John Q the movie was produced in 2002, starring Denzel Washington as John Q. The movie is directed by Nick Cassavetes, an American film director. Washington plays a character by the name of John Quincy Archibald whose son, Michael, played by Daniel E. Smith, collapses on the baseball field. Michael is diagnosed with an enlarged heart and ultimately requires a heart transplant. John and his wife Denise, played by Kimberly Elise, are informed in a meeting with Dr. Turner, played by James Woods, and Hospital Director, Rebecca Payne, cast as Anne Heche, that their health insurance does not cover the cost of the operation. They are also informed that they will be treated as a cash account customer and required to pay thirty percent or $75,000 of the total cost of $250,000, before their son can even be placed on the donor list for a donor heart. Shock and emotional turmoil ensues, along with disbelief, but they vow to do anything to save their son’s life.
John discusses this issue with his company representative and finds out that his company has switched carriers resulting in an HMO health plan. His son is only eligible for $20,000 in benefits because John is considered a part-time employee due to total hours worked. This information is extremely upsetting after paying premiums monthly and thinking you are covered. John determined to cover the cost of the operation, immediately starts selling personal items, including his car, as well as accepts donations from his church, friends, and family. These efforts are not enough, as John only raises $22,000. One day his wife arrives at the hospital and is informed of plans to release their son. She immediately calls John and tells him to do anything to keep this from happening. John mulls it over temporarily, and heads to the hospital with a gun inside a gym bag. He enters the hospital emergency room and sees Dr. Raymond Turner, the surgeon who will perform his son’s surgery without costs for his services. He asks Dr. Turner for a few words privately and after trying to resolve the release and asking for more time, he takes Dr. Turner and the entire emergency room (ER) team as hostages. John secures all the doors leading to and from the ER with a locks and chains.
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Police and news teams arrive, along with a police hostage negotiator, Lt. Frank Grimes, played by Robert Duvall. Lt. Grimes communicates with John and asks him to release the hostages. John decides to release four and insists that he wants his son placed on the donor list within the hour. Discussions take place between the hostages and John, as well as more police; including the police chief arrive outside. Police and security try to figure out how to get inside. Denise is asked to assist by talking to John on the phone after the Hospital Director talks to her and tells her they will cover the transplant surgery. Denise talks to John and tells him the good news; all the while S.W.A.T. is trying to get inside through a ceiling tunnel to stop the crisis. John is eventually arrested after watching his son get the transplant operation, from an accident victim’s heart in the first scene of the movie. John goes on trial and is convicted of kidnapping and false imprisonment of the ER team, with the hope of only serving two to three years. John Q leaves us still pondering the state of healthcare in America.
This movie briefly touches upon HMO programs, which are managed healthcare plans with restrictions requiring a primary care doctor and a network of defined professionals to use if we expect payment of expenses. Specialty doctors must be referred by your primary care doctor. John Q also introduces the questions of who is responsible, who decides, and who pays when a major catastrophic health condition occurs? The movie provides a few insights into the continuum of care concept, which involves a system of care which guides and tracks patients over time through a comprehensive array of health services spanning all levels of care. This concept looks at the leadership, processes, and framework which guide daily decisions for patient health care in all types of settings. Framework determines how a healthcare facility operates, their goals and core businesses. Continuum care also helps to define the professionals required in each setting and the functions they are responsible for.
The first point of contact for emergency care is typically the ER. A patient enters and talks to an intake person, which is normally a nurse or nursing staff. We assume this to be true in John Q. The ER nurse cares for sick people in one of the most demanding areas of healthcare. They are required to be licensed, a graduate of an accredited nursing program, and knowledgeable of HIPAA regulations. Nurses are required to take vitals, stand long hours, face hazards conditions and chemicals, and work with uncooperative, irrational, and agitated patients. After the nurse rooms the patient, the doctor steps in to further evaluate the situation. The ER doctor diagnoses and provides non-surgical treatment of diseases and injuries to patients. They must have knowledge of many types of medical problems, along with the ability to work with limited patient medical information. In John Q, the ER doctor suggested that a transplant might be necessary and Dr. Turner, head of Cardiology, and a transplant surgeon stepped in to further diagnose and confirm the condition. Like an ER doctor, a surgeon must graduate from an accredited medical school, become licensed, and in addition, acquire five years of general surgery experience in a residence program.
Board certification is also necessary from the American Board of Medical Specialists. Specialization in body organs such as the heart, liver, or kidney is required, along with skills in evaluating living donors, organ removal, and post-operative care of patients. John Q also exposed us to the position of the Hospital Director or Hospital Administrator. In John Q, we experience the power of this position, which is responsible for managing continuum care concepts on a daily basis. In a hospital, the administrator or director might be responsible for managing a medical or surgical unit, staffing, compliance, financial accounting, supply chain management, as well as marketing. This entails making decisions which impact employment, service payments, insurance, and quality of care, all hospital business management.
