Battles rage in West Ashley and Mount Pleasant and on James Island, where hospitals build new clinics and buy up doctors' practices in part to boost their influence and referring power. The fiercest battle, however, involves two Berkeley County hospitals that haven't been built. For the past three years, two local hospital systems have sparred over which should build a 50-bed hospital in the growing community. The duel draws parallels to a spat in neighboring Charleston County, where two new hospitals compete for too few patients. Healthcare systems vie for business in an industry where referrals and reputations, rather than low costs, direct patient spending. The Berkeley competitors purchased land near where developers planned to build tens of thousands of homes before the recession hit and growth stalled.