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And the government seems to fund most of that checking.
The federal government pays for health care through two different avenues: Medicare, which comes as a direct payment from the federal government and is aimed at the elderly, and Medicaid, a program that assists the poor and disabled. The federal government delegates the Medicaid program to states; in California, the program is known as Medi-Cal.
Medi-Cal records indicate that in 1995, the agency paid Thornton for 7,340 separate patient visits, totaling $179,406. In 1996, the state health care organization paid Thornton $178,326 for 8,254 patient visits -- or separate visits with about 159 patients each week. Those statistics do not include Medi-Cal patients who are participants in managed care plans, or patients covered by Medicare, which did not respond to a request for such information.
Thornton markets himself as a "house doctor" who doesn't replace a patient's primary doctor, if he has one, yet also doesn't handle emergencies. He goes to board and care homes at pre-scheduled times, does a cursory check on as many patients as possible, and, if he happens to find a need to perform a medical function, bills the government for it.
Somewhere along the way, Thornton's practice got high tech. William Adams, a Moraga lawyer who represents Thornton, says his client has spent more than $100,000 developing what he claims to be a highly sophisticated computer system that allows him to crank up the volume of his patient load. Thornton refused to demonstrate his technology for this story. Essentially, the doctor claims to be able to access all of his patients' pertinent records, coordinate billing information, and complete pre-made forms from a laptop computer that he carries with him.
One of Thornton's informational handouts describes his care this way:
"What I do that most other doctors cannot is provide safe, emergency care by telephone on short notice 24 hours a day. I do this by visiting your clients in the home every month or two and entering their medical data into a lap-top computer that I carry with me 24 hours a day. When they get sick, I can phone in medication, saving a trip to the hospital."
Thornton also provides patients with a laminated emergency card listing him as their doctor.
Yet according to the state's investigation, Thornton sees patients only at pre-scheduled visits, and is not available to them at other times. If there is an urgent situation, he does not go out to the board and care home on short notice. The care home is responsible if a patient needs hospitalization or emergency room service. Thornton does not have hospital privileges. He cannot perform pre-operative history and physical examinations. Nor does he do breast and pelvic examinations.
Despite all these limitations on the care he provides, Dr. Thornton's services are eagerly sought by board and care operators, who refer their residents to the doctor, if he will stop by once a month. Board and care home managers are legally required to see that their charges have adequate medical care; Thornton's visits make it easy to meet that requirement.
Whether this arrangement serves patients as well as it has served Dr. Thornton and the boarding homes he visits is another question entirely.
In fact, in the Medical Board settlement reached early this month, Thornton admitted that his computer system was inadequate to keep up with his patients, an admission that was a key factor in his sentence: five years of probation and a requirement that he pay the board $10,000 in costs it incurred while investigating Thornton's practice.
Perhaps the most troubling facet of that practice is this fact: Even though he has at least 1,000 patients scattered across Northern California, Dr. Thornton is still the only health care option for many disadvantaged people who are in board and care homes and whose welfare depends, in many ways, on the kindness of strangers.
Before administrative proceedings and court action closed the boarding facility permanently, three people had died at Nettie Irene Wilson's Family Care Home. And there were other problems. A mentally retarded woman had suffered fatal third-degree burns from scalding bath water. Another was locked out of the facility. Patient and medication records were missing. Food was left uncovered. The building was cold, hazardous, and dirty.
Dr. Thornton declined to be interviewed for this article. But William Adams, who represented the doctor during Medical Board disciplinary proceedings, spoke volumes in defense of his client, in those proceedings and in recent interviews. By Adams' garrulous estimation, Dr. Thornton has tried his best to provide good health care at facilities that range from decent to despicable.
"[Thornton] says that basically, the board and care home industry goes from snake pit to tolerable, and then in some nice neighborhoods to remarkably good," says Adams. "But most of the board and care homes -- let's face it, these are indigent patients. Essentially all of the expenses are being paid by public assistance, and usually they're right at the bottom of the barrel, so it's pretty hard to distinguish board and care homes down at the bottom.
"The question is: Should he withhold medical services from them because they're incompetent? It's almost hard to tell. Most board and care homes have no person there who's an expert at anything other than maybe running the home. There's no medical supervision whatsoever. And it's always a catch-as-catch-can situation.
"The homes in the very worst neighborhoods are usually kept up to about the same standards as the worst neighborhoods. I guess it boils down to: Should he be complaining about every little thing he finds, or just try to do his job as best as he can, and leave the systemic things to the experts?"
