HOSPITAL  CLOSURE:  1988 

Richard  I? Kusserow 
INSPECTORGENERAL 
OEl-O4-89-01810  MARCH  1990 
 OFFICE OF INSPECTOR  GENERAL 
The mission of the Office of Inspector General (OIG) is to promote the efficiency, effective
ness,and integrity of programs in the United StatesDepartment of Health and Human Ser
vices (HHS).  It does this by developing methods to detect and prevent fraud, waste, and 
abuse. Created by statutein 1976, the Inspector General keeps both the Secretaryand the Con
gressfully  and currently informed about programs or management problems and recommends 
corrective action.  The OIG performs its mission by conducting audits, investigations, and in
spections with approximately 1,400 staff strategically located around the country. 
OFFICE OF EVALUATION  AND INSPECTIONS 
This report is produced by the Office of Evaluation and Inspections (OEI), one of the three 
major offices within  the OIG.  The other two are the Office of Audit Servicesand the Office of 
Investigations.  Inspections are conducted in accordancewith professional standardsdevel
oped by OEI.  These inspections are typically  short-term studies designed to determine pro-
gram effectiveness,efficiency; and vulnerability  to fraud and abuse. 
The purpose of this inspection, entitled Hospital  Closure: 1988, is to describe the phenome
non of hospital closure in the United States. 
This inspection was performed under the direction of Linda Herzog, the Regional Inspector 
General of the Region IV Office of Evaluation and Inspections. Participating in the project 
were: 
Atlanta  Region  Headquarters 
Ron Kalil, Project Leader 
 CathaleenAhem 
Jim Wilson 
 Linda Moscoe 
Peggy Daniel 

JeanDufresne 

Ruth Reiser 

Doug Marshall 

Joe Townsel 

Betty Davis 

Chris Koehler 

Art Jones,Ph.D. 

JosephPatterson 

Liz Roper 
 EXECUTIVE  SUMMARY 

PURPOSE 
This report describes the phenomenon of hospital closure in the United States. It examines the 
characteristicsof, reasonsfor, and impact of closures in 1988, and compares hospitals closed 
in 1988 with those closed in 1987. 
BACKGROUND 
The closure of hospitals in recent years hasgeneratedincreasing public and congressional 
concern. At the request of the Secretaryof 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 Secretarythen asked the Inspector General to 
continue analysis of hospital closures to determine trends and effects of the phenomenon. 
FINDINGS 
This inspection found that in 1988: 
Eighty-eight  general, acute care hospitals closed- 19 more than in 1987, They were located 
in 29 States. Four of thesehospitals have sincereopened. 
Four new general, acute care hospitals opened in 1988. Eight hospitals which closed in prior 
yearsreopenedin 1988. 
Fifty of the closed hospitals were rural; 38 were urban. In relation to their numbers 
nationwide, a higher percentageof rural hospitals (1.9%) closed in 1988 than urban hospitals 
(1.3%). 
Hospitals that closed were significantly  smaller and had lower occupancy rates than the 
national averagesfor both rural and urban hospitals. 
The averageMedicare utilization  of hospitals that closed is not significantly  different from 
Medicare utilization  of all hospitals nationwide.  The averageMedicaid utilization  among 
hospitals that closed is slightly higher than national norms. 
The reasonsfor hospitals closing in 1988 are identical to those reported for hospitals closing 
in 1987. No single factor or event causedhospitals to close. Rather, a number of factors 
gradually weakened the financial condition of thesehospitals. Hospitals that closed were 
reported to have had: 
. 	 declining revenuesdue to fewer admissions,lower third-party reimbursement, 
and increasing uncompensatedcare; and 
i  . 	 rising costsdue to increasing demandsfor new medical technology, skilled 
personnel, and facility  repair and renovation. 
Emergency and inpatient medical care is available nearby for most communities where 
hospitals closed. 
ii  TABLE  OF CONTENTS 
EXECUTIVE  SUMMARY 
INTRODUCTION  ...........................................................~..................................~.......  I 
FINDINGS 
Extent  and  Nature  of  Hospital  Closure  ...........................................................  3 
How  Many  Closed?  ...................................................................................  3 
How  Many  Opened ...................................................................................  4 
What  Were the  Closed  Hospitals  Like ....................................................  4 
Why Did  They  Close?  ...............................................................................  7 
Impact  of  Hospital  Closure  ..............................................................................  8 
How  Many  Patients  Were Affected?  ........................................................  9 
Are  Inpatient  Care and  Emergency  Services  A vailable?  ....................  I 0 
What  Is the  Building  Used  For Now?  ....................................................  I2 
Differences  Between  Hospitals  Closed  in 1987 and  1988 ..........................  I3 
Number  CIosed ........................................................................................  I3
Y 
Size ...........................................................................................................  I3 
Occupancy  ...............................................................................................  I4 
Utilization  .................................................................................................  I4 
Summary  .........................................................................................................  I5 
ENDNOTES  ............................................................................................................. I6 
APPENDICES 
Appendix  A:  Methodology  ...........................................................................A-I 
Appendix  B:  1988  Hospital  Closure  Tables  ............................................... B-I  INTRODUCTION 

