Summary for "Informed Consent"

From dfcarter@umich.eduTue Mar 14 20:20:40 1995
Date: Tue, 14 Mar 1995 21:58:41 -0500 (EST)
From: "Deborah F. Carter" 
Subject: HOPE: Episode Summary, 3-13-95 (fwd)

---------- Forwarded message ----------
Date: Tue, 14 Mar 1995 20:18:07 -0500
Subject: CH Episode Summary, 3-13-95

CHICAGO HOPE, Season 1, Episode 1.18, "Informed Consent"
Teleplay by David E. Kelley and John Tinker and Dennis Cooper
Story by David E. Kelley and Kim Newton
Directed by Bill D'Elia
Original air date, March 13, 1995

After getting out of bed, Dr. Billy Kronk's is trying to persuade his new
girlfriend, Annie, to go with him to his hockey game. She agrees but makes
him promise not to fight and not to get hurt. As they walk into Chicago Hope
later, Billy is holding a bandage to his nose and forehead as Annie chastises
him for fighting, but Billy won't hear it: "This is a no-check league. If I
can't fight, I can't hurt anyone." Geri Infante is waiting to treat his
injury. She and Annie soon recognize each other, but both seem flustered. As
they hug, Geri struggles to explain their relationship; Annie helps her out
saying that they used to be friends. Suddenly an ambulance arrives with a
patient who lost consciousness after complaining of dizziness. The EMT's tell
Dr. Danny Nyland that they ran a rhythm strip on the patient, Ned Tannen. As
it turns out, Mr. Tannen is waiting for a heart transplant, and Jeffrey
Geiger is his doctor. When Dr. Nyland asks Mrs. Tannen if her husband hit his
head, she answers, "He ran out of paper. My husband was in the comfort
station when he fainted. Fell right off the commode."

In addition to a bad ticker, Ned Tannen has a large aneurysm at the base of
his brain. Under normal circumstances, Aaron Shutt would operate but in this
case the size of the aneurysm and risk of hemorrhage are too great; Mr.
Tannen couldn't survive the procedure. On the other hand, if the aneurysm
ruptures, it will most likely kill him. The aneurysm also means that Tannen
is no longer a candidate for a heart transplant; since donor hearts are hard
to come by, the transplant committee would never give one to a patient with
an aneurysm. The Tannens are stunned, but Mr. Tannen can only stare at Aaron,
saying, "So between my head and my heart I have between five minutes and a
year to live." Aaron responds, "That would be one way to put it."

That evening, Mrs. Tannen sees Aaron in his office to ask him if they should
go to another hospital. As gently as possible, Aaron starts to tell her that
her husband's condition is hopeless, but stops and then asks Mrs. Tannen to
give him the night to think it over; maybe he can come up with something they
haven't thought of yet.

The following day, Aaron tells Jeffrey he can help Mr. Tannen with a
procedure involving suspended animation, meaning he'd have to freeze his body
temperature down to 68; with no blood pressure they can fix the aneurysm with
less risk of hemorrhage, but his weak heart would start to fibrillate. Asking
Jeffrey if they could restart the heart, Jeffrey doesn't see any chance.
Aaron doesn't want to just let Tannen die. Jeffrey, asking Aaron how
aggressive he wants to be, throws out a suggestion: Jeffrey could do a
cardiomyoplasty which might strengthen his heart, but Aaron points out that
he'd never survive two anesthesias. Jeffrey's suggestion takes an even more
radical turn: one anesthesia, one procedure.

Back in Mr. Tannen's room, they explain their idea, pointing out that it is
very experimental but can be done, and is really the only chance at clipping
the aneurysm. Jeffrey goes on to detail the cardiomyoplasty, even saying the
word carefully and distinctly, which involves taking a piece of muscle from
Tannen's back and wrapping it around his heart so that the muscle functions
as a heart muscle and helps the heart pump. Asking the doctors if either of
them have ever done either of the operations before, they answer no, but that
they can do it, and that it can save his life.

