FIRST SUPPLEMENTAL INDENTURE
                                           
                                           
                       TENET HEALTHCARE CORPORATION, as Issuer
                                           
                                           
                                         AND
                                           
                                           
                                THE BANK OF NEW YORK,
                                      as Trustee
                                           
                                           
                                           
                                           
                             Dated as of October 30, 1995
                                           
                                           
                                           
                                           
                        Supplemental to Indenture, dated as of
                     October 16, 1995, relating to the Issuer's 
                             8-5/8% Senior Notes Due 2003




                                  TABLE OF CONTENTS

PARTIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RECITALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ARTICLE ONE -      DEFINITIONS AND OTHER GENERAL
                   PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 1.1    Definitions . . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 1.2    Effect of Headings and Table of
                   Contents. . . . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 1.3    Successors and Assigns. . . . . . . . . . . . . . . . . . .

    SECTION 1.4    Separability Clause . . . . . . . . . . . . . . . . . . . .

    SECTION 1.5    Benefits of First Supplemental
                   Indenture . . . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 1.6    Governing Law . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 1.7    Effectiveness . . . . . . . . . . . . . . . . . . . . . . .

ARTICLE TWO -      AMENDMENTS. . . . . . . . . . . . . . . . . . . . . . . . .

ARTICLE THREE -    NOTICE, ENDORSEMENT AND CHANGE OF FORM
                   OF SECURITIES . . . . . . . . . . . . . . . . . . . . . . .

    SECTION 3.1    Replacement of Exhibits . . . . . . . . . . . . . . . . . .

    SECTION 3.2    Notation on Securities. . . . . . . . . . . . . . . . . . .

SIGNATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACKNOWLEDGMENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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         FIRST SUPPLEMENTAL INDENTURE, dated as of October 30,1995 (the "First
Supplemental Indenture"), between TENET HEALTHCARE CORPORATION, a Nevada
corporation (hereinafter called the "Company"), and THE BANK OF NEW YORK, as
trustee (hereinafter called the "Trustee"), under the Indenture (the
"Indenture"), dated as of October 16, 1995, between the Company and the Trustee
relating to the Company's 8-5/8% Senior Notes due 2003 (the "Securities").  

                               RECITALS OF THE COMPANY

         The Company proposes to offer (the "Offering") Exchangeable
Subordinated Notes due 2007 which are exchangeable for shares of common stock of
Vencor, Inc. (the "Exchangeable Notes").  

         In connection with the Offering, the Company is soliciting consents to
the amendments to the Indenture (the "Amendments") (all as described in the
Solicitation of Consents, dated October 20, 1995 (the "Consent Solicitation").

         In accordance with Section 8.02 of the Indenture the Holders of a
majority of the outstanding principal amount of the Securities then outstanding
have consented to such Amendments.

         The Board of Directors of the Company has duly authorized the
execution and delivery of this First Supplemental Indenture.  The Company has
delivered an Officers' Certificate and an Opinion of Counsel to the Trustee
pursuant to Section 8.06 of the Indenture and has done all other things
necessary to make this First Supplemental Indenture a valid agreement of the
Company in accordance with the terms hereof and of the Indenture.

         WHEREFORE, each party agrees as follows for the benefit of the other
party and for the equal or ratable benefit of the Holders of the Securities:


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                                       ARTICLE I

                           DEFINITIONS AND OTHER PROVISIONS
                                OF GENERAL APPLICATION
                                           
         SECTION 1.1      DEFINITIONS.


         For all purposes of the Indenture and this First Supplemental
Indenture, except as otherwise expressly provided or unless the context
otherwise requires:

              (1)  the words "herein," "hereof" and "hereunder" and other words
    of similar import refer to the Indenture and this First Supplemental
    Indenture as a whole and not to any particular Article, Section or
    subdivision; and

              (2)  certain capitalized terms used but not defined herein shall
    have the meanings assigned to them in the Indenture.

         SECTION 1.2      EFFECT OF HEADINGS AND TABLE OF CONTENTS.

         The Article and Section headings and the Table of Contents are for
convenience only and shall not affect the construction hereof.  All references
to Sections in the Indenture shall remain unchanged.

         SECTION 1.3      SUCCESSORS AND ASSIGNS.

         All covenants and agreements in this First Supplemental Indenture by
the Company shall bind its successors and assigns, or any other obligor on the
Securities, whether expressed or not.

         SECTION 1.4      SEPARABILITY CLAUSE.

