Hoke County residents may have to wait a while longer to get their own hospital while two health care providers battle over whose plan best meets their needs.

Pinehurst-based FirstHealth of the Carolinas and Fayetteville-based Cape Fear Valley Health System are appealing the state's decision to allow both to build hospitals in that county.

Both appeals were filed late Wednesday afternoon with the state's Office of Administrative Hearings, just before the deadline. The appeal process blocks the two health systems from building the hospitals until legal matters are resolved, which could take several years.

Last week, FirstHealth CEO Charles Frock proposed that both sides drop any appeal to the state's decision, as well as drop all past appeals and move forward with construction. FirstHealth ran a full-page ad in the Sunday edition of The Fayetteville Observer to make its case.

FirstHealth's public appeal was met with harsh words from Mike Nagowski, CEO of Cape Fear Valley Health Systems, who said he was "surprised and frustrated." That prompted Cape Fear to run a full-page ad in Thursday's Fayetteville paper, which circulates in Hoke County, with a letter from Nagowski defending its decision to oppose FirstHealth's proposal.

Frock said in a statement released late Wednesday night that Cape Fear forced FirstHealth to appeal. He added that FirstHealth remained "committed" to dropping its appeals if Cape Fear does the same.

"Despite our efforts to negotiate privately and publicly, Cape Fear Valley Health System has not accepted our proposal to do what is best for Hoke County residents," Frock said in the statement. "We want Hoke County to have both hospitals and enjoy the benefits of greater health care access and competition.

"However, Cape Fear's silence on dropping the 2009 appeal and not appealing the 2010 approval has forced us into another appeal situation. FirstHealth has appealed our own 2010 approval. In an effort to protect our interests in our service area, FirstHealth has also appealed Cape Fear's approval."

Frock said in the statement that the state's approval of its 2010 application included a number of conditions it must accept, including one that "forces" FirstHealth Moore Regional Hospital to give back 30 acute care beds to the state.

"This condition is unacceptable given the high demand of Moore Regional's medical and surgical beds," he said in the statement. "We are required to appeal the decision before any discussion or negotiation with the state can take place. We look forward to discussing this issue with the state and are confident they will see the merit in our argument to retain the beds at Moore Regional.

"Regardless of the recent filing of appeals, we intend to continue to reach out to Cape Fear, and we stand by our commitment to withdraw all appeals if Cape Fear will do the same."

Nagowski said in the letter in the full-page ad that Cape Fear Valley chose to appeal the state's decision because the hospital proposed by FirstHealth is "essentially a way station," and that half of the admissions to the Hoke hospital would be transferred to FirstHealth Moore Regional Hospital in Pinehurst.

He said Cape Fear Valley was proposing an investment of $92 million with its 41-bed full-service hospital and outpatient center. He said Cape Fear has purchased the land and has secured a $38 million USDA loan for the outpatient center.

"In an era of health care reform, FirstHealth's proposal just doesn't make sense, both practically and fiscally, based on Hoke County's need," he said in the ad. "Simply put, Cape Fear Valley is offering a REAL solution for Hoke County, and FirstHealth is not. Therefore, we reluctantly have decided to oppose FirstHealth's CON (certificate of need).

"We fully intend to build a facility that will serve the residents of Hoke County without the added inconvenience of an additional ambulance ride to a full-service hospital for inpatient care. Hoke County residents deserve a full-service hospital in their own county, and that is exactly what we intend to do."

FirstHealth took exception to part of the ad that says FirstHealth appealed first, without notice to Cape Fear.

"They filed before we did," said Gretchen Kelly, public relations director for FirstHealth.

FirstHealth wants to build an eight-bed hospital at a projected cost of $34.1 million on U.S. 401 in Raeford. The FirstHealth Hoke Community Hospital would have an emergency room staffed by Pinehurst-based Moore Regional Hospital physicians, 24 hours a day, seven days a week.

In addition to the emergency beds, the hospital would include eight inpatient beds, an overnight observation unit and one operating room, full laboratory services, state-of-the-art imaging technology, diagnostic cardiology and transport options via critical care transport or helicopter.

The hospital would be built to allow for expansion. Future plans for the 30-acre medical complex site include medical office space and other health care-related services and facilities.

Kelly added that eight beds are all FirstHealth could take from Moore Regional Hospital for Hoke County at this time. She said the 2011 state plan identifies the need for an additional 65 hospital beds for Hoke County.

"We have every intention to expand our hospital based on demand," Kelly said.

Cape Fear Valley has proposed a $92 million, 41-bed hospital on U.S. 401 in Raeford. The health care system also plans to build an imaging center in Hoke and expand its primary care facility in the county.

The two health systems have been battling over the fast-growing Hoke County market for more than a year.

In 2009, the state approved applications from both health care providers to build hospitals within 10 miles of each other - FirstHealth Hoke Community Hospital on U.S. 401 in Raeford and Cape Fear's in Cumberland County near the Hoke County line.

Both health care systems filed legal appeals seeking to block each other, asserting that the state was wrong in its decision to allow both hospitals so close together.

Under the state's 2009 medical facilities plan, the Cumberland County-based system was not allowed to build a hospital in Hoke County because it was in a planning district with Moore County. At the request of Cape Fear, the state changed the plan this year to allow providers in both Moore and Cumberland counties to serve Hoke County.

Once it was changed, Cape Fear Valley submitted a request to build a hospital in Hoke, and FirstHealth re-submitted its own proposal.

Contact David Sinclair at dsinclair@thepilot.com.