Civista Health Inc., which runs Charles County's only hospital, may turn to commercial banks for loans to weather a financial crisis brought on by billing shortfalls, its president said Friday.

Such borrowing would need consent from county commissioners, who reacted coolly to Civista's request Monday for $10 million in loans from the county, in part to meet a $5 million debt payment due in January.

On Friday, several commissioners indicated they remain wary.

"If they default on a loan, the loan's going to come to our doorstep," said Commissioner Robert J. Fuller (D-St. Charles).

Civista Health runs Civista Medical Center, the former Physicians Memorial Hospital, which sits on county-owned land in La Plata. Partly to ensure repayment of construction bonds it has issued for the hospital, the county retains the right to approve borrowing by Civista.

Civista Health President Christine M. Stefanides said in an interview Friday that commercial banks had informally agreed to loans to help Civista through its crisis. The structure of the loans had not been set, Stefanides said.

"I would say under current circumstances the county would need to provide some type of backing," Stefanides said.

Stefanides and other Civista officials on Monday told commissioners that Civista is owed $23 million for services it has performed. Normally that number hovers around $10 million from month to month, they said.

Civista officials said the figure grew suddenly, in large part because of billing failures brought on by a troublesome switch to a new computer system in April. Because the system malfunctioned, Civista for months was unable to send out as many bills as usual.

With fewer bills going out, less money came in. Since July, Civista has collected roughly $300,000 less each week than it needs to pay its bills, according to figures it presented to county commissioners.

The problem may have been more severe before July.

Civista sends its bills to NCO Group Inc., a financial services company based in Fort Washington, Pa. NCO processes the bills and forwards them to insurers and other payers.

Civista submitted no bills at all for a month and a half after switching computer systems in April, NCO health services chief executive Bernard Miller said in an interview.

Stefanides said the computer problems appear to have been corrected, and billing volume has climbed rapidly since late August. Civista issued $5.5 million in bills in the last two weeks of September--a pace more than triple the historic average.

Civista anticipates the faster billing soon will alleviate its financial problems. Patient admissions are up and revenue is strong, Stefanides said.

However, there are several possible stumbling blocks. NCO executives said they have been processing Civista's payments at a normal pace, which suggests it could take some time for revenue to catch up with billings.

Civista officials told county commissioners they anticipate taking in an average of $926,000 weekly through the end of the year. That may leave a growing shortfall, for Civista's accountant estimates the hospital spends $950,000 weekly.

Even those estimates may be optimistic. Under questioning from county commissioners, Civista officials acknowledged the revenue estimates for coming weeks include assumptions that may not bear out. For instance, they said, they were unsure how quickly NCO is forwarding bills to payers.

Stefanides on Friday said it probably would be three to four weeks before Civista comes before the commissioners again.

They are likely to ask her about old bills. Payers such as insurance companies and government agencies place limits on how old bills can be. Depending on the payer, they may not accept bills submitted after a certain time, which ranges from 180 days to one year after service is rendered, Stefanides said.

She said Civista is working to make sure the oldest and largest bills are processed first. She could provide no estimate of how much money Civista will lose from bills that reach payers after an acceptable date.

In a letter to newspapers, Board of Commissioners President Murray D. Levy (D-At Large) said commissioners have agreed to short-term financial assistance for Civista, which ranks among the county's largest employers, with some 700 employees.

Privately, commissioners voice exasperation that Civista's management failed to quickly staunch the losses. Several said they are reluctant to extend loans or guarantees until Civista brings forth a convincing scenario for recovery.

"Explanations are not sufficient at this point," said one commissioner. "Results have to be forthcoming."