$500,000,000

                        INTEGRATED HEALTH SERVICES, INC.

                    9 1/4% SENIOR SUBORDINATED NOTES DUE 2008

                               PURCHASE AGREEMENT
                               ------------------

                                                              September 8, 1997
SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

c/o SMITH BARNEY INC.
388 Greenwich Street
New York, New York 10013

Dear Sirs:

                  Integrated Health Services,  Inc., a Delaware corporation (the
"Company"),  proposes,  upon the terms and conditions set forth herein, to issue
and  sell  to  you,  as  the  initial  purchasers  (the  "Initial  Purchasers"),
$500,000,000  aggregate principal amount of its 9 1/4% Senior Subordinated Notes
due 2008 (the "Notes").  The Notes will be issued  pursuant to the provisions of
an Indenture,  to be dated as of September 11, 1997 (the  "Indenture"),  between
the Company and First Union National Bank, as Trustee (the "Trustee").

                  The Company  wishes to confirm as follows its  agreement  with
the Initial Purchasers in connection with the purchase and resale of the Notes.

                  1. Preliminary  Offering  Memorandum and Offering  Memorandum.
The  Notes  will  be  offered  and  sold  to  the  Initial   Purchasers  without
registration  under the  Securities  Act of 1933,  as amended  (the  "Act"),  in
reliance on an exemption pursuant to Section 4(2) under the Act. The Company has
prepared  a  preliminary  offering  memorandum,   dated  August  26,  1997  (the
"Preliminary Offering Memorandum"),  and an offering memorandum, dated September
8, 1997 (the "Offering  Memorandum"),  setting forth  information  regarding the
Company  and the  Notes.  Any  references  herein  to the  Preliminary  Offering
Memorandum and the Offering Memorandum shall be deemed to include all amendments
and supplements  thereto and any documents  filed under the Securities  Exchange
Act of 1934, as amended,  and the rules and  regulations  of the  Securities and
Exchange Commission (the "Commission") thereunder  (collectively,  the "Exchange
Act") which are  incorporated  by reference  therein.  As used herein,  the term
"Incorporated  Documents" means the documents which at the time are incorporated
by reference in the Preliminary Offering Memorandum,  the Offering Memorandum



or any amendment or supplement thereto.  The Company hereby confirms that it has
authorized  the use of the  Preliminary  Offering  Memorandum  and the  Offering
Memorandum  in  connection  with the  offering  and  resale  of the Notes by the
Initial Purchasers.

                  The Company understands that the Initial Purchasers propose to
make  offers and sales (the  "Exempt  Resales")  of the Notes  purchased  by the
Initial  Purchasers  hereunder  only on the terms and in the manner set forth in
the Offering  Memorandum and Section 2 hereof, as soon as the Initial Purchasers
deem  advisable  after this Agreement has been executed and delivered to persons
whom the Initial  Purchasers  reasonably  believe to be qualified  institutional
buyers ("Qualified Institutional Buyers") as defined in Rule 144A under the Act,
as such rule may be amended  from time to time ("Rule  144A"),  in  transactions
under  Rule 144A  (such  persons  being  referred  to  herein  as the  "Eligible
Purchasers").

                  It is understood and acknowledged  that upon original issuance
thereof,  and  until  such  time as the same is no  longer  required  under  the
applicable  requirements  of the Act,  the Notes (and all  securities  issued in
exchange therefor or in substitution thereof) shall bear the following legend:

         THIS SECURITY HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933,
         AS  AMENDED  (THE  "SECURITIES  ACT"),  OR ANY STATE  SECURITIES  LAWS.
         NEITHER THIS SECURITY NOR ANY INTEREST OR  PARTICIPATION  HEREIN MAY BE
         REOFFERED,  SOLD,  ASSIGNED,   TRANSFERRED,   PLEDGED,   ENCUMBERED  OR
         OTHERWISE  DISPOSED  OF IN THE ABSENCE OF SUCH  REGISTRATION  OR UNLESS
         SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO,  REGISTRATION UNDER
         SUCH LAWS.

         THE HOLDER OF THIS  SECURITY  BY ITS  ACCEPTANCE  HEREOF  AGREES NOT TO
         OFFER, SELL OR OTHERWISE TRANSFER SUCH SECURITY, PRIOR TO THE DATE (THE
         "RESALE  RESTRICTION  TERMINATION  DATE")  WHICH IS TWO YEARS AFTER THE
         LATER OF THE ORIGINAL  ISSUE DATE HEREOF AND THE LAST DATE ON WHICH THE
         COMPANY OR ANY  AFFILIATED  PERSON OF THE COMPANY WAS THE OWNER OF THIS
         SECURITY (OR ANY PREDECESSOR OF SUCH SECURITY) UNLESS SUCH OFFER,  SALE
         OR OTHER TRANSFER IS (A) TO THE COMPANY, (B) PURSUANT TO A REGISTRATION
         STATEMENT  WHICH HAS BEEN DECLARED  EFFECTIVE UNDER THE SECURITIES ACT,
         (C) FOR SO LONG AS THE SECURITIES  ARE ELIGIBLE FOR RESALE  PURSUANT TO
         RULE 144A, TO A PERSON THE HOLDER  REASONABLY  BELIEVES IS A "QUALIFIED
         INSTITUTIONAL  BUYER" AS DEFINED IN RULE 144A UNDER THE  SECURITIES ACT
         THAT  PURCHASES  FOR ITS OWN  ACCOUNT OR FOR THE ACCOUNT OF A QUALIFIED
         INSTITUTIONAL  BUYER TO WHOM NOTICE IS GIVEN THAT THE TRANSFER IS BEING
         MADE IN  RELIANCE  ON RULE 144A,  (D) TO AN  INSTITUTIONAL  "ACCREDITED
         INVESTOR" WITHIN THE MEANING OF SUBPARAGRAPH (a)(1),  (a)(2), (a)(3) OR
         (a)(7) OF RULE 501  UNDER  THE  SECURITIES  ACT THAT IS  ACQUIRING  THE
         SECURITY  FOR  ITS  OWN  ACCOUNT,   OR  FOR  THE  ACCOUNT  OF  SUCH  AN
         INSTITUTIONAL  "ACCREDITED  INVESTOR," FOR INVESTMENT  PURPOSES AND NOT
         WITH A  VIEW  TO,  OR  FOR  OFFER  OR  SALE  IN  CONNECTION  WITH,  ANY
         DISTRIBUTION  IN  VIOLATION OF THE  SECURITIES  ACT, OR (E) PURSUANT TO
         ANOTHER AVAILABLE  EXEMPTION FROM THE REGISTRATION


                                       2


         REQUIREMENTS  OF THE SECURITIES ACT, AND IN EACH OF THE FOREGOING CASES
         SUCH OFFER, SALE OR OTHER TRANSFER IS IN COMPLIANCE WITH ANY APPLICABLE
         STATE SECURITIES LAWS, SUBJECT TO THE COMPANY'S AND THE TRUSTEE'S RIGHT
         PRIOR TO ANY SUCH OFFER,  SALE OR  TRANSFER  PURSUANT TO CLAUSES (D) OR
         (E) TO REQUIRE THE  DELIVERY  OF AN OPINION OF  COUNSEL,  CERTIFICATION
         AND/OR OTHER  INFORMATION  SATISFACTORY TO EACH OF THEM, AND IN EACH OF
         THE FOREGOING CASES, A CERTIFICATE OF TRANSFER IN THE FORM PROVIDED FOR
         IN THE  INDENTURE (A COPY OF WHICH MAY BE OBTAINED FROM THE TRUSTEE) IS
         COMPLETED AND DELIVERED BY THE  TRANSFEROR TO THE TRUSTEE.  THIS LEGEND
         WILL BE REMOVED  UPON THE REQUEST OF THE THEN  HOLDER OF THIS  SECURITY
         AFTER THE RESALE  RESTRICTION  TERMINATION DATE. ANY TRANSFEREE OF THIS
         SECURITY SHALL BE DEEMED TO HAVE REPRESENTED  EITHER (A) THAT IT IS NOT
         USING THE ASSETS OF AN EMPLOYEE  BENEFIT  PLAN  SUBJECT TO THE EMPLOYEE
         RETIREMENT  INCOME SECURITY ACT ("ERISA") OR THE INTERNAL  REVENUE CODE
         (THE  "CODE") TO PURCHASE  THIS  SECURITY OR (B) THAT ITS  PURCHASE AND
         CONTINUED HOLDING OF THE SECURITY WILL BE COVERED BY A U.S.  DEPARTMENT
         OF LABOR CLASS EXEMPTION WITH RESPECT TO PROHIBITED  TRANSACTIONS UNDER
         SECTION 406(a) OF ERISA.

                  It is also understood and acknowledged that holders (including
subsequent transferees) of the Notes will have the registration rights set forth
in the registration rights agreement (the "Registration  Rights Agreement"),  to
be dated  the date  hereof,  in  substantially  the form of  Exhibit  A  hereto.
Pursuant to the  Registration  Rights  Agreement,  the Company will agree (i) to
file  with  the  Commission,  under  the  circumstances  set  forth  therein,  a
registration  statement  on the  appropriate  form under the Act  relating  to a
proposed exchange offer (the "Registered  Exchange Offer") to the holders of the
Notes to issue and deliver to such  holders,  in exchange for the Notes,  a like
principal  amount of debt  securities  of the Company  identical in all material
respects  to the Notes (the "New  Notes")  and (ii) to use its  reasonable  best
efforts to cause such registration  statement to be declared  effective.  If (a)
the Company is not permitted to effect the Registered Exchange Offer because the
Registered  Exchange  Offer would violate any  applicable  law or the applicable
interpretations  of the Commission's staff or because of any change in currently
prevailing  interpretations  of the  Commission's  staff  or (b) the  Registered
Exchange  Offer has not been  consummated  for any other reason  within 240 days
after the Closing Date (as defined herein),  then the Company shall file and use
its  reasonable  best efforts to cause to be declared  effective a  registration
statement on an appropriate form under the Act relating to the offer and sale of
the  Notes by the  holders  thereof  from  time to time in  accordance  with the
methods of distribution  set forth in such  registration  statement and Rule 415
under the Act. The registration  statement to be filed under the Act pursuant to
the   Registration   Rights   Agreement  is  hereinafter   referred  to  as  the
"Registration  Statement."  This Agreement,  the Indenture and the  Registration
Rights  Agreement are  hereinafter  referred to  collectively  as the "Operative
Documents".

                  Capitalized  terms used  herein  without  definition  have the
respective  meanings  specified  therefor  in  the  Indenture  or  the  Offering
Memorandum.

