Braddock Mayor John Fetterman said yesterday that anger in his community is rising quickly over plans to close UPMC Braddock, and he now hopes political leaders can reverse the decision.

The health system announced Friday that after seeing years of declining admissions and financial losses, it plans to close the 123-bed hospital on Jan. 31. Later that day, Allegheny County Executive Dan Onorato said the shutdown was "disappointing and unacceptable."

Mr. Fetterman said he and other public officials will meet with UPMC leaders this week. A community meeting on the hospital closing is scheduled at 5 p.m. Tuesday in the hospital's professional building.

The scheduled closing of yet another small hospital in a poor community is a familiar story in America, experts said yesterday.

All over the nation, "hospitals that are 'haves' can raise rates to private insurers, while hospitals that are in poorer areas usually don't have that ability, and so they're more vulnerable" to being closed, said Paul Ginsburg, president of the nonprofit Center for Studying Health Care Change in Washington, D.C.

The UPMC Braddock closing also fits another trend in recent decades -- hospitals in mostly African-American communities are much more likely to shut down.

That's the conclusion that Boston University professor Alan Sager has reached after analyzing events at 1,200 American hospitals in 52 cities since 1936.

"When you track these changes decade after decade," Dr. Sager said yesterday, "some very clear patterns emerge, which are that smaller and mid-sized hospitals, and hospitals in black neighborhoods are much more likely to close, while large hospitals and teaching hospitals virtually never close."

These closings also have a much more disruptive impact on the health of their residents than if they had occurred in middle-class areas, he said. That's because in black communities, up to a third of all doctor visits take place either in the emergency room or hospital clinics.

"When you lose the place you've relied on, it takes a long time to re-establish your medical connections," he said.

His studies show 30 percent of these patients stop seeking any medical care for several months after a hospital shutdown.

That effect is compounded by poor residents often relying on public transportation to get to hospitals and doctors.

"Use of care falls as distance or travel time to the hospital increases," he said.

Braddock's mayor said he is already seeing signs of that in the fears residents are expressing to him.

"I keep getting more and more sad and angry stories from my constituents about 'I take my child there all the time' and 'My doctor is there, and where are we going to go?' "

UPMC Braddock doctors who could be reached yesterday were reluctant to comment on the planned closing, and some said they had been told not to say anything. Most said they had first learned about the closing from the media.

There are sometimes exceptions to the national trend of small-hospital shutdowns. In San Francisco last year, the California Pacific health system agreed to keep St. Luke's hospital open in a poorer neighborhood of the city after city officials threatened to block a proposed expansion of the system's main campus.

"So I think nonprofit hospitals do sometimes make concessions to serve communities that are not as attractive, but there's a limit to how far they will go," Dr. Ginsburg said.

Dr. Sager said many may feel that closings like UPMC Braddock's are being driven by market forces, but in his view, there is not a truly competitive free market in health care.

"We don't have anything close to real competition in health care costs," he said, "and that means nobody is accountable for identifying and keeping open the hospitals and emergency rooms that people need, and when you don't have that, you have something else, which is called anarchy, and that anarchy explains the steady loss of lower-cost community hospitals."

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