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EXHIBIT 4.1  

 
  TENET HEALTHCARE CORPORATION
  DEBT SECURITIES
  UNDERWRITING AGREEMENT    
  

        New York, New York

March 4, 2002 

To
the Representatives of the

several Underwriters named in the

respective Pricing Agreements

hereinafter described. 

Ladies
and Gentlemen: 

        From
time to time, Tenet Healthcare Corporation, a corporation organized under the laws of Nevada (the "Company"), proposes to enter into one or more Pricing Agreements (each a "Pricing
Agreement") in the form of Annex I hereto, with such additions and deletions as the parties thereto may determine, and, subject to the terms and conditions stated herein and therein, to issue and sell
to the firms named in Schedule I to the applicable Pricing Agreement (such firms constituting the "Underwriters" with respect to such Pricing Agreement and the securities specified therein)
certain of its debt securities (the "Securities") specified in Schedule II to such Pricing Agreement (with respect to such Pricing Agreement, the "Designated Securities"). 

        The
terms and rights of any particular issuance of Designated Securities shall be as specified in the Pricing Agreement relating thereto and in or pursuant to the indenture (such
indenture, including any supplement thereto relating to the Designated Securities, the "Indenture") identified in such Pricing Agreement. 

        1.    Particular
sales of Designated Securities may be made from time to time to the Underwriters of such Designated Securities, for whom the firms designated as
representatives of the Underwriters of such Designated Securities in the Pricing Agreement relating thereto will act as representatives (the "Representatives"). The term "Representatives" also refers
to a single firm acting as sole representative of the Underwriters and to Underwriters who act without any firm being designated as their representative. This Underwriting Agreement shall not be
construed as an obligation of the Company to sell any of the Securities or as an obligation of any of the Underwriters to purchase the Securities. The obligation of the Company to issue and sell any
of the Securities and the obligation of any of the Underwriters to purchase any of the Securities shall be evidenced by the Pricing Agreement with respect to the Designated Securities specified
therein. Each Pricing Agreement shall specify the aggregate principal amount of such Designated Securities, the initial public offering price of such Designated Securities, the purchase price to the
Underwriters of such Designated Securities, the names of the Underwriters of such Designated Securities, the names of the Representatives of such Underwriters and the principal amount of such
Designated Securities to be purchased by each Underwriter and shall set forth the date, time and manner of delivery of such Designated Securities and payment therefor. The Pricing Agreement shall also
specify (to the extent not set forth in the Indenture and the Registration Statement and Prospectus, as defined below, with respect thereto) the terms of such Designated Securities. A Pricing
Agreement shall be in the form of an executed writing (which may be in counterparts), and may be evidenced by an exchange of telegraphic communications or any other rapid transmission device designed
to produce a written record of communications transmitted. The obligations of the Underwriters under this Agreement and each Pricing Agreement shall be several and not joint. Certain terms used herein
are defined in Section 17 hereof. 

        2.    Representations and Warranties.    The Company represents and warrants to, and agrees with, each of the
Underwriters that: 

        (a)  A
registration statement on Form S-3 (File No. 333-74640) (the "Initial Registration Statement") in respect of the Securities has
been filed with the Securities and Exchange 

 

Commission (the "Commission"); such Initial Registration Statement and any post-effective amendment thereto have been declared effective by the Commission in such form; other than a
registration statement, if any, increasing the size of the offering (a "Rule 462(b) Registration Statement"), filed pursuant to Rule 462(b) under the Securities Act of 1933, as amended
(the "Act"), which became effective upon filing, no other document with respect to the Initial Registration Statement or document incorporated by reference therein has heretofore been filed or
transmitted for filing with the Commission (other than the prospectuses filed pursuant to Rule 424(b) of the rules and regulations of the Commission under the Act); and no stop order suspending
the effectiveness of the Initial Registration Statement, any post-effective amendment thereto or the Rule 462(b) Registration Statement, if any, has been issued and no proceeding
for that purpose has been initiated or, to the knowledge of the Company, threatened by the Commission (any preliminary prospectus included in the Initial Registration Statement or filed with the
Commission pursuant to Rule 424(a) of the rules and regulations of the Commission under the Act, being hereinafter called a "Preliminary Prospectus"; the
various parts of the Initial Registration Statement and the Rule 462(b) Registration Statement, if any, including all exhibits thereto and the documents incorporated by reference in the
prospectus contained in the Initial Registration Statement at the time such part of the registration statement became effective but excluding Form T-1, each as amended at the time
such part of the registration statement became effective or such part of the Rule 462(b) Registration Statement, if any, became or hereafter becomes effective, being hereinafter called the
"Registration Statement"; the prospectus relating to the Securities, in the form in which it has most recently been filed, or transmitted for filing, with the Commission on or prior to the date of
this Agreement, being hereinafter called the "Prospectus"; any reference herein to any Preliminary Prospectus or the Prospectus shall be deemed to refer to and include the documents incorporated by
reference therein pursuant to the applicable form under the Act, as of the date of such Preliminary Prospectus or Prospectus, as the case may be; any reference to any amendment or supplement to any
Preliminary Prospectus or the Prospectus shall be deemed to refer to and include any documents filed after the date of such Preliminary Prospectus or Prospectus, as the case may be, under the
Securities Exchange Act of 1934, as amended (the "Exchange Act"), and incorporated by reference in such Preliminary Prospectus or Prospectus, as the case may be; any reference to any amendment to the
Registration Statement shall be deemed to refer to and include any annual report of the Company filed pursuant to Section 13(a) or 15(d) of the Exchange Act after the effective date of the
Registration Statement that is incorporated by reference in the Registration Statement; and any reference to the Prospectus as amended or supplemented shall be deemed to refer to the Prospectus as
amended or supplemented in relation to the applicable Designated Securities in the form in which it is filed with the Commission pursuant to Rule 424(b) under the Act in accordance with
Section 5(d) hereof, including any documents incorporated by reference therein as of the date of such filing). 

        (b)  The
documents incorporated by reference in the Prospectus, when they became effective or were filed with the Commission, as the case may be, conformed in all material
respects to the requirements of the Act or the Exchange Act, as applicable, and the rules and regulations of the Commission thereunder, and none of such documents contained any untrue statement of a
material fact or omitted to state any material fact necessary to make the statements therein, in the light of the circumstances under which they were made, not misleading; and any further documents so
filed and incorporated by reference in the Prospectus or any further amendment or supplement thereto, when such documents become effective or are filed with the Commission, as the case may be, will
conform in all material respects to the requirements of the Act or the Exchange Act, as applicable, and the rules and regulations of the Commission thereunder and will not contain any untrue statement
of a material fact or omit to state any material fact necessary to make the statements therein, in the light of the circumstances under which they were made, not misleading; 

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provided, however, that the Company makes no representation or warranty as to the information contained in or omitted from the Prospectus as amended or supplemented relating to such Securities, in
reliance upon and in conformity with information furnished in writing to the Company by or on behalf of the Underwriters or the Representatives specifically for inclusion therein. 

        (c)  The
Registration Statement and the Prospectus conform, and any further amendments or supplements to the Registration Statement or the Prospectus will conform, in all
material respects to the requirements of the Act and the Trust Indenture Act of 1939, as amended (the "Trust Indenture Act"), and the rules and regulations of the Commission thereunder and do not and
will not, as of the applicable effective date as to the Registration Statement and any amendment thereto and as of the applicable filing date as to the Prospectus and any amendment or supplement
thereto, contain any
untrue statement of a material fact or omit to state any material fact necessary to make the statements therein, in the light of the circumstances under which they were made, not misleading; provided,
however, that the Company makes no representation or warranty as amended or supplemented relating to such Securities, made in reliance upon and in conformity with information furnished in writing to
the Company by or on behalf of the Underwriters through the Representatives specifically for inclusion therein. 

        (d)  The
Company has been duly organized, is validly existing as a corporation in good standing under the laws of the State of Nevada and has the requisite power and
authority to carry on its business as it is currently being conducted and to own, lease and operate its properties, and is duly qualified and is in good standing as a foreign corporation authorized to
do business in each jurisdiction where the operation, ownership or leasing of property or the conduct of its business requires such qualification and where failure to have such power and authority or
be so qualified or in good standing would have singly or in the aggregate a material adverse effect on the business, financial condition, results of operations or prospects of the Company and its
subsidiaries, taken as a whole (a "Material Adverse Effect"). Each significant subsidiary of the Company as defined in Rule 1-02 of Regulation S-X under the Act
(collectively, the "Significant Subsidiaries"), has been duly organized, is validly existing as a corporation in good standing under the laws of its jurisdiction of incorporation and has the requisite
power and authority to carry on its business as it is currently being conducted and to own, lease and operate its properties, and each is duly qualified and is in good standing as a foreign
corporation authorized to do business in each jurisdiction where the operation, ownership or leasing of property or the conduct of its business requires such qualifications and where failure to have
such power and authority or to be so qualified or in good standing would have a Material Adverse Effect. 

        (e)  All
the outstanding shares of capital stock of each Significant Subsidiary have been duly and validly authorized and issued and are fully paid and nonassessable, and,
except as otherwise set forth in the Prospectus, all outstanding shares of capital stock of the Significant Subsidiaries are owned by the Company either directly or through wholly owned subsidiaries
free and clear of any perfected security interest or any other security interests, claims, liens or encumbrances (each a "Lien") that could have a Material Adverse Effect. 

        (f)    The
Company is not, and after giving effect to the offering and sale of the Designated Securities and the application of the proceeds thereof as described in the
Prospectus will not be, an "investment company" within the meaning of the Investment Company Act, without taking account of any exemption arising out of the number of holders of the Company's
securities. 

        (g)  The
statements in the Prospectus under the heading "Description of Notes" fairly summarize the matters therein described. 

        (h)  This
Agreement has been duly authorized, executed and delivered by the Company; the Indenture has been duly authorized and, assuming due authorization, execution and
delivery 

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thereof by the Trustee, when executed and delivered by the Company, will constitute a legal, valid, binding instrument enforceable against the Company in accordance with its terms (subject to
applicable bankruptcy, reorganization, insolvency, moratorium, fraudulent transfer or other laws affecting creditors' rights generally from time to time in effect and to general principles of equity);
the Designated Securities have been duly authorized, and, when executed and authenticated in accordance with the provisions of the Indenture and delivered to and paid for by the Underwriters, will
have been duly executed and delivered by the Company and will constitute the legal, valid and binding obligations of the Company entitled to the benefits of the Indenture (subject to applicable
bankruptcy, insolvency, moratorium, fraudulent transfer or other laws affecting creditors' rights generally from time to time in effect and to general principles of equity). 

        (i)    No
consent, approval, authorization, filing with or order of any court or governmental agency or body is required in connection with the transactions contemplated
herein, in the Pricing Agreement or in the Indenture, except such as will be obtained under the Act and the Trust Indenture Act and such as may be required by the National Association of Securities
Dealers, Inc. or under the blue sky laws of any jurisdiction in connection with the purchase and distribution of the Securities by the Underwriters in the manner contemplated herein and in the
Prospectus. 

        (j)    Neither
the execution and delivery of the Indenture, this Agreement or any Pricing Agreement, the issue and sale of the Securities, nor the consummation of any other of
the transactions herein or therein contemplated, nor the fulfillment of the terms hereof or thereof will conflict with, result in a breach or violation or imposition of any Lien upon any property or
assets of the Company or any of its subsidiaries pursuant to: (i) the charter or by-laws of the Company or any of its subsidiaries; (ii) the terms of any indenture, contract,
lease, mortgage, deed of trust, note agreement, loan agreement or other agreement, obligation, condition, covenant or instrument to which the Company or any of its subsidiaries is a party or bound or
to which its or their property is subject; or (iii) any statute, law, rule, regulation, judgment, order or decree applicable to the Company or any of its subsidiaries of any court, regulatory
body, administrative agency, governmental body, arbitrator or other authority having jurisdiction over the Company or any of its subsidiaries or any of its or their properties. 

        (k)  The
consolidated financial statements and schedules of the Company and its consolidated subsidiaries included in the Prospectus present fairly in all material respects
the financial condition, results of operations and cash flows of the Company as of the dates and for the periods indicated, comply as to form in all material respects with the applicable accounting
requirements of the Act and have been prepared in conformity with generally accepted accounting principles applied on a consistent basis throughout the periods involved (except as otherwise noted
therein). 

        (l)    No
action, suit or proceeding by or before any court or governmental agency, authority or body or any arbitrator involving the Company or any of its subsidiaries or its
or their property is pending or, to the knowledge of the Company, threatened that (i) could reasonably be expected to have a material adverse effect on the performance of this Agreement, the
Pricing Agreement or the Indenture, or the consummation of any of the transactions contemplated hereby or thereby; or (ii) could reasonably be expected to have a Material Adverse Effect, except
as set forth or contemplated in the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing Agreement). 

        (m)  Neither
the Company nor any Significant Subsidiary is in violation or default of (i) any provision of its charter or bylaws; (ii) the terms of any
indenture, contract, lease, mortgage, deed of trust, note agreement, loan agreement or other agreement, obligation, condition, covenant or instrument to which it is a party or bound or to which its
property is subject; or (iii) any statute, law, rule, regulation, judgment, order or decree applicable to the Company or any of its subsidiaries of any court, regulatory body, administrative
agency, governmental body, arbitrator or 

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other authority having jurisdiction over the Company or such subsidiary or any of its properties, as applicable, except in each instance as would not have, singly or in the aggregate, a Material
Adverse Effect. 

