Department  of  Health  and  Human  Services 

OFFICE  6F  . 
~ 
INSPECTOR  .GENERAL 
HOSPITAL  CLOSURE:  1990 
Richard  P.  Kusserow 
INSPECTOR  GENERAL  OFFICE  OF INSPECTOR  GENERAL 
The  mission of  the Office  of Inspector  General  (OIG),  as mandated  by Public  Law  95452,  as 
amended,  is to protect  the integrity  of the Department  of Health  and Human  Services  (HHS) 
programs  as well  as the health  and welfare  of beneficiaries  served by those programs.  This 
statutory  mission  is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the Office  of Audit  Services, the 
Office  of Investigations,  and the Office  of Evaluation  and Inspections.  The  OIG  also informs 
the Secretary  of HHS  of program,  and management  problems,  and recommends  courses to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGs  Office  of Audit  Services (OAS)  provides  all auditing  services for  HHS,  either  by 
conducting  audits with  its own  audit  resources or by overseeing  audit  work  done  by others. 
Audits  examine  the performance  of HHS. programs  and/or  its grantees  and contractors  in 
carrying  out  their  respective  responsibilities  and are intended  to provide  independent 
assessments of HIIS  programs  and operations  in order  to reduce  waste,  abuse, and 
mismanagement  and to promote  economy  and efficiency  throughout  the Department. 
OFFIa  OF -TIGATIONS 
The  OIGs  Office  of Investigations  (01)  conducts  criminal,  civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penalties.  The  01  also oversees State  Medicaid  fraud 
control  units which  investigate  and prosecute  fraud  and patient  ahuse in the  Medicaid  program. 
OFFICE  OF EVALUATIONAND  INSPECIIONS 
The  OIGs  Office  of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and 
program  evaluations  (called  inspections)  that  focus on issues of concern  to the Repartment, 
the Congress,  and the public.  The  findings  and recommendations  contained  in these inspection 
reports  generate  rapid,  accurate,  and up-to-date  information  on the efficiency,  vulnerability, 
and effectiveness  of departmental  programs. 
OEIs  Atlanta  Regional  Office  staff prepared  this report  under  the direction  of Jesse J. 
Plowers,  Regional  Inspector  General  and Christopher  Koehler,  Deputy  Regional  Inspector 
General.  Principal  OEI  staff included: 
Atlanta  Region  Headquarters 
Ron  Kalil,  Project  Leader  Cathaleen  Ahem 
Maureen  Wilce  Linda  Moscoe 
Paula Bowker  EXECUTIVE  SUMMARY 
PURPOSE 
To descriie  the extent, nature, reasons for, and impact of hospital closure in 1990. 
BACKGROUND 
The closure of hospitals in recent years has generated increasing public and congressional 
concern.  According to a number of recent studies, more hospitals are expected to close 
in coming years.  Numerous questions have been raised about the reasons for and the 
impact of hospital closure, as well as the implications for public policy. 
At  the request of.the Secretary of the Department  of Health  and Human Services,the 
Office of Inspector General (OIG)  prepared a report in May 1989 describing the 
nationwide phenomenon of hospital closure in 1987. The Secretary then asked the 
Inspector General to continue analysis of hospital closure to determine trends and effects 
of the phenomenon.  We issued a report  on 1988 hospital closures in April  1990 and a 
report  on 1989 closures in January 1991. 
The findings from the OIG  1987, 1988 and 1989 studies were similar.  The hospitals that 
closed were small and had low occupancy rates.  When the hospitals closed, few patients 
were affected.  Most could get medical care nearby. 
FINDINGS   
Our inspection of hospital closures in 1990 produced findings similar to those previously 
reported for  1987, 1988, and 1989. 
Fifty-six general, acute care hospitals closed -- 20 fewer than in 1989. Twenty-
b 	
eight of the closed hospitals were rural; 28 were urban.  They were located in 26 
States. Seven new hospitals opened, and 2 hospitals that closed prior  to 1990 
reopened in 1990. 
Closed hospitals in both rural and urban areas were much smaller than the 
b 	
national averages. Rural hospitals that closed were less than half the size of the 
average rural hospital nationwide (38.8 beds vs. 82.5 beds).  Urban hospitals that 
closed were much smaller than the average urban hospital nationwide (93.1 beds 
vs. 245.1 beds). 
Occupancy rates for closed rural and urban hospitals were much lower than the 
b 	
national averages. Rural hospitals that closed had an average occupancy rate of 
23.5 percent compared to an average 38.6 percent for all rural hospitals 
i  nationally.  Urban hospitals that closed had an average occupancy rate of 30.5 
percent compared to an average 56.6 percent for all urban hospitals nationally. 
The average Medicare utilization  among hospitals that closed was slightly lower in 
b 	
rural  areas than the national average for rural hospitals (48.4 percent vs. 51.2 
percent).  In urban areas, the average Medicare utilization  among hospitals that 
closed was higher than the national average for urban hospitals (50.7 percent vs. 
44.8 percent). 
The average Medicaid utilization  among hospitals that closed was slightly higher in 
b 	
rural  areas than the national average for rural hospitals (12.3 percent vs. 10.6 
percent).  Minimal  differences existed in the average Medicaid utilization  among 
urban hospitals that closed and urban hospitals nationally. 
The reasons for hospitals closing in 1990 were similar to those,reported for 
b 	
hospitals closing in 1987, 1988 and 1989. Hospitals closed because of the 
interrelated  factors of declining occupancy, lagging revenues and rising costs. 
Hospital viability  depends on the stability of all three factors.  The weakening of 
one may begin a chain reaction eventually leading to hospital closure. 
Although  residents in a few communities had to travel greater distances for 
b 	
hospital care, emergency and inpatient medical care is available within  20 miles 
for most communities where hospitals closed. 
At  the time of our review, 31 of the 56 closed hospital facilities (55 percent) were 
b 	
being used, primarily  for health-related services. Also plans were being made for 
using 8 of the remaining 25 vacant hospitals for health-related services. 
ii  TABLE  OF  CONTENTS 
EXECUTIVESUMMARY  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  i 