                  2.  Agreements to Sell,  Purchase and Resell.  (a) The Company
hereby  agrees,  subject to all the terms and  conditions  set forth herein,  to
issue  and  sell  to  each  Initial   Purchaser  and,  upon  the  basis  of  the
representations, warranties and agreements of the



                                       3


Company  herein  contained and subject to all the terms and conditions set forth
herein,  each Initial Purchaser agrees,  severally and not jointly,  to purchase
from the  Company,  at a  purchase  price of  97.375%  of the  principal  amount
thereof,  the  principal  amount of Notes set  forth  opposite  the name of such
Initial Purchaser in Schedule I hereto.

                  (b) The Initial  Purchasers have advised the Company that they
propose to offer the Notes for sale upon the terms and  conditions  set forth in
this Agreement and in the Offering  Memorandum.  Each Initial  Purchaser  hereby
represents  and  warrants  to, and agrees  with,  the Company  that such Initial
Purchaser  (i) is  purchasing  the Notes  pursuant to a private sale exempt from
registration  under the Act, (ii) will not solicit offers for, or offer or sell,
the Notes by means of any form of general solicitation or general advertising or
in any manner  involving a public offering within the meaning of Section 4(2) of
the Act, and (iii) will solicit  offers for the Notes only from, and will offer,
sell or deliver the Notes as part of its initial offering,  only to persons whom
the Initial Purchasers reasonably believe to be Qualified  Institutional Buyers,
or if any such person is buying for one or more institutional accounts for which
such  person is acting  as  fiduciary  or  agent,  only  when  such  person  has
represented  to the  Initial  Purchasers  that each such  account is a Qualified
Institutional Buyer, to whom notice has been given that such sale or delivery is
being made in reliance on Rule 144A and in each case, in transactions under Rule
144A. The Initial  Purchasers  have advised the Company that they will offer the
Notes to Eligible Purchasers at a price initially equal to 100% of the principal
amount thereof,  plus accrued interest, if any, from the date of issuance of the
Notes.  Such  price  may  be  changed  by the  Initial  Purchasers  at any  time
thereafter without notice.

                  The Initial  Purchasers  understand  that the Company and, for
purposes of the opinions to be delivered to the Initial  Purchasers  pursuant to
Sections  7(c)(xiii) and 7(e) hereof,  counsel to the Company and counsel to the
Initial  Purchasers,  will rely  upon the  accuracy  and truth of the  foregoing
representations and agreements and the Initial Purchasers hereby consent to such
reliance.

                  3. Delivery of the Notes and Payment Therefor. Delivery to the
Initial  Purchasers  of and payment for the Notes shall be made at the office of
Smith Barney Inc., 388 Greenwich Street,  New York, NY 10013, at 10:00 A.M., New
York City time, on September 11, 1997 (the "Closing Date"). The place of closing
for the  Notes and the  Closing  Date may be varied  by  agreement  between  the
Initial Purchasers and the Company.

                  The Notes will be delivered to the Initial  Purchasers against
payment of the purchase price therefor by wire transfer of federal or other same
day funds to an account or accounts designated by the Company. The Notes will be
evidenced  by one or more global  securities  in  definitive  form (the  "Global
Note")  and will be  registered  in the  name of Cede & Co.  as  nominee  of The
Depository  Trust  Company  ("DTC").  The Notes to be  delivered  to the Initial
Purchasers  shall be made  available to the Initial  Purchasers in New York City
for inspection not later than 9:30 a.m., New York City time, on the business day
next preceding the Closing Date.

                  4.  Agreements  of the  Company.  The Company  agrees with the
Initial Purchasers as follows:

                  (a) The Company  will advise the Initial  Purchasers  promptly
and, if  requested  by them,  will  confirm  such advice in writing,  within the
period  of time  referred  to in  paragraph  (e)  below,  of any  change  in the
Company's condition (financial or other), business,  prospects,  properties, net
worth or results of operations, or of the happening of any event,


                                       4


which makes any statement  made in the Offering  Memorandum  (as then amended or
supplemented) untrue or which requires the making of any additions to or changes
in the Offering  Memorandum (as then amended or  supplemented)  in order to make
the  statements  therein  not  misleading,  or of  the  necessity  to  amend  or
supplement the Offering  Memorandum (as then amended or  supplemented) to comply
with any law.

                  (b)  The  Company  will  furnish  to the  Initial  Purchasers,
without charge, as of the date of the Offering Memorandum, such number of copies
of the Offering  Memorandum as may then be amended or  supplemented  as they may
reasonably request.

                  (c) The Company will not make any  amendment or  supplement to
the Preliminary  Offering  Memorandum or to the Offering Memorandum of which the
Initial Purchasers shall not previously have been advised or to which they shall
reasonably  object after being so advised or file any document which upon filing
becomes an Incorporated Document,  without delivering a copy of such document to
the Initial Purchasers, prior to or concurrently with such filing.

                  (d) Prior to the execution and delivery of this Agreement, the
Company has delivered or will deliver to the Initial Purchasers, without charge,
in such  quantities  as the  Initial  Purchasers  shall  have  requested  or may
hereafter reasonably request, copies of the Preliminary Offering Memorandum. The
Company  consents to the use, in accordance with the securities or Blue Sky laws
of the  jurisdictions  in which the Notes are offered by the Initial  Purchasers
and by  dealers,  prior  to  the  date  of  the  Offering  Memorandum,  of  each
Preliminary  Offering  Memorandum  so  furnished  by the  Company.  The  Company
consents  to  the  use of the  Offering  Memorandum  (and  of any  amendment  or
supplement  thereto) in accordance  with the  securities or Blue Sky laws of the
jurisdictions  in which the Notes are offered by the Initial  Purchasers  and by
all dealers to whom Notes may be sold, in connection  with the offering and sale
of the Notes.

                  (e) If, at any time prior to completion of the distribution of
the Notes by the  Initial  Purchasers  to Eligible  Purchasers,  any event shall
occur that in the  judgment  of the Company or in the opinion of counsel for the
Initial  Purchasers  should be set  forth in the  Offering  Memorandum  (as then
amended or supplemented) in order to make the statements  therein,  in the light
of the  circumstances  under which they were made, not  misleading,  or if it is
necessary to supplement or amend the Offering  Memorandum,  or to file under the
Exchange Act any document which upon filing becomes an Incorporated Document, to
comply  with  any  law,  the  Company  will  forthwith  prepare  an  appropriate
supplement or amendment thereto or such document, and will expeditiously furnish
to the Initial Purchasers and dealers a reasonable number of copies thereof.  In
the event that the Company and the Initial  Purchasers  agree that the  Offering
Memorandum should be amended or supplemented, or that a document should be filed
under the Exchange Act which upon filing becomes an Incorporated  Document,  the
Company,  if requested by the Initial  Purchasers,  will promptly  issue a press
release  announcing  or  disclosing  the  matters to be covered by the  proposed
amendment or supplement or such document.

                  (f) The Company will cooperate with the Initial Purchasers and
with  their  counsel  in  connection  with the  qualification  of the  Notes for
offering and sale by the Initial  Purchasers and by dealers under the securities
or Blue Sky laws of such  jurisdictions as the Initial  Purchasers may designate
and will file such consents to service of process or other  documents  necessary
or appropriate in order to effect such qualification;  provided that in no event
shall the Company be  obligated  to qualify to do  business in any  jurisdiction
where it is


                                       5


not now so qualified or to take any action which would  subject it to service of
process in suits,  other than those  arising out of the  offering or sale of the
Notes, in any jurisdiction where it is not now so subject.

                  (g) So long as any of the Notes are  outstanding,  the Company
will furnish to the Initial Purchasers (i) as soon as available,  a copy of each
report of the Company mailed to stockholders  or filed with the Commission,  and
(ii) from time to time such  other  information  concerning  the  Company as the
Initial Purchasers may request.

                  (h) If this Agreement  shall  terminate or shall be terminated
after execution and delivery  pursuant to any provisions  hereof (otherwise than
pursuant  to  Section  10 hereof or by notice  given by the  Initial  Purchasers
terminating  this  Agreement  pursuant  to Section 9 or Section 11 hereof) or if
this  Agreement  shall be  terminated by the Initial  Purchasers  because of any
failure  or  refusal  on the part of the  Company  to  comply  with the terms or
fulfill any of the conditions of this Agreement, the Company agrees to reimburse
the  Initial  Purchasers  for all  out-of-pocket  expenses  (including  fees and
expenses of its counsel) reasonably incurred by it in connection  herewith,  but
without any further obligation on the part of the Company for loss of profits or
otherwise.

                  (i) The Company will apply the net  proceeds  from the sale of
the  Notes  to be sold by it  hereunder  substantially  in  accordance  with the
description set forth in the Offering Memorandum.

                  (j) Except as stated in this Agreement and in the  Preliminary
Offering Memorandum and Offering Memorandum, the Company has not taken, nor will
it take, directly or indirectly, any action designed to or that might reasonably
be expected to cause or result in  stabilization or manipulation of the price of
the Notes to facilitate the sale or resale of the Notes.  Except as permitted by
the Act, the Company will not  distribute  any offering  material in  connection
with the Exempt Resales.

                  (k) The Company  will use its best  efforts to cause the Notes
to be eligible for trading on The PORTAL Market.

                  (l) From and after  the  Closing  Date,  so long as any of the
Notes are outstanding and are "Restricted  Securities" within the meaning of the
Rule 144(a)(3)  under the Act or, if earlier,  until two years after the Closing
Date, and during any period in which the Company is not subject to Section 13 or
15(d) of the Exchange  Act, the Company will furnish to holders of the Notes and
prospective purchasers of Notes designated by such holders, upon request of such
holders or such prospective purchasers, the information required to be delivered
pursuant to Rule 144A(d)(4) under the Act to permit compliance with Rule 144A in
connection with resale of the Notes.

                  (m) The Company agrees not to sell,  offer for sale or solicit
offers to buy or  otherwise  negotiate in respect of any security (as defined in
the Act) that would be  integrated  with the sale of the Notes in a manner  that
would  require  the  registration  under  the  Act of the  sale  to the  Initial
Purchasers or the Eligible Purchasers of the Notes.

                  (n) The  Company  agrees to  comply  with all of the terms and
conditions of the Registration Rights Agreement, and all agreements set forth in
representation  letters of the Company to DTC  relating  to the  approval of the
Notes by DTC for "book entry" transfer.


                                       6


                  (o) The Company agrees that prior to any  registration  of the
Notes pursuant to the Registration Rights Agreement,  or at such earlier time as
may be so required,  the Indenture  shall be qualified under the Trust Indenture
Act of 1939 (the "1939  Act") and will cause to be  entered  into any  necessary
supplemental indentures in connection therewith.

