Document:

<PAGE>
                                                                  EXHIBIT 10.2.2

                               SECOND AMENDMENT TO
                  SECOND AMENDED AND RESTATED CREDIT AGREEMENT

         THIS SECOND AMENDMENT TO SECOND AMENDED AND RESTATED CREDIT AGREEMENT,
dated as of August 1, 2003 (this "Amendment"), to the Existing Credit Agreement
(as defined below) is made by USP DOMESTIC HOLDINGS, INC., a Delaware
corporation (the "US Borrower"). USPE HOLDINGS LIMITED, a company incorporated
in England and Wales (the "UK Borrower", and together with the US Borrower,
collectively the "Borrowers" and each individually a "Borrower") and the Lenders
(such capitalized term and other capitalized terms used in this preamble and the
recitals below to have the meanings set forth in, or are defined by reference
in, Article I below).

                                   WITNESSETH:

         WHEREAS, the Borrowers, the Lenders, SunTrust Bank, as the
Administrative Agent, Lehman Commercial Paper, Inc., as the Syndication Agent,
and Credit Suisse First Boston Bank, as the Documentation Agent, are all parties
to the Second Amended and Restated Credit Agreement, dated as of November 7,
2002, as amended by that certain First Amendment to Second Amended and Restated
Credit Agreement dated as of June 3, 2003 (as amended, the "Existing Credit
Agreement", and as amended by this Amendment and as the same may be further
amended, supplemented, amended and restated or otherwise modified from time to
time, the "Credit Agreement");

         WHEREAS, the Borrowers have requested that the Lenders amend certain
provisions of the Existing Credit Agreement and the Lenders are willing, on the
terms and subject to the conditions hereinafter set forth, to amend the Existing
Credit Agreement as set forth below;

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

                                    ARTICLE 1

                                   DEFINITIONS

         SECTION 1.1 Certain Definitions. The following terms when used in this
Amendment shall have the following meanings (such meanings to be equally
applicable to the singular and plural forms thereof):

        "Amendment" is defined in the preamble.

        "Borrowers" is defined in the preamble.

        "Credit Agreement" is defined in the first recital.

        "Existing Credit Agreement" is defined in the first recital.

        "Second Amendment Effective Date" is defined in Article III.

<PAGE>

          SECTION 1.2 Other Definitions. Terms for which meanings are provided
in the Credit Agreement are, unless otherwise defined herein or the context
otherwise requires, used in this Amendment with such meanings.

                                    ARTICLE 2

                         AMENDMENT TO CREDIT AGREEMENT

         Effective on (and subject to the occurrence of) the Second Amendment
Effective Date, the provisions of the Existing Credit Agreement referred to
below are hereby amended in accordance with this Article II. Except as expressly
so amended, the Existing Credit Agreement shall continue in full force and
effect in accordance with its terms.

         SECTION 2.1 Modification of Article I. Article I of the Existing Credit
Agreement is hereby amended as follows:

                  SECTION 2.1.1 Section 1.1 of the Existing Credit Agreement is
         hereby amended by inserting the following definition in such Section in
         the appropriate alphabetical sequence:

                           "Amendment No. 2" means the Second Amendment to
                  Second Amended and Restated Credit Agreement, dated as of
                  August 1, 2003, to this Agreement.

         SECTION 2.2 Modification of Article II. Article II of the Existing
Credit Agreement is hereby amended as follows:

                  SECTION 2.2.1 Section 2.1.1 of the Existing Credit Agreement
         is hereby amended by restating clause (d) thereto to read as follows:

                           (d) Notwithstanding anything to the contrary
                  contained herein, until satisfaction of the covenants and
                  conditions set forth in Section 8.3, the Lenders will have no
                  obligation to issue Letters of Credit for the benefit of the
                  UK Borrower which would otherwise be permitted hereunder or
                  have any obligation to advance Loans to the UK Borrower which
                  would otherwise be permitted hereunder. Once the covenants and
                  conditions of Section 8.3 have been met to the satisfaction of
                  Administrative Agent, this clause (d) will no longer be
                  applicable to restrict the Credit Extensions to the UK
                  Borrower. The Borrowers agree to have all such covenants and
                  conditions of Section 8.3 met to the satisfaction of
                  Administrative Agent no later than September 15, 2003.