LNTRODUCTION...................................................  I 

FINDINGS 
Extent and Nature of Hospital  Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

How Many Closed? ........................................  3 

Where Were They?  ..............  T..........................  3 

How Many Opened?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 

What Were the Closed Hospitals Like?  . . . . . . . . . . . . . . . . . . . . . . . . . 4 

Why Did They Close?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7 

Impact of Hospital  Closure  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

How Many Patients Were Affected?  . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Are  Inpatient  Care and Emergency 

Setices  Available?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

What Is the Building  Used For Now?  . . . . . . . . . . . , . . . . . . . . . . . . .  10 

Summary ....................................................  11 

ENDNOTES  ......................................................  12 

APPENDIXES 
Appendix A:  Methodology  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-l 
Appendix  B:  Number of Hospital Closures by State . . . . . . . . . . . . . . . . . . .  B-l 
Appendix  C:  Number of Hospital Closures by 
Name and Location  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  C-l  INTRODUCTION 
PURPO!SE 
To describe the extent, nature, reasons for, and impact of hospital closure in 1990. 
This report  is a follow-up  to the recent Office of Inspector General (OIG)  studies 
entitled  Hospital  Closure: 1987 (OAI-04-89-00740), issued in May 1989, Hospital 
Closure: 1988 (OEI-04-89-01810), issued in April  1990 and Hospital  Closure: 1989 
(OEI-04-90-02440), issued in January 1991. 
This study was requested by the Secretary of the Department  of Health  and Human 
Semices. 
BACKGROUND 
In the past several years, the closure of general, acute care hospitals has generated 
increasing public and congressional concern.  According to a number of recent studies, 
more hospitals are expected to close in coming years.  Numerous questions have been 
raised about the reasons for and the impact of hospital closure, as well as implications 
for public policy. 
At  the request of the Secretary of the Department  of Health  and Human Services 
(HI%),  the OIG  released an inspection in May 1989 describing the extent, nature and 
impact of hospital closure in 1987 in the United  States. That study showed that 69 
hospitals closed in 1987. The results were presented to the Secretary, the Assistant 
Secretaries of HI-IS, and staff of the Health  Care Financing Administration  (HCFA)  and 
the Public Health Service (PHS).  The Inspector General testified before the U.S. House 
Ways and Means Subcommittee on Health regarding the study findings.  Many of those 
informed  of the study of 1987 hospital closures encouraged the Inspector General to 
continue analysis of the phenomenon to detect differences in the rate of hospital closure 
and in the characteristics and circumstancesof hospitals that close. 
Similar inspections of 1988 hospital closures and 1989 hospital closures showed that 88 
and 76 hospitals closed respectively. 
The findings from the 1987, 1988 and 1989 studies were similar.  The hospitals that 
closed were small and had low occupancy rates.  When the hospitals closed, few patients 
were affected.  Most could get medical care nearby. 
1 
 SCOPE 
We examined hospitals that closed in calendar year 1990. 