PURPOSE 
This report describesthe phenomenon of hospital closure in the United States. It examines the 
characteristicsof, reasonsfor, and impact of closuresin 1988, and compareshospitals closed 
in 1988 with those closed in 1987. 
BACKGROUND 
In the past severalyears, the closure of general, acutecare hospitals has generatedincreasing 
public and congressionalconcern. According to a number of recent studies,more hospitals 
are expectedto close their doors in coming years. The Office of Inspector General (OIG) 
releaseda report in May 1989 describing the phenomenon of hospital closuresin the United 
Statesin 1987. That study found that 69 hospitals closed in 1987. They were small and had 
low occupancy rates. When the hospitals closed, few patients were affected. In most cases, 
inpatient and emergency medical care was available nearby. 
The 1987 hospital closure study was presentedto the Secretaryof the Department of Health 
and Human Services (HHS) and the U.S. House Ways and Means Health Subcommittee. The 
Secretaryaskedthe Inspector General to continue analysis of the phenomenon. He wanted to 
learn about possible differences in the rate of hospital closures, and in the characteristics and 
circumstancesof hospitals closing their doors. This inspection and a companion inspection, 
Effects of 1988 RuralHospital Closureson Accessto Medical Care (OEI-04-89-00742), 
respond to those questions. 
SCOPE 
This study identifies specific characteristicsand experiencesof short-term, acute care 
hospitals that closed in 1988. 
For purposesof this study, the following  definitions were used: 
Hospital:  A facility  that provides general, short-term, acutemedical and surgical inpatient 
services. 
Closed Hospital:  One that stoppedproviding general, short-term, acute inpatient servicesin 
1988. If a hospital merged with or was sold to another hospital and the physical plant 
remained open for inpatient acutecare, it was not considereda closure.  If a hospital closed and reopenedin 1988, it also was not considered a closure. If a hospital 
closed in 1987, reopened in 1988, and closed again in 1988, it was counted asa closure for 
1987 but not again in 1988. 
Information for this study was obtained from contacts with State hospital associations,State 
licensing and certification agencies,State health planning agencies,officials associatedwith 
closed hospitals and hospitals nearby, and local public officials.  Information  which describes 
the characteristics of the hospitals was obtained from HCFA data bases. 
Appendix A describesinformation collection methods.  FINDINGS 
The study of hospitals closed in 1988 found that: 
. 	 Eighty-eight  general, acutecare hospitals closed in the United Statesduring 
1988 - 1.6 percent of all hospitals. 
. 	 Nineteen more hospitals closed in 1988 than in the previous year. The 
characteristics of, reasonsfor, and impact of closures were similar. 
. 	 Most hospitals that closed were small and had low occupancy. When a hospital 
closed, few patients were affected. Most had emergency and inpatient medical 
care available nearby. 
EXTENT  AND  NATURE  OF HOSPITAL  CLOSURE 
How Many Closed? 
Of the 6,800 hospitals nationwide, 5,449 are listed on HCFAs data baseas general, 
short-term, acute care, Medicare-participating hospitals. During Calendar Year 1988,88 of 
