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Dr. Howard Thornton bragged that his state-of-the-art computer system let him take on 1,000 patients a month, scattered across Northern California. But do his patients get anything like quality medical help?

Nancy Smitherman never knew all that much about her father's brother, Richard Walker, and it had been a long time since she had seen him. Her uncle lived with her grandmother and walked to work at a factory, somewhere in Oakland. When her grandmother died, Smitherman remembers, Walker moved to a board and care home, where he lived until its caretakers retired. Sometime in the early 1990s, Walker came under the care of Nettie Irene Wilson at Wilson's Family Care Home.

In May of 1993, Smitherman went to see her Uncle Richard, then 67 years old.
"My father was his brother and had made sure he was getting transferred to where he needed to be," Smitherman says. "When my father died, I felt like there was no other family to look after him, so I went to see him.

"I was thoroughly shocked by where he was living. It was dirty. It was old. My uncle had fingernails that were probably 2 inches long. It repulsed me."

Smitherman, who lived in Southern California at the time, was ill-prepared to take on the care of her uncle. She discussed his grooming and general condition with members of the staff at the home, and instructed them that she should be notified if he had any problems. During the next few months, Smitherman and Walker corresponded through letters and occasional phone calls. She sent him pictures, and he talked about things he'd read in the Bible.

"He would always return my letters right away," she says. "But to talk to him, I had to contact the home, and they would have to go get him.

"Toward the end of that year, he became very disoriented. I couldn't get him on the phone; they always said he was sleeping. I wrote another letter, which he never returned. Up until November, he was very alert and talking to me."

During this time, Walker was under the care of a sort of house physician who served Wilson's Family Care Home. Court records indicate that the doctor would visit Wilson's facility about once a month to check on its residents, including Walker. Smitherman had never met or spoken to or corresponded with the doctor.

Walker's medical treatment, or lack of it, during the end of 1993 and early 1994 is the subject of some debate among medical experts. It is clear, however, that Walker was cruelly neglected and rapidly deteriorating during his final months of life.

Walker was moved from the home to Humana Hospital (now San Leandro Hospital) on Feb. 5, 1994. Hospital records show that when he was admitted he had crusted teeth and lips (likely caused by malnutrition), scaling lesions on both feet, and a bedsore on his buttock.

He also had failing kidneys and pneumonia, and was anemic and severely emaciated. Walker had lost 25 pounds between April 1993 and February 1994, becoming so dehydrated during the month prior to his hospitalization that he could no longer walk.

Richard Walker died on Feb. 17, 1994, from pneumonia and hardening of the arteries. On April 12, 1995, Administrative Law Judge Robert Coffman signed an order revoking Wilson's license to run a board and care facility, finding that the deaths of three patients were largely caused by her negligence. But that order also made mention of the physician who served Wilson's Family Care Home, one Dr. Howard Thornton.

"There was substantial evidence that Dr. Thornton, who purports to serve more residential care homes than any other physician in the Bay Area, was guilty of gross negligence, and incompetency in providing care and treatment to [Wilson's] clients."

On Nov. 14, after a three-year investigation, the Medical Board of California's Division of Medical Quality agreed to settle complaints filed against Dr. Thornton in regard to the deaths of Richard Walker and two other patients. Under that settlement, Thornton is allowed to continue practicing medicine, but must be monitored by another physician for the next five years.

The Medical Board inquiry was fueled, at least in part, by the unusual nature of Dr. Thornton's practice.

And its unusual scope.
A Vietnam veteran and Yale University graduate, Thornton has been licensed to practice medicine in California since 1969. Health care was different back then. There was no managed care. Nursing homes weren't way stations for patients evicted from the hospital. People who lived in board and care homes needed a little help, not medical care.

Technically, a board and care facility serves elderly or disabled residents who need supervision in their daily lives. It's not a medical environment. Skilled nursing facilities provide care for patients who need medical monitoring and attention.

But the lines are blurring more and more, just as the line that once separated hospitals and nursing facilities has shifted. Medical decisions are increasingly based on cost and, with an aging population, space is tight. Nursing facilities are home to sicker patients. Today's board and care home residents might have medical problems that would have put them in a skilled nursing facility 10 years ago.

California has 5,748 board and care homes licensed to serve 121,619 elderly residents. Another 4,637 homes are licensed to serve 38,896 disabled adults.

In the midst of this health care revolution and facing an aging population, a forward-thinking Thornton found himself a niche. He decided to make house calls -- that is, he would travel to board and care homes and other residential facilities and practice medicine there. This would allow him to see several patients with each visit. Most of the health care for the board and care population is funded by the government. This coincidence helped streamline Thornton's process even more -- almost everyone he treated had a government health care number, and the bills could go to the same place, and be submitted on the same forms.

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