For purposes of this study, the following definitions were used. 
Hospital:  A facility  that provides general, short-term, acute medical and surgical 
inpatient  services. 
Closed Hospital:  One that stopped providing general, short-term, acute inpatient 
servicesin 1990. If  a hospital merged with or was sold to another hospital and the 
physical plant closedfor inpatient  acute care, it was considered a closure.  If  a hospital 
both closed and reopened in 1990, it was not considered a closure.  If  a hospital closed in 
1989, reopened in  1990, and closed again in 1990, it was counted as a closure for  1989 
but not again in 1990. 
METHODS 
To determine the extent and nature of hospital closure, we obtained information  from 
HCFA  data bases. To determine reasons for and impact of hospital closure, we 
interviewed State hospital associations,State licensing and certification  agencies,State 
health planning agencies,officials associatedwith closed and nearby hospitals, and local 
public officials. 
Appendix A describes information  collection methods in further  detail. 
. 
2 
 FINDINGS 
The Inspector Generals study of hospitals closed in 1990 showed that: 
Fifty-six general, acute care hospitals closed in 1990. Twenty fewer hospitals 
a 	
closed in 1990 than in the previous year. 
Most hospitals that closed were small and had low occupancy rates. 
a 
When a hospital closed, few patients were affected. 
a 
Although  residents of a few communities had to travel greater distances, most had 
l 
emergency and inpatient  medical care available within  20 miles of the closed 
hospital. 
EXTENT  AND  NATURE  OF  HOSPITAL  CLOSURE 
How  Many  Clad? 
In  1990, there were more than 6,800 hospitals in the United  States. Of those, 5,466 were 
general, short-term, acute care hospitals entered on HCFAs  data base as participating  in 
the Medicare program.  Fifty-six (56) hospitals closed in 1990 -- 1 percent of all hospitals 
nationally.  Twenty fewer hospitals closed in 1990 than in the previous year. 
II 
HOSPlTALS  IN  THE  U.S.:  5,466 
CLOSEDIN1990:  56  (1.0%)  H 
When they closed, the general, acute care inpatient bed supply was reduced by 3,694 
beds, or 0.4 percent. 
. 
WhereWmW? 
The closed hospitals were located in 26 States. The greatest number of closures was in 
Texas (lo),  followed by California  (7), Massachusetts(4), and.Louisiana (4).  These4 
States represented 45 percent of the closures. Thirteen States had one closure each. 
Appendix B lists the 1990 closures by State. 
3 
 One percent of all rural hospitals nationally closed in 1990. Similarly,  1 percent all urban 
hospitals nationally  closed in 1990. 
RURAL  URBAN 
HOSPITALS  IN  THE  U.S.:  5667  5799 
CLOSEDIN1990:  28 (1.0%)  28 (1.0%) 
How  M&y  Opened? 
While 56 hospitals closed in 1990, 7 new, general, acute care hospitals opened, adding 
700 beds to the national supply of beds. 
In addition  to the new openings during 1990, 2 hospitals that closed prior  to 1990 
reopened in 1990, adding another 61 beds. 
what  Wen  the  Closed  Hqitalr  Like? 
a: 	 Hospitals that closed in 1990were small.  More  than three-quarters had fewer than 
100 beds. 
SIZE  OF  CLOSED  HOSPITALS 
Closed hospitals in both rural and urban areas were much smaller than the national 
averages. Rural hospitals that closed were less than half the size of the average rural 
hospital nationwide (38.8 beds vs. 82.5 beds).  Urban hospit&  that closed were even 
smaller than the average urban hospital nationwide (93.1 beds vs. 245.1 beds). 