theseclosed - 1.6 percent of the hospitals nationwide. 
. 
I 
HOSPITALS  IN U.S.:  5,449 
CLOSED  IN  1988:  88 (1.6%) 
I 
The closed hospitals had a total of 5,893 available beds. The number of beds lost when 
hospitals closed equaled 0.65 percent of general, acutecare beds nationwide. 
The closed hospitals were located in 29 States. Texashad the most closures (18). Other 
Stateswith multiple  closuresincluded Alabama (7), California (5), Illinois  (5), Louisiana (5), 
Missouri (5), and West Virginia  (5). Eleven Stateshad only one closure. Appendix B has a 
list of the 1988 closures by State.  In relation to their numbers nationwide, a higher percentageof rural hospitals (1.9%) closed in 
1988 than urban hospitals (1.3%). 
I  I 
RURAL  I  URBAN 
I 
HOSPITALS  IN THE  U.S:  2,593  2,856 
I
CLOSED  IN  1988:  I  50 (1.9%) 1  38 (1.3%) 
How Many Opened? 
Only four new general, acutecare hospitals openedduring 1988. These openings added 475 
bedsto the national supply of beds. 
In addition to the new openings during 1988,8 hospitals that closed prior to 1988 reopened in 
1988, adding another 391 beds. 
Four hospitals that closed in 1988 have since reopened,adding 233 beds. 
What Were the Closed Hospitals Like? 
Size: Hospitals that closed in 1988 were small.  More than three-quartershad 100 bedsor 
fewer. 
. 
SIZE  OF CLOSED  HOSPITALS  , 
Number  of Beds 
4 
 Closed hospitals in both rural and urban areasare significantly  smaller than their national 
averages. 
HOSPITALS  THAT  CLOSED  WERE  SMALL 
+  OF BED8 
---m n  .. 
260 -
200 -
160-
loo-
SO-
0 
RURAL  HiXBPlTAL8  URBAN HOSPITALS 
Occupancy:  Occupancy ratesfor closed nual and urban hospitals were lower than the 
national averages.l 
., 
OCCUPANCY  RATES  WERE  LOW 
60% 
40% 
20% 
0% 
RURAL  HOSPIlAL8  URBAN HOSPITAL8 
- NATIONAL  AYQ  m  CLOSED  HOSPITAL  Ay<L 
5 
 Medicare and Medicaid  Utilization:  No significant difference exists in the average 
Medicare utilization  among hospitals that closed and all hospitals nationwide.  The average 
Medicaid utilization  among hpspitals that closed is slightly higher than nationwide averages 
for rural and urban hospitakL 
MEDICARE 
% UTIUZATION 
60% -
4a8%  49.9% 
/  -
SD% 
40% 
WI 
20% 
10% 
0% 
RURAL  HWPITMZ)  URBAN HOSPITAUI 
- NATIONAL  IVQ  m  CLOSED  HOSPITM  WQ. 
I, 
MEDICAID 
% UTlLlUTlON 
80% 
-- 
RURAL  H&PITM  URBAN HOSPITAL8 
- NATIONAL  rWQ.  m  CLOSED  HOSPITAL  Aya.  Why Did They Close? 
The reasonsfor hospitals closing in 1988, asreported by many health care professionals 
during the course of this study, are identical to the reasonsdescribed in the OIG report 
Hospital  Closure: 1987. The report, releasedin May 1989, indicated no single reason for 
hospital closure. Rather, a number of factors causeda kind of domino  seriesof failures 
which eventually led to the closure of the hospital. 
.  Declining  Occupancy 
.  Lagging  Revenues 
.  Rising Costs 
As occupancy declined, revenueslagged, but costscontinued to rise. Operating margins 
shrank, and ultimately  there was no choice but to sell, merge with another hospital, or close 
the doors. The following  is an abbreviated version of the reasonsreported in Hospital 
Closure: 1987: 
Declining  Occupancy:  Hospital occupancy is a function of the number of admissions and the 
lengths of hospital stay. Respondentscite fewer admissions asthe main causeof declining 
