and my answer standing is those 6000 -- that number will remain constant and above and beyond that, they are planning to grow by a projected number. i have heard and correct me if i am wrong. i have heard up to 1500 over 15 years. is that correct? >> yes. that sounds about correct. you're talking about in use? commissioner antonini: permanent jobs. not the construction. i have heard there are only probably projected to be 100 new jobs created are permanent jobs and 40 are entry level for local hire of people who do not have specialty training. they are entry-level, they may have to be trained by the hospital. is that correct? >> i think it is a little bit more on the permanent site.

there is some amount that has a turnover rate. the bottom line is the agreement thus far has been negotiated that it is 40 of those in use entry-level jobs. commissioner antonini: what i am pointing out is the actual number of new and used jobs is not that high. i heard 100 possibly per year and that is only a projection. >> how do i try to explain? the jobs peace is a lot of this thing you have heard here especially on the in use. for the purposes of my work, i have only focused on one end of that continuing. that is not the whole pie. a lot of the conversations and a lot of the speakers are talking about a much broader spectrum. above and beyond the piece that my work involves.

my work is on very entry level, not as high skilled an individual. that does not mean that the overall scope of jobs are larger. i could -- i have been here all day, i continue to hear their concerns around the jobs. we will continue to work through this till the end of cpmc. we have great conversations and we will continue to have that. it is an important distinction to make. this is -- for the purposes of the city, this is a private project where i keep hearing language around local hire and things of that nature. the local hire a lot as it is written does not apply to this project. because it is a private project. there are nuances that we have had to negotiate in good faith. we will continue those negotiations based on the concerns will continue to hear. commissioner antonini: thank you

very much. i appreciate that. i agree that it is remarkable that we are committing to that many jobs, because most of the positions have come up are medically trained personnel who have to have had some experience in many cases, so we can get that many commitments to entry- level, most of the people i hire have to have prior training and it is harder in that field to create entry-level jobs. this is a big commitment i think on their part. >> it continues to be based onrm cpmc, they currently employ as significant amount of san francisco residents. we will continue to work with everyone that has concerned and continue to work in good faith with the folks at cpmc to work through the issues. it is based on a continuum of skill set around employment and

trying to sort that out to come to a compromise that everyone can feel comfortable with. commissioner antonini: i also heard as they do this hiring, there will be a trading situation where they will bring in a lot of new hires and train them into some of the fields and become more employable in the future. >> a lot of the work we do, those folks as i said, under -- less than a two-year, the idea is to get the mine field and get them skilled up and get them to move up the ladder. we work with the number of hospitals here in san francisco, cpmc is one of a group of hospitals that provide employment to our health care academy. commissioner antonini: thank you very much. very impressive. one area here and that is on the housing field. there were some comments as to the level of housing and the

number of dollars spent. there was this figure thrown out of $73 million based on -- they began a special use district requirement -- the van ness special use district agreement -- requirement. there have been some considerable amounts talked about here. my math is there is $29 million to moh and another $21.20 $9 million -- $29 million, to people that qualifies as a for both housing and another 35 that would be money that would come back, $35 million that would come back as these are resaled from appreciation. i have that -- i add that up, it

comes up to [unintelligible] >> thankyou fok you for raisingt point. i would agree with your characterization of the uses of the money. that is what we have negotiated in the development agreement. a $29 million payment that would come over relatively quickly to the mayor's office of housing tree that will go directly to the affordable housing production program. again for your description, the second payment will go to a downpayment assistance program for households employed by cpmc at the 100% ami or below. the data that we were able to

come up with from the middle income housing study and report back that we -- which we did at land use a month or two back. what was interesting is because the maximum loan amount is $200,000, it in effect, what it does is it pushes up 100% ami households from the buying power up to the buying power of 150% ami. it puts them in a position to afford roughly 40% of the ownership housing stock in san francisco. it really increases a significant level of opportunity for those households to be able to live and work here in san francisco which i know is a critical goal of the city of this commission to kind of make sure that we have a job and housing in the city. the added benefit of this downpayment assistance loan program is upon resale, because

it is a loan, upon resale, the borrower has to repay the mayor's office of housing. not only do they have to repay the mayor's office of housing, they have to repay them with a portion -- every cent of the loan amount and the portion of the appreciation on the property. the mayor's office of housing is not only getting every cent back but they are getting an extra value added. that money will go directly back to moh and moh can use it for affordable housing production. commissioner antonini: thank you. this is a terrific program. this may be a model icahn -- we can use. this is -- could be something because the buying power as you said is going to make it possible for a lot more buyers to buy their first home. because they will have this money that will be theirs and the principal of which they have

to pay interest on will be less. thank you for commons. do you want to -- thank you for your comments. do you want to follow up? >> the $29 million that goes into the down payment program comes back upon sale of that unit at some future date. plus some portion in interest or whatever will not want to call it of the appreciation. in essence -- whatever we want to call it of the appreciation. it is not an additional $35 million, it is $6 million. >> that is correct. we are getting back the money that went into the downpayment assistance loan program. it is an additional use of the money. that is what we found very appealing about this program. in essence, we're able to use the same dollar two times