. 
4 
 HOSPITALS  THAT  CLOSED 
WERE  SMALL 
4 or Beda 
300  -- 
245.1 
/  I 
250  -
200  -
150  -
100  -
so  -
O
RURAL  HbSPlTALS  URBAN  HOSPITALS 
m 
Natlonal  Avg  m  Closed  Hospital  Avg 
OccuDan~:  Occupancy rates for closed rural and urban hospitals were much lower than 
the national average. 
GCCUPANCY  RATES  WERE  LOW 
70%-
S0.6X
60%- /  n 
so%
RURAL  l-&iP  ITALS  URBAN  ti.SP  ITALS 
m  Natlonal  Ava  a  CIOBI  l-los~ltal  AW 
. 
5 
 . 
Medicare  Utilization:  In  rural  areas, the average Medicare utilization  among hospitals 
that closed was slightly lower than the rural national average (48.4 percent vs. 51.2 
percent).  In urban areas, the average MediCare utilization  among hospitals that closed 
was higher than the urban national average (50.7 percent vs. 44.8 percent).2 
MEDICARE  UTILIZATION 
50%  -
40%-
30%  -
20%  -
10%  -
R  RURAL  HbSPITALS  URBAN  HOSPITALS 
- Natlonml  Avg  m  Cloord  lioopltal  Awl 
Medicaid  Utilization:  In rural areas, the average Medicaid utilization  among hospitals 
that closed was slightly higher than the rural national average (12.3 percent vs. 10.6 
percent).  Minimal  differences existed in the average Medicaid utilization  among urban 
hospitals that closed and all urban hospitals nationally? 
MEDICAID  UTILIZATION 
14x 
12% 
10% 
. 
BX 
8% 
4x 
2% 
0% 
RURAL  IIOSPITALS  URlAN  nbsPlrALs 
6 
 ?VhyDidl%eyChe? 
As in our previous hospital closuie studies, the many health care professionals 
interviewed for  1990 closures reported no single reason for hospital closure.  Hospitals 
close because of the interrelated  factors of declining occupancy, lagging revenues and 
rising costs. Hospital  viability was said to depend on the stability of all three factors. 
The weakening of one may begin a chain reaction eventually leading to hospital closure. 
Rising 
costs 
L 	
declining 
Revenues 
IMPACI  OF HOSPlTAL  CLOSURJZ 
In communities where hospitals closed in 1990,we assessedthe: 
number of patients affected by closure of hospitals; 
a 
availability of inpatient  care and emergency medical services;and 
l 
current use of the closed hospital facility. 
l 
How  Marry  Parierzrs, Were Affix&d? 
Few patients were affected by hospital closure.  For rural hospitals that closed in 1990, 
the average daily censusin the year prior to closure was nine patients.  The urban 
hospitals had an average daily censusof 28 patients. 
. 
7 
 WHEN  HOSPITALS  CLO!ED, 
HOW  MANY  PATIEN?s  WERE  AFFECYJYED? 
Rural Hospitals  Urban Hospitals 
Average Number of Beds  38.8  93.1 
Average Occupancy Rate  x 23.5%  x 30.5% 
Average Patient Census  9.1  28.4 
i 
We analyzed Medicare utilization  data to determine the number of elderly patients 
affected by hospital closure in 1990. In rural hospitals that closed, four Medicare 
patients were in the hospital on an average day in the year prior  to closure.  In the urban 
hospitals that closed, there were 14 Medicare patients on an average day. 
Average Patient Census  9.1  28.4 
Average Medicare Utilization  Rate  x 48.4%  x 50.7% 
* 
Are  Inpatient  Care  and  Emeqpcy  Services Available? 
We assessedavailability of inpatient  and emergency medical care in miles from closed 
-hospitalsto the nearest inpatient  and emergency facilities. 
Inpatient  Care:  In most communities where a hospital closed in 1990, inpatient  hospital 
care was available nearby. 
Rural: 	 Residents in 18 of the 28 rural communities where.a hospital closed could 