In the risk management meeting, Aaron insists that what he and Jeffrey
propose is Mr. Tannen's only chance. Phillip Watters seems to appreciate
their ambition but doubts whether or not both could or should be done
simultaneously. Dr. Diane Grad has other concerns: "If we aren't successful,
we would look like voodoo witch doctors. This is so radical, so futile."
Jeffrey responds, "Are you saying you would never consider a futile
experimental procedure if it were the patient's only hope?" Another member of
the committee points out that by doing these two procedures, there is no
escaping the publicity. "In success we're miracle workers. In failure, we
become Frankenstein's castle. . . . we're already considered miracle workers.
We have nothing to gain here." Becoming visibly frustrated, Jeffrey answers,
"Well, here's an extremely radical thought: Shouldn't the issue be what the
patient has to gain?" Once the committee determines that Tannen has
consented, Aaron and Jeffrey are instructed to get the consent in writing,
and the surgery is approved and scheduled.

Appearing at a joint press conference, Aaron and Jeffrey explain the
situation to the media, as Diane Grad stands in the background, watching and
listening, but the press only wants the juicy details. . . . "How long does
he stay frozen? So you have to kill him to save him? How many of these have
you done?" Sheepishly, Aaron answers, "Counting this one I'll have done one."

Dr. Grad finally visits the Tannens where she tells them about her father's
heart transplant and how it changed his life. She knows that Tannen isn't
having a transplant, but has used the topic to open the door so she can ask
Tannen if he knows how risky the operation is. Tannen acknowledges the risk,
but also shows his belief in the two doctors, who are supposed to be the
best. Grad agrees that they are the best, telling Tannen that with medication
he could probably live a year, but that with this surgery, he could die
today. During the latter part of their conversation, Geiger and Shutt arrive
in Tannen's room, and Jeffrey demands to know what she's doing. Aaron calls
Diane out of the room for a private talk. In the hallway, Aaron is furious
with her, saying that he hears she does good work, but that maybe she's been
in the lab too long, telling a patient about to be wheeled into surgery that
he might die. Diane defends herself, explaining that she just wanted to make
sure he understood the risks. She goes on to tell Aaron, "Look, I don't mean
to interfere but I've spent a lot of time in AIDS research and I know two
things: dying people will try anything, and it's never the patient's
decision. The patient is desperate; he's looking to be steered by the
doctor." When Jeffrey asks if she thinks they're steering him, she answers,
"I think experimental procedures are very exciting. Excitement can be
contagious." Aaron finally walks off in disgust, returning to Tannen's room.
He tells Mr. Tannen that he wants to be sure he knows that this operation is
a monumental risk, and that there is a very real possibility he won't survive
it. Tannen wonders if Aaron is suddenly nervous, but Aaron assures him that
he wants to be positive that Tannen understands. All Tannen knows is that
he's positive he won't survive without it for more than a year, and that he
wants to live more than a year. He and Mrs. Tannen kiss tenderly, as Aaron
and Jeffrey look away, not wanting to intrude on their private moment.

As Jeffrey is doing the first part of the procedure, Aaron and Camille are
waiting in the scrub room. Aaron is nervous, and Camille knows it, asking,
"Can you do this?" Aaron answers that he doesn't know, and when Camille tells
him he looks scared, he admits his fear. In the OR, Jeffrey completes the
first part of the job, then turns it over to Jeffrey (to the tune of the Four
Seasons singing  "I've Got You Under My Skin"). Aaron finds the aneurysm, and
tells Jeffrey that he can stop the heart anytime he wants. Jeffrey does so,
and Aaron clips the aneurysm. All seems to go well until both procedures are
done and it's time for the heart to come off bypass. Nothing happens, and
Jeffrey shocks the heart with the paddles once, then again. Nervously,
Jeffrey and Aaron are looking at each other, willing the treatment to work.
After Camille insists, "This is going to work," Aaron nods his head, Jeffrey
shocks the heart a third time, and the heart starts beating.

