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                                                                     EXHIBIT 4.1


                                 FIRST AMENDMENT

         FIRST AMENDMENT, dated as of June 23, 2000 (this "Amendment"), to the
Credit Agreement, dated as of March 13, 2000 (as amended, supplemented, or
modified, the "March 2000 Credit Agreement"), among HCA - THE HEALTHCARE COMPANY
(formerly known as Columbia/HCA Healthcare Corporation), a Delaware corporation
(the "Company"), the several banks and other financial institutions from time to
time parties hereto (the "Banks"), CHASE SECURITIES INC., as Lead Arranger and
Sole Book Manager, BANK OF AMERICA, N.A., as Documentation Agent and
Co-Arranger, THE BANK OF NOVA SCOTIA, as Syndication Agent and Co-Arranger,
DEUTSCHE BANK AG NEW YORK AND/OR CAYMAN ISLANDS BRANCHES, as Syndication Agent
and Co-Arranger, THE BANK OF NEW YORK, as Co-Arranger, THE INDUSTRIAL BANK OF
JAPAN, LIMITED, as Co-Arranger, CITICORP USA, INC., as Co-Agent, FLEET NATIONAL
BANK, as Co-Agent, CREDIT SUISSE FIRST BOSTON, as Lead Manager, SUNTRUST BANK,
as Lead Manager, WACHOVIA BANK, N.A., as Lead Manager and THE CHASE MANHATTAN
BANK, a New York banking corporation, as agent for the Banks hereunder (in such
capacity, the "Agent").

                              W I T N E S S E T H :

         WHEREAS, the parties hereto wish to amend certain provisions of the
March 2000 Credit Agreement on the terms set forth herein;

         NOW, THEREFORE, in consideration of the premises and of the mutual
agreements herein contained, the parties hereto agree as follows:

         1. Definitions. Unless otherwise defined herein, terms defined in the
March 2000 Credit Agreement shall be used as so defined.

         2. Amendment to Section 1.1 of the March 2000 Credit Agreement. Section
1.1 of the March 2000 Credit Agreement is hereby amended by deleting the defined
term "Consolidated Earnings Before Interest and Taxes" in its entirety and
inserting in lieu thereof the following new defined term in proper alphabetical
order:

            "'Consolidated Earnings Before Interest and Taxes': for any period
     for which the amount thereof is to be determined, Consolidated Net Income
     for such period, plus (i) all amounts deducted in computing such
     Consolidated Net Income in respect of interest expense on Indebtedness and
     income taxes and (ii) non-recurring charges incurred or made as of or for
     fiscal quarters ending on or after June 30, 2000 related to the Company's
     partial settlement with the Department of Justice not exceeding in the
     aggregate $745,000,000 on a pre-tax basis."

         3. Effective Date; Conditions Precedent. This Amendment will become
effective on June 23, 2000 (the "Effective Date") subject to the compliance by
the Company with




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its agreements herein contained and to the satisfaction on or before the
Effective Date of the following further conditions:

            (a) Loan Documents. The Agent shall have received copies of this
     Amendment, executed and delivered by a duly authorized officer of the
     Company, with a counterpart for each Bank, and executed and delivered by
     the Required Banks.

            (b) Fees. The Agent shall have received, for the account of each
     Bank which executes and delivers this Amendment on or prior to 5:00 p.m.
     New York City time on June 23, 2000, an amendment fee in an amount equal to
     2.5 basis points on such Bank's Commitment as in effect prior to the
     Effective Date, payable in immediately available funds on or before the
     Effective Date.

            (c) Company Officers' Certificate. On and as of the Effective Date
     and after giving effect to this Amendment, no Default shall have occurred
     (except a Default which shall have been waived in writing or which shall
     have been cured); and the Agent shall have received a certificate
     containing a representation to these effects dated the Effective Date and
     signed by a Responsible Officer.

            (d) Second Amendment to July 1998 Agreement. That certain credit
     agreement, dated as of July 10, 1998, among the Company, the several banks
     and other financial institutions from time to time parties thereto,
     Nationsbank, N.A., The Bank of Nova Scotia, Deutsche Bank Securities, and
     The Chase Manhattan Bank, as administrative agent (the "July 1998
     Agreement"), shall have been amended in a manner corresponding to the
     amendments hereof.

            (e) Sixth Amendment to February 1997 Five-Year Agreement and
     Amendment. The February 1997 Five-Year Agreement and Amendment shall have
     been amended in a manner corresponding to the amendments hereof.

         4. Legal Obligation. The Company represents and warrants to each Bank
that this Amendment constitutes the legal, valid and binding obligation of the
Company, enforceable against it in accordance with its terms, subject to the
effects of bankruptcy, insolvency, fraudulent conveyances, reorganization,
moratorium and other similar laws relating to or affecting creditors' rights
generally, general equitable principles (whether considered in a proceeding in
equity or at law) and an implied covenant of good faith and fair dealing.

         5. Continuing Effect; Application. Except as expressly amended hereby,
the March 2000 Credit Agreement shall continue to be and shall remain in full
force and effect in accordance with its terms.

         6. Expenses. The Company agrees to pay or reimburse the Agent for all
of its reasonable out-of-pocket costs and expenses incurred in connection with
the development, preparation and execution of, and any amendment, supplement or
modification to, this Amendment and any other documents prepared in connection
herewith, and the consummation of the transactions contemplated hereby and
thereby, including, without limitation, the reasonable fees and disbursements of
counsel to the Agent.




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         7. GOVERNING LAW. THIS AMENDMENT AND THE RIGHTS AND OBLIGATIONS OF THE
PARTIES UNDER THIS AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED AND INTERPRETED
IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK.

         8. Counterparts. This Amendment may be executed by one or more of the
parties to this Amendment on any number of separate counterparts and all of said
counterparts taken together shall be deemed to constitute one and the same
instrument. A set of the copies of this Amendment signed by all the parties
shall be lodged with the Company and the Agent.




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         IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
duly executed and delivered by their proper and duly authorized officers as of
the day and year first above written.


                                    HCA - THE HEALTHCARE COMPANY



                                    By: /s/ DAVID G. ANDERSON
                                        ----------------------------------------
                                        Name: David G. Anderson
                                        Title: Senior Vice President-Finance &
                                               Treasurer


                                    THE CHASE MANHATTAN BANK, as Agent and as a
                                    Bank



                                    By: /S/ DAWN LEE LUM
                                        ----------------------------------------
                                        Name: Dawn Lee Lum
                                        Title: Vice President