For most of its existence the Medical College was dependent on hospital clinical facilities that it neither owned nor controlled. Since opening in 1856 Roper Hospital had served as the primary teaching hospital for the college. For much of the time the relationship between the two institutions was cordial and mutually advantageous. This was due to the fact that the staff of Roper Hospital was the medical practitioners of Charleston, and the medical practitioners of Charleston were the faculty of the Medical College. In addition, many of these same physicians had received their education and training at the Medical College and felt an allegiance to their alma mater. However, as early as the 1930s, the relationship between these two institutions had been strained. Fiscal problems, personality clashes, and policy modifications were sources of conflict between the two institutions.
For the first two decades after the Medical College was transferred to the state, funding and space continued to be problems. The college's leadership had long been aware of the need for its own facilities to expand clinical teaching opportunities. As dean, Dr. Lynch realized that in order to advance and become a truly 20th century medical school, the college had to have a teaching hospital under its own authority As early as 1944 Dr. Lynch began planning for the new hospital. Some Charleston physicians opposed the expansion program because it meant a loss of control over the education of medical students. Legislators in Columbia fought it because it lessened the University of South Carolina’s chances for establishing its own medical school.
Dr. W. Cyril O’Driscoll, president of the Medical Society during this period, was also on the faculty of the Medical College. The Medical Society was the controlling and governing body of Roper Hospital. The Society approved the Medical College’s expansion program under O’Driscoll but the vote was not unanimous. Twenty-five physicians, all members of the Society, opposed the establishment of a hospital by the Medical College. The Board of Commissioners of Roper Hospital argued in a statement circulated among the legislators in Columbia that the new Roper Hospital [opened in 1946] and its proposed additions could furnish adequate teaching facilities, and that the construction of a Medical College hospital was unnecessary. The Medical Society renounced the actions of Roper Hospital’s Board of Commissioners as being inconsistent with the Society's previous endorsement of the expansion program.
Besides the support of the Medical Society, the expansion program was supported by the report of the “Committee of 17.” The Committee of 17 was composed of South Carolina Medical Association (SCMA) members representing all sections of the state except Charleston. No resident of Charleston, city or county, was named to the committee. The Committee of 17 was chaired by Dr. James McLeod, President-Elect of the SCMA. The committee, which was commissioned by the SCMA and the American Medical Association, studied the potential consequences of the expansion program on the state and medical education. Hearings were held throughout the state and to the SCMA’s House of Delegates.