The Last Hospital in America

By Omar Nabil Metwally, M.D.

13 January 2026

* * *

The Hospital That Was

I have a long-standing personal connection to this hospital. Over the decades, I watched it change names through a series of corporate mergers and acquisitions that made a lot of people rich—none of them the nurses, technicians, and doctors actually caring for patients and generating the revenue.

Despite the name changes, the hospital remained a cornerstone of our community, a safety-net hospital serving one of the most diverse patient populations I’ve ever seen. People from every walk of life came through those doors knowing they would be cared for. I treasure the encounters I’ve had with refugees, machinists, woodworkers, and factory workers among many others over the years.

My family and I used to visit on my days off. We’d see colleagues and friends, take photos with the toy bear in the lobby, and I’d work in the hospital library before it was converted into nursing offices and all the books were thrown away to make space for the ever-expanding corporate healthcare machinery.

I spent seven years as a practicing internal medicine physician there. It has been good to me. The hospital gave me the chance to care for people who really needed the help, to meet so many different people who’ve taken such diverse, interesting, and oftentimes difficult paths in life. It also gave me a respectable title, a parking spot, and the dignity of knowing I was doing something useful for others.

Today was my last day.

The Patient

The patient is an older man with schizophrenia who presented to the hospital with gastrointestinal hemorrhage—internal bleeding. He has almost no medical literacy and, due to his psychiatric condition, was lacking decision-making capacity. He was pending formal psychiatric evaluation to assess his competency.

When I reviewed his morning labs, his hemoglobin was 6.6.

For context: normal hemoglobin ranges from approximately 12 to 16 g/dL. A hemoglobin of 6.6 in a patient with active GI bleeding, particularly someone having active chest pain as was the case here, is a medical emergency. The patient needed blood. Immediately.

I placed an urgent order for blood transfusion.

The Refusal

Later, when I rounded on the patient, I discovered that the blood transfusion had not been performed.

I spoke with his nurse and asked why my order had not been executed. I explained clearly: this is a medical emergency. This patient needs blood transfused immediately.

Her response: I needed to obtain consent from the patient myself. This was, she said, hospital policy. From a patient who answered all of my questions with:

“I want to eat. Give me food.”

In seven years of practicing medicine at this hospital, I had never once been asked to personally consent a patient for blood transfusion. This is routinely performed by house officers or nurses, countless times per day across every hospital in America.

I asked the obvious question: Why are you refusing to transfuse someone who has questionable decision-making capacity and who urgently needs a blood transfusion?

I explained again that the patient lacked the capacity to consent. He was pending formal evaluation by a psychiatrist, and numerous colleagues had documented similar concerns about his capacity. As the attending physician and the one who ultimately bears responsibility for his fate, I was standing by his bedside and doing everything in my power to kick common sense into senseless corporate drones who have long ago lost respect for human dignity and life. Or perhaps they never had a chance to cultivate this quality in the first place. This was precisely the kind of situation where medical professionals are expected and entrusted to act in the patient’s best interest—and to absorb all the heartache and legal liability—while the Chief Medical Officer (a Caribbean medical school graduate) and the Chief Executive Officer (a nurse who has not touched a patient in decades and who is no more qualified to place orders than the CEO of an airline company is to fly a jumbo jet) count their cash and equity.

The nurse’s response:

“I have a family to feed, and I don’t want to lose my job by violating hospital policy.”

When a nurse’s first thought during a medical emergency is her employment status—when fear of administrative punishment outweighs fear of a patient dying on her watch—something has gone fundamentally wrong. Not with the nurse. With the system that created her fear.

The Exchange: A Real-Time Record

I contacted the Chief Medical Officer and explained the situation. I told him I was horrified that a floor nurse was more concerned about offending hospital administrators and losing her job than she was about watching a patient exsanguinate per rectum under her care. A patient whose physician had placed a transfusion order hours earlier and drove to the hospital to re-deliver the order face to face with a burnt out nurse and executive suite that would do humanity a favor by running a casino instead of a medical facility.

What follows is the text exchange, preserved in screenshots, that captures what happens when corporate healthcare confronts a dying patient.

Tuesday, January 13th. 3:20 PM. The patient is bleeding internally. His hemoglobin is 6.6—less than half of normal. He has chest pain. He cannot speak coherently. I have placed an order for an emergent blood transfusion. The nurse has refused to administer it. I pick up my phone and text the Chief Medical Officer:

“Dr. [CMO], pt in [room number] is apparent incompetent and needs emergent blood transfusion but RN is refusing.”

“She seems more concerned about not getting in trouble with hospital administrators than doing the right thing and saving a life.”

“I’m not sure who to report this to but this is unacceptable.”

I wait. The patient continues to bleed. One hour passes. Then another seven minutes. Finally, at 4:27 PM—sixty-seven minutes after my initial message—the CMO responds. Not with urgency. Not with concern. With policy:

“Nursing cannot do consents for transfusions. They can have the patient sign the form, but it can only be done after the physician obtains consent from the patient. You can speak to the patient with the nurse’s assistance and with her present over the phone.”

I reply immediately:

“The patient is incompetent.”

“It’s urgent.”

