"They don't have enough room, haven't had enough room since the last expansion, haven't been able to solve the problems of the last expansion," the neighbor said. "There's just not enough room in a four-acre space for what they already have, let alone add to it."

Pitkin said he understood the neighbors' concerns. "In general, hospitals have a reputation for being very poor neighbors, in part because the health care business as practiced in hospitals does have an unavoidable, undesirable impact," he said.

Concerns that Pitkin and city councillors said needed to be addressed include the increased use of the hospital's loading dock, which would accompany expansion, and the inconveniences the construction would cause to people who live on Line Street, which is adjacent to the hospital.

Some people have suggested satellites at alternate locations rather than an expansion of the current site. However, none of these have been found suitable by hospital officials, who feel that the future of the hospital is dependent on this project.

John G. O'Brien, the chief executive officer of the hospital, said that he thought that if this project were not carried out, "Cambridge Hospital would wither and die over time."

Healy, who agreed that the hospital would not be able to stay competitive without this expansion, said he was confident of the fiscal roundness of the move. "The benefits to me outweigh the risk on the fiscal side. I'm a believer, and I'm not easy to convince," he said.

Most people involved with the process felt that the plan could continue to move forward. "We've come a long way. We have a long way to go. But we have a process in place to deal with these issues," Pitkin said.