         SECTION 2.3 Modification of Article VIII. Article VIII of the Existing
Credit Agreement is hereby amended as follows:

                  SECTION 2.3.1 Section 8.1.7 of the Existing Credit Agreement
         is hereby amended by restating clause (a) thereto to read as follows:

                           (a) for working capital and general corporate
                  purposes of the Borrowers and the Subsidiary Guarantors,
                  including Investments and Permitted

                                       2
<PAGE>

                  Acquisitions permitted by this Agreement; provided, however,
                  that if such proceeds are directly or indirectly used for
                  Investments or Permitted Acquisitions involving any Person
                  which owns or will acquire assets in Spain (or which holds or
                  will hold Equity Interests in any Person which owns or will
                  acquire assets in Spain), Borrowers agree that only the UK
                  Borrower may request and receive Credit Extensions for that
                  purpose; and

                  SECTION 2.3.2 Section 8.1.8 of the Existing Credit Agreement
         is hereby amended by adding the following sentence immediately at the
         end of Section 8.1.8 contained therein:

                  Notwithstanding the foregoing, the Administrative Agent and
                  Lenders hereby agree that as long as the outstanding
                  Obligations of the UK Borrower do not exceed $20,000,000 at
                  any one time (including the face amount of all Letters of
                  Credit issued for the benefit of the UK Borrower or any
                  Foreign Subsidiary Guarantor), the Borrowers will not be
                  required to file or cause to be filed a Mortgage on any real
                  property acquired in Spain after the Closing Date by the UK
                  Borrower or any Foreign Subsidiary Guarantor. Until such time
                  as all Mortgages are duly filed and recorded on any such real
                  property acquired in Spain after the Closing Date and such
                  additional due diligence items are delivered to Administrative
                  Agent as required in Section 8.1.8. Lenders will have no
                  obligation to issue Letters of Credit for the benefit of the
                  UK Borrower or any Foreign Subsidiary Guarantor which would
                  otherwise be permitted hereunder or advance Loans to the UK
                  Borrower which would otherwise be permitted hereunder if the
                  making of such Loan or the issuing of such Letter of Credit
                  would cause the Obligations of the UK Borrower (including the
                  face amount of any existing Letters of Credit and, if
                  applicable, the Letter of Credit being requested) to exceed
                  $20,000,000; provided that the restriction in Section 2.1.1
                  (d) is no longer applicable by its terms.

                  SECTION 2.3.3 Section 8.2.12 of the Existing Credit Agreement
          is hereby amended by restating clause (b) thereto to read as follows:

                           (b) Notwithstanding the provisions of subsection (a)
                  set forth above or the provisions of other sections of this
                  Agreement referenced therein, OrthoLink Physicians Corporation
                  (a US Subsidiary Guarantor hereinafter referred to as
                  "OrthoLink") may sell certain of its accounts receivable to
                  such physicians groups specifically named in those certain
                  Service Agreements, as amended, set forth on Schedule
                  8.2.12(b) attached hereto (the "Service Agreements") pursuant
                  to amendments to such Service Agreements which amendments
                  shall be in form and substance satisfactory to Administrative
                  Agent (the "Second Amendments to Service Agreements"; the
                  accounts receivable referenced in said Second Amendments to
                  Service Agreements as "A/R Amount" or otherwise are referred
                  to herein as the "OrthoLink Receivables" and the physicians
                  groups parties thereto are referred to herein as the
                  "OrthoLink Receivables Purchasers"). In accordance with the
                  Second Amendments to the Service Agreements, if OrthoLink has
                  not received full payment in cash for its

                                       3
<PAGE>

                  sale of the OrthoLink Receivables from the OrthoLink
                  Receivables Purchasers on or before September 30, 2003,
                  OrthoLink shall receive from the applicable OrthoLink
                  Receivables Purchasers as payment for the remaining OrthoLink
                  Receivables (i) a Promissory Note and Security Agreement (a
                  "Note and Security Agreement") in substantially the form of
                  Exhibit 8.2(ii) attached thereto and Exhibit G attached hereto
                  and (ii) a Guaranty (a "Guaranty") in substantially the form
                  of Exhibit 8.2(ii) attached thereto and Exhibit H attached
                  hereto; provided, however, with respect to the Service
                  Agreement with Resurgens, P.C. ("Resurgens"), Borrower
                  represents that the obligations of Resurgens to OrthoLink to
                  pay the balance of the OrthoLink Receivables remaining after
                  September 30, 2003 will be evidenced by the Second Amendment
                  to Service Agreement executed by Resurgens (the "Resurgens
                  Second Amendment") and will not be evidenced by a Note and
                  Security Agreement and not guaranteed pursuant to a Guaranty
                  (each Note and Security Agreement, each Guaranty and the
                  Resurgens Second Amendment collectively referred to herein as
                  the "OrthoLink Receivables Loan Documents"). On or before
                  October 15, 2003, OrthoLink shall assign to Administrative
                  Agent, on behalf of the Lenders, as collateral hereunder all
                  such OrthoLink Receivables Loan Documents required to be
                  delivered to OrthoLink in accordance with the terms of the
                  Service Agreements pursuant to, and will perform the
                  obligations and conditions contained in, an Assignment and
                  Security Agreement in substantially the form of Exhibit I
                  attached hereto (which Assignment will be modified as deemed
                  necessary by Administrative Agent to incorporate the
                  assignment of OrthoLink's rights under the Resurgens Second
                  Amendment). The Net Disposition Proceeds of the OrthoLink
                  Receivables (whether delivered by the OrthoLink Receivables
                  Purchasers in cash on or before September 30, 2003 or pursuant
                  to the terms of the OrthoLink Receivables Loan Documents)
                  shall be applied as follows: (i) immediately upon receipt, 50%
                  of said Net Disposition Proceeds shall be applied to the
                  outstanding principal balance of the Loan; and (ii) within one
                  (1) year of receipt, the remaining 50% shall be used for
                  Investments and Permitted Acquisitions or applied to the
                  outstanding principal balance of the Loan. In connection with
                  Lender's agreement to permit the disposition of the OrthoLink
                  Receivables as set forth in this Section 8.2.12(b), Borrowers
                  agree in addition to the foregoing as follows: (A) Section 8.2
                  of the Service Agreements, as amended by the Second Amendments
                  to the Service Agreements, or such other section of the
                  Service Agreements addressing the OrthoLink Receivables, shall
                  not be further amended, modified, or changed without the
                  Administrative Agent's prior written consent, (B) OrthoLink
                  Receivables will only be sold to OrthoLink Receivables
                  Purchasers, (C) no OrthoLink Receivables will be sold,
                  assigned, or transferred for less than the net book value of
                  such receivable, and (D) Borrowers shall give Administrative
                  Agent an accounting of the use of the Net Disposition Proceeds
                  not applied to the outstanding balance of the Loan a year
                  after receipt of such Proceeds.