occupancy. 
Physicians control where patients are admitted for inpatient care. A number of reasonswere 
given for dwindling  physician referrals to most of the 88 hospitals that closed in 1988. 
.  Physician availability  is a problem in rural areas. 
.  Physicians lost confidence in the local hospital. 
.  Patients, too, preferred other hospitals. 
. 	 Doctors may be admitting patients lessreadily due to  more careful scrutiny of 
hospital admissions by Medicare Peer Review Organizations. 
.  Competition among hospitals is intense. 
.  Increasedmobility  hasexpandedpatients choices among hospitals. 
. 	 Medical advancesand new technology have allowed someproceduresthat 
formerly required a hospital stay to be performed on an outpatient basis. 
7 
 Lagging  Revenues: Lower occupancy meansless income for hospitals. Respondentsalso 
mentioned thesereasonsfor declining hospital revenue: 
. 	 Patients without hospital insurance,or with inadequate insurance, create 
substantial lossesfor the hospital. 
.  Insurers are better controlling their costs. 
. 	 Medicare payment differentials basedon hospital location generally result in 
rural hospitals receiving lower payments than urban hospitals. 
Rising Costs: According to many respondents,hospital costs are rising despite efforts to curb 
them. These are some of the important factors cited by respondents: 
.  New medical technology is a major capital expense. 
. 	 Labor costs are increasing, and competition is keen for scarcenursing and 
technical staff. 
. 	 Deteriorating facilities require major capital investment to renovate and 
modernize. 
Health care planners, regulators, and hospital administrators contacted during the course of 
this inspection described thesefactors--occupancy, revenue,and cost-as  intricately related 
and interdependent. Hospital viability  was said to dependon the stability of all three. The 
weakening of one may begin a chain reaction eventually leading to hospital closure. 
SmalI hospitals are least able to defend against this downward spiral.  Hospitals which closed 
in 1988 were significantly  smaller than average. All  of them had encountered some or all of 
the problems described here. 
IMPACT  OF HOSPITAL  CLOSURE 
In communities where a hospital closed in 1988, this study assessed: 
.  the number of patients affected by the closure of the hospital; 
. 	 the availability  of inpatient care and emergency medical servicesto communities 
in which hospitals closed, and 
.  the current useof the closed hospital facility. 
8 
 How Many Patients WereAffected? 
Few patients were affected by the closure of hospitals in 1988. In the year prior to closure, 
rural hospitals had an averagedaily censusof 11patients, and the urban hospitals had an 
averagedaily censusof 34 patients. 
WHEN  HOSPITALS  CLOSED, 
HOW  MANY  PATIENTS  WERE  AFFECTED? 
Rural  Urban 
Hospitals  Hospitals 
Average Number  of Beds  40.2  102.2 
Average Occupancy Rate  %26.7%  x 
Average Patient  Census  10.7  33.6 
Medicare utilization  data were analyzed to determine the number of elderly patients affected 
by hospital closure in 1988. In closed rural hospitals, only five Medicare patients were in the 
hospital on an average&dayprior to closure. Closed urban hospitals had an averagedaily 
Medicare censusof 15. 
WHEN  HOSPITALS  CLOSED, 

