The future of a £50m development is in doubt after councillors rejected plans on traffic worries.
Developers want to build a community hospital and GP centre on fields near Cardigan town centre, along with a care home, a supermarket and shops.
Permission had been granted last September but developers were unable to buy a crucial plot of land.
Ceredigion councillors turned down the revised plans, which cut access points to the site from two to one.
The planning committee rejected the changes by a majority of 10-8, arguing the development would bring traffic chaos to Cardigan.
Councillors were met by protesters against the scheme as they arrived for the meeting.
One of them, Gareth Jarman said: "We've had three petitions, one of over 3,000 signatures, another of over 1,000 signatures opposing the development.
"The town council have voted twice opposing the development, the chamber of trade are totally opposed to the development."
After the vote, developers Liberty Mercian confirmed they were considering an appeal.
They have said the project would have brought 600 jobs and economic benefits to the town. The future of the new community hospital was now also in doubt.
Emyr Williams, development director at the company, said they were very surprised by the decision.
"It went to the committee with a full officers recommendation for approval, backed by an independent consultant [who] validated our transport assessment and the only one change from the previous application was highways," he said.
Original plans included two access points to the site, one on Gwbert Road and the second near Theatr Mwldan.
But the developers were forced to re-submit the application with just one entrance after they were unable to buy land on Gwbert Road.
The land owner said he was happy for the site to used for a hospital, but not in combination with a supermarket.
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