inadequate.doc

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] 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?"

But that's not exactly what Thornton said in a 1994 letter to the Department of Social Services defending Wilson's home. In that letter, he said:

"I feel compelled to state, in no uncertain terms, without reservation or hesitation -- if my opinion matters -- that there is absolutely no merit to the allegations that Mrs. Wilson provided substandard care -- medical or otherwise -- for these two individuals [Walker and another resident], or for any other individuals under her care, for that matter."

And what he said in that letter is not exactly true.
Within two weeks of Richard Walker's death in February 1994, one of his housemates, George Klemmich, was also rushed to the hospital. Klemmich was 83 years old, and had lived at Wilson's Family Care Home for about a decade. Like Walker, Klemmich was a patient of Dr. Thornton.

About a year before, Thornton had taken a medical history from and performed a physical examination of Klemmich; thereafter, the doctor continued to see Klemmich about once a month. According to the Medical Board's accusation, Thornton failed to note a walnut-sized lesion on Klemmich's scalp. The lesion was recognized by a visiting nurse and brought to Thornton's attention. Still, Thornton didn't examine the lesion until his next scheduled visit a couple of weeks later, and then suggested that Wilson's staff bring Klemmich to a dermatologist for an exam. The tumor was eventually diagnosed as malignant melanoma -- an especially deadly form of skin cancer -- and removed by a surgeon. Thornton also failed to note a benign tumor on Klemmich's right shoulder, and two hernias that afflicted him.

Records show that Thornton saw Klemmich on Feb. 20, 1994, for a routine exam. Eight days later, Klemmich was rushed to San Leandro Hospital and diagnosed with a hole in his intestine, acute pneumonia, the two hernias Thornton had somehow missed, and the tumor in his right shoulder. He died March 1, 1994, from multiorgan failure and septic shock.

In his response to the Medical Board's accusation that Thornton was negligent in caring for Klemmich, Adams wrote this:

"Both the Medicare and Medi-Cal programs only pay for 'problem-focused' examinations. Dr. Thornton's examinations were therefore not intended, nor required, to be comprehensive in areas unrelated to a specific problem. Since the patient did not bring the tumor to Dr. Thornton's attention as a problem, there was no protocol requiring him to examine it -- a paradigm which also applies to the benign lump on the patient's back and the bilateral inguinal hernias."

It doesn't take much to persuade Maxine Richards to talk about her children and grandchildren. Their pictures decorate the mobile home in Scotts Valley where Maxine and husband Wayne, a retired teacher, live. On most weekends, their son Randy lives with them.

They, too, complained to the Medical Board about Thornton -- but their case is of a slightly different nature. In that case, and one other, Thornton is alleged to have provided care where it was not needed, and certainly not wanted.

The third child of Wayne and Maxine Richards, Randy is 34 years old, a tall, strapping, mentally retarded man, who suffers from autism and a disorder that causes him to have seizures.

Randy lived at home with Wayne and Maxine full time for 25 years. When it came time for Randy to move away, the options didn't seem promising. So, in 1986, Maxine and Wayne joined with a group of other parents who had children with similar needs and formed the Spark Foundation, which grew to encompass three houses in Los Gatos, Cupertino, and San Jose. Each location was home to six residents and a staff working around the clock, financed by a combination of state aid and private fund-raising.

"It was the only way we'd feel like we had some say over Randy's care," Maxine says.

The first mention of Dr. Thornton at the Spark Foundation came in a July 1994 report from the group's program director to the board of directors. The report said Thornton would visit each home one Sunday of every month to provide "supplemental medical care such as the annual physicals, TB tests, flu shots, and a clinic for minor illnesses"; these services would be billed under the residents' Medi-Cal accounts. Not only would this benefit the staff by saving time, the report says, Thornton would provide, at no cost, employee physicals and tests that are required by law.

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