Here's the backstory for those unfortunate enough to wander into this thread and are curious what happened...
I had a size 12 city I captured, growth in 3 turns, with no hospital and yet the option to build wasn't in the improvements drop down list. I double checked and couldnt figure out what was going on. Mind you, I was researching on the path to SDI at this point in the game.
What happened was I was playing an Archi map, and on my island I was CxxC so my planned max city size was 12. Yep, I never bothered researching Sanitation. I started capturing other Civs cities, most of them already had hospitals built, so it was some time until this particular city regrew to size 12 (after I shrank it down to size 1 to prevent a flip). By the time it got to size 12 I had completely forgotten I by-passed the optional Sanitation, hence my confusion.
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