                                       4
<PAGE>

                                    ARTICLE 3

                          CONDITIONS TO EFFECTIVENESS

         This Amendment and the amendments contained herein shall become
effective on the date (the "Second Amendment Effective Date") when each of the
conditions set forth in this Article III shall have been fulfilled to the
satisfaction of the Administrative Agent.

         SECTION 3.1 Counterparts. The Administrative Agent shall have received
counterparts hereof executed on behalf of the Borrowers and each Lender. The
delivery of an executed counterpart hereof by the Borrowers shall constitute a
representation and warranty by the Borrowers that, on the Second Amendment
Effective Date, after giving effect to this Amendment, all statements set forth
in clauses (a), (b), and (c) of Section 6.2.1 of the Existing Credit Agreement
are true and correct as of such date, except to the extent that any such
statement expressly relates to an earlier date (in which case such statement was
true and correct on and as of such earlier date).

         SECTION 3.2 Satisfactory Legal Form. The Administrative Agent and its
counsel shall have received all information, and such counterpart originals or
such certified or other copies of such materials, as the Administrative Agent or
its counsel may reasonably request, and all legal matters incident to the
effectiveness of this Amendment shall be satisfactory to the Administrative
Agent and its counsel. All documents executed or submitted pursuant hereto or in
connection herewith shall be reasonably satisfactory in form and substance to
the Administrative Agent and its counsel.

                                    ARTICLE 4

                                 MISCELLANEOUS

         SECTION 4.1 Cross-References. References in this Amendment to any
Article or Section are, unless otherwise specified, to such Article or Section
of this Amendment.

         SECTION 4.2 Loan Document Pursuant to Existing Credit Agreement. This
Amendment is a Loan Document executed pursuant to the Existing Credit Agreement
and shall (unless otherwise expressly indicated therein) be construed,
administered and applied in accordance with all of the terms and provisions of
the Existing Credit Agreement, as amended hereby.

         SECTION 4.3 Successors and Assigns. This Amendment shall be binding
upon and inure to the benefit of the parties hereto and their respective
successors and assigns.

         SECTION 4.4 Counterparts. This Amendment may be executed by the parties
hereto in several counterparts, each of which when executed and delivered shall
be an original and all of which shall constitute together but one and the same
agreement. Delivery of an executed counterpart of a signature page to this
Amendment by facsimile shall be effective as delivery of a manually executed
counterpart of this Amendment.

                                       5
<PAGE>

         SECTION 4.5 Governing Law. THIS AMENDMENT SHALL BE GOVERNED BY, AND
CONSTRUED IN ACCORDANCE WITH, THE INTERNAL LAWS OF THE STATE OF NEW YORK.

                  [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

                                       6
<PAGE>

         IN WITNESS WHEREOF, the parties hereto have executed and delivered this
Amendment as of the date first above written.