get inpatient  care within  20 miles of the closed hospital. 
Residents of 3 rural communities had to travel more than 30 miles for 
inpatient  care. 
Urban: 	 In all but 2 of the 28 urban communities where a hospital closed in 1990, 
inpatient  care was available within  10 miles of the closed hospital. 
8 
 NEAREST  INPATIENT  CARE  TO CLOSED  HOSPITALS 
NUMBER  OF CLOSED 
HOSPITALS 
DISTANCE  Rural  Urban 
Within  10 miles  9 (32%)  26 (93%) 
11-20 Miles  9 (32%)  2  (7%) 
21-30 Miles  7 (25%)  0  (0%) 
More  than 30 Miles  3 (11%)  0  (0%) 
Totals  28 (100%)  28 (100%) 
EmerPencv Services: When a hospital closed, the community lost not only inpatient beds, 
but also emergency services. 
Rural: 	 In all 28 communities where rural hospitals closed, emergency care facilities 
were available within 30 miles of closed hospitals. 
In all but 4 of the 28 rural communities where hospitals closed, emergency 
care facilities were available within  20 miles of the closed hospital.  In those 
four communities, ambulance servicesand physician serviceswere available.
I 
NEAREST  EMERGENCY  SERVICES TO CLOSED  RURAL  HOSPITALS 
NUMBER  OF CLOSED 
DISTANCE  HOSPITALS  . 
a 
Same Town  8 
Within  10 miles  6 
1l-20 miles  10 
21-30 miles  4 
More  than 30 miles  0 
Total  28 
. 
9 
 Urban: 	 In all but 4 urban communities where a hospital closed, emergency care 
facilities were less than 5 miles from the closed hospital.  In 3 of those 4 
communities, emergency care facilities were within  10 miles from the closed 
hospital.  Residents of the fourth community, Buna, Texas, must travel 15 
miles for emergency care.  That community has physician servicesand 
ambulance servicesavailable. 
What  I;r the Building  Used For  Now? 
At the time of our review, 31 of the 56 closed hospital buildings (55 percent) were being 
used, primarily  for health-related services. For example: 
McCone County Hospital  in Circle, Montana was converted to a Medical 
b 	
Assistance Facility.  It provides 24-hour emergency services,outpatient  care and 
up to 4 days of inpatient  care. 
Holden Hospital  in Holden, Massachusettswas converted to an urgent care 
center. 
Sardis Community Hospital in Sardis, Mississippi and Iola Hospital  in Iola, 
b 	
Wisconsin became nursing homes, 
Westland Medical Center in Westland, Michigan offers. substance abuse and 
b 	
psychiatric servicesin the former hospital building. 
The following chart illustrates the use of all 56 .hospital facilities after closure in 1990. 
USE  OF  CLOSED  HOSPITALS 
Use of Building  Number of Former Hospitals* 
Rural  Urban 
Specialty Treatment  Facility 
(e.g. chemical dependency) 
Long Term Care Facility 
II 
Outpatient  Services/Clinic  7 
II 
Offices 
II 
Social Services 
10 
 Plans were being made for using 8 of the remaining 25 vacant hospitals for health-related 
services. For example, Modesto City Hospital in Modesto, California  will be converted 
to a Rehabilitation  hospital.  Plans were being made for two of the closed facilities to 
reopen as acute care hospitals. 
Fifty-six hospitals closed in 1990 - 20 fewer than in 1989. Their  characteristics were very 
similar to hospitals that closed in 1987, 1988 and 1989. Most hospitals that closed in 
1990 were small and had low occupancy. When a hospital closed, few patients were 
affected.  Although  residents of a few communities had to travel greater distances for 
hospital care, most had emergency and inpatient  medical care available within  20 miles of 
the closed hospital. 
11 
 ENDNOTES 

