The day that Alyssa began to breathe on her own, Carol, who had been by her daughter's side since the birth, flew home to Tampa, Florida, to resume packing and close on her house. Now retired, she was moving to Nevada to be with Alyssa while Kathleen returned to work. "We were all sky-high," Carol recalls. "This was a miracle baby." Alyssa was also the only baby Kathleen would ever have, as doctors believed another pregnancy might kill her.

Kathleen left the hospital that night at around 11:30. Shortly after 3 a.m., she awoke to pump breast milk and called Summerlin. A nurse told her that Alyssa was a little short of breath. At 6:15 a.m., Kathleen called again but was told the nurses were in a shift change. Two hours later, a nurse said that Alyssa was a little "tired" but "okay" and would have her breathing tube reinserted, which was routine. At around 9 a.m., Kathleen and Richard were nearing the hospital for one of their twice-daily visits when Alyssa's doctor called, wanting to know when they'd be in. Was there a problem? Kathleen asked.

"No," he said. "I'll talk to you when you get here."

As they approached Alyssa's Isolette, Kathleen's heart fell. She saw a woman in a suit—the director of risk management—amid a knot of doctors. Alyssa was chalk white. Her doctor said there had been a problem with the baby's T.P.N. bag, which contains the drip solution of total parenteral nutrition used to feed neonates. She had gotten too much zinc, and her heart rate was plunging. Kathleen began to cry.

Could they use dialysis to purge the zinc? she asked. Could they give her anything to offset the heavy metals? Was she going to die? The doctors didn't know.

It would take months for her to learn the truth: that metastasizing problems of turnover and training lapses had left the Summerlin Hospital pharmacy in disarray. For years, Universal Health Services, the for-profit health-management company that owns Summerlin, had outsourced its pharmacy to a series of drug-distribution companies, which, taken together, buy and sell 90 percent of the country's medicine. For these companies, managing hospital pharmacies came as an add-on to their core business of selling drugs, a response to pressure for profit in the distribution business. The management of the pharmacy—and U.H.S.'s oversight of its contractor—would later prove fateful to Alyssa Shinn. (See how the giants that run U.S. pharmacies stack up.)

II. The Hospital Chain: Universal Health Services
Twenty minutes from the Las Vegas Strip, you can see for-profit health care at its most feverish. Turn in any direction and a hospital is being built. At Summerlin, which Kathleen drives by almost every day, a new $100 million tower will add 140 hospital beds. U.H.S., which operates Summerlin and three other Las Vegas-area hospitals, opened a fifth hospital in January. All told, five new hospitals have gone up in and around the city during the past two years.

For U.H.S., a $2.6 billion company and the nation's third-largest hospital manager, Southern Nevada serves as a model for its core business goal: "to build or purchase health-care properties in rapidly growing markets and create a strong presence based on exceptional service and cost control," according to its website.