The two agencies that evaluate Northern Virginia's health care needs for the state government have made different recommendations on how to serve Loudoun County's booming population, setting up a November showdown in Richmond between Loudoun Hospital Center and HCA, the country's largest for-profit hospital chain.

Both agencies -- the Virginia Division of Certificate of Public Need in Richmond and the local Health Services Agency of Northern Virginia -- rejected Hospital Corporation of America's request to shut down two of its area hospitals and build a 180-bed hospital in the Broadlands area of eastern Loudoun, saying that would cripple the nonprofit Loudoun Hospital Center.

They did not agree, however, on what should be done at the 103-bed hospital. The Health Services Agency said it should be allowed to add 32 beds because the population is growing quickly.

But in a report released Monday, the Division of Certificate of Public Need described such a move as premature, noting that the hospital is scheduled to open 42 beds by April and that several other area hospitals have received permission to expand. The report said it would be better to wait and gauge need after those projects were completed.

"This is absurd," said Scott K. York (R-At Large), chairman of the Board of Supervisors, who has written in support of both hospitals. "We need more beds in Loudoun County. . . . We need more health care in Loudoun County."

The decision by the Richmond agency came hours after a committee of community leaders and officials -- including David Goodfriend, Loudoun's director of public health -- told the supervisors that population growth has "strained the capacity of our medical community." Goodfriend urged the board to "support any qualified provider of health care facilities and services capable and willing to meet the health care needs of our county."

Erik Bodin, director of the Division of Certificate of Public Need, said in an interview that he was not opposed to growth at Loudoun Hospital, just to too much growth too soon. "Predicting the future is always a tricky thing," he said. "We should let what's approved come online and make its impact before we start adding any more resources."

The two hospitals offered muted criticism of the decisions.

"I can understand their position," said Rodney Huebbers, CEO of Loudoun Healthcare Inc., which runs Loudoun Hospital Center. "But what they said . . . it does validate that there's no need for that hospital in the Broadlands."

Hospital Center officials have said building a new hospital in the Broadlands area, only five miles from its campus, would cost it business and create competition for medical workers that would drive up health care costs.

Marilyn Tavenner, president of the central-Atlantic division of Nashville-based HCA, said she was optimistic that her company's project would be approved eventually.

"We really have a lot of support from the citizens, the EMS and fire and rescue squads," she said. "We're going to stress that this is a replacement hospital. This is not a request for new beds."

The next stage of the long regulatory process takes place Nov. 7-8 in Richmond when Loudoun Hospital Center and HCA make their arguments before a state health department adjudication officer. The Virginia Division of Certificate of Public Need and the Health Services Agency of Northern Virginia will also appear.

The adjudication officer must make a recommendation to the state health commissioner, Robert B. Stroube, who has the final say. That could take at least a month and possibly several. Bodin said he did not expect a ruling until early next year.

After the two days of hearings in Richmond, both parties have 30 days in which to file additional information to bolster their positions. Then the health commissioner has 45 days to obtain a recommendation from the adjudication officer and make a ruling.

At that point, the health commissioner can notify the attorney general that he needs 25 more days. If the health commissioner makes no decision, the projects are automatically approved.