The District government filed suit Friday against management of Providence Hospital, saying its move to shutter most of its operations has violated the terms of its hospital license.

The move sets up a legal showdown over the future of the city’s oldest continuously operating hospital, which began shutting down operations Friday.

The medical campus in Northeast Washington, serving some of the city’s neediest residents, ended outpatient services, closed its operating room and drastically scaled back acute and critical care. The hospital said it needed to close because it had been struggling financially.

But under pressure from city officials, Providence agreed to keep its emergency room open through April and maintain 10 out of 283 beds available for patients who need to be admitted.

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The lawsuit filed by the office of Attorney General Karl A. Racine (D) on behalf of Mayor Muriel E. Bowser (D) said Providence’s closure plan needed the approval of local health officials.

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A spokesman for the Ascension health system, which operates the hospital, did not respond to a request for comment Friday afternoon.

Stephen Frum of the National Nurses United, the union that represents Providence nurses, welcomed a legal challenge.

“Unfortunately it comes late in the game, but I do hope we are able to compel Ascension to halt its abandonment of the community,” Frum said.

Patients were anxious Friday about losing a key source of health care on the eastern side of the city, where black and low-income residents are concentrated and health disparities are stark.

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“I’m in shock. How can you close a hospital in a community that so many rely on?” said Elaine Harrison, who is 54 and has sought care at Providence for decades. “I wish a miracle would happen or something. I’ve been praying.”

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Harrison expects her primary doctor to continue working at Providence when the hospital shrinks to a small primary-care operation and a skilled-nursing facility.

But her general surgeon and endocrinologist are leaving. On Friday, she stopped by the hospital to pick up medical records but opted to have them mailed instead after seeing a long line of patients on a similar mission.

Ascension, the world’s largest Catholic health-care provider, said the changes were necessary because of the hospital’s finances.

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“Providence and Ascension remain committed to the District and are pleased to be able to respond to the community need for this extended period,” said Patricia A. Maryland, an Ascension executive, in a news release this week.

Local elected officials have been frustrated, however.

After D.C. Department of Health Director LaQuandra Nesbitt told lawmakers she was powerless to stop the hospital from closing, the D.C. Council passed legislation empowering the city government to force hospitals to remain open.

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“Providence has been around for more than 150 years, and yet Ascension has been able to ruin all of the goodwill engendered by Providence in that time,” said council member Kenyan R. McDuffie (D-Ward 5). “Nobody trusts them to operate in good faith at this point.”

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It’s unclear whether Friday’s lawsuit was brought under the authority granted by that legislation.

Frum, the labor representative, said 103 of 248 nurses represented by his union were able to keep working at Providence, but about a third of them will be on-call and won’t have regular hours.

“It’s just crazy. We don’t know what’s going on, and Ascension seems to be changing the plan every day,” said Audrey Michael, a nurse who learned Friday that she will now work on-call instead of a regular shift.

“I’ve only been here about 4½ years, but the people who have been here for decades and spent their entire career here, the majority of their lives here and now they have to go off and in search of a new job? It’s just very sad,” Michael said. “It’s very emotional for a lot of people.”

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The hospital didn’t look like it was shutting down Friday. The parking lot was nearly full; no signs on the windows warned patients about the upcoming changes, and patients continued to trickle in and out.

In interviews, patients praised their experiences at Providence and lamented the impending loss of a conveniently located hospital.

“You look at this in the neighborhood and it’s really kind of a prominent service,” said Lauri Winters, who is 62 and came to get mammogram records. “I don’t even know where we are going next.”

Marie Wallace, 70, said she’ll follow her specialist wherever he goes. But she said she fears for her community when the emergency room is gone amid rising homicides, and for those who rely on public transportation.

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“I’m blessed to be able to drive, but a lot of people can’t drive,” Wallace said.

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Leonard Monts, a lifelong D.C. resident, remembered when the city shut down the former public hospital D.C. General in Southeast Washington.

“They can’t keep closing down hospitals in Washington,” he said.

As Providence scales back, plans to open a new hospital in Southeast Washington to replace the troubled public hospital United Medical Center are in jeopardy , further aggravating concerns about access to health care.

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