Suburban Hospital has applied for special exception permits to build an ambulatory care building, an underground parking garage and a smaller above-ground parking lot on its nine-acre grounds on Old Georgetown Road in Bethesda.

Spokesmen said the nonprofit hospital has spent almost two years negotiating with area neighbors in an effort to address their concerns and lessen the impact of the expansion.

"I would estimate we increased the cost of this project by several million dollars in trying to solve problems with the neighborhood," said Lynn L. Frank, hospital administrator. She said most of this extra cost will be incurred by building the 509-space parking garage underground, so it will be less of an eyesore to the hospital's residential neighbors.

However, a neighborhood spokesman said this week that neighbors still have problems with the hospital's plan and may not back it when it goes before Montgomery County planners in July.

"I don't know if they're going to buy it," said Joe Gannon, president of the Huntington Terrace Citizens Association, which met last week to discuss the final plan. "The more they heard about the agreement, the less they seemed to like it."

Gannon said the citizens' association has contacted hospital administrators and asked them to drop plans for the 58-space above- ground parking lot and to promise that the ambulatory care facility will not include an abortion or methadone clinic.

Frank said the above-ground parking lot, which would be across the street from the hospital, is needed because it would save $175,000 on the cost of the $7 million underground garage. She also said there are no plans to include an abortion or methadone clinic in the ambulatory care facility.

The citizens' association, which represents some 300 neighbors, will vote on the final plan in June, Gannon said. But either way, the hospital has filed its application with the county and will proceed with its plan to secure permits to build the three projects.

However, Suburban admittedly is interested in attaining the blessing of neighbors in the expansion project. Ten years ago, the hospital lost several million dollars in a protracted legal fight with neighbors and the county when it attempted to build a parking garage and new wing of the hospital in opposition to the wishes of area residents.

The wing and garage eventually were built, but the episode left a lot of "bad blood" between the two, said S. Allan Adelman, hospital attorney.

"It just wasn't worth it," he said.

This time around the hospital has offered the neighbors a number of concessions in hopes to gain their support. Besides building the garage undergound, the hospital has vowed to spend $16,500 a year to maintain 11 rental homes it owns in the neighborhood, to hire a residential manager to take care of the properties and to keep open a nearby neighborhood store the hospital bought earlier this year. Suburban also has promised not to purchase any additional properties in the neighborhood for 10 years while selling four houses it already owns in the area, said Frank.

The hospital needs the support of the neighbors because it needs the ambulatory care facility, she said.

"This facility is really the wave of the future in hospital care," she said, because state and federal policies are sending patients home from the hospital sooner and putting a greater emphasis on outpatient care. She said 40 private doctors will care for outpatients in the $8 million facility, while using the hospital next door to conduct tests and analysis.

By state law the nonprofit hospital only can earn a certain amount of money -- $45 million next year, she said. Since the ambulatory care facility would cut the costs of running the hospital, it would result in a wider margin between costs and revenue, she said.

"That money can be used for salaries, to attract better people, to give us some room to work with," she said.

Neighbors will wait for the hospital administrators to respond to their request that plans for the surface parking lot be eliminated and then will decide whether they will support the plan at a public hearing scheduled for July, Gannon said.

"We would really like more time," he said. "But since the hospital has already filed for its special exception permits, we have to get things together before the hearing."

Gannon said most neighbors are not opposed to the ambulatory care facility even though, he said, it would create more traffic in the neighborhood. They are more concerned with Suburban's plans to build the auxilliary surface parking lot and its promises not to purchase any more houses in the neighborhood.

"The community isn't overly enamored of the hospital," he said. "There were agreements from 10 years ago that the hospital hasn't honored until this year, when it wants something from us."

For instance, said Gannon, the hospital only recently hired someone to direct traffic from the hospital onto Old Georgetown Road and away from nearby houses.

"This issue is a lot more complicated than it looks on the surface," he said.