ATTLEBORO - Fiscal conservatism, a growing and active corps of physicians and a propensity to plow back earnings into buildings and technology are being credited for helping Sturdy Memorial Hospital achieve that most elusive of titles: A well-equipped, well-staffed community hospital with virtually no debt and wellsprings of cash.

Sturdy earned roughly $21 million - about half of that from actual operations - according to the hospital's recently released financial statement. At the same time, Sturdy is pressing ahead with major investments in technology including a state-of-the-art CT scanning machine.

Joseph Kirkpatrick, vice president of the Massachusetts Hospital Association, said the hospital's shrewd investment strategy, an aversion to borrowing and "cost-effective" management has helped Sturdy maintain one of the most unique strings of surpluses in Massachusetts health care - 22 straight years in the black.

"That's very unusual," said Kirkpatrick, who noted that many health care organizations around the state have experienced fiscal uphevals, mergers - or worse - during the last two decades marked by the emergence of HMOs, physician networks and managed care.

A hard-nosed resistance to special deals with health care insurers also has helped to insulate Sturdy from some of the pains associated with insurance-driven reimbursement-cutting. "They operate on well-articulated principles that payers understand and are very rational," Kirkpatrick said. "Everyone gets access to the same fair deal."

In addition, the development of Sturdy Memorial Associates, a fast-growing cluster of doctor groups, has also helped to attract highly-qualified clinicians who in turn funnel patients to the hospital.

Linda Shyavitz, the hospital's president and CEO, says the hospital's continued financial success stems from good medicine, not fiscal finagling.

"Any success is not a management success," she said. "It's directly attributable to our patients, our medical staff and the physicians' loyalty to the hospital."

Sturdy has virtually no mortgages. Most all of the hospital's debt was retired years ago. Surpluses from operations and investments were, in turn, plowed back into expanding buildings and updating technology. The hospital's latest acquisition, the new CT scanner, will arrive next month.

The hospital also gets canny investment advice from an investment committee and experts in asset allocation. In the just-completed 12-month period, the hospital's investment portfolio earned about $10.2 million.

Some health care experts have attributed Sturdy's success at least partly to a lack of competition. It dominates in the number of patient admissions and discharges within its service area.

But some close observers who have watched Sturdy and Shyavitz over the years are dubious.

"I'd think it probably has more to do with Linda than having any niche," said Robert Marra of Cambridge Health Care Associates, who worked with Shyavitz at Boston City Hospital more than 20 years ago.

Marra said BCH at the time was a proving ground for bright young administrators, many of whom have since gone on to head their own hospitals. Shyavitz, he said, was a standout. Besides being a training ground, Boston City was among the first to experience some of the disclocations of the Brave New World of health care.

Marra suspects Shyavitz learned her lessons early, then went on to apply them in spades.

While Sturdy appears to be resting comfortably financially, it apparently is not doing so by soaking patients or insurance companies - at least according to information compiled by the Massachusetts Department of Health Care Financial Planning.

According to a 2006 survey of patient costs and quality, Sturdy consistently ranked in the middle of statewide average cost figures for treatment of heart attacks, congestive heart failure, Caeserian sections, hip fractures and pneumonia.

At the same time, quality measures remained at or near the statistical norm.

RICK FOSTER can be reached at 508-236-0360 or at rfoster@thesunchronicle.com.