The George Washington University Medical Center appears to be on the verge of getting a $50 million federal grant to renovate its hospital, thanks to the efforts of Sen. Daniel K. Inouye (D-Hawaii), an alumnus of the university's law school and a member of the university's board of trustees.

Some national medical associations and local hospitals, themselves starved for funds and worried about how to draw in paying patients, are angered by the prospect of one hospital collecting such a large grant. They said that at a time of dwindling public funds for health care, the federal government should be spreading money among scores of hospitals facing financial crises.

"For one congressman to step forward and do a special deal for one hospital is just absurd," said Tom Chapman, president of the Greater Southeast Community Hospital. "We will be up on the Hill on Monday to ask Senator Inouye for some money."

The grant is part of a bill approved yesterday by House and Senate conferees, whose report must still be voted on by both chambers. The university would have to raise a matching $50 million on its own to receive the federal money, creating a potential $100 million fund to renovate the 400-bed hospital or construct new buildings.

Pat DeLeon, Inouye's administrative assistant, said that the senator introduced the provision because GWU Medical Center asked him to do it. "The other hospitals have not done that," he said.

Michael Barch, associate vice president for medical affairs at GWU Medical Center, said that the hospital project is still very early in the planning stage. But he said the university has discussed several scenarios, including construction of a new emergency room near the hospital on 23rd Street NW.

Barch said that the renovation or construction would help GWU Medical Center to attract more paying patients, which in turn would help the hospital continue to care for poor patients. GWU Medical Center lost $24.7 million last year, Barch said, largely because of patients who could not or did not pay for health care.

"A new or renovated facility would put us on equal footing with other hospitals in the area who are seeking the same paying customers," said Barch. Additions have opened recently at Washington Hospital Center and Georgetown University Hospital, he said.

Hospitals throughout the region compete for paying patients. Some of the District's large hospitals fear that suburban medical centers will draw away more and more of the paying patients, leaving them with the increasingly costly burden of caring for the needy.

City hospitals in 1988 provided $176 million worth of care to poor patients -- almost $70 million more than in 1983, according to the D.C. Hospital Association.

Last summer, GWU Medical Center laid off 150 hospital workers and Howard University Hospital dismissed 281 employees to stem deficits incurred largely by caring for poor patients.

Capitol Hill Hospital has notified District health-care planning officials that it wants to convert to a long-term care facility. And Hadley Memorial Hospital, near the District's southern edge, has been on the market for more than a year because its owners no longer want to carry losses.

Local hospital officials said that the federal money going to GWU Medical Center would not address the issue of the rapidly increasing amounts of uncompensated care.

"It is just not dealing with the issue of uncompensated care, and that is what Congress should be dealing with to avert disaster in the health-care industry," said Kevin Lofton, who has been named director at Howard University Hospital.

Arthur L. Trask, a physician who is director of trauma services at Fairfax Hospital, said in a statement, "To single out one institution when hundreds of others across the country are struggling to keep their doors open is unconscionable."