Residents of the Forest Grove area of Silver Spring say a bid by Holy Cross Hospital to build a four-story, 40-suite ambulatory care facility on land occupied by 23 homes next to the hospital may damage the integrity of the neighborhood.

The staff of the Montgomery County Planning Board said it also will oppose the hospital's request for a special zoning exception at Monday night's scheduled public hearing. The planning staff said the proposal to build the 67,000-square-foot project is incompatible with the neighborhood and violates land use patterns detailed in the Forest Grove-Forest Glen sector plan.

Once the planning board makes its recommendation, the Holy Cross proposal goes to the county Zoning Appeals Board for a hearing Nov. 19.

Hospital officials said the new building would "meet the needs of the community" and said the current 400-bed hospital is overcrowded. By leasing space in the ambulatory care facility to Holy Cross staff doctors, follow-up care for patients will be more convenient, efficient and less costly, the officials said.

Nearby residents said there are seven or eight medical office buildings for staff doctors to rent along Georgia Avenue, all within a mile or two of the hospital. Norman G. Knopf, the lawyer for the citizen groups, said the proposal "is nothing more than a money-making scheme for the hospital."

He said zoning cases are being fought in Friendship Heights, where Geico Insurance Co. has "bought up all sorts of land," and in Bethesda, where Suburban Hospital is trying to win approval for the same kind of physicians' office building as Holy Cross.

"Once the camel gets its nose under the tent, there is tremendous pressure for development and neighborhoods get destroyed in the process," Knopf said.

Dwight Fortna, who heads a committee formed to fight the Holy Cross expansion, said the "first inkling that the hospital was planning to build came in the fall of 1984 when Holy Cross purchased 11 houses adjacent to the hospital's west parking area for double their appraised value."

The 11 homeowners received at least $230,000 apiece even though the houses are modest in size and within a quarter mile of the Capital Beltway and the Georgia Avenue exit, Fortna said. In addition, Fortna said the community did not know that for the previous 20 years the hospital had been slowly acquiring another 12 homes as they came on the market.

"They now own 23 homes, or 26 percent of that neighborhood," he said.

Civic leader and longtime resident Albert G.D. Levy was part of a citizens' group formed in the 1950s to develop support for and to finance a community hospital in Silver Spring. "We assembled the land and the money to buy it. We approached the Sisters of the Holy Cross to run it, and even supported the hospital when it wanted to add 210 beds in 1975," he said.

Levy and others said that in return for their support, the hospital promised the neighborhood that there would be no westward expansion into residential areas.

For their part, Holy Cross administrators denied they have been secretive about their plans and said most hospitals routinely buy residential property on their fringes as a buffer and "with an eye to probable expansion." Stanley J. Nadonley, general counsel for Holy Cross, said, "We did pay a premium for the last 11 houses to entice them to all sell at once so we could accelerate our program, but the community knew what was going on."

James M. Lynch, Holy Cross' vice president of corporate development, said that rather than "destroying the neighborhood, we see our project as enhancing it." He said the ambulatory care center will be shielded from nearby homes by landscaping and a berm, or grassy hill. "Parking will be above ground, but below the line of sight. The vista created by the park-like setting will be much more pleasant than what exists today."

Lynch said the Holy Cross proposal represents "a retooling of the health care industry," where the emphasis on treatment is shifting from long bed stays to outpatient or ambulatory care in an effort to reduce costs. Ambulatory care centers are in place at Montgomery General and Shady Grove Adventist hospitals, Lynch said, and a proposal for a similar facility near Suburban Hosptial in Bethesda will be decided by the zoning appeals board next month.

About 40 of Holy Cross' 400 doctors could lease space in the office building if it is approved. A pharmacy, laboratories and facilities for X-ray, CT-scanning and other diagnostic tools would be on a ground floor connected to the main hospital.