Standard&Poor's Ratings Services lowered its underlying rating (SPUR) to 'A+' from 'AA-' on the Louisiana Public Facilities Authority's outstanding bonds, issued for Franciscan Missionaries of Our Lady Health System Inc. (FMOLHS), a four-hospital system in Louisiana. The outlook is stable. The lower rating incorporates: Changing market dynamics, with the rise of specialty hospital competition in all three of the system's markets contributing to sharp volume declines, changing surgical referral patterns, challenging physician relationships, and increasing competition for clinical labor; Future facility needs at all three of the system's main hospitals that will require roughly $160 million-$240 million over the next five years, including the issuance of $100 million-$150 million in additional debt by mid-2005; and Weak operating performance
