The three top Naval officials recommended for sanctions in connection with the hiring and appointment of Cmdr. Donal M. Billig, a former Bethesda Naval Hospital surgeon facing court-martial following the death of four patients, have been issued administrative letters of censure, a Navy spokesman said yesterday.

Commodore James J. Quinn, the former commanding officer at Bethesda; Capt. Leon Georges, the former head of the hospital's internal review committee; and retired Capt. John Raymond Fletcher, the former head of surgery who was cited as directly responsible for supervising Billig, were issued letters Aug. 12 by Secretary John F. Lehman, a Navy spokesman said.

Quinn and Georges, who requested retirement after the Billig court-martial was announced, were approved then for retirement, according to the Navy. Quinn will retire Sunday, and Georges has been permitted to retire Oct. 1.

An administrative letter of censure is regarded as severe criticism but does not require a reduction in retirement pay or other punitive measures, the Navy spokesman said. In one recent case, retired Adm. Hyman G. Rickover received a censure from the Navy secretary for accepting unauthorized gratuities from General Dynamics.

The secretary's decision comes two months after Rear Admiral William M. McDermott Jr. recommended that Quinn and Georges receive formal censures for their involvement in the hiring and appointment of Billig. McDermott, however, had recommended that Fletcher, who is now practicing in Nashville, be recalled for general court-martial.

Navy spokesman Lt. Stephen Pietropaoli said yesterday that Lehman agreed with McDermott that Fletcher should be held accountable for his "dereliction of duty" but that Lehman decided that a "formal administrative letter of censure would be filed in his records and would be the appropriate means of accountability."

Pietropaoli would not elaborate on how that decision was made.

Fletcher, reached at his home in Nashville, confirmed last night that he had received the letter from the Navy.

He said it was his first formal notice from the Navy that his conduct was being reviewed in connection with the Billig case.

"The Navy never notified me about the recommended court-martial. I was never charged with anything," Fletcher said. "The only thing I knew about it was what I read from your paper, and then I got this letter saying I was being censured.

"I've never been involved in anything like this before," said Fletcher, who served in the Navy for 21 years. "I don't know how they normally do these kind of things . . . . I don't want to speculate about the whole thing. What would you think about it?"

Neither Quinn, whose relatives said he was out of town, nor Georges could be reached for comment last night.

The censures of the three former officers at Bethesda Naval Hospital are the most serious actions taken against others in connection with the alleged activities of Billig, the former head of heart and chest surgery at Bethesda.

Four other officers, who have not been identified, have received nonpunitive letters for dereliction of duty in connection with the case.

Two other officers, charged with making false statements and contributing to the death of four patients, are still being investigated.

Billig, 54, has been charged with involuntary manslaughter in connection with the deaths of four patients at Bethesda Naval Hospital and 22 charges of dereliction of duty for operating without proper supervision during the time he was at the hospital, January 1983 through November 1984.

Billig was recommended for court-martial after a formal board of investigation was called by McDermott in April to review the recruiting, appointment and practice of the heart surgeon. The results of that investigation -- and the recommended sanctions against Billig's superiors -- were revealed June 19. It was also revealed after that investigation that Billig has had a severe loss of sight in his right eye.

Attorneys for Billig, during a pretrial hearing a few weeks ago, asked for an additional investigation of the charges. The court-martial is expected to be scheduled next month after that investigation is completed.