BROWNSVILLE -- The abrupt closure of Tara Hospital at Brownsville on Sunday is a sign of the difficult financial times for medical centers in small rural communities, experts say.

While outright closures have been relatively uncommon in Pennsylvania, several small rural hospitals have either been sold to for-profit companies or merged with larger hospital systems in order to maintain their financial health. The changes in ownership help rural hospitals finance everything from investments in information technology to the sizable premiums that medical centers must pay for malpractice and health insurance.

Tara Hospital at Brownsville also operated in a region that still has plenty of hospital capacity, some say, even with the closures in recent years of a few hospitals, including St. Francis Medical Center in Lawrenceville.

"I've been told that there are too many hospitals and there's no room for small community hospitals," said Harry Cancelmi, the chief executive officer of Tara Hospital at Brownsville. "Communities like Brownsville and Waynesburg want to fight and maintain their hospitals, but maybe we're swimming upstream."

Yesterday, Brownsville residents and community leaders decried the loss of one of the area's major employers, which they say has saved many lives over the years. Todd Nicholson, a paramedic with the Brownsville Ambulance Service for 15 years, said that what would have been a 5-minute ambulance ride to Tara Hospital will now be a 20-minute trip to hospitals in Monongahela or Uniontown.

"It's a very unhealthy population," Mr. Nicholson of people in the community who rely on the hospital. "A lot of older people with heart disease, diabetes, high blood pressure."

Tara Hospital employed nearly 200 people, said Brownsville council President Jack Lawver, who was born at the hospital in 1957. Mr. Lawver, who works as a mechanic for Brownsville Bus lines, said his company would undoubtedly feel the impact of the closure, as would the copy shop around the corner, which handled much of the hospital's printing.

Established in 1916 as Brownsville General Hospital, the Fayette County medical center was in the midst of contract talks with its unionized nurses when it closed Sunday. The hospital had been renamed in June after a group of physicians purchased it earlier this year and made it a for-profit operation.

By laying off at least 60 employees during the past two months and making changes in health benefits, the new owners were trying to save a hospital that had struggled financially for several years. Figures from the Pennsylvania Health Care Cost Containment Council show that between 2001 and 2004, the hospital's operating expenses consistently exceeded patient revenue; total margin at Brownsville General was minus 7.6 percent during fiscal 2004, according to the council.

Last week, members of the Brownsville Nurses Association of the Pennsylvania State Education Association-Health Care, which represents registered nurses at the hospital, voted unanimously to allow negotiators to call a strike if contract talks were unsuccessful. At that time, Gary Gosai -- one of the hospital's owners -- threatened to close the medical center within 90 days if nurses didn't agree to concessions and withdraw unfair labor practice charges.

The labor situation came as the hospital was confronting problems with government regulators.

Late last year, inspectors from the state Department of Health found extensive problems with the hospital's administration and management and put the facility under a provisional license. The action jeopardized the hospital's ability to receive payments for treating Medicare patients, said Mr. Cancelmi.

"With all of these things coming at one time, the owners thought it best to take a respite, not operate and determine if they can continue to restart with a new application," he said, adding that he had several conversations with workers yesterday about how the hospital might re-open.

As of Sunday, only 10 patients were being treated at the 82-bed hospital. Some were transferred to other hospitals, while others simply went home.

While not commenting directly on the mix of factors at Tara Hospital, experts in hospital finance said the closure isn't surprising considering broad trends.

Rural hospitals generally treat more patients on publicly funded health insurance programs, which don't pay as well as private insurance carriers, said Lisa Davis, director of the Pennsylvania Office of Rural Health. She added that rural hospitals often lack economies of scale that help larger hospital systems such as the University of Pittsburgh Medical Center.

Tara Hospital at Brownsville was one of at least three nonprofit hospitals in the state that was converted to for-profit status during 2005. Such conversions can help rural hospitals raise capital for needed improvements, said Cheri Rinehart, a vice president with the Hospital & Healthsystem Association of Pennsylvania.

But access to capital isn't the only challenge, Ms. Rinehart noted. Small rural hospitals struggle with liability costs and shortages of some health care professionals, just as larger medical centers do, she said. The growth of freestanding surgery centers also contributes to the financial challenges, Ms. Rinehart said, because they often drain the most profitable services from hospitals.

While the closure might make people in Brownsville nervous about their access to care, the region does not suffer from a lack of hospital beds, said Cliff Shannon, executive director of SMC Business Councils in Churchill and a board member with the Pennsylvania Health Care Cost Containment Council.

"People can say what they want about a rinky-dink hospital, but in an emergency situation [they want it nearby]," said Kim Black, an insurance agent from Brownsville, who often used to watch from her home as the helicopters took off and landed at Tara.

But it was the economic future of Brownsville that Ms. Black and her co-worker, Kristin Calcek, seemed most concerned about. Registered nurses might be able to find more work, but the office workers and custodians who have worked at the hospital for decades don't know much else, they said.

"Who's going to hire a 60-year old woman, unskilled, who has 30, 40 years up there?" asked Ms. Black. "People are going to lose their houses. Economically, no matter what way you look at it, it just sucks for everybody."

"This place has been impacted by so many things, between the mines and everything else," said Ms. Calcek. "It's a shame to see one more thing go."