Sisters with the religious order that founded Minnesota's first hospital are speaking out against a plan that would add 100 beds to Regions Hospital in St. Paul.

In a letter filed with state regulators this week, the Sisters of St. Joseph of Carondelet said they are concerned the proposal could give an unfair advantage to Regions and its parent company, Bloomington-based HealthPartners, when competing against the other two hospitals in downtown St. Paul.

It's the first clear sign of opposition over a proposal that otherwise has garnered support from a number of groups including Gillette Children's Specialty Healthcare, the St. Paul Chamber of Commerce and the labor union SEIU Healthcare.

"We are concerned that this legislative action provides an exemption that gives one St. Paul business an unfair advantage over its competitors," states the letter from seven sisters in the St. Paul-based order, including a former state health commissioner during the administration of Gov. Rudy Perpich.

Late last year, Regions filed an application for state approval for an expansion that officials say is needed to serve an aging population in a facility that is already near capacity.

With the extra beds, Regions says it would hire the equivalent of an additional 296 full-time workers by the end of 2020, with extra annual spending on salaries and benefits that year of $33.6 million.

In recent weeks, a number of groups have filed letters of support for the project, including the Minnesota Chapter of the American College of Emergency Physicians, the Minnesota Coalition Against Sexual Assault, the Ramsey County Board of Commissioners and the St. Paul Building and Construction Trades Council.

"More beds will allow Regions to better coordinate patient care and meet the increasing demands of healthcare into the future," wrote Brenda Kyle, president of the St. Paul Chamber, in a March 12 letter of support to state officials. "In addition, we take economic impact into consideration when supporting this project, as this expansion will generate jobs."

The president of Gillette Children's, which is located on the Regions campus, wrote in a letter earlier this month: "In the east metro, Regions is the only burn center and level one adult/pediatric trauma center."

Opposition to the project comes from a venerable name in Minnesota health care. In 1853, the Sisters of St. Joseph of Carondelet founded St. Joseph's Hospital, which is about a mile from Regions and is now operated by Minneapolis-based Fairview Health Services. The downtown St. Paul area also includes United Hospital, which is owned by Minneapolis-based Allina Health System.

"HealthPartners' increased ability to direct its clients exclusively to its own hospital will impact patient choice and access," the sisters wrote in their letter. "Before the Legislature provides exemptions that specifically benefit one facility, it is essential to understand the long-term and potentially deleterious impact this exemption will have on patient censuses at other area hospitals."

Regions did not comment Friday on the letter.

Ultimately, approval for the project must come from the Legislature, which hasn't been asked for such a large expansion of medical and surgical beds and maternity capacity since it approved the construction of Maple Grove Hospital more than 10 years ago.

On Thursday, a health care committee in the state Senate approved a bill for the Regions expansion, which will next be considered by the full Senate. The committee included an amendment that makes approval contingent on a finding from the Minnesota Department of Health about whether the project is in the public interest, said Sen. Michelle Benson, R-Ham Lake.

Minnesota has a moratorium that blocks the expansion of existing hospital capacity without legislative approval. Hospitals can seek an exception to the moratorium, but state law calls for the Health Department to study the need for any such expansion.

While the Health Department has started its review process, it's not yet clear how much will be finished by the time the Legislature adjourns in May. Benson said Friday that her goal is for the Senate to pass legislation that would then move into a conference committee, which would let lawmakers "wait as long as we can, for as much information as we can."

In addition to Gillette Children's, two other health care providers have submitted comments to the state on the Regions proposal.

Dr. Jon Pryor, the chief executive for the parent company of Hennepin County Medical Center, wrote that his health system could support the general idea of adding beds under certain conditions. A spokeswoman for Fairview filed comments that described the Health Department review as a "particularly challenging decision given the scope of the request."

Minnesota established its hospital expansion moratorium in 1984. Legislators were concerned about the possible impact on health care spending, since each licensed bed can represent a significant expense in staffing, technology and use of health care services.

The Regions proposal included new beds for maternity care, although hospital officials say that most would allow for better flow of patients through the unit rather than facilitate growth. Separately, the hospital is considering a plan for building a new center for mothers and babies.

The proposal for more maternity space at Regions came just a few months after St. Joseph's Hospital closed its unit last year.