Focus of the eight-year (and growing) question of who will build Loudoun’s second hospital and where it will be built, has shifted to Richmond, where the state health commissioner must decide by the end of the month whether HCA will be allowed to move its Broadlands Regional Medical Center to the Arcola area of U.S. 50.

Inova Health System, parent of Inova Loudoun Hospital, has notified Health Commissioner Karen Remley that it will stand by its pledge not to block a “genuine relocation” of the 164-bed hospital from Broadlands to U.S. 50. But, the letter goes on, HCA’s real intentions could be to tie the beds up and to use them somewhere else, perhaps in its Reston Hospital Center expansion.

Approving the relocation without requiring the project to be completed on U.S. 50, the letter continues, “would be akin to handing HCA paper beds (and paper ORs and a paper cardiac cath lab, etc.)” and preventing the development of health-care facilities in the entire planning district “until the real plan is unveiled.”

HCA Vice President Mark Foust countered that his company has been trying to build a hospital in Loudoun for the last eight years, “dodging Inova’s roadblocks all that time. The real question is whether Inova will keep its two promises: first, withdrawing its Route 50 application, and second, refraining from challenging ours.”

Inova applied July 1 to build an 80-bed hospital on its 95 acres adjacent to the HCA site on U.S. 50. In mid-August, HCA, which had said up to that point it would not consider building along U.S. 50 until there is a larger population, applied to move its project to its 25 acres in Arcola.

The Reston project and the U.S. 50 plans are separate and independent, Foust said. “There are no plans whatsoever to shift beds back to Reston.”

The Inova letter to Remley asks for three restrictions on any approval of the relocation:

• Prevent HCA from moving any of the beds or other regulated services from the U.S. 50 site until well after a hospital opens there and is serving patients;

• Require full regulatory review of any shift of those services, not just the 30-day “significant change”;

• Require HCA to notify all other hospitals in the planning district of any filings with the Department of Health.

As for its plans for a U.S. 50 hospital, Inova requested and was granted permission to put that application on hold until Oct. 10. Inova will not withdraw its hospital application until after Remley has ruled on the HCA relocation, and until it can evaluate whether “Inova’s concerns are being addressed.”

The Health Services Agency of Northern Virginia is expected to release its recommendation on the HCA move to U.S. 50 by the end of this week. The final decision rests with Remley, who must release her decision within 35 days of HCA’s Aug. 20 request.