To Tenet ( THC), Cecil Josefsson is little more than civil case No. 147273. The lawsuit, filed by Josefsson's only child, is one of hundreds pending against the company in a rural California town that made its name as a great place to fly-fish. But that town, a community of 85,000 known as Redding, is now associated with more than giant salmon and steelhead trout. It is the place where more than 1,000 people may have undergone unnecessary -- and sometimes even fatal -- heart surgeries at Tenet's Redding Medical Center. Attorneys estimate that cases like Josefsson's could wind up costing cash-strapped Tenet $1 million apiece. Josefsson's medical records, which spill over from file to bulging file, already document a heart surgery that's being challenged by outside experts. The records also note the complications that finally ended Josefsson's life. They even include a $1.9 million hospital bill that, for Tenet, translates into revenue of less than half a penny a share. But the records omit plenty. They never show Josefsson howling at the Nazis he conquered as a brave teenager. They fail to capture all the terror and agony -- barely muted by Tenet's marked-up $190 pain pills -- that engulfed Josefsson near the end. Julie Inouye, a physician's wife who has crusaded against Tenet's practices on both sides of the country, predicts even more pain to come. "This is not a story about stocks and bonds," Inouye said of Tenet, without referring to the Josefsson case. "This is a story about human beings. It is a story about life and death."
Underground Fighter"I guess I was a child until ... I used my revolver the first time," Josefsson told the Shoah Foundation in a documentary about World War II survivors five years ago. "This changed my life completely, as far as my own thinking."
Josefsson joined the Danish underground as a carefree teenager mostly interested in soccer, a year after Germans invaded his helpless country in 1940. He began with a simple task, distributing leaflets hidden between schoolbooks in his satchel, but stepped into a far more dangerous role as his patriotism grew. He had seen Denmark's beloved king brave Hitler's wrath by placing the Star of David on his own chest -- and suggesting that millions of other non-Jews would follow suit if the Nazis used the symbol to target the country's tiny Jewish population. Josefsson, among those scarce Jews, grew quite brazen himself by the age of 15. As the youngest member of a Danish underground group, he began blowing up the trains and railroads that kept occupying forces supplied. He would then race from the scene into a nearby forest and, on more than one occasion, find himself chased by a German soldier. "I've been asked this question: 'Were you ever scared? Were you ever frightened?'" Josefsson later told the Shoah Foundation. But "you don't have time to think anything. ... You shoot, or you're shot." Josefsson obviously shot. And with help from his underground movement, roughly 6,500 Jews -- of 7,000 total -- escaped from Denmark to Sweden before the Nazis could follow through with plans to herd them into concentration camps. Josefsson had to flee ahead of most, because the Nazis had identified his secret underground group. But he spent nearly two weeks moving from house to house, waiting for the perfect wind conditions to power a silent nonmotorized boat, before he could finally depart. Even then, his family remained in danger. "My brother was only 11 months old," he later explained for the documentary. "It was very difficult, for little babies, to keep them quiet and stuff."
Still, Josefsson's family drifted away undetected beneath the hull of a quiet fishing boat. They spent the next 10 hours making a trip to nearby Sweden that had taken barely 90 minutes when Josefsson used to visit his grandparents in gentler times. Granted, Josefsson's underground work was not yet finished. But the handsome teenager -- transformed into a man by pulling the trigger on another -- had every reason to believe that his gravest dangers lay behind him. They did not. They still waited, another long journey away, in the land of opportunity.
