction in benefits. The unemployed divorced father complains his job search leaves him little time to interact with his growing children. Most importantly, the emergency room care sought by Highland Hospital’s patients will never substitute for truly effective health care. Until American society admits that everyone regardless of income is entitled to preventive and follow-up care as well as emergency room care, there will continue to be a class divide in access to medical treatment.
“The Waiting Room”’s creation preceded Romney’s public lies about the role of emergency rooms in providing health care for the indigent and uninsured. Nicks’ footage came from five months of filming in 2010. The seeming timelessness of the events captured testifies to the film’s unfortunately continual relevance.
(“The Waiting Room” opens October 19, 2012 at the Sundance Kabuki Cinemas (1881 Post, SF).)