FORTMILL, S.C. -- Carolinas HealthCare System has won the seven-year battle to build the first hospital in Fort Mill - but appeals from the losing sides could be on the way, prolonging the fight.

S.C. regulators announced this morning that the company can build the 64-bed Carolinas Medical Center-Fort Mill. The decision opens the way for owner Carolinas HealthCare System, which has hospitals in seven area locations, to become the main healthcare provider in northern York County. It would gain millions of dollars in revenue through a steady stream of patients using its Fort Mill hospital and York County physicians.

Tenet Healthcare Corp., which runs Piedmont Medical Center in Rock Hill, and Novant Health, which runs Presbyterian Hospital, also submitted bids to build hospitals. All three applicants had purchased land.

The applications had to go through South Carolina's certificate of need process, a state regulation to determine how much and what kind of health care is needed in a region, and who gets to build.

CMC's application was the most compliant, according to Beverly Brandt, chief of health facilities and services for the S.C. Department of Health and Environmental Control.

These criteria include items such as community need, financial feasibility cost containment and adverse impact upon other facilities, Brandt said in a statement.

Presbyterian suggested the competition isn't over.

We're very disappointed with State's decision to deny our application, Paula Vincent, senior vice president of operations for Presbyterian Hospital, said in a statement.

We strongly believe that Presbyterian Hospital Fort Mill best met the criteria for the new hospital, and we're disheartened on behalf of the 10,000 area residents, physicians and community leaders who expressed their support for our proposal.

...After a careful review of the decision, we will determine an appropriate course of action, which could include an appeal.

The dispute has been unusually long and public. State regulators decided in 2004 that Fort Mill needs a 64-bed hospital.

Tenet, which runs Piedmont Medical Center in Rock Hill and was the only for-profit entity in the three-way competition, won the initial bid from the state in 2006. CHS and Novant appealed. Each group put up billboards along Interstate 77 and launched websites promoting their hospital projects.

And each hospital group launched a letter-writing campaign, resulting in more than 24,000 pieces of mail to DHEC.

DHEC's decision becomes final 15 days after notice has been mailed to applicants. Losing applicants then have 15 days to appeal to the board. They could also appeal to an administrative law court if the board refuses to hear the case again - or if the board does hear the case, and issues a ruling parties don't like.

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