S&P

The ratings agency changed its outlook on its BBB-minus rating to negative from stable Wednesday.

S&P noted volume growth and solid operating margins at the large Florida-based healthcare system.

S&P Global Ratings primarily cited a "precipitous decline" in unrestricted cash to explain its triple-notch downgrade of the system.

S&P cited the government's improved fiscal position as a factor in the positive outlook.

The ratings agency cited strong and growing activity and favorable economic trends in the region.

Wittstruck takes over the S&P role previously held by Robin Prunty, who retired in August.

S&P Global Ratings placed more than 400 state and local government issuers under criteria observation as the agency adopts an updated rating methodology.

Robin Prunty, who retired Aug. 31 as S&P's chief analytical officer for governments, took on a role on its U.S. board the next day.

"We withdrew the rating because we have determined we do not have sufficient information to maintain a forward-looking credit opinion on the city," S&P said.

The criteria should result in a nearly equal number of upgrades and downgrades in the next half year, according to the rating agency.