if national health is different than what is being promoted now, there is still a floor that they will have to negotiate or have to provide it the equivalent of the 10,000 new medicare or medical recipients. >> we would have to discuss what happened if they made it so that they were unable. >> it is true that they have implemented health reform in the absence -- commissioner antonini: i have another statement or question, the development agreement. of course, this is a minimum of 20 years. no other hospitals, public or private, they have some sort of

commitment of operation that is mandatory. i think this is sort of an extraordinary thing. and we have provisions for that if it were to happen. the other thing is the master plan for health, and the question that some people have brought up is the delay that we can't really afford with the seismic question, and it could be a few years before we have the plan city-wide. 33% or more come from outside san francisco. we have a patient base that

transcends and franciscos needs, and those needs have to be met equally by all the hospitals here, and we're building a new one out of mission bay right now. i am in favor of moving this forward and it is good to look at san francisco's needs city- wide in a health care master plan, but it does not control individual hospitals. >> of the master plan is not anticipated to be final for about another year. >> held the san francisco, understand the northeast medical service is one of the biggest providers for healthy san francisco. from what i have been told, they have the largest share of the healthy san francisco patients. i believe that is 13,000 patients. another charitable party that is

not necessarily included in what we have seen so far. what were the other topics we were supposed to talk about? the other question is trying to make st. luke's larger in cathedral hill smaller. it has been pointed out quite accurately that community hospitals and smaller hospitals treat normal medical problems and normal deliveries. there will be full service at st. luke's, so most of the things that you might have our routine surgery, routine procedures that require hospitalization. if there are a specialty problems and an at-risk deliverer -- and delivery, you want a center with an anesthesiologist for this specialize in that kind of care.

all the other specialties the deal without risk mothers and infants. i came from the east bay originally and i know that people have to travel 15 or 20 miles from one acute-care hospital to another, even areas that are fairly affluent because there aren't as many hospitals. a lot of these places don't even have a smaller community hospitals. have outpatient clinics where they can go for emergency care and be transferred to a hospital. huge miles and a number of people between those hospitals. we have a lot of different hospitals in san francisco, so this access issue is not one that resonates through much with me. the last thing is a number of beds at st. luke's. i understand we have about 150 beds of which, rooms, rather.

the beds are crammed into multiple bedrooms. i think they will all the individual rooms. i believe it is required, and as we heard, the census was historical year-round 59 -- around 59. that sense is goes back quite a ways. those are my main questions and concerns regarding health care, except maybe for the site needs. we heard earlier today and i brought it up the the head 18 site beds at the pacific, and oftentimes, there were only 11 patients, the same is true of the beds that were at st. francis, saint mary's, langley porter.

a lot of the care, especially with the restrictions, the hospitalizations are somewhat limited. unless they are special circumstances, most of it is an outpatient. that is what i have heard everyone tell us. >> we try to be responsive to psychiatric care and creating the most effective programs in the least restrictive setting, and that is what you see in the amended development agreement. commissioner antonini: what were other subjects? that pretty much takes care of it for health care. commissioner sugaya: on the health care master plan, tell me. if and when is adopted, will it have any impact on cpmc. >> only after the date is

adopted. commissioner sugaya: because it is another year of, we're not going to make the decision, i can tell you the right now. the board of supervisors makes the decision and it gets approved. once the health care master plan is approved, there is no effect. it can stay within the city and county of san francisco. there are certain kinds of desires or goals put in place, and it would be desirable to have whatever the facilities might be for the services or whatever. >> if it goes into effect, they will have other facilities after words that needed permits and entitlements that will be subject to what had already been entitled before you today. >> in terms of the answer i received on the status of the master plan, it looks like by the end of this month next

month, the task force will have matter and they will have formulated recommendations, is that correct? >> in june, will be seeing something from them. >> the task force was charged to look at the impact of the health care services master plan on the city's vulnerable populations and make recommendations to planning as we draft a master plan. their report will be available to you and we can make sure that you get a copy, but those recommendations are not the master plan itself, but the public input processed for development of the plan. commissioner sugaya: and whether the recommendations that affect this particular process? >> i have been part of the process all along and i don't think there was this level of specificity. >> wouldn't it be prudent for us to continue this out another six