        (n)  To
the knowledge of the Company, KPMG LLP, who have certified certain financial statements of the Company and its consolidated subsidiaries and delivered their report
with respect to the audited consolidated financial statements included in the Prospectus, are independent public accountants with respect to the Company within the meaning of the Act and the
applicable published rules and regulations thereunder. 

        (o)  Except
as contemplated by the Prospectus and Registration Statement, subsequent to the respective dates as to which information is presented in the Prospectus and up to
the Time of Delivery for the Designated Securities (as defined in Section 4 hereof) (i) neither the Company nor any of the Significant Subsidiaries has incurred any liabilities or
obligations, direct or contingent, or entered into any transaction not in the ordinary course of business, which could reasonably be expected to have a Material Adverse Effect, and (ii) there
has not been any change, or any development involving a prospective change, that could reasonably be expected to have a Material Adverse Effect. 

        (p)  No
labor problem or dispute with the employees of the Company or any of its subsidiaries exists or, to the knowledge of the Company, is threatened or imminent that could
reasonably be expected to have a Material Adverse Effect, except as set forth in or contemplated in the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing
Agreement). 

        (q)  The
Company and its subsidiaries are insured by insurers of recognized financial responsibility against such losses and risks and in such amounts as are prudent and
customary in the businesses in which they are engaged. 

        (r)  No
subsidiary of the Company is currently prohibited, directly or indirectly, from paying any dividends to the Company, from making any other distribution on such
subsidiary's capital stock, from repaying to the Company any loans or advances to such subsidiary from the Company or from transferring any of such subsidiary's property or assets to the Company or
any other subsidiary of the Company, except as described in or contemplated by the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing Agreement) or where such
prohibitions, individually or in the aggregate, would not reasonably be expected to have a Material Adverse Effect. 

        (s)  The
Company and its subsidiaries possess all licenses, certificates, permits, accreditations and other authorizations (each, an "Authorization") issued by the
appropriate federal, state or foreign regulatory authorities necessary to conduct their respective businesses, except where the failure to possess such Authorization would not reasonably be expected
to have a Material Adverse Effect, and neither the Company nor any such subsidiary has received any notice of proceedings relating to the revocation or modification of any such Authorization which,
singly or in the aggregate, if the subject of an unfavorable decision, ruling or finding, would reasonably be expected to have a Material Adverse Effect, except as set forth in or contemplated in the
Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing Agreement). 

        (t)    To
the extent required by the Exchange Act, the Company and its subsidiaries maintain a system of internal accounting controls sufficient to provide reasonable
assurances that (i) transactions are executed in accordance with management's general or specific authorizations; (ii) transactions are recorded as necessary to permit preparation of
financial statements in conformity with generally accepted accounting principles and to maintain asset accountability; 

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(iii) access to assets is permitted only in accordance with management's general or specific authorization; and (iv) the recorded accountability for assets is compared with the existing
assets at reasonable intervals and appropriate action is taken with respect to any differences. 

        (u)  The
Company and its Significant Subsidiaries are (i) in compliance with any and all applicable foreign, federal, state and local laws and regulations relating to
the protection of human health and safety, the environment or hazardous or toxic substances or wastes, pollutants or contaminants ("Environmental Laws"); (ii) have received and are in
compliance with all permits, licenses or other approvals required of them under applicable Environmental Laws to conduct their respective businesses; and (iii) have not received notice of any
actual or potential liability for the investigation or remediation of any disposal or release of hazardous or toxic substances or wastes, pollutants or contaminants, except where such
non-compliance with Environmental Laws, failure to receive required permits, licenses or other approvals, or liability would not, individually or in the aggregate, have a Material Adverse
Effect and except as set forth in or contemplated in the Prospectus. 

        Any
certificate signed by any officer of the Company and delivered to the Representatives or counsel for the Underwriters in connection with the offering of the Securities shall be
deemed a representation and warranty by the Company, as to matters covered thereby, to each Underwriter. 

        3.    Purchase and Sale.    Upon the execution of the Pricing Agreement applicable to any Designated Securities and
authorization by the Representatives of the release of such Designated Securities, the several Underwriters propose to offer such Designated Securities for sale upon the terms and conditions set forth
in the Prospectus as amended or supplemented. 

        4.    Delivery and Payment.    Unless otherwise specified in the applicable Pricing Agreement, global certificates for
Designated Securities to be purchased by each Underwriter pursuant to such Pricing Agreement, registered in the name Cede & Co., shall be delivered by or on behalf of the Company to The
Depository Trust Company, which shall release such Designated Securities to the accounts of the Representatives for the account of such Underwriter, against payment by such Underwriter or on its
behalf of the purchase price therefor by wire transfer payable in same-day funds to the account specified by the Company, all at the place and time and date specified in such Pricing
Agreement or at such other place and time and date as the Representatives and the Company may agree upon in writing, such time and date being herein called the "Time of Delivery" for such Designated
Securities. 

        5.    Agreements.    The Company agrees with each of the Underwriters of any Designated Securities: 

        (a)  The
Company will furnish to each Underwriter and to counsel for the Underwriters, without charge, during the period referred to in paragraph (c) below, as many
copies of the Prospectus and any amendments and supplements thereto as they may reasonably request. 

        (b)  If,
prior to the completion (as determined by the Representatives) of the distribution of the Securities by the Underwriters, any event shall occur as a result of which
the Prospectus as then amended or supplemented would include an untrue statement of a material fact or omit to state any material fact necessary in order to make the statements therein, in the light
of the circumstances when such Prospectus is delivered, not misleading, or if it shall be necessary during such same period to amend or supplement the Prospectus or to file under the Exchange Act any
document incorporated by reference in the Prospectus in order to comply with the Act, the Exchange Act or the Trust Indenture Act, the Company will promptly prepare and, upon the request of the
Representatives, file an appropriate amendment or supplement to the Prospectus so that the Prospectus, as so amended or supplemented, will not include an untrue statement of a material fact or omit to
state any material fact necessary in order to make the statements therein, in the light of the circumstances existing as of the date the Prospectus is so delivered, not misleading, and will comply
with applicable law, and will promptly notify you of such event and 

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amendment or supplement and furnish to each Underwriter without charge such number of copies thereof as you may reasonably request of an amended Prospectus or a supplement to the Prospectus which
will correct such statement or omission or effect such compliance, provided, however, that in case any Underwriter is required under the Act to deliver a prospectus in connection with the offering or
sale of the Designated Securities at any time more than nine months after the date of the Pricing Agreement relating to the Designated Securities, the costs of such preparation and furnishing of such
amended or supplemented Prospectus shall be borne by the Underwriters of such Designated Securities. 

        (c)  Promptly
after receiving a reasonable request from the Representatives that it do so, the Company will arrange, if necessary, for the qualification of such Designated
Securities for offering and sale under the securities laws of such United States jurisdictions as the Representatives from time to time may reasonably request and to maintain such qualifications in
effect so long as required for the sale of such Designated Securities; provided that in no event shall the Company be obligated to qualify to do
business in any jurisdiction where it is not now so qualified or to take any action that would subject it to service of process in suits, other than those arising out of the offering or sale of the
Securities, in any jurisdiction where it is not now so subject, and provided further that in connection therewith the Company shall not be required to qualify such Designated Securities for offering
and sale under the securities laws of any such jurisdiction for a period in excess of nine months after the initial time of issue of the Prospectus as amended or supplemented relating to such
Designated Securities. The Company will promptly advise the Representatives of the receipt by the Company of any notification with respect to the suspension of the qualification of the Securities for
sale in any jurisdiction or the initiation or threatening of any proceeding for such purpose. 

        (d)  The
Company will prepare the Prospectus as amended and supplemented in relation to the applicable Designated Securities in a form approved by the Representatives and to
file such Prospectus pursuant and in accordance with Rule 424(b) under the Act; the Company will make no further amendment or any supplement to the Registration Statement or Prospectus as
amended or supplemented after the date of the Pricing Agreement relating to such Securities and prior to the Time of Delivery for such Securities (other than by means of incorporation of documents by
reference into the Registration Statement or Prospectus through the filing of a report under the Exchange Act) at any time prior to having afforded the Representatives for such Securities a reasonable
opportunity to review and comment thereon; the Company will advise the Representatives promptly of any such amendment or supplement after such Time of Delivery and furnish the Representatives with
copies thereof; the Company will file promptly all reports and any definitive proxy or information statements required to be filed by the Company with the Commission pursuant to Section 13(a),
13(c), 14 or 15(d) of the Exchange Act for so long as the delivery of a prospectus is required in connection with the offering or sale of such Securities, and during such same period to advise the
Representatives, promptly after it receives notice thereof, of the time when any amendment to the Registration Statement has been filed or becomes effective or any supplement to the Prospectus or any
amended Prospectus has been filed with the Commission, of the issuance by the Commission of any stop order or of any order preventing or suspending the use of any prospectus relating to the
Securities, of the suspension of the qualification of such Securities for offering or sale in any jurisdiction, of the initiation or threatening of any proceeding for any such purpose, or of any
request by the Commission for the amending or supplementing of the Registration Statement or Prospectus or for additional information; and, in the event of the issuance of any such stop order or of
any such order preventing or suspending the use of any prospectus relating to the Securities or suspending any such qualification, the Company will use its best efforts to obtain the withdrawal of
such order. 

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        (e)  The
Company will make generally available to its securityholders as soon as practicable, but in any event not later than eighteen months after the effective date of the
Registration Statement (as defined in Rule 158(c)), an earning statement of the Company and its subsidiaries (which need not be audited) complying with Section 11(a) of the Act and the
rules and regulations of the Commission thereunder (including at the option of the Company, Rule 158). 

        (f)    The
Company will cooperate with the Representatives and use its reasonable efforts to permit the Securities to be eligible for clearance and settlement through The
Depository Trust Company. 

        (g)  The
Company will not, during the period beginning from the date of the Pricing Agreement for such Designated Securities and continuing to and including the Time of
Delivery for such Designated Securities, without the prior written consent of the Representatives, offer, sell or contract to sell, or otherwise dispose of (or enter into any transaction which is
designed to, or might reasonably be expected to, result in the disposition (whether by actual disposition or effective economic disposition due to cash settlement or otherwise) by the Company or any
Affiliate of the Company or any person in privity with the Company or any Affiliate of the Company), directly or indirectly, or announce the offering of, any debt securities issued or guaranteed by
the Company (other than the Designated Securities). 

        (h)  The
Company will not take, directly or indirectly, any action designed to or which has constituted or which might reasonably be expected to cause or result, under the
Exchange Act or otherwise, in stabilization or manipulation of the price of any security of the Company to facilitate the sale or resale of the Securities. 

        (i)    The
Company agrees to pay the reasonable costs and expenses relating to the following matters: (i) the preparation of the Indenture, the issuance of the
Securities and the fees of the Trustee; (ii) the preparation, printing or reproduction of the Registration Statement, Preliminary Prospectus and Prospectus and each amendment or supplement to
either of them; (iii) the reasonable fees, disbursements and expenses of the Company's counsel and accountants in connection with the registration of the Securities under the Act and the
printing (or reproduction), delivery (including postage, air freight charges and charges for counting and packaging) and filing of such copies of the Registration Statement, the Preliminary Prospectus
and, subject to the proviso to Section 5(b), the Prospectus, and all amendments or supplements thereto, as may, in each case, be reasonably requested for use in connection with the offering and
sale of the Securities; (iv) the preparation, printing, authentication, issuance and delivery of certificates, if any, for the Securities, including any stamp or transfer taxes in connection
with the original issuance and sale of the Securities; (v) the printing (or reproduction) and delivery of this Agreement, any Pricing Agreement, any blue sky memorandum and all other agreements
or documents printed (or reproduced) and delivered in connection with the offering of the Securities; (vi) any registration or qualification of the Securities for offer and sale under the
securities or blue sky laws of the several states (including filing fees and the reasonable fees and expenses of counsel for the Underwriters relating to such registration and qualification);
(vii) the transportation and other expenses incurred by or on behalf of Company representatives in connection with presentations to prospective purchasers of the Securities; (viii) any
filing fees incident to any required review by the National Association of Securities Dealers, Inc. of the terms of the sale of the Securities; and (ix) all other reasonable costs and
expenses incident to the performance by the Company of its obligations hereunder. It is understood, however, that, except as provided in this Section, Section 7 and Section 8 hereof, the
Underwriters will pay all of their own costs and expenses, including the fees and expenses of their counsel, transfer taxes on resale of any of the Securities by them, and any advertising expenses
connected with any offers they may make. 

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        6.    Conditions to the Obligations of the Underwriters.    The obligations of the Underwriters of any Designated
Securities under the Pricing Agreement relating to such Designated Securities shall be subject to the accuracy of the representations and warranties on the part of the Company contained herein at the
date of the execution hereof and Time of Delivery for such Designated Securities, to the accuracy of the statements of the Company made in any certificates pursuant to the provisions hereof, to the
performance by the Company of its obligations hereunder and to the following additional conditions: 

        (a)  The
Prospectus as amended or supplemented in relation to the applicable Designated Securities shall have been filed with the Commission pursuant to Rule 424(b)
within the applicable time period prescribed for such filing by the rules and regulations under the Act and in accordance with Section 5(d) hereof; no stop order suspending the effectiveness of
the Registration Statement or any part thereof shall have been issued and no proceeding for that purpose shall have been initiated or, to the knowledge of the Company, threatened by the Commission;
and all requests for additional information on the part of the Commission shall have been complied with to the Representatives' reasonable satisfaction. 

