Virginia Health Commissioner Robert B. Stroube has rejected a proposal by a Nashville-based hospital chain to open a new medical center in Loudoun County, saying it would create "harmful competition and unnecessary duplication" in Northern Virginia.

HCA Inc., the nation's largest for-profit hospital chain, had sought to build a 180-bed facility in eastern Loudoun's Ashburn area. HCA planned to close two other facilities -- 164-bed Northern Virginia Community Hospital in Arlington County and Dominion Hospital, a psychiatric unit in Falls Church -- and combine their staffs and services at the new site.

Stroube also denied an application by Loudoun Hospital Center to add 32 beds at its Lansdowne campus and a request by Inova Fair Oaks Hospital for 40 new beds.

Marilyn Tavenner, president of HCA's Central Atlantic Division, said she hadn't seen the full decision but was upset by it. "We're disappointed," Tavenner said. "All three projects being denied doesn't expand health services in Northern Virginia. The current facilities have aged beyond reasonable function."

Although Loudoun Hospital officials said they were disappointed that their pitch for expansion was turned down, they were pleased that a rival would not be coming to the county. HCA's proposed hospital -- Broadlands Regional Medical Center -- would have been five miles away from Loudoun Hospital's Lansdowne campus.

During recent months, Loudoun Hospital officials have sparred with HCA over the proposal as both camps lobbied local politicians and appealed to residents with glossy mailings and newspaper advertisements.

Officials at Loudoun Hospital -- the county's only hospital -- argued that the two hospitals would compete for physicians, other medical workers and patients and that the bottom line would be higher health care costs. HCA insisted more than one hospital was needed in the nation's second-fastest growing county.

"We're pretty pleased," said Rodney Huebbers, CEO of Loudoun Healthcare Inc., which runs Loudoun Hospital Center.

"The theme we've been saying is that if you have two county hospitals neither is going to be able to grow to the level of sophistication that the community needs."

Stroube, in a four-page letter sent Friday, said the proposed Broadlands Regional Medical Center would be "a threat to the continued viability and independent existence" of Loudoun Hospital Center, which he described as an "essential community hospital." He said residents in Loudoun and western Fairfax are well served by Reston Hospital Center, Inova Fair Oaks Hospital and Loudoun Hospital.

Loudoun County Board Chairman Scott K. York (R-At Large) said he was angered by the decision and is concerned that residents will not have sufficient health care services or options.

"Once again, Northern Virginia and Loudoun get shortchanged by the state," York said. "They seem to forget that Loudoun is growing rapidly, and we need the facility. I believe Loudoun has matured enough to support two hospitals," York said.

Loudoun Supervisor James G. Burton (I-Mercer) said eastern Loudoun doesn't need a new hospital. However, Burton said he's lobbying Loudoun Hospital Center to provide more services for western Loudoun residents, who often travel to Lansdowne or seek care at Winchester Medical Center.

Tavenner said Northern Virginia is underserved and changes need to be made. "Closing [Northern Virginia Community Hospital and Dominion Hospital] is not an option," she said. "Replacing them is."

Tavenner said HCA now has two options: to accept the decision, "which is not the way we want to go," or mount a court appeal. No decision has been made, she said.

HCA officials have said that their case before the public and state and local review boards had been hurt by the publicity from a massive Medicare fraud investigation that began in the mid-1990s.

The firm settled criminal cases and civil litigation, agreeing to pay $840 million in fines, penalties and civil damages, according to news accounts.

Officials with Inova Fair Oaks Hospital, which was turned down for a 40-bed expansion, declined comment. "We want to reserve comment until we get a chance to read the commissioner's ruling," said Inova spokeswoman Lisa Wolfington.

Huebbers said Loudoun Hospital was adding 25 beds next week. "The door isn't closed. We'll be back," Huebbers said.

Loudoun Board of Supervisors Chairman Scott K. York is concerned residents won't have sufficient health care services.