The competition between Southwest Virginia’s two major health care systems can be as fierce as what you see on a college football field.

Which may explain why officials at Carilion Clinic were so perturbed when Virginia Tech football coach Frank Beamer began endorsing their rival, LewisGale Regional Health System, in television and newspaper advertisements.

“The right decision can make all the difference in the outcome,” Beamer says in the TV commercials, which began airing in early September. “LewisGale emergency rooms: It’s a choice for my team, and my family.”

To some officials at Carilion, Beamer’s pitch was seen as a slight to the relationship between the Roanoke-based health care system and Tech – a bond that grew stronger five years ago with the creation of the Virginia Tech Carilion School of Medicine and Research Institute.

No one is suggesting that Beamer did anything wrong. But if nothing else, what happened after the commercial’s debut illustrates the intense rivalry between Carilion and LewisGale, which compete for patients in a market where the word of a popular football coach goes a long way.

The following Monday morning, an email popped up on the computer screen of Nancy Agee, Carilion’s president and CEO. It was from a nurse who wondered if it “bothered anyone else” to see Beamer endorse LewisGale.

“I know we can’t dictate where people go but that should be a real slap in the face for Carilion,” the nurse wrote.

Less than three hours later, Agee sent an email to Virginia Tech President Timothy Sands, with the message from the nurse attached.

“I know the Coach can pretty much do as he likes but as your partner in healthcare, his local ads for HCA/Montgomery have released a gazillion (good academic word!) emails to me like this latest from an employee,” she wrote. HCA is the parent company of four LewisGale hospitals, including one in Montgomery County.

“They are coming from all sorts of people … employees, physicians, area lawyers, patients, (your) donors, students,” she wrote in the email, which Tech provided to The Roanoke Times in response to a Freedom of Information Act request.

Agee asked Sands in the email if there is anything Carilion could do “to offset or counter” the commercials. She raised the possibility of approaching Beamer to ask him if he would be willing to endorse Carilion in its own ad.

After getting the email, Sands asked Tech’s associate vice president for university relations, Larry Hincker, to look into the matter.

Hincker, who also serves as the school’s spokesman, said he reviewed Beamer’s employment contract and determined that it allowed the coach to make endorsements like the one of LewisGale. He briefed Sands and made a call to Mike Dame, Carilion’s senior director of communications.

Since then, there has been no follow-up by Carilion on the idea of seeking a Frank Beamer stamp of approval.

Agee’s email was “intended as a quick ‘heads-up’ that we were considering pursuing those opportunities with the Coach,” Dame wrote in an emailed response to questions about the matter.

Dame mentioned Carilion’s “long history and growing partnership” with Tech in his email. “Following the recent commercial promoting our competition, many Carilion employees and supporters encouraged us to take additional steps to publicize that partnership,” he wrote.

But in the private-sector world that Carilion occupies, Beamer’s endorsements might be viewed differently than they are at a public university, where employees and students have more freedom to say what they want publicly.

Those different standards may have contributed to Carilion’s apparent concern that a statement from Beamer amounts to one from Tech, Hincker said.

“He’s a high-profile person,” he said of Beamer. “It looks like a university endorsement, but it’s not. And that’s where we would part ways with our dear friends at Carilion. It’s Frank; it’s not us.”

Beamer declined to comment for this story.

This is by no means the first time Beamer has agreed use his popularity and name recognition for commercial gain – both for himself and for whatever business he chooses to plug. In recent years, he has appeared in television and radio commercials for Kroger, K-Guard gutters, nTelos and even Camp Sauce, a meat and vegetable marinade.

Hincker couldn’t say what Beamer is paid for those spots, saying that’s a private matter between the coach and whoever hires him. Beamer earns about $2.5 million annually from Tech.

LewisGale’s vice president of marketing and public relations also declined to say how much the Salem-based health care system is paying for Beamer’s imprimatur.

“As with other organizations, we do participate in fee-based sponsorships that provide marketing benefits,” Nancy May said in a statement. And LewisGale clearly sees a benefit, based on the proliferation of Beamer endorsements, which can be seen or heard on television commercials, newspaper ads, radio spots and billboards.

“Coach Beamer’s impeccable character makes him one of the most trusted, respected, individuals in the country,” May said.

And for all the talk about the close relationship between Carilion and Tech, officials at LewisGale say they have one, too.

For years, orthopedic surgeons at LewisGale Hospital Montgomery have provided medical treatment, surgery, sports clinics and other services to Tech athletes. “It is only a natural fit for us to feature [Beamer] as our spokesman,” May said, given the health system’s close ties to the Tech athletic department and other Blacksburg institutions, including the Edward Via College of Osteopathic Medicine.

LewisGale also operates the closest hospital emergency room to the Tech campus – and the one with the shortest wait times, as the Beamer advertising campaign promotes.

As LewisGale’s advertising campaign shows no sign of slowing down, the concerns expressed by Carilion to Tech don’t seem to have led to any changes.

In one of the emails provided by Tech, athletic director Whit Babcock wrote to a citizen raising concerns about the Beamer endorsement that “you do bring to light a good point … that we need to be aware of these situations as Carilion and Virginia Tech are collaborating even more now.”

Asked if that means a change in policy is afoot, Hincker responded that he couldn’t say. But, he added, “I plan to further the internal discussions of endorsements.”