        (b)  The
Company shall have requested and caused to be furnished to the Representatives: 

        (1)  an
opinion of Sullivan & Cromwell, counsel to the Company, dated the Time of Delivery for the Designated Securities and addressed to the Representatives, to the
effect that: 

        (i)    this
Agreement and the Pricing Agreement with respect to the Designated Securities have been duly authorized, executed and delivered by the Company; 

        (ii)  the
Indenture has been duly authorized, executed and delivered by the Company; and the Indenture constitutes a valid and legally binding obligation of the Company
enforceable in accordance with its terms, subject to bankruptcy, insolvency, fraudulent transfer, reorganization, moratorium and similar laws of general applicability relating to or affecting
creditors' rights and to general equity principles; 

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        (iii)  the
Designated Securities have been duly authorized, executed, authenticated, issued and delivered; and the Designated Securities constitute valid and legally binding
obligations of the Company enforceable in accordance with their terms, subject to bankruptcy, insolvency, fraudulent transfer, reorganization, moratorium and similar laws of general applicability
relating to or affecting creditors' rights and to general equity principles; 

        (iv)  all
regulatory consents, authorizations, approvals and filings required to be obtained or made by the Company under the Federal laws of the United States or the laws of
the States of New York or California for the issuance, sale and delivery of the Designated Securities to be issued and sold by the Company to the Underwriters under this Agreement and the Pricing
Agreement have been obtained or made; 

        (v)  the
execution and delivery by the Company of this Agreement, the Indenture and the Pricing Agreement, the issuance of the Designated Securities in accordance with the
Indenture and the sale of the Designated Securities by the Company to you pursuant to this Agreement and the Pricing Agreement do not, and the performance by the Company of its obligations under this
Agreement, the Indenture and the Pricing Agreement will not, violate any Federal law of the United States or law or regulation of the States of New York or California applicable to the Company;
provided, however, that for purposes of this paragraph (v), such counsel need express no opinion as to Federal or state securities laws, other antifraud laws or fraudulent transfer laws;
provided, further, that insofar as performance by the Company of its obligations under this Agreement, the Indenture and the Pricing Agreement is concerned, such counsel need express no opinion with
respect to Section 8 of this Agreement or to bankruptcy, insolvency, reorganization, moratorium and similar laws of general applicability relating to or affecting creditors' rights; and 

        (vi)  the
Company is not, and after giving effect to the offering and sale of the Securities and the application of the proceeds thereof as described in the Prospectus, will
not be required to register as an "investment company" under the Investment Company Act. 

        Such
counsel shall state that the Registration Statement and the Prospectus as amended or supplemented and any further amendments and supplements thereto made by the Company prior to the
Time of Delivery (other than financial statements or other financial data derived from accounting records included therein, as to which such counsel need not express any opinion or belief), appear on
their face to be appropriately responsive in all material respects relevant to the offering of the Designated Securities to the requirements of the Act and the Trust Indenture Act and the applicable
rules and regulations thereunder. In addition, such counsel shall state that nothing has come to its attention in the course of such counsel's review that has caused such counsel to believe that
(i) any part
of the Registration Statement, when such part became effective contained any untrue statement of a material fact or omitted to state any material fact required to be stated therein or necessary to
make the statements therein not misleading or that the Prospectus, as of the date of the Pricing Agreement (except as to each for financial statements or other financial data derived from accounting
records included therein, as to which such counsel need not express any opinion or belief), contained any untrue statement of a material fact or omitted to state a material fact necessary in order to
make the statements therein, in the light of the circumstances under which they were made, not misleading and (ii) the Prospectus, as of the Time of Delivery (except for financial statements or
other financial data derived from accounting records included therein, as to which such counsel need not express any opinion or belief), contained any untrue statement of a material fact or omitted to
state a material fact necessary in order to make the statements therein, in light of the circumstances under which they were made, not misleading; provided, however, that such counsel may state that
because of the limitations 

10

 

inherent in the independent verification of factual matters and the character of determinations involved in the preparation of the Prospectus and the Registration Statement, such counsel does not
assume any responsibility for the accuracy, completeness or fairness of the statements contained in the Prospectus and the Registration Statement except for those made under the captions "Description
of the Notes" and "Plan of Distribution" in the Prospectus and the Registration Statement insofar as they relate to provisions of the Designated Securities, the Indenture, the Company's Certificate of
Incorporation and By-laws, this Agreement and the Pricing Agreement therein described. 

        Such
counsel may state that such counsel expresses no opinion as to the laws of any jurisdiction other than the Federal laws of the United States and the laws of the States of New York
and California. 

        In
rendering such opinion, such counsel may rely (A) as to matters involving the application of laws of the State of Nevada on the opinion of Woodburn and Wedge or other Nevada
counsel to the Company, and as to the laws of any other jurisdiction, other than the States of New York or California or the Federal laws of the United States, to the extent they deem proper and
specified in such opinion, upon the opinion of other counsel of good standing whom they believe to be reliable and who are satisfactory to counsel for the Underwriters; and (B) as to matters of
fact, to the extent they deem proper, on certificates of responsible officers of the Company and public officials. Such counsel may note that the Preliminary Prospectus as supplemented does not
necessarily contain a current description of the Company's business and affairs since, pursuant to Form S-3, it incorporates by reference certain documents filed with the Commission
which contain information as of various dates. References to the Prospectus in this Section 6(b)(1) include any amendment or supplement thereto at the Time of Delivery. 

        (2)  an
opinion of Christi R. Sulzbach, Esq., Executive Vice President and General Counsel of the Company, or Richard B. Silver, Senior Vice President and Assistant General
Counsel of the Company, dated the Time of Delivery and addressed to the Representatives, to the effect that: 

        (i)    the
descriptions in the Prospectus of statutes, legal and governmental proceedings, contracts and other documents and regulatory matters described in the Company's
Annual Report on Form 10-K for the most recently ended fiscal year for which a Form 10-K is required to be filed (the "Form 10-K") under
the captions "Business—Medicare, Medicaid and Other Revenues" and "Business—Healthcare Reform, Regulation and Licensing", insofar as such statements constitute summaries of
legal matters, documents or proceedings referred to therein, provide a fair summary in all material respects; 

        (ii)  each
of the Company and its Significant Subsidiaries has such Authorizations from all regulatory or governmental officials, bodies and tribunals as are necessary to
own, lease and operate its respective properties and to conduct its business in the manner described in the Prospectus, except as could not reasonably be expected to have, singly or in the aggregate,
a Material Adverse Effect; 

        (iii)  to
the best of such counsel's knowledge, there is no current, pending or threatened action, suit or proceeding before any court or governmental agency, authority or
body or any arbitrator involving the Company or any of its subsidiaries or to which any of their respective property is subject of a character required to be disclosed in the Prospectus that is not
adequately disclosed in the Prospectus; 

        (iv)  except
as otherwise disclosed in the Prospectus, all of the issued and outstanding shares of capital stock of, or other ownership interests in, each Significant
Subsidiary of the Company have been duly and validly authorized and issued, and, except as otherwise 

11

 

described in the Prospectus, the shares of capital stock of, or other ownership interests in, each of its Significant Subsidiaries are owned of record, directly or through subsidiaries by the
Company, are fully paid and nonassessable, and to the best knowledge of such counsel are owned free and clear of any material, consensual Lien that could have a Material Adverse Effect; 

        (v)  the
Company and each of its Significant Subsidiaries is a duly organized corporation in good standing, has the requisite corporate power and authority to own, lease and
operate its properties and to conduct its business as described in the Prospectus, and, to the extent each is a party thereto, to execute, deliver and perform its obligations pursuant to the
Indenture, this Agreement and the Pricing Agreement, and is duly qualified as a foreign corporation and in good standing in each jurisdiction where the ownership, leasing or operation of property or
the conduct of its business requires such qualification, except where the failure so to have such power and authority or be qualified or in good standing could not reasonably be expected to have,
singly or in the aggregate, a Material Adverse Effect; and 

        (vi)  the
execution and delivery by the Company of this Agreement, the Indenture and the Pricing Agreement and the issuance and sale of the Designated Securities to you as
contemplated thereby and the performance of its obligations pursuant to this Agreement, the Indenture and the Pricing Agreement will not conflict with or result in a breach or violation of any of the
terms or provisions of, or constitute a default (with the passage of time or otherwise) under, or result in the imposition of a Lien on any properties of the Company or any of its subsidiaries or an
acceleration of indebtedness pursuant to any of the agreements listed on a schedule attached to such counsel's opinion (which schedule shall list all agreements where such breach, default, Lien,
acceleration of indebtedness or conflict could have, singly or in the aggregate, a Material Adverse Effect), where, in any such instance,
such breach, default, Lien, acceleration of indebtedness or conflict could have, singly or in the aggregate, a Material Adverse Effect. 

        In
giving his or her opinion, such counsel shall state that no fact has come to the attention of such counsel that leads him or her to believe that the descriptions of statutes, legal
and governmental proceedings, contracts and other documents and regulatory matters described in the Prospectus under the captions set forth in subsection (i) of this Section 6(b)(2)
contained an untrue statement of a material fact or omitted to state a material fact required to be stated therein or necessary to make the statements therein, in the light of the circumstances under
which they were made, not misleading. 

        Such
counsel may state that such counsel expresses no opinion as to the laws of any jurisdiction other than the Federal laws of the United States and the laws of the State of California. 

        In
rendering such opinion, such counsel may rely (A) as to matters involving the application of laws of the State of Nevada on the opinion of Woodburn and Wedge or other Nevada
counsel to the Company, and as to the laws of any other jurisdiction, other than the State of California or the Federal laws of the United States, to the extent they deem proper and specified in such
opinion, upon the opinion of other counsel of good standing whom they believe to be reliable and who are satisfactory to counsel for the Underwriters; and (B) as to matters of fact, to the
extent they deem proper, on certificates of responsible officers of the Company and public officials. References to the Prospectus in this Section 6(b)(2) include any amendment or supplement
thereto at the Time of Delivery. 

12

 

        (3)  an
opinion of Woodburn and Wedge, special Nevada counsel to the Company, dated the Time of Delivery and addressed to the Representatives, to the effect that: 

        (i)    each
of this Agreement and the Pricing Agreement has been duly authorized, executed and delivered by the Company, and the Designated Securities and the Indenture have
been duly authorized, executed and delivered by the Company; 

        (ii)  the
Company is a duly organized and validly existing corporation in good standing under the laws of the State of Nevada and has the requisite corporate power and
authority to own, lease and operate its properties and to conduct its business as described in the Prospectus, to authorize, issue and sell the Designated Securities as contemplated by this Agreement
and the Pricing Agreement and to execute and deliver, and perform its obligations pursuant to, the Indenture, the Designated Securities, this Agreement and the Pricing Agreement; 

        (iii)  no
consent, approval, authorization, or order of any Nevada governmental agency or body is required for the consummation by the Company of the transactions
contemplated by this Agreement and the Pricing Agreement in connection with the issuance and sale of the Designated Securities; 

        (iv)  the
execution and delivery by the Company of this Agreement, the Indenture and the Pricing Agreement and the issuance and sale of the Designated Securities to you as
contemplated by this Agreement and the Pricing Agreement and the performance of its obligations pursuant to this Agreement, the Indenture and the Pricing Agreement will not conflict with or result in
a breach or violation of any of the terms or provision of, or constitute a default under, (a) any of the charter or bylaws of the Company, or (b) any existing applicable statute, rule or
regulation or any order of any Nevada court or governmental agency or body having jurisdiction over the Company or any of its properties; provided that the opinion expressed in clause (b) is
limited to those statutes, rules or regulations which, in the experience of such counsel, are normally applicable to transactions of the type contemplated by this Agreement, the Indenture or the
Pricing Agreement; and 

        (v)  in
any action or proceeding arising out of or relating to this Agreement, the Indenture or the Pricing Agreement in any court of the State of Nevada or in any federal
court sitting in the State of Nevada, such court would recognize and give effect to the provisions of Section 14 of this Agreement and Section 112 of the Indenture wherein the parties
thereto agreed, to the extent therein stated, that each such document shall be governed by and construed in accordance with the internal laws of the State of New York. 

        (c)  The
Representatives shall have received from counsel for the Underwriters such opinion or opinions, dated the Time of Delivery and addressed to the Representatives, with
respect to the issuance and sale of the Designated Securities, the Indenture, the Registration Statement, the Prospectus (as amended or supplemented at the Time of Delivery for such Designated
Securities) and other related matters as the Representatives may reasonably require, and the Company shall have furnished to such counsel such documents as they may reasonably request for the purpose
of enabling them to pass upon such matters. 

