The Powers That Be

A CEO chronicles how Saudi Arabia’s royal family carried out a hostile takeover of the private hospital he led.

Utgard, an American hospital executive with international experience, spent three years in Saudi Arabia, from 1998 to 2001, trying to turn around the struggling Al-Salama Hospital in Jeddah. Its owner, Sheik Khalid Bin Mahfouz, one of the world’s richest men—later rumored to have ties to Osama bin Laden—recruited Utgard through intermediaries. This foreshadowed a consistent pattern: Although holding the title of chief executive, Utgard never dealt directly with the so-called powers that be. In his debut, Utgard tells his story in clear prose and granular detail. From the outset, his assignment appears misbegotten. The board chairman never attends any meetings; a multimillion-dollar remodeling project lacks a written contract and stalls repeatedly over payment disputes; representatives from the royal family’s hospital in Riyadh enthusiastically propose a strategic partnership, then will not return phone calls; deadlines and commitments evaporate like mirages. Subterfuge and misdirection rule the day, symbolized by a euphemism Utgard uses to describe the acquisition: “reverse privatization.” Ample conflict drives the action, and Utgard sketches his characters convincingly, but their dialogue occasionally sounds unnatural since he forces into it explanatory information better left to narration. Meanwhile, the pace bogs down when storytelling yields to documenting the historical record, and detailed accounts of staff meetings and management strategies sometimes read like an academic textbook or legal deposition. On the other hand, the book is highly personal, with insightful observations about Saudi business practices, culture and geography. Utgard, an outdoor enthusiast, peppers the narrative with tales of family vacations, desert road trip and diving in the Red Sea; an entire chapter is a travelogue of places he visited on days off work. This amalgam may prove too personal for some business readers, while managerial minutiae may overwhelm general readers. However, it’s a valuable case study, particularly for anyone in hospital administration, and a broader cautionary tale about the risks of operating private enterprises where governments wield unchecked power.

A unique memoir that provides a rare window into the Saudi kingdom.