Ealing Council has been refused permission to take a hospital reconfiguration plan to judicial review.
The decision by the High Court means the north west London plan to significantly change services across eight London boroughs is one step nearer.
The Shaping a Healthier Future process put together by the former north west London cluster of primary care trusts proposes closing three of the eight accident and emergency units in the area - Ealing, Central Middlesex and Charing Cross - among other measures.
It was described by NHS England chief executive Sir David Nicholson as the most significant reconfiguration project in the country.
The proposals have already been referred to the Independent Reconfiguration Panel whose recommendations are being considered by health secretary Jeremy Hunt.
At the High Court hearing on 10 October Mr Justice Mitting told the court that he would not allow the case to proceed to a full judicial review.
Ealing Council had argued the process was unlawful because it had consulted on the broad outlines of the proposals before consulting on the actual proposals themselves.
It also said the Shaping a Healthier Future programme had taken insufficient account of the ill-health of Ealing’s population.
Mark Spencer, an Ealing GP and the programme’s medical director, said: “We are pleased with the outcome of this case. We have always been confident of the benefits of the work we have done with staff, patients and key organisations – and continue to believe that the plans developed by clinicians are in the best interests of our patients.
Ealing council leader Julian Bell called the plans “monstrous” and urged Mr Hunt to reject them.