On September 11, 2008, on the eve of a major public hearing before the Loudoun County Planning Commission, Middleburg's Town Council unanimously passed a resolution opposing construction of Hospital Corporation of America's proposed new 164-bed hospital, sited on nearly 60 acres, in Broadlands, near the intersection of State Route 659 and the Dulles Greenway, roughly five miles from Inova Loudoun's existing facility.

Specifically, Council requested that the Planning Commission and the Board of Supervisors comply with what it believes to be the clear language of the County's current Comprehensive Plan, namely that "...the next full-service hospital be constructed closer to Middleburg, at some point on Route 50."

The September 11 resolution reflected Middleburg's official view on new hospital construction since HCA first requested permission to build in 2004.

On October 15, roughly 120 people spoke for and against the new hospital, its Broadlands location, or both, at a sometimes raucous standing-room-only public hearing, convened by the County Planning Commission in the Eagle Ridge Middle School auditorium.

At press time the Planning Commission had requested still further information for review at its Tuesday, October 21, work session, prior to submitting its formal recommendations to the Board of Supervisors.

In 2004 a generally pro-development Board of Supervisors denied HCA's request to build its new Broadlands Regional Medical Center. It was the only request, out of nearly 90 similar ones, to be denied. HCA sued to have the Supervisor's decision overturned in Loudoun County Circuit Court. With legal proceedings dragging on, in March, 2008, by a one-vote majority, a new Board of Supervisors agreed to allow HCA to put forward a new application. That application, submitted by HCA in April, was, for all practical purposes identical to the one submitted nearly four years earlier. During that entire period the Virginia State Health Commission's vital "Certificate of Public Need" for the hospital had been reviewed and extended several times.

On the eve of the Eagle Ridge hearing, senior executives from both Inova Loudoun Hospital and HCA responded to questions from the Middleburg Eccentric about the key issues in the on-off-on-off struggle, that has divided the County for four years.

Loudoun County's Comprehensive Plan

According to Inova Loudoun Hospital CEO, Randy Kelley, the County's Comprehensive Plan is clear, and little or nothing has changed since 2004 to negate the goal of having health care facilities available to "all county residents" within "twenty minutes driving time" during peak traffic. Putting a second hospital within five miles of an already existing facility, according to Kelley, neither conforms to the intentions of County planners, nor serves the best interests of potential patients of either Inova Loudoun or HCA.

The most recent staff report from the County's land-use planning staff, recommending that rezoning to allow construction of the HCA facility be approved, did not specifically address the issue of peak-traffic travel time for residents of the western side of the county.

HCA's Mark Faust contends that the Broadlands site meshes perfectly with both the intent of the County's Comprehensive Plan and the realities of patient need in the County. Pointing to maps of current and projected population-density, Faust notes that Broadlands site best addresses current needs and current growth projections, and that the State of Virginia's often-renewed Certificate of Need for new hospital beds in the area supports HCA's plans.

Does Competition Improve Care?

HCA's Faust insists that having two large hospitals within five miles of each other is both a good idea now, and for the foreseeable future. In addition to putting needed healthcare facilities near where most potential patients already live, Faust asserts that vigorous competition among highly motivated professionals is healthy, that it promotes high standards, and, by doing so, not only steadily improves the quality of care and staff, but works to promote cost efficiency as well.

Inova Loudoun's Kelley, on the other hand, notes that unlike most businesses, "Healthcare doesn't really benefit from competition." The statistics on the "quality-of-care" side are unequivocal, he points out. The more of a given procedure hospital surgery teams do, the better they do it. And the more complicated and critical the procedure, the stronger the effect. If HCA builds at Broadlands, according to Kelley, the county risks having two "good" hospitals within five miles of each other, instead of one "excellent" hospital fully capable of serving the same area.

What About Money?

Inova Loudoun contends that reducing the number of patients served by its non-profit facility at Lansdowne risks having a severe impact on cash flow. Less money coming in may dictate having a smaller staff for existing facilities, fewer services offered, and less money, if any, available for long-planned outreach programs and the Inova Loudoun Foundation's other charitable activities in the County.

HCA, the country's largest for-profit hospital corporation, contends that the county's high-income demographics, combined with its demonstrated need for more hospital beds, comes as close as humanly possible to guaranteeing the financial stability of both Inova Loudoun's Lansdowne facility and HCA's new hospital at Broadlands. Otherwise, Faust noted, HCA would not have made a well-considered business decision to invest millions building on the Greenway.

Can't We All Just Get Along?

When asked what would happen if HCA's four-year-old request to build at Broadlands were finally approved, both Inova Loudoun and HCA responded diplomatically.

Inova Loudoun's Kelley observed that his non-profit hospital was about to celebrate a century of service to the County, and would do its best to continue its long and special history of care, no matter what obstacles were thrown in its way. His primary concern, and that of all those associated with the hospital, he said, was to provide first-class medical care, county-wide. According to Kelley, Inova Loudoun would not only be willing to work with HCA to provide that care, but would be willing to sell property along Route 50 to HCA to help make sure that such care was appropriately accessible, financially rational, and safely distributed around the county.

HCA agreed that first-class care was everyone's primary goal, noted that HCA's history and the State of Virginia's certification of the need for new hospital beds spoke precisely to that goal, and looked forward to an excellent working relationship between healthcare providers working from Inova's facility at Lansdowne and those based in the new Broadlands Medical Center.

From the point of view of Middleburg's Town Council, both Lansdowne and Broadlands remain, in every respect, still far, far away.