Health chiefs have decided to close the accident and emergency unit at Monklands Hospital in Airdrie.
Members of NHS Lanarkshire's board met to decide which of the area's three hospitals would lose the service.
Monklands will be downgraded to a planned care hospital, retaining a minor injuries and illness service but not emergency medicine.
About 100 campaigners who attended the meeting said they would now take the fight to Scottish ministers.
The final decision will be taken by Health Minister Andy Kerr's deputy as Hairmyres Hospital is in Mr Kerr's constituency.
"We had to make some very difficult choices about what was best for the future"
The other two hospitals are also located in the seats of leading Labour politicians.
Monklands is in the Westminster constituency of Home Secretary John Reid, the former UK health secretary, while Wishaw General is in First Minister Jack McConnell's constituency.
More than 50,000 people signed a petition against cuts at Monklands Hospital.
However, the vote at the board meeting on Tuesday evening was 19 to one in favour of closing the Monklands unit.
Medical director Dr John Browning said: "The decision was taken on the basis of the cost of the service, the access and the quality of care that we can provide.
Quality of care
"A huge amount of effort has gone into identifying the issues.
"All the hospitals in Lanarkshire are currently busy but we are not looking at what happens now. We had to make some very difficult choices about what was best for the future."
He said the decision would give those living in Lanarkshire the best quality of care.
"Decisions about the health of people in Lanarkshire should not be made on the basis of cost"
If the decision is ratified by the Scottish Executive's health department the Monklands A&E unit could be closed as early as 2009.
Campaigner Elaine Smith, the Labour MSP for Coatbridge and Chryston, said she was "astonished" by the decision.
"It was clearly based on cost, and decisions about the health of people in Lanarkshire should not be made on the basis of cost," she said.
"Monklands serves an area of the highest level of poverty in Lanarkshire."
She promised not to give up the fight and said she would take the case directly to the Scottish Executive.
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