                  5.  Representations and Warranties of the Company. The Company
represents and warrants to the Initial Purchasers that:

                  (a)  The   Preliminary   Offering   Memorandum   and  Offering
Memorandum  with respect to the Notes have been  prepared by the Company for use
by the Initial  Purchasers in connection  with the Exempt  Resales.  No order or
decree preventing the use of the Preliminary Offering Memorandum or the Offering
Memorandum or any amendment or supplement  thereto,  or any order asserting that
the transactions  contemplated by this Agreement are subject to the registration
requirements  of the Act, has been issued and no proceeding for that purpose has
commenced or is pending or, to the knowledge of the Company, is contemplated.

                  (b) The  Preliminary  Offering  Memorandum  and  the  Offering
Memorandum as of their  respective  dates and the Offering  Memorandum as of the
Closing Date,  did not or will not at any time contain an untrue  statement of a
material fact or omit to state a material fact required to be stated  therein or
necessary  to make the  statements  therein  not  misleading,  except  that this
representation  and warranty does not apply to  statements in or omissions  from
the  Preliminary  Offering  Memorandum and Offering  Memorandum made in reliance
upon and in  conformity  with  information  relating to the  Initial  Purchasers
furnished  to the Company in writing by or on behalf of the  Initial  Purchasers
expressly for use therein.

                  (c) The Incorporated  Documents heretofore filed were filed in
a timely manner and, when they were filed (or, if any amendment  with respect to
any such  document was filed,  when such  document was filed),  conformed in all
material respects to the requirements of the Exchange Act and did not contain an
untrue statement of a material fact or omit to state a material fact required to
be stated  therein or necessary to make the statements  therein not  misleading;
and any further Incorporated Documents will, when so filed, be filed in a timely
manner and conform in all material  respects to the requirements of the Exchange
Act and will not contain an untrue statement of a material fact or omit to state
a  material  fact  required  to be  stated  therein  or  necessary  to make  the
statements therein not misleading.

                  (d) The Indenture has been duly and validly  authorized by the
Company and, upon its  execution,  delivery and  performance  by the Company and
assuming due authorization,  execution, delivery and performance by the Trustee,
will be a valid and binding agreement of the Company,  enforceable in accordance
with its terms,  except as  enforcement  thereof  may be limited by  bankruptcy,
insolvency or other similar laws  affecting  creditors'  rights  generally,  and
conforms in all  material  respects to the  description  thereof in the Offering
Memorandum; and no qualification of the Indenture under the 1939 Act is required
in  connection  with the offer and sale of the Notes  contemplated  hereby or in
connection with the Exempt Resales.

                  (e) The Notes have been duly  authorized  by the Company  and,
when executed by the Company and authenticated by the Trustee in accordance with
the Indenture and delivered to the Initial  Purchasers  against payment therefor
in  accordance  with the  terms  hereof,  will  have  been  validly  issued  and
delivered,  and will  constitute  valid and binding  obligations  of the Company
entitled to the benefits of the Indenture  and  enforceable  in accordance  with
their  terms,  except as  enforcement  thereof  may be  limited  by  bankruptcy,
insolvency or other similar laws affecting the enforcement of creditors'  rights
generally, and the


                                       7


Notes will conform in all material  respects to the  description  thereof in the
Offering Memorandum.

                  (f) All the outstanding shares of capital stock of the Company
have been duly authorized and validly issued,  are fully paid and  nonassessable
and  are  free  of any  preemptive  or,  except  as set  forth  in the  Offering
Memorandum,  similar  rights  and were  issued and sold in  compliance  with all
applicable  Federal and state securities laws; and the authorized  capital stock
of the Company conforms to the description thereof in the Offering Memorandum.

                  (g) The  Company  is a  corporation  duly  organized,  validly
existing and in good standing  under the laws of the State of Delaware with full
corporate  power and authority to own,  lease and operate its  properties and to
conduct its  business  as  described  in the  Offering  Memorandum,  and is duly
registered and qualified to conduct its business and is in good standing in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or  qualify  does not have a  material  adverse  effect  on the
condition (financial or other), business,  prospects,  properties,  net worth or
results of  operations  of the  Company  and the  Subsidiaries  (as  hereinafter
defined) taken as a whole (a "Material Adverse Effect").

                  (h) All the  Company's  subsidiaries  (as  defined in the Act)
included in Exhibit 21 to the Company's  Annual Report on Form 10-K for the year
ended  December  31,  1996,  together  with those  subsidiaries  of the  Company
identified in Schedule II to this Agreement, are referred to herein individually
as a "Subsidiary" and collectively as the  "Subsidiaries."  Each Subsidiary is a
corporation or limited partnership duly organized,  validly existing and in good
standing  in the  jurisdiction  of its  organization,  with  full  corporate  or
partnership  power and authority to own, lease and operate its properties and to
conduct its  business  as  described  in the  Offering  Memorandum,  and is duly
registered and qualified to conduct its business and is in good standing in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or  qualify  or be in good  standing  does not have a  Material
Adverse  Effect.  None  of  the  subsidiaries  of the  Company  other  than  the
Subsidiaries  is engaged in any business  activities  or  operations  or has any
material assets or liabilities.  All the outstanding  shares of capital stock of
each of the  Subsidiaries  which is a corporation  have been duly authorized and
validly issued,  are fully paid and  nonassessable,  and are wholly owned by the
Company directly or indirectly through one of the other  Subsidiaries,  free and
clear  of  any  lien,  adverse  claim,   security  interest,   equity  or  other
encumbrance,  except as described in the Offering  Memorandum and except for the
shares of capital stock of certain  Subsidiaries  pledged to Citibank,  N.A., as
administrative  agent  ("Citibank"),  in connection with the Company's Revolving
Credit  Agreement  dated as of May 15, 1996 with  Citibank  and the lenders from
time to time party thereto (the "Credit Agreement") and/or to Meditrust Mortgage
Investments, Inc. and/or any of its affiliates (collectively, "Meditrust"). Each
limited  partnership  agreement  pursuant to which the  Company or a  Subsidiary
holds a  general  partnership  interest  in a  limited  partnership  which  is a
Subsidiary  is in full  force and effect and  constitutes  the legal,  valid and
binding  agreement of the parties thereto,  enforceable  against such parties in
accordance with the terms thereof,  except as enforcement thereof may be limited
by  bankruptcy,  insolvency or other similar laws  affecting the  enforcement of
creditors' rights generally and by general equitable  principles;  and there has
been no material  breach of or default under,  and no event which with notice or
lapse of time would  constitute  a material  breach of or  default  under,  such
agreements by the Company or any Subsidiary or, to the Company's best knowledge,
any other party to such agreements.


                                       8


                  (i) There are no legal or governmental proceedings pending or,
to the knowledge of the Company,  threatened,  against the Company or any of the
Subsidiaries,  or to which the Company or any of the  Subsidiaries,  or to which
any of their respective  properties,  is subject,  that are not disclosed in the
Offering  Memorandum and which, if adversely  decided,  are reasonably likely to
cause a Material  Adverse Effect or materially  affect the issuance of the Notes
or the consummation of the transactions contemplated by the Operative Documents.
There  are no  material  agreements,  contracts,  indentures,  leases  or  other
instruments  that  are not  described  in the  Offering  Memorandum  or that are
required to be filed as an exhibit to any Incorporated  Document that are not so
filed.  Neither the Company nor any  Subsidiary  is involved in any strike,  job
action or labor  dispute  with any group of  employees,  and,  to the  Company's
knowledge,  no such action or dispute is threatened,  which is reasonably likely
to have a Material Adverse Effect.

                  (j) Neither the Company nor any of the  Subsidiaries is (i) in
violation of its  certificate or articles of  incorporation  or by-laws or other
organizational   documents,   or  of  any  law,  ordinance,   administrative  or
governmental  rule  or  regulation  applicable  to  the  Company  or  any of the
Subsidiaries or of any decree of any court or governmental agency or body having
jurisdiction over the Company or any of the Subsidiaries,  except where any such
violation  or  violations  in the  aggregate  would not have a Material  Adverse
Effect or (ii) in default in any  material  respect  in the  performance  of any
obligation, agreement or condition contained in any bond, debenture, note or any
other evidence of indebtedness or in any material agreement, indenture, lease or
other  instrument to which the Company or any of the  Subsidiaries is a party or
by which any of them or any of their respective  properties may be bound, except
as may be disclosed in the Offering Memorandum.

                  (k)  Neither  the  issuance,  offer,  sale or  delivery of the
Notes, the execution,  delivery or performance of this Agreement,  the Indenture
or the Registration  Rights Agreement by the Company nor the consummation by the
Company of the  transactions  contemplated  hereby or thereby (i)  requires  any
consent,  approval,  authorization  or other order of, or registration or filing
with, any court,  regulatory body,  administrative  agency or other governmental
body,  agency or official (except such as may be required in connection with the
registration  under the Act of the Notes and/or the New Notes in accordance with
the Registration Rights Agreement,  the qualification of the Indenture under the
1939 Act and  except  for  compliance  with the  securities  or Blue Sky laws of
various jurisdictions) or conflicts or will conflict with or constitutes or will
constitute  a breach of, or a default  under,  the  certificate  or  articles of
incorporation or bylaws, or other  organizational  documents,  of the Company or
any of the  Subsidiaries  or (ii) conflicts or will conflict with or constitutes
or will constitute a breach of, or a default under, in any material respect, any
material agreement, indenture, lease or other instrument to which the Company or
any of the  Subsidiaries  is a party  or by  which  any of them or any of  their
respective  properties may be bound, or violates or will violate in any material
respect any statute, law, regulation or filing or judgment, injunction, order or
decree  applicable  to the  Company or any of the  Subsidiaries  or any of their
respective properties, or will result in the creation or imposition of any lien,
charge or  encumbrance  upon any property or assets of the Company or any of the
Subsidiaries  pursuant to the terms of any  agreement or instrument to which any
of them is a party or by which  any of them may be bound or to which  any of the
property or assets of any of them is subject.

                  (l) The  accountants,  KPMG Peat  Marwick  LLP and  Deloitte &
Touche  LLP,  who have  certified  or shall  certify  the  financial  statements
included as part of the Offering  Memorandum  (or any  amendment  or  supplement
thereto), are independent certified public


                                       9


accountants under Rule 101 of the AICPA's Code of Professional  Conduct, and its
interpretation and rulings.