In post-op recovery, Jeffrey and Aaron are asking Mr. Tannen to move his
fingers, then to wiggle his toes, but he can't. They push him to try, and he
finally wiggles his toes. Aaron asks him, "How about your name? Do you know
your name?" When they get the response they were looking for, it begins to
appear that the procedures have worked, and Jeffrey and Aaron shake hands
across Mr. Tannen's bed.

But all is not well. Running into Tannen's room later, Aaron and Jeffrey find
Mrs. Tannen sobbing on Camille's shoulder, and learn that Mr. Tannen has
died, apparently of a massive myocardial infarction. Stunned, angry and
sickened, Geiger calls out to Mrs. Tannen, "I am so sorry. I'm so sorry."
With tears in her eyes, Mrs. Tannen looks up at Aaron and Jeffrey saying,
"Thank you. I know you both did everything humanly possible. I will never
forget. Because of you, I know he died with hope. I will always be grateful."

After Dr. Dennis Hancock treats one of his elderly patients and walks her
out, he notices Jonathan Saunders, the HMO representative, in the waiting
room. Walking back into his office, Hancock asks Saunders why the HMO is
terminating their contract with him, adding that 80% of his practice can't
see him anymore. Saunders realizes that if Hancock isn't HMO-approved,
Hancock's patients can't come to see him, but tosses his concerns aside,
telling Hancock that there are plenty of other doctors they can see. When
Hancock questions the quality of care those other doctors might give,
Saunders is ready with a retort: "Maybe they're simply more cost conscious,
allowing them to offer treatment to people who might not otherwise get it."

Hancock, Phillip Watters and Alan Birch are discussing the HMO's termination
of its contract with Hancock. Alan offers his opinion that the contract is
binding, and there is no recourse because the terms of the contract are
unilateral, that is, the HMO can terminate the contract by giving 30 days
notice to Dr. Hancock. He adds that he would love -- love -- to take a shot
at them and nail them for bad faith, going on to say that HMOs give
sweetheart deals to doctors, then once they've got all his patients on board,
they dump the doctor. Watters tells him to go for it.

In court, Saunders is telling Judge Harold Aldrich, "A contract is a contract
is a contract." Alan interrupts, saying, "Except when vitiated by bad
faith." Judge Aldrich stops Alan, yelling, "I don't like that word
'vitiate.' It's a word only lawyers use. If regular people said vitiate every
once in a while, that'd be one thing. But they don't. Normal people just
don't walk around saying vitiate. Only lawyers. And I hate the word." Birch
tells Judge Aldrich that the HMO entered into the contract with Hancock with
promises that he could treat his patients as he saw fit. Now, after he's
built up his practice mostly with HMO patients, and with Hancock dependent
upon the HMO for his practice, they tell him to cut costs or else, and when
he doesn't do that they fire him, arguing that the HMO's actions constitute
bad faith.

The Judge wants to hear from Hancock, who testifies that he agreed to lower
his rates to continue seeing his patients after the HMO enrolled them. He
also says that he agreed to lower his rates, not the quality of care, and
that everything he does he has to be approved -- x-rays, a consult, anything.
He tells the court that when the bean counters have to pull up guidelines to
see if his wheezing patient needs a tank of oxygen, he has a problem. The HMO
told him he could treat patients as he saw fit, and at first he could. Then
six months later, with 80% of his practice HMO patients, they start with the
squeeze, ". . . . no x-rays, no consults, no ultrasound, let's go with the
cheap antibiotics. You force me to give less treatment, inferior treatment,
and it stinks." When Saunders objects to the characterization and the
inflammatory nature of Hancock's words, Birch pipes up, "Everyday word,
Judge." The judge asks him what he's talking about. "Stinks. Everyday word.
Used by regular people, not just lawyers." Judge Aldrich can only growl.