weeks until after we received those recommendations? >> i am not sure that they would have an impact the way that they are drafted, they are not yet finalized. commissioner sugaya: another question with the beds, i can't find it in my development agreement, but can you tell me how the wording does is set to require those 100 beds? >> they are required to provide 100 beds in 10 years. the current thought is the thirty eighth of those will be ed the campus where 38 of them are now and that 62 will the new beds created elsewhere and would not take from existing stock. it is page 12. >> from the city's standpoint,

is in equally desirable or not desirable, to have the beds within a hospital or within another location? >> often times nursing beds with a hospital facility are not long term -- the long term care beds, but a step down from an acute care episode. in the community, it is more often long-term care in a residential care facility. much like in such jiechi -- and psychiatric care, the trend is going away from a facility based model to a community-based model. in fact, options for long-term care are also able to be funded in the innovation fund. in-houscommissioner sugaya: the

arguments for the campus is that it needs to be this is it is because all of these specialized services and what ever can come together, including the children's hospital and everything. and if i get sick, i can be rushed down the hall and get whatever i needed. is there a standard? is there some guideline that says how big one of these facilities has to be in order to sustain that level of service? >> i don't know the answer to that. you mean on the cathedral hillside? i don't know the answer to that. >> we are wrestling with people that say that saint luke's should be bigger, that kind of thing in the argument for cathedral hill has to be the size it is because we are doing all of this stuff, but nobody

has told me in other instances whether it has to be 550 beds or if it could be 300 and have the services there anyway. let's see. the mental health component, the way we are trying to approach it is not some much they are committed to keeping the existing beds at the campus. is that going to be in the development agreement? i think the answer was no. we will get to that when we get to the development agreement. the way that the current suggestion is for approaching mental health is that it to be included in the innovative program or innovative services, whatever it is called.

and they are going to find that with millions of dollars. the way i read the process, it says that somebody has to apply for a grant in order to get the money. to have that come up with some kind of innovative program and apply for grants. but there are no goals and the innovative program that i can see currently that makes mental health any kind of goal, objective, or priority. >> we did not get to the goals or objectives, but is in the amended development agreement that you have had it specifically calls about the behavior health service that does, as i described earlier. the innovation fund will be a partnership between the department of public health, the city, and the san francisco foundation.

the three of us together on grant making will develop of the goals and objectives that will be used in the distribution of the innovation fund in line with the general overview included in the development agreement. commissioner sugaya: you say that the service is one of the -- is not a goal yet, but one of the priority considerations? >> it is specifically called out. it says it will provide infrastructure support for community-based, health, human service, and a specific focus on the western addition, south of market, tenderloin, bayview, a chinatown neighborhood and allows patients to receive services in the most appropriate in the least restrictive

setting. >> i assume the essence is a three-way partnership, so to speak, if programs come forth that are being funded and somehow, through the years, it turns out that mental-health programs are not being funded, how does the public know that? >> there will be a reporting process involved with the innovation fund, certainly. the health commission is charged with being the oversight body. commissioner sugaya: we're not talking about 1%, are we? on the 1%, testimony was given

that what happens at 1% or something is that the rating company suddenly drops your rating down to some unknown level where somebody wants to loan you money or whatever. if that is the case, does that rating applies solely yoo-hoo cpmc, or because it is a subsidiary, how does that work? >> the data on the ratings that we presented earlier was not meant as a specific -- but we're not talking about the ratings, the point of that statistic was to simply look get the operating margin metric that we have in

the development agreement and to show how that measure ties to the way of the operating margin for a hospital is viewed financially, so the actual ratings as an aggregate statistics, hospitals that have this level of rating on average have an operating margin at this level, so that is all it was designed to communicate. commissioner sugaya: i am being cynical, but is it possible that it can be driven down to that level, get rid of st. luke's, and then put money back and drive the margin back up? >> is actually a good question and we will look in a moment. there is language in the development agreement that specifically does not allow that to happen. the only way that that could happen is that money were deliberately moved out into the parent company and they can't do

that. will find that section in a moment, and we can monitor cash flow to the extent that they are allowed to move cash for the sole purpose of doing that. commissioner borden: back about innovation fund, you have 25% of the hon. it is correct. dodge is not just for psychiatric services, but health and human services generally. commissioner borden: you are not working that for mental health? i just wanted to understand that. another question i had, i know