1. 	 Hospital  occupancy rate is defined as the actual number of patient days divided by 
the total bed days available.  National occupancy rate is defined as the sum of all 
hospitals occupancy rates, divided by the number of hospitals. 
2. 	 Average Medicare utilization  of closed urban and rural hospitals is defined as the 
percent of Medicare patient days compared to the total patient days for each 
hospital, summed and divided by the number of hospitals.  National  average 
Medicare utilization  is the percent of Medicare utilization  of each hospital, 
summed and divided by the total number of hospitals. 
3.  Medicaid utilization  is calculated in the same way as Medicare utilization. 
. 
12 
 APPENDIX  A 

METHODOLOGY 
Extent and N-e  of Hosphl  Chnue 
To determine how many hospitals closed in 1990,we contacted all 50 State licensing and 
certification  agencies. We also contacted State hospital associationsand State health 
planning agencies. When a closed hospital met the studys definition  or when there were 
questions, we contacted officials associatedwith the closed hospitals and officials 
associatedwith hospitals nearest to the closed hospital. 
To determine the number of hospitals in the United  States, we used the Hospital  Cost 
Report  Information  System (HCRIS)  maintained by the Health  Care Financing 
Administration  (HCFA).  We included only the general, short-term, acute care hospitals 
under Medicares Prospective Payment System (PPS) in the universe.  There were 5,466 
hospitals listed on HCRIS  as short-term, acute care, general hospitals for the sixth year 
of PPS (PPS 6). 
To analyze characteristics of closed hospitals, we used HCFAs  HCRIS  data:  We used 
the latest pre-closure cost reports.  For example, if a hospital closed in May 1990 and its 
accounting year was on a January-December cycle, we used the providers January 1, 
1989 to December 31, 1989 report. 
. 
We contacted officials of the following organizations to determine the reasons for  1990 
hospital closure: 
b  State hospital associations 
b  State health planning agencies 
b  State certification  and licensing agencies 
b  Closed hospitals 
b  Nearest hospitals to closed hospitals 
Impact  of Hmpikzl  Clbswe 
We limited  our impact analysis to distance from a closed hospital to the nearest still-
operating hospitals and to emergency services. We obtained data for our analysis from 
the following sources: 
. 
A -1 
 Former hospital administrators, board members, and/or staff of closed hospitals 

b 
b  Hospital  administrators and/or staff at the nearest hospitals 

b  Local police and health officials 

b  Local government officials 

b  State health planning agencies 

b  State certification  and licensing agencies 

State hospital associations 

a 
A -2 
 APPENDIX  B 
II 
State  Total  Closures  I  Rural Closures  1  Urban  Closures  II 
II 

II  II 

Massachusetts 
II  II 

Arkansas 
II 
2 
II  II 
Florida 
II~~  II 
Illinois
II  II 
Michigan  2 
II 
11  New Y&k  2  2 
II  II 
Oklahoma  2 
II  II 
Washington  2 
II 
Alabama  1 
Mississippi 