Then, as the absurdity of the situation becomes clear:

“The nurse has to use her brain. This is ridiculous. The man is hemorrhaging.”

“The day people are more worried about hospital policy than saving lives is a really sad day for healthcare.”

“I’m disappointed, Dr. [CMO].”

The CMO’s response was three sentences:

“Then you need to speak to the DPOA. She cannot seek approval. It’s a policy. Sorry.”

Sorry. A single word of pseudo-empathy appended to a directive that was impossible to follow.

Because there was no DPOA. The patient had no durable power of attorney—a fact clearly documented in the medical record by other members of the care team. The CMO was telling me to contact someone who did not exist.

When I pointed this out, the CMO offered another bureaucratic workaround:

“If you cannot call the DPOA then the House officer can do it for you.”

My final messages to the CMO abandoned any pretense of professional courtesy:

“Thanks for your help.”

“How much do you get paid?”

“What kind of CMO are you?”

The CMO—a physician by training, bound by the same oath to do no harm—sided with the nurse. He told me this was hospital protocol. A man bleeding to death in a hospital bed was less important than the chain of command and an organization founded on conflicts of interest.

The CEO

I then contacted the hospital’s Chief Executive Officer. I repeated everything. I told her plainly: this is not a company. This is a hospital. First and foremost, we are here to take care of human beings. Whatever policy is preventing this patient from receiving the blood he urgently needs is either being misunderstood or is a policy that warrants explanation.

Her response:

“We’ll talk tomorrow.”

Tomorrow. As if hemorrhage operates on business hours.

I told her: Just make sure the patient gets blood tonight. We can talk tomorrow, God willing.

That was my last communication with the hospital.

The Cover-Up

But the institutional betrayal didn’t end there.

I consulted a psychiatrist that same day to formally assess the patient’s decision-making capacity—a reasonable clinical step when capacity is in question. This is how medicine is supposed to work: when there’s doubt about a patient’s ability to make decisions, you get a specialist evaluation.

Hospital leadership blocked that consultation.

Instead, the CMO—going behind my back—arranged for a different psychiatrist, one I had never heard of and never seen, to evaluate the patient and attest that he was competent. Then, for good measure, the CMO got a resident—an unlicensed physician still in training who is supposed to be taking orders from me—to write a note that same night documenting that the patient was fully competent to make his own medical decisions.

Let that sink in.

An attending physician since 2017 with seven years of experience at this hospital, who had examined the patient at bedside daily, who had documented the patient’s inability to form coherent sentences, who had placed urgent orders to save his life—was being contradicted by a trainee’s documentation produced at the direction of hospital administration.

The move was surgical in its cynicism: undermine the attending’s clinical judgment and credibility while creating a paper trail that protected the institution. If the patient died, the chart would show he was “competent” and had “refused” care. Much easier than strapping him to a hospital bed and transfusing him against his will. The physician who tried to save him would be the outlier.

“The lengths they went to to cover up their mistake and gaslight me is incredible.”

What This Is Really About

A man with schizophrenia—vulnerable, lacking the capacity to advocate for himself, bleeding internally—was denied a potentially life-saving blood transfusion because hospital administrators have created an environment where nurses fear paperwork violations more than they fear a patient dying on their watch.

Cover-your-ass policy is official hospital policy.

The Chief Medical Officer, whose duty is to ensure quality patient care, sided with policy over the patient.

The Chief Executive Officer deferred the conversation to tomorrow—as if internal bleeding would politely wait for the next business day.

I became a physician to serve humanity and save lives. I did not become a physician to be a corporate drone, to be dismissed by corporate drones, or to stand helplessly while patients suffer the consequences of administrative cowardice dressed up as protocol.

A Note on Policy

Informed consent is a vital part of medicine. It protects patient autonomy. It is a right.

But every hospital in America recognizes exceptions for patients who lack capacity to consent and face medical emergencies. This is not a gray area. This is standard of care. When a patient cannot speak for themselves and will die without intervention, physicians act. That is the job. That is the oath.

A policy that prevents life-saving treatment for an incapacitated patient is not a policy—it is malpractice institutionalized.

To The Hospital

You were a place where families in our community came to be healed, where we took photos in the lobby, where the library had books and medical students and residents, and the hallways had heart.

Now you are a place where nurses say “I have a family to feed” while a patient bleeds, and executives schedule meetings to discuss why doctors are upset about it.

I don’t know what you are anymore.

But I know what you’re not.

You’re not a hospital. Not tonight.

The Bigger Picture

If you or someone you love has ever been a patient at a hospital, this story is about you.

It is about what happens when healthcare systems prioritize liability over life, when corporate culture infects medicine so deeply that a nurse’s first thought during an emergency is her employment status, and when the people at the top of the chain hear “this patient may die tonight” and respond with “let’s talk tomorrow.”

All that’s left in America is medical factories where health administrators have free reign to practice medicine without a license, using licensed doctors as liability-laden proxies.

This is one story. There are thousands.

* * *

Dr. Metwally is a licensed, board-certified Internal Medicine physician in good standing, a proud graduate of the University of Michigan and the University of Michigan Medical School. He has never been named in a malpractice lawsuit. He practiced internal medicine at this hospital for seven years. This writing does not reference the author’s alma mater.