Sick in a Hospital Town
Phoebe Putney Memorial Hospital Katie Campbell/ProPublicaEarly morning, May 26, 2022Anthony Parker was tired of feeling tired. He was approaching his 70th birthday and his third decade as president of Albany Technical College in southwest Georgia. He was close to accomplishing the professional project of his dreams, a brand-new center for training nurses, when his heart began to give him trouble. Hed found that it was hard to walk short stretches across campus without getting winded. Hed stopped using the pedestrian bridge that connected the east and west sides of the college because it had become too difficult to climb the stairs. His wife and three adult children were struck by his sudden urge to take afternoon naps, something hed once ribbed them about, saying they were sleeping their lives away.But perhaps what most bothered Dr. Parker which is what everyone called him because hed earned a Ph.D. and because honorifics are considered good manners in the South was that his severely irregular heartbeat had begun to affect his golf game. So, on the day before he checked into Phoebe Putney Memorial, Albanys only hospital, Dr. Parker was anxious to get his stamina back.His cardiologist, Dr. Jos Ernesto Betancourt, recommended a procedure called an ablation. It involved running a catheter through a blood vessel from his groin to his heart and applying extreme heat or cold to create tiny patches of scar tissue on the outer walls of the organ, blocking the electrical signals that were causing his arrhythmia. Betancourt told Dr. Parker the procedure was minimally invasive and had a high success rate in men his age. In most cases, patients were sent home the day after the procedure and able to return to normal activities in a day or two.Because Betancourt was relatively new to Phoebe, the Parkers sought a second opinion from a close friend, a cardiologist who was godfather to their second child. After he heard what other measures had been taken to try to address Dr. Parkers condition, he agreed that an ablation was an appropriate next step.Next came the decision about whether to have the procedure at Phoebe. The Parkers had heard horror stories about the hospital from friends and colleagues over the years. But every hospital had stories like that as far as they were concerned, those were isolated incidents. Dr. Parker was confident that what might have happened to other people would never happen to him. If thered been anything serious to worry about, some systemic problem, he would have heard about it. For much of the time the Parkers had lived in Albany, hed served on Phoebes board of directors, one of the few African Americans invited to do so. He was a member of what the hospital called the Phoebe Family.He scheduled the ablation for the Thursday before Memorial Day in 2022. He assured his staff hed be back at work by the following Tuesday and even half-joked about getting out to hit a few golf balls during the break.When the day arrived, Sandra, Dr. Parkers wife of nearly 50 years, drove him the 15 minutes to Phoebe. By 7:30 a.m., he had checked into the surgery center. A nurse arrived to wheel him to the catheter lab, where the procedure would take place. Mrs. Parker walked alongside them as far as the entrance. Before saying goodbye, Dr. Parker pulled off his wedding ring and handed it to her for safekeeping. She slipped it on top of her own ring. Then she kissed her husband and told him she loved him as the nurse rolled him away.One of her younger daughters best friends from high school called to check on Mrs. Parker.Phoebe better not mess up, she said.Anthony Parker with his family in 1990 after he earned his Ph.D. at the University of South Carolina and with his wife, Sandra, in 2008CHAPTER 1Albany, Georgia, is a sleepy, majority African American city of some 67,000 that sits along the banks of the Flint River, more than a three-hour drive south from Atlanta. Its not on any major interstate. Getting there isnt easy, though theres not much reason to go without family ties. Its one of the states poorest cities in one of its poorest counties, Dougherty. Its so isolated and so untouched by time that its own residents like to joke that when the world ends, Albany is the place to be because it will take another 20 years for the end to arrive there.COVID-19 upended that way of thinking. In early March 2020, Albany became one of the countrys first hot spots. It had the fourth-highest per capita case rate in the world (after Wuhan, China, the Lombardy region of Italy and New York), and the virus was taking a disproportionate toll on neighborhoods with the highest concentrations of poor, Black residents. Suddenly a city that most Americans couldnt place on a map had become a harbinger of doom: If the virus could strike Albany, nowhere was safe. Phoebe Putney Memorial, the primary command center for the regional COVID-19 response, was inundated with calls from journalists seeking to make sense of how the virus was being transmitted, who was most affected and whether our health care system could save us.The storylines that were drawn tended to cast American hospitals as national heroes, and Phoebe, like its counterparts elsewhere, embraced the role. Its doctors, nurses and chaplains appeared on magazine covers and morning news shows. They testified at congressional hearings, hosted delegations of state and federal elected officials, were honored at area military ceremonies and virtually presided at the opening bell of the New York Stock Exchange. Phoebes executives used daily livestreamed press briefings to appeal for calm and answer questions about whatever new federal guidelines were being issued for preventing the virus from spreading.Sometimes the executives tripped over the color line, like when the hospitals chief medical officer, Dr. Steven Kitchen, who is white, announced that thanks to prudent medical history-taking, Phoebe had discovered that the outbreak was touched off by an infected visitor from Atlanta who came to attend a service with more than 100 other mourners at a Black funeral home. Many of them went to a second funeral the following weekend. The assertion was so clearly loaded in a town once considered a bulwark of the Confederacy that the chair of the Dougherty County government, who was also white, quickly chimed in, saying, This is not to besmirch anyones reputation, adding, No one did anything wrong by going to any of these funerals.Most of the messaging, though, celebrated the miracles happening inside the hospitals COVID-19 wards. One video that the press office circulated featured a 99-year-old patient named Maude Burke, who Phoebe had determined was well enough to be discharged from the hospital. In her honor, nurses and doctors had staged their own version of a ticker-tape parade. Burke, peeking out from beneath a poofy hair bonnet, was propped up on a gurney that orderlies pushed through hallways thronged withstaff who cheered and waved balloons as it, and she, glided by.We continue to celebrate with our COVID-19 patients when they get well enough to go home, Phoebe wrote in a statement that was released along with the video. The statement noted that Burke was a few months shy of her 100thbirthday, which made her the oldest COVID-19 patient it had been able to discharge. Her strength and determination are amazing, the statement read, adding, Thank you for being an inspiration Ms. Maude!The Harlem neighborhood, once the center of African American culture and commerce in Albany, Georgia Katie Campbell/ProPublicaI was among the throng of journalists who rushed to report about what was happening in Albany. I thought, at first, that it was a compelling place to tell a story about a small town facing a mammoth crisis: David versus Goliath. I interviewed intensive care doctors and emergency room nurses who would call to update me on conditions at the hospital at the end of their shifts. I monitored livestreams of city council meetings and church services. I gathered data about the identities and comorbidities of people who were dying of COVID-19. As I watched the pandemic unfold, I realized I was chasing the wrong story.COVID-19 was just the latest in a long list of health crises to hit the city. Since the 1990s, its residents had suffered some of Georgias highest death rates from heart and kidney disease, according to the states Department of Public Health. Data from the Centers for Disease Control and Prevention showed that theyd also suffered some of the highest rates of diabetes in the country. Life expectancy rates in the census tracts immediately adjacent to the hospital were lower than the state average. Teen pregnancy rates were higher. And the indicators that affect a communitys well-being, known as the social determinants of health such as poverty, unemployment, educational attainment, violent crime and food insecurity had been going in negative directions for the previous two decades.Albanys Poverty Rate Was More Than Double the National Rate in 2023Source: American Community Survey 2023 Five-Year EstimatesPerhaps the most important determinant of a communitys health, however, is access to care. In this, Albany seemed more fortunate than other cities its size because it has Phoebe, a self-described world-class health system that is so intimately woven into residents lives that they call it by its first name. Its main hospital in Albany is licensed to operate 691 beds, and it owns two other area hospitals, a cancer center, a hospice, as well as numerous outpatient clinics, urgent care facilities and medical practices covering specialties, including bariatrics, cardiology, anesthesiology, gastroenterology, neurology, urology and sports medicine. It has long run training programs for specialists in family medicine and pharmacists. Over the past three decades, the system has not only grown into the largest provider of health care in southwest Georgia, but it has also become the regions largest employer with more than 5,500 employees and a footprint that covers a large swath of the center of town.I began to focus on the relationship between Phoebes breakneck growth and the rates of chronic illnesses among Albanys residents and wondered whether the city was more of a microcosm than a hot spot. It wasnt the only place where the poorest among us are also the sickest. The United States is blessed with one of the most scientifically and technologically advanced health care systems in the world, a sprawling industry so vast and lucrative that it is now one of the largest drivers of the economy, accounting for more jobs and revenue than manufacturing. But for all the money flowing in and out, Americans have more chronic illnesses and shorter lifespans than people in other wealthy nations. When it comes to health outcomes among those countries, the United States ranks last.I set out to answer a question I hoped would resonate with anyone whos ever struggled to get the health care they need. Why are people in Albany and, for that matter, the city of Albany itself so sick when its most powerful institution is a hospital?I started by speaking to dozens of people whose loved ones had died at Phoebe during COVID-19. It didnt surprise me to learn that not all the miracles posted on Phoebes Facebook page were true. Maude Burkes relatives told me she hadnt fully recovered from COVID-19. Shed been readmitted to the hospital a couple days after she was discharged and died shortly thereafter. Nor did it surprise me that relatives like hers were bitter about their loss and that some blamed Phoebe for mishandling their loved ones cases. (A Phoebe spokesperson said, We are confident that Ms. Burke received quality, compassionate care during her stay at Phoebe and that she was appropriately discharged.)What I didnt expect was how fearful people were to criticize Phoebe on the record and how powerless they were to hold the hospital to account. The same was true of many of the current and former employees of the hospital.Phoebe Putney Memorial Hospital at sunrise Almudena Toral/ProPublicaStill, people encouraged me to keep digging. Among them was Pastor Daniel Simmons at Mt. Zion Baptist Church, home to one of the Rev. Martin Luther King Jr.s earliest and least successful civil rights campaigns. He told me that he had serious doubts about Phoebes account of the outbreaks origins and that rather than bringing the community together it had cast African Americans as culprits. Even Georgias governor, Brian Kemp, picked up the explanation, telling the press, We had an infected person do the wrong thing and go to a funeral service. The funerals, Simmons said, were not the only potential superspreader events to have occurred in the weeks leading up to the outbreak. The city had also hosted a marathon to raise money for Phoebe that drew runners from across the country.I later learned that Simmons was on to something when I met an epidemiologist named Daniel Pollock, whod retired from the CDC and was researching a paper that examined the origins of Albanys outbreak. He told me that Phoebes assertions were, at best, highly speculative and, at worst, deliberately misleading. Phoebes COVID-19 narrative, he told me, was deeply flawed from an epidemiological perspective, stigmatizing from a health communications perspective and unjust from an ethical perspective.There was no conclusive scientific evidence linking the viruss introduction in Albany to a single person, Pollock said. Yes, he told me, Patient Zero, as he came to be called, could have carried the virus to the city. But theres compelling evidence that the virus was circulating widely and undetected in Georgia, including in Albany, weeks before the patient arrived at Phoebe. Doctors there mistakenly thought his rapidly deteriorating condition was connected to a previous and long-standing respiratory illness, not a new one. They never tested him for COVID-19, which Pollock said went against the CDCs recommendations at the time.That patient spent seven days at Phoebe before he was transferred to a hospital back in the Atlanta area, where he could be closer to home. That hospital notified Phoebe that the patient was COVID-19 positive.Because Phoebe failed to test the patient, its impossible, Pollock told me, to know for sure whether he carried the virus into the hospital or contracted it there. Whats certain, though, is that the phone call from Atlanta was the first time Phoebe understood that dozens of its staff had been exposed to the virus. At the minimum, the hospital was as much a superspreader location for Albanys outbreak, Pollock said, as the two Black funerals that Phoebe officials had called out in that March 2020 press briefing.It was an abject failure on Phoebes part not to test him and isolate him as soon as he entered the hospital, Pollock said. He pointed out that although tests were hard to come by at the time, the Atlanta-area hospital tested the patient as soon as he arrived. Phoebes failure to do so, he said, made it difficult to pinpoint when and where the first case occurred. Instead of admitting as much, Phoebe wanted to find an explanation that omitted their medical mishaps. It amounted to a cover up.Kitchen agreed that without having tested Patient Zero for COVID-19, it was impossible to definitively say that he was the source of the outbreak. However, he added, I think its very likely that he was. His conclusions, he said, were based on the best information he had at an extraordinarily chaotic time. Pollock has had the luxury of investigating the matter long after the crisis ended.A Phoebe spokesperson echoed Kitchens views. He said: It is a fact that the first confirmed COVID patient treated at Phoebe was visiting Albany for a funeral. It is also true that most of the sickest patients who filled our critical care units in the first days of our COVID battle were connected to several gatherings in the community.When I asked Kitchen about the stigmatizing effect of Phoebes initial assertions about the origins of the outbreak, he seemed taken aback. How could telling the public what he knew as soon as he knew it be stigmatizing? He hadnt said anything in any way that had blamed anyone. Why would Black people feel that he had?There was no suggestion or tone of judgment or blame, he said. I was simply conveying information factually and with great sensitivity and compassion for everyone who was affected.Simmons didnt know about Pollocks paper. His skepticism about Phoebes funeral explanation came from what hed learned during his years living in Albany about how power works there. It was part of a familiar pattern, he said, and with time, I would see it, too.If Albany, Georgia, had done things differently over the years, our community wouldnt have been as vulnerable as it was, he told me. If the health care system was different, if it had a different relationship with poor people and people of color, the outcome would have been different.The main lesson he said that he hoped I and other people would take from Albanys COVID-19 crisis was, It didnt have to be this way.*Responses From Phoebe**Ginger Thompson emailed a detailed set of questions to former Phoebe Putney Health System CEO Joel Wernick, left multiple voicemail messages and sent him three letters by FedEx but received no response. She sent a letter with questions to Phoebes former attorney, Robert Baudino, and received no response. She also sent letters with questions to those involved in Dr. Anthony Parkers care Dr. Jos Ernesto Betancourt, Dr. Jyotir Mehta, Dr. Dianna Grant, Dr. James Palazzolo, Dr. William Garrett, Alan-Wayne Howard, Dr. Michael Coleman and Dr. Marla Morgan and received no response.In response to questions, a Phoebe spokesperson accused ProPublica of intentionally excluding positive patient stories. Most patients have positive experiences at Phoebe, he said. Ignoring that fact is wrong.