Let the battle begin — again.

Cape Fear Valley Health System has appealed the state’s decision to award 28 additional hospital beds to FirstHealth of the Carolinas for its Hoke Community Hospital.

FirstHealth received conditional approval from the N.C. Division of Health Service Regulation on Nov. 27 to add the beds and a second operating room to the hospital it is building on U.S. 401 east of Raeford.

In a petition filed Wednes-day, Cape Fear Valley said the 28 beds should be added to its main hospital on Owen Drive in Fayetteville because the 490-bed hospital’s average daily census has increased from 381 patients a day in 2007 to 487 patients a day in March of this year.

Cape Fear Valley claimed in the petition that the state’s decision gave FirstHealth unfair “benefits and competitive advantages.”

“We are disappointed that Cape Fear Valley has filed three appeals to the state’s certificate of need approvals, two of which concern Hoke County,” Lynn DeJaco, chief financial officer for First Health, said in a statement Friday. “This is yet another example of Cape Fear’s desire to impede access to health care in Hoke County, and these tactics have been going on since 2009.

“Despite these tactics, FirstHealth has never wavered in its commitment to Hoke County, and we are excited to be opening the first hospital in Hoke in 2013.”

Cape Fear Valley officials could not be reached Friday for comment on the appeal, which was filed with the Certificate of Need Section of the N.C. Department of Health and Human Services and with the N.C. Office of Administrative Hearings.

The matter will now go before a judge with the administrative hearings office if the two sides cannot reach resolution.

FirstHealth, Moore County’s largest employer, and Cape Fear Valley recently engaged in a lengthy battle over which health care system would construct a hospital in Hoke County before settling the dispute last April following an extensive mediation process.

In 2010, FirstHealth was awarded state permission to build an eight-bed hospital in Hoke County. Cape Fear Valley, which is headquartered in Fayetteville, received approval to build a 41-bed hospital in Cumberland County near the Hoke line.

Each hospital appealed the other’s permit, and the appeals effectively prevented either from starting construction.

FirstHealth began building Hoke Community Hospital earlier this year and expects to complete the $34.1 million project next year. It planned to move forward with the additional beds and operating room once it received final approval from the state.

Initial plans for Hoke Community Hospital included a 24-hour-a-day, seven-day-a-week emergency room as well as inpatient beds, an overnight observation unit and an operating room, full laboratory services, state-of-the-art imaging technology, diagnostic cardiology, and transport options via critical care transport or helicopter.

The original hospital plan also included the option for expansion involving additional inpatient beds, medical office space, and other health care-related services and facilities on a 30-acre medical complex site. The 28 beds and additional operating room fit right into that strategy, but

FirstHealth began providing health services in Hoke County with physician practices in the early 1990s and soon afterward built a multi-million-dollar family care center and Center for Health and Fitness in Raeford. Dental care services were added for Medicaid and low-income eligible children, and

Cape Fear Valley plans to invest more than $100 million at its 60-acre site on U.S. 401. The first phase — an outpatient center called Health Pavilion Hoke — is under construction.

Contact Ted M. Natt Jr. at (910) 693-2474 or tnatt@the

pilot.com.