Despite two years of negotiations between Suburban Hospital and residents of a nearby Bethesda neighborhood over the hospital's planned expansion, significant community opposition remains over the project's size and commercial nature.

The Montgomery County Board of Appeals, which will decide on the hospital's request to build a five-story medical office building and multilevel parking garage, last week gave Suburban until October to further revise its plans and respond to project modifications suggested by the community and the county planning board.

The board of appeals was scheduled to begin final hearings last week on Suburban's project but agreed to the hospital's request for a continuance. The county planning board recommended July 18 that the board of appeals seek numerous modifications in the plan.

"We're afraid the hospital is trying to wear us down," said Kevin Foskett, a member of the board of directors of the Huntington Terrace Citizens Association. Huntington Terrace is a neighborhood of about 320 single-family homes surrounding the 42-year-old hospital, which is on Old Georgetown Road near the National Institutes of Health.

The entry of a commercial building into a residentially zoned area concerns the neighborhood, Foskett said, and with the new building the land-use intensity of the hospital's main property between McKinley and Lincoln streets will equal that of the central Bethesda business district one mile away.

"People are reacting to the urbanization of Bethesda," said hospital administrator Lynn L. Frank. "The hospital has to be prepared to handle" the growth of Bethesda, she said, citing an expected 62 percent increase in jobs there in the next few years.

In the course of about 15 meetings during the last two years between Suburban and the community, several aspects of the project have been changed or deleted, Frank said.

A 118-space parking lot planned for a one-acre lot purchased late last year by Suburban was eliminated after the community objected to the expected loss of the 61-year-old Bethesda Community Store. The store has since been recommended by the planning board for historic designation.

Suburban's present plans for the lot are undetermined, Frank said.

A 509-space parking garage, to be located in front of the hospital, will now be placed entirely underground.

A helicopter emergency landing site, which does not have to be approved by the board of appeals but is opposed by the community, was to be moved during the expansion from the front parking lot to the roof of a five-story rear hospital wing adjacent to the neighborhood.

In response to the opposition, the hospital is considering locating the landing site atop a planned two-story structure near the emergency room entrance at the front of the building, a more costly and also less safe proposition for helicopter pilots, Frank said.

As suggested by the planning board and the community, Suburban also will install road and traffic improvements to control the flow of traffic in the neighborhood.

As suggested by the planning board, Suburban will "soften" the architectural lines of the upper levels of the medical office building and move it 30 feet away from the neighborhood toward Old Georgetown Road.

But Suburban will not reduce the size of the planned $10 million, 68,000-square-foot medical office building to 35,000 square feet, Frank said.

The medical office center is needed to accommodate the larger health industry trend toward out-patient care, she said.

With next-door proximity, doctors can check on their hospital patients more efficiently and reduce response time to emergencies at the hospital. In addition, utilization of hospital medical equipment by the nearby doctors would result in lower costs to the patient for testing or treatment and increased hospital revenues.

Foskett said the community suggests usable space might be found inside the main hospital, especially because Suburban fills only 375 of the 465 beds it is licensed to have, in-patient care is on the decline and a recent state-commissioned study suggested reducing the number of hospital beds statewide.

But Frank argued that seven wings formerly occupied by beds at Suburban are now used for several inpatient or outpatient programs including day care, alcohol treatment, cardiac care and stroke rehabiliation.

The medical office building is not an extension of regular hospital operations, Frank said. It will not be owned by the hospital, but by the individual owners of the office condominiums. Suburban will sell or lease the land to a developer who must build according to the hospital's specifications.

Suburban said its revised expansion plans will be available for the community to see by the end of August. A meeting with the planning board is expected in September and the board of appeals hearings will begin Oct. 17.