Virginia Commissioner of Health Karen Remley has granted an extension until Sept. 19 to HCA's approval from the state to build a 164-bed hospital in Broadlands.

The project still lacks land-use approval from the county. Supervisors in February cited disruption to an adjacent residential neighborhood and denied the application. HCA is asking the Circuit Court to overturn that vote.

The four-year delay -- five, if counted from the original 2004 award of a Certificate of Public Need, or COPN -- can be traced, the hospital corporation argued, to Inova Loudoun Hospital's court battle to overturn the approval.

Remley agreed, writing in the April 9 ruling, " ... it has been the practice of the Department to not expect the certificate holder to proceed with a project while the decision is appealed."

By state law, the commissioner must cancel a COPN when the project has not been completed in three years "... except when delays in completion of a project have been caused by events beyond the control of the owner."

Commissioner Robert Stroube issued the COPN for Broadlands May 13, 2005. Remley, who was appointed to the job after Stroube stepped down, approved a one-year extension of the approval on May 9, 2008, on the grounds that HCA could not be expected to commit money to the project while the COPN was tied up in court.

Inova Loudoun Hospital has challenged the validity of Stroube's award since it was made, and the challenge has since worked its way through the court system. On Sept. 19, 2008, the Virginia Supreme Court refused to hear Inova's appeal of a lower court's denial of its challenge to the awarding of the COPN.

Remley's extension runs out a year from the Supreme Court's action. At that time, she wrote, HCA, parent of the Broadlands project, will have to ask for another extension "... or request authorization to relocate its project to another site."

HCA owns property on U.S. 50, where the majority of county supervisors would prefer to see the next hospital built. Since Feb. 3, when supervisors turned down its request for approval to build the hospital in Broadlands, HCA has said that it will not move its project there.

Three days before Remley's decision, the National Nurses Organizing Committee, based in Oakland, Calif., asked her to deny the extension. The committee, the national organizing arm of the California Nurses Association, reiterated that the Broadlands project is bad land use and bad health-care planning.

It also charges that Secretary of Health and Human Resources Marilyn Tavenner's close ties to HCA will taint any ruling. The Commissioner of Health reports directly to the Secretary.

Tavenner started as a nurse and rose through HCA's ranks to become president of HCA's Central Atlantic Division. In that position, she spearheaded HCA's campaign for state and county approval of the Broadlands project.

HCA's Mark Foust said, "It remains unclear why a union based in Oakland, Calif., keeps trying to insert itself into a Loudoun County matter -- or why it continues to raise issues that have already been discredited."

Since February, when the Board of Supervisors denied for the second time HCA's request to build in Broadlands, HCA announced plans to expand its 187-bed Reston Hospital Center by 152 beds. Inova Loudoun Hospital has announced its own plans to build a hospital on land it owns on U.S. 50 near Arcola.