Forty-five people has found died in New Orleans’ Memorial Medical Center by the time of Hurricane Katrina. Sheri Fink’s astonishing, 13,000-word piece in last Sunday’s New York Times Magazine set out to explain why the cluster of doctors decided that at slightest 17 patients required to be dosed with lethal amounts of morphine along with other drugs.

Most of those 17 people had something in general: They were housed at a “hospital inside a hospital,” an 82-bed long-term-care facility called LifeCare to leased space from Memorial Medical Center. While Fink explained, LifeCare “credentialed its own doctors … had its personal administrators, nurses, pharmacists along with supply chain.”

This sliding door of authority as well as personnel caused chaos in the days subsequent to Katrina and probably contributed to the death toll at the hospital. Fink reports that LifeCare’s patients supposedly weren’t part of the original evacuation plan put together by Memorial’s owner, Tenet Healthcare Corp. And the doctors who eventually administered lethal drug cocktails towards the LifeCare patients were Memorial staffers who, in Fink’s telling, that seem to be unfamiliar with the requirements of the patients in the “hospital within a hospital.” One of the Memorial doctor told to Fink that some of his colleagues didn’t trust in LifeCare’s mission: They thought “excessive resources [were] is been poured into impossible cases.”

Fink’s story is an outstanding feat of investigative journalism, but there’s one piece that she had left out. Why did LifeCare exist in the first place, and why would a “hospital inside a hospital” include a separate worker? It turns out that there may be some interesting answer to this question, one that reveals the peculiar along with complex financial relationships that make the American health care system so hard to reform.

Long-term-care hospitals similar to LifeCare were created to acquire advantage of the way Medicare payouts work. The requisite that LifeCare and its ilk have split up administrative control is an endeavor by the federal government to make sure that they aren’t taking excessively much of an advantage—that they aren’t scamming Medicare.