Pushing the management restructuring of Grady Memorial Hospital one large step closer to reality, the Fulton County Board of Commissioners approved a lease agreement Wednesday that would shift operational control from the hospital board to a new nonprofit corporation.

The vote was five to two. The restructuring plan still requires the approval of the DeKalb County Board of Commissioners, which is expected to vote Tuesday.

"This is a glorious deal for Grady," said Commissioner Tom Lowe, an ardent supporter of the plan. "It just opens the door to the community to help in the salvation of this great, great institution."

The lease agreement puts daily operations of the hospital system under control of a nonprofit board of business and community leaders; the Grady board would continue to have broad oversight and would own the real estate.

The power shift would fulfill the demand of state and business leaders who have promised, in exchange, millions in extra funding for the financially crippled hospital.

The Grady board last month approved the agreement, which was recommended by a task force of the Metro Atlanta Chamber of Commerce.

DeKalb and Fulton counties have to approve the measure because they have bond agreements with the Grady board. The two counties provide about $100 million of Grady's annual budget.

DeKalb commissioners will hold a public hearing on the agreement at 6:30 tonight at the Manuel Maloof Auditorium of the DeKalb goverment center in Decatur.

Fulton commission chairman John Eaves said the change will help keep the hospital open. The hospital's financial problems caused some Grady officials to predict last year that the hospital could close without added funding.

Grady has operated in the red for a decade and its budget deficit reached more than $50 million last year.

Eaves said the hospital's closure could jeopardize health care across metro Atlanta. Grady is the metro area's only top level trauma center, a teaching hospital that trains a quarter of the state's doctors and the area's major provider of health care to the indigent and uninsured.

Dissenting votes were cast by commissioners Emma Darnell and Bill Edwards.

Several commissioners said they were uncomfortable with the political pressure to pass the lease quickly, saying they received the latest draft only a day or so ago.

"I'm not comfortable with what I have here. ... I'm going on hope and faith," said Commissioner Robb Pitts. Pitts said his positive vote was based on the promise by state elected officials and business leaders to provide upwards of $300 million in added funding for Grady.

Critics of the plan, including the local advocacy group called the Grady Coalition, blasted the commission for consenting to what they called a white business take over of the hospital, which largely serves and is run by African-Americans. They fear that the new nonprofit will cut jobs and services to the poor.

"It was a bewildering, frustrating, outrageous vote," said Dianne Mathiowetz, a Grady Coalition member. "It didn't honor their commitment to taxpayers or to the issue of public health."