*Anthony Parker and his son, Richard, in 1986Late afternoon, May 26, 2022Mrs. Parker felt her eyes well up as she arrived at the waiting room. Sixty-seven years old, compact, with a dark complexion and close-cropped hair, she had been a high school assistant principal for many years and had a lot of practice projecting confidence under pressure. But her wide, expressive eyes gave her away. The clerk took Mrs. Parker by the hand and promised to pass on any and every update she received about her husband.Mrs. Parker took a seat in a less-crowded corner of the waiting room and pulled a bag of peppermints and her iPad from her purse, hoping shed find enough reading to distract her. On the wall above her, she caught sight of a portrait of the late Dr. Carl Gordon, a towering figure in the hospitals history and a friend of the Parkers.Gordon had left Albany after high school in the mid-1940s to attend college. Afterward he joined the military, served in Korea and Vietnam, then returned to Albany in 1968 because there were no Black surgeons in the city. He told people that conditions at Phoebe had improved 100% since hed left by which he meant they were still bad, but less bad. Federal law had forced Phoebe to integrate its staff and patient wings. Dr. Gordon became the second Black physician granted privileges at Phoebe and, in 1993, its first Black chief of staff.The Parkers moved to Albany two years later when Dr. Parker took over running Albany Tech. The two families became close, partly because they were among the handful of African Americans in high positions at major institutions, whod bought homes in neighborhoods next to country clubs, and moved easily or knew how to make it look like they moved easily across the color line.Looking up at the portrait, Mrs. Parker tapped out a text to Dr. Gordons son. Your Dad, she wrote, is keeping me company and giving me comfort.Relationships like that made Phoebe feel like more than a hospital to the Parkers. In the weeks leading up to the procedure, theyd received well wishes from the hospitals president and the health systems CEO and chief medical officer, along with nurses whod been students of hers and her husband. Phoebe had recently hired the Parkers elder daughter, Kim, who has a Ph.D. in public health, and had agreed to a $40 million deal with Albany Tech to significantly expand its nursing program. It was a project that Dr. Parker for years had pressed Phoebe to support. He believed it would create good jobs for a community badly in need of them, revitalize the school and address critical staffing shortages at the hospital.The morning and afternoon passed with no word, except that the procedure was still underway. Around 4 p.m., Mrs. Parker asked for the umpteenth time about her husband. A nurse arrived from the catheter lab to tell her that there was nothing to worry about. It was not unusual for an ablation to take longer than expected because of the time required to map the arteries of a patients heart. The receptionist told Mrs. Parker that the waiting room would close soon, but that she could stay there as long as she needed.Around 4:30, Betancourt arrived. He seemed a bit out of breath, but he was smiling. The procedure had gone well, he told Mrs. Parker. Her husbands blood pressure was running low, but they were giving him some medication to stabilize it, and they were going to have him spend a night in the ICU so that he could be closely monitored.He told her that her husband might be out of it for the next six to 12 hours but that he believed they had accomplished what they wanted. He asked Mrs. Parker to give him an hour to get her husband ready for transfer and then hed take her back to see him. She could stay with him for a while, if she liked, but he said she should go home and get a good nights sleep since Dr. Parker was unlikely to be awake before morning.Relieved, Mrs. Parker dashed off texts to her three kids and eight siblings. She packed her iPad and sat back down to wait for Betancourt to return.When Betancourt reappeared, she thought he looked pale and panicked.He pulled up a chair and told her there had been some complications. Her husband had gone into cardiac arrest.Mrs. Parker felt the room spin and blinked hard to try to keep herself focused. Maybe she misunderstood the doctor. He was Cuban-born and -trained and spoke with a thick accent.She thought to herself, Did he just say Anthony had a heart attack?Before she could open her mouth to ask, Betancourt told her that hed responded to the arrest as soon as it happened. As for how long her husbands heart had stopped beating, it couldnt have been more than five or six minutes.Thats not a lot of time, she thought. Is it?CHAPTER 2In May 2020, after the first wave of the pandemic had subsided, Albanys mayor, Kermit Bo Dorough, discussed the citys response to the crisis in an interview with a monthly current affairs program called The Buzz on Queen Bee radio station.Video of the show was livestreamed, so I was able to watch it. Queen Bees studios were inside a downtown brewpub. Like the mayor, the two hosts were white and had long been fixtures on the local political scene: Carlton Fletcher, the longtime editor of the Albany Herald, the areas one daily newspaper, and B.J. Fletcher, no relation, a rare Republican member of the City Commission, what Albany calls its city council.The mayor, a workers compensation lawyer in his early 60s, had only been in office for four months, a tenure that had been consumed entirely by COVID-19. Hed long been an opponent of the citys establishment, especially Phoebe. His election had been attributed more to abysmally low turnout among Black voters rather than a surge among whites.After opening the conversation on a congratulatory note, the hosts turned quickly to the crisis at hand, and Carlton Fletcher asked his co-host and guest to share their thoughts about Phoebes performance.B.J. Fletcher answered first. Just as shed been raised to show respect to military officers and preachers by standing up when they walked into a room, she said, she now felt compelled to do the same for health care workers. I cant see Albany without Phoebe, she said, and called the hospitals response to the pandemic top of the line.When she finished speaking, Dorough pounced like a dog on a rib eye. Thats a juvenile statement, he said. Then he cleaved his hands to his chest and reminded those listeners living in Albany, or anywhere else in Dougherty County, that the hospital belonged to them.WeownPhoebe Putney, he huffed.Rainbow Records in Harlem Katie Campbell/ProPublicaA car hobbyist meetup in North Albany Ross Landenberger for ProPublicaDorough wasnt just spouting a political talking point. Founded in 1911, Phoebe Putney Memorial was operated by the county government from 1941 until the early 1990s. But then, in a move that allowed the hospital to expand its services beyond the county limits, Dougherty officials agreed to lease the facility to a private nonprofit entity with the same name. Thats when Phoebe Putney Health System was born. Under the new arrangement, the county kept ownership of the building in which the main hospital operated, but it lost control of the day-to-day management of the hospital, including, to Doroughs chagrin, how much it charges its patients.Dorough told Queen Bee listeners that he was convinced Phoebes patients paid way too much. Just because Phoebe Putney has made such valiant contributions to our community in the last few months, he said, doesnt change the fact that health care costs are higher here than anywhere else in the southeast United States.Cost is one of the great mysteries of American health care, and few communities have fought over the issue more vigorously than Albany. Phoebe hasnt always been Albanys only hospital. It became so after a long and highly contentious fight that was the subject of countless newspaper articles, a feature-length documentary and a lawsuit by the Federal Trade Commission that went all the way to the Supreme Court. Throughout that fight, Phoebe had denied that its prices were out of line, but, like most hospitals, it refused to divulge them for competitive reasons.Dorough reminded listeners that on the night he became mayor he pledged to find a way to get an independent study of health care costs across the region to determine how Phoebes fees compared with those of other hospitals, something hed been demanding for years. Now that he was mayor he felt confident he was in a position to get it done, and he challenged his colleagues on the city and county commissions to join him, saying that Albanys future was at stake.I dont think its a community hospital that first and foremost benefits the community, he said of Phoebe. I think it is a business model where youre driven by profits.A few weeks later, I met a young Black man named Clifford Alexander Thomas. We met at a sandwich shop downtown. Hed lost his 61-year-old mother, Beverly Kay Thomas, to COVID-19 not long after the outbreak and was still grieving. It was hard enough, he told me, to make peace with the fact that a virus from China had made its way to Small-bany, as he called his hometown, and took away his favorite person in the world. But he doubted hed ever be able to make peace with Phoebe, not because it didnt know how to save her but because of the way it had treated her, and him, after she died.Thomas, tall and thick through the middle, pulled out his cellphone and showed the last photo hed taken of his mother. She was lying on her bed at the hospital, her mouth caked in mucus, her torso half-exposed and tangled in tubes and tape. Judging from the way his mother looked and by the gowns and sheets that littered the floor, Thomas guessed that his mothers final moments had caused some commotion. But what he couldnt understand was why the hospital staff hadnt taken the time to clean her and her room, even though hed told them that he and his sister were on their way to the hospital to say their goodbyes.Why would they leave her like that? Thomas asked. Is that what they call taking care of someone? Did they really do everything they could to save her life? Did they think about how it would feel if that was their momma left like a lab rat?I suggested there might be an explanation. Hospital staffers were probably so busy handling the crush of COVID-19 cases that they couldnt clean his mother up as quickly as they should have. Perhaps theyd had to rush away to try to save other lives?Thomas didnt budge. He told me that while he and his sister were standing over their mothers body, a white nurse walked into the room and, without saying a word, began disconnecting the IV.He said he broke the awkward silence by asking her whether he could retrieve his mothers belongings. The nurse, he told me, looked over at him and said, This one didnt have any belongings.He said he struggled to keep his composure because thats what his mother would have wanted. Shed been born at Phoebe, delivered by an obstetrician who used forceps to pull her into the world, leaving her with a permanently disfigured right limb. Her parents sent her to Atlanta for surgeries to try to repair the damage. But they never filed a complaint against Phoebe or its obstetrician because Black people didnt sue white doctors in those times, and no one, particularly poor African Americans, dared get on the wrong side of the only hospital in town.Watching that nurse removing tubes from his mother without acknowledging his and his sisters loss, Thomas said, his anguish got the best of him. He told the nurse, Be mindful of the next words that come out of your mouth. Then he asked her to get out of his mothers room altogether.He said the nurse left and came back with a security guard who ordered him to leave.That definitely tore me with Phoebe, he said.Remembering Beverly Kay Thomas1958-2020Beverly Kay Thomas Courtesy of the Thomas familyThomas with her son, Clifford Alexander Thomas, top; his wife, Diamond Thomas, left; their son, CaMarion Alexander Thomas; and Cliffords sister, Zandria Thomas, right Courtesy of the Thomas familyA Phoebe spokesperson said that while the hospital could not confirm Thomas encounter with the nurse, his perception indicates that she and we as an organization could have done better.All across Albany, I found evidence of tattered relations between the hospital and the city. Those with insurance many of them white or well-off were critical of the hospital in the same ways as Dorough. They described Phoebe as a behemoth that had unfairly driven off its competition, jacked up its prices and pumped more money into executive salaries than into improving its services. They complained that the hospitals nonprofit status created a drain on the countys tax base, and they blamed the hospitals high fees for their exorbitant health insurance rates.Those without insurance or on Medicaid many of them Black and employed in low-wage jobs complained about the quality of care. They described everything from long waits in the emergency room and dismissive attitudes among nurses and doctors to lapses that cost them or their relatives life and limb. They almost never claimed ownership of the hospital but instead described its leadership and their own stubbornly high rates of disease as vestiges of the institutions history, throughout which whites set the hospitals priorities and expected African Americans to go along or go elsewhere, knowing there wasnt anywhere else.Both critiques were not only commentaries on Phoebes economic and political power but echo American sentiments about our health care system as a whole. Thats largely because most people dont think of hospitals the way they think of themselves. Although the United States is the only industrialized country without universal health insurance, we cling to the notion of our health care system as a public service because thats often how hospitals portray themselves.The reality, however, is that hospitals are businesses, first and foremost. The decisions they make about the kinds of services they provide, the staffing they need to provide them and even the amount of financial assistance they offer to the poor are not driven first by the health needs of a community but by what the hospital needs to maintain its bottom line. Thats even true at the nearly 60% of hospitals that are nonprofits, which enjoy tax exemptions worth $37.4 billion a year.Nearly 1,600 mergers over the past two decades have made hospitals some of the biggest companies in the country. They have played leading roles in the redevelopment of old industrial capitals like Cleveland, Buffalo, Baltimore and Pittsburgh and turned their downtrodden centers into gleaming, glass-encased landscapes. All this consolidation, however, has its pernicious effects. Its not the pharmaceutical industry that is most responsible for driving up the nations health care costs; its the hospital industry. The Centers for Medicare & Medicaid Services recently reported that hospitals account for nearly one-third of the $4.9 trillion the nation spends on health care. Retail and prescription drugs, according to the report, account for only 9% of spending.Just like any other industry, the more concentrated the money becomes, the fewer incentives there are to lower costs or improve quality and the less communities can do about either. The imbalance is most acute in small cities like Bryan, Ohio; Beatrice, Nebraska; St. Joseph, Missouri; Owensboro, Kentucky and Albany, Georgia. Their survival is hitched to the fates of oligopoly health systems the way towns in West Virginia and Kentucky once were to coal. Theyve become hospital towns.Doretha Moultrie, bottom row, second from left, with her nursing school classmates and instructor in 1963. She went on to work at Phoebe. Courtesy of Doretha MoultrieEarly evening, May 26, 2022Kim, the Parkers elder daughter, was the first to show up at the hospital after her mother alerted the family about Dr. Parkers cardiac arrest. The two of them had barely stepped off the elevator on their way to one of Phoebes intensive care units when his cardiologist, Dr. Jos Ernesto Betancourt, and three other physicians rounded the corner. For Mrs. Parker, the sight of them, shoulder to shoulder, all in white coats, conjured the image of the Four Horsemen of the Apocalypse. This isnt good, she whispered to Kim.Dr. Jyotir Mehta, the chief of Phoebes critical care team, stepped ahead of the pack to take Mrs. Parkers hand and asked whether she knew who he was. Of course she did, Mrs. Parker thought to herself. Shed known Dr. Mehta for years. Hed served on the health systems board with her husband. What he was really asking, Mrs. Parker thought, was whether she had her wits about her; whether she was mentally capable of understanding what he was about to tell her; that if she wanted to fall apart, now was not the time.Yes, Dr. Mehta, she nodded, thanking him for being there.Dr. Dianna Grant, the health systems chief medical officer and a friend shed been the one whod hired Kim arrived shortly after. She told Mrs. Parker that the health systems entire executive team had been notified about what had happened. Your Phoebe family is here, she said, and we love you.This was the embrace Mrs. Parker had hoped for the one Phoebe reserved for its inner circle. Whether Grant intended it, her words felt to Mrs. Parker like a secret handshake, an invitation to let down her guard and cry, and she did, falling into Grants arms sobbing.Friends and colleagues from Albany Tech began arriving. Betancourt pulled Mrs. Parker and her daughter aside and began going over what hed said before: how hed been right there when the cardiac arrest occurred and how quickly hed gotten Dr. Parkers heart beating again. It couldnt have been more than five minutes. It appeared the cardiac arrest hadnt caused any significant harm to Dr. Parkers heart. It was functioning well. What worried Betancourt and the rest of the critical care team was the extent of damage to their patients brain, which had been starved of oxygen when his heart had stopped beating.He told her that Dr. Parker had not awakened. Another doctor, whom Mrs. Parker didnt recognize, joined the conversation and told her that the medical team wanted to try a treatment that would involve cooling her husbands body below normal to slow his metabolism and reduce his brains need for oxygen, giving it time to rest and restore. The cure is a little R&R, she thought to herself.The doctor explained that therapeutic hypothermia had been developed by doctors whod found that they could revive skiers whod fallen unconscious below sheets of snow and ice for long periods. Betancourt assured Mrs. Parker that her husband would be kept comfortable throughout the treatment, which he estimated would last 72 hours. In the final phase, he told her, theyd slowly return Dr. Parkers temperature to normal and wake him.Mrs. Parker took the doctors plans to wake him as a promise. The sooner the doctors got started, the sooner shed have her husband back. Thats no time at all, she said to Kim. Hell, we can stand on our heads for 72 hours if we need to.Anthony Parker with his elder daughter, Kim, in 1999, celebrating her masters degree from the University of South CarolinaCHAPTER 3More than a century ago, the great sociologist and civil rights activist W.E.B. Du Bois wrote about Albany in his landmark The Souls of Black Folk, and the city still looks and feels a lot like the place he described: wide-streeted and placid. The Flint River, which once separated Black neighborhoods from white ones, still serves as an economic dividing line, with wealth concentrated on its far west side and poverty on the east. The town, Du Bois wrote, takes frequent and prolonged naps. There were many afternoons when I drove through Albany and felt as if I were the only one there except for Phoebe.Phoebes everywhere. Its logo and advertising can be found on the sides of high school sports stadiums and on billboards rising above the fast-food restaurants, Dollar Generals, discount strip malls and liquor stores that line commercial thoroughfares. There are Phoebe golf tees. Phoebe pens find their way into glove compartments and purses.I went to the beach with Clifford Thomas family, and he offered me a Phoebe beach chair. At almost every community event I attended, at least one person wore a Phoebe T-shirt, cap or jacket.The hospital itself isnt much to look at. Its a blond brick-and-concrete structure with a spearmint-colored roof, made up of a main building with nine patient floors and two adjoining wings for outpatient services and a new trauma tower. Those facilities occupy more than five square blocks at the center of the city.. The hospital towers over the properties that surround it, including nearly 100 that Phoebe had acquired over the years. It has turned a bit more than half of those properties into facilities for its own use an energy plant, parking lots, housing for cancer patients, a day care center for its employees. It has left many vacant and unattended.A block from Phoebe, on one of my solitary drives through town, I spotted an elderly man watering a rose bush with deep fuschia blooms outside a red brick Craftsman-style home. His name was Nathaniel Smith. He and his wife, Mary, seemed happy to have some company, and they invited me up to their porch to talk.Are you the only people living on this block? I asked.He smiled, and nodded yes, as if hed heard that question before. Then he asked whether I worked for Phoebe and was interested in buying his place. The hospital began acquiring the other houses on his block in 1986. It now owned all but one, he told me. I looked around roofs had fallen in, lawns were littered with empty liquor bottles and fast-food wrappers, there were holes in walls where windows used to be.The Smiths asked me if I had any idea whether the hospital had a plan for the houses. I told them that I did not. Then Mr. Smith shook his head and scowled, It dont make sense for a nonprofit hospital to buy up all these houses and let them go to waste like that.Nathaniel and Mary Smith were in their 80s. When they moved into their home in 1987, he worked as a peanut sorter at the M&M Mars plant. They paid $46,000 for the house. They told me they put down all the money they had, but they saw it as a smart investment in a home where they could comfortably live out their days and then pass on to their daughter. When they arrived in the neighborhood, it was filled with working families like theirs. Their daughter was able to walk to school. Mary, a seamstress, converted the shed out back into her sewing studio. Nathaniel doted on his flowers. It was a real nice place to live, he told me.By the time I showed up, Phoebe and Mr. Smiths rosebush seemed about the only thing flourishing in his neighborhood. The Smiths had stayed put all those years because they couldnt afford to leave. Phoebe, they said, had been the only buyer to express interest in their property, but the hospital had only offered a little more than what theyd paid for it, which wasnt enough to cover their mortgage and the cost of settling elsewhere.When