Montana 

New Hampshire 

New Mexico 

Nevada 

Ohio 

Oregon 

Vermont 

Wisconsin 

West Virginia 

26 States 

B-l  APPENDIX  C 
1990 HO!SPITAL CLOSURES BY NAME  AND  LOCATION 
Rural/ 
Hospital Name  City  State  Urban 
Clebume Community Hospital  and 
Nursing Home  Heflin  rural 
Buffalo  Island Hospital  Manila  rural 
Dermott-Chicot  Memorial  Hospital  Dermott  rural 
Valley View Community Hospital  Youngstown  AZ  urban 
Ranch0 Encino Hospital  Encino  CA  urban 
Community Hospital  of Salinas  Salinas  CA  urban 
Mendocino Community Hospital  Ukiah  CA  rural 
Modesto City Hospital  Modesto  CA  rural 
Fowler Community Hospital  Fbwler  CA  urban 
AM1 Community Hospital 
of Santa Cruz  Santa Cruz  CA  urban 
Marina Hills Hospital  Los Angeles  CA  urban 
Washington County Public Hospital  Akron  co  rural 
La Plata Community Hospital  Durango  co  rural 
Centro Asturiano  Hospital  Tampa  FL  urban 
North Miami  Medical Center    Miami  FL  urban 
Physiciansand Surgeons Hospital  Atlanta  GA  urban 
Atlanta  Hospital  .  Atlanta  GA  urban 
Community Memorial  Hospital  Postville  IA  rural 
Central Community Hospital  Clifton  IL  urban 
Douglas County Jarman 
Memorial  Hospital  Tuscola  rural 
Rayne-Branch Hospital  Rayne  rural 
E.S. Pike Memorial  Hospital  Kentwood  rural 
St. Luke General Hospital  Arnaudville  rural 
Plaquemines Parish General Hospital  Port Sulpher  rural 
Holden Hospital  Holden  urban 
Hunt  Hospital  Danvers  urban 
MassachusettsOsteopathic Hospital 
and Medical Center  Boston  urban 
St. Lukes Hospital of Middleborough  Middleboro  urban 
Westland Medical Center  Westland  MI  urban 
Northwest General Hospital  Detroit  MI  urban 
C-l  1990 HOSPITAL  CLOSURES BY NAME  AND  LOCATION  (cent) 
Rural/ 
Hospital Name  City  State  Urban 
Sardis Community Hospital  and 
Nursing Home  Sardis  MS  rural 
McCone County Hospital  Circle  rural 
Newport Hospital  Newport  rural 
Valencia Presbyterian Hospital  Belen  rural 
Incline Village Community Hospital  Incline Village  urban 
Tioga Community Hospital  Waverly  urban 
Adirondack Regional Hospital  Corinth  NY  urban 
St. John Hospital  Cleveland  OH  urban 
Hominy City Hospital  Hominy  OK  urban 
Doctors General Hospital  Oklahoma City  OK  urban 
St. Helens Hospital  and 
Health  Center  St. Helens  OR  rural 
Hico Community Hospital  Hico  TX  rural 
Corpus Christi Osteopathic Hospital  Corpus Christi  TX  urban 
Charles R. Drew Medical Center  Houston  TX  urban 
E.L. Graham Memorial  Hospital  Cisco  TX  rural 
Ranger General Hospital  Ranger  TX.  .  rural 
Burleson Memorial  Hospital  Caldwell  TX  rural 
Harris Methodist - Dublin  Dublin  TX  rural 
David Granberry Memorial  Hospital  Naples  TX  rural 
Buna Medical Center Hospital,  Buna  TX  urban 
Hubbard Hospital  Hubbard  TX  rural 
Rockingham Memorial  Hospital  Bellows Falls  VT  rural 
West Seattle Community Hospital  - Seattle  WA  urban 
Saint Cabrini Hospital  of Seattle  Seattle  WA  urban 
Iola Hospital  Iola  WI  rural 
Wyoming General Hospital  Mullens  rural 
c-2