"I'm sympathetic to the appellants' concerns,'' says Supervisor Tony Hall, who represents the Westside district. But he pointed out that the city's Public Health Department held 35 community meetings to solicit public comment for the long-term care facility's upgrade, and many of those objecting to the new, more visible location on Clarendon Hill had apparently not participated when they had the chance.

The $400-million project was approved by voters in 1999. The current buildings on the 62-acre site are 70 to 90 years old and do not meet earthquake standards. According to city officials, the hospital's new campus promises to be one of the most innovative and humane long-term rehabilitation centers in the nation. On completion, the campus will include a 1,200-bed acute care/nursing facility and 140 assisted living units.

City staff members said the project would have suffered financial strains amounting to $750,000 a day if the board had delayed it by sustaining the appeal. Construction is currently slated to begin around the end of 2003 and be completed in 2010.