I first told Mr. Smith that I was a reporter, his eyes lit up and he asked whether Id ever met Oprah. I shook my head and told him that Id spent the bulk of my career reporting from Latin America. Then he said something that made me think he was reading my mind.I bet you aint never seen a place like Albany.Nathaniel and Mary Smiths home in Albany, Georgia, a block from Phoebe Katie Campbell/ProPublicaOne of the many ironies about Albany, a city where Confederate flags still fly, is that its most important institution was founded with money from a man who fought for the North. Francis Flagg Putney, a New Hampshire native and a veteran of the Union Army, arrived in Albany shortly after the Civil War. A supporter of Black civil rights, he was shot in the shoulder in 1868 in what became known as the Camilla Massacre when whites opened fire on a political rally he helped lead in a nearby town, leaving 12 dead and dozens injured.Putney abandoned politics soon after; instead, he devoted his energy to building the regions largest and most profitable cotton farm. In 1909, a womens association asked his support for the construction of the citys first hospital. He agreed to donate $25,000 on three conditions: that the hospital be made of bricks, so that it was fire resistant; that it bear his mothers name; and that it serve both Blacks and whites.The women agreed, which set the hospital apart from most others in the country. But just because Phoebe admitted Blacks, it didnt mean they received the same treatment as whites. There were only a small number of Black nurses until the mid-1950s, and they were almost exclusively assigned to Black patients or to night shifts. White nurses were addressed by their last names; Black nurses were just called nurse. The cafeteria had white-only counters. Until at least 1960, Black patients were housed in the basement, alongside the furnace, steam pipes and laundry machines. Black doctors were denied privileges until 1965.Phoebe acknowledges its segregated past in a 230-page book it published called A History from the Heart, but it makes few mentions of how Black patients and doctors were treated, and even those minimize the nature and effects of the indignities Blacks endured. Heres one passage:Queen Jenkins, R.N., Phoebes only African American registered nurse in 1960, remembers some difficulties with patients, black and white, and co-workers. White patients often asked for a white nurse, and so did some black patients. LPNs and nurses aides sometimes did not want to take orders from her. Remembering her mothers advice, let your work speak for you, Mrs. Jenkins tried to ignore the racial prejudice.Before World War II, Albany was an impoverished agricultural town, its majority black population working mostly in the surrounding cotton and pecan fields. After the war, thanks largely to the opening of a nearby B-52 bomber base and, later, a Marine logistics base, it experienced an economic boom. In 1952, Merck opened a pharmaceutical factory on a 640-acre lot, drawing hundreds of chemists and their families.The influx of money and educated workers contributed to changing Albany to a majority white town but also to making race relations there different from the poorer, rural counties around it. Although the Ku Klux Klan openly held meetings around the city, Albany did not experience the lynchings and other forms of terrorism that raged elsewhere. Amid the relative calm grew a small, but notable Black elite, made up of doctors, lawyers, business owners, ministers and educators, who held onto their gains, as nurse Jenkins did, by not openly challenging the racial status quo mostly because they knew things could be much worse.The quiescence was disrupted in 1961, when the citys Black high school and college students, emboldened by the sit-ins and Freedom Rides challenging segregation throughout the South, launched a series of protests at the Trailways bus station. Administrators at the historically Black Albany State University attempted to quell the demonstrations by suspending protesters. There were discussions among ministers about driving the organizers out of Albany, though no one acted on them. When the students pressed on, and the police chief began sending them en masse to jail, the elders rushed to take control of the movement, hoping to stop the tensions from turning violent.They turned for leadership to the 32-year-old Rev. Martin Luther King Jr., who had gained renown five years earlier for organizing the Montgomery bus boycott in Alabama. Albany became his second major civil rights campaign and is widely considered the only one that failed. The city was seized by demonstrations and arrests, with at least 1,000 people following King to jail. But the resentments between the older and younger factions of the movement never mended. They were unable to agree on the goals of their campaign, much less the tactics for winning them. In the end, the movement ran out of money and foot soldiers before the police chief ran out of jail cells.Demonstrators in front of Albany City Hall in January 1962 Donald Uhrbrock/Getty ImagesAlbany taxicabs with the words White Only in August 1962 Warren K Leffler/PhotoQuest/Getty ImagesThe Rev. Martin Luther King Jr. and the Rev. Ralph Abernathy, far right, talking with a group in an Albany pool room in July 1962 Bettmann Archive/Getty ImagesA Ku Klux Klan gathering of approximately 3,000 outside of Albany in September 1962 Bettmann Archive/Getty ImagesKing left Albany defeated. Managers at the public library closed its doors when Blacks attempted to check out books. Public transit administrators shut down service rather than allow Blacks to occupy any seats on buses that they wanted. Park supervisors took down nets at an African American tennis court when integrated doubles attempted to play there. After Congress passed the Civil Rights Act in 1964, whites established private schools or moved to surrounding counties to keep their kids out of integrated classrooms. And in 1970, a group of white neurosurgeons opened a new medical center, less than 2 miles from Phoebe, called Palmyra Park.The neurosurgeons had joined forces with what would become the largest for-profit hospital chain in the country the Hospital Corporation of America. Its founders patterned the company after fast-food franchises, seizing on the fact that the newly enacted Medicare bill essentially allowed hospitals and doctors to charge the federal government what they wanted. With its manicured gardens, high-end meals and private rooms, the 223-bed Palmyra quickly became the hospital for people with means.The Phoebe swag that blankets the region today? No one went near it back then, according to Duncan Moore, who ran Phoebe in the mid-1980s. Throughout his time in Albany, Moore told me, white people referred to Phoebe as the nigger hospital. He said he had a hard time getting doctors to stop sending all their well-insured patients to Palmyra and all their underinsured patients to Phoebe. He would wander the hospital floors, scanning daily admissions sheets and engaging in hallway shouting matches with offending doctors. It got to be like hand-to-hand combat, he said.Late evening, May 26, 2022After giving Phoebes doctors permission to begin the hypothermia, Mrs. Parker asked to go see her husband. When she got to his room, she barely recognized him. He looked nothing like the person shed kissed that morning. That man was vibrant, upbeat and indomitable. This one prone, pale, cold to the touch was at the mercy of others.Thats so not Anthony, she thought, not the man who in most crises during their 50 years of marriage had taken charge.She started talking to him with all the confidence she could gather, hoping that he was able to hear her. I love you. Im here. Im not going anywhere. I know youre going to pull through this. You always do.This will be one more thing well have to talk about.From the moment he escorted her to the junior prom in Orangeburg, South Carolina, she and Anthony talked about everything. Like so many teenage love affairs, their attraction was primarily physical at first. He was tall and had a mustache. She had curves and a blinding smile. His parents were friends with her grandparents. Shed been raised in a big, raucous family by a father who was a truck driver and a mother who was a cosmetologist. Hed been the sheltered only child of an elementary school teacher and the principal at a nearby high school that was segregated like hers. But their different temperaments complemented each other. Shes the nicest girl Ive ever met, he wrote in his senior memory book. And somehow Im going to get it through her thick head that I love her.Two years later, when she was a freshman and Anthony a sophomore at the historically Black South Carolina State University, he asked her to marry him. She skipped gym class and he took the night off from his job as an orderly at the campus hospital to elope. His mother swore shed never forgive her new daughter-in-law for denying her the joy of a big wedding, but then Kim was born and any hard feelings were forgotten.Mrs. Parker wasnt worried that Anthony lacked a clear plan when he earned his business degree. They would figure it out. After getting laid off from an administrative job in a nearby factory, he went back to South Carolina State for a masters in rehabilitation counseling and landed a job in the marketing department of Augusta Technical Institute, which was part of Georgias system of technical colleges. It was there that he found his calling. Hed run a school, like his father.He received a Ph.D. in education administration at the University of South Carolina. Few of the white administrators at Georgias technical colleges had doctorates. They also didnt have to get over the same hurdles he did. Still, that awareness didnt prevent him from being deeply wounded when he was passed over for president of the technical college in Statesboro in favor of a white man. He declared himself done with Georgia and took a job at a trade school in South Carolina. Then in 1995, one of his former colleagues called to tell him that the presidents position was open at Albany Tech and that the commissioner of the states trade schools wanted him to apply.A nurse tapped on the door of Dr. Parkers room. She gently mentioned to Mrs. Parker that it was getting late and offered to take her to a place where she and her children could make themselves comfortable during the 72-hour cooling period. It wasnt going to be necessary for them to contort themselves into rigid chairs. Phoebe had set them up in what it called its hospit-el hotel rooms in a hospital that it offered to VIPs. The nurse said that Mrs. Parkers family had been assigned one of the nicest rooms.It had two double beds, a flat-screen television and a desk.Not at all plush, Mrs. Parker thought, but it was comfortable, and she was grateful for it.Her water aerobics bag with a change of clothes was in the trunk of her car, and after shed unpacked, the nurse returned with a goodie basket, filled with snacks and soft drinks, wrapped in colored cellophane.Anthony Parker with Sandra on prom night in 1971 and with their first child, Kim, in 1973CHAPTER 4Moore didnt stay long in Albany. He knew the fight to overcome the competition from Palmyra would always be ugly. Closer to the end of his career than the beginning, he didnt have the energy for it. But he knew someone who did, his 34-year-old protg, Joel Wernick. The two men had met when Wernick was a star right guard on his high school football team in Fort Smith, Arkansas, and worked as a groundskeeper at the hospital that Moore ran. Wernick was brash and competitive, Moore told me, and he encouraged him to go to business school and pursue a job like his.Wernick took Moores advice and became part of a growing number of hospital administrators whod been trained in business, not medicine. They were the kind of men and the vast majority of them were men who would walk into a room with a pregnant woman and immediately know how much her care was going to cost, rather than the kind of person who could walk into that same room and know immediately what care that woman would need for a safe delivery, said Richard Ray, a former Phoebe vice president. Theyre both important, but they have different priorities.In 1988, Moore recommended Wernick to the Hospital Authority of Albany-Dougherty County, whose nine members approved Phoebes spending and operations. From the moment Wernick arrived in Albany, his No. 1 priority was to get rid of Palmyra. He had a powerful ally in the chair of the authority, William Harry Willson, who would hold the position for 31 years. A Harvard Business School graduate, Willson had converted his familys pecan farm into a successful mail-order business, helped found a local bank and became the citys leading philanthropist.Albanys economy had shifted from agriculture to industry. In 1968, Firestone had opened a factory that employed some 1,600 workers. Procter & Gamble had built a paper products plant in 1973. Within the citys white establishment, old and new money were vying for influence. Willson and Phoebe represented the old, Palmyra the new. To hear Phoebes supporters explain it, Palmyra was driven by racism and greed. Not only did it provide scant care to the poor, but it had no obligations to invest any of the money it was making off of Albany into Albany. Meanwhile, as a public hospital, Phoebe was legally obligated to serve the poor, and in the years when the hospital ran a deficit, the countys taxpayers were on the hook to make up the difference.Willson moved to make Phoebe a business, too. Among his first instructions to Wernick was to reach out to Palmyras parent company and offer to buy it out. When the Hospital Corporation of America turned him down, they decided that the only way Phoebe could compete was to expand, and the only way it could expand was to change its governance.The two persuaded Dougherty County to relinquish oversight of Phoebe and transfer it to a private management company that would also finance its operations. Under the new structure, the county would retain ownership of the actual building but lease it to the new entity for $1 a year.That lease still stands as the countys only leverage over how the hospital is run. County officials can revoke it without warning, although the conditions of the lease leave a lot to Phoebes discretion. It broadly requires that Phoebe provide quality care to the community at a reasonable cost without defining what that means that it spend 3% of its revenue on free and subsidized care for the poor and that it uphold Phoebes founding promise to treat all people, no matter their ability to pay.Hospital authority chair William Harry Willson, left, and Phoebe CEO Joel Wernick in 1988. Courtesy of Phoebe Putney Memorial Hospital The construction site for Phoebes medical tower two years later. Courtesy of Phoebe Putney Memorial Hospital With that move, Phoebe Putney Memorial Hospital became the centerpiece of the Phoebe Putney Health System. Controlled by Wernick, the health system was now free to pursue business ventures in the wealthier suburbs outside the county limits with the same tax-free status as before but without the same burden of public scrutiny.Under Wernick and Willsons leadership, the hospital authority approvedhundreds of millions of dollars in bonds for the construction of new clinics, office towers and medical wings, including some that werent in Dougherty County.Rather than staging hallway tirades to get doctors to refer their paying patients to Phoebe, Wernick bought their practices. He lobbied to prevent Palmyra from obtaining a state license to deliver babies by using Georgias strict certificate-of-need provisions, which put limits on the kinds of health care services that can be provided in any one market.The laws are meant to prevent massive chains from squeezing out smaller hospitals, but in practice they often stifle the competition. Wernick refused to negotiate rates with managers of factories who complained that the costs to insure their workers in Albany were higher than in other cities. When Blue Cross, Georgias largest health insurer, moved to include Palmyra in its health care plans, Wernick threatened to withdraw from the network if it went ahead with the deal. It did not.In 10 years, Wernick dramatically reshaped Phoebe from a small community hospital in a small city to a behemoth hospital system spread across the state. In 1998, a decade after Wernick arrived, The Wall Street Journal reported that the hospitals profit margins were double the national industry average. Along the way, though, he had made enemies. In 2003, Phoebes chief of surgery and a local health care accountant started sending a series of anonymous faxes to businesses, accusing Phoebe and Wernick of an array of excessive and predatory behavior. The faxes, called Phoebe Factoids, were drawn from public records and leaks. A lot of the allegations they made were true that Phoebe paid its executives high six-figure salaries; that it treated the members of its board of directors to all-expenses-paid trips to Europe and the Caribbean; and that it employed aggressive measures to collect medical debts from the poor. But the information was couched in so much spin and crude innuendo that it wasnt easy to tell what was accurate and what wasnt.A Phoebe Factoid critical of Wernick and the hospital Obtained by ProPublica For months, the Factoids held Albany in thrall. Wernick used his connections in the district attorneys office led by a Putney descendant and a former FBI agent to help him investigate who was behind them. Once he knew who the authors were, Phoebe sued one of them for defamation. They brought their own suits against Wernick and Phoebe, accusing them of retaliation. Each side denied the allegations.Eventually the faxes stopped, and the lawsuits were dismissed or dropped, but not before attracting attention from state and national media, which, in turn, got the attention of Iowa Republican Sen. Charles E. Grassley. The chair of the Senate Finance Committee, he was launching an investigationinto whether nonprofit hospitals like Phoebe were giving enough back to their communities to justify what they were receiving in tax breaks.The committee released its findings in 2006, and they were devastating. Among the 10 hospitals that answered the senators questions, eight of them submitted information about the amount of free and discounted care they provide to the poor. According to the committee, Phoebes terms were the least generous. It offered free services only to people whose income was under 125% of the poverty line and discounted care to those below 200%. Under those terms, a single mother with two dependent children who earned more than $21,000 a year would not qualify for free care. The other seven hospitals covered patients whose income was at least one and a half times that much.Even more damning was how aggressively Phoebe pursued patients with medical debt. The hospital told the committee that it had filed lawsuits against more than 1,000 people during the previous five years and that nearly 40% of those suits involved people who owed less than $500.Decades later, when I spoke with Dean Zerbe, who led the Grassley investigation, he got worked up again about Phoebes debt collection practices. They werent doing that because they genuinely expected to collect $500, he said. When hospitals go after people like that, its because they dont want them to come back.One of the many Phoebe billboards in Albany Katie Campbell/ProPublicaThree former executives at Phoebe told me that the Grassley report rattled Wernick, because he couldnt disparage the findings as a terrorist conspiracy the way he had done with the Factoids. It wasnt the only public relations hit. The Albany Herald published an accounting of the properties the hospital was acquiring in the downtown historic district, raising questions about the drain on the countys property tax base. In 2006, The Associated Press reported that Phoebe had used its relationship with the county government, which has the power of eminent domain, to force a 93-year-old retired domestic worker named Julia Lemon out of her home. The hospital wanted to raze the house so that it could expand a day care center for its employees. A jury ruled in Lemons favor.That same year, the Albany Herald obtained a deposition in which the hospitals chief financial officer revealed that