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Two expanding downcounty hospitals are having very different experiences trying to cooperate with adjacent neighborhoods.

Officials at the Holy Cross Hospital in Silver Spring and nearby residents describe a collaborative design process that began almost two years ago and incorporated key residential suggestions. But for several years, Suburban Hospital in Bethesda and the adjacent Huntington Terrace Citizens Association have disagreed on a proposed expansion that will demolish 23 nearby hospital-owned homes and close one block of Lincoln Street, a residential thoroughfare.

On June 22, County Hearing Examiner Martin Grossman recommended approval to the Board of Appeals of Holy Cross's expansion, which features a seven-story tower that will enable the hospital to utilize more single-patient rooms, and an extension of a parking lot to add 306 spaces. Both the tower and the parking facility will be built on the hospital's current 14.2 acre operating site on Forest Glen Road.

Meanwhile, hearings about Suburban's expansion are entering their ninth month, with a hearing date scheduled on Monday before County Hearing Examiner Francoise Carrier. Suburban's proposed expansion, which would increase the hospital's operating site from 10 acres to 15.2 acres, would also add parking spaces and single-patient rooms, as well as new surgical suites and physician offices.

Holy Cross has said it will not alter the current use of the 13 homes it owns in the nearby neighborhood that are leased or used by nuns associated with the hospital. Suburban has continued to buy homes not necessary to its current expansion plans, and closely considers homes up for sale in the block immediately north of its current facility on Old Georgetown Road.

Neither expansion would add beds to the hospitals. Holy Cross currently has 454 licensed patient beds while Suburban is licensed for 228 beds.

John Howley, a liaison to Holy Cross from the Forest Estates Community Association, said when the hospital first approached residents about expanding in September 2007, there were no drawings or blueprints. Instead, he said the hospital described its goals, and then asked how it could accommodate these needs while also respecting neighbors and their desires. Multiple meetings with both the architect and hospital CEO Kevin Sexton followed.

"They came in with a concept and idea of what their needs were, and then we worked with them as they developed that," Howley said.

As a result of the meetings, the 128-foot tower with the new single-patient rooms and enhanced surgical services was shifted from the northern to the southern part of the Holy Cross campus close to the Capital Beltway, so that it imposed less on residents.

"The hospital adopted a plan that looked a whole lot like our recommendations," said Adam Pagnucco, a past president of Forest Estates.

"We involved our community from the very beginning," said Holy Cross spokeswoman Yolanda Gaskins, noting that a similar process was used for a Holy Cross expansion finished in 2005.

Huntington Terrace residents living near Suburban, however, describe a much less cooperative atmosphere. Amy Shiman of the neighborhood's citizens association said the neighborhood left the hospital's Community Panel for a Healthy Future, formed in 2005, because the hospital's expansion plans were set in stone before the panel began.

"Our input was not sought out, it was not being even recorded, and we were the most relevant community because this is our neighborhood," Shiman said.

Shiman noted that Suburban will continue to have significantly fewer patient beds than Holy Cross after the expansion. She criticized the hospital's desire to "sprawl" over the neighborhood rather than expand vertically as Holy Cross has proposed with the 128-foot tower. Holy Cross has requested a 17 percent increase in the ratio of its buildings' footprint to the campus size, while Suburban has not sought such a variance from county guidelines.

Margaret Fitzwilliam, however, a planning director for capital projects with Suburban, said trying to link the number of beds to an appropriate density was misplaced, since the new surgical suites and other support facilities required additional space.

Leslie Weber, a senior vice president with Suburban, said the hospital has tried to engage the neighborhood since 2001 in multiple discussions, but that the neighborhood simply did not accept "what the hospital defined as medical need."

She did say that Suburban presented preliminary plans to Huntington Terrace in 2005 that were farther along than what Holy Cross presented nearby residents in 2007.

Weber said multiple suggestions from members of the Community Panel resulted in changes to the parking structure and physician offices. She said building on its current operating site would force the hospital to shut down for periods of time, something the hospital would not contemplate.

"We are dealing with a very tight, constrained campus," Weber said.

Hospital officials said Carrier's recommendation to the county's Board of Appeals on Suburban may not be issued until the fall. Shiman said she hoped the recommendation would be issued by that time.