In cross examining Hancock, Saunders brings out facts proving that HMOs can
help people and at lower costs. Hancock doesn't dispute the good that HMOs in
general can do; his problem is with non-health care workers making medical
decisions and dictating what treatment should be prescribed. Addressing the
court, Saunders says, "Millions of dollars are wasted routinely. HMOs try to
reduce waste, which Hancock knew when he signed the contract." Saunders
continues asking rhetorical questions: "We should leave all the decisions to
the physicians, like it's always been, because health care works so well
today, doesn't it? Because physicians police each other very well, we should
just leave well enough alone?"

The Judge has made his decision, however, and denies Hancock's petition for a
temporary restraining order.

Being treated for his hockey-related injury, Kronk is pumping Geri for
details, insisting that he knows Geri enlarged Annie's breasts. Afterwards,
Billy goes to wash his face and leaves Annie alone with Geri, who assures
Annie that she didn't tell him anything. Annie wonders if she should tell
him, and Geri asks Annie if they're serious, saying, "If this is just an
affair, I'd say don't tell him but if this is, you know, if this man is your
future  . . . " Annie is left to wonder how in the world she can tell her
boyfriend she used to be a man.

While Annie visits Kronk in his office, we learn that when they met, Billy
had thought he'd played hockey with her brother, Andy. Annie tells him she
likes him a lot -- maybe even loves him, a little -- but that she has to be
honest with him. Billy reveals that he knows about her breast implants, but
that he doesn't have a problem "with that kind of stuff." Knowing what she
must say, but struggling with her words, Annie opens the door by telling
Billy that he never played hockey with her brother, that his defense partner
was her. To Billy's amazement, Annie finally announces that when she was 12,
her name was Andy, but now she's Annie, and she's had a sex change operation.
Learning that Geri had performed the surgery, Billy is even more
flabbergasted, wanting to know who else knows. "I am just a bit homophobic to
begin with. My God, I've slept with you. We were like the two high scorers on
the team, you were No. 2 in penalty minutes in the league and I've had sex
with you. I'm a doctor, how could I not know?" Although he says he could have
handled her being married, even being a criminal, he's completely revolted by
the fact that she used to have a penis. Annie insists that Billy fell in love
with whom she is, not who she used to be, but Billy doesn't see it as that
simple, just because it's not that simple.

Running into Geri, Billy starts to ask her how it all happened, but then
doesn't really want to know. Geri tries to tell Billy that Annie was only a
freak when she was a man, but Billy wants no part of this "very politically
correct" conversation because he slept with "it." Telling him, "Okay, from
me, the doctor -- she suffered from gender dysphoria syndrome, an innate
abnormality which results in a female person being trapped in a male body.
Through therapy and estrogen and finally surgery it's been corrected. Annie
is a woman. Now, me, as your friend, I don't know what your feelings were or
are for her, but I do know that love is love." Billy can't believe he could
look at her without throwing up, but Geri encourages him to give this thing a
chance. When he answers, "That's the problem. I don't know what this thing
is. Freak, mutant, you tell me? How could I possibly be with that?" Geri,
walking away, responds, "Fine. I was feeling bad for her, but now I kinda
feel sorry for you."

Dr. Hancock is again treating his elderly patient when she tells him she's
heard he's leaving. Dennis confirms that he's going to CH and that another
doctor will be coming in. His patient wants to know, "Who's going to know all
these things about me? How my jawbone gives me headaches and how I burp worse
in the winter. Do I gotta go through all this stuff with the new doctor?"
Dennis tells her that Chicago Hope is starting a new outpatient clinic, and
that although tecnically her HMO plan doesn't qualify, if she wants to see
him, if she doesn't like this new doctor, she should come on over and he'll
get you in. She replies, "Well, that's a long way for me to travel, but I do
appreciate it. You're a good doctor, Dr. Hancock, and a good man. I'll miss
you." Hancock is a good doctor, and a good man, but he's caught by the red
tape and bureaucracy that has become a staple of modern day health care in

