In brief: An effective but not fully realized allegory on the bureaucracy of medical care.
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. Very infuriating.
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?