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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?

Thornton's niche grew and grew.
It's all but impossible for an outsider to determine just how many patients the enterprising Dr. Thornton actually had or has. In an interview with state investigators last year, however, Thornton said he was seeing approximately 1,000 patients a month -- that is, roughly 33 patients a day, if he worked seven-day weeks. He has acknowledged traveling to as many as 12 facilities a day -- some as far apart as San Jose and Tracy -- where he spends an average of five minutes or less checking out patients who have no problems.

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.

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