Suburban Hospital's bid to build a four-story, 40-suite ambulatory-care facility adjacent to the hospital will be heard by the Montgomery Zoning Appeals Board next Thursday after two years of sometimes contentious negotiations with the community about the proposed expansion.

Hospital administrator Lynn L. Frank said, "throughout the process, we have compromised considerably with the community, but they are still afraid of the rapid urbanization of Bethesda, and that's understandable."

Frank said the hospital has added $1 million in various changes to the 65,000-square-foot project in an effort to try to satisfy neighbors whose homes abut three sides of the hospital across from the National Institutes of Health in Bethesda. She said the $10 million "walk-in/walk-out" ambulatory-care facility will be leased only to staff physicians at Suburban.

In an effort to get its proposal approved, the Bethesda hospital has agreed to build a $7 million, 472-space parking garage underground and has eliminated another above-ground parking area that was planned near the Bethesda Community Store, a popular neighborhood general store. The proposed building also will be heavily landscaped with mature trees and redesigned to reflect the residential character of the neighborhood.

But residents of the 320 single-family homes off Old Georgetown Road said they still are not happy with the expansion and plan to fight it at Thursday's hearing. They said the new offices will create additional noise and traffic congestion in an area already severely affected by the opening of Bethesda's Metro station one mile to the south and by the development it has spawned.

"It's the density of the land use that we're concerned about," said Spring Swinehart, president of the Huntington Terrace Citizens Association. "If they build this, the land-to-office space ratio would be comparable to the central business district in Bethesda."

"We question the building's 'ambulatory-care' label," she said. "We see this facility as no different from any other medical office building except that it will be attached to a hospital by a walkway." The Huntington Terrace group is being joined in its opposition by Arylawn and Sonoma citizens associations.

Swinehart said residents object to the fact that Suburban will sell or lease the land to an as-yet-undisclosed developer. She said the residents "are afraid the hospital will lose control of the tenants" and that office suites will be leased to various types of professionals.

Swinehart acknowledged that the hospital's developers have made changes, but contended that the changes are largely architectural and aesthetic, and do "nothing substantial to reduce the density of the land use in the area."

The hospital's neighbors have argued that vacant office space, as well as buildings under construction in Bethesda's business district, offer more than enough office options that do not threaten their residential area.

The county's Office of Economic Development said that in June, the most recent month for which figures are available, there was 681,100 square feet of vacant office space in the Bethesda-Chevy Chase area, out of a total of 6.5 million square feet of office space, said Vic Erikson, treasurer of the Huntington Terrace Association.

Erickson said figures supplied by economic development officials indicate that there are "at least 12 additional office buildings in Bethesda either under construction or awaiting formal building permits," for a total of 2.63 million square feet; most of this is expected to become available within two years. "We think these figures show there is adequate space for doctors in Bethesda without this building in our neighborhood."

But Frank said Suburban Hospital, the county's only designated trauma facility, needs the ambulatory-care building for physicians who are surgical, orthopedic or pulmonary specialists on call to the trauma unit.

"The study that our consultants did indicates there is a need for medical space. . . . This is different than a medical office building. All these doctors will have practices based at Suburban. It will make out-patient care a lot more convenient," she said.

Physicians will be able to hold down patient costs, she said, by having laboratory tests, electrocardiograms and chemotherapy at the adjacent hospital.