         In case any provision in this First Supplemental Indenture shall be
invalid, illegal or unenforceable, the validity, legality and enforceability of
the remaining provisions shall not in any way be affected or impaired thereby.

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         SECTION 1.5      BENEFITS OF FIRST SUPPLEMENTAL INDENTURE.

         Nothing in this First Supplemental Indenture, express or implied,
shall give to any Person, other than the parties hereto and their successors
hereunder, any Paying Agent and the Holders, any benefit or any legal or
equitable right, remedy or claim under this First Supplemental Indenture.

         SECTION 1.6      GOVERNING LAW.

         This First Supplemental Indenture shall be governed by and construed
in accordance with the laws of the State of New York and all rights and remedies
shall be governed by such law without reference to its conflict of laws
provision.

         SECTION 1.7      EFFECTIVENESS.

         This First Supplemental Indenture shall take effect on the date (the
"Effective Date") that each of the following conditions shall have been
satisfied:

              (a)  the Trustee shall have received an Opinion of Counsel and an
Officers' Certificate from the Company each dated the Effective Date and in the
form set forth in Section 8.06 of the Indenture.

              (b)  each of the parties hereto shall have executed and delivered
this First Supplemental Indenture.


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                                      ARTICLE II

                                    THE AMENDMENTS

         1.   Section 1.01 of the Indenture is hereby amended, by including the
following between the definition of "Specified Assets" and the definition of
"Stockholders' Equity":

         "SPECIFIED EXCHANGE" means any retirement of Indebtedness upon the
    exercise by a holder of such Indebtedness, pursuant to the terms thereof,
    of any right to exchange such Indebtedness for shares of common stock of
    Vencor, Inc. or any successor thereto or any other equity securities, other
    than Equity Interests of a Subsidiary, owned by the Company as of October
    11, 1995, or for any securities or other property received with respect to
    such common stock or equity securities, whether or not such right is
    subject to the Company's ability to pay an amount in cash in lieu thereof.

         2.   Subsection (iii) of the first paragraph of Section 3.07 of the
Indenture is hereby amended and restated, in its entirety, to state the
following:

         (iii) make any principal payment on, or purchase, redeem, defease or
    otherwise acquire or retire for value any Indebtedness that is subordinated
    to the Securities, except at the original final maturity date thereof or
    pursuant to a Specified Exchange or the Refinancing;

                                     ARTICLE III

                 NOTICE, ENDORSEMENT AND CHANGE OF FORM OF SECURITIES

         SECTION 3.1      NOTICE TO SECURITYHOLDERS.


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         After the Amendments become effective, the Company shall mail to
Securityholders a notice briefly describing such Amendments in accordance with
Section 8.02 of the Indenture.

         SECTION 3.2      NOTATION ON SECURITIES.

              (a)  Securities authenticated and delivered after the
effectiveness of this First Supplemental Indenture shall be affixed by the
Trustee with the following notation:

         "The Company and the Trustee have entered into a First Supplemental
    Indenture, dated as of October 30, 1995, which amended the covenant
    regarding limitations on restricted payments.  Reference is hereby made to
    such First Supplemental Indenture, copies of which are on file with The
    Bank of New York, Trustee."



         The Trustee may require holders of Securities authenticated and
delivered prior to the effectiveness of this First Supplemental Indenture to
deliver such Securities to the Trustee so that the Trustee may affix them with
the aforementioned notation.

              (b)  If the Company or the Trustee so determines, the Company, in
exchange for the Securities, shall issue and the Trustee shall authenticate new
Securities that reflect the changed terms.

                                      * * * * *


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         This First Supplemental Indenture 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 in the same
    instrument.

    Dated as of October 30, 1995

TENET HEALTHCARE CORPORATION



                                       By: /s/ Maris Andersons
                                           --------------------------
                                            Name: Maris Andersons
                                            Title: Senior Vice President

    Attest:


                                                 (Seal)
    /s/ Alan Lundgren
    --------------------------
    Name: Alan Lundgren
    Title: Assistant Secretary


    Dated as of October 30, 1995

                                       THE BANK OF NEW YORK,
                                            as Trustee



                                       By: /s/ Vivian Georges
                                           --------------------------
                                            Name: Vivian Georges
                                            Title: Assistant Vice President

    Attest:


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                                                 (Seal)
    /s/ Paul Schmalzel
    --------------------------
    Name: Paul Schmalzel
    Title: Assistant Treasurer


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