Mayor Anthony A. Williams is calling for at least $200 million to build and support a 250-bed medical center that Howard University would own and run on the grounds of the former D.C. General Hospital. Critical services at Howard University Hospital could be moved to the site, leaving unclear the future of the facility on Georgia Avenue NW.

The National Capital Medical Center, a joint project first announced in much smaller form nearly two years ago, has major implications for a city with some of the worst health outcomes in the country. Two key medical organizations say a new inpatient facility does not best address residents' needs, and they question its potential impact on the District's financially shaky hospital system. They plan to voice their opposition today at a hearing focused solely on the proposed project.

The complex, though, has strong backing in numerous neighborhoods on the District's east side, where the incidence of trauma and chronic disease is greatest, hospital beds are fewest and D.C. General's 2001 closure remains a bitter loss. Several hundred people at a Ward 7 community meeting last week repeatedly applauded Williams (D), City Administrator Robert C. Bobb and Howard administrators as they described what the medical center would offer.

Williams promised to give the D.C. Council detailed legal and financial agreements by Oct. 1 "so we can continue moving forward on this critical part of our health care system."

And the mayor, who shut D.C. General and declared he never would support another "poor people's hospital," suggested he could agree to funding for certain inpatient programs or care of indigent, uninsured District residents, beyond the construction outlay.

"That's a wholly different thing" from an ongoing operating subsidy, Williams said.

The District's $200 million would pay for half of the estimated cost to build the National Capital Medical Center on nine acres at Independence Avenue and 20th Street SE. A consultant for the city concluded this year that the only way a new hospital of any size could break even would be if Howard closed its 30-year-old facility and transferred staff and subsidies.

A report prepared by the city and Howard was circulated yesterday by Bobb's office. The latest explanation of the plans and forecasts, it says that "Howard University Hospital and the NCMC will become a two-campus healthcare system under unified governance." But almost immediately, in identifying emergency and trauma care as the top need of communities east and just west of the Anacostia River, the report says the university "will consider moving" Howard University Hospital's Level 1 trauma service, along with neurosurgery, cardiovascular and orthopedic surgery, to the new medical center.

Relocation also will be considered for pediatric and adolescent services and the neonatal intensive care unit, the report states. Howard has about 370 occupied beds daily.

The report goes no further in discussing how the Georgia Avenue facility could evolve and does not mention the topic some city officials have discussed privately, that it ultimately could become an ambulatory care center with no beds. University President H. Patrick Swygert dismissed that prospect after the Ward 7 meeting.

Council member Jim Graham (D), whose Ward 1 includes Howard, said yesterday that he was concerned about any possible downsizing and wants "very clear answers" about the city's medical exigencies before the city invests $200 million or more in the project.

"In the past, I have been repeatedly reassured that there would be no change in function at Howard University Hospital," he said. "These are new developments that we'll have to look at closely."

Ward 7's council representative, Vincent C. Gray (D), wants significantly more health care services for residents there. "How do we create more equity . . . more parity, in services citywide?" he asked in an interview. Still, while saying he was generally pleased with last week's presentation, he is waiting on more specifics on financing, needs and capacity.

Few specifics, however, could justify such a major expenditure, officials with the District of Columbia Hospital Association and the D.C. Primary Care Association contend. They say the city's most urgent challenges -- among them, heart disease, diabetes and asthma -- are where hundreds of millions of new dollars should be allocated, not in a new hospital.

"I continue to believe [the project] is a misguided solution," said Sharon Baskerville, executive director of the primary care group.

Officials in both groups question the way the project has come about, outside of competitive bidding or a "certificate of need" process. "You wouldn't have had a $400 million proposal if you'd had some competition," Baskerville said.

The report does not address the implications for the city's other hospitals, two of which have laid off workers this year. Greater Southeast Community Hospital in Ward 8, which previously struggled with bankruptcy and accreditation issues, is generally considered most at risk from the competition of the National Capital Medical Center. But should Howard University Hospital diminish significantly in size, Washington Hospital Center and Providence Hospital might experience increased financial pressures, particularly through their emergency departments.

The project, slated to open in 2009, would include a medical office building designed to attract specialty physicians and address the dearth of specialty care in this quadrant of the city. Additionally, "it will provide a much-needed referral point for diagnostic testing that requires major medical equipment," the report says.

Council member David A. Catania (I-At Large), who chairs the Committee on Health, which has today's hearing, said he is concerned about the District's ability to finance hospital construction on top of construction of a baseball stadium. Nonetheless, he has offered qualified support.

His conditions: defined funding for some level of care for uninsured patients there, "meaningful" substance abuse programs and a renewed commitment to primary care in the community -- "the salvation to improving health outcomes in our city," he said.

An artist's conceptual rendering of the proposed National Capital Medical Center shows the 250-bed hospital and accompanying physicians office building.