        (d)  The
Company shall have furnished to the Representatives a certificate of the Company, signed by an executive officer and a financial officer of the Company, dated the
Time of Delivery, to the effect that the signers of such certificate have carefully examined the Registration 

13

 

Statement, the Prospectus, any amendment or supplement to the Prospectus, this Agreement and the Pricing Agreement and that: 

        (i)    the
representations and warranties of the Company in this Agreement are true and correct in all material respects on and as of the Time of Delivery with the same effect
as if made on the Time of Delivery, and the Company has complied with all the agreements and satisfied all the conditions on its part to be performed or satisfied hereunder at or prior to the Time of
Delivery; and 

        (ii)  since
the date of the most recent financial statements included in the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing
Agreement), there has been no Material Adverse Effect, whether or not arising from transactions in the ordinary course of business, except as set forth in or contemplated by the Prospectus (exclusive
of any amendment or supplement thereto after date of the Pricing Agreement). 

        (e)  At
the date of the Pricing Agreement for the Designated Securities and at the Time of Delivery, the Company shall have requested and caused KPMG LLP, or such other
independent accountants of the Company who have certified the consolidated financial statements of the Company included or incorporated by reference in the Registration Statement, to furnish to the
Representatives letters, dated respectively as of the date of the Pricing Agreement and as of the Time of Delivery, in form and substance reasonably satisfactory to the Representatives, confirming
that they are independent accountants within the meaning of the Act and the Exchange Act and the applicable rules and regulations thereunder, that they have performed a review of the unaudited interim
financial information of the Company included in the Prospectus or included in the Company's Form 10-Q incorporated by reference into the Prospectus and stating in effect that: 

        (i)    in
their opinion the audited financial statements included or incorporated in the Registration Statement or Prospectus and reported on by them comply as to form in all
material respects with the applicable accounting requirements of the Act and the Exchange Act and the related published rules and regulations thereunder; 

        (ii)  on
the basis of a reading of the latest unaudited financial statements made available by the Company and its subsidiaries; their limited review in accordance with the
standards established under Statement on Auditing Standards No. 71, of the unaudited interim financial information for the period ended the date of the latest consolidated balance sheet
included or incorporated in the Prospectus; carrying out certain specified procedures (but not an examination in accordance with generally accepted auditing standards) which would not necessarily
reveal matters of significance with respect to the comments set forth in such letter; a reading of the minutes of the meetings of the stockholders, directors and executive, finance and audit
committees of the Company and the Significant Subsidiaries; and inquiries of certain officials of the Company who have responsibility for financial and accounting matters of the Company and its
subsidiaries as to transactions and events subsequent to the date of the latest audited financial statements of the Company, nothing came to their attention which caused them to believe that: 

        (1)  any
unaudited financial statements included or incorporated in the Prospectus or the Registration Statement do not comply in form in all material respects with
applicable accounting requirements and with the published rules and regulations of the Commission with respect to financial statements included or incorporated in quarterly reports on
Form 10-Q under the Exchange Act; and said unaudited financial statements are not in conformity with generally accepted 

14

 

accounting principles applied on a basis substantially consistent with that of the audited financial statements included or incorporated in the Prospectus; 

        (2)  any
unaudited pro forma condensed consolidated financial statements included or incorporated by reference in the Prospectus do not comply as to form in all material
respects with the applicable accounting requirements of Rule 11-02 of Regulation S-X and that the pro forma adjustments have not been properly applied to the
historical amounts in the compilation of those statements; or 

        (3)  as
of a specified date not more than five days prior to the date of the letter, there were any changes in excess of $25 million in the long-term debt
of the Company and its subsidiaries or in the capital stock of the Company (other than as a result of stock option exercises or disclosed stock repurchase programs) or decreases in the shareholders'
equity of the Company as compared with the amounts shown on the latest consolidated balance sheet included or incorporated in the Prospectus, or for the period from the date of the latest consolidated
balance sheet included or incorporated in the Prospectus to such specified date not more than five days prior to the date of the letter there were any decreases, as compared with the corresponding
period in the preceding year in net operating revenues, operating income, income before income taxes or in total or per share amounts of net income of the Company and its subsidiaries, except in all
instances for changes or decreases set forth in such letter, in which case the letter shall be accompanied by an explanation by the Company as to the significance thereof unless said explanation is
not deemed necessary by the Representatives. 

        (iii)  they
have performed certain other specified procedures as a result of which they determined that certain information of an accounting, financial or statistical nature
(which is limited to accounting, financial or statistical information derived from the general accounting records of the Company and its subsidiaries) set forth in the Prospectus, including the
information set forth under the caption "Summary Financial Information" in the Prospectus, the information included or incorporated in Items 1, 2, 6, 7 and 11 of the Company's Annual Report on
Form 10-K, incorporated in the Prospectus and the Registration Statement and the information included in the "Management's Discussion and Analysis of Financial Condition and Results
of Operations" included or incorporated in the Company's Quarterly Reports on Form 10-Q, incorporated in the Prospectus and the Registration Statement agrees with the accounting
records of the Company and its subsidiaries, excluding any questions of legal interpretation. 

        References
to the Prospectus in this Section 6(e) include any amendment or supplement thereto at the date of the applicable letter. 

        (f)    Subsequent
to the date of the Pricing Agreement or, if earlier, the dates as of which information is given in the Prospectus (exclusive of any amendment or supplement
thereto), there shall not have been (i) any change or decrease specified in the letter or letters referred to in paragraph (e) of this Section 6; or (ii) any change, or any
development involving a prospective change, in or affecting the business, financial condition, results of operations or prospects of the Company and its subsidiaries, taken as a whole, whether or not
arising from transactions in the ordinary course of business, except as set forth in or contemplated in the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing
Agreement) the effect of which, in any case referred to in clause (i) or (ii) above, is, in the sole judgment of the Representatives, so material and adverse as to make it impracticable
or inadvisable to proceed with the public offering and delivery of the Designated Securities as contemplated by the Prospectus (exclusive of any amendment or supplement thereto after the date of the
Pricing Agreement). 

15

 

        (g)  Subsequent
to the date of the Pricing Agreement, there shall not have been any decrease in the rating of any of the Company's debt securities by any "nationally
recognized statistical rating organization" (as defined for purposes of Rule 436(g) under the Act) or any notice given that any such organization has under surveillance or review its rating of
any of the debt securities of the Company with any intended or potential decrease in any such rating or of a possible change in any such rating that does not indicate the direction of the possible
change. 

        (h)  Prior
to the Time of Delivery, the Company shall have furnished to the Representatives such further information, certificates and documents as the Representatives may
reasonably request. 

        (i)    If
any of the conditions specified in this Section 6 shall not have been fulfilled in all material respects (except for Sections 6(f) and 6(g), which shall have
been fulfilled in all respects) when and as provided in this Agreement, or if any of the opinions and certificates mentioned above or elsewhere in this Agreement shall not be in all material respects
reasonably satisfactory in form and substance to the Representatives and counsel for the Underwriters, this Agreement, the Pricing Agreement and all obligations of the Underwriters hereunder may be
cancelled at, or at any time prior to, the Time of Delivery by the Representatives. Notice of such cancellation shall be given to the Company in writing or by telephone or facsimile confirmed in
writing. 

        (j)    The
documents required to be delivered by this Section 6 will be delivered at the office of Sullivan & Cromwell, counsel for the Company, at 1888 Century
Park East, Los Angeles, CA 90067, at the Time of Delivery. 

        7.    Reimbursement of Expenses.    If the sale of the Designated Securities provided for herein is not consummated
because any condition to the obligations of the Underwriters set forth in Section 6 hereof is not satisfied, because of any termination pursuant to Section 10 hereof or because of any
refusal, inability or failure on the part of the Company to perform any agreement herein or comply with any provision hereof other than by reason of a default by any of the Underwriters, the Company
will reimburse the Underwriters severally on demand for all reasonable out-of-pocket expenses (including reasonable fees and disbursements of counsel) that shall have been
incurred by them in connection with the proposed purchase and sale of the Designated Securities. 

        8.    Indemnification and Contribution.    

        (a)  The
Company agrees to indemnify and hold harmless each Underwriter, the directors, officers, employees and agents of each Underwriter and each person who controls any
Underwriter within the
meaning of either the Act or the Exchange Act against any and all losses, claims, damages or liabilities, joint or several, to which they or any of them may become subject under the Act, the Exchange
Act or other Federal or state statutory law or regulation, at common law or otherwise, insofar as such losses, claims, damages or liabilities (or actions in respect thereof) arise out of or are based
upon any untrue statement or alleged untrue statement of a material fact contained in the Preliminary Prospectus, any preliminary prospectus supplement, the Registration Statement or the Prospectus as
amended or supplemented, or in any amendment thereof or supplement thereto, or arise out of or are based upon the omission or alleged omission to state therein a material fact required to be stated
therein or necessary to make the statements therein not misleading, and agrees to reimburse each such indemnified party, as incurred, for any reasonable legal or other expenses reasonably incurred by
them in connection with investigating or defending any such loss, claim, damage, liability or action; provided, however, that the Company will not be liable in any such case to the extent that any
such loss, claim, damage or liability arises out of or is based upon any such untrue statement or alleged untrue statement or omission or alleged omission made in the Preliminary Prospectus, any
preliminary prospectus supplement, the Registration Statement and the Prospectus as amended or supplemented, in reliance upon and in conformity with written information furnished to the Company by or
on behalf of any 

16

 

Underwriters or the Representatives specifically for inclusion therein. This indemnity agreement will be in addition to any liability which the Company may otherwise have. 

        (b)  Each
Underwriter severally and not jointly agrees to indemnify and hold harmless the Company, each of its directors, each of its officers, and each person who controls
the Company within the meaning of either the Act or the Exchange Act, to the same extent as the foregoing indemnity from the Company to each Underwriter, but only with respect to losses, claims,
damages or liabilities that arise out of or are based on written information relating to such Underwriter furnished to the Company by or on behalf of such Underwriter through the Representatives
specifically for inclusion in the Preliminary Prospectus, any preliminary prospectus supplement, the Registration Statement or the Prospectus as amended or supplemented. This indemnity agreement will
be in addition to any liability which any Underwriter may otherwise have. 

        (c)  Promptly
after receipt by an indemnified party under this Section 8 of notice of the commencement of any action, such indemnified party will, if a claim in
respect thereof is to be made against the indemnifying party under this Section 8, notify the indemnifying party in writing of the commencement thereof; but the failure so to notify the
indemnifying party (i) will not relieve the indemnifying party from liability under paragraph (a) or (b) above except to the extent that such failure materially adversely affects
the ability of the indemnifying party to defend or assume the defense of such action; and (ii) will not, in any event, relieve the indemnifying party from any obligations to any indemnified
party other than the indemnification obligation provided in paragraph (a) or (b) above. The indemnifying party shall be entitled to appoint counsel of the indemnifying party's choice at
the indemnifying party's expense to represent the indemnified party in any action for which indemnification is sought (in which case the indemnifying party shall not thereafter be responsible for the
fees and expenses of any separate counsel retained by the indemnified party or parties except as set forth below); provided, however, that such counsel shall be reasonably satisfactory to the
indemnified party. Notwithstanding the indemnifying party's election to appoint counsel to represent the indemnified party in an action, the indemnified party shall have the right to employ separate
counsel (including local counsel) (which counsel shall be reasonably acceptable to the indemnifying party and shall not, except with the indemnifying party's consent, be counsel to the indemnifying
party) and the indemnifying party shall bear the reasonable
fees, costs and expenses of such separate counsel, subject to repayment to an indemnifying party if it is finally determined by a court of competent jurisdiction that such indemnified party is not
entitled to indemnification hereunder, if (i) named parties to any such action (including any impleaded parties) include both the indemnified party and the indemnifying party and the
indemnified party shall have been advised in writing by counsel, with a copy of such writing to the indemnifying party, that either (x) there may be one or more legal defenses available to such
indemnified party and/or other indemnified parties that are different from those available to the indemnifying party or (y) a conflict may exist between such indemnified party and the
indemnifying party; (ii) the indemnifying party shall not have employed counsel reasonably satisfactory to the indemnified party to represent the indemnified party within a reasonable time
after notice of the institution of such action; or (iii) the indemnifying party shall authorize in writing the indemnified party to employ separate counsel at the expense of the indemnifying
party; provided that with respect to clauses (i), (ii) and (iii), the indemnifying party shall not, in connection with any one such action or separate but substantially similar or related
actions in the same jurisdiction arising out of the same general allegations or circumstances, be liable for the fees, costs and expenses of more than one separate firm of attorneys (in addition to
any local counsel) for all of the indemnified parties. An indemnifying party shall not be liable for any settlement of any such action or proceeding effected without its written consent, which consent
may not be unreasonably withheld, but if settled with the written consent of the indemnifying party, the indemnifying party agrees to indemnify and hold harmless any indemnified person from and
against any loss or liability incurred in such settlement to the extent provided herein. An 

17

 

indemnifying party will not, without the prior written consent of the indemnified parties, which consent may not be unreasonably withheld, settle or compromise or consent to the entry of any judgment
with respect to any pending or threatened claim, action, suit or proceeding in respect of which indemnification or contribution may be sought hereunder (whether or not the indemnified parties are
actual or potential parties to such claim or action) unless such settlement, compromise or consent includes an unconditional release of each indemnified party from all liability arising out of such
claim, action, suit or proceeding. 