                  (m) The  historical  financial  statements,  together with the
related  schedules  and notes forming part of the Offering  Memorandum  (and any
amendment or supplement thereto), comply as to form with the requirements of the
Exchange  Act and  present  fairly in all  material  respects  the  consolidated
financial  position,  results of operations and changes in stockholders'  equity
and cash  flows of each of the  Company  and its  Subsidiaries,  First  American
Health Care of Georgia,  Inc. ("First American") and RoTech Medical  Corporation
("RoTech")  on the basis stated in the  Offering  Memorandum  at the  respective
dates or for the  respective  periods to which they apply;  such  statements and
related  schedules  and notes have been prepared in  accordance  with  generally
accepted  accounting  principles  consistently  applied  throughout  the periods
involved,  except as disclosed therein;  and the other financial and statistical
information and data set forth in the Offering  Memorandum (and any amendment or
supplement thereto) is accurately  presented and, to the extent such information
and data is derived from the financial  books and records of the Company and its
Subsidiaries,  First  American  or RoTech,  as the case may be, is prepared on a
basis consistent with such financial  statements and the books and records.  The
pro  forma  financial  statements  and other  pro  forma  financial  information
included or  incorporated  by  reference in the  Offering  Memorandum  have been
prepared in accordance with the  Commission's  rules and guidelines with respect
to pro forma financial  information and have been properly compiled on the basis
described therein,  and the assumptions used in the preparation  thereof are, in
the Company's opinion, reasonable.

                  (n) The  Company  has all  requisite  power and  authority  to
execute,  deliver and  perform  its  obligations  under this  Agreement  and the
Registration   Rights  Agreement;   the  execution  and  delivery  of,  and  the
performance  by the Company of its  obligations  under,  this  Agreement and the
Registration  Rights  Agreement  have been duly and  validly  authorized  by the
Company, and this Agreement and the Registration Rights Agreement have been duly
executed  and  delivered  by the  Company and  constitute  the valid and legally
binding agreements of the Company, enforceable against the Company in accordance
with their terms, except as the enforcement hereof and thereof may be limited by
bankruptcy,  insolvency  or other  similar laws  affecting  the  enforcement  of
creditors'  rights  generally  and  subject  to  the  applicability  of  general
principles  of  equity,  and  except  as rights to  indemnity  and  contribution
hereunder and thereunder may be limited by Federal or state  securities  laws or
principles of public policy.

                  (o) Except as  disclosed in the  Offering  Memorandum  (or any
amendment  or  supplement  thereto),  subsequent  to the date as of  which  such
information is given in the Offering  Memorandum (or any amendment or supplement
thereto),  neither the  Company nor any of the  Subsidiaries  has  incurred  any
liability or obligation,  direct or contingent, or entered into any transaction,
not in the ordinary course of business,  that is material to the Company and the
Subsidiaries taken as a whole, and there has not been any material change in the
capital stock, or material  increase in the short-term or long-term debt, of the
Company or any of the  Subsidiaries,  or any  material  adverse  change,  or any
development  involving  or which  could  reasonably  be  expected  to  involve a
prospective  material  adverse  change,  in the condition  (financial or other),
business,  properties, net worth or results of operations of the Company and the
Subsidiaries taken as a whole.

                  (p)  Each of the  Company  and the  Subsidiaries  has good and
marketable  title to all property (real and personal)  described in the Offering
Memorandum as being owned by it, free and clear of all liens,  claims,  security
interests  or other  encumbrances  except such as are  described in the Offering
Memorandum  or in an  Incorporated  Document  or  exhibit  thereto,


                                       10


and all the property  described in the Offering  Memorandum  as being held under
lease by each of the Company  and the  Subsidiaries  is held by it under  valid,
subsisting and enforceable leases, with only such exceptions as in the aggregate
are not materially  burdensome and do not interfere in any material respect with
the  conduct of the  business of the  Company  and the  Subsidiaries  taken as a
whole.

                  (q)  Except  as  permitted  by the Act,  the  Company  has not
distributed  and, prior to the later to occur of the Closing Date and completion
of the distribution of the Notes,  will not distribute any offering  material in
connection  with the offering  and sale of the Notes other than the  Preliminary
Offering Memorandum and Offering Memorandum.

                  (r)  Each of the  Company  and the  Subsidiaries  and,  to the
Company's  knowledge,  the owners of the facilities and other businesses managed
by the  Company  or any  Subsidiary  have such  permits,  licenses,  franchises,
certificates and other approvals or authorizations of governmental or regulatory
authorities  ("Permits")  as are  necessary  under  applicable  law to own their
respective  properties  and to conduct their  respective  business in the manner
described  in the  Offering  Memorandum  (including,  without  limitation,  such
Permits as are required  under such  federal,  state and other health care laws,
and  under  such HMO or  similar  licensure  laws and  such  insurance  laws and
regulations,  as are applicable  thereto),  and with respect to those facilities
and other businesses that  participate in Medicare and/or  Medicaid,  to receive
reimbursement  under  Medicare  and  Medicaid,  subject  in  each  case  to such
qualifications as may be set forth in the Offering  Memorandum and except to the
extent that the failure to have such Permits  would not have a Material  Adverse
Effect; the Company and each of the Subsidiaries have fulfilled and performed in
all material respects, all their respective material obligations with respect to
the Permits, and no event has occurred which allows, or after notice or lapse of
time would  allow,  revocation  or  termination  thereof or results in any other
material  impairment of the rights of the holder of any such Permit,  subject in
each case to such  qualification as may be set forth in the Offering  Memorandum
and except to the extent that any such revocation or termination  would not have
a Material Adverse Effect; and, except as described in the Offering  Memorandum,
none of the Permits  contains any restriction  that is materially  burdensome to
the Company or any of the Subsidiaries.

                  (s) The  business  practices  of the  Company  and each of its
Subsidiaries do not violate in any material respect any applicable provisions of
federal or state law governing Medicare or any state Medicaid program, including
without  limitation,  Sections  1320a-7a  and 1320a-7b of Title 42 of the United
States Code, and no individual with an ownership or control interest, as defined
in 42 U.S.C. ss.1320a-3(a)(3), in the Company or any of its Subsidiaries, or who
is an  officer,  director,  or  managing  employee,  as  defined  in  42  U.S.C.
ss.1320a-5(b),  of the Company or any of its  Subsidiaries is a person described
in  42  U.S.C.   ss.1320a-7(b)(8)(B),   and  the   Company's  and  each  of  its
Subsidiaries'  business  practices  do not violate in any  material  respect any
applicable  provisions of federal or state law regarding physician ownership of,
or financial  relationship  with, or referral to entities  providing health care
related goods or services,  or laws requiring  disclosure of financial interests
held by  physicians  in  entities  to which  they  may  refer  patients  for the
provision of health care related goods or services.

                  (t) The information presented in the Offering Memorandum under
the caption "Business of RoTech" fairly presents the information purported to be
shown and does not  contain an untrue  statement  of a material  fact or omit to
state a material  fact  required to be stated  therein or  necessary to make the
statements therein not misleading.


                                       11


                  (u) The  Company  maintains  a system of  internal  accounting
controls  sufficient to provide reasonable  assurances that (i) transactions are
executed in accordance with management's general or specific authorization; (ii)
transactions  are  recorded as  necessary  to permit  preparation  of  financial
statements in conformity with generally  accepted  accounting  principles and to
maintain  accountability for assets; (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  existing  assets  at
reasonable  intervals  and  appropriate  action  is taken  with  respect  to any
differences.

                  (v) Neither the  Company nor any of the  Subsidiaries  nor, to
the Company's knowledge,  any employee or agent of the Company or any Subsidiary
has made any  payment of funds of the Company or any  Subsidiary  or received or
retained any funds in violation of any law, rule or regulation,  which violation
would have a Material Adverse Effect.

                  (w)  Except  as  disclosed  in the  Offering  Memorandum,  the
Company and each of the  Subsidiaries  have filed all tax returns required to be
filed, which returns are true and correct in all material respects,  and neither
the Company nor any  Subsidiary  is in default in the payment of any taxes which
were payable  pursuant to said returns or any assessments  with respect thereto,
except where the failure to file such returns and make such  payments  would not
have a Material Adverse Effect.

                  (x)  The  Company  and the  Subsidiaries  own or  possess  all
patents,  trademarks,  trademark  registration,   service  marks,  service  mark
registrations,  trade names, copyrights, licenses, inventions, trade secrets and
rights  described  in the Offering  Memorandum  as being owned by any of them or
necessary for the conduct of their respective businesses, and the Company is not
aware of any claim to the  contrary or any  challenge by any other person to the
rights of the Company and the Subsidiaries with respect to the foregoing.

                  (y) The  Company  is not  and,  upon  sale of the  Notes to be
issued and sold thereby in accordance  herewith and the  application  of the net
proceeds to the Company of such sale as  described  in the  Offering  Memorandum
under the caption "Use of Proceeds," will not be an "investment  company" within
the meaning of the Investment Company Act of 1940, as amended.

                  (z) When the Notes are issued and  delivered  pursuant to this
Agreement,  such Notes will not be of the same class (within the meaning of Rule
144A(d)(3)  under the Act) as any  security of the  Company  that is listed on a
national  securities  exchange registered under Section 6 of the Exchange Act or
that is quoted in a United States automated interdealer quotation system.

                  (aa) Neither the Company nor any affiliate (as defined in Rule
501(b) of  Regulation  D  ("Regulation  D") under  the Act) of the  Company  has
directly,  or through any agent (provided that no  representation  is made as to
the Initial Purchasers or any person acting on their behalf),  (i) sold, offered
for sale,  solicited  offers to buy or otherwise  negotiated  in respect of, any
security  (as  defined  in the  Act)  which  is or will be  integrated  with the
offering and sale of the Notes in a manner that would  require the  registration
of the Notes under the Act or (ii)  engaged in any form of general  solicitation
or general  advertising  (within the meaning of Regulation D) in connection with
the offering of the Notes.

                  (ab) The Company is not  required  to deliver the  information
specified in Rule  144A(d)(4) in connection  with the offering and resale of the
Notes by the Initial Purchasers.


                                       12


                  (ac) Assuming (i) that the  representations  and warranties in
Section 2 hereof are true, (ii) the Initial Purchasers comply with the covenants
set forth in  Section 2 hereof and (iii)  that each  person to whom the  Initial
Purchasers offer, sell or deliver the Notes is a Qualified  Institutional Buyer,
the  purchase  and sale of the Notes  pursuant  hereto  (including  the  Initial
Purchasers'  proposed  offering  of the Notes on the terms and in the manner set
forth in the  Offering  Memorandum  and  Section  2 hereof)  is exempt  from the
registration requirements of the Act.