Wernicks compensation came with a long list of perks, including a country club membership, six-figure bonuses, an automobile of his choice every three years and a termination agreement guaranteeing that if he was fired for cause, hed receive three years pay unless he was convicted of a felony. This was on top of a $650,000 salary.If all that wasnt enough, in 2009, the battle between Wernick and the authors of the Factoids became the subject of a feature-length documentary. The timing of all the coverage couldnt have been worse. Plants in Albany had begun to shut down, and thousands of people were being thrown out of work: Bobs Candies (236 employees); Merck (273 employees); MacGregor Golf (200 employees); Flint River Textiles (230 employees); and, the biggest hit, Cooper Tire, which had replaced Firestone (1,268 employees). On their way out of town, plant managers complained that one of the reasons for the closures was the high cost of health care.Sandra Morris was a human resources manager at the Procter & Gamble plant, which didnt close but whose workforce has shrunk over the years. I was trying to do everything I could to lower our costs, she told me. But, she added, I was fighting a monstrosity of a hospital.Men playing checkers across the street from the checker club in downtown Albany Katie Campbell/ProPublicaThe battle with Palmyra ended when Phoebe least expected it when it looked like it had lost. Palmyra applied in 2008 for a license to deliver babies. Phoebe spent millions of dollars, including $8.8 million to the firm of its lead attorney, Robert Baudino, to challenge the request. Palmyra took its case to court, charging Phoebe with a host of antitrust violations, and it won. In April 2010, the 11th U.S. Circuit Court of Appeals ruled against Phoebe and, in remanding the case, recommended that the health system could be held liable for damages amounting to three times the value of any provable harm.Those who worked with Wernick told me that he saw the ruling as a matter of life and death. The damages Phoebe might have to pay would gut its finances. Just as troubling was that Palmyras ability to begin delivering babies would have dealt a significant blow to Phoebes ability to compete for patients. Ive spoken to numerous people about Wernick, and the one quality that both his allies and detractors agree on is that his determination to win was extreme. Where they disagree is about his motives. His supporters say that he operated on the belief that what was good for Phoebe was good for Albany and that it was his commitment to doing right by the community that compelled him to fight as hard as he did.To his critics, he was only interested in building a health care empire, whether that was what Albany needed or not. Lynda Hammond, a former Phoebe vice president, told me that for Wernick it was all about being the only hospital, not the better hospital.Three months after the 11th Circuits ruling, Wernick dispatched Baudino to Hospital Corporation of Americas headquarters to discuss, again, Phoebes interest in buying Palmyra. The only public records of how the deal was consummated come from the filings made by the Federal Trade Commission, which mounted a legal battle to undo it.According to those records, HCA seized on Phoebes vulnerability and asked for $195 million in cash, which was more than twice Palmyras net revenue for the previous 12 months and which the FTC said far exceeded other recent hospital deals. HCA demanded that the agreement be kept confidential until it was signed. Also, if the acquisition failed to go through, either because of antitrust challenges or opposition from the hospital authority, Phoebe would have to pay the chain a breakup fee of some $52.5 million.Wernick presented the terms to the hospital authority a week before Christmas. Baudino, Phoebes lawyer, was assigned to represent the authority. As the FTC would later point out in a legal complaint, this put him in the position of both pitching the merger and weighing its merits. He recommended that the authority approve the deal. Seven of its nine members attended the meeting, and they voted unanimously in favor.Feelings among the residents of Albany, who didnt learn about the purchase until after it was signed, ranged from confusion to outrage.The Albany Herald quoted opponents to the deal saying that it was mind-boggling that the hospital authority would agree to a merger of this magnitude without taking time to do an independent assessment of its potential impact on the cost and quality of care. They accused the members of the authority of conducting themselves as agents of the hospital rather than representatives of the public good.Within months, the FTC sued Phoebe, describing the hospital authority as a rubber stamp and the deal as a merger to monopoly that would cause consumers and employers in the Albany region to pay dramatically higher rates for vital health care services. The agency pointed out that many people in the city were already struggling to keep up with rising medical expenses. It added that the merger was also likely to reduce the quality and choice of services available.Over the years Phoebe had done many things to lose the confidence of the community it was supposed to serve, but the purchase of Palmyra at a huge cost, revealed only at the last minute, without public input or any assessment of its repercussions was a turning point for many residents.The hospital authority didnt call a public hearing on the merger until May 2012, some 17 months after the deal was announced. It attracted an overflow crowd and lasted more than three hours, as one impassioned speaker after another shared their views. Why did it take the FTC to recognize what you did not the need to protect our citizens from an overreaching hospital, asked a resident named Hope Campbell, speaking for many in the room.In response, Wernick promised that, in order to keep the merger from draining revenue from the county, Phoebe would voluntarily continue to pay what had been Palmyras property taxes. Not only would there be no increases in the cost of care, Wernick said, but ending the rivalry between two hospitals would allow Phoebe to streamline services in a way that would reduce costs and broaden its ability to provide the region with high-quality, affordable and accessible health care.He explained that Phoebe Putney Health System had grown to cover 35 counties. As a result, it had to expand to keep up with the demand, and buying a facility was much cheaper and much less disruptive than building one. Phoebe would finally have the space and resources, he said, to address some of the regions most pressing needs, including establishing a trauma center. And he pledged to convert Palmyra into a medical facility that focused on care for women and children.The matter of the merger was not settled for five years, and although Phoebe lost the legal battle, it ultimately won. The Supreme Court ruled against the merger, but by then Phoebe had taken control of Palmyra, combining its services and staff and even giving the facility a new name, Phoebe North. The FTC fought another couple of years to find a way to separate the two entities, but it eventually decided that Georgias strict certificate-of-need provisions would make it almost impossible for an outside health system to sustainably take over Phoebe North.Richard Ray, the former Phoebe vice president, recalled being summoned to an executive meeting shortly after the settlement with the FTC was announced.He said that the mood at the meeting was anything but celebratory. The purchase had thrust Phoebe deep into debt. Nobody was sure how the hospital was going to keep its doors open.Wasnt the plan to turn Phoebe North into a women and childrens facility? I asked.It was clear that no real due diligence on the idea had ever been done, he said. We had bought this facility that we couldnt use.How did Phoebe explain that to the public? I asked.We knew we couldnt say that to the public, he said, so we really didnt say anything.Rosalynn Almond holding the urn containing the ashes of her sister LaTosha Almudena Toral/ProPublicaMay 27-29, 2022Just a little more than 24 hours had passed when Mrs. Parker realized that word about her husbands condition had gotten out. She received a text from someone she and Anthony barely knew, a middle manager in Phoebes human resources department. But somehow the woman had heard he was in critical condition and messaged to say that she was praying for him.How does she know? Mrs. Parker wondered. Had news about Anthony gotten out?If that wasnt intrusive enough, the woman stopped by the room. You dont want to move him to Emory or somewhere? she whispered. Shouldnt you get him out of here?It seemed an inappropriate question on so many levels, not the least of which was how little they knew each other. Still, Mrs. Parker was polite. Were good, she responded. I appreciate your concern, but were good.Other people might not have a high opinion of Phoebe, but Mrs. Parker did. She was confident its staff was going to save Anthony. She compared it in her mind to when President Donald Trump came down with COVID-19 and had to be rushed to Walter Reed National Military Medical Center. That was an all-hands-on-deck emergency, and the staff at Phoebe, whose senior executives milled in and out of Anthonys room, had made it clear that this was an all-hands-on-deck emergency, too.Andrea, the Parkers middle child, who was 43 and served as a commander in the Coast Guard, had arrived from suburban Washington, D.C., late the previous evening. So had Richard, a UPS long-haul driver, based in Atlanta, who was 39 and the youngest sibling. None of them doubted that their father was in good hands. They supported their mother, and their mother was going to stick with Phoebe.Thats what Anthony had always done when others raised questions about the hospital. When doctors shared concerns about staffing issues that were leading to poor patient outcomes, Anthony questioned the propriety of their actions, not Phoebes. When friends complained about loved ones dying in Phoebes care, he didnt use his position on the board to press the hospital for an inquiry. He would say he was confident Phoebe had acted appropriately. When he asked Phoebe to invest in Albany Techs nursing program and instead it gave money to the predominantly white community college, he stewed privately, but he didnt raise a ruckus. They just dont know they need us yet, hed say to his staff. Well be here when they do.Mrs. Parkers loyalties also ran deep. When the spouse of a co-worker had nearly died from an infection shed gotten after a hysterectomy at Phoebe, she asked Mrs. Parker to help get a letter to CEO Joel Wernick. Mrs. Parker didnt do it. Who knew whether Phoebe was responsible? she reasoned. It didnt feel like something she should take to Anthony, much less for Anthony to take to Wernick.Yes, there was the time years earlier when he was being treated for lymphoma and had been admitted for what was supposed to be a laparoscopic biopsy of a spot that had been detected on one of his lungs. The doctor emerged from the biopsy saying hed ended up performing major surgery. Did he just tell me he opened Anthonys chest? she said to herself, feeling a lot like she would when Dr. Jos Ernesto Betancourt told her that her husband had gone into cardiac arrest. The surgeon back then explained that hed changed plans because hed had a hard time reaching the section of the lung that hed wanted to check for cancer and that fortunately hed found no signs of disease. But afterward, Dr. Parkers radiation oncologist complained that the biopsy hadnt been necessary.Why hadnt her husbands doctors communicated with one another? Mrs. Parker wondered. A lawsuit certainly crossed her mind but not her husbands. He would have never considered such a thing. Not when it came to Phoebe. Hed have a longer recovery, but hed be fine. His thinking was, Lets move on.She was praying that her husband would be fine this time, too, that his faith in Phoebe would be vindicated. On Sunday, three days after the ablation, it seemed that might be the case. The cooling period had ended. Dr. Parkers body was being returned to normal temperature. His three children were in his room, singing along with a recording of the South Carolina State fight song Get up for the Bulldogs. Everybody, get up! hoping their father could hear them, when suddenly he opened his eyes.Anthony Parker pinning a corsage on his younger daughter, Andrea, in 1997 and with Andrea during parents weekend at the Coast Guard Academy the following yearCHAPTER 5Phoebe spending nearly $200 million to buy and then mothball most of Palmyra while so many Albany residents were struggling to pay their medical bills was disastrous for its reputation and its finances. The hospital had paid cash for Palmyra, cobbling together the financing afterward, including arranging for the hospital authority to issue yet another bond this one for $108 million. The additional debt helped send Phoebes expenses soaring from $508 million in 2012 to $576 million the next year.I spoke with several former Phoebe executives about what things were like during that time. They told me that conditions were bleak. One recalled Joel Wernick, whod now run the health system for 25 years, spending millions of dollars on a communications expert to come up with a branding campaign. We had soiled beds, waiting rooms with holes in the chairs, mounting sepsis issues and had just laid off 200 qualified nurses, he recalled, but we had a new logo.A former vice president at Phoebe showed me an email chain that shed saved from around that time. It had been written under the subject line ICU Morale. The emails captured a conversation among a group of intensive care nurses who were encouraging one another to try to make the best of the conditions because there wasnt much else they could do.Money problems in the hospital (despite all of our opinions) have dictated that cutbacks are necessary, one of the nurses wrote. People and family are going to die, our patients are going to die, sometimes quick sometimes not sometimes despite everything we do. The nurse went on. People are going to be treated wrong, people will suffer, work will not be the best at times, he wrote. We will continue to feel underpaid no matter what job, company or title we attain.One of the nurses colleagues thanked him for speaking up. A supervisor encouraged everyone on the email chain to try to make the best of a bad situation. However, there was a long response from a nurse whose positivity was spent.She wrote that during a typical shift in the ICU, it wasnt unusual for a single nurse to manage three critically ill patients at a time, while guidelines advise only being responsible for one to two. She described how doctors ignored late-night calls, leaving her and her colleagues scurrying on their own to figure out how to save patients whose vital signs were crashing. She recalled running out of essential supplies and having to spend hours on the phone and away from her patients to get them restocked.She despaired about having to answer questions from patients and families about why something wasnt done or checked, when youve been doing your best just to stay afloat.Its easy to talk about keeping a positive attitude, she wrote. But when youre hit with tidal wave after tidal wave, night after night, even the most faithful, positive person will start to waver.A Phoebe spokesperson said the emails represent the opinions of a few individuals, not facts. At the time, he said, Phoebe was not under undue financial strain and never prioritized financial considerations over quality and safety.The conversation in those emails resonated because Id pored over hundreds of pages of Phoebes financial records. Revenue from patient stays was flat. The former Phoebe vice president told me that Palmyras patients were so upset by the merger that those who could afford to travel for health care, which often included people with decent insurance, went out of their way not to go to Phoebe. Providing care for the poor and uninsured became an even bigger burden. The amount of bad debt that Phoebe accumulated because patients werent paying their bills increased from $16.5 million in 2012 to more than $121.7 million in 2018.Despite Wernicks promises, the cost of care at Phoebe increased immediately after the merger, and, a year later, so did the cost of health insurance. An Atlanta Journal-Constitution examination in 2013 of the online market that had been established by the Affordable Care Act found that a middle-tier insurance plan for a typical 30-year-old consumer in Albany was the highest in the state.The following year, The Washington Post published a national study of the online marketplace. It found that southwest Georgia was one of the most expensive health insurance regions in the country. The only places with higher premiums were in the areas around the Colorado resort towns of Vail and Aspen.If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month, the Post story opened. If he lived in Beverly Hills, he would pay $1,405. But Mullins, who builds custom swimming pools, lives in southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.What that meant, I was told over and over again in Albany, was that the poor and uninsured stopped seeking routine care, and the rates of treatable illnesses began to climb.I sought out Wesley James, a sociologist at the University of Memphis, whose research focuses on health, mortality and life expectancy in rural parts of the country, and asked him to analyze mortality rates for Dougherty County over the past 50 years. Drawing on Centers for Disease Control and Prevention data, he found that for most of that time, the countys diabetes mortality rate had tracked closely with the rates for the state and nation. In the decade after the merger, however, it leaps off the charts like rocket trails, going from 36 to 76 per 100,000 people.James told me that it wasnt unusual to see modest upticks in poor, rural communities that have experienced steep population decreases and been hit by economic turmoil but that hed rarely seen spikes as high as the ones hed recorded in Dougherty County.The Rate of Deaths from Diabetes Was Far Higher in Dougherty County than in Georgia or the United StatesSource: Centers for Disease Control and Prevention WONDER DatabaseNone of this affected Wernicks compensation. In 2017, the year he turned 63, the health system provided him with a $6 million retirement package, in addition to his more than $1.1 million in salary and deferred pay.In 2018, Wernicks last full year as CEO, his earnings per bed were more than twice as much as that of the CEO at the Mayo Clinic, one of the top-rated health systems in the country. In the two years following his departure, Wernick was paid almost $2.8 million, because the board had extended his contract in case it wasnt able to find a replacement.If Wernick had made peace with his opponents by the time he left, he gave no sign of it in the exit profile that the Albany Herald published. The kind of unwarranted criticism I was subjected to never really hurt my pride, as it was intended to do, he told the paper. Nor, he said, did it diminish his commitment to Albany. This is a place where thousands live, and millions wish they could, he said. I intend to continue contributing to it.Eight months later, he moved to the other side of the state.May 29, 2022When Dr. Parker opened his eyes, his pupils rolled upward. He didnt say anything. His body was clenched and trembling as if hed felt a jolt of electricity. The entire episode only lasted a few seconds, but that was the signal Mrs. Parker and her family had been praying for the Greys Anatomy moment she had told everyone was going to happen. Anthony was coming back. He would wake up. He might not remember who they were right away, but hed wake up.There were so many big things ahead for him. His and Mrs. Parkers 50thwedding anniversary. Andreas retirement from the Coast Guard. His newly elected position on the Rotary Club board. And the launch of Albany Techs partnership with Phoebe that would double the colleges nursing enrollment. The project marked the culmination of Dr. Parkers effort to transform the image of his school from one that gave students manual skills to one that turned them into professionals.Mrs. Parker remembered the naysayers people who never believed it would happen or believed it