Highland Hospital is a prime example of what city officials say they want - a current employer planning to stay in Rochester and expand.

But in a city with little vacant land, neighborhood residents don't always welcome expansion by businesses or institutions. And Highland's plan to build a three-story ramp garage has become a major controversy.

Highland employs about 2,400 people, 1,900 of them at the hospital's main site in the city's southeast area. Hospital officials say they have a serious parking shortage, and that is causing two problems: hiring and retaining nurses and satisfying patients and their families.

About 250 Highland employees park at the former Rochester Psychiatric Center lot on Elmwood Avenue and take a shuttle to and from the hospital. That adds another 10 to 15 minutes to their commute, employees say. A commute that takes 20 to 30 minutes from their home to the lot becomes a 40 to 50-minute trip each way. The inconvenience is causing some employees and prospective employees to look for work elsewhere.

"Many times, nurses are discouraged when they are interviewing and are told that they have to take a shuttle," Gayle Jech, the hospital's nurse manager, said at a Rochester Planning Commission hearing on May 21. "We don't work 9-to-5 hours, so we are not in a normal commute schedule to use mass transit easily. And after you have been standing on your feet all day, the last thing you want to do is stand on a shuttle ride back to your car."

Highland's management says that if the problem isn't corrected, it could affect the hospital's future. Two existing garages and small surface lots don't provide enough parking during peak hours. The hospital's studies conclude that it needs at least 364 additional spaces.

"The employee shortage in health care is well known," Steve Goldstein told Planning Commission members. Goldstein, who is president and CEO of Highland and Strong Memorial hospitals, noted that Rochester is having trouble attracting young professionals. "Highland Hospital will not be able to compete in the future," he said, "and put quite bluntly, this community needs Highland Hospital."

It's not just employees who are complaining. "Patients have told nurses that families and friends won't visit "because it takes too long to find a parking space," said Goldstein. And, he said, even doctors are hearing requests from patients wanting to be placed in different hospitals so their families can visit them more easily.

Some employees and visitors have found their own alternative to the shuttle and crowded garages.

"Many of my employees don't use the shuttle, because they need quick and easy access to transportation," said Deb Zicari, Highland's director of nutritional services. "They have kids in day care or elderly parents they have to take care of, so they park on the street. This isn't what neighbors want to hear, but it is what's happening."

Growing pains have not always been a problem for Highland. Only 10 years ago, the hospital was headed for closure, Goldstein said. Built in 1889, Highland is among the last generation of smaller hospitals designed for community care. Losing millions, it became affiliated with Strong Health in 1997, borrowed $23 million from the University of Rochester for operating expenses, and invested nearly $25 million more in renovations and medical technology. It continues to maintain its own operating license and functions as an independent hospital.

Highland is profitable today, Goldstein said, and it has managed to retain its intimate, small-hospital character. While it serves the nine-county Greater Rochester area, 20 percent of its patients come from nearby neighborhoods.

State regulations limit Highland to 251 beds; it is operating at 220 but often hits peak capacity. Known for its women's health-care services, it delivers more babies each year than any hospital in Monroe County.

The hospital is asking the city for a special permit to build an ancillary garage in an area that is zoned R-1: low-density residential. The request has taken on some urgency, hospital officials say, because the new owner of the Rochester Psychiatric Center property, where the shuttle lot is located, says he is ready to begin development there. That prompted hospital officials to enter into a contract to buy a 1.3 acre parcel at 875 South Avenue. The existing single-story building would be demolished to make way for the garage.

Hospital officials initially wanted a five-story garage with 410 parking spaces. At its highest point, it would have been 73 feet tall. Neighbors complained that the building was so tall that it would cast a shadow over nearby homes. And they were concerned about traffic congestion and fumes during shift changes.

Architects have reduced the garage to three stories and the height to 43 feet. It would contain 323 parking spaces, and instead of a large rectangular box, the new plan calls for a graduated step design. At its nearest point, the building would be set back 10 feet from South Avenue. All of the garage's setbacks, except the one on its north property line, fail to meet city zoning requirements.

The new plan represents a 42 percent reduction from the original, says Goldstein. If that was supposedto make Highland's neighbors rejoice, however, it didn't work. It shows instead the deep and often emotional opposition developers can face when their projects are close to residential areas, and the dilemma of city officials who want to increase development and employment and also make neighborhoods attractive for residents.

City Council President Lois Giess couldn't comment directly about the Highland garage because it is a pending case. But she says one of the first things business owners and developers are encouraged to do is talk to the neighbors.

"Before they get too far down the road, we ask that they involve their neighbors in the process," Giess says. "They are told quite directly they should set up meetings with the various community groups and get a sense of their concerns about the project they are proposing. It's crucial that they try to make sure that all of the people who have a position on the project be at the same table, and their concerns are heard."

But coming to a consensus over development can be hard. "It's a balancing act," says Giess. "Yes, we have zoning conformities and requirements. No, they are not set in stone." Many large projects need some flexibility, she says, "but if you're going to develop an area close to a residential neighborhood, you have to approach it from the beginning with sensitivity to the people living there."

Although hospital officials have met with neighbors several times, long-time resident Chris Jones says she feels they haven't listened to residents' concerns. Like many of her neighbors, she says the site is inappropriate for a garage and is the result of the hospital's lack of planning.

