A judge has ruled that Berkeley County can support two new hospitals, but Trident Health still insists there can be only one.

The decision Wednesday allowing Trident and Roper St. Francis to build 50-bed facilities ended the latest round in a long-running legal brawl that stalled the rival expansion plans.

But another round between industry heavyweights Trident and Roper is just beginning.

The dispute impacts the access area that residents will have to in-patient hospitals, and plays a role in the cost of health care, but it is fundamentally a conflict between business rivals.

The S.C. Administrative Law Court decision issued was a setback for Trident. The for-profit medical provider said the ruling was “made in error” and that it plans to appeal, meaning neither hospital will get built until the legal issues are resolved.

“Under this scenario, Trident cannot build a hospital in Moncks Corner,” said Todd Gallati, president and CEO of Trident. “We do not want to be a part of a process which promotes unnecessary spending of health-care dollars to duplicate services.”

In a videotaped statement, Roper St. Francis President and CEO David Dunlap said both hospital plans should be allowed to move forward.

“If the state says two hospitals can be supported, and court in Columbia says the two hospitals are needed, then for the sake of Berkeley County, everyone should come together and agree it’s time to get going,” he said. “Let’s put all our differences aside and bring both hospitals that were promised to the people of Berkeley County, the people that need them and deserve them the most.”

Administrative Law Judge John D. McLeod’s decision gave nonprofit Roper the green light to transfer 50 beds from downtown Charleston to a site it owns near Goose Creek. Trident said that would compete directly with its proposed facility in Moncks Corner.

“The main point of contention we’ve had is that we believe these two hospital plans are competing,” Gallati said.

McLeod disagreed.

“I find that Berkeley’s population size is well able to support two 50-bed hospitals.” McLeod wrote.

The judge noted that Berkeley County’s population has soared, to 177,843 in 2010, and is expected to keep rising. There are no inpatient hospitals in the county today.

“The lack of hospital beds or general acute care services in Berkeley County is especially surprising given the explosive population growth of the county in the last four decades,” McLeod wrote.

He wrote that the county population recorded in the 2010 census was already nearly 8,000 higher than projected when both health care companies sought permission to build hospitals.

Trident said it will ask the judge to revisit his 52-page decision, and, if the order stands, it will take its appeal to a higher court.

Roper is urging Trident not to do so.

“It is time to put the legal fighting behind us and move forward,” Dunlap said.

“Roper St. Francis has fought hard for Berkeley County for more than three years on this issue,” he added. “We have not wavered in the position that both hospitals, proposed for two different areas, are needed and would be supported.”

While Trident wants to create 50 new hospital beds in the area, Roper sought permission to relocate 50 beds to Goose Creek from its downtown hospital. McLeod found that distinction important.

“Roper St. Francis is not applying to add any additional beds to the Tri-County Service Area,” he wrote.

The permitting dispute goes back to 2008, when Trident and Roper each proposed hospitals about 12 miles apart, providing similar acute-care services. Both providers have said they were attracted to the housing and population growth projected for the county.

McLeod found that each hospital would be in a distinct community within the county, and that each had the support of community and government leaders.

While Trident was first to apply to the state Department of Health and Environmental Control for permission in 2008, the company was aware of Roper’s plan at the time, McLeod wrote.

Trident’s plan centered on an expansion of its existing Moncks Corner medical center. Roper filed it plan a few months after Trident and purchased land for its project in the Carnes Crossroads area.

DHEC approved the two proposals by issuing the required “Certificate of Need” to each provider in June 2009.

Gallati reiterated Thursday that if both hospitals were built they would be underutilized.

“That’s not a scenario you want to find yourself in,” he said. “We want to make sure when we start a hospital there’s enough demand where we can offer a large number of services.”