shouldnt. At lunch one day, William Harry Willsons wife, like her husband, a major benefactor of the hospital and community, took Dr. Parker playfully by the hand and cautioned him against trying to turn the school into something for which it was not intended. Willson didnt say it in so many words, but the message Dr. Parker took from her was: Dont forget what your school is there for. Teach those kids to use their hands, not their brains.She remembered her husband repeatedly asking the hospital to support Albany Techs nursing program and Wernick regularly turning him down. The one time Phoebe did give a large donation, Wernick insisted that Dr. Parker keep it anonymous. It ticked Dr. Parker off. It felt to him like the same kind of hush money that Strom Thurmond, the segregationist senator from South Carolina, had secretly sent to the Black child hed fathered but never publicly acknowledged.Dr. Parker never let on publicly how he really felt about Wernicks request, and he told his wife not to do so either. He did what hed always done: accepted the gift, privately thanked the hospital and made the most of the money without saying where it came from.Anthony Parker with his children in 1986CHAPTER 6Before coming down with COVID-19, LaTosha Almond earned about $9 an hour working for a company that laundered the hospitals linens. Her health habits were typical of the poor and uninsured. She couldnt afford regular checkups. She sought medical help usually by going to the emergency room only when she was sick, which was a lot. She was raised in the tiny town of Cotton, where her mother, grandmother and great-grandmother had worked on a farm, both in the fields and in the kitchen.Almond was the youngest of six children, raised by a mother who struggled with mental health and a father with a violent temper. She spent her childhood bouncing between a troubled home and foster care and her adulthood bouncing between dead-end jobs.By the time she was about to turn 42, she was morbidly obese, diabetic and in the early stages of congestive heart failure. If that wasnt enough to make her a perfect target for COVID-19, shed been hospitalized with the flu just months before the start of the pandemic.But it wasnt COVID-19 that killed Almond. Her medical records show that she died from cardiac arrest and severe brain damage, which her family believes was caused by a series of alarming and inexplicable lapses by medical staff at Phoebe. Three nurses, who were either involved in Almonds care or had detailed knowledge of it, agreed.According to her medical records, Almond was admitted to Phoebe with COVID-19 in early April 2020 and was hospitalized there until June 1. She announced that she was being discharged on Facebook. Her voice was weak and raspy, but her mood was upbeat. Shed not only beaten COVID-19, shed shed 100 pounds. Im getting fine, girl, she said to one friend who typed a comment congratulating her. Fine, fine, fine.That wasnt all. My life has changed, she went on. I feel better about myself. No matter what nobody say, you cant bring me down.The day after Almond arrived home, her mother, Tersas Laster, detected an awful stench coming from her daughters bedroom.I went in and asked Tosha, Whats that smell, baby? Laster said. She told me, Ma, its that wound. Almond had a severe bedsore on her lower back. Laster described it as big as a dinner plate and so deep that she could see her daughters bone. It was pouring out yellow and gray pus, she said. Smelling like a dead carcass on the side of the road thats how they sent my baby home.A home health nurse whom Phoebe had assigned to follow up with Almond instructed Laster to get Almond back to the hospital. The nurse told me they should have never discharged my baby with that wound, Laster said. Almonds medical records indicate that she underwent emergency surgery to debride the wound. The surgeons also performed a tracheotomy because her airway had narrowed, making it hard for her to breathe.Almond spent an additional three weeks at Phoebe and was discharged on June 25 with a tracheostomy tube that required regular cleaning to keep her airway open. Laster only attended school until the eighth grade and acknowledged to me that she doesnt read or write well. She said that Phoebe did not teach her or her daughter how to manage the trach, as required for discharge. According to Almonds medical records, she was rushed back to the emergency room three times after the trach became clogged.The first time was on June 27. Records indicate that doctors in Phoebes emergency room removed a large mucus plug and sent her home. She was back in the ER again on July 12, with another plug, which doctors removed. A few minutes before noon the next day Almond was back at Phoebe for the third and final time.Patient arrived in cardiac arrest, which seemed secondary to respiratory arrest, her medical records said. Her heart had stopped beating for nearly 15 minutes before doctors were able to revive her, according to the records. They removed her trach and put her on a ventilator and tried treating her with hypothermia cooling her body to give her brain time to recover. However, the records said, the heart attack had caused too much damage. Almond was not exhibiting any purposeful activity or signs of brain activity.She was pronounced dead shortly before 10 a.m. on July 15. Her sister Rosalynn Almond said the way Phoebe had treated Almond was inhumane, adding, What kind of doctor sends a person home with an open wound like that?Citing privacy protections, a Phoebe spokesperson said he could not comment on the specifics of Almonds case but added we believe Phoebe provided appropriate care.She and her mother attempted to find a lawyer who would represent them against Phoebe, but no one would take their case. Georgia, like many other states, enacted an emergency immunity law that shielded health care providers from civil liability in COVID-19 cases, except when plaintiffs could meet the nearly unattainable standard of proving gross negligence or willful misconduct. Almond was classified as a COVID-19 death, even though that wasnt what killed her.I feel like if theyd have done what they were supposed to, my child would be here now, Laster said. I wouldnt have had to bury my baby.Remembering LaTosha Almond1978-2020LaTosha Almond Courtesy of the Almond familyAlmond with her sister Vontressia Almond at a nightclub Courtesy of the Almond familyTwo of Almonds home health nurses told me that in the chaos of COVID-19 families were not always getting the supplies and the training they needed to properly manage trach patients, because Phoebe either didnt have the resources or didnt provide them. Another nurse, who knew of Almonds case but was not assigned to it, said she scoured Amazon every day looking to buy inner cannulas, the tubes that are placed inside the trach, that were the right sizes for her patients needs. She said that cannulas were so hard to find that she asked patients to reuse them more times than standards advised, and she reluctantly asked for them back from patients who had recovered.A Phoebe spokesperson said the hospital had no recollection of anyone ever reaching out to complain about a lack of home health supplies or to indicate they were scouring Amazon in search of proper supplies.Cases like Almonds had me wondering how well Phoebe had tended to its patients before the pandemic. In 2012, the year after it acquired Palmyra, Phoebe was rated one of the worst hospitals in the country by a coalition of large health insurers and leading patient safety experts known as the Leapfrog Group. The groups members had been alarmed by reports that across the country 200,000 people were being killed or injured each year by medical mistakes and wanted to provide patients a way to evaluate their health care options.The Leapfrog Group began giving letter grades to hospitals based on information it gathered from the institutions themselves and on an analysis of public data from the Centers for Medicare & Medicaid Services. The Albany Herald reported that part of the reason for Phoebes poor first grade it got an F was that Leapfrog gave the hospital only 5 points out of 100 for ICU physician staffing. The hospitals senior vice president of medical affairs told Georgia Health News that he was troubled by Leapfrogs methodology, which he described as inaccurate and misleading. The score resonated with me because it tracked with what Id read in the email exchange Id obtained and with what Id been told by several nurses who worked at Phoebe during that time. They said that the ICUs back then were not staffed 24 hours and that getting critical care physicians to respond to emergencies was hit or miss.In 2015, CMS developed a star system to rate the quality of care at the nations hospitals, based on reports of hospital-acquired illnesses, readmissions, emergency room wait times and overall patient satisfaction. The ratings, while imperfect, are widely cited among industry analysts because of the agencys regulatory authority.According to the system, one star indicates poor performance, and five indicates excellence. Phoebe received one star when the first reports were published in 2016. CMS rated Phoebe below national averages in the most crucial categories, including hospital mortality rates, the rigor of the safety measures practiced by its staff, the numbers of preventable readmissions and general patient satisfaction. The hospitals Medicare reimbursements were docked because of high rates of hospital-acquired infections and rates of readmission.Phoebe responded by pointing to one of the glaring weaknesses in the CMS rating system, which is that it puts hospitals that serve predominantly poor and uninsured populations on equal footing with hospitals in wealthier communities. Dr. Steven Kitchen, the chief medical officer, said, The ratings given to hospitals like Phoebe show that this simple star system does not accurately represent the quality or complexity of care provided by teaching hospitals. However, to put Phoebes score in context, 96% of the nations hospitals rated by the agency scored higher. All the other hospitals within a 100-mile radius of Albany received three or four stars. Only four other hospitals in Georgia received one star, including Grady Memorial Hospital, a publicly run, 634-bed safety-net hospital in Atlanta.A banner in the lobby of Phoebe Putney Memorial Hospital announcing it received an A rating in 2022 from a patient safety group. Its rating has since dropped to a C. Almudena Toral/ProPublicaThe Georgia Department of Community Health examined Phoebes surgical records. It found two separate incidents of surgeons who operated on the wrong section of a patients spine and another where doctors operated on the wrong hip. Home health nurses, according to the inspection reports, were not keeping adequate service records, making it hard to scrutinize whether patients were receiving the medications and therapy they needed. Inspectors obtained audio recordings that showed Phoebes physicians refusing to accept critically ill and injured patients who had been referred by emergency rooms at smaller facilities. One case involved a patient with a serious head injury, whom Phoebes neurosurgeon dismissed as a serial drunk.CMS gave the hospital a two-star rating in 2017. Then in 2018, under enormous pressure from the American Hospital Association, one of the most powerful lobbies in Washington, CMS paused its rating system to adjust its metrics. That year, state officials inspected the death of a Phoebe patient whod arrived at the emergency room complaining of weakness and persistent diarrhea. The hospital had initially reported the death as a freak incident. However, the states investigation revealed that staff either ignored or silenced alarms that indicated the patient was in distress 19 times until relatives discovered the patient unresponsive. Inspectors found that the patient was down for possibly thirty (30) minutes before CPR was initiated.A Phoebe spokesperson said any health system of its size will sometimes have patient outcomes that are not optimal. It is the responsibility of every hospital to learn from those cases and do everything in their power to do better the next time.When the results of the new CMS system were back online in 2019, Phoebe received one star again. It had a one-star rating in 2020, when Albany was hit by COVID-19 and patients like Almond flooded in for care. Phoebe is still struggling to address the issues raised by Almonds case. In 2023, it was penalized for a high readmission rate, which tracks patients who return to a hospital within 30 days after their discharge. That metric can serve as an indication that they may have been released too early or without proper instructions. According to that data, Phoebe also continued to have a problem with bedsores in 2023. The hospital has two stars today, which places it among the bottom 30% of all CMS-rated hospitals in the country.An email sent this year from an ICU nurse to hospital leaders suggests that some of the same staffing issues nurses complained about more than a decade ago persist.The nurse described staffing levels at Phoebes ICUs as a crisis. She wrote that charge nurses, who supervise their units and therefore are not supposed to participate directly in patient care, routinely manage two patients. Nurses who should be handling no more than two patients were often assigned three. This is not only unsafe for patient care, but also unsustainable for staff morale and retention, the nurse wrote.If immediate action is not taken to correct the staffing crisis, the hospital will not only see a decline in patient outcomes, she continued, but also a significant loss of experienced ICU nurses who cannot continue to work under these unsafe conditions.A Phoebe spokesperson disputed the nurses charge, saying, We have not had a staffing crisis in our ICUs. He added, We staff for the volume and acuity of our patients and currently do not have any issues with staffing in our critical care unit.Downtown Albany Katie Campbell/ProPublicaJune 1, 2022On Wednesday, Mrs. Parkers sixth day sitting vigil, Dr. James Palazzolo introduced himself, explaining that he was now the critical care specialist on call. Mrs. Parker had seen Palazzolo around the hospital over the years. Shed been put off a bit by his formal bearing until a close friend who had been Palazzolos patient told her how much she liked him. Palazzolo, in fact, was warm, but he hadnt come to bring Mrs. Parker good news. He wanted to know whether Dr. Parker had signed a living will that explained how he wanted her and his doctors to manage the end of his life, in the event that he was unable to tell them himself.Mrs. Parker froze for a second and then asked Palazzolo what he meant. She hadnt been preparing for the end of her husbands life. Shed been preparing for a Greys Anatomy moment. He seemed so close. Hed already opened his eyes.Palazzolo asked her if she had spoken with a neurologist.Mrs. Parker shook her head. Should she have? she wondered to herself. How was she supposed to know that? Palazzolo said that her husband was being seen by a neurologist and that hed arrange for her to meet with him. She didnt even know a neurologist had been involved in her husbands care. Palazzolo explained that he wanted her to get a specialists opinion of her husbands condition, but his reading of the medical records suggested that Dr. Parkers brain damage was extensive. He wasnt getting progressively better, and it seemed unlikely that he would.Mrs. Parker suddenly didnt know whom to believe. The previous doctors had told her that they were going to give her husbands brain time to rest and recover and then would wake him. No one had raised the possibility that he wouldnt recover. Anthony opened his eyes, she reminded Palazzolo.That was a reflex, a spasm, the doctor said. It wasnt a sign of brain activity. There hadnt been any meaningful sign of brain activity since the surgery, he told her.Mrs. Parker stood in stunned silence. Why hadnt anyone told her that? She didnt want to think the worst of Phoebe, that the hospital had been deliberately keeping the truth from her, but she couldnt help herself.Palazzolo asked her whether she and her husband had ever discussed what they would want the other to do under these kinds of circumstances. He encouraged her to summon her children to discuss next steps, and he repeated that he would make sure to have a neurologist meet with her before the end of the day.Andrea, the Parkers middle child, arrived at the hospital soon after. They were sitting in a waiting area outside of Dr. Parkers room when Dr. William Garrett, the neurologist on call, appeared in a white lab coat and bow tie. He invited the Parkers to talk in his office. The space, little bigger than a closet, was cramped and cluttered. Garrett sat behind a desk and turned his computer monitor toward them, calling up different models of the brain, and proceeded to show images and charts that explained the various kinds of damage that could have been caused during the four to 14 minutes Dr. Parkers heart had stopped beating.Andrea, taking notes, wrote, 4-14, and then looked up. We thought it had only been a few minutes, five at the most, she said. Now youre saying it could have been 14?The neurologist told her that the records hed seen from the day of the procedure werent clear, so he couldnt be sure, but it looked to him like it might have taken much longer than five minutes to restore her dads heartbeat. Then he turned back to his models, describing something about inconclusive clinical trials, which made it hard to assess certain kinds of damage to the brain and the chances for recovery.Mrs. Parkers face went blank again. She was unable to absorb most of what Garrett was saying. What did those images on his computer have to do with Anthony? she thought to herself. Why is this man speaking to me like Im one of his med students?Andrea was also losing patience. She was scribbling the doctors words extensive posturing in all extremities, flexor response at day six, reminiscent of diffuse expression but she had no idea what they meant. When he told her that there was no single data point that he could use to provide a conclusive prognosis, she stopped him. I know neurology isnt an exact science, she said, but I dont want to talk about models.Pointing at herself and then at her mother, she went on, I want to talk about this case about my dad, her husband.The doctor said he wished he knew more about the extent and severity of the brain damage, but he hadnt been able to perform a scan because Phoebe didnt have a mobile MRI machine and her dad was too unstable to be moved.Based on the little he knew, Andrea asked, what would he do if this was his loved one?Garrett turned away from his computer and toward Mrs. Parker. He told her that he was married to a sweet, beautiful woman whom he loved dearly, but that he didnt think it would be useful to speculate on what hed do in Mrs. Parkers shoes. He told her that his clinical assessment of her husbands condition was the same as Palazzolos. It wasnt getting progressively better. As for what she should do, he said perhaps she wouldnt have to do anything. Sometimes, he told her, God makes the decision for us.The room went silent. Mrs. Parker could feel her daughter about to explode. Why was this doctor talking in circles? Was he hiding something? Was Phoebe hiding something? Suddenly its embrace seemed more like a trap.Anthony Parker soon after he became president of Albany Technical College in 1995CHAPTER 7Scott Steiner, who succeeded Joel Wernick as the CEO at Phoebe, was happy to cooperate with my reporting when I was focused on the hospitals response to COVID-19. But he was less enthusiastic when I told him that my focus had shifted to the health systems relationship with Albany. He explained why when I met with him in his office, and he told me about the first time he sat with Wernick.It was 2018, and the office looked different back then. Wernick, he said, kept it like a bunker dimly lit with a dark carpet, hunter-green furniture and thick velvet drapes that were drawn shut. Steiner had been told that Wernick barely left the office during work hours anymore and that he never opened the drapes. According to Steiner, when he asked Wernick why not, the CEO looked at him with a little wily smile and said, For fear of being shot.Leading Phoebe during COVID-19 hadnt been easy, Steiner