Russo’s letter, obtained by The Washington Post, shows that the years-long effort to replace the District’s troubled public hospital with a new facility to serve the mostly poor and African American neighborhoods of Southeast Washington hangs by the thinnest of threads. United Medical Center, the public hospital in Southeast Washington, has been plagued by mismanagement and poor quality of care.

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The communication stopped short of what project supporters feared would be a prompt exit from the deal by GWU Hospital following the council’s actions. But a path forward in the negotiations was not immediately clear.

D.C. Mayor Muriel E. Bowser (D) said in a statement that the council had “legislated specific terms that are best left for the negotiating table.”

Bowser said that although the pause in negotiations with GWU Hospital officials is “an unfortunate turn, it does not change our resolve to finally deliver for our residents a new hospital that is part of an integrated health system, is financially stable and offers robust lines of service. Anything less will not deliver a lasting solution for our residents and our city.”

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At issue are the council’s votes Tuesday to require that the new hospital honor union contracts and employ nurses and other health-care workers from United Medical Center — the city’s current public hospital — and enter into an affiliation agreement that would allow Howard University medical students and doctors to practice at the hospital.

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Howard officials had complained that GWU Hospital’s expanded presence could put Howard’s hospital out of business. In the run-up to the vote, Howard University’s closely knit network of supporters had bombarded legislators with requests to heed those concerns.

The new conditions on the deal came as amendments to a bill, written by D.C. Council member Vincent C. Gray (D-Ward 7), that would waive the review process typically required of new medical facilities. Gray, who chairs the health committee, and the Bowser administration had said that step would speed up construction of the hospital, but the bill drew opposition because it also would have exempted from review a large expansion of specialty services at the hospital’s current site in Foggy Bottom.

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After the council approved the amendments, Gray postponed further debate on the bill until Dec. 18, an effort to salvage a version of the legislation that would be acceptable to GWU Hospital executives.

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The final version of the bill that Gray advanced would have expedited the building of a 200-bed hospital on the campus of St. Elizabeths and the addition of 220 beds at the current site of GWU Hospital.

But the specter of a new tower to hold most of those beds was slammed by critics, including those who live near the hospital and even George Washington University itself.

The university owns only a minority stake in the hospital that bears its name. The hospital is primarily controlled by a subsidiary of Universal Health Services, a Pennsylvania-based corporation that owns facilities across the country.

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Gray, who has helped lead the effort to build a hospital, said in a statement that each of those measures would be a “poison pill” and that he was “enormously disappointed” with his fellow council members for approving them.

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Council member Elissa Silverman (I-At Large), who introduced the union-related amendment, said she wants to meet in the coming weeks with GWU Hospital officials to understand their concerns.

“I hope that they can help answer these questions of why it’s a bad thing to make sure there are good quality union jobs at the new hospital, and why it would be a bad thing to have an academic affiliation with Howard University Medical School,” she said.

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Silverman added, “Let me be clear: I want a new hospital for Ward 8.”

Council member Trayon White Sr. (D-Ward 8), who introduced the amendment on Howard University, said in a text message that the university was “one of the largest bases of doctors of color in the country” and should have a place at a new medical facility in Southeast. “I’m confident that we will get an East End Hospital,” White wrote.

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The Bowser administration entered a tentative agreement in August with GWU Hospital to operate a new hospital in Southeast. Before the council’s action on Tuesday, a final agreement was set to be reached by early next year. That agreement would have to be approved by the council.

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In a letter to Howard University President Wayne A.I. Frederick this week, Bowser said her administration was willing to “consider a range of partnership opportunities” for Howard at the new Southeast hospital but would need more details on the costs of Howard’s proposal.

United Medical Center has long struggled to find an economically viable formula for providing care to its largely Medicaid-reliant patients from Southeast Washington and Prince George’s County, Md. During fiscal 2015 and 2016, taxpayers subsidized the hospital — which is supposed to be financially independent — with roughly $17 million over the two years.