Managed Health
"Critical Care" Plot Summary:
The Doctor is activated inside a giant spaceship hovering in a smoke-filled atmosphere. Gar, the thief who has taken the mobile emitter from Voyager, offers the EMH to the head administrator. The Doctor says he won't perform services for thieves, but when trauma victims arrive, his programming compels him to treat the injured. The medical technicians are impressed with his skills but can't get him the supplies he needs for triage. Back on Voyager, Paris and Kim take their holo-hockey wounds to sickbay and discover that the Doctor's program is missing.
The Doctor meets a young man named Tebbis who wants to become a medic. Tebbis is suffering from a virus treatable with cytoglobin, but he's already passed his medical allocation. The Doctor learns that the Allocator -- the computer that runs the hospital facility -- has summoned him to Level Blue, which he assumes is critical care. But when he arrives, he finds that Level Blue hosts wealthy, famous, and important patients, most of whom are receiving preventive medicine that could be used to save lives down below on Level Red.
Dysek, the head doctor, and Chellick, the administrator, believe the Doctor should understand that the long-term health of an agricultural engineer is more important than the life span of a waste processor. Chellick was brought in specifically to make efficient use of the facility's resources. The Allocator calculates a patient's social value and assigns a "TC" -- a treatment coefficient -- that determines the level of treatment available for that person. Though the Doctor admires Dysek's surgical technique, he is horrified at the cold-blooded disregard for sick patients on the levels below.
Voyager chases after Gar, who stole the Doctor's program while being treated in sickbay for indigestion. Janeway pretends that Tuvok is her lover so a jealous wife will tell her Gar's current location. Meanwhile, the Doctor requests additional cytoglobin given as a preventive measure to Level Blue patients, and sneaks down to Red Level to treat Tebbis and the others. Once Tebbis has begun to recover, he begins to work with Voje, the doctor on that level. Tebbis doesn't want to be sent home because his low social status would prevent him from becoming a doctor.
On Level Blue, Dysek becomes angry when he learns the Doctor prescribed unnecessary medication for his patients, but the Doctor warms that if they don't request sufficient resources this month, the Allocator may refuse to increase necessary supplies next month, and their treatment rates could drop. The Doctor returns to Level Red to finish Tebbis' treatment, but learns the patient has been moved to Level White -- the morgue. Chellick says Tebbis died of an acute secondary infection which they couldn't treat because the Doctor had exceeded the boy's medical allotment. Because of his lying and stealing, the Doctor's program is linked directly to the Allocator, which will determine when and where he can practice medicine.
Voyager picks up Gar's ship and beams the thief to the brig, where Neelix interrupts an investigation with dinner. But Gar again gets indigestion, and tells them where he left the Doctor in exchange for an antidote. The Doctor gets Voje to help him sneak back to Level Red, where they attract the attention of Chellick long enough to inject him with the virus ravaging the ward. The Doctor also injects some of Tebbis' antigens, so the computer won't recognize the administrator and will offer only the level of treatment available to a low-status individual. The Doctor refuses to practice until Chellick is willing to let him treat every patient on the level with cytoglobin.
When Janeway hails the medical ship and hears that administrator Chellick is unavaiable, she sends Torres and Chakotay to retrieve the Doctor. He refuses to leave until he has finished treating his patients. Voje brings Dysek, but the other doctor won't treat Chellick either, now that he knows his own resources may be affected by the administrator's decisions. Finally Chellick agrees to transfer all Level Red patients to Level Blue, where they will receive standard cytoglobin injections.
Back on Voyager, the Doctor completes Seven's regular examination, then asks her to check his systems. She says he is functioning within normal parameters, even his ethical subroutines. The Doctor explains that he hoped he had been affected by interfacing with an alien computer when he deliberately poisoned Chellick. Seven raises an eyebrow that he chose to sacrifice an individual to save a collective, which almost sounds Borg. "I'm sorry, Doctor, but I must give you a clean bill of health."
Analysis:
Despite being a little obvious and over-the-top in its criticism of managed health care, this episode has snappy pacing and good performances by an extended list of guest stars. Picardo got to do a turn as McCoy among the barbarians -- no cracks about needles and sutures, but he did make a remark about leeches. Despite the advance hype, "Critical Care" feels less like an original Trek ethics episode than one of the Next Generation tales where Crusher or Data wound up in a less-civilized society and had to find some way to teach Federation values instantaneously.
The Doc doesn't have any Prime Directive angst about sharing medical knowledge and he certainly doesn't stop to fret over forcing change upon a society. He does what his ethical programming suggests. If the society falls apart because the engineers start dying while street sweepers are saved with medicine that would otherwise have been given to the engineers, Voyager won't be around to see. We don't know much about this society beyond what we see in the hospital, but euthanasia of the sick isn't unheard of among humans; surely Voyager has encountered it before. Not that I'm defending the horrific conditions on Level Red, but we get a very one-sided view of the social crisis that led to the institution of The Allocator.
Ironically, "Critical Care" does as much to point out the vicissitudes of ethical choices as to condemn rigid systems that attempt to dole out fairness on a national level. The Doctor feels sure his subroutines must have been impaired if he deliberately made Chellick ill, but they're working fine; apparently his system can tolerate that sort of trade-off. He also has no problem singling out Tebbis for treatment when he takes one injection of cytoglobin into a ward with hundreds of sick patients, some more critically ill than the boy. Has he changed since "Latent Image," when his program crashed because he had to choose one life to save over another?
Then there's a cute scene between Tuvok and Neelix in the brig, when Tuvok accuses the cook of unethical behavior for poisoning the broth, only to be reminded that he just threatened Gar with a mind-meld to extract information about the Doctor's whereabouts. Neelix, who blames himself for the kidnapping since his cooking caused Gar to meet the Doctor in the first place, has no qualms about using mild torture to remedy the situation. Would the captain have approved? No one asks her, but one suspects she would have smiled.
How to get Janeway to love you, in two short weeks: 1) Start a mutiny by mind-melding with Maquis crewmembers. 2) Allow a thief to kidnap one of your crewmembers and steal a unique piece of technology right under your nose. If only Chakotay had known that second season, he could have gotten lucky. I like Tuvok as much as the next person, but Neelix makes a better chief of security than he does. It's just dumb. Moreover, the writers have a perfect chance to throw Janeway/Chakotay fans a bone this episode just by having the captain take her first officer's hand instead of her pet Vulcan's; instead, they give Tuvok his second snuggle in as many episodes. What's the fun in that?
There are lots of nice details in the dialogue: medical slang both for patients' conditions and for administrative matters, Janeway's witty negotiations with the half-dozen people Gar ripped off, Tebbis' shared appreciation for music with the Doctor, the Doctor's assumption that Dysek's excellent surgical techniques will mean they share common values about medical treatment rather than the value of reputation. The look of the episode is wonderful, with a claustrophobic Level Red that resembles Bajoran prison quarters on Terok Nor, and a spacious Level Blue that looks sort of like Voyager's sickbay from the time Neelix redecorated it to add color. That the med techs wear clothes the colors of their wards adds to the sense that the caste system is immutable.
I'm curious about the fact that all the doctors we saw were male, while most of the nurses were female; is that meant to indicate a backward society, or did nobody in casting even think about it? The adulterous wife of one of Gar's contacts assumed Janeway would know she left her husband because he was overweight, a trait that apparently isn't tolerated any better in outer space than in Hollywood. Of course the thief and the evil administrator look the most "alien" of any of the humanoids -- one resembles a runaway from Cats, the other is red-faced and fatter than the adulteress' husband. These petty things make me think that no matter how many social issues Voyager tackles, it's still showing little progress on the details.