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Code Black: LAFF Review

Code Black Still - H 2013

The Bottom Line

An urgent, deeply felt report from the frontlines of emergency health care.

Venue

Los Angeles Film Festival (Documentary Competition)

Director

Ryan McGarry

Director-physician Ryan McGarry’s first-person look at the U.S. medical system won the jury award for best documentary at the Los Angeles Film Festival.

Code Black, the profound debut feature by Ryan McGarry, joins a recent crop of hard-hitting documentaries about emergency health care -- notable among them Living in Emergency: Stories of Doctors Without Borders and the Bay Area-set The Waiting Room. What sets Code Black apart is that the filmmaker is himself a physician. His extraordinary access to life-and-death moments and his illuminating perspective on the medical system make for a powerful viewing experience.

McGarry’s dispatch from Los Angeles County General, the public hospital also known as County/USC, was named best film in the L.A. Film Festival’s Documentary Competition, and it’s a work of urgency that’s sure to draw broader interest as the national health care debate rages on.

McGarry was a resident at the teaching hospital when he began making the film. His initial goal was to create archival footage of C-Booth, the compact trauma bay that was scheduled to close once a new, earthquake-code-compliant facility was ready. The scenes from C-Booth, as doctors and interns jostle to treat the most critical patients, look like another world. To the outsider, it’s 20 by 25 feet of sheer chaos, but appearances belie the finely unified teamwork amid the shouting and blood.

It’s no wonder that one doctor calls the room “hallowed ground.” McGarry uses the difference between the old facility -- he was among the last generation to have worked there -- and its brand-spanking-new replacement to incisive effect. It’s a contrast that encapsulates the increasingly impersonal approach to health care in the United States, a sea change from the high-wire intensity of C-Booth’s cowboy culture to one mired in paperwork; in some cases, filling out forms can be more time-consuming than the actual consultation and treatment. But the new, larger quarters also provide greater privacy and dignity for the patients.

McGarry and his fellow students discuss such trade-offs in talking-head interviews woven throughout the film, and in scenes set around a restaurant table. Whether they’re addressing philosophical matters or budgetary constraints, their comments are informed by a stirring depth of feeling and sense of commitment. A senior ER nurse, Luis Enriquez, offers particularly eloquent observations.

“Mercy medicine,” a phrase not heard in the national conversation about health care, pops up repeatedly in Code Black. The residents speak of their mission to relieve suffering, their role in the safety net for those without insurance and their struggle to maintain their ideals in an underfunded, understaffed system. Footage of them on the job (the director served as d.p. in the C-Booth scenes; Nelson Hume handled the camera work in the new emergency room) serves as potent illustration of principles in action and those same principles caught in the bureaucratic logjam.

The film’s title refers to a full-beyond-capacity emergency room, and one of its most upbeat sequences involves the residents’ brainstorming to reduce patient wait time and emphasize the primacy of the doctor-patient relationship, an element that has been tellingly factored out of modern hospital design. The positive results of their new check-in procedure are striking. And then fiscal realities force a retreat from this progress.

The mix of graphic triage scenes and quiet reflections is dynamic and well balanced, with strong work by editor Joshua Altman. Music could have been more judiciously used, but the sound design, atypically creative for this kind of film, is an apt enhancement. McGarry indulges in more than one summing-up, via voiceover commentary -- and though one would have sufficed, it’s evident that he’s grappling with big issues, made personal on a daily basis.

The film provides pertinent background information on the director and several of his colleagues, defining experiences that drove them to pursue a career in emergency medicine. But even without this material, it’s clear that, in their eagerness to enter the life-and-death fray, they’re a different breed from most of us. And in their devotion to public health care, the kind that doesn’t turn away people who wouldn’t be “profitable” patients, they’re heroic. There are no easy answers in Code Black, but it finds the vital signs in an ailing system.

Venue: Los Angeles Film Festival (Documentary Competition)

Production company: C-Booth, LLC

Director: Ryan McGarry

Writers: Ryan McGarry, Joshua Altman

Producer: Linda Goldstein Knowlton

Executive producers: Mark Jonathan Harris; Marti Noxon; Edward Newton, M.D.; William "Billy" Mallon, M.D.; Jan Shoenberger, M.D.; Matthew Damron; Diku Mandavia, M.D.

Director of photography: Nelson Hume

Music: James Lavino

Co-producers: Andrew C. Richey, Thomas G. Miller

Editor: Joshua Altman

No MPAA rating, 80 min.