The state and city hospitals targeted for closure and alteration next week will be expecting to see an outstretched arm from the powerful health care lobbying groups that have traditionally stood as a bulwark against budget cuts and other threats.

Having come to their rescue in the past, the state’s two major hospital associations and the health care workers union will extend condolences, but probably won’t bail out the hospitals targeted by Governor Pataki’s hospital closure commission.

In four days, the Commission on Health Care Facilities in the 21st Century will deliver a jolt of pain to the state’s troubled hospital industry, presenting to Mr. Pataki a prescription of tough medicine that will include recommendations to merge, convert, shrink, and close dozens of hospitals around the state, including several in New York City.

In recent weeks, speculation as to which hospitals would be marked for closure and which would be spared has reached a high pitch. But for state and city officials and the anxious health care industry, the bigger question isn’t what will happen on Tuesday but what happens after the initial shock.

While Mr. Pataki and state lawmakers are expected to yield to the commission’s recommendations and allow them to become law, Albany is also girding for a backlash from communities and interest groups that could delay or halt the more controversial measures.

The closing of a hospital is often a traumatic experience for a community. When Mayor Koch closed the public Sydenham Hospital in Harlem in 1980, angry protesters occupied the building’s offices for days and clashed with police.

This time around, signs are pointing to a battle that is more local in scope, with individual hospitals organizing protest rallies and filing lawsuits seeking an injunction against closures but not necessarily in coordination with the associations and the union, the groups that wield the clout in Albany.

The Greater New York Hospital Association, the statewide Healthcare Association of New York State, and 1199 SEIU will not openly endorse the shuttering of any hospital, regardless of its financial condition. Giving their seal of approval would be viewed as an act of betrayal by dues-paying hospitals and their employees, many of whom will be out of jobs. When the health care panel releases its report on Tuesday, the groups will likely issue press releases voicing lament and indignation.

“It’s a horrible day in the life of the health care system,” the president and chief executive officer of the Greater New York Hospital Association, Kenneth Raske, told The New York Sun in a recent interview. “It will be the biggest cut in health spending ever registered in the United States.”

Mr. Raske said he did not know how his group would respond to the report because he has not been briefed on its contents. He said one possible course of action is “not to do anything.” His lobbying group, he said, won’t discourage neighborhood protests but it might not “go on the field.”

A muted approach would be a far cry from the association’s rapid mobilization against Mr. Pataki in the spring, when the governor was threatening hospitals with cuts to reimbursement rates.

Mr. Raske’s association and the health care union spent millions of dollars on a statewide television ad campaign that accused the governor of putting the lives of premature babies at risk. With his public approval rating dipping to new lows, Mr. Pataki later restored virtually all of the hospital money in the final budget.

“Medicaid cuts and the commission report are mutually exclusive,” Mr. Raske said. Mr. Pataki’s proposed budget cuts, he said, were a blunt instrument that would have only “amplified” the failures of hospitals. The commission, on the other hand, is engaged in a “planning process” that will trim the fat from the system without weakening all of the players.

There’s a major incentive for Mr. Raske to cooperate in the form of $2.5 billion in state and federal waiver money that is contingent on the implementation of the report. Spread over five years, the funds are supposed to help pay for new hospital technology and capital upgrades and defray the transition costs of the mergers and closures. The money would also be used to help what could be thousands of displaced employees find new jobs. 1199 SEIU will probably lobby the Spitzer administration for more money to keep more of their members employed.

For Mr. Raske, there is also a realization that some hospitals cannot be saved. In the last decade, the association has seen hospitals fail to make payroll or contribute to the benefit fund, forcing his group and the union to pool money and appeal for government funds to keep them operating. When his group endorsed the formation of the commission in 2004, “it was clear to us that the health care system was going into a tailspin,” he said.

Hospital industry experts say it will be difficult for an institution that is marked for closure to survive. Some are likely to sue in state Supreme Court and accuse the government of acting arbitrarily and capriciously and demand an injunction against closure. A court case could take months or years, and by the time it’s over the damage to the hospitals would already have been done.

Vendors will have stopped shipping goods out of a fear that they won’t get paid. Doctors, who are unwilling to take chances, will have fled to competitors. It’s also predicted that hospitals will have been drained of their technical support, as x-ray technicians and nurses fill vacancies at other institutions. Patients will defect to hospitals that have more stability.

While they may be doomed, the hospitals will be able to rely on less potent support from local activists and politicians. A City Council member representing Bay Ridge, Brooklyn, Vincent Gentile, is already planning a rally in front of Victory Memorial Hospital, one of at least six New York City hospitals that is said to be on the closure list.

“We’re definitely going to do our part in trying to make it not close,” a spokesman for Mr. Gentile, Eric Kuo, said. “I have very little doubt that we’re going to rally in front of Victory. Hospitals are like firehouses. The immediate area is not going to want it to close.”