The Medical University of South Carolina Board of Trustees took a significant step on Friday towards building the largest capital project ever proposed at MUSC.

A new $350 million facility for the Children's Hospital and Women's Pavilion on the peninsula could be completed by mid-2020, said Dr. Pat Cawley, vice president for clinical operations and executive director of the nonprofit Medical University Hospital.

Barely a year has passed since Medical University Hospital had less than 10 days operating cash on hand, and former President Ray Greenberg said he spent restless nights worried about the bottom line.

"This is all contingent on huge fundraising," said Board of Trustees Chairman Tom Stephenson. "We don't have the money to build it, but if you don't plan, it will never happen. If we had to do it now, we couldn't."

While the Board of Trustee's action on Friday did not constitute final approval, plans to build the new Children's Hospital will very likely move forward.

"There will be approvals along the way. This was the first one," Cawley said. He verified it is the most expensive project ever proposed at the medical university.

The board voted Friday to update a two-year-old feasibility study that explored the option of constructing the new building, which would be located on the corner of Courtenay Drive and Calhoun Street.

The board entertained an option of building a remote hospital in North Charleston but determined that project would be more expensive than a new hospital on the peninsula.

The new 675,000-square-foot facility would be situated adjacent to the $275 million Ashley River Tower, which opened in 2008. The existing Children's Hospital is attached to the main hospital on the MUSC Horseshoe on Ashley Avenue.

"We recognized the need back three years ago that our Children's Hospital and our Women's Pavilion are getting very space strapped," Cawley said. "The only way to fix that is to put them in a new facility. We have to do that in order to continue to deliver cutting-edge children's and women's care."

Cawley said the project would have the same sleek, modern design as the Ashley River Tower.

Both the Ashley River Tower and the proposed new Children's Hospital and Women's Pavilion are part of a long-term capital plan designed to ultimately replace the current teaching hospital.

The new project is to be paid for with a combination of donations, annual operating revenue and borrowed money, similar to a mortgage. It may take 20 to 30 years to repay, Cawley said.

He said the institution temporarily delayed moving forward with the project when the hospital's financial balance was more precarious.

Board Chairman Stephenson estimated they will need to raise $50 million to $100 million to help pay for the project.

The Board of Trustees is scheduled to discuss assembling a team, including architects and contractors, at its April meeting.

Construction will not begin until 2017.

Reach Lauren Sausser at 937-5598.