Conflict between for-profit medicine and medical ethics

The conflict between for-profit medicine and medical ethics is a recurring pressure in the history of Memorial Medical Center: as medical technology made it possible to sustain critically ill patients for longer, the rising costs of care met an increasingly commercial system that sought to measure and manage treatment as a business. The tension was not simply between money and compassion. It reached into clinical decisions, hospital governance, disaster response, and the later emotional burden carried by staff. The book traces that conflict from the expansion of intensive care through corporate restructuring and the crisis at Memorial, where resource pressures and professional duties met under extreme conditions.

Technology, costs, and the professional ethic

The growth of intensive care changed both what medicine could do and what it had to decide. Memorial’s predecessor, Southern Baptist Hospital, expanded its facilities in the 1960s, adding piped oxygen and an intensive care unit for heart patients. It was also believed to be the first hospital in the Southeast to purchase a crash cart, equipped with a respirator, cardiac monitor, pacemaker, defibrillator, and other tools for resuscitation. The hospital’s 1967 newsletter promised that auxiliary power would prevent interruption if city electricity failed. The equipment embodied a new confidence in intervention, but also raised questions about when life support should begin and what counted as extraordinary treatment.

Horace Baltz saw the new technology alongside another transformation: the rise of cost consciousness and for-profit medicine. By the early 1980s, healthcare had become a medical marketplace. Baltz worried that accountants and other nonclinicians might determine which tests and treatments doctors could provide to which patients. As medical staff president, he urged colleagues to remain compassionate and selective in adopting new technologies, and supported the creation of a hospital ethics group. In discussions of the Clarence Herbert case, in which doctors faced murder charges after withdrawing life support and intravenous fluids from a comatose patient, Baltz emphasized that decisions about dying required careful consideration. The charges were dismissed, but the case also exposed how end-of-life decisions could divide doctors, nurses, and families.

The duty to treat and the temptation to ration

The financial and ethical conflict became explicit in debates over patients who required extensive, prolonged care. After LifeCare established a long-term acute care hospital on Memorial’s seventh floor in 1997, Baltz heard colleagues complain that too many resources went to its typically elderly and infirm patients. One colleague argued that such patients should be allowed to die; Baltz answered that no doctor had the right to decide who lived and who died. His response rejected a simple equation between high cost, limited prognosis, and diminished claim to care.

The argument echoed the national controversy over Colorado governor Richard Lamm’s call for older people to make way for younger generations rather than remain alive through expensive technologies. The phrase that people had a duty to die provoked a public furor. Hospitals had become increasingly capable of prolonging life, while Medicare covered new technologies and policymakers worried about projected spending. The controversy revealed a clash between rationing arguments and the human impulse to rescue an individual in extremis. It also exposed how the language of efficiency could turn a question about shared resources into a judgment about which lives deserved them.

Corporate restructuring and Memorial’s prosperity

The institutional setting changed as well. Susan Mulderick began working in the intensive care unit at Southern Baptist Hospital in 1973 and remained there through its merger with Mercy in the early 1990s and its sale to Tenet Healthcare Corporation in 1995. The transition replaced the Baptist name on paper and its longstanding healing motto with corporate language about financial performance and partnerships. Patient-care managers received monthly budgets and productivity goals; failing to meet them brought pressure, while success could be followed by still tighter budgets. Mulderick adapted to this system and continued in nursing leadership.

By January 2005, Memorial’s visible fortunes contrasted with the troubles of its parent company. Tenet Healthcare Corporation faced falling stock prices, large operating losses, lawsuits over Medicare billing and allegations of misleading investors, and was selling twenty-seven hospitals that failed to meet financial goals. At the same time, Memorial staff had reasons to celebrate: a new $18 million cancer institute had opened across the street, the labor and delivery center had undergone a $5 million renovation, the hospital had passed an accreditation survey, and employee satisfaction rankings were high within Tenet. This juxtaposition matters because commercial pressures did not erase local investment or staff pride; prosperity at the hospital existed alongside corporate retrenchment and a system increasingly organized around budgets and performance.

Disaster decisions and professional authority

When floodwaters threatened Memorial, the hospital’s command meeting took on the atmosphere of a military operation. Nearly two hundred patients needed safety, and leaders initially proposed moving those most dependent on life support first. Yet doctors had established an exception: patients with do-not-resuscitate orders would be evacuated last. The order itself meant that a patient whose breathing or heartbeat stopped should not be revived; it did not, by itself, mean the patient was terminal or should receive lower priority in evacuation. The decision reflected a disputed understanding of the order and translated a clinical designation into a judgment about who had the least to lose. Jannie Burgess, a longtime nurse who had once been barred from receiving care at hospitals where she could care for others, was among the four DNR patients in the intensive care unit.

The evacuation also showed authority being contested in practice. On the helipad, Richard Deichmann was managing operations when a nurse with Air Force experience offered to run the flight line. After a Coast Guard pilot had left following a dispute over helicopter capacity, Deichmann put her in charge; she cleared the landing area and moved doctors and patients away so pilots could work. Later, neonatal nurses resisted Deichmann’s decision to let a helicopter take babies to a hospital other than the one that had agreed to receive them. Their director insisted on a flight to Baton Rouge or no transfer, and approval came within minutes. In these episodes, professional judgment was not aligned neatly with rank: nurses’ operational knowledge and responsibility for fragile patients could constrain physicians’ decisions during a crisis.

Aftermath and the human cost of institutional pressure

After the storm, the conflict persisted in accounts of responsibility and in staff members’ lives. In an interview, Mulderick said her discussions had concerned comfort care, not speeding death. She described the idea of medicating patients as originating with her, while the prescriptions seized during the search showed that Anna Pou and other doctors had already prescribed ordinary comfort medications during the disaster. The discrepancy became part of the investigation’s scrutiny of who proposed treatment and what purpose it served. Separately, the district attorney’s office had not been involved in the yearlong investigation until the case came before it, illustrating how institutional divisions could complicate the assignment of responsibility.

The lasting consequences were not limited to legal or administrative questions. Gina Isbell described sleeplessness, nightmares, hair loss, guilt about the staff she had assigned to work the hurricane, and grief for patients who died. Karen Wynn found that preparing for possible grand-jury testimony could make her feel as if she were reliving the disaster; she recognized signs of lasting trauma in herself and colleagues and no longer wanted the managerial responsibility she had carried. John Thiele later rejected the idea that he had regretted his actions at Memorial, distinguishing his own illnesses as potentially reversible. These differing responses resist a single account of what the crisis meant to those who worked through it. Together, they show how institutional decisions and professional loyalties could continue to shape moral judgment long after the immediate emergency ended.