                  (ad) The execution and delivery of this  Agreement,  the other
Operative  Documents  and the sale of the Notes to the Initial  Purchasers or by
the Initial  Purchasers to Eligible  Purchasers  will not involve any prohibited
transaction  within the meaning of Section  406 of ERISA or Section  4975 of the
Code. The  representation  made by the Company in the preceding sentence is made
in reliance  upon and  subject to the  accuracy  of, and  compliance  with,  the
representations  and covenants made or deemed made by the Eligible Purchasers as
set forth in the  Offering  Memorandum  under the  section  entitled  "Notice to
Investors."

                  6. Indemnification and Contribution. (a) The Company agrees to
indemnify and hold harmless each Initial  Purchaser and each person, if any, who
controls  any Initial  Purchaser  within the meaning of Section 15 of the Act or
Section 20 of the  Exchange  Act,  from and against any and all losses,  claims,
damages,  liabilities and expenses (including reasonable costs of investigation)
arising out of or based upon any untrue statement or alleged untrue statement of
a material fact  contained in the  Preliminary  Offering  Memorandum or Offering
Memorandum or in any amendment or supplement thereto, or arising out of or based
upon any omission or alleged  omission to state therein a material fact required
to be stated therein or necessary to make the statements therein not misleading,
except insofar as such losses,  claims,  damages,  liabilities or expenses arise
out of or are based upon any untrue  statement  or  omission  or alleged  untrue
statement  or  omission  which has been made  therein  or omitted  therefrom  in
reliance upon and in conformity  with the  information  relating to such Initial
Purchaser  furnished  in writing to the Company by or on behalf of such  Initial
Purchaser expressly for use in connection therewith; provided, however, that the
indemnification  contained in this paragraph (a) with respect to the Preliminary
Offering  Memorandum shall not inure to the benefit of any Initial Purchaser (or
to the benefit of any person  controlling  any Initial  Purchaser) on account of
any such loss, claim, damage,  liability or expense arising from the sale of the
Notes by such Initial Purchaser to any person if the untrue statement or alleged
untrue statement or omission or alleged omission of a material fact contained in
the Preliminary Offering Memorandum was corrected in the Offering Memorandum and
such Initial Purchaser sold Notes to that person without sending or giving at or
prior  to  the  written  confirmation  of  such  sale,  a copy  of the  Offering
Memorandum  (as then  amended or  supplemented)  if the Company  has  previously
furnished  sufficient  copies thereof to such Initial  Purchaser.  The foregoing
indemnity  agreement shall be in addition to any liability which the Company may
otherwise have.

                  (b) If any action, suit or proceeding shall be brought against
any Initial Purchaser or any person controlling any Initial Purchaser in respect
of which indemnity may be sought against the Company,  such Initial Purchaser or
such  controlling   person  shall  promptly  notify  the  parties  against  whom
indemnification  is  being  sought  (the  "indemnifying   parties"),   and  such
indemnifying parties shall assume the defense thereof,  including the employment
of counsel and payment of all fees and expenses.  Such Initial  Purchaser or any
such  controlling  person shall have the right to employ separate counsel in any
such action,  suit or proceeding and to participate in the defense thereof,  but
the fees and  expenses of such  counsel  shall be at the expense of such Initial
Purchaser or such controlling person unless (i) the indemnifying



                                       13


parties  have  agreed  in  writing  to pay  such  fees  and  expenses,  (ii) the
indemnifying  parties have failed to assume the defense and employ  counsel,  or
(iii) the named parties to any such action,  suit or proceeding  (including  any
impleaded  parties)  include  both such Initial  Purchaser  or such  controlling
person  and  the  indemnifying  parties  and  such  Initial  Purchaser  or  such
controlling person shall have been advised by its counsel that representation of
such indemnified  party and any indemnifying  party by the same counsel would be
inappropriate under applicable standards of professional conduct (whether or not
such  representation  by the same  counsel has been  proposed)  due to actual or
potential differing interests between them (in which case the indemnifying party
shall  not  have  the  right to  assume  the  defense  of such  action,  suit or
proceeding on behalf of such Initial Purchaser or such controlling  person).  It
is understood,  however, that the indemnifying parties shall, in connection with
any one such action, suit or proceeding or separate but substantially similar or
related actions,  suits or proceedings in the same  jurisdiction  arising out of
the same general allegations or circumstances, be liable for the reasonable fees
and  expenses of only one separate  firm of attorneys  (in addition to any local
counsel) at any time for all such Initial Purchasers and controlling persons not
having actual or potential  differing  interests with the Initial  Purchasers or
among  themselves,  which firm shall be  designated  in writing by Smith  Barney
Inc.,  and that  all such  fees and  expenses  shall be  reimbursed  as they are
incurred. The indemnifying parties shall not be liable for any settlement of any
such action, suit or proceeding  effected without their written consent,  but if
settled  with such  written  consent,  or if there be a final  judgment  for the
plaintiff in any such action, suit or proceeding, the indemnifying parties agree
to indemnify and hold harmless any Initial Purchaser,  to the extent provided in
paragraph (a), and any such controlling person from and against any loss, claim,
damage, liability or expense by reason of such settlement or judgment.

                  (c) Each Initial Purchaser agrees,  severally and not jointly,
to indemnify and hold harmless the Company, and its directors and officers,  and
any person who controls the Company  within the meaning of Section 15 of the Act
or Section 20 of the Exchange Act to the same extent as the  indemnity  from the
Company to each Initial  Purchaser set forth in paragraph  (a) hereof,  but only
with  respect to  information  relating to such Initial  Purchaser  furnished in
writing  by or on  behalf of such  Initial  Purchaser  expressly  for use in the
Preliminary  Offering  Memorandum  or Offering  Memorandum  or any  amendment or
supplement  thereto.  If any action, suit or proceeding shall be brought against
the Company,  any of its directors or officers,  or any such controlling  person
based on the  Preliminary  Offering  Memorandum or Offering  Memorandum,  or any
amendment or supplement thereto, and in respect of which indemnity may be sought
against such Initial  Purchaser  pursuant to this  paragraph  (c),  such Initial
Purchaser shall have the rights and duties given to the Company by paragraph (b)
above  (except that if the Company  shall have assumed the defense  thereof such
Initial  Purchaser  shall not be  required  to do so,  but may  employ  separate
counsel  therein  and  participate  in the  defense  thereof,  but the  fees and
expenses of such counsel shall be at such Initial Purchaser's expense),  and the
Company, its directors and officers,  and any such controlling person shall have
the rights and duties given to the Initial  Purchasers  by paragraph  (b) above.
The foregoing  indemnity  agreement  shall be in addition to any liability which
the Initial Purchasers may otherwise have.

                  (d) If the  indemnification  provided for in this Section 6 is
unavailable  to an  indemnified  party  under  paragraphs  (a) or (c)  hereof in
respect of any losses,  claims,  damages,  liabilities  or expenses  referred to
therein,  then an indemnifying  party, in lieu of indemnifying  such indemnified
party,  shall contribute to the amount paid or payable by such indemnified party
as a result of such losses, claims, damages, liabilities or expenses (i) in such
proportion as is  appropriate to reflect the relative  benefits  received by the
Company on the one hand and the  Initial  Purchasers  on the other hand from the
offering of the Notes, or (ii) if the allocation


                                       14


provided  by clause  (i)  above is not  permitted  by  applicable  law,  in such
proportion as is appropriate to reflect not only the relative  benefits referred
to in clause  (i) above but also the  relative  fault of the  Company on the one
hand and the Initial  Purchasers on the other in connection  with the statements
or omissions  that  resulted in such losses,  claims,  damages,  liabilities  or
expenses, as well as any other relevant equitable  considerations.  The relative
benefits  received by the Company on the one hand and the Initial  Purchasers on
the other shall be deemed to be in the same proportion as the total net proceeds
from the offering (before  deducting  expenses)  received by the Company bear to
the total discounts and commissions received by the Initial Purchasers,  in each
case as set forth in the table on the cover page of the Offering Memorandum. The
relative fault of the Company on the one hand and the Initial  Purchasers on the
other hand 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 supplied by the Company
on the one hand or by the Initial  Purchasers on the other hand and the parties'
relative intent, knowledge,  access to information and opportunity to correct or
prevent such statement or omission.

                  (e) The Company and the Initial Purchasers agree that it would
not be just and  equitable  if  contribution  pursuant  to this  Section  6 were
determined by a pro rata  allocation  or by any other method of allocation  that
does not take account of the equitable  considerations  referred to in paragraph
(d) above. The amount paid or payable by an indemnified party as a result of the
losses, claims,  damages,  liabilities and expenses referred to in paragraph (d)
above shall be deemed to include,  subject to the  limitations  set forth above,
any legal or other expenses  reasonably  incurred by such  indemnified  party in
connection with  investigating  any claim or defending any such action,  suit or
proceeding.  Notwithstanding  the  provisions  of this  Section  6,  no  Initial
Purchaser  shall be required to contribute any amount in excess of the amount by
which the total price of the Notes  purchased  and resold by it as  contemplated
hereby  exceeds  the amount of any  damages  which such  Initial  Purchaser  has
otherwise  been  required  to pay by reason of such  untrue  or  alleged  untrue
statement  or  omission  or alleged  omission.  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.

                  (f) No  indemnifying  party shall,  without the prior  written
consent of the  indemnified  party,  effect  any  settlement  of any  pending or
threatened action,  suit or proceeding in respect of which any indemnified party
is or could have been a party and indemnity could have been sought  hereunder by
such indemnified party, unless such settlement includes an unconditional release
of such  indemnified  party from all  liability  on claims  that are the subject
matter of such action, suit or proceeding.

                  (g) Any losses, claims,  damages,  liabilities or expenses for
which an indemnified party is entitled to  indemnification or contribution under
this Section 6 shall be paid by the indemnifying  party to the indemnified party
as such losses,  claims,  damages,  liabilities  or expenses are  incurred.  The
indemnity  and  contribution  agreements  contained  in this  Section  6 and the
representations  and warranties of the Company set forth in this Agreement shall
remain  operative  and  in  full  force  and  effect,   regardless  of  (i)  any
investigation  made by or on  behalf  of any  Initial  Purchaser  or any  person
controlling any Initial Purchaser, the Company, its directors or officers or any
person  controlling  the  Company,  (ii)  acceptance  of any Notes  and  payment
therefor hereunder,  and (iii) any termination of this Agreement. A successor to
any Initial Purchaser or any person controlling any Initial Purchaser, or to the
Company, its directors or officers or any person controlling the Company,  shall
be entitled to the benefits of the  indemnity,  contribution  and  reimbursement
agreements contained in this Section 6.