Billy and Annie are talking; he isn't sure if he wants to keep seeing her.
When she wants to know why he asked her to come to his office, he first says
he doesn't know, then admits that he does know: he just wanted to see whether
he could look at her "without feeling  . . . " Annie has to supply the word,
"Repulsed?" He nods, and admits it. Billy tells her that she is a fantastic
woman, and a very beautiful woman. Annie wants them to try, confessing that
she wouldn't have told him the truth if the stakes weren't so high. Almost
reluctantly, Billy seems to want to try, too. He leans over to kiss Annie,
but he can't hold it, and she knows it. They both realize that it's not going
to work, that her sex change is standing in the way. Billy apologizes to
Annie, saying he wishes she hadn't told him. As Annie leaves, she says,
"Well, bye."

In their offices that night, Aaron is talking to Jeffrey about Ned Tannen:
"We killed him. Diane Grad was right. We said all the right things to Ned
Tannen, explained all the risks, but our tone, our body language, everything
that oozed out of us told him to go for it because we wanted to go for it.
Suspended animation, wrap around heart flap, we wanted him to say yes,
Jeffrey. He had maybe a year to live, to be with his grandkids, and we took
that year. I got to do a suspended animation procedure, you did a heart flap.
We took that year." Though Aaron's tone is very matter of fact, it's clear
that he is struggling to keep his emotions in check; but tears are in
Jeffrey's eyes, about to pour over onto his cheeks.


This show seemed to be all about the doctors' self-examination, of themselves
as people, of themselves as individual doctors and of the profession itself.
The final scene between Aaron and Jeffrey shows us their obvious
introspection, and Billy's feelings upon recognizing his bigotry and
homophobia were pretty obvious as well, but as usual Kelley has given us one
plotline that was more subtle: Dennis Hancock. His story begins as a
clear-cut contract issue, and winds up as an indictment of our health care
system in general. More importantly, Hancock has to acknowledge that doctors
in general are partly to blame. On shows like these, where the stars are the
doctors or the lawyers or whatever, I root for the stars to be the good guys,
but when an episode comes along and shows me their "feet of clay," it wakes
me up. Thus, for my money, the most telling dialogue belonged to Judge
Aldrich in handing down his decision:

"This is capitalism. Greed is what drives us all. Now, greed is wonderful,
greed works. Certainly the public's upset that we can't do a damn thing about
health care. We've watched them wobble in Washington, like impotent flaccid
little rats drowning in hypocrisy and incompetence. The only way that we can
insure the welfare of the nation's people is to make that welfare a
profitable enterprise, and that's why we have HMOs, Mr. Birch, because greed
works. Dr. Hancock, you had to know how HMOs do business when you signed that
contract, so the petition for the temporary restraining order is denied. God
Bless the United States of America. Adjourned."

(Having said all that, I still think that Hancock has a cause of action and
the right to an appeal. But I'm not going to get into all that lawyer stuff.
If someone wants to correspond with me privately on this issue, let's do it,
but I didn't want to bring it to the group as a whole because
contract law is pretty bizarre, as a whole.)

For the first time I'm beginning to wonder if Geiger has lost his edge,
especially since during the "Previously on Chicago Hope" portion they reran
Alan's speech to Jeffrey saying that he's not angry any more and that his
anger is what made him brilliant. Also, Jeffrey's facial expressions during
the procedure (he seemed almost unsure of himself) and how reactions to
Aaron's thoughts in the last scene contribute to this. I have a feeling we
haven't heard the coda to this episode or plotline.

Great take: When Aaron comes into Jeffrey's office to tell him he's found a
way to help Mr. Tannen, and Jeffrey is standing behind the door, Aaron looked
scared to death for real. Wonder if Geiger's placement behind the door was an
ad lib, unbeknownst to Aaron?

Line of the week, Judge Aldrich to Birch and Saunders: "The last time you two
appeared before me you were toads in concert."

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