May 27-29, 2022

Just a little more than 24 hours had passed when Mrs. Parker realized that word about her husband’s condition had gotten out. She received a text from someone she and Anthony barely knew, a middle manager in Phoebe’s 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 wasn’t intrusive enough, the woman stopped by the room. You don’t want to move him to Emory or somewhere? she whispered. Shouldn’t 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. “We’re good,” she responded. “I appreciate your concern, but we’re 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 Anthony’s 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.

That’s 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 Phoebe’s. When friends complained about loved ones dying in Phoebe’s care, he didn’t 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 Tech’s nursing program and instead it gave money to the predominantly white community college, he stewed privately, but he didn’t raise a ruckus. “They just don’t know they need us yet,” he’d say to his staff. “We’ll be here when they do.”

Mrs. Parker’s loyalties also ran deep. When the spouse of a co-worker had nearly died from an infection she’d gotten after a hysterectomy at Phoebe, she asked Mrs. Parker to help get a letter to CEO Joel Wernick. Mrs. Parker didn’t do it. Who knew whether Phoebe was responsible? she reasoned. It didn’t 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 he’d ended up performing major surgery. “Did he just tell me he opened Anthony’s chest?” she said to herself, feeling a lot like she would when Dr. José Ernesto Betancourt told her that her husband had gone into cardiac arrest. The surgeon back then explained that he’d changed plans because he’d had a hard time reaching the section of the lung that he’d wanted to check for cancer and that fortunately he’d found no signs of disease. But afterward, Dr. Parker’s radiation oncologist complained that the biopsy hadn’t been necessary.

Why hadn’t her husband’s doctors communicated with one another? Mrs. Parker wondered. A lawsuit certainly crossed her mind but not her husband’s. He would have never considered such a thing. Not when it came to Phoebe. He’d have a longer recovery, but he’d be fine. His thinking was, “Let’s 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. Parker’s 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.

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.”

Despite Wernick’s 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 county’s 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 wasn’t unusual to see modest upticks in poor, rural communities that have experienced steep population decreases and been hit by economic turmoil but that he’d rarely seen spikes as high as the ones he’d recorded in Dougherty County.

May 29, 2022

When Dr. Parker opened his eyes, his pupils rolled upward. He didn’t say anything. His body was clenched and trembling as if he’d 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 “‘Grey’s 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 he’d wake up.

There were so many big things ahead for him. His and Mrs. Parker’s 50th wedding anniversary. Andrea’s retirement from the Coast Guard. His newly elected position on the Rotary Club board. And the launch of Albany Tech’s partnership with Phoebe that would double the college’s nursing enrollment. The project marked the culmination of Dr. Parker’s 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 shouldn’t. At lunch one day, William Harry Willson’s 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 didn’t say it in so many words, but the message Dr. Parker took from her was: “Don’t 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 Tech’s 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 he’d fathered but never publicly acknowledged.

Dr. Parker never let on publicly how he really felt about Wernick’s request, and he told his wife not to do so either. He did what he’d always done: accepted the gift, privately thanked the hospital and made the most of the money without saying where it came from.

Two of Almond’s 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 didn’t have the resources or didn’t provide them. Another nurse, who knew of Almond’s 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 Almond’s 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 group’s 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 Phoebe’s poor first grade — it got an F — was that Leapfrog gave the hospital only 5 points out of 100 for ICU physician staffing. The hospital’s senior vice president of medical affairs told Georgia Health News that he was “troubled” by Leapfrog’s methodology, which he described as “inaccurate and misleading.” The score resonated with me because it tracked with what I’d read in the email exchange I’d obtained and with what I’d 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 nation’s 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 agency’s 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 hospital’s 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 Phoebe’s score in context, 96% of the nation’s 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.

The Georgia Department of Community Health examined Phoebe’s surgical records. It found two separate incidents of surgeons who operated on the wrong section of a patient’s 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 Phoebe’s 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 Phoebe’s 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 who’d arrived at the emergency room complaining of weakness and persistent diarrhea. The hospital had initially reported the death as a freak incident. However, the state’s 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 Almond’s 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 Phoebe’s 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 nurse’s 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.”

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.