said, but distancing himself from his predecessor was even more challenging. In his first year, hed held 570 meetings with community groups, churches and medical practices, many of them taken up with decades-old grievances what Steiner described as the ghosts that will outlast me.Steiner, who is 57, grew up in St. Louis. His mother was an intensive care unit nurse, his father an executive at a printing company. He received his MBA from nearby Webster University. Before joining Phoebe he had been the CEO for a group of Detroit hospitals, owned by Tenet Healthcare, the second-largest for-profit health system in the country. It was a miserable experience, he told me. He oversaw five layoffs in his first two and a half years. Then he had to manage the fallout from a series of newspaper stories that revealed how some of the hospitals had nearly lost their licenses after doctors filed complaints about dirty and broken surgical instruments.Three prominent cardiologists claimed that the health system fired them for making those complaints public, and two filed a wrongful termination suit against Tenet and Steiner. The cardiologists eventually won a $10.6 million award. (Officials at Tenet did not respond to multiple requests for comment.) Steiner didnt want to talk about his role in the matter when we met, except to say that the turmoil made him open to calls from a headhunter who told him about the opportunity at Phoebe.I didnt think places like this existed anymore, he told me. Compared to the shit show in Detroit, he said, Phoebe Factoids, the anonymous fax campaign against the hospital that consumed Albany in the early 2000s, seemed like a lot of external nonsense. Phoebes future direction would ultimately rest with him, not distant corporate overlords. All he had to do was get people in Albany to trust him, to put the past behind them. What Ive tried to say to people is, its a new chapter. he told me. My reporting, he said, threatened to stir up old tensions.The Westgate neighborhood of Albany Ross Landenberger for ProPublicaNorthwest Albany Ross Landenberger for ProPublicaHe knew such tensions were already stirring well before I came along. Hed heard them firsthand during his numerous meetings with the community. Mayor Kermit Bo Dorough, whod been a critic of the hospital since the Factoid days, was threatening to commission a study of health care costs. And in early 2020, nearly a year after Steiners arrival and weeks before COVID-19 hit the city, The Albany Southwest Georgian, a weekly Black newspaper, published the official portraits of Phoebes executive team across its front page. Most were people Steiner had inherited. None was Black.The racial composition of Albanys political hierarchy had shifted in the previous 20 years. The citys manager and police chief were both Black, and so was the county district attorney and chief judge of the county court. Until Doroughs election as mayor in 2019, African Americans had held the office for four straight terms. The majority of the members of the hospital authority was Black. Among them was a retired civil rights lawyer named Nyota Tucker, who was alarmed by the Southwest Georgians front page. Why were there no Blacks on the health systems executive team, she asked Steiner during one authority meeting.A front page of The Albany Southwest Georgian from February 2020 showing Phoebes executive team The Albany Southwest Georgian Bespectacled and silver-haired, Tucker, 76, carries herself with quiet reserve. As a teenager, she was one of six students all girls to integrate her hometowns high school. She went on to become the first African American woman to graduate from the University of Georgia School of Law. Afterward, she moved to Albany to work for Georgia Legal Aid, where judges in her first cases demanded she provide proof that she was a member of the bar. She left Albany for a few years to join the NAACP Legal Defense Fund in San Francisco and then returned, eventually becoming a member of the faculty at the historically Black Albany State University and later its chief counsel.She didnt know much about the health care system or how it worked when she agreed to serve on the hospital authority in 2017. She saw volunteering as a way to stay active after she retired and to serve the community. The authority was not known to cross Phoebe, Tucker told me. Quickly, she established herself, according to one board member, as the contrarian in the room the person who said what nobody else wanted to say.In late 2020, Steiner added Dr. Dianna Grant, a Black physician, to his executive team. The next year, the hospital authority elected its first African American chair, a businessman named Glenn Singfield. When I interviewed Singfield, he made clear he was also aware of the authoritys history as a rubber stamp. He told me he wanted to break from the days when the authority consisted of people whod been handpicked by Phoebe to do the hospitals bidding. He said, I can assure you those days are over.There were reasons to be skeptical. The authority relied on Phoebe for its funding as well as for its administrator and lawyer. The hospital managed the authoritys website and routinely hosted its meetings in the Phoebe board room. And five out of its nine members were doctors or had other financial ties to Phoebe, including a former mayor who had received numerous campaign contributions from Phoebe executives and Singfield, who owned a construction company that had contracts with the health system.Still, Tucker wanted to believe Singfield and wanted to believe that Steiner would lead Phoebe in a new direction. But she soon found herself at odds with him. As the pandemic loosened its grip on Albany, she resurfaced a proposal she had made the year before to have the authority hire a consultant to assess whether the hospital was meeting its lease obligations to provide safe and affordable care to the community.The previous review had been done in 2012, before the advent of Obamacare and Georgias decision not to expand Medicaid. The assessment would allow the authority to get a better sense of those policies effects. Besides, she was new to the authority, and Steiner was new to the health system, and it seemed like a good way to get a baseline understanding of where things at the hospital stood so they could see where things could be improved.Steiner told the authority he was not opposed to a review but wondered whether hiring an outside consultant was a good use of precious resources. He said that Phoebe would provide any information the authority requested to assess how well the health system was managing the hospital.Tucker argued that hiring an outside firm was the only way to get an assessment that was free of any hidden agendas, even though the money for the review would ultimately come from Phoebe. Since several members of the authority, including herself, had little to no experience in health care, they might not know what questions to ask, she said.Retired lawyer Nyota Tucker sat on the hospital authority board from 2017 to 2022. Alyssa Pointer for ProPublica The authority voted in favor of hiring outside consultants. They presented their findings at a meeting in May 2021. Marvin Laster, president of the citys Boys and Girls Club and a member of the hospitals board of directors, attended. Tucker was surprised. Laster hadnt ever come to an authority meeting that Tucker could remember, but she knew him she was on the clubs board and she was happy to have a friend in the room.The analysis read like an exercise in damning with faint praise. Phoebe, the consultants wrote, was committed to providing quality care and was delivering comparable or better quality than its peers in many areas. However, when they zeroed in on the seven metrics that make up the Centers for Medicare & Medicaid Services star rating system, they found that Phoebe currently ranks below the national average in five of the areas, including mortality, readmission, patient experience, effectiveness of care and timeliness of care.While Phoebe had spent hundreds of millions of dollars in building, buying and equipping new facilities, the consultants pointed out, its investments in the maintenance and modernization of the old buildings which the consultants emphasized were among the health systems core obligations to the county were consistently on the lower end of its peers.The hospitals financial margins were comparable if not better than its peers, the report concluded, but it relied more heavily on long-term debt to fund its operations an indication that Phoebe still hadnt fully absorbed the cost of the Palmyra merger 10 years earlier.As for the percentage of gross revenues that Phoebe spent to help the poor, the report found it had a lower charity/indigent care percentage than its local, regional and national peers, in all years except 2015. And finally, the report found that Phoebes cost of services are, on average, higher than local, regional and national peers. In short, the issues that had bedeviled the hospitals relations with its community the quality of care, cost of care and its outreach to the poor hadnt changed.When the consultants concluded their presentation, the first questions to arise were less about the findings and more about what to do with them, according to two authority members attending the meeting.Singfield was emphatic, Tucker said. He declared the report was not for public consumption. (Singfield did not respond to questions about the meeting.) Another member of the authority told me that everyone saw the finding regarding cost of care as the big elephant in the room. The member said, There wasnt any way to sugarcoat it.Steiner did not offer an opinion, but Laster weighed in. It was understood that he was speaking on Phoebes behalf, according to two members of the authority. Laster said that even though most of the assessment was upbeat, the information about the high costs of care could hurt the hospitals image. He compared the potential effect to rat poison. Ninety percent of its not toxic, Tucker and the other member recalled him saying, but its the 10% thatll kill you. (Laster later denied that he was proposing keeping the report secret.)The consultants reminded the authority that because it was subject to open records laws, the report was going to get out. However if the authority released it, members would have better control of how it was perceived: It would demonstrate the bodys independence and its fidelity to its oversight responsibilities.Tucker spoke vigorously in support of this view and suggested that if the authority was uncomfortable with announcing the report, it should at least post the findings on its website. That had been the practice until 2012, when, at Wernicks urging, the authority voted not to release that years report. She said the authority should not condone that kind of secrecy anymore.An authority member, who did not want to be named, told me the rest of the board was not convinced: Even if the cost of care is too much, there was agreement in the room that undermining Phoebe, damaging Phoebe publicly, criticizing Phoebe too harshly in public is bad for the community in that Phoebe is the biggest employer and the only place you can go if youre getting sick.Singfield suggested tabling the discussion until the next meeting, saying he was committed to releasing the report but wanted to give the authority time to work on how to do so. Four years later, the authority has still not made the report public.June 1-2, 2022Palazzolo returned to meet with Mrs. Parker, Andrea and her sister, Kim. He asked again whether Dr. Parker had signed a living will. Andrea said that he had, but there was no need for one. Her mother knew her fathers wishes. She would make any and all calls on her fathers care, and the children would support her 100%. What they needed from Phoebe was a clear assessment of their fathers condition. She asked whether he was brain dead.Palazzolo said that he wasnt and that, in fact, Dr. Parker was largely breathing on his own. His cognitive function, though, had been damaged beyond repair and would likely make it impossible for him to ever be the person he was.Kim asked him to say more. Palazzolo stammered, searching for the right words. That man in there, he said, is not our dad, Kim said, finishing his sentence.Palazzolo nodded.Kim kept going. Because our dad left the day of the procedure.Palazzolos eyes lowered.Mrs. Parker wanted another opinion. How could Phoebe have gone from telling her one minute that there was a chance to save her husband to saying that hed been doomed from the time his heart stopped beating a week ago? She tried to come up with the name of a doctor she trusted to put her familys interests ahead of Phoebes. There wasnt anyone who didnt have ties to the hospital. She immediately thought of her own neurologist, Marla Morgan. On staff at Phoebe, shed become close to Mrs. Parker. Morgan came from another of Albanys prominent Black families. Her late father had served as president of Albany State University for 16 years. She arrived at Phoebe late Thursday afternoon and spent about 20 minutes in Dr. Parkers room. Afterward, she asked Mrs. Parker whether hed ever responded to the sound of her voice, to her pleas to open his eyes or squeeze her hand? Mrs. Parker shook her head.Morgan said she didnt see any sign of cognitive brain function. There was only the slimmest chance there ever would be.She used the same language Mrs. Parker had heard from Palazzolo. Her husband wasnt getting progressively better.That was enough for Mrs. Parker. Anthony would never want to live in a vegetative state. She instructed the medical staff to withdraw nutritional and respiratory support. In the previous days, Phoebe executives had stopped coming by Dr. Parkers room. She wondered whether their absence was a gesture of respect or avoidance. Ever since her meeting with Garrett, the kids were increasingly unable to keep up a polite front and were fine not to see them. Kim and Andrea did not want to watch their father die. They said their goodbyes and asked their mother to call them when it was over. Richard offered to stay.Mrs. Parker felt that she and her family were on their own and that they always had been. She couldnt make sense of how this had happened, of how Phoebe had allowed this to happen. She wanted so badly to scream at someone and demand an explanation, but there was no one around.She needed to write a text to her siblings, Dr. Parkers staff and several of their close friends, but how was she going to explain what had occurred, much less what was ahead for her husband? The cruel truth, she thought to herself, was that he was doped up and dying she knew she couldnt say that, though. She pulled out her phone, summoned what felt like her last shred of sanity and composed a message, which said only that he had begun transitioning and thanked them for their prayers.Anthony Parker and a pregnant Sandra in 1973 and the Parker children, Andrea, Kim and Richard, on a trip to Tennessee in 1984CHAPTER 8Mt. Zion Baptist Church, the home of the 1961 civil rights protests, remains one of the most influential Black congregations in the city. Its pastor, Daniel Simmons, told me that in 2007 his members helped fund the opening of a free clinic, called Samaritan, across the street from Phoebe, for people without health insurance. The country was in the throes of the Great Recession. People were dying in our backyard, he said. It wasnt because they didnt want to go to the doctor. It was because they couldnt afford it.Phoebe donated one of its properties a single-story brick building across the street to the clinic and agreed to provide lab work for patients who qualified for state indigent funds. When I sat down with Simmons 13 years later, the need for the clinic wasnt all that different from when it had opened. Some 16% of Albany residents were uninsured, almost double the national average, in part because the governor and the legislature had decided not to expand Medicaid. Albany, though, had Phoebe, a hospital whose mission was to care for people no matter their race or ability to pay. So I asked Simmons why a safety-net hospital needed a safety net.Simmons arranged for me to meet Nedra Fortson, the nurse practitioner who runs the clinic. The day I met Fortson, she wasnt seeing patients but was waiting for a repairman to come patch two holes in the buildings leaky roof. Phoebe hadnt done much to maintain the property, she told me. (A Phoebe spokesperson said that over the years the hospital had invested significantly in maintenance and repairs to the building.)As I began to ask the same question I had asked Simmons why would people seek care at the clinic when Phoebes emergency room was right across the street there was a knock at the door. In came a tall, muscular man wearing carpenters jeans, a face mask with Phoebes logo and a T-shirt with the words, I am Phoebe. His jaw was swollen from an infected tooth, and he was wondering whether Fortson could help him find someone to take it out.The man told me he was 36 and worked on contract as a groundskeeper at the hospital. I recalled that Wernick had gotten his start as a hospital groundskeeper. I also thought that this mans story was such a perfect illustration of the clinics importance that if his jaw hadnt been oozing with pus, I might have thought I was being set up.I asked him whether hed sought help from Phoebe. He explained that hed gone to the emergency room a few days earlier, and after a 10-hour wait and a 10-minute examination by a nurse, he walked out with two slips of paper: one with a prescription for antibiotics, the other with a list of dentists. I asked what happened to the slips of paper. He rolled his eyes and said, I threw em away.On his $9-an-hour salary, he said, he couldnt afford health insurance, and without insurance, he couldnt afford antibiotics or a dentist. He had tried home remedies mostly gargling with saltwater but the pain in his mouth got worse. It feels like I got hit with a fastball, he said. The groundskeeper, who asked not to be identified because he didnt want to put his job at risk, still forced himself to go to work because he needed the money. That turned out to be a good thing, he said, because one of his colleagues spotted Fortson driving into the clinic parking lot and sent him over to see whether Samaritan could refer him to a dentist who could treat him for free.Then it was Fortson who rolled her eyes, not about the request of finding a dentist, which she managed to do that afternoon, but about someone doing work for Phoebe and coming to her for medical care. The groundskeeper wasnt an anomaly, she told me. Nodding in the direction of the hospital, she said: They all know us over there. Their cafeteria workers, their janitors, their clerks, their nursing assistants and so on.With more than 5,500 workers, Phoebe Putney Health System is the largest employer in southwest Georgia. Its growth tracks with whats happening across the country as the health care sector expands and manufacturing declines. But national studies have shown that hospital jobs are not like the manufacturing jobs theyve replaced. The latter generally pay salaries that help lift unskilled workers into the middle class. Most hospital jobs dont, which has an effect on both the workers and their ability to stimulate the local economy.One 2017 study of workers in 11 industrial states found that for every higher-paying job held by doctors, six health care employees including phlebotomists, orderlies, cooks make less than $15 an hour. In Albany, where 78% of residents do not have college degrees, they were making on average less than $10.Jack Nicholas Hilton, a former Cooper Tire worker, told me that at the time hed gotten laid off, he was making $24 an hour. He said he was lucky enough to have a wife who was working as a nurse at Phoebe and could support him while he went back to school for a nursing degree. He made $21 an hour when he started at Phoebe in 2010. In addition, health benefits for him and his family of four came with a $5,000 deductible. If he had a kidney stone, which he did from time to time, that was $2,500 out of his pocket. People think that if you work in health care you get good benefits, he said. Mine were terrible. Hilton left Phoebe after three years and no longer works as a nurse.Numerous other nurses at Phoebe shared similar stories. One former senior nursing manager told me she paid $300 every two