        (d)  In
the event that the indemnity provided in paragraph (a) or (b) of this Section 8 is finally determined by a court of competent jurisdiction to be
unavailable or insufficient to an indemnified party for any reason, the Company and the Underwriters agree to contribute to the aggregate losses, claims, damages and liabilities (including legal or
other expenses reasonably incurred in connection with investigating or defending same) (collectively "Losses") to which the Company and one or more of the Underwriters may be subject in such
proportion as is appropriate to reflect the relative benefits received by the Company on the one hand and by the Underwriters on the other from the offering of the Securities. If the allocation
provided by the immediately preceding sentence is unavailable for any reason, the Company and the Underwriters shall contribute in such proportion as is appropriate to reflect not only such relative
benefits but also the relative fault of the Company on the one hand and of the Underwriters on the other in connection with the actions, statements or omissions which resulted in such Losses, as well
as any other relevant equitable considerations. Benefits received by the Company shall be deemed to be equal to the total proceeds from the offering (net of the Underwriters' purchase discounts and
commissions but before deducting expenses) received by it, and benefits received by the Underwriters shall be deemed to be equal to the total purchase discounts and commissions in each case set forth
on the cover of the Prospectus. Relative fault shall be determined by reference to, among other things, whether the untrue or alleged untrue statement of a material fact or the omission or alleged
omission to state a material fact relates to information provided by the Company on the one hand or the Underwriters on the other, the intent of the parties and their relative knowledge, information
and opportunity to correct or prevent such untrue statement or omission. The Company and the Underwriters agree that it would not be just and equitable if contribution pursuant to this
paragraph (d) were determined by pro rata allocation or any other method of allocation which does not take account of the equitable considerations referred to above. Notwithstanding the
provisions of this paragraph (d), no person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Act) shall be entitled to contribution from any person who
was not guilty of such fraudulent misrepresentation. In no case shall any Underwriter (except as may be provided in any agreement among the Underwriters relating to the offering of the Securities) be
required to contribute in the aggregate, any amount in excess of the purchase discount or commission applicable to the Securities purchased by such Underwriter hereunder. For purposes of this
Section 8, each person who controls an Underwriter within the meaning of either the Act or the Exchange Act and each director, officer, employee and agent of an Underwriter shall have the same
rights to contribution as such Underwriter, and each person who controls the Company within the meaning of either the Act or the Exchange Act and each officer and director of the Company shall have
the same rights to contribution as the Company, subject in each case to the applicable terms and conditions of this paragraph (d). 

        9.    Default by an Underwriter.    If any one or more Underwriters shall fail to purchase and pay for any of the
Designated Securities agreed to be purchased by such Underwriter hereunder and under the terms of the Pricing Agreement relating to such Designated Securities and such failure to purchase shall
constitute a default in the performance of its or their obligations under this Agreement, the remaining Underwriters shall be obligated severally to take up and pay for (in the respective proportions
which the amount of the Designated Securities set forth opposite their names in Schedule I to the Pricing Agreement bears to the aggregate amount of the Designated Securities set forth opposite 

18

 

the names of all the remaining Underwriters) the Designated Securities which the defaulting Underwriter or Underwriters agreed but failed to purchase; provided, however, that in the event that the
aggregate amount of Designated Securities which the defaulting Underwriter or Underwriters agreed but failed to purchase shall exceed 10% of the aggregate amount of the Designated Securities set forth
in Schedule I to the Pricing Agreement, the remaining Underwriters shall have the right to purchase all, but shall not be under any obligation to purchase any, of the Designated Securities, and
if such nondefaulting Underwriters do not purchase all the Designated Securities, the Pricing Agreement will terminate without liability to any nondefaulting Underwriter or the Company. In the event
of a default by any Underwriter as set forth in this Section 9, the Time of Delivery shall be postponed for such period, not exceeding five Business Days, as the Representatives shall determine
in order that the required changes in the Prospectus, Registration Statement or in any other documents or arrangements may be effected. Nothing contained in this Agreement shall relieve any defaulting
Underwriter of its liability, if any, to the Company or any nondefaulting Underwriter for damages occasioned by its default hereunder. 

        10.    Termination.    This Agreement and each Pricing Agreement shall be subject to termination in the absolute
discretion of the Representatives, by notice given to the Company prior to delivery of and payment for the Designated Securities, if at any time prior to such time (i) trading in the Company's
common stock shall have been suspended by the Commission or the New York Stock Exchange or trading in securities generally on the New York Stock Exchange shall have been suspended or limited or
minimum prices shall have been established on such Exchange; (ii) a banking moratorium shall have been declared either by Federal or New York State authorities; (iii) a major disruption
of settlement of securities shall have occurred; or (iv) there shall have occurred after the date of the Pricing Agreement any attack on the United States, an outbreak or escalation of
hostilities or acts of terrorism involving the United States, any declaration by the United States of a national emergency or war, any change in United States or international financial, political or
economic conditions or currency exchange rates or
exchange controls or any other calamity or crisis the effect of which on financial markets is such as to make it, in the sole judgment of the Representatives, impracticable or inadvisable to proceed
with the offering or delivery of the Designated Securities as contemplated by the Prospectus (exclusive of any amendment or supplement thereto after the date of the Pricing Agreement). 

        11.    Representations and Indemnities to Survive.    The respective agreements, representations, warranties,
indemnities and other statements of the Company or its officers and of the Underwriters set forth in or made pursuant to this Agreement will remain in full force and effect, regardless of any
investigation made by or on behalf of the Underwriters or the Company or any of the officers, directors or controlling persons referred to in Section 8 hereof, and will survive delivery of and
payment for the Securities. The provisions of Sections 7 and 8 hereof shall survive the termination or cancellation of this Agreement and the Pricing Agreement. 

        12.    Representatives; Notices.    In all dealings hereunder, the Representatives of the Underwriters of Designated
Securities shall act on behalf of each of such Underwriters, and the parties hereto shall be entitled to act and rely upon any statement, request, notice or agreement on behalf of any Underwriter made
or given by such Representatives jointly or by such of the Representatives, if any, as may be designated for such purpose in the Pricing Agreement. All communications hereunder will be in writing and
effective only on receipt, and, if sent to the Representatives, will be mailed, delivered or telefaxed to the address of the Representatives as set forth in the Pricing Agreement; or, if sent to the
Company, will be mailed, delivered or telefaxed to its Treasurer (fax no. (805) 563-6943) and its General Counsel (fax no. (805) 563-7085) and confirmed to their
attention at 3820 State Street, Santa Barbara, California 93105. 

        13.    Successors.    This Agreement and each Pricing Agreement will inure to the benefit of and be binding upon the
parties hereto and their respective successors and the officers and directors and 

19

 

controlling persons referred to in Section 8 hereof, and no other person will have any right or obligation hereunder. 

        14.    Applicable Law.    This Agreement and each Pricing Agreement will be governed by and construed in accordance
with the laws of the State of New York applicable to contracts made and to be performed within the State of New York. 

        15.    Counterparts.    This Agreement and each Pricing Agreement may be executed in one or more counterparts, each of
which shall constitute an original and all of which together shall constitute one and the same instrument. 

        16.    Headings.    The section headings used herein are for convenience only and shall not affect the construction
hereof. 

        17.    Definitions.    The terms which follow, when used in this Agreement, shall have the meanings indicated. 

        "Affiliate"
shall have the meaning specified in Rule 501(b) of Regulation D under the Act. 

        "Business
Day" shall mean any day other than a Saturday, a Sunday or a legal holiday or a day on which banking institutions or trust companies are authorized or obligated by law to close
in The City of New York. 

20

        If the foregoing is in accordance with your understanding of our agreement, please sign and return to us the enclosed duplicate hereof, whereupon this Agreement and your acceptance shall
represent a binding agreement between the Company and the several Underwriters. 

	 	 	Very truly yours,

Tenet Healthcare Corporation
	

 	
 	

By:	

/s/  STEPHEN D. FARBER      
	 	 	 	

	 	 	 	Name:	Stephen D. Farber
	 	 	 	Title:	Senior Vice President & Treasurer
	 	 	 	 	 

Accepted as of the date hereof: 

	Credit Suisse First Boston Corporation

Salomon Smith Barney Inc.

Banc of America Securities LLC
	

By:	
 	

Credit Suisse First Boston Corporation
	

By:	
 	

/s/  GRANT F. LITTLE, III      
	 	 	

	 	 	Name:	 	Grant F. Little, III
	 	 	Title:	 	Managing Director
	 	 	 	 	 
	

By:	
 	

Salomon Smith Barney Inc.
	

By:	
 	

/s/  RICHARD LANDGARTEN      
	 	 	

	 	 	Name:	 	Richard Landgarten
	 	 	Title:	 	Managing Director

For themselves and the other several

Underwriters named in Schedule I to

the Pricing Agreement. 

 
 
 

Annex I    
  

 
 

Pricing Agreement

Credit
Suisse First Boston Corporation

Salomon Smith Barney Inc.

Banc of America Securities LLC,

    As Representatives of the several

    Underwriters named in Schedule I hereto,

c/o Salomon Smith Barney Inc.

    388 Greenwich Street

    New York, New York 10013 

March 4,
2002 

Ladies
and Gentlemen: 

        Tenet
Healthcare Corporation, a corporation organized under the laws of Nevada (the "Company"), proposes, subject to the terms and conditions stated herein and in the Underwriting
Agreement, dated March 4, 2002 (the "Underwriting Agreement"), between the Company on the one hand and Credit Suisse First Boston Corporation, Salomon Smith Barney Inc. and Banc of
America Securities LLC on the other hand, to issue and sell to the Underwriters named in Schedule I hereto (the "Underwriters") the Securities specified in Schedule II hereto (the
"Designated Securities"). Each of the provisions of the Underwriting Agreement is incorporated herein by reference in its entirety, and shall be deemed to be a part of this Agreement to the same
extent as if such provisions had been set forth in full herein; and each of the representations and warranties set forth therein shall be deemed to have been made at and as of the date of this Pricing
Agreement, except that each representation and warranty which refers to the Prospectus in Section 2 of the Underwriting Agreement shall be deemed to be a representation or warranty as of the
date of the Underwriting Agreement in relation to the Prospectus (as therein defined), and also a representation and warranty as of the date of this Pricing Agreement in relation to the Prospectus as
amended or supplemented relating to the Designated Securities which are the subject of this Pricing Agreement. Each reference to the Representatives herein and in the provisions of the Underwriting
Agreement so incorporated by reference shall be deemed to refer to you. Unless otherwise defined herein, terms defined in the Underwriting Agreement are used herein as therein defined. The
Representatives designated to act on behalf of the Representatives and on behalf of each of the Underwriters of the Designated Securities pursuant to Section 12 of the Underwriting Agreement
and the address of the Representatives referred to in such Section 12 are set forth at the end of Schedule II hereto. 

        An
amendment to the Registration Statement, or a supplement to the Prospectus, as the case may be, relating to the Designated Securities, in the form heretofore delivered to you is now
proposed to be filed with the Commission. 

        Subject
to the terms and conditions set forth herein and in the Underwriting Agreement incorporated herein by reference, the Company agrees to issue and sell to each of the Underwriters,
and each of the Underwriters agrees, severally and not jointly, to purchase from the Company, at the time and place and at the purchase price to the Underwriters set forth in Schedule II
hereto, the principal amount of Designated Securities set forth opposite the name of such Underwriter in Schedule I hereto. 

        If
the foregoing is in accordance with your understanding, please sign and return to us six counterparts hereof, and upon acceptance hereof by you, on behalf of each of the Underwriters,
this letter and such acceptance hereof, including the provisions of the Underwriting Agreement 

1

 

incorporated herein by reference, shall constitute a binding agreement between each of the Underwriters and the Company. It is understood that your acceptance of this letter on behalf of each of the
Underwriters is or will be pursuant to the authority set forth in a form of Agreement among
Underwriters, the form of which shall be submitted to the Company for examination upon request, but without warranty on the part of the Representatives as to the authority of the signers thereof. 

	 	 	Very truly yours,

TENET HEALTHCARE CORPORATION
	

 	
 	

By	

/s/  STEPHEN D. FARBER      
	 	 	 	

	 	 	 	Name:	Stephen D. Farber
	 	 	 	Title:	Senior Vice President & Treasurer
	 	 	 	 	 

Accepted as of the date hereof: 

	Credit Suisse First Boston Corporation

Salomon Smith Barney Inc.

Banc of America Securities LLC
	

By:	
 	

Credit Suisse First Boston Corporation
	

By	
 	

/s/  GRANT F. LITTLE, III      
	 	 	

	 	 	Name:	 	Grant F. Little, III
	 	 	Title:	 	Managing Director
	 	 	 	 	 
	

By:	
 	

Salomon Smith Barney Inc.
	

By	
 	

/s/  RICHARD LANDGARTEN      
	 	 	

	 	 	Name:	 	Richard Landgarten
	 	 	Title:	 	Managing Director

For themselves and the other several

Underwriters named in Schedule I hereto. 

2

 
 
 

SCHEDULE I    
  

	Underwriter
 
	 	Principal

Amount of

Designated

Securities

To be

Purchased

	Credit Suisse First Boston Corporation	 	$	180,000,000
	Salomon Smith Barney Inc.	 	 	180,000,000
	Banc of America Securities LLC	 	 	120,000,000
	Fleet Securities, Inc.	 	 	12,000,000
	First Union Securities, Inc.	 	 	12,000,000
	J.P. Morgan Securities Inc.	 	 	12,000,000
	Merrill Lynch, Pierce, Fenner & Smith Incorporated	 	 	12,000,000
	Morgan Stanley & Co. Incorporated	 	 	12,000,000
	Mizuho International plc	 	 	12,000,000
	PNC Capital Markets, Inc.	 	 	12,000,000
	Scotia Capital (USA) Inc.	 	 	12,000,000
	SunTrust Capital Markets, Inc.	 	 	12,000,000
	UBS Warburg LLC	 	 	12,000,000
	 	 	

	 	Total	 	$	600,000,000
	 	 	

3

 
 
 

SCHEDULE II    
  

Title of Designated Securities:  

61/2%
Senior Notes due 2012. 

