AYER — In a move that will pave the way for Nashoba Valley Medical Center to remain local for the foreseeable future, town meeting approved the establishment of a 40-acre medical services district at the hospital’s Old Groton Road location.

Approximately 123 voters took part in the May 9 decision.

The district was described as a vital step toward retaining one of the town’s leading employers and taxpayers by hospital interim Chief Executive Officer Steven Roach. Essent Health Care, which owns Nashoba Valley Medical Center, has publicly stated its intent make $50 million in improvements to the site, but wanted surety over the uses allowed there before proceeding.

After the vote, Roach was optimistic that the 40-year-old hospital will be upgraded soon.

”Essent Health Care couldn’t be happier about having the support of the town,” he said. “We look forward to building a state-of-the-art facility here in Ayer.”

Prior to the approval, the hospital was a non-conforming use in a residential zone. In order to expand, the district or an appeal to the Zoning Board of Appeals would be required.

The latter option was rejected because it carries the risk of expensive planning and engineering that could be scrapped by the disapproval of the board, said attorney Thomas Gibbons.

There was also an indication that the district could protect the town as well.

A petition to the zoning board would not carry the specific district parameters that were reviewed by a number of town boards, said Planning Board Chairman Elizabeth Hughes. Instead, it would be judged solely against whether it would be detrimental to the neighborhood.

Many of the uses permitted in the district already take place at the site, said Roach, and accessory uses such as gym or drug store would be related exclusively to the hospital’s medical mission.

”We’re not going to have a CVS or a Gold’s Gym,” he said.

Site plans for the hospital have not been produced, said Roach, but the goal is to replace the 40 beds double suites with 60 beds in single suites. He said the square footage involved would range from 225,000 to 240,000, up from the current total of 140,000.

While the district had a great deal of popular support, it was not unanimous.

A number of issues with the proposal included traffic, location and what the final product of expansion would look like, said resident Dennis Curran.

He was concerned about the hospital being on a secondary road, saying a location off 2A or at North Post would be better. He also raised reservations about traffic and the district allowing a new hospital to have six floors.

Those comments were addressed by Board of Selectmen member Cornelius “Connie” Sullivan and Planning Board Chairman Elizabeth Hughes, who disagreed with his interpretation of the circumstances and cited an overriding need to keep the hospital local.

Fire Chief Paul Fillebrown spoke to that issue as well. He said the ambulance squad’s priority for patients in unstable conditions is to get them to the hospital, and Leominster or Emerson hospital were the closest alternatives.

”The most important thing (to) any ambulance service is getting the patients to the closest facility,” he said.

Former Planning Board Chairman William Oelfke attested to the work put in by hospital representatives to address the town’s concerns.

”They have been very, very good about listening to input and making changes,” he said. “I think, for them to be able to do what we want in this town, they need some latitude there.”

Curran also questioned where parking would go and what the facility would look like. Gibbons responded those items would be addressed during site plan review of any expansion.

”What you are seeing today is proposals, not what you will see there,” he said.

Curran remained opposed to the plan, but the question soon passed with a vote of 118-5.