Fitch Ratings downgraded Decatur, Ga.-based DeKalb Medical Center's series 2010 revenue anticipation certificates to "BB" from "BBB-," affecting $178 million of debt.
The downgrade is a result of several factors, including the medical center's consistently low operating margin, declining unrestricted cash levels, very competitive market and high labor costs.
The bonds have been removed from Rating Watch Negative
The outlook is negative.