Fitch Ratings downgraded Tyler-based East Texas Medical Center Regional Health System's series 2011 and series 2007A revenue bonds to "B+" from "BBB-," affecting a total of $280 million of debt.
The downgrade is a result of several factors including ETMC's quick financial depreciation, increased competition, challenges navigating payer shifts and under utilization of its network of rural hospitals.
The bonds have been placed on Rating Watch Negative.