weeks to cover herself, her husband and two children, including one in college, who had to drive home three hours for routine exams because Phoebes health plans did not cover those services elsewhere. The nurse now works for a hospital in California and pays $80 a month for the same coverage, and her daughter can receive care in the town where she goes to school.An ICU nursing supervisor, who suffers serious allergies, told me he got his EpiPens from a school nurse, who would give him the extras she had every month. One day he and his wife went to see a Phoebe doctor to discuss a vasectomy and were told hed have a $900 copay up front, which was not reimbursable. He said that he joked about it with his wife, saying, $900 will buy us a lot of condoms.East Albany Almudena Toral/ProPublicaA Phoebe spokesperson said the health system offered high-deductible health insurance plans for those who wish to minimize premiums, as well as offering a co-pay plan for those who prefer not to have a high-deductible plan. This year, he added, Phoebe is paying 87% of the cost of health insurance premiums for employees.Like hospitals across the country, Phoebe has been overwhelmed by nursing and physician shortages. According to the hospitals financial records, between 2014 to 2022, its spending on contract staff exploded from $2.5 million to $150.2 million. Administrators told me that about $100 million of that went to pay for traveling nurses. Although they dont receive health benefits, traveling nurses fetch salaries that are at least twice as high as those paid to the permanent nursing staff. This transient staff is not only a drain on Phoebes resources but typically doesnt invest in the community by buying homes or sending their children to local schools.Its part of a vicious cycle that incentivizes permanent nurses to travel, further crippling Albanys economy. The people who remain in town, for the most part, are low-skilled, low-paid employees, like the certified nursing assistant who worked part-time as a DoorDash delivery driver; the oncology scheduler whose colonoscopy bill had been sent to a collection agency; and Louise Williams, 51-year-old single mother and grandmother, known by her nickname, Weezie. She worked 22 years at Phoebe in what is called the environmental services cleaning and disinfecting patient rooms. During the first year of the pandemic, she was the only person on Phoebes staff to die of COVID-19.In her honor, the hospital renovated the environmental services staff break room, installing recliners, a refrigerator stocked with healthy snacks and a flat-screen TV. At a ribbon-cutting ceremony that was attended by Steiner and other hospital executives, the room was christened Weezies Place. The hospital invited her family, including her daughter, Shabreka Dent, who thanked Phoebe for remembering unsung heroes like her mother. My mom was a Phoebe person, she said. She loved working here.Remembering Louise Weezie Williams1968-2020Williams in her Phoebe uniform and with her daughter Shabreka Dent Courtesy of the Williams familyA few months before the dedication, I had gone to see Williams family because two nurses at the hospital had told me they were taking up a collection to help pay her funeral costs. Dent said the same thing to me that she would say at Phoebe: Her mother loved working at the hospital.Nothing we ever said would get her to leave that place, Dent told me.Did you try to get her to leave? I asked.I used to tell her all the time she should quit that job, she said.Why? I asked.Because she was always struggling.Dent said that when her mother first started at Phoebe more than 20 years ago, she worked part time, thinking shed eventually find a different job with better hours and better pay. But Williams prospects were limited, because she hadnt finished high school, factories were starting to lay people off and the only employer whose future looked bright was the hospital. Two decades later, Williams was earning less than $10 an hour, often taking home less than $300 a week.When Williams died, she was late on her rent, which Dent said happened frequently. Her mothers day-to-day existence, she said, was a gantlet of overdue bills and payday loans, which became even more crushing in 2014, after Dents older sister died of cervical cancer and Williams took custody of her two teenage grandsons.She would call me, and say, Hey, Im fine, but if you could get the boys something to eat. Or there were several times I paid the light bill for her, or shed come around, and Id pay her cellphone bill, or when time for school came around, Id get clothes for all the kids.Dent showed me where shed gotten her mothers name tattooed on her right forearm. She used to say she liked taking care of people, she said. I told her, Thats all good, but you got to take care of you, too.Sandra Parker in front of a portrait of her husband at Georgias Albany Technical College Alyssa Pointer for ProPublica June 3-6, 2022There was no longer any reason to keep Dr. Parker in the ICU. On Friday, Mrs. Parker agreed to have him moved to a regular medical floor. The next day, a nurse asked whether she wouldnt like to have him transferred to Phoebes hospice, which is set in a quiet, wooded area of northwest Albany. Its design was inspired by Frank Lloyd Wright, and it was named for William Harry Willson, the pecan magnate whod first invited Dr. Parker to join the hospitals board.This room was made for daddy, Richard said when he walked in, marveling at the prints of World War II fighter planes on the walls and at the floor-to-ceiling windows that looked out onto a patio, shaded by pine trees.On Sunday afternoon, Mrs. Parkers nephew brought ribs from the Parkers favorite barbecue restaurant in Columbus. Two friends, including a woman whod worked as the executive assistant to Joel Wernick, the former CEO, joined for lunch. Pastor Daniel Simmons of Mt. Zion Baptist Church stopped by to pray. And then Mrs. Parker spoke by telephone with her daughters, giggling with them about the plans shed made for that evening. The NBA finals were on television. She was going to put the game on and cheer for Steph Curry while cuddling beside her husband, as theyd done on so many date nights.When Mrs. Parker scooted in the bed, Dr. Parker began to spasm. She hopped out and made a joke of the whole thing to the kids. Can you believe your daddy kicked me out of the bed? she texted. I told him,Thats fine. I didnt really want to sleep with you either.After the game, she brushed her teeth and then sat next to the bed to pray. She started by thanking God for the time shed had with Anthony and for whatever time they had left. Let your will be done, she said, and allow us to be able to accept your will. Then she looked up at her husband. He would have hated the way he looked, she thought; unbathed, mouth stuck open, face covered with stubble, a cold sore on his top lip. She whispered to him: Were going to be OK. Dont worry about us. Then she laid her head on his stomach and was lulled to sleep by the rise and fall of his breathing.At about 1:30 in the morning, she woke up with a start. His stomach had stopped moving.Well, damn, she whispered. For some crazy reason, she had held out hope that her husband would prove the doctors wrong.She drew his South Carolina State blanket up over his chest, pulled out her phone and took a couple of pictures in case she wanted to remember the moment, in case there came a time when shed want others to know.Then she kissed him, told him she loved him and let the undertaker take him away.Anthony Parker watching his son, Richard, play Pee Wee football in 1990 CHAPTER 9I learned about Dr. Parkers death from Nyota Tucker. The hospital authority board member knew the Parker family because her daughter, who was chief of pediatrics at a large Boston hospital, was close to Andrea, the Parkers younger daughter. In a small town like Albany, the death of someone as important as Dr. Parker was big news. Phoebe issued a statement lamenting the loss of a beloved board member that didnt mention hed died in its care. The Albany Herald ran statements of appreciation from other leaders in the community and an obituary, without saying how and where hed died. There was a flurry of posts on the not-always-reliable Phoebe Factoids Facebook page, alleging that something at the hospital had gone terribly wrong.If true, the quality of care Phoebe provided was worse than Id thought. Dr. Parker had not died like so many of the patients Id learned about amid the chaos of the pandemic Maude Burke, LaTosha Almond and Louise Williams. He wasnt a poor, uninsured person unable to afford to take care of himself, like the people Id met at the Samaritan clinic. He was a well-known, well-off, widely respected pillar of the community who seemed to have gone to the hospital for a routine, elective procedure. Even more than that, he was a member of the health systems board. If he couldnt get good care at Phoebe, then who could?Tucker was sure that Mrs. Parker would hire a lawyer to demand answers from the hospital and file suit for restitution. She wasnt sure what the CEO, Scott Steiner, would do, though. Would he help the Parkers get to the bottom of what happened or fight them? That, in her mind, would indicate how much Phoebes relationship with Albany had or had not changed.She had no idea, however, that there was another clash looming between Phoebe and Albany, that it would play out in the open and that Tucker would wind up on the losing side.The issue was such a hyperlocal affair that I ignored it for the longest time. It involved the hospitals plans to demolish the old Albany Middle School and use the property for the construction of the nurses living and learning center that had been Dr. Parkers dream. Phoebe had acquired the building 20 years earlier, shortly after it had been replaced by a modern facility. Like so many of its properties, the hospital had done little to maintain it. Now Phoebe was saying that the school had fallen into such disrepair that demolishing it was much cheaper than restoring and adapting it. But to raze the school, Phoebe had to gain the approval of Albanys Historic Preservation Commission, an eight-member panel of volunteers appointed by the city and county councils.In a 4-3 vote, the commission denied Phoebes request. The majority argued that the school, which opened in 1925 for whites only, was one of the last remaining examples of Beaux Arts architecture in town and was on the commissions register of historically significant structures. The city planning department also recommended that the building be preserved and urged Phoebe to consider one of its other properties for the project, including the old Palmyra building.The hostility coming from the overwhelmingly white crowd felt so visceral to the preservationists that the one Black member of the commission, whod voted in favor of the demolition, felt compelled to defend her colleagues on the other side. She told the crowd that there was more than bricks and mortar at stake, that landmarks held history.Were not the enemy sitting up here, she said. I was born at Phoebe Putney hospital. My grandfather installed the first air conditioning at Phoebe Putney hospital. She went on to say, My aunt was one of the first African American social workers at the hospital.The editor of the Albany Herald, Carlton Fletcher, had weighed in with a column under the headline Attempt to stop Phoebe/Albany Tech project beyond ridiculous. He laid out an argument that was so similar to the one I had heard from Steiner that if I didnt know better, Id have thought he had written it. Opponents to the demolition were motivated by old grudges toward Wernick, Fletcher wrote. Their position was an example of the depths to which some would sink to sabotage the health care facilitys moving forward.Tucker was paying close attention to the fight. She had no doubt the new nursing school would be good for Albany and Phoebe. But she didnt think the preservationists were being unreasonable either, and she was increasingly troubled by the tone of the hospitals campaign. Phoebe had plenty of other properties that could be used for the living and learning center, and even if the hospital was dead-set on tearing down the school, she hoped it, and Steiner, would proceed with the same together-we-rise spirit that theyd professed during the pandemic.A week after the vote, Phoebe and the hospital authority filed an appeal with the City Commission, accusing the preservation commission of abusing its discretion. Tucker didnt believe me when I asked her about the appeal. The authority, she said, had never held a vote to take such an action. I sent her a copy of the appeal, which showed that it had been filed by the authority and signed by Phoebes lawyer.Tucker said she had no idea what was going on. The authority was independent of the hospital, or at least thats what shed been led to believe. Phoebes lawyer should not be acting on the authoritys behalf, she said. She called Glenn Singfield, the authoritys chair. According to Tucker, he told her he believed the members of the authority supported the hospital and had taken it upon himself to sign on to the appeal, at Phoebes request. She told him his actions bordered on unethical behavior and could be seen as a violation of public trust.Singfield refused to talk to me about the phone call with Tucker but insisted that he was not doing the hospitals bidding. He said the same to her and later, in a text, promised, I will protect our independence. He convened a special meeting of the authority for later that day to take a formal vote on what hed already done without one. Tucker called as soon as the meeting was over and told me that several members expressed concern about the way Singfield had handled the appeal but still threw their support behind Phoebe. She was the only one who voted against the appeal.A month later, the Albany City Commission convened to consider Phoebes appeal. Mayor Kermit Bo Dorough, who had long vowed to rein in Phoebe, oversaw the proceedings. I was watching the livestream but couldnt see the crowd. Tucker and the mayor told me the room was packed.Bryant Harden, a political science professor at Mercer University and chair of the preservation commission, spoke first to explain the groups vote against demolition. Its majority wasnt opposed to the construction of a nursing school, he said, but the hospital had so many places it could build the new campus without knocking down an important part of the citys history. What was the harm in considering other options?The Steiner who took the podium sounded different from the man Id met during the pandemic. From his first words he was confrontational. He said there were a few loud people in our country, our state of Georgia and here locally in Dougherty County and Albany that seek to keep us all divided. The projects opponents were pushing their own selfish causes and not whats in the best interests of our businesses, our people, our police, our region, our nurses, our schools, our churches and certainly not our community.When a city council member asked Steiner about the preservation commissions plea to find an alternative location for the project, he thought for a second and said: You know, if you just salvaged the front exterior or the whole building and created the worlds biggest liquor store, it would be OK with the HPC.Tucker told me people gasped the proliferation of liquor stores in poor Black neighborhoods had long been a sensitive subject in Albany and her hope for a new kind of leadership at Phoebe evaporated. She lamented that Steiner would take such a cheap shot, and added, At that moment, he reminded me of Joel Wernick.Ill admit that I gasped too not just because it seemed like such a gratuitous comment; it was how it embodied the hospitals conduct during the entire fight. At every turn, Phoebe sought to beat the preservationists into submission. Ultimately it worked. The City Commission, which includes the mayor, voted unanimously to approve the demolition. Weve only got one hospital, Dorough told me, and were not going to get another one.The preservationists took their fight to the Dougherty County Superior Court and found Phoebes reach extended even there. The chief judge recused himself because his daughter worked for the hospital. The next judge, who acknowledged that she served on a bank board with Steiner and Phoebes outside counsel, denied the preservationists request that she recuse herself and ruled in favor of the demolition.If that wasnt enough of a victory, the City Commission voted not to renew two of the four members who had opposed the demolition, prompting two other members to resign in protest. The city commissioners replaced them with four new members. One of them had financial ties to Phoebe, another to Albany Tech. A city commissioner told the Albany Herald that he certainly wasnt letting politics get in the way of my vote. Another said, We chose who we thought were the best.Then Albany and Phoebe turned on Tucker. She had come to the end of her first five-year term on the hospital authority and was up for reappointment, which required a vote by the county commission. Reappointment to the authority had previously been a perfunctory affair. All a sitting member needed to do was to tell the county that they were willing to serve again. Tucker was so sure of it that she didnt attend the vote. Afterward, however, a clerk called to notify her that she hadnt been renewed.I asked a board member who served with Tucker about her removal. He told me that the hospital and the authority didnt see her as a team player and wanted her off. She was for sure not reappointed for that reason, he said. I have no doubt about that. (When asked about Phoebes role in her departure, a hospital spokesperson said the Dougherty County Commission has the sole responsibility of deciding whether to reappoint any member.)Several weeks later, Tucker addressed the county commission. She had no illusions about getting reinstated, and she had no intention of asking. Nervous and halting, she said that when she joined the hospital authority, she committed herself to serving the public, not Phoebe. The commissions decision made her wonder whose team they were on. An independent hospital authority board does not happen in a vacuum, she said. It cannot happen if members are removed from the board who question or who point out discrepancies. When they are removed from the board, you can expect that independence will end.Crews demolish the old Albany Middle School to make way for Phoebe Putney Memorial Hospitals living and learning center. Alyssa Pointer for ProPublicaAugust 2023Shortly after her husband died, Mrs. Parker retained a lawyer named Adam Malone. She was prepared to sue, she told her kids, but she was hoping she wouldnt have to. Malone had won some of the largest malpractice awards in Georgias history. But what appealed to Mrs. Parker was that although he lived in Atlanta, he had grown up in Albany. His father had been a prominent lawyer there in the 1950s and 60s and was one of the few whites willing to collaborate with Black law firms and take on Black clients. If she sued, she believed, Malone would understand the forces he was up against and not be intimidated by them.Mrs. Parker had no idea what had caused her husbands death. None of the executives who had sat with her and her family at her husbands bedside had called or visited to offer an explanation. Shed invited Steiner to speak at the funeral, but that was to keep up appearances. She took his invitation to attend a health system board ceremony in honor of Dr. Parker as evidence of his trying to do the same. Phoebes silence felt like a conspiracy. Even worse, at times, were calls from people she and Phoebe had in common. They always left her wondering whose side were they really on.It was a question that nagged at her as she considered the lawsuit. She doubted that many of those people would stand with her if she sued at least not publicly. People like Glenn Singfield, who would check in from time to time to see how she was doing and say how sorry he was about what had happened. She had every right to demand an explanation, hed say, but she kept her plans to herself because as close as the two were, he was chair of the hospital authority.The relationship with her husbands successor at Albany Tech changed, too. Hed been her husbands protg, but the school needed the financial boost