HCA's financial profile keeps getting worse as PE firms extract profits.

Bondholders were just recovering from news a few weeks ago that the hospital operator, which carries more than $25 billion in debt, would pay a $1.75 billion dividend to its owners, mostly private equity firms.

Then on Monday, the company announced it would raise $1 billion to refinance existing debt - not even to pay off the debt used to fund the dividend payments, as noted Vicki Bryan, analyst at GimmeCredit, in a report this week.

Finally, the $1 billion turned into $1.4 billion when the transaction priced Wednesday.

"HCA is full of surprises these days, and none of them are good news for bondholders," Bryan wrote.

She added that HCA will have higher interest expenses for a longer period, while revenue growth will slow going forward as a result of the company's new policy to write off a higher percentage of charity care.

A closer look at a 10K filing with the Securities and Exchange Commission from Monday reveals that HCA's financial condition could get worse still as the company may continue to pile on fresh debt.

The risk scenario that HCA discloses there is eye opening, and could materialize regardless of the course of the economy. Cash flow growth would suffer if the recovery takes long to materialize. But interest costs could soar if a strong recovery sends rates higher.

"Because a significant portion of our indebtedness matures in the next few years, we may find it necessary or prudent to refinance that indebtedness with longer-maturity debt at a higher interest rate," the company said.

HCA has heavy loads of debt due from 2011 until 2014, with $629 million, $3.273 billion, $8.108 billion and $1.646 billion due respectively in each, as of the end of 2009.

"Higher debt, higher interest costs, slower revenue growth, and weakening EBITDA margin will likely keep credit risk inflated indefinitely," GimmeCredit's Bryan said.