                                        USP DOMESTIC HOLDINGS, INC.,
                                        as the US Borrower

                                        By: /s/ Mark Kopser
                                            -----------------------------------

                                        Title: Chief Financial Officer and VP
                                               --------------------------------

                                        USPE HOLDINGS LIMITED,
                                        as the UK Borrower

                                        By:  /s/ Mark Kopser
                                            -----------------------------------

                                        Title:  Director
                                               --------------------------------

                                        SUNTRUST BANK,
                                        as the Administrative Agent, a Lender
                                        and Swingline Lender

                                        By:  /s/ Mark D. Mattson
                                            -----------------------------------

                                        Title:  Director
                                               --------------------------------

<PAGE>

                                        LEHMAN COMMERCIAL PAPER INC.,
                                        as the Syndication Agent and a Lender

                                        By:   /s/ Francis Chang
                                            -----------------------------------

                                                   Francis Chang
                                        Title:    Vice President
                                               --------------------------------

<PAGE>

                                        BANK OF AMERICA, N.A.,
                                        as a Lender

                                        By: /s/ Ken P. Burton
                                            -----------------------------------

                                        Title: Vice President
                                               --------------------------------

<PAGE>

                                        SOCIETE GENERALE,
                                        as a Lender

                                        By: /s/ Carol Radice
                                            -----------------------------------

                                                Carol Radice
                                        Title:  Corporate Banking, Societe
                                                Generale
                                               --------------------------------

<PAGE>

                            CREDIT SUISSE FIRST BOSTON,
                            acting through its Cayman Islands
                            Branch, as the Documentation Agent and
                            a Lender

                            By: /s/ Christopher Lally    /s/ Jennifer A. Pieza
                                -----------------------------------------------

                                    Christopher Lally      Jennifer A. Pieza
                            Title:   Vice President          Associate
                                   ------------------------------------------

<PAGE>

                                        SOUTHWEST BANK OF TEXAS,
                                        as a Lender

                                        By: /s/ William B. Pyle
                                            -----------------------------------

                                        Title:  Senior Vice President
                                               --------------------------------

<PAGE>

                                        BANK OF OKLAHOMA, N.A.,
                                        as a Lender

                                        By: /s/  Heather S Williams
                                            -----------------------------------

                                        Title:  Assistant Vice President
                                               --------------------------------<PAGE>
                                                                 EXHIBIT 10.6.1

                       AMENDMENT OF EMPLOYMENT AGREEMENT

                  This Amendment is entered into as of February 18, 2004, by
and between United Surgical Partners International, Inc., a Delaware
corporation ("USPI"), and Donald E. Steen ("Employee"), with reference to the
following facts:

                                    RECITALS

                  A.       The parties hereto entered into that certain
Employment Agreement, dated as of November 15, 2002 (the "Agreement"), pursuant
to which Employee is the Chairman of the Board and Chief Executive Officer of
USPI. The capitalized terms used in this Amendment and not otherwise defined
herein shall have the meanings given to them in the Agreement.

                  B.       After consultation with the Board of Directors of
USPI, Employee and USPI have mutually agreed that Employee will step down as
Chief Executive Officer, while remaining as Chairman of the Board, effective
concurrently with the election of William H. Wilcox as Chief Executive Officer
of USPI. Accordingly, the parties have agreed to make certain changes to the
Agreement.

                  THEREFORE, the parties agree hereto as follows:

                                   AGREEMENT

                  1.       Amendment of Agreement. The Agreement is amended as
follows:

                           (a)      Employee resigns as Chief Executive Officer
of USPI and USPI accepts his resignation, effective concurrently with the
election of William H. Wilcox as Chief Executive Officer of USPI. Accordingly,
Employee shall be a part-time employee of USPI whose duties as Chairman of the
Board are estimated to require approximately 50% of Employee's business time.

                           (b)      Effective on April 1, 2004, Employee's
"Base Salary" shall be reduced to 50% of the Base Salary currently in effect.
Accordingly, Employee's base salary shall be reduced to $262,500 per year as of
April 1, 2004.

                           (c)      Employee shall continue to be entitled to
participate in USPI's performance bonus program for senior executives as
provided in Section 3(b) of the Agreement, but shall not be entitled to the
bonuses referenced in Section 3(a)(i)(B) or (ii)(B) of the Agreement.

                  2.       Ratification. Except as expressly amended herein,
the terms and provisions of the Agreement are hereby ratified and confirmed and
shall remain in full force and effect, including without limitation the office
services and other benefits described in Section 4 of the Agreement.

AMENDMENT OF EMPLOYMENT
AGREEMENT (2).DOC
<PAGE>
                  IN WITNESS WHEREOF, the undersigned have executed this
Amendment of Employment Agreement as of the date first above written.

                                UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

                                By /s/ Paul B. Queally
                                  ---------------------------------------------
                                  Paul B. Queally
                                  Chairman, Options and Compensation Committee

                                /s/ Donald E. Steen
                                -----------------------------------------------
                                Donald E. Steen

AMENDMENT OF EMPLOYMENT
AGREEMENT (2).DOC

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00062-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00062-of-00352.parquet"}]]