                                       15


                  7.  Conditions  of the Initial  Purchasers'  Obligations.  The
several  obligations of the Initial  Purchasers to purchase the Notes  hereunder
are subject to the following conditions:

                  (a) At the  time of  execution  of this  Agreement  and on the
Closing Date, no order or decree  preventing the use of the Offering  Memorandum
or any  amendment  or  supplement  thereto,  or any  order  asserting  that  the
transactions  contemplated  by this  Agreement  are subject to the  registration
requirements  of the Act shall  have been  issued  and no  proceedings  for that
purpose  shall have been  commenced or shall be pending or, to the  knowledge of
the Company, be contemplated.  No stop order suspending the sale of the Notes in
any jurisdiction designated by the Initial Purchasers shall have been issued and
no  proceedings  for that purpose shall have been  commenced or shall be pending
or, to the knowledge of the Company, shall be contemplated.

                  (b) Subsequent to the effective date of this Agreement,  there
shall  not  have  occurred  (i)  any  change,  or any  development  involving  a
prospective  change,  in  or  affecting  the  condition  (financial  or  other),
business,  properties, net worth, or results of operations of the Company or the
Subsidiaries not contemplated by the Offering  Memorandum,  which in the opinion
of the Initial Purchasers,  would materially adversely affect the market for the
Notes, or (ii) any event or development  relating to or involving the Company or
any officer or director of the  Company  which makes any  statement  made in the
Offering  Memorandum  untrue or which,  in the  opinion of the  Company  and its
counsel or the Initial Purchasers and their counsel,  requires the making of any
addition to or change in the  Offering  Memorandum  in order to state a material
fact required by any law to be stated  therein or necessary in order to make the
statements  therein not misleading,  if amending or  supplementing  the Offering
Memorandum  to reflect such event or  development  would,  in the opinion of the
Initial Purchasers, materially adversely affect the market for the Notes.

                  (c) The Initial  Purchasers shall have received on the Closing
Date an opinion of Fulbright & Jaworski L.L.P.,  counsel for the Company,  dated
the Closing Date and addressed to the Initial Purchasers, to the effect that:

                        (i) The Company is a corporation  duly  incorporated and
validly  existing in good standing  under the laws of the State of Delaware with
full corporate  power and authority to own, lease and operate its properties and
to conduct  its  business  as  described  in the  Offering  Memorandum  (and any
amendment or supplement thereto);

                        (ii) Each Significant  Subsidiary (as defined in Section
1.02(w) of Regulation S-X  promulgated  under the Act) is a corporation  validly
existing  and in  good  standing  under  the  laws  of the  jurisdiction  of its
organization, with full corporate power and authority to own, lease, and operate
its  properties  and to  conduct  its  business  as  described  in the  Offering
Memorandum  (and any amendment or supplement  thereto);  and all the outstanding
shares of capital stock of each of the Significant  Subsidiaries  have been duly
authorized  and validly  issued,  are fully paid and  nonassessable,  and to the
knowledge  of such  counsel,  are  wholly  owned  by the  Company  directly,  or
indirectly through one of the other Subsidiaries, free and clear of any security
interest, lien, adverse claim, equity or other encumbrance,  except as described
in the Offering Memorandum and except for the shares of capital stock of certain
Subsidiaries  pledged  to  Citibank  as agent  in  connection  with  the  Credit
Agreement and/or to Meditrust;

                                       16



                        (iii) The authorized  capital stock of the Company is as
set forth under the caption "Capitalization" in the Offering Memorandum;

                        (iv) The Company has  corporate  power and  authority to
enter into this Agreement and the  Registration  Rights  Agreement and to issue,
sell  and  deliver  the  Notes  to be sold by it to the  Initial  Purchasers  as
provided herein,  and this Agreement and the Registration  Rights Agreement have
been duly authorized, executed and delivered by the Company and are valid, legal
and  binding  agreements  of the  Company,  enforceable  against  the Company in
accordance  with their terms,  except (A) as  enforcement of rights to indemnity
and  contribution  hereunder and  thereunder  may be limited by Federal or state
securities  laws  or  principles  of  public  policy  and  (B)  subject  to  the
qualification that the enforceability of the Company's obligations hereunder and
thereunder  may be limited by  bankruptcy,  fraudulent  conveyance,  insolvency,
reorganization,  moratorium,  and other laws relating to or affecting creditors'
rights generally and by general equitable principles;

                        (v) The Indenture has been duly and validly  authorized,
executed and delivered by the Company and, assuming due authorization, execution
and  delivery by the Trustee,  is a valid and binding  agreement of the Company,
enforceable in accordance with its terms,  subject to the qualification that the
enforceability  of  the  Company's  obligations  thereunder  may be  limited  by
bankruptcy, fraudulent conveyance, insolvency,  reorganization,  moratorium, and
other laws relating to or affecting  creditors'  rights generally and by general
equitable  principles;  and no qualification of the Indenture under the 1939 Act
is  required  in  connection  with the offer and sale of the Notes  contemplated
hereby or in connection with the Exempt Resales;

                        (vi) The Notes have been duly and validly  authorized by
the Company and when  executed by the Company in  accordance  with the Indenture
and, assuming due  authentication of the Notes by the Trustee,  upon delivery to
the Initial  Purchasers  against  payment  therefor in accordance with the terms
hereof,  will have been validly issued and delivered,  and will constitute valid
and  binding  obligations  of  the  Company  entitled  to  the  benefits  of the
Indenture, subject to the qualification that the enforceability of the Company's
obligations  thereunder  may be limited by  bankruptcy,  fraudulent  conveyance,
insolvency, reorganization,  moratorium, and other laws relating to or affecting
creditors' rights generally and by general equitable principles;

                        (vii) Neither the offer,  sale or delivery of the Notes,
the execution,  delivery or performance  by the Company of this  Agreement,  the
Registration  Rights Agreement or the Indenture,  compliance by the Company with
the  provisions  hereof  or  thereof  nor  consummation  by the  Company  of the
transactions  contemplated  hereby or thereby  constitutes or will  constitute a
breach or  violation  of, or a  default  under,  in any  material  respect,  the
certificate  or  articles  of  incorporation  or bylaws or other  organizational
documents of the Company or any of the Significant  Subsidiaries or any material
agreement,  indenture,  lease or other instrument to which the Company or any of
the Significant  Subsidiaries is a party or by which any of them or any of their
respective  properties is bound that is an exhibit to any Incorporated  Document
or is known to such counsel, or will result in the creation or imposition of any
lien, charge or encumbrance upon any property or assets of the Company or any of
the Significant  Subsidiaries pursuant to the terms of any material agreement or
instrument  to which any of them is a party or by which any of them may be bound
or to which any of the  property or assets of any of them is subject  that is an
exhibit to any Incorporated  Document or is known to such counsel,  nor will any
such action result in any violation in any material respect of any existing law,
or any  regulation,  ruling  (assuming  compliance  with  all  applicable  state
securities


                                       17


and Blue Sky laws and, in the case of the Registration Rights Agreement, the Act
and the Exchange Act and the 1939 Act),  judgment,  injunction,  order or decree
known to such counsel, applicable to the Company or the Significant Subsidiaries
or any of their respective properties;

                        (viii)  No  consent,  approval,  authorization  or other
order  of,  or  registration  or  filing  with,  any  court,   regulatory  body,
administrative  agency  or other  governmental  body,  agency,  or  official  is
required  on the part of the  Company  (except as have been  obtained  under the
Exchange Act, or such as may be required under state securities or Blue Sky laws
governing the purchase and distribution of the Notes, or such as may be required
to qualify  the  Indenture  under the 1939 Act,  and such as may be  required in
connection  with the  performance  by the Company of its  obligations  under the
Registration  Rights  Agreement,  as to which such  counsel  need not express an
opinion) for the valid issuance and sale of the Notes to the Initial  Purchasers
as contemplated by this Agreement;

                        (ix)  The   Incorporated   Documents   (except  for  the
financial statements and the notes thereto and the schedules and other financial
and statistical data included therein, as to which such counsel need not express
any opinion), at the time they were filed, appear on their face to have complied
as to form in all material respects with the requirements of the Exchange Act;

                        (x) To the knowledge of such  counsel,  (A) there are no
legal or governmental  proceedings  pending or threatened against the Company or
any of the Subsidiaries,  or to which the Company or any of the Subsidiaries, or
any of their  property,  are  subject,  which are not  disclosed in the Offering
Memorandum and which,  if adversely  decided,  are reasonably  likely to cause a
Material  Adverse  Effect or materially  affect the issuance of the Notes or the
consummation of the transactions contemplated by the Operative Documents and (B)
there  are no  material  agreements,  contracts,  indentures,  leases  or  other
instruments, that are not described in the Offering Memorandum (or any amendment
or  supplement  thereto)  or that are  required to be filed as an exhibit to any
Incorporated Document that are not filed as required;

                        (xi) The statements in the Offering Memorandum,  insofar
as they are descriptions of contracts,  agreements or other legal documents,  or
refer to  statements of law or legal  conclusions,  are accurate in all material
respects and present fairly the information described therein;

                        (xii) When the Notes are issued and  delivered  pursuant
to this Agreement,  such Notes will not be of the same class (within the meaning
of Rule 144A(d)(3)  under the Act) as any security of the Company that is listed
on a national securities exchange registered under Section 6 of the Exchange Act
or that is quoted in a United States automated interdealer quotation system;

                        (xiii) No  registration  of the  Notes  under the Act is
required for the sale of the Notes to the Initial  Purchasers as contemplated in
this  Agreement  or for the  Exempt  Resales  (assuming  (A) that  any  Eligible
Purchaser who buys the Notes in the Exempt Resales is a Qualified  Institutional
Buyer and (B) the accuracy of the Initial Purchasers'  representations and those
of the Company in this Agreement  regarding the absence of general  solicitation
in  connection  with the Exempt  Resales);

                        (xiv)  The  Company  is  not  required  to  deliver  the
information  specified in Rule  144A(d)(4) in  connection  with the offering and
resale of the Notes by the Initial Purchasers; and


                                       18


                        (xv) Although such counsel has not undertaken, except as
otherwise indicated in their opinion, to determine  independently,  and does not
assume any  responsibility  for, the accuracy,  completeness  or fairness of the
statements  in the Offering  Memorandum,  such counsel has  participated  in the
preparation of the Offering  Memorandum,  including review and discussion of the
contents thereof, and has reviewed the Incorporated  Documents,  and, relying as
to  materiality  to a large  extent  upon the  opinions  of  officers  and other
representatives  of the  Company,  nothing  has  come to the  attention  of such
counsel that has caused them to believe that the Offering Memorandum,  as of its
date and as of the Closing Date 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 light of the circumstances under which they
were made,  not  misleading  or that any amendment or supplement to the Offering
Memorandum,  as of its respective date, and as of the Closing Date contained any
untrue statement of a material fact or omitted to state a material fact required
to be stated  therein or necessary in order to make the statements  therein,  in
light of the circumstances  under which they were made, not misleading (it being
understood  that such  counsel  need  express  no  opinion  with  respect to the
financial statements and the notes thereto and the schedules and other financial
and  statistical  data  included or  incorporated  by  reference in the Offering
Memorandum and information furnished by or on behalf of the Initial Purchasers).

