MIDDLETOWN — It looks as if Middletown Regional Hospital is going the way of the rest of the city — east — and longtime residents are not one bit happy about it.

        “I like it where it is,” said the Rev. Elmon W. Prier, 54, associate minister at United Missionary Baptist Church. “It's convenient for all Middletown citizens.”

        Middletown Regional is expected to move east of Interstate 75 to Union and Greentree roads in Warren County, city and Warren officials say. A decision could be announced as soon as today.

        After 83 years on McKnight Drive, a central, residential neighborhood, the hospital has outgrown its 26-acre site, leaders say.

        Frank Latimer disagrees.

        “I think it could stay where it is,” the 76-year-old Armco Steel retiree said. “I don't think it has to move. ... When you visit the hospital, you see empty rooms.”

        Middletown Regional is just the latest in a long line of city businesses to head east. Downtown bustled with shops in the 1940s and '50s, old-timers say, but has been on the decline since Towne Mall was built at Ohio 122 and I-75 in the 1970s.

        City Development Director Neal Barille takes an even longer view of the city's direction: “Middletown was started on the Great Miami River 200 years ago, and over that 200-year period since, Middletown has constantly grown to the east.”

        That's because transportation arteries — first the Miami-Erie Canal, then the railroad and finally the interstate — have always been east of the city, Mr. Barille said.

        “It's true of most towns across the country that they tend to grow toward transportation,” he said.

        But some Middletown residents see the move more in terms of the hospital getting closer to rich newcomers in Butler and Warren counties.

        “It's probably for economic reasons, because of the growth in West Chester and such, although it looks like we're going to suffer because of it,” said Mr. Latimer, who lives on the west side.

        Now, Warren County residents have to wade through Towne Mall-area traffic to get to the hospital, whereas the proposed site would force Mr. Latimer and his neighbors to deal with the traffic, he said.

        At the least, residents say, Middletown Regional should keep a satellite emergency department on McKnight.

        “For people our age, you might have to go out to the emergency room most any time,” Mr. Latimer said.

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