from its new partnership with Phoebe. She knew he couldnt risk that project by calling out the hospital. (He did not respond to a request for comment.)I asked Mrs. Parker what she thought her husband would have done if he was alive and a different board member had died under the same circumstances. She said she would like to think that he would privately press the hospital for answers, but she doubted that hed have questioned or criticized the hospital in public. Dr. Parker was a loyal member of the Phoebe family, she said, adding air quotes. Whenever the hospital had come under fire, he gave it the benefit of the doubt, partly because he didnt want to be marked as a traitor, much less painted as a crank like the people behind Phoebe Factoids, and lose his place on the board, and partly because few people had ever taken on Phoebe and won.He wasnt a naive man, Mrs. Parker said, but I think he drank the Kool-Aid.In August 2023, 14 months after Dr. Parker died, Mrs. Parker filed a lawsuit against both the hospital and the health system, as well as three members of the anesthesiology team involved in her husbands operation, accusing them of negligence. She told me she wanted Phoebe to pay restitution to her and her children. She wanted answers about what caused his death, and she believed Phoebe wouldnt give them to her unless it had to. She wanted to give her husbands death, and her own future, some meaning. But there was something else. She worried about what message it would send if she didnt sue: I dont want them to get away with it this time.CHAPTER 10Over a couple of days, at the end of last year, Scott Steiner and I talked. He looked like a different person than when we first met. Hed lost a lot of weight. Hed previously struck me as someone who didnt fuss over his appearance, but it was hard to miss the attention he now paid to his hair, beard and close-fitting blazer. I would have been embarrassed to tell him that he seemed like a guy in the throes of a midlife crisis, but, without prompting, he admitted as much, sharing a picture of his new car: a 1979 Pontiac Trans Am. It was either a new car or a girlfriend, he joked. A car is cheaper.With some $200 million in new projects nearly half of which was funded with county bonds parts of Phoebe looked different, too. A glass-encased trauma center had recently opened, with an ICU for newborns and a helipad on the roof, which was now the highest point in Albany. At the same time, hed begun to put several of Phoebes unused properties on the market and donated four of them to Habitat for Humanity.Steiner took me on a short tour of the new living and learning center, whose lobby is dominated by a large mural that includes likenesses of the hospitals first Black nurses and whose 80 fully furnished apartments have walk-in closets that I told him might qualify as bedrooms in New York City. He pointed out that some of the brick, benches and light fixtures inside the lobby were original to the building. So, too, were some of the arches and moldings on the facade. Id been warned that he wasnt going to comment on the Parkers lawsuit. Still, I thought it was telling that he didnt show me Dr. Parkers portrait, which was hanging in an alcove toward the rear. What was even more telling was how a man whod made so many changes at Phoebe and whod insisted that he wanted everyone to let go of past grudges was still quick to raise them. Within 20 minutes after we sat down in the lobby, I asked him how hed describe Albany to someone who wasnt from there, and the words Joel Wernick were part of his answer.Hed begun by riffing on how Albany is a very historical community and a melting pot of race. He said it has issues like any community and that Albanys were crime and poor schools. As for the people, he recalled how friendly they were to him and his wife when they first arrived. Hed gotten used to their tendency to obsess over the things Albany could have been. But there were qualities that still really bothered him. I think theres a segment of the population that doesnt want to see it better, he said. Then he added: People want to live in the past so much. People still want to talk about Joel Wernicks shortcomings.I wanted to make clear thats not why I was there and tried to move the focus of our conversation to some of the things Id learned during my reporting, like the way diabetes rates spiked in the years after Phoebe acquired Palmyra. I hadnt come up with a way to explain it, I told Steiner, but in reading the hospitals nonprofit filings, I couldnt help noticing that the spike coincided with a decline in the share of revenue that Phoebe spent on preventive health services and on providing free and subsidized care to the poor.Steiner pointed out that Phoebes lease with the county only required it to spend 3% of its revenue on charity care and that it had never never failed to meet that requirement. That was true, I acknowledged, but I reminded him that Phoebes own lease analysis showed that at the time Steiner arrived the hospital wasnt providing as much assistance to the poor as its state and regional peers. Some of them were spending as much as 10% of their revenue on charity care.Steiner held firm. But we still met the lease.Actually, Steiner had done more than that. After getting the results of the lease analysis, which showed that Phoebe was not spending as big a share of its revenue on free and subsidized care as its peers, he expanded the pool of people who were eligible for assistance. His staff had also increased its efforts to get more patients to apply for care.Steiner said he wasnt measuring the hospitals contributions entirely on dollars spent. I want to do the most impactful programs. I want to impact the most lives, he said.He looked around at the soaring lobby in which we were sitting and talked about how the living and learning center would address one of the biggest drains on the hospitals budget: traveling doctors and nurses. People could question: Whyd yall spend money on this? Yall spent $40 million, $45 million. And yeah, I can understand that, but I also know the cost and the impact of having a rotating staff and that its not good. Its not good financially. Its not good from a patient care standpoint. Its not good for our community.He said that the nursing shortage at Phoebe was nowhere near what it had been during the pandemic, but that even as we spoke, half of the 500 job openings at the hospital were for nurses. When I asked whether that affected the quality of care, he said, Absolutely, 100%.Speaking about the differences between staff nurses and travelers, he said, We know that when its our own team, when its a Phoebe employee, there are less errors and qualitys higher, and we know when its contract nurses, there are higher errors, and our patients are less safe.I brought up the hospitals persistently poor quality of care scores that Phoebe still only had two stars from the Centers for Medicare & Medicaid Services, and its grade from the Leapfrog Group, a coalition of large health insurers and leading patient safety experts, had gone down from an A in 2022 to a C in 2024 and remained there in 2025. The ratings reports indicated that the hospital had made improvements in crucial areas like sepsis prevention, but it continued to have trouble with readmission rates, accidental cuts and tears after surgery, bedsores and dangerous blood clots.Steiner didnt deny the findings but criticized them as unreliable because theyre based on data that is at least three years old. CMS ratings were particularly misleading, he said, because they included how patients feel about being in the hospital as well as how well a hospital follows standards of care and no patient likes being in the hospital. Consumers are inherently unhappy, he said, whether its Subway, whether its a gas station.I pressed him to clarify, because Subway sandwiches are different from readmission rates. Im just saying there are big chunks of these ratings, theyre saying patient safety is how good the food is, he said.When I returned to the hospitals high readmission rates, Steiner retreated. We have work to do, no doubt, he said and then went back to laying the blame elsewhere. Would I like to be a five star? Absolutely. But when you look at who four- and five-star hospitals are, theyre usually not in challenging communities that have a lot of poverty.Thats not entirely true. A good number of hospitals with three and four stars are in poor places. What Steiner said next made clear he knew that. Were not OK being a one- or two-star hospital, he said. Were not OK being a C. Our community deserves for us to be better.Then I talked to Steiner about some of the patients whose stories Id looked into during my time in Albany. I told him about LaTosha Almond having been sent home with a bedsore so severe she was readmitted to the hospital the day after shed been discharged, then was sent home with a trach no one had taught her to manage and ultimately died. I also brought up the hospital groundskeeper Id met at the Samaritan clinic and asked Steiner why he thought a man who worked for a safety-net hospital would have to turn to a free clinic for medical care?Steiner seemed moved. He told me that he didnt know Almond but that if what Id told him was true, there was no excuse for what happened to her. As for the groundskeeper, he was troubled by that story, too. But he painted it as less an indictment of Phoebe and instead as part of the brokenness in general of the health care system. He said, Even though I think we are a safety net were an essential hospital for tens of thousands of people a year a net still has openings. He added, I dont think the health care system in the United States is set up to help him.The Westover neighborhood of Albany Ross Landenberger for ProPublicaAfter about two and a half hours, Steiners spokesperson reminded him it was time to wrap up. Before we did, I wanted to go back to something hed said earlier. Hed told me that when it came to choosing which services Phoebe provides, he made the call, and he wasnt afraid to be held responsible. What I asked him was: Who holds him to account?He said something that surprised me. Or perhaps it was me not thinking of Phoebe the way it thinks of itself as a business. I hope that our consumers do, right? he said. They can do that by electing to get care elsewhere.What he didnt say was that most people in Albany dont have anywhere else.A couple of days later, Steiner agreed to meet again. I wondered, with the passage of time, whether he regretted his liquor store comment during the Albany Middle School fight. But nope, he repeated it. I could have opened Georgias largest liquor store, and that group didnt care, he told me. They wouldve said, We approve.For his part, hed been mulling over what Id told him about the groundskeeper and the Samaritan clinic. Theres a fine line between providing everything at no cost and at no responsibility and being able to run any business, he said. I think its just like somebody walking into a grocery store saying: Im hungry. My children are hungry. Im malnourished, so Im going to fill my cart up and Im going to walk out. Wheres that balance, right?Yes, he said, the hospitals mission is to provide care regardless of race, religion and ability to pay, but were always trying to balance that out with paying the bills. He added, Weve got human beings lives in our hands. Most days we get it absolutely correct, and some days we dont.He reminded me that Phoebe had allowed the clinic to operate in one of the health systems properties without charging rent. He said it had done so precisely because it understood there were uninsured people who might fall through the cracks. The clinic, he said, was not some separate safety net, it was part of Phoebes.I asked Steiner whether he was aware that the net had collapsed: Samaritans offices and exam rooms had been so overtaken by mold that theyd been deemed unsafe and had been shuttered for more than a month.A few days later, Nedra Fortson, the clinics administrator, called to tell me that Steiner had surprised her with a request to visit the facility. He did a walk-through and arranged for the clinic to move into another building.EpilogueIn April, a Dougherty County jury awarded $70 million to a woman from nearby Camilla who had accused Phoebe and three Albany-area physicians of negligence. She charged that the doctors administered an overdose of blood pressure medications without adequate oversight for more than 40 hours. The blood flow to her extremities was severely constricted, she argued, and caused such irreparable damage to her legs they had to be amputated above the knee. She was 28 at the time.Phoebe reached a settlement with her before the case went to trial. A spokesperson described what had happened to the patient as undeniably tragic but added that the evidence indicates she would have died without the interventions provided by the care teams. The physicians held out. They, too, asserted that they had saved the patients life. After the verdict one of the largest in Georgias history the doctors settled for an undisclosed amount.I suspected that Phoebe would quickly settle the Parker lawsuit, making it almost impossible for the family to find out what had happened to Dr. Parker. Instead, the case stretched out for almost 20 months, with both parties gathering medical records and conducting depositions. What occurred during his ablation began to emerge. Most damning was a statement from Dr. Jos Ernesto Betancourt, the cardiologist who oversaw the procedure to correct Dr. Parkers irregular heartbeat. He described Dr. Parkers cardiac arrest as a preventable event, saying it happened very unfortunately.According to the depositions, Dr. Parkers blood pressure plummeted so low partway through the procedure that Betancourt paused to make sure that he hadnt inadvertently punctured Dr. Parkers heart. Once he determined that he hadnt, he gave the nurse anesthetist, Alan-Wayne Howard, time to stabilize Dr. Parker with medication, then resumed the procedure, finishing a little before 4 p.m.At this point, Howard took over Dr. Parkers care. Neither he nor Betancourt were on staff at the hospital. Both were contract workers. Both lived hours away in Florida but stayed in Albany when on duty. Its also important to know that Howard was a nurse practitioner, not a doctor. Nurse anesthetists who have advanced degrees specializing in anesthesia care are often used at hospitals and surgery centers as a way to cut costs or fill staffing shortages. Because they dont have the same years of training as a physician, their work is usually done under supervision by an anesthesiologist, who is responsible for the care they provide. He is supposed to check in on them from time to time and is on call for any emergencies.Betancourt testified that after the ablation Howard recommended sending Dr. Parker to the ICU for observation before removing his breathing tube and withdrawing anesthesia. He said Howard wanted to make sure Dr. Parkers vital signs were stable before extubating him, and he also wanted Dr. Parker to have the medical support he needed if his blood pressure crashed. We will need a couple of hours to be able to titrate down the medication to support the blood pressure until it can be completely withdrawn, Betancourt recalled Howard saying.Betancourt agreed with that plan, and he left the recovery room to talk to Mrs. Parker. He said he was gone for 10 minutes.When he returned, at about 4:44 p.m., he said that he looked in again on Dr. Parker and found that Howard had changed the post-operative plan. The anesthetist had removed the breathing tube and begun withdrawing anesthesia. Betancourt said he was surprised but didnt question the decision: It was Howards call to make. He said he asked how Dr. Parker was doing, and Howard assured him that everything was great. He left to start his report.A minute later, Dr. Parker went into crisis. According to handwritten notes by Dr. Michael Coleman, one of the two anesthesiologists assigned to supervise Howard, Dr. Parker developed bradycardia and hypotension, leading quickly to asystole. In lay terms that meant that his heart rate and blood pressure plummeted, losing oxygen to his brain, until his heart eventually stopped.In his deposition, Howard said that it wasnt until 4:54 nine minutes later that he summoned Betancourt and Coleman for help. Betancourt said he was at Dr. Parkers side at 4:55 10 minutes with little to no oxygen going to his brain and began chest compressions. Coleman arrived a minute later and helped Howard reintubate Dr. Parker, whose heart began beating again at 5 p.m.None of the doctors or nurses who testified could say exactly when Dr. Parkers heart had stopped beating during that 15-minute window, which is why there was, and still is, confusion about whether his brain went without oxygen for five or 14 minutes. When asked whether her record was reliable, the nurse assigned to keep track of the time testified that based on my documentation, I dont think they have an accurate time. No.Howard wasnt asked during his deposition about why hed decided to remove respiratory and blood pressure support earlier than initially planned. (His deposition occurred months before Betancourts.) However, Howard did let on that he was in a hurry that afternoon. He said that he had hoped to tend to his elderly father in Florida and that Dr. Parkers procedure went on for so long that he was running late.In its initial response to the lawsuit, Phoebe argued that because the health system did not employ any nurse, physician or advanced practice provider involved in Dr. Parkers care, it was not liable for his death. Its an argument that many hospitals make when they are sued and traveling nurses and doctors are involved. Howard denied that he was negligent in any manner whatsoever.This summer, Phoebe, the two supervising anesthesiologists and Howard settled for an undisclosed sum. The three clinicians declined to comment. A Phoebe spokesperson said: While rare, complications like those that occurred in this case are possible with a cardiac ablation. The care provided in this instance matched the standard of care that should be expected, and we do not believe there is evidence of negligence or malpractice.As part of the agreement, Mrs. Parker promised not to disclose the sum but made clear that she was relieved that she and the hospital had come to terms before Georgia capped malpractice awards at $1.05 million. By this time Mrs. Parker had moved to South Carolina, where she could be closer to her siblings.Before leaving Albany, shed hired painters to help get her house ready to put on the market. The crews chief came to the door to express his condolences. He knew a little something about her pain, he said.His 35-year-old brother had recently died from sepsis at Phoebe and left him and his family with a lot of questions. Mrs. Parker asked whether they had tried to get answers. The painter shrugged and shook his head no. When she asked him why not, he said, What good would it do? Its Phoebe.Kim and Sandra Parker in South Carolina in 2024 Almudena Toral/ProPublicaHow We Reported This StoryGinger Thompson interviewed more than 150 current and former residents of Albany, Georgia, as well as more than 75 current and former staff members of Phoebe Putney Memorial Hospital and Phoebe Putney Health System. She consulted with dozens of public health professionals, medical and legal experts, health care economists and strategists, and historians. Two of those interviewed, Demetrius Young and Nathaniel Smith, have since died.To reconstruct Sandra Parkers experiences before, during and after the surgery of her husband, Anthony Parker, Thompson drew from extensive interviews with her and her children as well as from texts, emails, medical records and depositions.She and Doris Burke reviewed the minutes of the hospitals board as well as those of the Hospital Authority of Albany-Dougherty County. They examined text messages and emails; medical records; nonprofit IRS filings; Centers for Medicare & Medicaid Services data; census records; Georgia public and community health data; Georgia death records; tax assessor data; federal and state court filings; federal, state and local campaign contribution filings; municipal bond offering documents; and bond rating agency reports.The post Sick in a Hospital Town appeared first on ProPublica.
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