The board of St. Vincent Catholic Medical Centers voted on Tuesday night to close its flagship hospital in Greenwich Village, ending its long struggle to stay afloat despite millions of dollars of debt.

The exact timing for the closing of St. Vincent’s Hospital Manhattan, which has about 400 inpatient beds, was not immediately clear, but the process of shutting down has already begun, and the State Department of Health will become involved to ensure an orderly closing. Elective surgeries are to end by April 14.

“The decision to close St. Vincent’s Hospital Manhattan inpatient services was made only after the board, management and our advisers exhausted every possible alternative,” Alfred E. Smith IV, chairman of St. Vincent Catholic Medical Centers, said in a statement. They were unable to come up with a plan, he said, “to save the inpatient services at the hospital that has proudly served Manhattan’s West Side and downtown for 160 years.”

Gov. David A. Paterson said Tuesday that he would work with the board and the Department of Health to preserve some of the hospital’s most important community functions, perhaps by scaling it down to an urgent care center that could take patients with conditions ranging from ankle sprains to heart attacks. That plan would also try to maintain some outpatient services, like those that provide H.I.V. treatment and primary care, but it remains at a conceptual stage and would require finding a partner, people close to the process said.