for uses that are important to this city. >> the commitment on the part of cpmc is still $29 million. >> $29 million on the front and an $29 billion comes back for affordable housing. -- 29 million comes back for for all housing. commissioner antonini: -- >> these are projections. thank you. i had a couple of other comments. some other things that came out. -- came up with the continuing of care. this is being done in ways that the campuses are continued to allow -- allowed to continue operating. this is not always the case, project. that is important. one other speaker, i am surprised one brought this up. improvements in the neighborhood

from the revitalization and the indirect economic benefits to the neighborhood in which these hospitals are being built, particularly with reference to van ess campus. it is a huge benefit that is not factored into what we're seeing as part of the development agreement. it will provide people working there, living there, spending money there, it will benefit everyone in the city, particularly the neighborhood. that is just about all my comments. there was one couple of comments on the eir which is not before us today. i think that this is a really good project and i will of course read over the development agreements in greater length before our next hearing later on this month as well as the comments and responses for the eir. commissioner borden: i have a series of questions and i apologize, people might have to get up at different times to

answer them. looking through the development agreement, there are provisions for the dvds campus community. -- davis campus community group. i did not see anything for cathedral help. is there not plans for an advisory committee for the hospital? >> there are not currently plans for cathedral hill. the reason that you saw the other three is because those are what are referred to as long term projects. those, although there is general ideas in the development plan about what projects may have been on those campuses in the future, the idea was to make sure that there is a community process in place. when the proposal is moving through and coming to you in the future, the reason we do not see them for cathedral hill of st. lukes, there would be no point to put our requirement for

that planning process in the da is is not signed until these are approved. does that make sense? commissioner borden: you think there would be an ongoing role. >> in terms of the ongoing operation of those hospitals, that is not there right now. >> thcommissioner borden: the question around a local hire and the language. someone who has been here seven days, where does that definition come from? >> the definition for local hire comes from the requirements around voter -- what it takes to vote here. and so that is part of a local hire law that went to the fact that is impacted on public projects. commissioner borden: that is the

law, seven days. >> for the local hire a lot. commissioner borden: i am shocked. they move here -- >> it is definitely one of the pieces of legislation we need to fix. commissioner borden: the other question in that regard, because of the concerns on the area of jobs, why not do a percentage with a minimum as opposed to putting a number in there? for the 200 jobs being created. >> as i mentioned earlier, we're still in the process of negotiating parts of our area. so we will continue to do that with and like i said in good faith with cpmc, most of the work that passes in my office with these types of agreements

have percentages and things of that nature. we were trying to work through different datasets. when you are doing this stuff, it is not always art and science. the numbers are projections. you try to figure out what is get you -- what is getting you the best bang for your buck. there is opportunity for us to work in partnership with cpmc. commissioner borden: i would recommend a minimum and then a percentage. >> we have a ceiling on that type of thing. we have opportunities. as i heard throughout the day the concerns on the permanent site. commissioner borden: thank you. my next question is about the affordable housing again. in terms of the downpayment assistance, is there any requirement that the person be a current san francisco resident? presumably, a bunch of people get jobs and they get housing but they do not live here and i am not saying i am against people having that benefit.

in terms of helping the people that are here, is there anything -- >> there is currently nothing written into the development agreement that would require the applicant to be a san francisco resident. our desire in opening the field or making the pool all little bit more open was because we know there is going to be folks who are working in san francisco from this pool of applicants, we wanted to put people in a position who wanted to perhaps if they lived in oakland or the east bay, to have an opportunity to move over here to san francisco, using this program. and that is why we did not have that requirement. commissioner borden: i think it is something to think about from a nuanced standpoint. i am not against people who -- at the same time, we have this

issue locally. we do not help conquer that issue if we are bringing other people in who are taking advantage of the program. i think we need to figure out a way to nuance around that so we can help those people at the income range the matter what. bienick sure we are tackling the issue of people who are here. -- we need to make sure we are tackling the issue who are here. my next question is around the psychiatric beds. maybe director garcia would like to talk about that. i was surprised, we have dealt with the sick beds but the issue around psychiatric care is to giant san francisco. you just walk down the street and see the need. -- the issue around psychiatric care is huge in san francisco. >> there -- any day we can 40 or 50 people who are not at the

acute level of the hospital, medi-cal has changed. what we have found to be more effective has been the new urgent care center we have opened. that is what we would recommend to look at in st. luke's and that way you would get two people earlier. we do not believe that hospitalization is the way to care to people. we have to get into early intervention. and if we can keep our beds filled, i worry about st. luke's keeping their beds filled. >> we're talking about the urgent care aspect but it is currently not codified in this agreement? >> we are working with them on that need in terms of -- part of the issue is the development agreement should not be the only way we engage with cpmc. and so i think that we did hear

the psych bed issue for a long time as we were progressing through this and i can say i'm struggling in the department to keep that a viable program within the department. trying to look at st. luke's and saying the best thing we can do is to keep it a viable organization on its own. i would not recommend psych beds for it. i would recommend a strong psychiatric intervention program, early intervention program urgent c borden: what at cathedral held campus? >> i think both of those. the city's responsibilities for mental health overall, we should have an engagement with both hospitals around that, particularly with the tenderloin community. >commissioner borden: i think in terms of pressing health care needs in san francisco, you only