                  The  opinion of such  counsel  shall be limited to the laws of
the United States, the State of New York and the internal corporation law of the
State of Delaware.

                  (d) The Initial  Purchasers shall have received on the Closing
Date an opinion of Marshall A.  Elkins,  Esq.,  General  Counsel of the Company,
dated the Closing  Date and  addressed to the Initial  Purchasers  to the effect
that:

                        (i) The  Company is duly  registered  and  qualified  to
conduct its business and is in good  standing as a foreign  corporation  in each
jurisdiction  or place where the nature of its  properties or the conduct of its
business requires such  registration or qualification,  except where the failure
so to  register  or qualify or to be in good  standing  does not have a Material
Adverse Effect;

                        (ii) All the  shares  of  capital  stock of the  Company
outstanding  prior to the  issuance of the Notes have been duly  authorized  and
validly issued, are fully paid and nonassessable;

                        (iii) Each  Subsidiary is duly  registered and qualified
to conduct its  business  and is in good  standing as a foreign  corporation  or
limited  partnership  in each  jurisdiction  or place  where  the  nature of its
properties  or the  conduct  of  its  business  requires  such  registration  or
qualification,  except  where the  failure so to register or qualify or to be in
good standing does not have a Material Adverse Effect;

                        (iv) Neither the Company nor any of the  Subsidiaries is
in violation in any material  respect of its respective  certificate or articles
of incorporation or bylaws, or other  organizational  documents,  or to the best
knowledge  of such  counsel  after  reasonable  inquiry,  is in  default  in any
material  respect in the  performance of any material  obligation,  agreement or
condition  contained  in  any  bond,  debenture,   note  or  other  evidence  of
indebtedness or in any material agreement,  indenture, lease or other instrument
to which the  Company or any of the  Subsidiaries  is a party or by which any of
them or any of their respective  properties may be bound, except as disclosed in
the  Offering  Memorandum  and except to the extent that any such  violation  or
default would not have a Material Adverse Effect;


                                       19


                        (v) Such  counsel  has no  reason  to  believe  that the
Company  and its  Subsidiaries  do not  have  all  Permits  (including,  without
limitation,  such Permits as are  necessary  under such federal and state health
care laws and under such HMO and similar  licensure laws and such insurance laws
and  regulations as are applicable to the Company and its  Subsidiaries)  as are
necessary to own,  lease and operate its  properties  and conduct its  business,
except to the  extent  that the  failure to have such  Permits  would not have a
Material  Adverse  Effect;  and to the  best  knowledge  of such  counsel  after
reasonable  inquiry there are no proceedings  pending or threatened  against the
Company  or any of its  Subsidiaries  that may  cause  any such  Permit  that is
material  to  the  conduct  of  the  business  of  the  Company  or  any  of its
Subsidiaries to be revoked, withdrawn, cancelled, suspended or not renewed;

                        (vi) Such  counsel has no reason to believe that (a) the
business  practices  of the  Company or any of its  Subsidiaries  violate in any
material  respect any  applicable  provisions  of federal or state law governing
Medicare or any state Medicaid program,  including without limitation,  Sections
1320a-7a  and  1320a-7b  of  Title 42 of the  United  States  Code,  or that any
individual  with an  ownership  or  control  interest,  as  defined in 42 U.S.C.
ss.1320a-3(a)(3),  in  the  Company  or any  of  its  Subsidiaries  or who is an
officer,  director, or managing employee as defined in 42 U.S.C.  ss.1320a-5(b),
of the Company or any of its  Subsidiaries  is a person  described  in 42 U.S.C.
ss.1320a-7(b)(8)(B),  or that (b) the  Company's  or any  Subsidiary's  business
practices  violate in any material respect any applicable  provisions of federal
or state law regarding physician  ownership of, or financial  relationship with,
or referral to entities providing health care related goods or services, or laws
requiring  disclosure of financial  interests  held by physicians in entities to
which they may refer  patients for the provision of health care related goods or
services;  and to the best knowledge of such counsel after  reasonable  inquiry,
neither the Company nor any of its  Subsidiaries  is in  violation  of any other
law, ordinance,  administrative or governmental rule or regulation applicable to
the  Company  or any of  its  Subsidiaries  or of any  decree  of any  court  or
governmental  agency or body having  jurisdiction over the Company or any of its
Subsidiaries,  except to the  extent  that any such  violation  would not have a
Material  Adverse  Effect;  and

                        (vii) Although such counsel has not  undertaken,  except
as otherwise  indicated in such counsel's opinion,  to determine  independently,
and does not  assume any  responsibility  for,  the  accuracy,  completeness  or
fairness  of the  statements  in  the  Offering  Memorandum,  such  counsel  has
participated in the preparation of the Offering  Memorandum and the Incorporated
Documents, and nothing has come to the attention of such counsel that has caused
such counsel to believe that the Offering  Memorandum,  as of its date and as of
the Closing Date,  contained an untrue  statement of material fact or omitted to
state a material  fact  required to be stated  therein or  necessary to make the
statements  therein,  in light of the circumstances  under which they were made,
not  misleading or that any amendment or supplement to the Offering  Memorandum,
as of its  respective  date,  and as of the Closing  Date  contained  any untrue
statement of a material  fact or omitted to state a material fact required to be
stated therein or necessary in order to make the statements therein, in light of
the  circumstances  under  which  they  were  made,  not  misleading  (it  being
understood  that such  counsel  need  express  no  opinion  with  respect to the
financial statements and the notes thereto and the schedules and other financial
and  statistical  data  included or  incorporated  by  reference in the Offering
Memorandum and information furnished by or on behalf of the Initial Purchasers).

                  (e) The Initial  Purchasers shall have received on the Closing
Date an opinion of Dewey Ballantine,  counsel for the Initial Purchasers,  dated
the Closing Date, and addressed to the Initial  Purchasers,  with respect to the
matters referred to in clauses (iv), (v), (vi), (xiii)


                                       20


and (xv) of the foregoing  paragraph  (c) and such other related  matters as the
Initial Purchasers may request.

                  (f)  The  Initial   Purchasers  shall  have  received  letters
addressed to the Initial  Purchasers,  and dated the date hereof and the Closing
Date from KPMG Peat Marwick LLP and Deloitte & Touche LLP, independent certified
public  accountants,  substantially  in the  forms  heretofore  approved  by the
Initial Purchasers.

                  (g) (i) There shall not have been any  material  change in the
capital  stock of the Company nor any  material  increase in the  short-term  or
long-term  debt of the Company  (other than in the ordinary  course of business)
from that set forth or contemplated in the Offering Memorandum (or any amendment
or supplement  thereto);  (ii) there shall not have been,  since the  respective
dates  as of which  information  is given  in the  Offering  Memorandum  (or any
amendment  or  supplement  thereto),  except as may  otherwise  be stated in the
Offering  Memorandum  (or any  amendment or  supplement  thereto),  any material
adverse  change in the  condition  (financial  or other),  business,  prospects,
properties,  net  worth  or  results  of  operations  of  the  Company  and  the
Subsidiaries  taken as a whole; (iii) the Company and the Subsidiaries shall not
have any liabilities or obligations, direct or contingent (whether or not in the
ordinary  course  of  business),  that  are  material  to the  Company  and  the
Subsidiaries,  taken as a whole,  other than  those  reflected  in the  Offering
Memorandum  (or  any  amendment  or  supplement  thereto);   and  (iv)  all  the
representations  and warranties of the Company contained in this Agreement shall
be true and correct in all material respects on and as of the date hereof and on
and as of the  Closing  Date as if made on and as of the Closing  Date,  and the
Initial Purchasers shall have received a certificate, dated the Closing Date and
signed by the chief executive  officer and the chief  accounting  officer of the
Company (or such other officers as are acceptable to the Initial Purchasers), to
the effect set forth in this Section  7(g) and in Section  7(h) hereof.

                  (h) The  Company  shall  not  have  failed  at or prior to the
Closing Date to have  performed or complied  with any of its  agreements  herein
contained  and required to be  performed or complied  with by it hereunder at or
prior to the  Closing  Date.

                  (i) The Initial  Purchasers  shall have received  certificates
dated the date  hereof  and the  Closing  Date  signed  by the chief  accounting
officer of the Company  substantially  in the forms  heretofore  approved by the
Initial  Purchasers,  respecting  the  Company's  compliance  with the financial
covenants set forth in each of the Company's  indentures,  the Credit  Agreement
and certain other  agreements of the Company.

                  (j)  There  shall  not  have  been  any  announcement  by  any
"nationally recognized statistical rating organization," as defined for purposes
of Rule 436(g) under the Act, that (i) it is downgrading  its rating assigned to
any class of  securities  of the  Company,  or (ii) except as  disclosed  in the
Offering  Memorandum,  it is  reviewing  its  ratings  assigned  to any class of
securities of the Company with a view to possible downgrading,  or with negative
implications,  or  direction  not  determined.

                  (k) The Notes shall have been  approved for trading on PORTAL.

                  (l) Prior to the date of this  Agreement,  the  Company  shall
have received and shall have furnished to the Initial  Purchasers  copies of the
requisite  written  consent of the lenders party to the Credit  Agreement to the
consummation  by the Company of the  transactions  contemplated by the Operative
Documents and the Offering  Memorandum.


                                       21


                  (m) The Company shall have furnished or caused to be furnished
to the Initial Purchasers such further certificates and documents as the Initial
Purchasers shall have requested.

                  All such opinions,  certificates,  letters and other documents
will be in compliance  with the  provisions  hereof only if they are  reasonably
satisfactory in form and substance to the Initial Purchasers and counsel for the
Initial Purchasers.

                  Any  certificate  or  document  signed by any  officer  of the
Company and delivered to the Initial  Purchasers,  or to counsel for the Initial
Purchasers,  shall be deemed a representation and warranty by the Company to the
Initial Purchasers as to the statements made therein.

