Maryland state regulators voted Thursday to grant permission for Holy Cross Hospital to build the first new hospital in Montgomery County in 30 years.

The vote by the Maryland Health Care Commission comes after Adventist HealthCare and Holy Cross spent more than two years in a fierce and costly high-stakes battle to expand their market positions in affluent Montgomery, the state's most populous jurisdiction.

Nine commission members voted in favor of Holy Cross, three members recused themselves, and the panel's vice chairman, Garrett Falcone, did not vote.

In recent weeks, the limitations on care available at Catholic hospitals such as Holy Cross have raised concern among women's and religious groups. After the vote, Catholics for Choice called the vote "troubling." In a statement, the group said the vote means women in Montgomery who go to Catholic hospitals will have no access to abortion, even in cases of rape or incest; to in-vitro fertilization; or to treatment for ectopic pregnancies.

A coalition of advocacy groups had urged the state to reject Holy Cross, citing concerns about access to reproductive health care, especially for poor women and teenagers.

The meeting at commission headquarters in Baltimore drew a standing-room-only crowd of about 120.

Commission Chairman Marilyn Moon, who last month recommended Holy Cross over Adventist, said she understood the concerns about family planning and reproductive health services. But she said there are no state standards that require hospitals to offer such services.

She said she believed that she followed state health requirements and addressed the reproductive rights issues appropriately during her review.

"This has been a lengthy but thorough process," she said. Adventist officials had sought to delay the vote, but Moon said: "I do not believe I need additional time or additional information. I do not believe additional work needs to be done."

During a brief question-and-answer period between commission members and hospital representatives, an audience member, Linda Mahoney, president of Maryland NOW, tried to ask a question but was ruled out of order because public comment was not allowed. After the vote, an unidentified woman told the commissioners, "Thank you all for deciding women are not people."

Moon's recommendation that the full commission adopt the Holy Cross proposal for a $202 million, 93-bed hospital on the Germantown campus of Montgomery College clearly carried significant weight in the final vote. She said the Silver Spring-based Holy Cross plan was superior to that of Rockville-based Adventist HealthCare, which wanted to build a $177 million, 86-bed hospital a few miles to the north in Clarksburg. The new hospital will be the sixth in the county.

In a memo summarizing her decision, Moon said the Holy Cross approach would do a better job of improving access to hospital services for residents of upper Montgomery and providing adequate bed capacity for the future "that is both reasonable in its cost and located [in] the area of the county that will experience the highest levels of population growth." She also said Holy Cross's parent organization, Trinity Health, a Catholic hospital system based in Michigan, is financially well positioned to undertake the project.