HOW  MANY  MEDICARE  PATIENTS  WERE  AFFECTED? 

Rural  Urban 
Hospitals  Hospitals 
Average Patient  Census  10.7  33.6 
Average Medicare  Utilization  Rate  x  x 43.2% 
Average Medicare  Patient  5.3  14.5 
9 
 Are Inpatient  Care and Emergency ServicesAvailable? 
This study determined the availability  of medical care to residents of communities where 
hospitals closed. It did not evaluate the accessibility and utilization  of the nearestavailable 
services. 
To more fully  addressthe question of access,a companion study was conducted. Effects of 
1988 Rural Hospital Closures on Accessto Medical Care determines how accessto medical 
care in rural communities was affected when local hospitals closed in 1988. 
Availability  of inpatient and emergency medical care, for purposesof this report, was 
measuredin miles from the closed hospital to the nearestinpatient and emergency facility. 
Inpatient  Care:  In most communities where a hospital closed in 1988, inpatient hospital care 
is available nearby. 
Three-quarters of the 50 rural communities where a hospital closed can get inpatient care 
within  20 miles of the closed hospital.  Residentsof four communities must travel more than 
30 miles for inpatient care: 
.  Ekalaka, Montana  36 miles 
.  Kearny, Arizona 50 miles 
1 
.  Metaline Falls, Washington  - 50 miles 
.  Cuba, New Mexico  80 miles 
The communities of Ekalaka, Kearny, and Cuba have emergency care servicesto stabilize 
patients prior to transporting them to acutecare hospitals. Although Metaline Falls has no 
physician in the community, there is ambulance service and a clinic with a nursepractitioner. 
In all but three urban communities where a hospital closed in 1988, inpatient care is available 
within  10 miles of the closed hospital.  In more than half of those communities, another 
hospital is less than a mile away. The remaining three communities are within 20 miles of an 
inpatient hospital. 
10 
 AVAILABILITY  OF INPATIENT  CARE 
Distance  from  Closed  Hospital  to  Nearest  Open  Hospital 
\ 
Rural  Urban 
Within  10 Miles  20 (40%)  35 (92%) 
11 - 20 Miles  17 (34% j  3(8%) 
21- 30 Miles  9 (18%)  O(O%) 
I 
More Than 30 Miles 
Emergency Services: In all 50 casesof closed rural hospitals, emergency care facilities are 
available within  30 miles of the closed hospital. 
NEAREST  EMERGENCY  SERVICES  TO CLOSED  RURAL  HOSPITALS 
DISTANCE  Number  of Closed 
Hospitals 
. 
Same Town  17 
Within  10 miles  10 
11 - 20 miles  16 
21 - 30 miles  7 
More than 30 Miles  0 
TOTAL  50 
In 33 of the 38 urban communities where a hospital closed, emergency care facilities are less 
than 3 miles from the closed hospital. The remaining five urban communities are within 20 
miles of the nearestemergency care facility. 
11 
 What Is the Building  UsedFor Now? 
Forty percent of the closed hospital facilities are currently being used. These facilities, while 
ceasing to operate asacute care hospitals, continue to provide servicesto the community.  For 
example: 
. 	 Tucker County Hospital facility  in Parsons,West Virginia  continues to provide 
outpatient and 24-hour emergency services; 
.  GastonEpiscopal Hospital in Dallas, Texas is now a rehabilitation hospital; 
.  Woodruff County Hospital in McCrory, Arkansas is now a nursing home; 
. 	 Frank Cuneo Hospital in Chicago, Illinois  has beenconverted to a shelter for 
abusedchildren; and 
. 	 JamestownHospital in Jamestown, New York is currently an alcohol 
rehabilitation and mental health facility. 
CURRENT  USE OF CLOSED  HOSPITALS 
II  Number  of Former  Hospitals* 
Current  Use of Building 
Rural  Urban 
Reopened Hospital 
Specialty Treatment  Facility 

