And the number of record keepers has risen sharply as hospitals and doctors have scrambled to meet demands for paperwork from Federal and private insurers.

"The clock ran out on us," Mr. Rose said, adding that the hospital was scrambling on many fronts on the eve of the survey.

Doctors and hospitals across the country are scrambling to satisfy the booming demand for surgery that shrinks the stomachs of severely obese people.

Changes in the system have accelerated as hospitals, physicians and insurers scramble to anticipate or deflect President Clinton's health care proposals.

And hospitals are scrambling to find ways to communicate with them.

Now, Dr. Califf said, the hospital is scrambling to make sure such treatments are not neglected again.

The recommendations from the panel come amid turmoil in the health care industry, as doctors, hospitals and other health care providers scramble for financial survival in fiercely competitive markets.

New York City's hospitals are scrambling to prepare for a new era of competition that is unclear but seems inevitable.

The hospitals "are scrambling to cut costs like never before," she said, adding that a skilled chief financial officer "can almost name his price."

New York City's hospitals are scrambling to prepare for a new era of competition - not even defined yet, but almost surely on its way.