Early evening, May 26, 2022

Kim, the Parkers’ elder daughter, was the first to show up at the hospital after her mother alerted the family about Dr. Parker’s cardiac arrest. The two of them had barely stepped off the elevator on their way to one of Phoebe’s intensive care units when his cardiologist, Dr. José 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 isn’t good,” she whispered to Kim.

Dr. Jyotir Mehta, the chief of Phoebe’s critical care team, stepped ahead of the pack to take Mrs. Parker’s hand and asked whether she knew who he was. Of course she did, Mrs. Parker thought to herself. She’d known Dr. Mehta for years. He’d served on the health system’s 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 system’s chief medical officer and a friend — she’d been the one who’d hired Kim — arrived shortly after. She told Mrs. Parker that the health system’s 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 Grant’s arms sobbing.

Friends and colleagues from Albany Tech began arriving. Betancourt pulled Mrs. Parker and her daughter aside and began going over what he’d said before: how he’d been right there when the cardiac arrest occurred and how quickly he’d gotten Dr. Parker’s heart beating again. It couldn’t have been more than five minutes. It appeared the cardiac arrest hadn’t caused any significant harm to Dr. Parker’s heart. It was functioning well. What worried Betancourt and the rest of the critical care team was the extent of damage to their patient’s 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 didn’t recognize, joined the conversation and told her that the medical team wanted to try a treatment that would involve cooling her husband’s body below normal to slow his metabolism and reduce his brain’s 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 who’d found that they could revive skiers who’d 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, they’d slowly return Dr. Parker’s temperature to normal and wake him.

Mrs. Parker took the doctor’s plans to wake him as a promise. The sooner the doctors got started, the sooner she’d have her husband back. “That’s no time at all,” she said to Kim. “Hell, we can stand on our heads for 72 hours if we need to.”

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 Phoebe’s former attorney, Robert Baudino, and received no response. She also sent letters with questions to those involved in Dr. Anthony Parker’s care — Dr. José 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.”

One 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 region’s largest and most profitable cotton farm. In 1909, a women’s association asked his support for the construction of the city’s 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 mother’s 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 didn’t 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. Here’s one passage:

“Queen Jenkins, R.N., Phoebe’s 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 mother’s 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 city’s 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.

King 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, 2022

After giving Phoebe’s 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 she’d kissed that morning. That man was vibrant, upbeat and indomitable. This one — prone, pale, cold to the touch — was at the mercy of others.

“That’s 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. I’m here. I’m not going anywhere. I know you’re going to pull through this. You always do. This will be one more thing we’ll 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. She’d been raised in a big, raucous family by a father who was a truck driver and a mother who was a cosmetologist. He’d 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. “She’s the nicest girl I’ve ever met,” he wrote in his senior memory book. “And somehow I’m 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 she’d 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 wasn’t 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 master’s in rehabilitation counseling and landed a job in the marketing department of Augusta Technical Institute, which was part of Georgia’s system of technical colleges. It was there that he found his calling. He’d 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 Georgia’s technical colleges had doctorates. They also didn’t have to get over the same hurdles he did. Still, that awareness didn’t 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 president’s position was open at Albany Tech and that the commissioner of the state’s trade schools wanted him to apply.

A nurse tapped on the door of Dr. Parker’s 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 wasn’t 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. Parker’s 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 she’d unpacked, the nurse returned with a goodie basket, filled with snacks and soft drinks, wrapped in colored cellophane.

Chapter 4

“It Was All About Being the Only Hospital”

Moore didn’t 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 didn’t have the energy for it. But he knew someone who did, his 34-year-old protégé, 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 Moore’s advice and became part of a growing number of hospital administrators who’d 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. “They’re both important, but they have different priorities.”

In 1988, Moore recommended Wernick to the Hospital Authority of Albany-Dougherty County, whose nine members approved Phoebe’s 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 family’s pecan farm into a successful mail-order business, helped found a local bank and became the city’s leading philanthropist.

Albany’s 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 city’s white establishment, old and new money were vying for influence. Willson and Phoebe represented the old, Palmyra the new. To hear Phoebe’s 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 county’s 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 Palmyra’s 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 county’s 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 Phoebe’s 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 Phoebe’s founding promise to treat all people, no matter their ability to pay.

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 Willson’s leadership, the hospital authority approved hundreds of millions of dollars in bonds for the construction of new clinics, office towers and medical wings, including some that weren’t 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 Georgia’s 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, Georgia’s 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 hospital’s profit margins were double the national industry average. Along the way, though, he had made enemies. In 2003, Phoebe’s 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 wasn’t easy to tell what was accurate and what wasn’t.

For months, the Factoids held Albany in thrall. Wernick used his connections in the district attorney’s 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 investigation into 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 senator’s questions, eight of them submitted information about the amount of free and discounted care they provide to the poor. According to the committee, Phoebe’s 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 Phoebe’s debt collection practices. “They weren’t doing that because they genuinely expected to collect $500,” he said. “When hospitals go after people like that, it’s because they don’t want them to come back.”

Three former executives at Phoebe told me that the Grassley report rattled Wernick, because he couldn’t disparage the findings as a “terrorist conspiracy” the way he had done with the Factoids. It wasn’t 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 county’s 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 Lemon’s favor.

That same year, the Albany Herald obtained a deposition in which the hospital’s chief financial officer revealed that Wernick’s 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, he’d receive three years pay unless he was convicted of a felony. This was on top of a $650,000 salary.

If all that wasn’t 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 couldn’t have been worse. Plants in Albany had begun to shut down, and thousands of people were being thrown out of work: Bob’s 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 didn’t 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.”

The 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 Palmyra’s ability to begin delivering babies would have dealt a significant blow to Phoebe’s ability to compete for patients. I’ve 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 Circuit’s ruling, Wernick dispatched Baudino to Hospital Corporation of America’s headquarters to discuss, again, Phoebe’s 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 Phoebe’s vulnerability and asked for $195 million in cash, which was more than twice Palmyra’s 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, Phoebe’s 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 didn’t 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.

How We Reported This Story

Ginger 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 Parker’s 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 hospital’s 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.

Story Credits

Creative direction, design and development by Anna Donlan. Visual editing by Alex Bandoni. Videos by Katie Campbell and Almudena Toral. Audio produced by Katherine Wells and Theater of War Productions.

Additional Credits

Graphics by Lucas Waldron/ProPublica. Additional video editing by Gerardo del Valle/ProPublica. Hospital research by Russell Autry. Parker family photos courtesy of Sandra Parker. Display typeface by Vocal Type.