Aggregate principal amount:  

$600,000,000. 

Price to Public:  

99.175%
of the principal amount of the Designated Securities, plus accrued interest from March 7, 2002 to the date of delivery. 

Purchase Price by Underwriters:  

98.525%
of the principal amount of the Designated Securities, plus accrued interest from March 7, 2002 to the date of delivery. 

Form of Designated Securities:  

Book-entry
only form represented by one or more global securities deposited with The Depository Trust Company ("DTC") or its designated custodian, to be made available for checking by the
Representatives at least twenty-four hours prior to the Time of Delivery at the office of DTC. 

Specified funds for payment of purchase price:  

Same
day funds. 

Time of Delivery:  

March 7,
2002. 

Indenture:  

Indenture,
dated November 6, 2001, as amended, between the Company and Bank of New York, as Trustee. 

Fourth
Supplemental Indenture, dated March 7, 2002, between the Company and Bank of New York, as Trustee. 

Maturity:  

June 1,
2012. 

Interest Rate:  

61/2%. 

Interest Payment Dates:  

Payable
semi-annually on June 1 and December 1 of each year, commencing June 1, 2002. 

4

 

Redemption Provisions:  

The
Notes are subject to redemption, in whole or in part, at any time, at the election of the Company upon not less than 30 nor more than 60 days' notice at a Redemption Price equal to the
Make-Whole Price. 

"Make-Whole
Price" means an amount equal to the greater of (i) 100% of the principal amount of the Notes being redeemed and (ii) the sum of the present values of the
remaining scheduled payments of principal and interest thereon (excluding accrued and unpaid interest to the Redemption Date) discounted to the Redemption Date on a semiannual basis (assuming a
360-day year consisting of twelve 30-day months) at the Adjusted Treasury Rate (as defined herein) plus 0.30%, plus, in each of cases (i) and (ii), accrued and unpaid
interest thereon to the Redemption Date. 

"Adjusted
Treasury Rate" means, with respect to any Redemption Date: (i) the yield, under the heading that represents the average for the immediately preceding week, appearing in the most
recently published statistical release designated "H.15(519)" or any successor publication that is published weekly by the Board of Governors of the Federal Reserve System and that establishes yields
on actively traded United States Treasury securities adjusted to constant maturity under the caption "Treasury Constant Maturities," for the maturity corresponding to the Comparable Treasury Issue (if
no maturity is within three months before or after the Remaining Life, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue shall be determined and the
adjusted Treasury Rate shall be interpolated or extrapolated from such yields on a straight line basis, rounded to the nearest month); or (ii) if such release (or any successor release) is not
published during the week preceding the calculation date or does not contain such yields, the rate per annum equal to the semi-annual equivalent yield to maturity of the Comparable
Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage of its principal amount) equal to the Comparable Treasury Price for such Redemption Date. The
Adjusted Treasury Rate shall be calculated on the third business day preceding the Redemption Date. 

"Comparable
Treasury Issue" means the United States Treasury security selected by an Independent Investment Banker as having a maturity comparable to the remaining term of the Notes to be redeemed
that would be utilized, at the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable maturity to the remaining term of
the Notes (the "Remaining Life"). 

"Comparable
Treasury Price" means, with respect to any Redemption Date, (i) the average of the Reference Treasury Dealer Quotations for such Redemption Date, after excluding the highest and
lowest Reference Treasury Dealer Quotations, or (ii) if the Independent Investment Banker obtains fewer than five such Reference Treasury Dealer Quotations, the average of all such quotations. 

"Independent
Investment Banker" means one of the Reference Treasury Dealers appointed by the Company. 

"Reference
Treasury Dealer" means (i) each of Credit Suisse First Boston Corporation, Salomon Smith Barney Inc. and Banc of America Securities LLC and their respective successors;
provided that if any of the foregoing ceases to be a primary U.S. Government securities dealer in New York City (a "Primary Treasury Dealer"), the Company will substitute therefor another Primary
Treasury Dealer, and (ii) any other Primary Treasury Dealer selected by the Company. 

"Reference
Treasury Dealer Quotations" means, with respect to each Reference Treasury Dealer and any redemption date, the average, as determined by the Independent Investment Banker, of the bid and
asked prices for the Comparable Treasury Issue (expressed in each case as a 

5

 

percentage of its principal amount) quoted in writing to the Independent Investment Banker by such Reference Treasury Dealer at 5:00 p.m., New York City time, on the third Business Day
preceding such Redemption Date. 

In
the event of redemption of this Note in part only, a new Note or Notes of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the Holder hereof upon the
cancellation hereof. 

Sinking Fund Provisions:  

No
sinking fund provisions. 

Defeasance provisions:  

The
Notes shall be subject to the defeasance and discharge provisions of Section 1302 of the Indenture and the defeasance of certain obligations and certain events of default provisions of
Section 1303 of the Indenture. 

Closing location:  

Sullivan &
Cromwell

1888 Century Park East, Suite 2100

Los Angeles, CA 90067 

Names and addresses of Representatives:  

	 	 	Designated Representatives:	 	Salomon Smith Barney Inc.

Credit Suisse First Boston Corporation

Banc of America Securities LLC
	 	 	 	 	 
	 	 	Address for Notices, etc.:	 	Salomon Smith Barney Inc.

388 Greenwich Street

New York, New York 10013
	 	 	 	 	 
	 	 	 	 	Credit Suisse First Boston Corporation

11 Madison Avenue

New York, New York 10010
	 	 	 	 	 
	 	 	 	 	Banc of America Securities LLC

9 West 57th Street

New York, New York 10019

Other Terms:  

        For purposes of Section 8 of the Underwriting Agreement, the only information furnished to the Company by or on behalf of the Underwriters through the
Representatives specifically for inclusion in
the Prospectus Supplement is (i) the last paragraph on the cover page of the Prospectus Supplement regarding the delivery of the Designated Securities and (ii) the fourth, seventh,
eighth and ninth paragraphs under the caption "Underwriting" in the Prospectus Supplement. 

6

QuickLinks

TENET HEALTHCARE CORPORATION DEBT SECURITIES UNDERWRITING AGREEMENT

Annex I

Pricing Agreement

SCHEDULE I

SCHEDULE IIQuickLinks
 -- Click here to rapidly navigate through this document

 
 

Exhibit 4.3    
  

TENET
HEALTHCARE CORPORATION 

Fourth Supplemental  

 Indenture  

Dated as of March 7, 2002  

 (Supplemental to Indenture Dated as of November 6, 2001)  

 THE BANK OF NEW YORK,

as Trustee

 

        FOURTH SUPPLEMENTAL INDENTURE, dated as of March 7, 2002, between Tenet Healthcare Corporation, a corporation duly organized and existing under the laws of the State of Nevada
(herein called the "Company"), and The Bank of New York, a New York banking corporation, as Trustee (herein called "Trustee"); 

R E C I T A L S:  

        WHEREAS, the Company has heretofore executed and delivered to The Bank of New York, as trustee, an Indenture, dated as of November 6, 2001 (the "Existing
Indenture", and the Existing Indenture, as the same may be amended or supplemented from time to time, including by this Fourth Supplemental Indenture, the "Indenture"), providing for the issuance from
time to time of the Company's unsecured debentures, notes or other evidences of indebtedness (herein and therein called the "Securities"), to be issued in one or more series as provided in the
Indenture; 

        WHEREAS,
Section 901 of the Existing Indenture permits the Company and the Trustee to enter into an indenture supplemental to the Existing Indenture to provide for the issuance of
and establish the form and terms and conditions of any additional series of Securities; 

        WHEREAS,
Sections 201, 301 and 901 of the Existing Indenture permit the form of notes of each additional series of notes to be established pursuant to an indenture supplemental to the
Existing Indenture; 

        WHEREAS,
Section 301 of the Existing Indenture permits certain terms of any additional series of notes to be established pursuant to an indenture supplemental to the Existing
Indenture; and 

        WHEREAS,
pursuant to resolutions of the Board of Directors of the Company adopted at a meeting duly called on December 5, 2001, the Company is authorized to issue up to
$2,000,000,000 aggregate principal amount of Securities in one or more series of Securities; 

        WHEREAS,
in accordance with such resolutions, the Company has authorized the issuance of $600,000,000 aggregate principal amount of 61/2% Senior Notes due 2012 (the
"Notes"); 

        WHEREAS,
the Company has duly authorized the execution and delivery of this Fourth Supplemental Indenture to establish the form and terms of the Notes; 

        WHEREAS,
all things necessary to make this Fourth Supplemental Indenture a valid agreement according to its terms have been done; and 

        WHEREAS,
the foregoing recitals are made as statements of fact by the Company and not by the Trustee; 

        NOW,
THEREFORE, THIS FOURTH SUPPLEMENTAL INDENTURE WITNESSETH: 

        For
and in consideration of the premises and the issuance of the Notes provided for herein, it is mutually agreed, for the equal and proportionate benefit of all Holders of the Notes, as
follows: 

ARTICLE ONE

DEFINITIONS AND OTHER PROVISIONS

OF GENERAL APPLICATION  

Section 1.1.    Relation to Existing Indenture  

        This Fourth Supplemental Indenture constitutes an integral part of the Existing Indenture (the provisions of which, as modified by this Fourth Supplemental
Indenture, shall apply to the Notes) in respect of the Notes but shall not modify, amend or otherwise affect the Existing Indenture insofar as it relates to any other series of Securities or affect in
any manner the terms and conditions of the Securities of any other series. 

1

 

Section 1.2.    Definitions  

        For all purposes of this Fourth Supplemental Indenture, the capitalized terms used herein (i) which are defined in this Section 1.2 have the
respective meanings assigned thereto in this Section 1.2, and (ii) which are defined in the Existing Indenture (and which are not defined in this Section 1.2) have the
respective meanings assigned thereto in the Existing Indenture. For all purposes of this Fourth Supplemental Indenture: 

        1.2.1  All
references herein to Articles and Sections, unless otherwise specified, refer to the corresponding Articles and Sections of this Fourth Supplemental
Indenture; 

        1.2.2  The
terms "hereof", "herein", "hereby", "hereto", "hereunder" and "herewith" refer to this Fourth Supplemental Indenture; and 

        1.2.3  The
following terms, as used herein, have the following meanings: 

        "Adjusted
Treasury Rate" has the meaning specified in the form of Note contained in Section 2.3. 

        "Affiliated
Entity" has the meaning specified under the definition of "Subsidiary" in this Section 1.2.3. 

        "Attributable
Debt" when used in connection with a Sale and Lease-Back Transaction, means, as of the date of determination, (i) as to any capitalized lease
obligations, the liability related thereto set forth on the consolidated balance sheet of the Company and (ii) as to any operating lease, the present value (discounted at the rate per annum
equal to the rate of interest set forth or implicit in the term of the lease, as determined in good faith by the Board of Directors of the Company) of the total obligation of the lessee for net rental
payments during the remaining term of the lease (including any period for which an option to extend such lease has been exercised). 

        "Code"
means the Internal Revenue Code of 1986, as amended and as in effect on the date hereof. 

        "Comparable
Treasury Issue" has the meaning specified in the form of Note contained in Section 2.3. 

        "Comparable
Treasury Price" has the meaning specified in the form of Note contained in Section 2.3. 

        "Depositary"
means The Depository Trust Company, its nominees and their respective successors. 

        "Global
Note" means any Note bearing the legend specified in Section 2.2 evidencing all or part of the Notes, issued to the Depositary or its nominee and registered in the name of
the Depositary. 

        "Independent
Investment Banker" has the meaning specified in the form of Note contained in Section 2.3. 

        "Interest
Payment Date" has the meaning specified in the form of Note contained in Section 2.2. 

        "Liens"
means liens, mortgages, pledges, charges, security interests or other encumbrances. 

        "Make-Whole
Price" has the meaning specified in the form of Note contained in Section 2.3. 

        "Primary
Treasury Dealer" has the meaning specified in the form of Note contained in Section 2.3. 

        "Principal
Property" means each hospital owned solely by the Company and/or one or more of its Subsidiaries which has an asset value shown on the books of the Company in excess of 5% of
the Consolidated Net Tangible Assets of the Company. 

        "Reference
Treasury Dealer" has the meaning specified in the form of Note contained in Section 2.3. 

2

 

        "Reference
Treasury Dealer Quotations" has the meaning specified in the form of Note contained in Section 2.3. 

        "Remaining
Life" has the meaning specified in the form of Note contained in Section 2.3. 

        "Sale
and Lease-Back Transactions" has the meaning specified in Section 3.2. 

        "Securities"
has the meaning ascribed to it in the first paragraph under the caption "Recitals." 

        "Successor
Security" of any particular Security means every Security issued after, and evidencing all or a portion of the same debt as that evidenced by, such particular Security; and,
for the purposes of this definition, any Security authenticated and delivered under Section 306 in exchange for or in lieu of a mutilated, destroyed, lost or stolen Security shall be deemed to
evidence the same debt as the mutilated, destroyed, lost or stolen Security. 

