The Hospital for Sick Children in Northeast Washington -- not to be confused with Children's Hospital in Northwest Washington -- is the only facility in the metropolitan area that provides critical long-term medical care to children with chronic diseases. In the past few years, partly because of the number of babies born addicted to drugs or infected with AIDS and partly because of advances in technology, the need for the care HSC provides has grown. The hospital must expand from 80 to 130 beds by constructing a new facility.

The expansion effort, unfortunately, has put the hospital in the middle of a preservation controversy. A Post article {"City Puts Brakes on Demolition Plan," District Weekly, April 26} gave the impression that HSC arbitrarily rejected preservation of the landmark 1929 Nathan Wyeth building in favor of its demolition. This is not true.

One of the chief constraints to expansion is, of course, money. HSC accepts patients without regard to their ability to pay, and 97 percent of its operational revenues come from Medicaid. HSC's goal in redesigning its facility has therefore been a design that meets the needs of the children and the staff at a cost sustainable by Medicaid funding.

HSC thoroughly evaluated the possibility of retaining the 1929 building. It employed two different teams of architects and engineers to explore the options. Each team examined the possibility of including the 1929 structure in an expanded facility, and each concluded that the adoption of any design retaining that building would result in increased construction costs.

Under local regulations, the 1929 building cannot be used for housing patients even if it is renovated; an additional hospital wing would have to be constructed behind the renovated structure. Because of the limited space available at the site, construction of the additional wing would require the destruction of HSC's forested, secluded setting.

In contrast, the design approved preserves the trees that provide a natural buffer for the surrounding residential community. The cost of renovating the old building would also decrease the funds available for the construction of the new wing. In the long term, preservation of the old structure would increase the operational and maintenance costs of both; each would have separate heating and cooling systems, security needs and maintenance requirements. These additional annual costs would decrease funds for patient care.

Throughout the controversy, the preservationists' position has been that retention of the 1929 building is an easy decision, with no negative impact on HSC's mission. Unfortunately, this is not the case. Meetings undertaken at the mayor's agent's behest in the last two weeks to identify a compromise have underscored this even to the preservationists, as it has become apparent that any compromise will be at the expense of the patients HSC serves.

It's important to remember that HSC sought extensive public participation during the planning in 1987 and 1988. Public meetings were held in various local forums. HSC worked with the community, and the project as planned has won the support of the nearby citizens' associations and the local advisory neighborhood council.

Significantly, no one from the preservation community or from "Friends of the Children's Country Home" appeared at any of these meetings or voiced any concerns. Not until mid-1989, when the building was registered as a landmark and when most of the planning had been completed and when the funds available for those elements of the project were exhausted, did the "Friends" demand that HSC abandon the work already completed and reexamine the preservation of the 1929 structure. Their 11th-hour demand was not accompanied by any offer of financial assistance.

Preservation costs money. Given this, should HSC spend its limited resources on renovation and maintenance costs or on the care of the children? HSC cannot pass the increased costs of preservation onto a tenant or a purchaser, as can a developer. The cost of preservation would be at the expense of HSC's patients and the staff who care for them.

Unlike the "Friends" who can go home and start on their next preservation battle, the patients and staff at HSC have to live with the outcome of this dispute for decades to come. Because of the economic realities, HSC made the difficult decision that historic preservation is a luxury.

Stephen Montgomery

is treasurer of the Hospital for Sick Children.