(e.g. chemical dependency) 

Long-Term  Care Facility 

Outpatient  Services/Clinic 

Offlces 
 1  6 
Social Services 
 I  2  I  3  I 
Vacant 

*Duplicate count. In nine of the 88 former hospitals more than one service is now offered. 
12 
 Plans are being made for 13 of the currently vacant hospitals to be used for other types of 
health care services. For example, the English Park Medical Center in Marion, South Carolina 
will  become a nursing home. Fairview Hospital in Bayou Vista, Louisiana is being converted 
to a mental health and substanceabuseclinic. 
Plans are being made for severalof the closed facilities to reopen as acute care hospitals. For 
example, Mt. Linton Hospital in Metaline Falls, Washington will  reopen as soon asthe 
community recruits a physician. 
DIFFERENCES  BETWEEN  1987 AND 1988 HOSPITAL  CLOSURES 
Number Closed 
Nineteen more hospitals closed in 1988 than in 1987,13 more mral and 6 more urban 
hospitals. 
Thirty-five  Stateshad at least one hospital close in the 2-year period.  Twenty-one Stateshad 
hospitals close in both years. 
Fifty percent of all the hospitals closed in the 2-year period were in Texas (32), Alabama (lo), 
California (lo),  Illinois  (9), Louisiana (9), and Michigan (8).  Appendix B lists, by State, the 
number of hospitals closed in the 2-year period. 
1 
Size 
Urban hospitals that closed in 1988 had, on average,19 more beds than those that closed in 
1987. There was no significant difference for rural hospitals in the 2-year period. 
SIZE  BY NUMBER  OF BEDS 
Closed  Hospital  Averages 
t  OF BEDS 
120  102.2 
100 
80 
00 
42.0 
40.2
/ 
40 
20 
0 
RURAL  H&PlTALB  URBAN HOSPITALS  Occupancy 
The occupancy rate of closed hospitals, on average,was slightly higher in 1988 compared to 
closed hospitals in 1987. 
OCCUPANCY 

Closed  Hospital  Averages 

RURAL  HO2PITALS  URBAN HOSPITAL2 
Utilization  .* 
Medicare and Medicaid utilization  was, on average,slightly higher for closed hospitals in 
1988 compared to closed hospitals in 1987. 
14 
 MEDICARE 

Closed  Hospital  Averages 

% UTILIZATION 
*Am 
WV-U 
80% 
40% 
80% 
20% 
10% 
: 
0% 
RURAL  HOSPITAL8  URBAN HOSPITALS 
ml@987  ml288 
MEDICAID 

Closed  Hospital  Averages 

% UTILIZATION 
60% 1 
-I 
RURAL  HiX3PlTAL8  URBAN HOSPITAL8 
SUMMARY 
Eighty-eight hospitals closed in 1988. While more hospitals closed in 1988 than in the 
previous year, the characteristicsof, reasonsfor, and impact of closures were similar.  Most 
hospitals that closed were small and had low occupancy. When a hospital closed, few patients 
were affected. Most had emergency and inpatient medical care available nearby. 
1 
 ENDNOTES 

1. 	 Hospital occupancy rate is defined asthe actual number of patient days divided by the 
total bed days available. National occupancyrate 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 averageMedicare 
utilization  is the percent of Medicare utilization of each hospital, summed and divided 
by the total number of hospitals. Medicaid utilization is calculated in the sameway. 
16 
 APPENDIX  A 

METHODOLOGY 
Phenomenon of closure 
To determine how many hospitals closed in 1988, 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 
made contact with officials  associatedwith the closed hospitals and officials associatedwith 
the hospital nearestto 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 
ProspectivePayment System (PPS) in the universe. There were 5,449 hospitals listed.  This 
was the current universe, at the time of inquiry, of short-term, acutecare, general hospitals on 
HCRIS for the fourth year of PPS (PPS4). 
Characteristics of closed hospitals 
To analyze characteristicsof closed hospitals, we usedHCFAs HCRIS data. Cosr reports 
were not available for 3 of the 88 closed hospitals becausethey were not Medicare providers 
in the years prior to closure. For the remaining 85 hospitals, we used the latest cost reports 
prior to closure containing sufficient data. For example, if a hospital closed in May 1988 and 
its accounting year was on a January-Decembercycle, we used the providers January 1, 1987 
to December 31, 1987 report. 
Reasonsfor  hospital closures 
We contactedofficials of the following  organizations to determine the reasonsfor 1988 
hospital closure: 
.  State hospital associations; 
.  State health planning agencies; 
.  Statecertification and licensing agencies; 
.  closed hospitals; and 
.  nearesthospitals to closed hospitals. 
A-l  Impact of hospital closure 
We limited  the impact  issuesto distancefrom the closed hospital to the nearest 
still-operating hospitals and to emergency services. To determine this, we contactedmany of 
the following: 
.  former hospital administrators, board members, and/or staff; 

