Whittier, Calif.-based PIH Health had its outlook revised to negative from stable amid what S&P Global described March 27 as an "uneven operating trend" including a negative performance through its most recent reported quarter.
The rating for the three-hospital system was affirmed at "A" both for a series of bonds and on its default rating.
"It further reflects PIH Health's worsened balance sheet following the addition of a significant line of credit that has negatively affected debt-related ratios," analyst Aamna Shah said of the decision to revise the outlook.
As well as its hospitals, PIH Health operates several outpatient offices, urgent care sites and specialty services including cardiac care and women's health, serving more than 3 million residents in the Los Angeles, Orange County and San Gabriel Valley region.