Mount Sinai Medical Center, which has been suffering financially for years because of Miami Beach's shift to a younger demographic, is telling investors of its junk-rated bonds that it expects an operating loss of $18.5 million this year -- twice as much as last year.

What's more, the hospital now projects an even greater loss next year -- $19.7 million, according to hospital documents provided by the bond information service Dacbond.com.

Still, Chief Executive Steven Sonenreich said he thinks the hospital is on the right track. ''Actually, we are doing quite well right now,'' he said in a telephone interview Tuesday. ``We are rebuilding our medical staff. . . . Our volume is growing, with the opening of a free-standing emergency department, which has been a tremendous success.''

In its third-quarter report, the hospital attributed most of the deepening losses to the hospital's shift toward employing more physicians, a move which accounted for 61 percent of the losses through the third quarter.

The rest of the loss at Miami Beach's only remaining hospital was blamed on growing numbers of uninsured patients, more patients with low-paying Medicaid and a shift from cardiac admissions, which tend to produce high-revenue, to patients with other, lower-paying types of medical problems.

Last year, Mount Sinai reported a loss of $8.9 million. This year, it had budgeted for a loss $7.7 million, but losses grew because of bad economic conditions, which are now being experienced by many hospitals nationwide. Boca Raton Community Hospital lost $120 million last year.

On Tuesday, Bloomberg News reported that Fitch Ratings changed its outlook from stable to negative for nonprofit hospitals that sell tax-exempt bonds because over the next three years the hospitals could face investment losses, higher borrowing costs and increasing bad debt.

Though the bond report and state regulatory filings do not take into account philanthropic giving, Sonenreich said the most accurate way to look at the hospital's finances was to include the $10 million contribution made to it annually by the Mount Sinai Foundation. He said the hospital and the foundation should be viewed as ``a combined group that guarantees our debt.''

The report to investors indicates the foundation has also seen a decline in support. For the first three quarters, the foundation received $5.3 million in pledges, gifts and bequests, compared with $9 million received for the same period last year. However, Sonenreich said he is close to announcing ``an eight-figure gift to the medical center.''

Many local hospitals do not publicly reveal their finances, which become available only a year later after being filed with the state. But because Mount Sinai has $389.4 million in bonds issued through the City of Miami Beach Health Facilities Authority, it makes quarterly reports. Moody's rates the bonds at Ba1, which is defined as ''non-investment grade,'' or junk.

While many hospitals are seeing growing amounts of bad debt, primarily because of patients without insurance, Mount Sinai has had the additional problem of being in Miami Beach, which in recent decades has gone from a senior citizen enclave to a much younger group attracted to the revival of South Beach.

The hospital has attempted to broaden its base by opening a stand-alone emergency room in Aventura, which has been visited by 6,467 patients during the first nine months of 2008. It also opened a primary care satellite on Key Biscayne.

In its investor presentation, the hospital said it has purchased high-tech equipment, hired new heart surgeons and successfully completed its accreditation surveys.

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