I worked at another medical device manufacturer. Often, they will "buy" a company they actually staked in the first place. The medical device company wants to develop a new technology or device, so what they do is give money to a startup that barely has an idea, and sends management over there to keep track of things. They'll see if the device pans out, then "buy" the company and integrate the device's manufacturing and design into their own system once the FDA approves the device. Then, they just keep it on life support for several decades, making as few changes as possible to prevent the need to redo FDA certifications.

There’s also a clear sense that software quality is absolutely not a priority. The sense that software quality is explicitly set as not a priority.

For instance, I think I can confidently say that lessons learned from previous software stacks are not accumulated and applied to improve subsequent ones.

I’d like to add that I believe the individual developer is doing their best. It’s in the decision-making layer.