that you gave us a lot of information about the tenderloin, everything that was identified, a number of people spoke today about the health care issue. i know that you were looking to have a partner in the clinic, and has that been identified? >> it would be an existing click, have a way that the development agreement is written is the first, the management service organization, that is via administrative entity allows participation would be set out with an organization that has a provider based in the tenderloin. the primary care provider would be in the tenderloin and there are a few right there right now. there is the senior center, there is how our own health center, a few in the tenderloin

out. if there is no provider of primary care provider base, they are able to participate in this organization and it goes to a provider that has a significant number of patients in the tenderloin. we will go to them so it has an existing relationship with cpmc. commissioner borden: it won't be determined until later? they're looking for health services, and i am not going to figure out or try to figure out of the city. >> of those conversations are going on right now in coordination with the community clinic consortium. south of market is another provider that has a significant number of tenderloin patients. commissioner borden: i think

that is kind of confusing, in the language, more specificity. we need information about where to go and it has to be pretty clear. >> the reason is not so clear right now as there is not an organization that has the ability to participate in the way that we would like them to. we need to figure out who the best partner is. it will be an application process through the san francisco foundation. commissioner borden: i have a question, it is in the area of health care, but is not. that came to our attention that the hospital situation, i don't know if anybody can speak to or knows anything about that. i recognize it is probably

different, but i want to understand what it was. >> it is not something we are aware, but the project sponsor can comment on it. >> i am a lawyer that represents the cpmc. i like some of the things you have heard this evening over the course of the day, a little bit of information gets messed around. the situation is not analogous at all. you're probably familiar with the township health care district. there is a dispute about that is in litigation about ownership of the hospital. there was a court decision about two weeks ago that dismissed litigation about in in favor of what should take place, and at

this juncture, there are no plans to close the hospital. things are under review. no notice has been provided. >> and no agreement around operating margins? >> i apologize for not being more specific, i wanted to give the the big idea to have some familiarity with it, but not a lot. the understanding is that there is a lease hot, and the issue was what gave rise to the right to terminate the lease. but we don't own that property and never did. i think it is a lease conclusion termination issue between the health care district have the operators, it is not the circumstance that we have here. have the ability to continue to operate it is based on the

assets of the system. commissioner borden: we talked a bit about the skilled nursing facility. going back to the issue where there doesn't seem to be an issue, someone even mentioned in situations where people are being held in gurneys and not being amended. how do we track utilization of the beds and whether or not when people come in from of emergencies, the transition to those? is there any way to know? >> we track them very closely and san francisco general, but we don't track them at other hospitals. >> my concern about the situation is that i know there

is a real problem, and i understand there is hesitation to put anything in the agreement about that specifically. i understand that long term beds, people being hospitalized is not where we want to go, but my only concern is the short- term people that show up, do they get access to a bad or not? i don't have any proof of the event and stories that i know firsthand and that some people have expressed. >> the program that we are proposing, it specifically addresses the issue for patients in the emergency room. some of them have substance- abuse issues and some need to be stabilized on medication. some of them go to other kinds of treatment programs. those people can do that under

clinical supervision elsewhere. if we take those people away, there will be more room for the people that really do need the psychiatric -- >> are they being evaluated? got his program will work for that purpose, too. >> just show up at the emergency room. >> how does that work? and do we send them somewhere else, or do they go through the process? >> she is the one that put the program together. >> when a patient comes in, they

have to be cleared. once they are cleared, we're going to be hiring a social worker and that will be connected to the cpmc. that will determine whether not they can johann and identify other program. it will be the discharge process to the door street or any other facility. they will work case by case. i believe that the way that we were in the emergency area, they try to bring them back if they can. that is going to determine whether or not they go into the psych bed.

>> the only issue is making sure they have access to those beds. that is my only concern. >> we can work through that on the issue of this program and make sure that they receive those beds. commissioner borden: they need to add a bunch of beds, i want to make sure that -- >> because there is not capacity utilization, it should be capacity when necessary for individuals to come for that process. they would also have homes like consoles. >> st. luke's will be transferred to cpmc? >> that is the determination of the consoles. -- consult. we have-nots worked on this

social work. -- we have not worked ont h the social work. commissioner miguel: thank you for clearing up some of mine. i appreciate the comments on the san francisco consortium of clinics, particularly as to the tenderloin, the manner in which they will work through that through the innovation find. -- fund. you have covered that to a great extent and i appreciate the comments, those of psych care. this