ARTICLE TWO

GENERAL TERMS AND CONDITIONS OF THE NOTES  

Section 2.1.    Forms of Notes Generally  

        The Notes shall be in substantially the forms set forth in this Article with such appropriate insertions, omissions, substitutions and other variations as are
required or permitted by the Indenture, and may have such letters, numbers or other marks of identification and such legends or endorsements placed thereon as may be required to comply with the rules
of any securities exchange or Depositary thereof, the Code and regulations thereunder, or as may, consistently herewith, be determined by the officers executing such Notes, as evidenced by their
execution thereof. The Trustee's certificates of authentication shall be in substantially the form set forth in Section 2.4. 

        The
definitive Notes shall be printed, lithographed or engraved or produced by any combination of these methods on steel engraved borders or may be produced in any other manner permitted
by the rules of any securities exchange on which the Notes may be listed, all as determined by the officers executing such Notes, as evidenced by their execution thereof. 

        In
certain cases described elsewhere herein, the legends set forth in the first three paragraphs of Section 2.2 may be omitted from Notes issued hereunder. 

        The
Notes will be issued only in registered form. The Notes will be issued in minimum denominations of $1,000. 

Section 2.2.    Form of Face of the Notes  

        [INCLUDE IF NOTE IS A GLOBAL NOTE—THIS NOTE IS A GLOBAL NOTE WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS NOTE MAY NOT BE EXCHANGED IN WHOLE OR IN PART FOR A NOTE REGISTERED, AND NO TRANSFER OF THIS
NOTE IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE.] 

        [INCLUDE IF NOTE IS A GLOBAL NOTE AND THE DEPOSITORY TRUST COMPANY IS THE DEPOSITARY—UNLESS THIS CERTIFICATE IS
PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY ("DTC"), A NEW YORK CORPORATION, TO THE COMPANY OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY
CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. 

3

 

OR TO SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE
REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. 

        THIS
SECURITY MAY NOT BE EXCHANGEABLE IN WHOLE OR IN PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SECURITY IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON
OTHER THAN SUCH DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE.] 

4

 
TENET HEALTHCARE CORPORATION

___% SENIOR NOTES DUE 2012 

No.
__________

CUSIP No.: 88033G AW 0 $ 

        TENET
HEALTHCARE CORPORATION, a corporation duly organized and existing under the laws of Nevada (herein called the "Company," which term includes any successor Person under the
Indenture referred to on the reverse hereof), for value received, hereby promises to pay to                        , or registered
assigns, the principal sum of                        Dollars,
[include if Global Note—or such other amount (not to exceed Six Hundred Million Dollars (U.S. $600,000,000) when taken together
with all of the Company's    % Senior Notes due 2012 issued and outstanding in definitive certificated form or in the form of another Global Note) as may from time to time represent the
principal amount of the Company's    % Senior Notes due 2012 in respect of which beneficial interests are held through the Depositary in the form of a Global Note,] on
June 1, 2012, and to pay interest thereon from March 7, 2002, or from the most recent Interest Payment Date (as defined below) to which interest has been paid or duly provided for,
semi-annually in arrears on June 1 and December 1 in each year (each such date, an "Interest Payment Date"), commencing on June 1, 2002, until the principal hereof is
paid or made available for payment. The interest so payable, and punctually paid or duly provided for, on any Interest Payment Date will, as provided in such Indenture, be paid to the Person in whose
name this Note (or one or more Predecessor Notes) is registered at the close of business on the Regular Record Date for such interest, which shall be the May 15 or November 15 (whether
or not a Business Day), as the case may be, next preceding such Interest Payment Date. Any such interest not so punctually paid or duly provided for will forthwith cease to be payable to the Holder on
such Regular Record Date and may either be paid to the Person in whose name this Note (or one or more Predecessor Notes) is registered at the close of business on a Special Record Date for the payment
of such Defaulted Interest to be fixed by the Trustee, notice whereof shall be given to Holders of Notes not less than 10 days prior to such Special Record Date, or be paid at any time in any
other lawful manner not inconsistent with the requirements of any securities exchange on which the Notes may be listed, and upon such notice as may be required by such exchange, all as more fully
provided in said Indenture. 

        Interest
shall be computed on the basis of a 360-day year comprised of twelve 30-day months. 

        In
the event that an Interest Payment Date is not a Business Day, the Company shall pay interest on the next day that is a Business Day, with the same force and effect as if made on the
Interest Payment Date, and without any interest or other payment with respect to the delay. If the Stated Maturity or earlier Redemption Date falls on a day that is not a Business Day, the payment of
principal and interest, if any, need not be made on such date, but may be made on the next succeeding Business Day, with the same force and effect as if made on the Stated Maturity or earlier
Redemption Date, provided that no interest shall accrue for the period from and after such Stated Maturity or earlier Redemption Date. 

        Payment
of the principal of this Note, any premium and any interest due at Stated Maturity will be made in immediately available funds upon surrender at the office or agency of the
Paying Agent, as defined on the reverse hereof, maintained for that purpose within the City and State of New York, or at such other paying agency as the Company may determine. Payments of interest,
other than interest due at Stated Maturity, may at the Company's option be made by check mailed to the address of the Person entitled thereto as such address shall appear in the Securities Register.
Holders who have given wire instructions to the Paying Agent will be entitled to receive payments of interest, other than interest due at Stated Maturity, by wire transfer of immediately available
funds if appropriate wire transfer instructions have been received by the Paying Agent in writing earlier than the relevant Record Date. 

5

 

        Reference
is hereby made to the further provisions of this Note set forth on the reverse hereof, which further provisions shall for all purposes have the same effect as if set forth at
this place. 

        Unless
the certificate of authentication hereon has been executed by the Trustee referred to on the reverse hereof by the manual signature of one of its authorized signatories, this Note
shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 

        IN
WITNESS WHEREOF, the Company has caused this instrument to be duly executed. 

Dated:

	

 	
 	

TENET HEALTHCARE CORPORATION
	

 	
 	

By	

 
	 	 	 	

6

 

Section 2.3.    Form of Reverse of the Notes  

        This Note is one of a duly authorized issue of securities of the Company (herein called the "Notes"), issued and to be issued in one or more series under an
Indenture, dated as of November 6, 2001, as supplemented by the Fourth Supplemental Indenture (the "Fourth Supplemental Indenture"), dated as of March 7, 2002 (as so supplemented, the
"Indenture", which term shall have the meaning assigned to it in such instrument), between the Company and The Bank of New York, as Trustee (herein called the "Trustee", which term includes any
successor trustee under the Indenture), and reference is hereby made to the Indenture for a statement of the respective rights, limitations of rights, duties and
immunities thereunder of the Company, the Trustee and the Holders of the Notes and of the terms upon which the Notes are, and are to be, authenticated and delivered. This Note is one of the series
designated on the face hereof. The Company has appointed The Bank of New York at its corporate trust office in New York, New York as the paying agent (herein called the "Paying Agent", which term
includes any additional or successor Paying Agent appointed by the Company) with respect to the Notes. 

        The
Notes are subject to redemption, in whole or in part, at any time, at the election of the Company upon not less than 30 nor more than 60 days' notice at a Redemption Price
equal to the Make-Whole Price. 

        "Make-Whole
Price" means an amount equal to the greater of (i) 100% of the principal amount of the Notes being redeemed and (ii) the sum of the present values
of the remaining scheduled payments of principal and interest thereon (excluding accrued and unpaid interest to the Redemption Date) discounted to the Redemption Date on a semiannual basis (assuming a
360-day year consisting of twelve 30-day months) at the Adjusted Treasury Rate (as defined herein) plus 0.3%, plus, in each of cases (i) and (ii), accrued and unpaid
interest thereon to the Redemption Date. 

        "Adjusted
Treasury Rate" means, with respect to any Redemption Date: (i) the yield, under the heading that represents the average for the immediately preceding week, appearing in
the most recently published statistical release designated "H.15(519)" or any successor publication that is published weekly by the Board of Governors of the Federal Reserve System and that
establishes yields on actively traded United States Treasury securities adjusted to constant maturity under the caption "Treasury Constant Maturities," for the maturity corresponding to the Comparable
Treasury Issue (if no maturity is within three months before or after the Remaining Life, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue shall be
determined and the adjusted Treasury Rate shall be interpolated or extrapolated from such yields on a straight line basis, rounded to the nearest month); or (ii) if such release (or any
successor release) is not published during the week preceding the calculation date or does not contain such yields, the rate per annum equal to the semi-annual equivalent yield to maturity
of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage of its principal amount) equal to the Comparable Treasury Price for such
Redemption Date. The Adjusted Treasury Rate shall be calculated on the third business day preceding the Redemption Date. 

7

   
        "Comparable Treasury Issue" means the United States Treasury security selected by an Independent Investment Banker as having a maturity comparable to the remaining term of the Notes to
be redeemed that would be utilized, at the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable maturity to the
remaining term of the Notes (the "Remaining Life"). 

        "Comparable
Treasury Price" means, with respect to any Redemption Date, (i) the average of the Reference Treasury Dealer Quotations for such Redemption Date, after excluding the
highest and lowest Reference Treasury Dealer Quotations, or (ii) if the Independent Investment Banker obtains fewer than five such Reference Treasury Dealer Quotations, the average of all such
quotations. 

        "Independent
Investment Banker" means one of the Reference Treasury Dealers appointed by the Company. 

        "Reference
Treasury Dealer" means (i) each of Credit Suisse First Boston Corporation, Salomon Smith Barney Inc. and Banc of America Securities LLC and their respective
successors; provided that if any of the foregoing ceases to be a primary U.S. Government securities dealer in New York City (a "Primary Treasury Dealer"), the Company will substitute therefor another
Primary Treasury Dealer, and (ii) any other Primary Treasury Dealer selected by the Company. 

        "Reference
Treasury Dealer Quotations" means, with respect to each Reference Treasury Dealer and any redemption date, the average, as determined by the Independent Investment Banker, of
the bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted in writing to the Independent Investment Banker by such Reference
Treasury Dealer at 5:00 p.m., New York City time, on the third Business Day preceding such Redemption Date. 

        In
the event of redemption of this Note in part only, a new Note or Notes of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the Holder
hereof upon the cancellation hereof. 

        This
Note does not have the benefit of any sinking fund obligations. 

        The
Indenture contains provisions for defeasance at any time of the entire indebtedness of this Note or certain restrictive covenants and Events of Default with respect to this Note, in
each case upon compliance with certain conditions set forth in the Indenture. 

        If
an Event of Default with respect to Notes of this series shall occur and be continuing, the principal of the Notes of this series may be declared due and payable in the manner and
with the effect provided in the Indenture. 

        The
Notes are entitled to the benefits of the covenants of the Company set forth in Article Ten of the Indenture and Article Three of the Fourth Supplemental Indenture. 

        This
Note is a Global Note and shall be exchangeable for Notes registered in the names of Persons other than the Depositary or its nominee only if (i) the Depositary notifies the
Company that it is unwilling or unable to continue as Depositary for this Global Note or if at any time such Depositary ceases to be a clearing agency registered as such under the Securities Exchange
Act of 1934, as amended, at a time when such Depositary is required to be so registered in order to act as Depositary, and the Company fails to appoint a successor Depositary under the Indenture,
(ii) the Company executes and delivers to the Trustee a Company Order that the Global Note shall be so exchangeable, or (iii) there shall have occurred and be continuing an Event of
Default with respect to the Notes. To the extent that the Global Note is exchangeable pursuant to the preceding sentence, it shall be exchangeable for Notes registered in such names as the Depositary
may direct. In the event of a deposit or withdrawal of an interest in this Note (including upon an exchange, transfer, redemption or repurchase of this Note in part only) effected in accordance with
the Applicable Procedures, the Security Registrar, upon receipt of notice of such event from the Depositary's custodian for this Note, shall make an adjustment on its records to reflect an increase or
decrease of the Outstanding principal amount of Notes of this series resulting from such deposit or withdrawal, as the case may be. 

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        The
Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification of the rights and obligations of the Company and the rights of the Holders
of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a majority in principal amount of the Securities at
the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of specified percentages in principal amount of the Securities at the time
Outstanding, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with certain provisions of the Indenture and certain past defaults under the Indenture and
their consequences. Any such consent or waiver by the Holder of this Note shall be conclusive and binding upon such Holder and upon all future Holders of this Note and of any Note issued upon the
registration of transfer hereof or in exchange hereof or in lieu hereof, whether or not notation of such consent or waiver is made upon this Note. 

        As
provided in and subject to the provisions of the Indenture, the Holder of this Note shall not have the right to institute any proceeding with respect to the Indenture or for the
appointment of a receiver
or trustee or for any other remedy thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default with respect to the Notes of this series, the
Holders of not less than 25% in principal amount of the Notes of this series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event of
Default as Trustee and offered the Trustee reasonable indemnity, and the Trustee shall not have received from the Holders of a majority in principal amount of Notes of this series at the time
Outstanding a direction inconsistent with such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The
foregoing shall not apply to any suit instituted by the Holder of this Note for the enforcement of any payment of principal hereof or any premium or interest hereon on or after the respective due
dates expressed herein. 

        No
reference herein to the Indenture and no provision of this Note or of the Indenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay
the principal of (and premium, if any) and interest on this Note at the times, place and rate, and in the coin or currency, herein prescribed. 

