After two years of planning, negotiating and controversy, Howard University trustees have recommitted to their partnership with the city to build a $400 million hospital complex intended to fill gaps in acute and emergency care on the District's eastern side.

The National Capital Medical Center would include a 250-bed facility with a top-level trauma unit, research divisions and a professional office building. Howard would own and operate it, and the trustees' action during two days of closed-door discussions this weekend was a major step forward for a project that still presents nearly as many questions as answers.

University Senior Vice President Hassan Minor made the announcement last night at a Ward 1 Democrats forum on the medical center, saying the board had "passed a resolution reaffirming strongly its partnership with the city to proceed."

But the wording of its statement, which garnered "absolutely overwhelming" support, will remain private, Minor said. "Because we don't do that. Our resolutions are not public."

The project would rise in Southeast Washington on the grounds of the former D.C. General Hospital, which closed in 2001 amid bitter community opposition. Despite that history and the minimum $201 million in taxpayer funds anticipated for construction, the city and Howard have made clear that the National Capital Medical Center would not operate as a public hospital delivering unlimited care for District residents who lack health coverage.

Exactly how much care the hospital would give such residents in return for the city's investment remains a crucial issue. Howard officials have promised they will soon give a dollar amount or percentage to the D.C. Council's Health Committee.

"I just want to see specifically what they have approved," said committee Chairman David A. Catania (I-At Large). "I want to see what they have done in writing."

By Jan. 1, the partners are to send the council a complete financial and governance package and to sign the "exclusive rights agreement" that would control the steps leading to construction. As of late last month, city officials said their respective proposals for that agreement were far apart.

The council needs to vote on final approval, as well as decide whether to exempt the project's specifics from the certificate-of-need process that scrutinizes health care construction for the impact it might have on costs and duplication of services. City Administrator Robert C. Bobb is pushing to bypass such a review.

"Quite frankly, we've been waiting, waiting, waiting for a signal from Howard trustees as to whether this is what they want," council member Jim Graham (D-Ward 1) said last night, admitting that he is still "unequivocally undecided" about his own position.

Because of concern over the city's rapidly spiraling indebtedness from large capital works, the District would pay its 50 percent share of construction costs with $100 million expected from the national tobacco settlement and $100 million from an anticipated budget surplus in fiscal 2009.

In voting its support, the Howard board put much on the line financially. Even if it hits its high targets for occupancy rates, surgeries and outpatient procedures, the National Capital Medical Center is expected to run multimillion-dollar deficits for several years at least. The university would be responsible for covering shortfalls; Mayor Anthony A. Williams (D) has stressed repeatedly that the city would not provide ongoing operating subsidies.

The trustees' support also affects the future of Howard University Hospital on Georgia Avenue NW. Administrators say they would move all trauma care to the new location, plus obstetrics and gynecology, pediatrics and much of the intensive-care service.

The project was first proposed in November 2003 as a 110- to 120-bed hospital that would cost $175 million at most. As its scope and price tag increased and then more than doubled, so did concerns about how the project addresses the city's pressing health concerns.

Backers say it will begin to remedy a stark geographic disparity of hospital beds -- "a gaping hole," in Bobb's words -- that has resulted because the vast majority of the District's medical facilities are in Northwest. And with very limited emergency care and no trauma service on the city's east side since D.C. General's closure, some supporters contend that victims of heart attacks, car accidents and gunshots have died while being transported across town.

Opponents argue that the hundreds of millions of dollars to be spent on the project will do little to solve the city's chronic health problems. With extreme rates of diabetes, heart disease and cancer, to name just a few, the District has some of the worst health outcomes of any jurisdiction in the country.

Bobb countered last night that the medical center was never about fixing those problems. "It requires an entire system of health care to address health disparities in the District of Columbia," Bobb said forcefully. "So it's not fair to say this hospital in and of itself shouldn't be built."