Hospitals continue hiring and new medical offices are opening, providing a glimmer in a gloomy economy. But jitters over the economy are putting retirements on hold and forcing hospitals to rethink once-aggressive expansion plans.

"We are not in a position of business as usual," said Nancy Turner, spokeswoman for Sutter Health. Sutter may delay projects that have yet to break ground, including construction of a long-awaited hospital in Elk Grove.

"We have more projects out there than we can afford," Turner said.

Aging baby boomers and a surge in the region's population will keep demand for health care strong, hospital officials say. But the boom of the past decade is clearly on the wane, revealing how the industry – while still outpacing other sectors of the economy – can suffer even when all signs should be pointing to steady growth.

Last month, the American Hospitals Association released an ominous report on how the financial crunch could make it difficult for hospitals to raise capital for expansions and major equipment purchases. The report also warned that the poor economy could cause patients to delay care.

In California, about two in five hospitals have halted construction plans or put off major purchases such as sophisticated imaging equipment, according to a yet-to-be released survey by the California Hospital Association. About 25 percent of the hospitals surveyed said they are having difficulty securing financing for construction projects.

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