Profit MachineEven some Tenet critics call the company's original founders "absolutely brilliant." The three men, all attorneys, sniffed opportunity almost as soon as Medicare was born. Led by mastermind Richard Eamer -- who knew far more about tax breaks than he did about clinical medicine -- the trio set out after the healthy profits guaranteed by the new government program. To get started, they simply needed real estate. So they bought up six California hospitals and formed a regional health care chain that went public as National Medical Enterprises in 1969. Over time, NME grew to become the second-largest for-profit hospital operator in the nation. But the company remained as nimble as ever, dancing around the same challenges that faced some of its peers. In the mid-1980s, for example, NME shifted its entire focus in response to tightened Medicare rules. Frustrated by shrinking hospital profits, NME decided to concentrate on the evolving -- and loosely regulated -- area of psychiatric care instead. The strategy paid off. According to popular legend, NME started making so much money that it flew even the founder's dog -- in his own first-class seat -- across the country in fancy, corporate-owned jets. NME got rich, in part, by locking up ordinary juveniles who suffered from no mental illness at all. But it also profited from patients such as Mark Wilson in the process. Wilson, a troubled youth who would never live to see 20, spent weeks under "lockup" -- receiving no real therapy -- until NME suddenly booted him from one of its hospitals.
"Wham! They called one afternoon, and I was advised I needed to come and pick up my son, that his insurance had run out a week prior to this," Wilson's mother, Brenda, recalled years later. "They apologized, saying it was their mistake, but I did need to come and get him. I was then sent a bill for about $20,000 that the insurance company would not pay." NME ultimately forgave the bill after Wilson threatened to report the company to the authorities. And the psychiatrist who "treated" her son has since lost his medical license -- and landed behind bars -- for claiming to render services when he was actually on vacation. But Wilson still feels shortchanged. She learned years later that her son was among 28 young boys probably victimized by a neighborhood child molester. But by then, he could no longer be helped. He had already turned to heroin for comfort. And as other teenagers crafted their first love letters, he began to scrawl out suicide notes instead. He finally died on his 19th birthday after his tire blew out and he steered his vehicle, at full speed, off the highway and into a parked car. "I understand that God has a purpose for all of us," his mother wrote in a 1997 letter a few years after the wreck. But "all I have
are bitter memories of all the bad times and the hurt. I was deprived of my son."
Rising MoonNME agreed to pay a massive government fine -- and exit the psychiatric business entirely -- after Wilson buried her only child. The company had little choice. It faced damaging evidence that it had locked up psychiatric patients, many of them healthy, just to bilk their insurance companies. In one internal memo, an NME administrator actually ridiculed the notion that the company owed anything to its patients or to society as a whole.
"I have heard individuals within the company make remarks along these lines, and it is absolute nonsense," the administrator wrote in corporate documents submitted to the court by a former insider. "Let's call a spade a spade: We are here for one reason only -- to make a profit for the shareholders who put up the money so that we could exist in the first place." In the end, NME paid the federal government $379 million -- a record penalty at the time -- to settle fraud charges and move on. That 1994 settlement, which forced NME to shift its focus back to acute care, came the very year that Charles Dahlgren felt his throat tighten during a routine jog. The avid runner hadn't suffered any breathing problems since he was a young boy sleeping "next to the refrigerator" in his cramped childhood home. Back then, after a doctor cured him with penicillin, Dahlgren had grown so excited that he'd changed his career plans. He decided he would rather be a doctor than even a cowboy. Dahlgren had long achieved his dream by the time he wound up on a hospital bed, undergoing a heart catherization, beneath a ranting Chae-Hyun Moon. Dahlgren, who declined anesthesia before the procedure, felt his blood pressure spike as he stared up in disbelief at Redding's superstar doctor. "Moon started screaming, 'Oh my God! You're going to die!'" Dahlgren said in an interview last year. "'You've got to have surgery now. ... I can't believe you're still here!'" Infuriated by Moon's behavior, Dahlgren arranged to have his heart bypass performed by a trusted colleague in San Francisco instead. But his friend called back to report that he -- and at least three fellow cardiologists -- could find no sign that Dahlgren needed any surgery at all.