.  hospital administrators and/or staff at the nearesthospitals; 

.  local police and health officials; 

.  local government officials; 

.  State health planning agencies; 

.  Statecertification  and licensing agencies;and 

.  Statehospital associations. 

A-2 
 APPENDIX  B 
NUMBER  OF HOSPITAL  CLOSURES:  1987 and  1988 
Number  Closed 
Ranked 
BvState  l#Bz  UB  2-Year Total 
Texas  14  18  32 
Alabama  3  7  10 
California  5  5  10 
Illinois  4  5  9 
Louisiana  4  5  9 
Michigan  6  2  8 
Missouri  1  5  6 
West Virginia  1  5  6 
Wisconsin  2  4  6 
Arkansas  3  2  5 
Minnesota  5  0  5 
New York  2  3  5 
Massachusetts  2  2  4 
Tennessee    0  4  4 
Washington  3  1  4 
Arizona  I  1  2  3 
Georgia  1  2  3 
Montana  1  2  3 
Oklahoma  1  2  3 
Idaho  1  1  2 
Nebraska  2  0  2 
New Jersey  1  1  2 
Pennsylvania  0  2  2 
Ohio  1  1  2 
Oregon  1  1  2 
Alaska  1  0  1 
Colorado  1  0  1 
Kansas  0  1  1 
Maine  0  1  1 
North Carolina  0  1  1 
North Dakota  1  0  1 
New Mexico  0  1  1 
South Carolina  0  1  1 
South Dakota  0  1  1 
Virginia  1  0  1 
TOTALS  69  88  157 
B-l  1988  HOSPITAL  CLOSURES  BY NAME  AND  LOCATION 