        As
provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Note is registrable in the Security Register, upon surrender of this Note for
registration of transfer at the office or agency of the Company in any place where the principal of and any premium and interest on this Note are payable, duly endorsed by, or accompanied by a written
instrument of transfer in form satisfactory to the Company and the Security Registrar duly executed by, the Holder hereof or his attorney duly authorized in writing, and thereupon one or more new
Notes of this series and of like tenor, of authorized denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 

        The
Notes of this series are issuable only in fully registered form without coupons in denominations of $1,000 and any integral multiple thereof. As provided in the Indenture and subject
to certain limitations therein set forth, the Notes of this series are exchangeable for a like aggregate principal amount of Notes of this series and of like tenor of a different authorized
denomination, as requested by the Holder surrendering the same. 

        No
service charge shall be made for any such registration of transfer or exchange, but the Company may require payment of a sum sufficient to cover any tax or other governmental charge
payable in connection therewith. 

        Prior
to due presentment of this Note for registration of transfer, the Company, the Trustee and any agent of the Company or the Trustee may treat the Person in whose name this Note is
registered as the owner hereof for all purposes, whether or not this Note be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 

9

 

        All
terms used in this Note which are defined in the Indenture shall have the meanings assigned to them in the Indenture. 

        The Indenture and this Note shall be governed by and construed in accordance with the laws of the State of New York, without regard to conflicts of laws
principles thereof.

Section 2.4.    Form of Trustee's Certificate of Authentication of the Notes  

        The Trustee's certificates of authentication shall be in substantially the following form: 

        This
is one of the Notes of the series designated therein referred to in the within-mentioned Indenture. 

        Dated: 

	

 	
 	

THE BANK OF NEW YORK, as Trustee	
 	

 
	

 	
 	

By	

 	
 	

 
	 	 	 	
 Authorized Signatory	 	 
	 	 	 	 	 	 

Section 2.5.    Title and Terms  

        The Notes shall be issued in one series and shall be known and designated as the "61/2% Senior Notes due 2012" of the Company. The aggregate
principal amount of the Notes that may initially be authenticated and delivered under this Fourth Supplemental Indenture is limited to $600,000,000, except for Notes authenticated and delivered upon
registration of transfer of, or in exchange for, or in lieu of, other Notes pursuant to Section 304, 305, 306 or 906 of the Existing Indenture or Article Two of this Fourth Supplemental
Indenture. The Company may, without the consent of the Holders of the Notes, issue additional notes having the same ranking, interest rate, Stated Maturity, CUSIP number and terms as to status,
redemption or otherwise as the Notes, in which event such notes and the Notes shall constitute one series for all purposes under the Indenture, including without limitation, amendments, waivers and
redemptions. 

        The
Stated Maturity of the Notes shall be June 1, 2012, and they shall bear interest and have such other terms as are described in Sections 2.2 and 2.3 of this Fourth Supplemental
Indenture. 

        The
Company shall have no obligation to redeem or purchase the Notes pursuant to any sinking fund or analogous provision, or at the option of a Holder thereof. The Notes shall be
redeemable at the election of the Company, as a whole or from time to time in part at the times and at the prices specified in the form of Note set forth in Section 2.3 of this Fourth
Supplemental Indenture. 

        The
Notes shall be subject to the defeasance and discharge provisions of Section 1302 of the Existing Indenture and the defeasance of certain obligations and certain events of
default provisions of Section 1303 of the Existing Indenture. 

        Upon
their original issuance, the Notes shall be issued in the form of one or more Global Notes, as provided in this Fourth Supplemental Indenture, registered in the name of The
Depository Trust Company, as Depositary, or its nominee and deposited with the Trustee, as custodian for The Depository Trust Company, for credit by The Depository Trust Company to the respective
accounts of beneficial owners of the Notes represented thereby (or such other accounts as they may direct). The Global Notes shall bear the legends provided for in the form of Note contained in
Section 2.2 of this Fourth Supplemental Indenture and may be exchanged in whole or in part for Notes registered, and transfers of Global Notes in whole or in part may be registered, in the name
or names of Persons other than the Depositary only as set forth herein and in the Indenture. 

10

 

        The
Notes shall have the benefit of the covenants set forth in Article Three of this Fourth Supplemental Indenture, in addition to the covenants set forth in Article Ten of the Existing
Indenture. 

        The
Notes shall be issuable only in registered form without coupons and only in denominations of $1,000 and integral multiples thereof. 

        The
Notes shall be executed, authenticated, delivered and dated in accordance with Section 303 of the Existing Indenture. 

ARTICLE THREE

COVENANTS  

Section 3.1.    Limitations on Liens  

        Nothing in this Indenture or in the Notes shall in any way restrict or prevent the Company or any Subsidiary from incurring any debt; provided that the Company
covenants and agrees that neither it nor any Subsidiary will issue, incur, create, assume or guarantee any debt secured by Liens upon any Principal Property, without effectively providing that the
Notes then Outstanding and thereafter created (together with, if the Company so determines, any other debt then existing and any other debt thereafter created ranking equally with the Notes) shall be
secured equally and ratably with, or prior to, such debt as long as such debt shall be so secured, except that the foregoing provisions shall not apply to: 

        (a)(i)Liens
securing all or any part of the purchase price or the cost of construction of property acquired or constructed by the Company or a Subsidiary, provided such
debt and related Lien are incurred within 12 months after acquisition, or completion of construction and full operation, whichever is later; 

        (ii)  Liens
on property owned by the Company or a Subsidiary securing all or any part of the purchase price or the cost of construction of additions, substantial repairs or
alterations or substantial improvements to such property, provided such debt and related Lien are incurred within 12 months after the completion of such construction, additions, repairs,
alterations or improvements; 

        (b)  Liens
existing on property at the time of acquisition of such property by the Company or a Subsidiary or on the property of an entity at the time of the acquisition of
such entity by the Company or a Subsidiary (including acquisitions through merger or consolidation), provided that such Liens were in existence prior to
the closing of, and not incurred in contemplation of, such acquisition and, in the case of the acquisition of an entity, the Liens do not extend to any assets other than those of the entity acquired; 

        (c)  In
the case of a Consolidated Subsidiary, Liens in favor of the Company or another Consolidated Subsidiary; 

        (d)  Liens
existing on the date of this Fourth Supplemental Indenture; 

        (e)  Liens
in favor of a government or governmental entity that: 

        (i)    secure
debt that is guaranteed by the government or governmental entity, or 

        (ii)  secure
debt incurred to finance all or some of the purchase price or cost of construction of goods, products or facilities produced under contract or subcontract for
the government or governmental entity; 

        (f)    Liens
arising in connection with the transfer of tax benefits in accordance with Section 168(f)(8) of the Code (or any similar provision of law from time to time
in effect); provided, that such Liens (i) are incurred within 90 days (or any longer period, not in excess of one year, as any such provision of law may from time to time permit) after
the acquisition of the property or equipment subject to said Lien, (ii) do not extend to any other property or equipment, 

11

 

and (iii) are solely for the purpose of said transfer of tax benefits or otherwise permitted by this Section 3.1; 

        (g)  Liens
created in substitution of or as replacements for any Liens permitted by clauses (a) to (f) set forth herein, provided that, based on a good faith
determination of the Board of Directors of the Company, the property encumbered by any substitute or replacement Lien is substantially similar in nature to and no greater in value than the property
encumbered by the otherwise permitted Lien that is being replaced; and 

        (h)  Any
extension, renewal or replacement (or successive extensions, renewals or replacements), in whole or in part, of any Lien referred to in the foregoing clauses
(a) to (g) inclusive or of any debt secured thereby; provided that the principal amount of debt secured thereby shall not exceed the principal amount of debt so secured at the time of
such extension, renewal or replacement, and that such extension, renewal or replacement Lien shall be limited to all or part of the same property that secured the Lien extended, renewed or replaced
(plus improvements on such property). 

Section 3.2.    Limitations on Sale and Lease-Back Transactions  

        The Company covenants and agrees that neither it nor any Subsidiary will enter into any arrangement with any Person (other than the Company or a Subsidiary), or
to which any such Person is a party, providing for the leasing to the Company or a Subsidiary for a period of more than three years of any Principal Property that has been or is to be sold or
transferred by the Company or such Subsidiary to such Person or to any other Person (other than the Company or a Subsidiary), to which the funds have
been or are to be advanced by such Person on the security of the leased property (herein referred to as "Sale and Lease-Back Transactions") unless either: 

        (i)    the
Company or such Subsidiary would be entitled, pursuant to Section 3.1, to incur debt secured by a Lien on the property to be leased, without equally and
ratable securing the Notes, or 

        (ii)  the
Company (and in any such case the Company covenants and agrees that it will do so) during or immediately after the expiration of 120 days after the effective
date of such Sale and Lease-Back Transaction (whether made by the Company or a Subsidiary) applies an amount equal to the value of such Sale and Leaseback Transaction to the acquisition,
construction, addition, reparation, alteration or improvement of a Principal Property and/or to the voluntary retirement of any debt of the Company which would be defined as long-term debt
on a balance sheet prepared in accordance with generally accepted accounting principles. 

        For
purposes of this Section 3.2, the term "value" shall mean, with respect to a Sale and Lease-Back Transaction, as of any particular time, the amount equal to the
net proceeds of the sale or transfer of the property leased pursuant to such Sale and Lease-Back Transaction divided first by the number of full years of the term of the lease and then
multiplied by the number of full years of such term remaining at the time of determination, without regard to any renewal or extension options contained in the lease. 

Section 3.3.    Exception to Limitations  

        Notwithstanding the provisions of Sections 3.1 and 3.2, the Company and any Subsidiary may issue, incur, create, assume or guarantee debt secured by Liens and
enter into Sale and Lease-Back Transactions that would otherwise be subject to the restrictions in Sections 3.1 and 3.2, respectively, provided (a) the aggregate outstanding
principal amount of all other debt of the Company and its Subsidiaries that is subject to the restrictions in Section 3.1 (not including debt permitted to be secured under clauses (a) to
(f) inclusive of Section 3.1), plus (b) the aggregate Attributable Debt in respect of the Sale and Lease-Back Transactions in existence at such time (not including
Sale and Lease-Back Transactions permitted by Section 3.2(i) or (ii)), does not exceed 15% of the Consolidated Net Tangible Assets. 

12

 

Section 3.4.    Waiver of Certain Covenants  

        The Company may, with respect to the Notes, omit in any particular instance to comply with any term, provision or condition set forth in any particular instance
to comply with any term, provision or condition set forth in any covenant in any of Sections 3.1 or 3.2, if before the time for such compliance
the Holders of at least a majority in principal amount of the Outstanding Notes shall, by Act of such Holders, either waiver such compliance in such instance or generally waive compliance with such
term, provision or condition, but no such waiver shall extend to or effect such term, provision or condition except to the extent so expressly waived, and, until such waiver shall become effective,
the obligations of the Company and the duties of the Trustee in respect of any such term, provision or condition shall remain in full force and effect. No supplemental indenture shall, without the
consent of the Holder of each Outstanding Note affected thereby, modify any of the provisions of this Section 3.4, except to increase the percentage required to waive compliance by the Company
of the covenants referenced here, provided, however, that this clause shall not be deemed to require the consent of any Holder with respect to changes in the references to "the Trustee" and
concomitant changes in this Section 3.4. 

ARTICLE FOUR

MISCELLANEOUS  

Section 4.1.    Conditions Precedent  

        The effectiveness of this Fourth Supplemental Indenture is conditioned upon the receipt by the Trustee of the items specified in Section 903 of the
Existing Indenture. 

Section 4.2.    Relationship to Existing Indenture  

        The Fourth Supplemental Indenture is a supplemental indenture within the meaning of the Existing Indenture. The Existing Indenture, as supplemented and amended by
this Fourth Supplemental Indenture, is in all respects ratified, confirmed and approved and, with respect to the Notes, the Existing Indenture, as supplemented and amended by this Fourth Supplemental
Indenture, shall be read, taken and construed as one and the same instrument. 

Section 4.3.    Modification of the Existing Indenture  

        Except as expressly modified by this Fourth Supplemental Indenture, the provisions of the Existing Indenture shall govern the terms and conditions of the Notes. 

Section 4.4.    Governing Law  

        This instrument shall be governed by and construed in accordance with the laws of the State of New York, without regard to conflicts of laws principles thereof. 

Section 4.5.    Counterparts  

        This instrument may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall
together constitute but one and the same instrument. 

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        In
Witness Whereof, the parties hereto have caused this Fourth Supplemental Indenture to be duly executed all as of the day and year first above written. 

	

 	
 	

TENET HEALTHCARE CORPORATION	
 	

 
	

 	
 	

By	

/s/  STEPHEN D. FARBER      	
 	

 
	 	 	 	
 Name: Stephen D. Farber

Title: Senior Vice President and Treasurer	 	 
	 	 	 	 	 	 
	 	 	 	 	 	 

	
 	
 	

THE BANK OF NEW YORK, as Trustee	
 	

 
	

 	
 	

By	

/s/  STACEY B. POINDEXTER      	
 	

 
	 	 	 	
 Name: Stacey B. Poindexter

Title: Assistant Treasurer	 	 
	 	 	 	 	 	 

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QuickLinks

Exhibit 4.3

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