In response to vocal citizen concern about its hospital proposal, Hospital Corporation of America doubled its donation to expand Belmont Ridge Road, eliminated a helicopter landing site and pledged $200,000 to combat cut-through traffic in Broadlands, but it wasn't enough.
A mostly mute Board of Supervisors voted Monday night to deny HCA's request to build the 164-bed Broadlands Regional Medical Center.
The lack of discussion on the night of the vote came on the heels of three years of passionate debate about health care in the county: namely, where it should be and who should provide it.
Along the way, HCA and nonprofit health-care provider Loudoun Healthcare, now a subsidiary of Inova Health System, duked it out in court. Loudoun Healthcare claimed the new hospital five miles away would threaten its own financial viability.
It also maintained that HCA's certificate of public need, which is granted by state Health Commissioner Robert Stroube, was invalid because the commissioner reversed an earlier denial of HCA's proposal.
The Loudoun County Circuit Court disagreed, and HCA won the battle for state approval.
BUT ON THE LOCAL level, HCA was up against a different beast. Loudoun Healthcare has been the sole provider of health care in the county for a century. Loudoun County's recent population boom proved that the 155-bed Lansdowne hospital and the outpatient facility on Cornwall weren't enough: 51 percent of the population receives health care outside the county.
Still, local support was strong for Loudoun Healthcare, which many residents perceived as a kind of David against the Goliath of HCA, the country's largest for-profit hospital chain. That perception persisted even after Loudoun Healthcare joined Inova Health System, Northern Virginia's largest provider of health care, earlier this year.
As the discussion moved from the courts and into Loudoun public meetings over the last few months, anti-HCA citizens took to wearing bright yellow "I live in the HCA fallout zone" T-shirts. Wearers of the shirts said they lived in the neighborhood across the street from the proposed site.
On Monday, that was not quite the case. One Leesburg woman said she was wearing the shirt "by proxy" for friends of hers who lived in Broadlands. Another man said he was a Loudoun Healthcare employee and declined to comment further.
Linda Kuhn was the real deal. A Broadlands resident, she had followed HCA's proposal closely and spoken out against it.
She echoed the concerns that other anti-HCA citizens have cited: traffic, noise and the idea that she had bought into a residential neighborhood with an undeveloped piece of land zoned for office space, not a hospital.
"People felt betrayed," Kuhn said.
But Broadlands residents have won, she added.
"People stood up in the community, and we were heard," she said.
TWO SUPERVISORS joined Chairman Scott York (I-At Large), a vocal proponent of HCA, in refusing to vote against Broadlands Regional Medical Center.
Unlike York, however, both Jim Burton (I-Blue Ridge) and Sally Kurtz (D-Catoctin) expressed reservations about HCA.
"I believe that their real intent is to drive [Loudoun Healthcare] out of business," Burton said. But because HCA had met all the concerns brought up by the county and Planning Commission Ñ and Burton called the Planning Commission's 14 reasons to recommend denial "weak" and "shallow" Ñ he voted against denial.
"When I looked at it overall, I too, like Mr. Burton, cannot find a mitigation that hasn't been addressed in terms of protecting the neighborhood and getting access to the hospital," Kurtz said before voting against denial.
Supervisors in support of voting to deny HCA's request declined to comment before the vote, with the exception of Supervisor Stephen Snow (R-Dulles), whose district contains the proposed site. He read from a prepared statement because extemporizing on the topic "would get me in trouble," he said.
Even in his statement, Snow was uncharacteristically uncolorful. He has been adamantly against the Broadlands site in the past and even met with HCA representatives to try to convince them to relocate in the Route 50 corridor. When he spoke Monday, however, he only noted that the proposal was not, in his opinion, "compatible with the existing neighborhood."
AFTER THE VOTE, the board room was filled with applause. People shook Loudoun Healthcare CEO Rod Heubbers' hand.
But the war isn't over Ñ not yet.
HCA still owns the 64-acre site, which is zoned for office buildings.
Bryan Dearing, Broadlands Regional Medical Center CEO, said HCA will announce its intentions in the coming weeks.
"It's very disappointing," he said. "Obviously, we need additional health care, but we're not being allowed to provide it."
As for an appeal to the Loudoun County Circuit Court, Dearing said he's "looking at it." He also raised the possibility of putting medical office buildings on the site.
The votes to keep HCA, the state's fourth largest employer, out of the county puzzled Dearing.
"It's been pretty obvious for a long time that the decision was going to be along party lines," he said. "It seems interesting to me that the Republicans on the board would not be in favor of free market bringing services to the county. It's pretty baffling."