                  8. Expenses. The Company agrees to pay the following costs and
expenses and all other costs and expenses  incident to the  performance by it of
its obligations hereunder: (i) the preparation,  printing or reproduction of the
Offering Memorandum (including financial statements thereto), and each amendment
or  supplement  thereto;  (ii)  the  printing  (or  reproduction)  and  delivery
(including postage,  air freight charges and charges for counting and packaging)
of such copies of the Offering Memorandum,  the Preliminary Offering Memorandum,
the Incorporated Documents,  and all amendments or supplements to any of them as
may be reasonably  requested for use in connection with the offering and sale of
the  Notes;  (iii)  the  preparation,  printing,  authentication,  issuance  and
delivery of certificates for the Notes,  including any stamp taxes in connection
with  the  original  issuance  and sale of the  Notes;  (iv)  the  printing  (or
reproduction)  and delivery of this Agreement,  the Indenture,  the Registration
Rights  Agreement,  the preliminary and supplemental  Blue Sky Memoranda and all
other  agreements  or  documents   printed  (or  reproduced)  and  delivered  in
connection with the offering of the Notes;  (v) the application for quotation of
the  Notes on  PORTAL;  (vi) the  qualification  of the Notes for offer and sale
under the  securities  or Blue Sky laws of the  several  states as  provided  in
Section 4(f) hereof  (including the reasonable fees,  expenses and disbursements
of counsel for the Initial Purchasers  relating to the preparation,  printing or
reproduction,  and  delivery  of  the  preliminary  and  supplemental  Blue  Sky
Memoranda and such  qualification);  (vii) the performance by the Company of its
obligations  under  the  Registration  Rights  Agreement;  (viii)  the  fees and
expenses  of the  Company's  accountants  and the fees and  expenses  of counsel
(including   local  and  special   counsel)  for  the  Company;   and  (ix)  the
transportation   and  other  expenses  incurred  by  or  on  behalf  of  Company
representatives  in connection with  presentations to prospective  purchasers of
the Notes.  The  Company  hereby  agrees that it will pay in full on the Closing
Date the fees and  expenses  referred  to in  clause  (vi) of this  Section 8 by
delivering to counsel for the Initial Purchasers on such date a check payable to
such counsel in the requisite amount.

                  9.  Effective Date of Agreement.  This Agreement  shall become
effective  upon the  execution  and delivery  hereof by all the parties  hereto.
Until  such  time as this  Agreement  shall  have  become  effective,  it may be
terminated  by the  Company,  by  notifying  the Initial  Purchasers,  or by the
Initial  Purchasers,  by notifying the Company.

                  Any  notice  under  this  Section 9 may be given by  telegram,
telecopy or telephone but shall be subsequently confirmed by letter.

                  10. Default by an Initial Purchaser.  If any Initial Purchaser
shall fail or refuse to purchase  the Notes which it is obligated to purchase on
the Closing Date, and arrangements  satisfactory to the  non-defaulting  Initial
Purchasers and the Company for the


                                       22


purchase of such Notes by the  non-defaulting  Initial  Purchasers or by another
party or parties  satisfactory to the non-defaulting  Initial Purchasers and the
Company  are not made within  thirty-six  (36) hours  after such  default,  this
Agreement shall terminate  without  liability on the part of the  non-defaulting
Initial  Purchasers  or the  Company.  In any such case which does not result in
termination of this Agreement,  either the non-defaulting  Initial Purchasers or
the Company shall have the right to postpone the Closing  Date,  but in no event
for longer than seven (7) days, in order that the required  changes,  if any, in
the Offering  Memorandum or any other documents or arrangements may be effected.
Any action taken under this  paragraph  shall not relieve a  defaulting  Initial
Purchaser  from liability in respect of such default under this  Agreement.  The
term "Initial Purchaser" as used in this Agreement includes, for all purposes of
this  Agreement,  any party not identified in this Agreement who purchases Notes
which a defaulting  Initial  Purchaser is  obligated,  but fails or refuses,  to
purchase.

                  11. Termination of Agreement.  This Agreement shall be subject
to termination  in the absolute  discretion of the Initial  Purchasers,  without
liability on the part of the Initial Purchasers to the Company, by notice to the
Company, if prior to the Closing Date (i) trading in securities generally on the
New York Stock  Exchange,  American Stock Exchange or the Nasdaq National Market
shall have been suspended or materially  limited,  (ii) a general  moratorium on
commercial  banking  activities  in New York shall have been  declared by either
Federal or state authorities, or (iii) there shall have occurred any outbreak or
escalation of hostilities or other international or domestic calamity, crisis or
change in political,  financial or economic  conditions,  the effect of which on
the  financial  markets  of the  United  States  is such as to make  it,  in the
judgment of the Initial Purchasers,  impracticable or inadvisable to commence or
continue  the  offering of the Notes on the terms set forth on the cover page of
the Offering  Memorandum or to enforce  contracts for the resale of the Notes by
the Initial  Purchasers.  Notice of such termination may be given to the Company
by  telegram,  telecopy or  telephone  and shall be  subsequently  confirmed  by
letter.

                  12.  Information  Furnished  by the  Initial  Purchasers.  The
statements set forth in the stabilization  legend on the inside front cover, the
last paragraph on the cover page and in the third and seventh  paragraphs  under
the caption "Plan of  Distribution" in the Preliminary  Offering  Memorandum and
Offering Memorandum,  constitute the only information  furnished by or on behalf
of the Initial  Purchasers as such  information  is referred to in Sections 5(b)
and 6  hereof,  except  that  each of Smith  Barney  Inc.,  Donaldson,  Lufkin &
Jenrette Securities Corporation and Citicorp Securities,  Inc. has furnished the
information  relating to them  contained in the eighth  paragraph,  and Citicorp
Securities, Inc. has furnished the information contained in the ninth paragraph,
under the caption "Plan of Distribution"  contained in the Preliminary  Offering
Memorandum and the Offering Memorandum.

                  13. Miscellaneous. Except as otherwise provided in Sections 4,
9 and 11 hereof,  notice given pursuant to any provision of this Agreement shall
be in writing and shall be delivered (i) if to the Company, at the office of the
Company at 10065 Red Run Boulevard,  Owings Mills, MD 21117, Attention:  General
Counsel, with a copy to Fulbright & Jaworski L.L.P., 666 Fifth Avenue, New York,
NY 10103, Attention:  Roy L. Goldman, Esq. or (ii) if to the Initial Purchasers,
to Smith Barney Inc.,  388  Greenwich  Street,  New York,  NY 10013,  Attention:
Manager,  Investment  Banking Division,  with a copy to Dewey  Ballantine,  1301
Avenue of the Americas, New York, NY 10019, Attention: Frederick W. Kanner, Esq.

                  This  Agreement has been and is made solely for the benefit of
the Initial  Purchasers,  the  Company,  its  directors,  its  officers  and the
controlling  persons  referred  to in  Section  6 hereof  and  their  respective
successors and assigns, to the extent provided herein, and


                                       23


no other  person  shall  acquire  or have any  right  under or by virtue of this
Agreement. Neither the term "successor" nor the term "successors and assigns" as
used in this Agreement shall include a purchaser from the Initial  Purchasers of
any of the Notes in his status as such purchaser.

                  14.  Applicable  Law;  Counterparts.  This Agreement  shall 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
without  giving  effect to the  choice of laws or  conflict  of laws  principles
thereof.

                  This  Agreement  may be signed in various  counterparts  which
together constitute one and the same instrument. If signed in counterparts, this
Agreement  shall not become  effective  unless at least one  counterpart  hereof
shall have been executed and delivered on behalf of each party hereto.


                                       24



                  Please  confirm that the  foregoing  correctly  sets forth the
agreement between the Company and the Initial Purchasers.



                                            Very truly yours,

                                            INTEGRATED HEALTH SERVICES, INC.


                                            By: /s/ Eleanor J. Harding
                                               ---------------------------------
                                            Name:  Eleanor J. Harding
                                            Title: Executive Vice President-
                                                   Finance


Accepted in New York, New York

September 8, 1997


Confirmed as of the date first above mentioned.

SMITH BARNEY INC.
MORGAN STANLEY & CO. INCORPORATED
DONALDSON, LUFKIN & JENRETTE
  SECURITIES CORPORATION
CITICORP SECURITIES, INC.

By:   SMITH BARNEY INC.



By:  /s/ Benjamin R. Lorello
     -------------------------------
     Name: Benjamin R. Lorello
     Title: Managing Director

                                      II






                                   SCHEDULE I


                        INTEGRATED HEALTH SERVICES, INC.



                                                                Principal Amount
Initial Purchaser                                                   of Notes
- -----------------                                               ----------------

Smith Barney Inc.........................................         $250,000,000

Morgan Stanley & Co. Incorporated........................          100,000,000

Donaldson, Lufkin & Jenrette
  Securities Corporation.................................           75,000,000

Citicorp Securities, Inc.................................           75,000,000
                                                                  ------------
Total....................................................         $500,000,000
                                                                  ============


                                       


                                   SCHEDULE II
                                   -----------



========================================================================================================================
                                                   STATE OF                            STATE(S)
                     COMPANY                    INCORPORATION                 QUALIFIED TO DO BUSINESS
- ------------------------------------------------------------------------------------------------------------------------
                                                                               
HEALTH CARE INDUSTRIES                             Florida
- ------------------------------------------------------------------------------------------------------------------------
IHS ACQUISITION XX, INC.                           California
- ------------------------------------------------------------------------------------------------------------------------
IHS NETWORK SERVICES, INC.                         Delaware                          Florida
- ------------------------------------------------------------------------------------------------------------------------
INTEGRATED HEALTH SERVICES OF           
KURT, INC.                                         Delaware                          Washington
- ------------------------------------------------------------------------------------------------------------------------
SYMPHONY RESPIRATORY SERVICES, INC.                Delaware                          Arkansas
                                                                                     Arizona
                                                                                     California
                                                                                     District of Columbia
                                                                                     Florida
                                                                                     Georgia
                                                                                     Idaho
                                                                                     Illinois
                                                                                     Indiana
                                                                                     Iowa
                                                                                     Kentucky
                                                                                     Louisiana
                                                                                     Maine
                                                                                     Maryland
                                                                                     Michigan
                                                                                     Minnesota
                                                                                     Missouri
                                                                                     Mississippi
                                                                                     North Carolina
                                                                                     Nebraska
                                                                                     New Hampshire
                                                                                     New Jersey
                                                                                     New York
                                                                                     Ohio
                                                                                     Oklahoma
                                                                                     Pennsylvania
                                                                                     South Carolina
                                                                                     Tennessee
                                                                                     Texas
                                                                                     Virginia
                                                                                     Wisconsin
                                                                                     West Virginia
                                                                                     Wyoming
- ------------------------------------------------------------------------------------------------------------------------
TEXAS LPC, INC.                                    Texas
- ------------------------------------------------------------------------------------------------------------------------
WEST COAST CAMBRIDGE, INC.                         California
- ------------------------------------------------------------------------------------------------------------------------
WOODRIDGE CONVALESCENT CENTER, INC.
CENTER, INC.                                       Texas
========================================================================================================================