Stanford University's hospital expansion project took another step toward final approval Wednesday, when the Palo Alto Planning and Transportation Commission voted in favor of a report analyzing its impacts on the environment.

The commission voted 4-2 to recommend that the Palo Alto City Council certify the $3.5 billion project's environmental impact report, and adopt a statement saying that the benefits of the project outweigh problems such as traffic and air pollution.

After four years of planning and a total of 95 public meetings in four different cities, the project is scheduled to come before Palo Alto council members for final approval on June 6. The council will be asked to approve the environmental report, zoning changes, and entitlements that would allow the facilities to be built.

The planning commission did not have time Wednesday to finish discussing the other aspects of the project approval, such as the entitlements, which include a development agreement under which Stanford will pay the city tens of millions of dollars for affordable housing, climate change initiatives and other civic efforts. The commission is scheduled to continue its discussion on May 18.

The proposed expansion project would add 1.3 million square feet to Stanford and Lucile Packard Children's hospitals, as well as the School of Medicine. Stanford says it needs to modernize and expand its facilities to meet state seismic standards and the area's demand for medical services. The project would add 144 new beds at Stanford Hospital, 104 new beds at Lucile Packard, and a variety of new spaces such as operating, diagnostic and treatment suites at both hospitals.

In brief remarks at Wednesday's meeting, Michael Peterson, Stanford Hospital vice president of special projects, said he feels the project has come to "a point where we can see the end of the process and the beginning of the hard work," which is construction of the buildings.

A handful of members of the public spoke, almost all urging the commission to move forward with the project. Palo Alto resident Caren Chappel said the project has been "analyzed, re-analyzed, modified, adjusted."

"We will all benefit from a hospital that doesn't have a 15-hour wait in the emergency room because it's so overcrowded," Chappel said. "This process has been going on for what seems to me to be forever ... The city has had its hand out, pretty much constantly. As far as I can tell, all of their requests have been met one way or another. It's time to stop dithering about and just make the decision."

Commissioners Arthur Keller and Susan Fineberg voted against recommending approval of the environmental report, and Chairman Samir Tuma recused himself. Keller said he had concerns about whether the cost of Stanford's agreement to provide Caltrain passes for hospital employees will properly account for inflation.

Fineberg raised a variety of issues, such as concerns about the project's housing impacts being underestimated. She said she also wanted to ensure there are mechanisms available to enforce requirements of the environmental report.

"There's need for speed, but there's also a need for getting it right," Fineberg said.

City officials said Fineberg's concerns would fit better in later discussions.