The Loudoun County, VA, Board of Supervisors has voted to reject a proposal by HCA Virginia to build a hospital in Loudoun, capping more than five years of fierce debate over how best to meet the rising demand for medical care. After an intense campaign by Inova Health System to prevent a competitor from taking root in Loudoun, the board voted against the proposal to build a 164-bed acute-care facility. The decision was the latest development in a long-running battle between nonprofit Inova and the for-profit hospital network HCA.