Rural/ 
HosDital  Citv  State  Urban 
Henry County Hospital  Ab beville  AL  rural 
First Health Courtland  Courtland  AL  rural 
ChambersCounty Hospital  Lafayette  AL  rural 
Perry Community Hospital  Marion  AL  rural 
North Mobile Community Hospital  Satsuma  AL  urban 
Medical Park West  Birmingham  AL  urban 
Columbia Regional Medical Center  Andalusia  AL 
Woodruff County Hospital  McCrory  AR  rural 
Lee Memorial Hospital  Marianna  AR  rural 
Phoenix General Hospital  Phoenix  AZ  urban 
Kennecott Samaritan  Keamy  AZ  rural 
AMI  Clairemont CommunityHospital  San Diego  CA  urban 
Community Hospital Sacramento  Sacramento  CA  urban 
RossGeneral Hospital  Ross  CA  urban 
Hayward Hospital  Hayward  CA  urban 
Metropolitan Hospital  Los Angeles  CA  urban 
Heard Community Hospital  Franklin  GA  rural 
Turner County Hospital  Ashburn  GA  rural 
Marsh VaIley Hospital  Downey  ID  rural 
White Hall Hospital  White Hall  IL  rural 
Hospital of Englewood  Chicago  IL  urban 
Frank Cuneo Memorial Hospital  Chicago  IL  urban 
St. Annes Hospital  Chicago  IL  urban 
Mary Thompson Hospital  Chicago  IL  urban 
Axtell  Christian Hospital  Newton  KS  rural 
Fairview Hospital  Bayou Vista  LA  rural 
Gueydon Memorial Hospital  Gueydon  LA  rural 
TensasMemorial Hospital  Newellton  LA  rural 
Regent Hospital Feliciana  Clinton  LA  rural 
PleasantHill  General Hospital  PleasantHill  LA  rural 
Brookline Hospital  Brookline  MA  urban 
Farren Memorial Hospital  Montague  MA  Nld 
Castine Community Hospital  Castine  ME  Nl-d 
Bay Area Medical Center  Menominee  MI  rural 
Brent General Hospital  Detroit  MI  urban 
Lindell  Hospital  St. Louis  MO  urban 
University Hospital  KansasCity  MO  urban 
Levering Hospital  Hannibal  MO  rural 
St. Francis Hospital  Marceline  MO  rural 
St. Marys North  KansasCity  MO  urban 
B-2 
 Rural/ 
Mission Valley Hospital  St. Ignatius  MT 
rural 
Dahl Memorial Hospital  Ekalaka  MT  rural 
Blackwelder Memorial Hospital  Lenoir  NC  rural 
The Livingston  Community Hospital  Livingston  NJ  urban 
Cuba Hospital  Cuba  NM  rural 
Jamestown General Hospital  Jamestown  NY 
rural 
ParsonsHospital  Flushing  NY  urban 
Johnstown Hospital  Johnstown  NY 
NortheasternOhio General  Madison  OH  urban 
Cordell Memorial Hospital  Cordell  OK  NE-d 
E.P. Clapper Memorial  Medical  Waynoka  OK 
Eugene Hospital and Clinic  Eugene  OR  urban 
University Medical Center  Philadelphia  PA  urban 
Scranton StateGeneral Hospital  Scranton  PA  urban 
English Park Medical Center  Marion  SC  rural 
Ipswich Community Hospital  Ipswich  SD  rural 
Scott Memorial Hospital  Lawrenceburg  TN 
rural 
JohnsonCounty Memorial Hospital  Mountain City  TN 
NCil 
Smyrna Hospital  Smyma  TN  urban 
St. Marys North Hospital  Lake City  TN  urban 
King William  Health Center  SanAntonio  TX  urban 
Gaston Episcopal Hospital  Dallas  TX  urban 
Golden Plains Community Hospital  Borger  TX  rural 
Milam  Regional Medical  Center  Cameron  TX  Nl-d 
Oakwood Family Hospital  Lubbock  TX  urban 
Omni Hospital and Medical Center  Houston  TX  urban 
Shiner Hospital  Shiner  TX 
rural 
Flow Memorial Hospital  Denton  TX  urban 
Whitcomb Memorial Hospital  Grand Prairie  TX  urban 
Robertson Medical Center  Heame  TX  Nl-d 
Bastrop Hospital  Bastrop  TX  rural 
Taft Hospital District  Taft  TX  urban 
Marion County Hospital  Jefferson  TX  rural 
TeagueGeneral Hospital  Teague  TX  rural 
Kirbyville  Community Hospital  Kiibyville  TX 
Nl-d 
Comfort Community Hospital  comfort  TX  rural 
Landmark Medical Center  El Paso  TX  urban 
Hart Clinic Hospital  Gladewater  TX  urban 
Mt. Linton Hospital  Metaline Falls  WA  rural 
Bayfield County Memorial Hospital  Washburn  WI  rural 
St. Anthonys Family Medical Center  Milwaukee  WI  urban 
New Berlin Memorial Hospital  New Berlin  WI  urban 
B-3 
 Rural/ 
HosDital  Citv  State  Urban 
First Hospital of Milwaukee  Milwaukee  urban 
Tucker County Hospital  Parsons  Nd 
Guthrie Memorial Hospital  Huntington  urban 
Elizabeth Leonard Hospital  Buckhannon  Nral 
Wyoming General Hospital  Mullens  rural 
Holden Hospital  Holden  rural 
B-4