As a decade of public acrimony concludes with a Route 50 hospital in sight and the Supervisors saying "no more" to appeals to continue the Inova/HCA hospital location fight, it's easy to understand why residents in Western Loudoun feel they've won a critically important fight for quality medical care.

"I promised at the first public hearing on October 6th that we would extend our services with a quality healthcare facility on Route 50 if HCA's Broadlands application was not approved," said Inova Loudoun CEO Randy Kelley. "All the behind the scenes design work is done and we're committed to putting our services where they are needed by Greater Loudoun citizens."

Kelley describes the new hospital as the cornerstone of a medical campus that will grow and evolve to meet community needs.

"It will probably take two-to-three years to open the doors," Kelley explained. "We have to receive approval for our application, complete the road work that is part of our proffers and recruit the level of staff we demand to provide the highest quality of care."

The battle to build the next Loudoun County Hospital has been long and agonizing for Hospital Corporation of America and for Inova Health System. HCA, the largest hospital chain in the country controlling 166 hospitals nationally, a dozen hospitals in Virginia and three in Northern Virginia, tried to position Inova, that controls five hospitals total, as a monopoly in Loudoun County that was seeking to quell competition.

Inova countered that the issue was not whether or not to build another hospital in Loudoun County but where that facility was to be built. The need, according to Inova, was in the West, not on the Greenway just four miles from the main Inova medical campus.

According to experts, successful hospitals that offer both basic and sophisticated care to their patients must have stable patient populations to make the investments required to provide the best care.

The different orientations of the competing hospitals, HCA being a for-profit enterprise and Inova a not-for-profit institution, was the basis of heated debate at Supervisor's meetings and at public hearings, but the entrepreneurial spirit of HCA, sometimes described as a "buy, relocate, sell and close" strategy did not compare well with the "build, purchase and hold" business philosophy of Inova.

In the end, more than anything else, the issue was location. A majority of Supervisors simply did not believe the Broadlands location proposed by HCA was best. If their proposal had been located on Route 50, many believe the result would have been very different.

But, in the end, residents of Western Loudoun were well satisfied with both the decision and with Inova's response.