"They've known about this for years," says Jones. "This is not a new development. They've already built two ramp garages in the last 15 years. And we have offered many suggestions on alternative ways to handle this, but they haven't even looked at other options."

Neighborhood groups have recommended more than a dozen alternatives to building a new garage, including adding on to the existing garages, finding more convenient locations for shuttle lots, and offering incentives for employees to car pool and bicycle to work.

Hospital officials say they have explored all of the alternatives. They have even moved some of their departments, such as breast care and dialysis, out of the hospital. A new garage, they say, is the only long-term solution.

"We have looked at adding floors to both garages, and we would get more parking spaces from that," says John Turner, a hospital spokesperson. But it was "structurally questionable" whether either of the buildings could support more floors. "It just doesn't look feasible," says Turner. "And we can't build on the surface lots, because they are too small and irregular to accommodate a structure like a garage."

Jones says Highland's exploration of alternatives hasn't gone far enough, however. And members of the Planning Commission seem to agree. They postponed their decision until June 18, and they have asked Highland to further investigate alternatives to the most recent proposal.

"They [the Planning Commission] want to take a more in-depth look at combinations of methods to solve the parking problem," says Art Ientilucci, the city's director of zoning. "Better utilization of interim parking, additions to the existing lots, perhaps a smaller garage with a surface lot - they're asking what happens if you approach it with several options."

But Jones was pessimistic.

"For all of their concern about keeping nurses, they don't offer any incentives to their employees to use things like mass transit, assistance with purchasing a home in a nearby neighborhood, or enhanced shuttle services," she says. "They haven't given any serious thought to these sorts of things. And really, Strong needs to get involved here and work collaboratively with Highland, because they are within a mile of each other, and their parking issues are having the same impact, encroaching on neighborhoods in both areas."

The possibility that the neighborhoods near Highland might deteriorate is the fear driving much of the opposition to the garage. Many of the houses closest to the hospital were built in the early 1900's, and the neighborhoods between South Clinton and South Avenue are among those in the city that have seen a renaissance.

"There has always been some commercial use of the area around Highland," says Bob Boyd, president of the South Wedge Planning Committee, "and we understand that they are an important neighbor. But we have worked unbelievably hard to change this community. We are the real success story in this city. More than 30 percent of the stores on South Avenue were vacant five to six years ago. Now we have less than 5 percent vacancy. We have an active business association with 70 members, and our housing sells quickly. Prices are now running 3 percent above the median price for the city."

Some of Highland's critics point to the experience of Genesee Hospital, whose officials made similar arguments as the hospital expanded and encroached on the adjacent neighborhood. Not too long after its last expansion, the hospital closed.

"We heard all of this before with Genesee," Jones says. "How they are vital to the community and so on. First, they literally destroyed that neighborhood, and then they added that huge garage. Now look at it. The same thing will happen here. That's why you'll see property owners around Highland leave or turn it over to rental. We keep expecting the city to help protect us from this kind of encroachment, but they just aren't doing it."

Many residents say that even if Highland gets approval to build the garage, they doubt that all of the employees currently using the shuttle will use the garage. Highland's shuttles make 171 trips daily from the hospital to the lot between 6 a.m. and 9 p.m. And parking in the lot and use of the shuttle are free.

Employees would be required to pay for a permit to park in the new garage. Jones and several residents who attended the May Planning Commission hearing challenged hospital officials, asking what assurances they have that employees will pay to use the new garage.

The hospital's vice president and chief operating officer, Cindy Becker, said there are no guarantees that employees won't park on the street to avoid paying at the garage. "But," she said, "we would be open to working with neighborhood associations on enforcing some type of street parking program."

Critics also say that the design of the garage isn't compatible with the surrounding neighborhood.

"The garage is a detriment to the character of the area," says Katie Comeau, advocacy coordinator for the Landmark Society. "Our concern is that the area, which includes Linden and part of South Avenue, is eligible for national preservation status. ‘Officially eligible' doesn't give the area protection, but it does raise the area's historical status. When you add something like this, it can greatly alter future development."

But with the complex housing School 12, the Highland Branch Library, and the South Avenue Recreation Center all nearby, the garage would not be the first large public structure in the area. And it wouldn't it be the only one whose design doesn't conform to the older buildings in the neighborhood.

Both Comeau and Bob Boyd of the South Wedge Planning Committee oppose the garage, but they say if it is approved, they want to work with the hospital's architects to improve the design. Boyd says there are too many colors and oddly shaped windows.

"There are some people who just don't want anything," says Boyd. "They oppose it 100 percent. But if it does go forward, I think the design could be cleaner, crisper, and more architecturally relevant. And I hope they will let us work with them. Sometimes that's what it comes down to, finding a way to work together."

Tension over development is nothing new. City Council President Giess says neighborhood groups offer much-needed oversight and, she says, the process works better than it used to.

"Oh, gosh, it was much worse some years ago," she says. "Developers would propose almost anything. We had design that respected the car more than it did people, and we got some real monstrosities out of that period. I don't think that would happen today."

The City Planning Commission will meet at 6:30 p.m. on Monday, June 18. A vote on Highland Hospital's request for a special permit for a new garage is expected to be on the agenda.