D.C. Council member Vincent C. Gray (D-Ward 7), left, said the city must move quickly to open a new hospital to replace United Medical Center. (Bill O’Leary/The Washington Post)

D.C. lawmakers voted Tuesday to close the District’s only public hospital within four years, ending six decades of turbulent history at the only full-service hospital in the low-income and predominantly African American neighborhoods east of the Anacostia River.

The closure of United Medical Center, accompanied by funding restrictions that could dramatically scale back services at the hospital in its final years, was part of the $15.5 billion budget approved by the council for the next fiscal year, which begins Oct. 1.

The local portion of the budget controlled by city officials will be $8.6 billion, a 9.3 percent increase over current spending. The remainder of the budget is federal or other forms of special funding. The council must vote a second and final time on the budget later this month.

D.C. Council Member Vincent C. Gray (D-Ward 7), who proposed the closure of UMC, said it would limit the city’s losses at the hospital — which in recent years has required tens of millions in taxpayer bailouts — as the District prepares to open a new hospital in Southeast.

But as negotiations to build that replacement hospital look increasingly precarious, critics say closing UMC risks cutting off access to medical care for neighborhoods already struggling with high rates of infant mortality, gun violence and fatal drug overdoses, among other problems.

“We know at some point that there will be a new hospital, but that day is not today,” said council member Trayon White Sr. (D-Ward 8), who was born at UMC, located in his ward. “We are making a rash decision to defund a hospital that is still in existence right now. We should not pull the plug.”

In recent weeks, the debate over the city’s budget has devolved into a running battle between Mayor Muriel E. Bowser (D) and the council, which overhauled key parts of her spending plan.

Among other things, lawmakers weakened a $55 million package of affordable-housing initiatives that Bowser — reelected in November — said would jump-start a second term focused on the District’s housing crisis.

Bowser had also pushed the council to embrace a plan for Benjamin Banneker Academic High School, a high-performing school with a largely black student body, to move into an empty school building in Northwest Washington. That proposal was opposed by families in the Shaw neighborhood, who said they were promised a middle school on the site.

The mayor cast the conflict as a gentrification battle, saying she was “shocked” that lawmakers would tell Banneker students “they need to stay put” in Columbia Heights. But council members defied her wishes Tuesday, voting narrowly to keep Banneker at its current location and renovate it there.

Council member Brianne K. Nadeau (D-Ward 1), who chairs the Human Services Committee, successfully argued for a reduction in tax credits for high-tech businesses, with nearly $16 million redirected to social services, including outreach to and housing for the homeless, child-care subsidies, mental health services in schools, and replacement of lead service lines.

The council increased combined deed and recordation taxes for commercial real estate worth more than $2 million to 5 percent from the current 2.9 percent, and raised the sales tax on soda to 8 percent from 7 percent.

Lawmakers backed away from a proposal to restrict the District’s open-records law. D.C. Council Chairman Phil Mendelson (D) had advanced legislation that would shield from Freedom of Information Act requests any communications sent on the government email system in which public officials discussed matters not related to work.

Critics said that could make it harder for members of the public or journalists to uncover conflicts of interest or self-dealing.

In March, The Washington Post reported that council member Jack Evans (D-Ward 2) had repeatedly used his government email account to send business proposals to potential employers, offering his connections and influence as the city’s longest-serving lawmaker and chairman of the Washington Metropolitan Area Transit Authority. Journalists obtained those emails through the District’s FOIA law.

At the last minute, Mendelson pulled the measure, although it could be reintroduced as part of a separate bill.

The most consequential council action Tuesday may have been the vote to wind down operations at UMC by January 2023.

It was a decision long unimaginable in District politics. Elected officials have previously sought to preserve the hospital, which was built in the 1960s, saying it was needed to serve Southeast Washington. In 2010 the city bought the hospital after it entered bankruptcy and went through a rocky period of corporate management.

In recent years the 234-bed hospital has faced spiraling financial losses driven by a declining stream of patients. In the summer of 2017, health regulators closed UMC’s obstetrics ward because of dangerous medical errors, and The Post reported later that year on questionable deaths at the hospital.

The District is negotiating with George Washington University Hospital to build a new hospital in Southeast on the former site of St. Elizabeths Hospital. However, that deal almost fell apart in December, and its fate remains unclear.

UMC officials say they will need a $40 million subsidy to stay afloat during the next fiscal year. But Gray’s measure limits annual subsidies to $15 million until the hospital closes, requiring only that UMC continue to operate an emergency room and provide psychiatric services. If the current hospital board couldn’t meet those conditions, it would be replaced by a financial control board.

“What we’re trying to do is bring some fiscal rigor to this operation, and to the extent that we can, not harm any people,” Gray said Tuesday. “It’s a tough situation we have before us. I want to see the hospital continue to operate as effectively as it can in this interim period, and I want to move forward as quickly as we can on getting a new hospital built.”

Roberta LeNoir, UMC president of the D.C. Nurses Association, said the hospital’s employees are already working without sufficient supplies or staffing. She said patient loads have increased since the recent closure of Providence Hospital in Northeast Washington.

This week the union received a 60-day warning of impending layoffs.

“You take us away, it’s going to cause that much [more] stress to a system that’s already stressed,” said LeNoir, an emergency department nurse who has worked at UMC for a decade. “The people in Wards 7 and 8 deserve a hospital east of the Anacostia.”