Why You Watch: The Hospital (1971)

Even if this bleak, blistering comedy mines our broken healthcare system for plenty of laughs, it still shows how a director can fail a script.

Let’s say we’ve just finished watching a terrible picture, one of those inert cinematic turds that ruin the very idea of movies, and we want to blame someone. In most cases, we’ll train our sights on the director, but then we’ll recall some terrible dialogue or a ridiculous plot twist and we turn our attention to the screenwriter.

Before we put the scribe up against the wall and offer them their last cigarette, it would be good to remember how rarely we can assign blame or credit to the writer. Screenplays are collaborative endeavors, which is a polite way of saying they are baskets for everyone’s ideas, good, bad or idiotic.

Their job is often juggling contradictory notes from the director, producer, and development executive. Critics will often hold screenwriters accountable for a lousy line that was an improvisation on set, or as a director’s demand. A screenwriter pal of mine was mocked relentlessly in the reviews for a moronic exchange they had never written. And yes, screenwriters might also get credit for a brilliant riff they never wrote.

This is why it can be hard for screenwriters to earn renown beyond industry circles. Most people think a screenplay is written, bought, and untouched through the production process, and some folks forget there is even a writer at all. Peak TV has rectified this in some ways by making the showrunner, a writer/producer, into another auteur. But feature film writers are still largely unheralded with some exceptions.

Paddy Chayefsky is one of them. He’s the rare screenwriter who built a name for himself, which requires two things: delivering hit movies with a distinct voice, and a willingness to take credit for it in public. This can be hard as directors would prefer to hoard the applause by pretending their movies write themselves, (so long as they didn’t write them, of course). Chayefsky refused to accept this and remains the only person to win three solo screenplay Oscars for both adapted and original work, and in a refreshing twist, each is well-deserved.

THE HOSPITAL won one of those Oscars, his second of three, after the massive hit MARTY way back in 1955. Chayefsky originally wrote MARTY for television, where he was a wunderkind, owning the one-hour anthology format with the likes of Rod Serling, during that first golden age of television in the fifties. The movie adaptation of that elegant, working-class romance was a runaway success and Oscar champ, but like all Hollywood writers, he had so little control over the fate of his work that all through the sixties, he ended up with plenty of gigs, but little success.

However, after his wife received terrible care at a US hospital in ’69, he decided to set his next script inside one, and in 1971, the resulting movie gave him his first hit since MARTY. Watching it now, it’s hard to imagine people flocking to this grim prank about healthcare, but then again, MASH became the third-highest grossing movie in 1970 for cracking wise in a war zone.

THE HOSPITAL is set over two days at a Manhattan teaching hospital and portrays the struggles of Dr. Herb Bock, the Head of Medicine (George C. Scott). It’s the rare role that taps the full breadth of what Scott can do, from his trademark glare to his fragility, as if his mountain of a frame was about to collapse under the weight of the day. He’s funny too, self-aware and snarky, in a completely different comic mode than his arch glee in DR. STRANGELOVE.

As soon as we meet Dr. Bock, he’s already suicidal. He recently separated from his wife, remains estranged from his children, and is well aware of his hospital’s failings. Once a medical prodigy who swiftly earned his place in textbooks, he’s circling the drain. And that was before he showed up to work to find out one of his doctors was killed by a nurse who mistook that diabetic doc for a patient, and loaded him up with insulin. The nurse could be forgiven, since that doctor was passed out naked in one of the beds, after taking a sex break with another nurse.

Even worse, Scott learns that his staff managed to so mishandle a routine check-up that a perfectly healthy patient (Barnard Hughes) ended up in a coma. Now that patient’s daughter Barbara (Diana Riggs) wants to take him out of the hospital, and back to Mexico where they run a clinic for Native Americans. After a second doctor ends up dead in another mysterious accident, it’s clear someone is holding the staff accountable for their piss poor performance. Meanwhile, activists protest outside, upset the hospital evicted people from a nearby apartment complex to expand its facilities.

Scott handles this powder keg by getting drunk and preparing to inject a concoction that will kill him, but look like natural causes. This effort is interrupted by Riggs, who understands exactly how to mock his pride and self-pity in such a way to both aggravate and woo him all at once, leaving him too riled up to off himself. Her own self-awareness and stubborn streak break him, and their affair begins in a way that is wild and utterly plausible.

The affair brings Scott back to life in a way, but Riggs has no interest in staying in New York. She wants him to join her and her father down in Mexico. Scott is tempted but feels responsible for the mess his hospital has become, especially as more and more staff end up dead at the hands of some killer who’s smart enough to use the hospital’s own mismanagement as a murder weapon.

Like NETWORK, it exaggerates reality in ways that were satire at the time but has since only become a well-documented reality: the craven administrator drifting through the ER demanding proof of insurance even as the patients can barely speak through their misery, the surgeon who butchers his patients but uses real precision when evading taxes, and the staff that are too tired and overwhelmed to give a shit. In one of the movie’s best moments, an African American nurse refuses to believe a doctor is dead, mostly because she’d have to stand up and deal with it. Her exhaustion is so palatable, I was rooting for her to find a way to stay sitting.

One of Chayefsky’s rare gifts is the ability to skewer characters without reducing them to caricatures. His gags are built on who they are, not the point he wants to make. He may portray the activists as obnoxious and naïve, but he also shows they’re not wrong. The script dramatizes the hospital’s double bind: Give the people affordable housing while keeping the hospital too small to serve the community, or expand the facility, and evict the very people they hope to serve better.

