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But Adams explains the allegations surrounding the Spark Foundation another, less concise way:
"That was something that [Dr. Thornton] had arranged with the board and care home, that they would determine which of the residents had approval from their guardians for Dr. Thornton to see, and it was up to them to present to him which people had the authorization.
"In many cases, there are going to be existing records that will be a lot more valuable than guardian information. If the guardian wishes to talk to him to provide additional stuff, then he would certainly listen. But usually, it isn't normal to talk to a guardian for even that kind of information because the medical world is just too complex to just call up somebody -- a guardian especially, not even a parent -- and say, 'Well, what's wrong with Johnny?'
"Except for some specific problem, there wouldn't be -- unless the parents were willing to pay for a physical or something -- that person would never be seen by another doctor in any other context. And even though it was a nice neighborhood in Los Gatos, these are all still indigent people and probably indigent families as well."
Neither family involved in these Medical Board cases is in a financial situation that even approximates indigency.
For the most part, California doctors are policed by other California doctors, through the Division of Medical Quality of the Medical Board of California, which is an arm of the state Department of Consumer Affairs. The board consists of 19 people, 12 of whom are doctors, and all but two of whom are appointed by the governor. The cases against Thornton were among 11,465 complaints the board received in 1994. The case was assigned to one of the board's 90 investigators. At the time, each investigator averaged about 35 active cases. (The average has since dropped to less than 30 cases.)
Investigator Noelle Holloway contacted Nancy Smitherman, Richard Walker's niece, for the first time in January 1996 -- more than a year after the complaint about Thornton's treatment of Walker was filed. And it wasn't until another year had gone by that the state Attorney General's Office filed an official accusation against Thornton on behalf of the Medical Board.
This month, Thornton joined the ranks of the more than 110 doctors placed on probation every year. The Medical Board and Thornton agreed on a settlement that allows Thornton to continue practicing uninterrupted, under the supervision of a physician he chooses and the board approves. Thornton must pay $10,000 in court costs, and take continuing education classes in subjects including ethics. Thornton has three chances to pass a medical competency exam.
"In general, settlements involve compromise," explains Deputy Attorney General Russell Lee. "What usually happens is that we get the penalty that we need to protect the public, and they don't have to have the findings they might get otherwise -- the admissions are far less than what is charged."
The Attorney General's Office refused to comment on whether a separate Medi-Cal fraud investigation launched during the Medical Board's investigation is still under way.
In the settlement, Thornton admitted no wrongdoing with regard to the two patients at the Spark Foundation. In essence, he admitted only that his computerized record-keeping system was inadequate for determining other patients' course of treatment, and that he had failed to adequately ensure that residential care facilities where he worked had fully informed patients or their guardians of the purpose of his visits.
In his final statement to the Medical Board on behalf of Dr. Howard Thornton, Adams summed up not only his client's job, but the board and care industry:
"They [Thornton's patients] reside in homes where there are no medically trained personnel on staff, and they have little or no access to medical care. Board and care home operators are not required to have anything more than rudimentary medical knowledge, and there is no one in these homes other than the lay home operators and their untrained, largely foreign-born staff to recognize and deal with medical emergencies ...
"... It is against this backdrop that the care that has been called into question was given."
In fact, Thornton is one of few doctors willing to visit residents in board and care homes. If those residents actually fit the description given them by the system charged with administering their care -- specifically, that they don't require regular medical supervision -- his traveling medical show would not be so attractive to the homes he services. In large number, however, those residents suffer the types of chronic ills that all but demand regular medical attention.
The system itself is ill. The pressure to cut costs from health care programs is tumbling an increasing number of patients from hospitals into skilled nursing facilities, and from skilled nursing facilities into board and care homes, which are not prepared to deal with the sicker charges.
In theory, having doctors make house calls at such residential facilities is an ideal way to look after the medically needy people who are increasingly housed there. But as the case of Dr. Howard Thornton shows, theory and practice -- even computer-aided practice -- can be as different as life and death.