A stunned Dahlgren rushed to inform others in the medical community. But he found himself, rather than Moon, staring at raised eyebrows. "At Redding Medical Center, as far as I could tell, Moon was God," Dahlgren said. "The people there thought he could do no wrong." Moon still had his supporters even after the scandal erupted. But the doctor, who continues to maintain his innocence, has stopped practicing medicine because he can no longer obtain malpractice insurance. For its part, Tenet blames individual doctors -- rather than the hospital or the company itself -- for any wrongdoing at Redding. The company has also replaced top management, paid a record-setting fine and promised to behave itself in the future. But NME took the exact same steps when it reinvented itself as Tenet less than a decade ago. "Tenet says it's changing, but I'm skeptical," said Senate Finance Chairman Charles Grassley, an Iowa Republican who is leading a big probe of the company. "On one hand, Tenet told me it wants to be known for both the quality of its care and its people. On the other hand, Tenet argued in court recently that it is not responsible for what happens in its hospitals, that it has no duty to its patients. The company can't have it both ways." In the end, Dahlgren wound up looking out for himself. As a trained physician, familiar with professional codes of conduct, he felt confident enough to defy Moon. As a result, he dodged an unnecessary bypass and continued to enjoy the very activities -- such as jogging, kayaking and skiing -- that Moon had sternly warned him against. He is still alive, absent any surgical intervention, nearly a full decade after Moon supposedly left him for dead.
Doomed 'Survivor'Moon found Josefsson to be far more receptive. Decades earlier, Josefsson had seen another physician help save hundreds of lives. The doctor sedated a number of Jewish babies so that their families could quietly join a mass exodus to Sweden just before Germans planned to capture them. Although Josefsson had already braved the journey with his infant brother awake, he knew that bigger crowds -- slipping away by the hundreds -- could not take such risks.
"Any kind of noise ... would have been fatal for everybody," he later explained in the war documentary. Josefsson singled out the doctor as a hero in his 1998 interview with the Shoah Foundation. And he continued to blindly trust others in the profession as he set out for Redding's big heart festival a few years later. Although he had been taking aspirin regularly as a precaution against heart disease, Josefsson had seen his wife suffer a painful death and sought reassurance that he wasn't headed for the same. Workers at the heart fair, held in a local mall, instead told him that his tests had come back abnormal and referred him on to Moon. A pile of marketing brochures, featuring a tombstone emblazoned with the letters "R.I.P.," implied that far younger men had perished from untreated heart ailments. And Moon, who gazed with confidence from local billboards, enjoyed celebrity status as the best cardiologist around. Still, Josefsson's son, Peter, was never impressed. After hearing that Moon was aggressive -- and seeking a second opinion about his father -- Peter said the doctor acted "very much like a superstar who had been insulted." But Josefsson himself was too scared to notice. "He was the perfect gullible patient," Peter said. "If a doctor said that something was wrong, he would definitely listen." Warned by Moon that he might otherwise die, Josefsson agreed to undergo an immediate heart bypass. But Josefsson's blood, thinned by years of aspirin use, failed to properly coagulate after the procedure. And an undetected ulcer soon flared up, requiring a second -- and finally a third -- surgery, from which Josefsson would never recover. Peter accuses Moon of rushing his father off for a risky heart bypass that he never even needed.
"I understand that most times, when people are on aspirin, the doctor will postpone surgery for two weeks," Peter said in an interview last month. "If my father wouldn't have had that heart operation, he would still be here today." Instead, Peter saw his father tortured by imaginary Nazis before permanent brain damage set in. Peter finally agreed to remove Josefsson from life support a week after the Nazis "returned." "He died that night," Peter said. "It was not the way he was meant to go." Josefsson, who once inspired schoolchildren with his talks about World War II, has been silent for more than a year. He speaks only from a dated documentary that still casts him as a survivor. And his final comments, in particular, sting with irony. "Would you like to give advice -- or leave a message -- after having lived through what you did?" Josefsson was asked. Josefsson's response no longer sounds like an ordinary cliche. He speaks about the most important things in life. And he places only one item above world peace. "The first thing you want for everybody in the whole world," Josefsson declared, "is good health."