MARION, Ill. -- A Tennessee health-care company is putting the finishing touches on a new $42 million hospital that developers say will be the first hospital built in far Southern Illinois in 40 years.

It may also renew an old rivalry over heart surgery in the region.

Heartland Regional Medical Center will attract people who now leave the state for complex medical care not provided by most of the 20 small hospitals south of Interstate 64, Ron Seal, the new hospital's chief executive, said Thursday.

In that region, it's not uncommon for people to head to Cape Girardeau; Paducah, Ky.; Evansville, Ind.; or St. Louis for their complex medical needs, including cardiac care.

The 92-bed Marion facility, which has risen from a 40-acre lot near Interstate 57, is set to open Dec. 12 and will replace Marion Memorial Hospital, which the Brentood, Tenn.-based Community Health System bought in 1996.

It will also offer open-heart surgery and cardiac catheterization, which patients in deep Southern Illinois can now find only at the Memorial Hospital of Carbondale, a 10-minute drive away.

St. Mary's Good Samaritan Hospital, 50 miles north on I-64 in Mt. Vernon, Ill., also offers cardiac care, but is outside of Heartland's immediate area.

Heartland officials decided to locate the new hospital in Marion because they see a surge of growth in Williamson County, Seal said.

"This area is growing in leaps and bounds," he said, citing a new retailer and manufacturer opening nearby, and a relatively low 4.4 percent county jobless rate.

Carbondale Memorial, as its closest neighbor, wasn't a major factor in the company's plans, he said.

But whether the region can support two relatively major medical centers fewer than 15 miles apart has been the topic of debate for years.

George Maroney, administrator of Carbondale Memorial, said an emergency room is needed in a bunch of communities, referring to the 20 hospitals in far Southern Illinois that are little more than that.

"But you don't need a cardiac cath lab" in as many, he said.

The issue first surfaced after the Marion and Carbondale hospitals each asked the Health Facilities Planning Board in the late 1990s for the OK to start open-heart surgery centers. Each argued the region could not support multiple centers.

The board approved the applications after six months of negotiations among the hospitals failed to result in a cooperation agreement.

Seal plays down the suggestion that his planned cardiac center, which is expected to open with the new hospital, will have to fight to compete with Carbonale's, which opened in February 2001.

However, he left no doubt he's in the business to win. "I think the region can support one, maybe two, but not three" cardiac centers, he said.

"And if it can only support one, we'll be doing open-heart surgery," he said.