The interim chief executive officer of the former Aliquippa Community Hospital described mass employee firings earlier this month as "gut-wrenching" but said it was a cost-cutting move crucial to the debt-burdened facility's survival.

Willie E. Wilson, a self-described hospital turnaround specialist who has worked in the health care industry for more than 35 years, said that the terminations brought the size of the staff in line with the number of patients.

"It was totally out of whack. It was three times what it should have been," Mr. Wilson said. "You had to be losing money. ... You have your staffing reflect your census."

Mr. Wilson said there are an average of only 25 to 27 inpatients each day in the 96-bed facility, which has been renamed Commonwealth Medical Center, although the signs have not yet been changed.

There are now 189 employees, down from 305. Of the 233 original Service Employee International Union Healthcare Pennsylvania members on the payroll, 116 remain.

Mr. Wilson described lower costs and physician recruitment as the cornerstones to turning around the hospital.

"To make money you control expenses. You bring in more clients, which are your patients. You do that by recruiting more doctors and upgrading services. That is the vision you have to have. That is what has to happen," he said.

He knows he is battling a long history of difficulties at the facility, including a past bankruptcy, millions of dollars of debt, licensing problems, declining numbers of patients and labor friction.

When Commonwealth Medical Center Inc. bought Aliquippa Community Hospital, it turned a 51-year-old nonprofit institution built with contributions from area steel workers into a for-profit entity teetering on financial ruin and at risk of shutting down.

Mr. Wilson said he hopes cutting labor costs will have a positive impact on the bottom line. He said he was not privy, however, to what is undoubtedly another major expense, the structure of the hospital's current debt.

Chicago-based Bridge Finance Group, the hospital's lender, put up the money for Commonwealth to fund the $23 million purchase. Bridge, a high-interest lender, had also been Aliquippa Community Hospital's main creditor through a loan and a separate line of credit.

The hospital is operating on its fourth and final provisional license, which expires Feb. 2.

State Department of Health inspectors toured the facility at the beginning of the month and found deficiencies that have not been made public.

Mr. Wilson said he was "unsure" what the deficiencies were but noted that the hospital has submitted a plan to correct the problems and was waiting to hear back from inspectors. If the problems are not remedied by the license's expiration date, the hospital will be forced to close.

Mr. Wilson, 65, came to Aliquippa from the West Coast. He is a resident of La Palma, Calif., and commutes home for the weekends. He has been at the hospital for a matter of weeks. Mr. Wilson said he came out of retirement after receiving a job offer from old friend Thomas McNaull, the hospital's former CEO and Commonwealth's chairman.

Already, Mr. Wilson is facing the union's ire over the firings, which he said were carried out by Aliquippa Community Hospital prior to the change in ownership.

It is standard practice for an old employer to cut employees from its payroll when a business is sold; the new employer has the option to hire them anew as long as it does so without discrimination. Whether there is contractual language binding the old employer to ensure that workers are rehired is a more complex issue.

Commonwealth selectively rehired according to an internal assessment of who was best qualified, Mr. Wilson said. Among those employees not hired were two union officials.

The union filed an unfair labor practices charge with the National Labor Relations Board, claiming that the hospital discriminated against certain employees because of their union membership.

Mr. Wilson said there was no discrimination and shot back that the only complaints he hears from the union have to do with those two individuals.

"The union is talking about two people that were let go. What about the other 100 of their members that were let go? Do they not care about them? It boggles my mind. Every conversation that we attempt to have with them is about those two people," he said.

The union has countered that its old contract should remain in effect.

"They don't have a contract," Mr. Wilson said. "I think they retain the right to be the bargaining agent."

A meeting between Mr. Wilson and the union is scheduled for this morning, two days before a potential strike.

"We have no problem with sitting down and discussing. My thing is, I think in a democratic situation, I think the people should speak. I think the employees should speak," Mr. Wilson said. "If the employees speak and say they want to be represented, we can't stop that, but on the other hand if they speak and say they do not want to be represented, I think that should be it."

Mr. Wilson said he was not engaged in trying to break the union.

"I get offended when somebody says we're trying to break a union. We're trying to save a hospital for the community. If that means being partners with labor, so be it."

Mr. Wilson declined to go into detail about the hospital's strategies for improving business but pointed to the hiring of a physician recruiter and two clinical consultants.

"We get the doctors in, we upgrade equipment, we bring in specialists, we bring in family practitioners, and that's how a hospital survives. It's not brain surgery. It's a simple method," he said. "Our goal is to have this hospital survive to serve the community in Aliquippa."

Mr. Wilson said the recruiter will speak with orthopedic and cardiac surgeons, family practitioners and psychiatrists.

"We're talking to any physician that can come in here and help us with our [patient] census," he said. "You can't rely just on surgery. We'd like to beef up all of our areas."

He would not discuss what incentives were being offered to doctors to work at the hospital.

"I won't get into that. That's something we discuss one on one with physicians," Mr. Wilson said. "Everything is on the table."

He did say that no doctors have been asked to invest in the hospital. In the weeks leading up to the sale, there had been talk of selling ownership stakes in the hospital to physicians.