Four District hospitals say a city plan to save Greater Southeast Community Hospital could have catastrophic effects on health care in the city and have asked a judge to block it. The plan would convert the emergency room on the D.C. General campus into an urgent care center and make it harder for hospitals to bill the city for treating uninsured patients.

Too many patients would be shifted into emergency rooms at Washington Hospital Center, Providence Hospital, George Washington University Hospital and Children's Hospital under the plan, an attorney for the hospitals told the federal judge overseeing the Greater Southeast bankruptcy case.

In a brief filed Tuesday, attorney Bonnie Hochman Rothell said the changes would cause "devastating" and "catastrophic" damage to the health care system.

The plan was designed to save money so Greater Southeast could emerge from bankruptcy intact and continue serving much of the city's east side, officials said.

But the brief for the four hospitals said the legal rights of creditors of Greater Southeast and its corporate parent, Doctors Community HealthCare Corp. of Scottsdale, Ariz., should take a back seat to the overriding public interest in a stable District hospital network.

The city wants U.S. Bankruptcy Judge S. Martin Teel Jr. to approve changes that would redirect more than 10,000 "true emergency" visits a year away from D.C. General. The plan also would drop the city's policy of "presumptive eligibility," in which any uninsured person who claims District residency is covered by the city's privatized indigent health care system for 30 days while eligibility is checked. The hospitals say that change alone would cost them millions in unpaid claims.

The bankruptcy proceedings focus on the city's $70 million-a-year privatized indigent care program because Greater Southeast has been its prime contractor since 2001, a role that includes running the large emergency room and multispecialty outpatient center at D.C. General.

"The District should not be permitted to take advantage of Greater Southeast's bankruptcy to rid itself of its own responsibilities with respect to D.C. General and the overall delivery of health care to the poor and uninsured residents of the District," Rothell wrote. A hearing is scheduled for Wednesday.

City officials said the four hospitals' position is misguided. "If they succeed at convincing the court and creditors to delay this [contract modification] so Greater Southeast can keep spending money at the rate it is, and Greater Southeast closes, that will have a catastrophic impact on these hospitals and the people in Wards 7 and 8," said City Administrator John A. Koskinen. "The purpose is to strengthen the ability of Greater Southeast to survive."

Koskinen said the city hoped to cut its direct support of the outpatient facility at D.C. General from $10 million to $8 million a year under its contract with Greater Southeast. The hospital's executives say they lost an additional $8 million a year supporting the outpatient center and it is no longer supportable with the firm under the control of the bankruptcy court and a demanding group of creditors.

The dispute boils down to whether a new urgent care center at D.C. General will shift thousands of patients to other emergency rooms or, as the city asserts, draw thousands out of those hospital ERs and back to D.C. General for their mostly minor health problems.

Daniel P. McLean, chief executive at George Washington and chairman of the D.C. Hospital Association, said Mayor Anthony A. Williams, Deputy Mayor Carolyn N. Graham and Health Department Director James A. Buford have ignored the hospitals' appeals despite several meetings.

"Mr. Buford made it very clear that their only consideration at this time is keeping Greater Southeast alive, which is also a prime consideration of the hospital association," McLean said. "Without Greater Southeast, we are in severe possibility of having the entire health care system in the District collapse -- not overnight, but it could cause a domino effect."

McLean complained that the administration seems bent on following its plan. "We did not believe that they had either analyzed the ramifications correctly or understood them entirely, and certainly they did not consult with the hospitals," he said.

City Administrator John A. Koskinen said delaying the plan for Southeast Community Hospital would "have a catastrophic impact on these hospitals and the people in Wards 7 and 8."