That kind of balance only comes from a deep understanding of a system’s contradictions. The reason right-wingers are lousy at this kind of satire is so much of modern conservative thought requires a willful blindness to reality, rather than any attempt to comprehend how life is actually lived. Add to this the fact that it’s hard to poke fun of a system when one is desperately sucking up to the rich and the bigoted who run it, as evidenced by the ham-handed defenses of Elon Musk for being an epic douchebag of late. Nobody giggles at people earnestly bowing to a king.

Chayefsky bows to no one, and his lurid little murder mystery is solved with no grand investigative effort but in happenstance. He has no interest in turning Scott into Philip Marlowe here. It remains a dark farce to the end, that still somehow manages to end on a note of kamikaze optimism. One that doesn’t pretend the rock won’t roll back down the hill, but finds grace in getting back underneath it and pushing once more.

However, what’s so useful about looking at THE HOSPITAL from a craft perspective is how much it echoes Chayefsky’s later masterwork, NETWORK, a hyper-literate, scathing portrait of the TV industry as hilarious as it is heartbreaking. But that classic was helmed by Sidney Lumet, who better understood how to translate Chayefsky’s work to the screen, and might have learned from the mistakes of THE HOSPITAL’s director, Arthur Hiller.

Hiller and Lumet both honed their craft in TV as contemporaries of Chayefsky, although Lumet would emerge as a reliable star director, churning out movies for almost 40 years with a string of masterpieces in the 70s and early 80s. Hiller had a far less reliable track record but his own highlights, including THE IN-LAWS (1979) and THE SILVER STREAK, one of the best Wilder/Pryor buddy pictures.

Hiller has chops, but not quite the imagination that Lumet would bring to the likes of SERPICO or DOG DAY AFTERNOON, where his no-frills decisions were mistaken for a lack of style. Lumet’s long filmography is riddled with misfires, but he was often able to make the most of great screenplays, and his work on NETWORK only shines brighter next to what Hiller did here.

Chayefsky’s scripts aren’t easy to film. They are crammed with dense, rambling monologues that flirt with the absurd while still feeling organic to the character, and involve swift and radical tonal shifts. A scene that starts out as broad as an SNL sketch can spiral into something that shatters his characters. Hiller opens with a roaming hand-held camera, awkwardly stumbling through the chaos of the hospital. Altman can pull this style off because he moves the camera like a smirking party host, knowing just when to drift past that conversation in the corner, and when to move on, knowing what tidbit to show that reveals character and builds mystery.

Hiller is at his best when following Scott in the story, and does his very best during the monologue Scott gives Riggs explaining why he’s killing himself. He keeps half of Scott’s office in deep shadow so that we see Scott almost swallowed by a black void as he rails at his life, cutting back to Rigg’s reactions in a far brighter side of the room- managing to be both organic and stylized all at once. It grants power to Scott’s tantrum while letting Riggs deflate his sense of grandeur. This spartan, clever staging, coupled with the performances from Riggs and Scott, hints at what the movie might have been.

The problem is that Scott’s monologue happens early in the picture. It’s not the climax, as much as the inciting incident. Chayefsky is poking fun at Scott’s rage and pity because Riggs is so quick to note how blind he still is about himself. Hiller needs to build from the heights he reached here, and he’s far less comfortable with the farcical elements to produce the visual flourishes the script demands.

He’s too polite in staging the murders when there needs to be certain grotesque splendor to turn them into proper gags, and we’re left watching victims get thumped gently and dragged out of sight. And then when the murderer reveals themselves, the confession needs a Grand Guignol visual riff, rather than another monologue in shadow.

In NETWORK, Lumet knew to make the hit TV show climax at the end into a circus of rainbow spite. Chayefsky needs a director who is capable of both restraint and madness. On the other side of the spectrum, Ken Russell’s ALTERED STATES shows what happens when a director chooses madness over restraint.

Lumet’s astute flexibility was never better employed than in NETWORK, where he could step back to simple medium shots and close-ups so William Holden could shine in two-handers with Faye Dunaway and Beatrice Straight, only to turn around and place Ned Beatty in a cavernous, fantastical boardroom like a portly Rasputin, retelling Howard Zinn’s version of American history but as a boast, rather than a confession, in one of the greatest monologues in American movies.

Hiller’s more literal-minded approach doesn’t offer sufficient bandwidth to contain all the shades of Chayefsky’s script. If not for NETWORK, we might never have understood there was a way to tap all the shades of his work. It’s so rare to see two directors tackle such similar content in such different ways.

Much the way OUT OF SIGHT and JACKIE BROWN showed a movie could capture both the humor and dread of Elmore Leonard’s colorful lowlifes, in equal measure, when we thought we had to choose between GET SHORTY and STICK.

The truth is that Hiller does some solid work here, but simply falls short of making the most of the material. THE HOSPITAL remains one of the best movies about American medicine for depicting all its rabid profiteering and broken idealism, and for that, Paddy Chayefsky clearly deserves most of the credit.

THE HOSPITAL is currently streaming on Amazon Prime and available for rent elsewhere.

Why You Watch is a weekly series looking at forgotten, rarely seen, or underrated movies for what they can teach about culture and filmmaking craft. Show some love by sharing it, or follow me here or on Twitter, @arthousepunch.