Presenting the morally complicated underbelly of for-profit ambulance services in Mexico City, Luke Lorentzen’s documentary “Midnight Family,” which just premiered at Sundance, is a thrilling, subjective, portrait of one family’s attempts to navigate the corrupt economy of emergency health care while, also, providing much-needed services for a city desperately in need of EMTs.

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Lorentzen tracks a few months in the Ochoa family’s for-profit ambulance. Beginning the film, the text informs that “In Mexico City, the government operates fewer than 45 emergency ambulances for a population of 9 million.” In response to this underfunding, an entire underground economy has cropped up, run by people that have little to no EMT training or certification. The Ochoa’s are one such family, having to bribe police to receive emergency calls before, often, racing other ambulances to be the first on the scene of an accident. Once there, they treat patients, taking them to hospitals in the hopes of extracting payment immediately from either the patient directly or the family.

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Within this ethically murky job, the Ochoa’s are seen as, relatively, decent people. While having to bribe cops and being, essentially, unlicensed health care workers, they will help whomever, often losing money in the process, as many patients cannot, or simply refuse, to pay for their services. As the film progresses, and their monetary struggles continue, the Ochoa’s become increasingly desperate to find patients that are willing to pay.

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For those expecting a sweeping, informative, view of this underground economy, Lorentzen shies away from an objective viewpoint. He, instead, favors a highly subjective mise-en-scene, placing viewers in the ambulance, without commentary as the Ochoa’s race around Mexico City. Filming from the ambulance’s dashboard, Lorentzen structures his film in a way much more akin to a narrative film, oscillating between the boredom and monotony of waiting for a call and the thrill and terror when they receive one. In between those two modes are the complicated economics of running the ambulance, as the family is constantly harassed by police officers looking for a bribe.

What Lorentzen sacrifices in contextual clarity, he makes up in the intimacy and immediacy, presenting the Ochoas’ moral dilemma, as they struggle between helping outpatients in need and, somehow, trying to turn a profit. Obviously the Ochoa’s care about the patients, but they never forget that they are operating at a loss and need to recuperate money. The post-ride conversations, in which the family tries to extract payment from the patients, and their families, are some of the hardest to watch, particularly in one instance in which the patient died en route to the hospital. What emerges from these conversations is the matter of fact nature in which they treat their job. While sometimes they save a life, sometimes they make a profit, often it doesn’t go so well.

Within their constant struggles to break even, the Ochoas don’t have time to reflect on the larger economic and political issues that have created their unlicensed economy, and the film firmly stands with their viewpoint, presenting their lives as a microcosm for a larger health care debate, but never really gesturing to that bigger issue. That’s fair enough, considering Lorentzen resists making the type of documentary that confronts these systemic problems. Yet I found myself wondering more about the larger implications of the Ochoa ambulance. Yes, they are fulfilling a desperate need, but what is the ethical cost of their work? Even if the Ochoa’s are, by and large, good-natured people, they lack the proper training to help many of these patients. The film doesn’t dig deep enough to confront these issues, but it is undoubtedly a thrilling ride, nonetheless. [B]

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