have to walk down the street to see the psychiatric end. >> people will be put into the hospital, three days later, they get better and they are out of the hospital and that cycle continues to happen. what i believe has to happen is not only -- the end game is not hospitalization. it is trying to get them stabilized prior. commissioner borden: 4 even my friends who have health insurance to have psychiatric needs, they have not been able to get health immediately -- help immediately. >> you should be using the hospitalization for the most acute clients who are at the most acute levels. commissioner borden: after hours, where do people show up if they have a need? >> they would go to the emergency room or the hospital. commissioner borden: that is not ideal. it was mentioned earlier. >> i worry about the st. luke's

campus because that is where it has been discussed. i worry about financial viability. we have a hard time looking at how to keep right now today, i have a 40% admit date, 40% of clients should not be at the hospital level, they should be back into a lower level of care. commissioner borden: i recognize it is a challenge. a lot of people cannot afford to pay for it. it is not something -- there's not a lot of money in that space. >> the department is responsible for mental health needs of the city. we have alm clinics that are not only the department's critics but also the cpo clinics. having another urgent care center would be beneficial. we have seen thousands in our urgent care center who have never had to touch the hospital. commissioner borden: to that point, why not have something that provides some sort of

funding mechanism for the infra? >> maybe through the innovations fund, that is something i woudl bld be totally committed to. commissioner borden: this is our only chance to weigh in significantly to push it forward. my preference would be something around mental health, whether it is language round funding, the urgent care center you mentioned at st. luke's or cathedral hill. it would be a travesty if we went through this process and did not do with it in some way. >> that is a reasonable request. we will look into that. commissioner borden: another question i have is about -- the

provision in the development agreement around the systemwide operations margin of 1%. maybe someone can talk about what has been their average over the last 10 years for their operational margins and when you see systemwide how many hospitals are we talking about are in that system? >> i would like to introduce greg wagner, the cfo for the department of public health and he can go into that information. >> good afternoon. it is a good question and i do not have the data on all that history. we can certainly provide you at the next hearing with more information than what i have with me. we do know that at the moment, the equivalent figure to what is

in the development agreement at 1% is 12.5%. 12.5 per cent signt -- 12.5% to 12.8%. in terms of the facilities that are included in that calculation, there is a list which i will have to find the actual -- apologies. commissioner borden: no worries. is this something that cpcpmc requested? >> you can take a look at that. this provision was mutually agreed upon by the city and cpmc. the idea here is that there had to be some sort of mechanism in the agreement to protect cpmc in

the case they come on too difficult financial times. the city thought that was a reasonable request. knowing that it would be difficult for cpmc and the board of directors to accept an undue amount of financial risk. this was a negotiated agreement. it was designed to provide a metric and prices falling them hitting that metric for the city and cpmc to engage in discussions, should the end up in a financial position to put them at risk. the actual level that was achieved was negotiated but it is designed to trigger a process if cpmc is at the point where they are close to being in a position where they are getting out of the black. commissioner borden: i noticed

in the agreement their obligations are not discharged -- dischargeable. i wanted to know, is it st. luke's or cpmc, i am trying to figure out where the system is. >> it is every facility that cpmc operates in the city of san francisco. cpmc is an affiliate of sadr -- sutter. there are no facilities outside of san francisco. it is all the hospitals and a list of other things that have lined san francisco. -- that are outside san francisco. it is an important part of the development agreement. we said a couple of things to them very early on in the

negotiations. the first thing we said was, we need a guarantee for st. luke's absolutely as long as possible. we are willing to get a longer guarantee to identify working with you, kind of catastrophic provision. we did not know how to define that. if there is a catastrophe, then this could be reconsidered. as we went through it, we need something definable. a catastrophe, is that defined as something that is driving the hospital on the brink of going out of business? that is the best way to look at it. we can have a hospital -- cannot have a hospital that serves the reports -- 35% of the city go out of business. the number we started out was a higher number. it was not two years in a row, it was one year. this is something i would say having been through all the negotiations that we push, the

absolute hardest of all the provisions in this agreement. we cannot have anything but the tightest possible assurances on this one. commissioner borden: i do not recall seeing language on here. >> is on there. it is a process. -- it is in there. it is section 7, if my memory serves me right. first of all, you have to -- on the first year it happens, they let us know, the show was the numbers. they give us a year to audit those numbers and talking to them, trying to figure out a way around it. in the second year if they do not go below 1% the whole thing's -- if they do not go below 1%, the whole thing stops. we have another series of opportunities to audit them and if we do not believe the numbers, take them to binding arbitration. they owe us as part of the

process of third-party audit. it is pretty tight. commissioner borden: i see the arbitration language. >> if you give me a moment i will find it. let's go to the next question and i will find it and i will come back and tell you. commissioner borden: i have a question around the centers of excellence at st. luke's. and whether or not pediatrics is going to be at that hospital. >> i believe that pediatrics is one of the specialties listed in the services. the center of excellence in community health is a prevention focused disease