that's of concern of you that we heard three weeks ago. looking at the first slide, have you the key points and they haven't changed. significantly larger saint likes which is a part of the cpn system. cpn obligate to provide charity care with with no reference to their financial condition and about $80 million in cash for community benefits. saint like is 120 beds and it will open based on the da 24 months or less or fewer offer cathedral hill. instead of the 80 beds at saint likes with a 20 operating commitment, st. louis are be at 120 beds and more sustainable. they'll have excellence and senior committee health. standard have advices are provided in acute hospitals and a new medical office building needs to be built

within five years or the city has the opportunity to do same. on health care, cpn shows hey baseline of 30,000 unduplicated patients and that's their obligation and $8 million in other services, it must be the partner and you're familiar with the new med-cal beneficiary at 5,400 and these are commitments and don't -- they'll fund an $8.6 million health care innovation fund and you're familiar with that. it insures the innovation fund to 5cent. on the how longing, it's $4.1 million to replace housing physically, displaced and 36.5 million through the mayors office for housing through affordable housing. local higher and work force

training, 30 percent local higher, mere is the local higher ordinance and 50 percent for new positions and cnc will observe 40 local higher for entry level permanent jobs for ten years and provide 4 years of training and you saw these last time. on the transportation side, 6.5 million to the mta in lieu of tdif which they don't owe legally but it's apart of the agreement. parking fee of 50 cents for every entry and exit off peek and 75 cents on peek. i forgot the dollar sign there. $400,000 for study of bicycle planning relating to the campuses. the next three you heard about last time but are new to the da this time around.

survey evaluating the program and more studies every three years at a cost up to $40,000 to look at the traffic congestion in cathedral hill and help the city deal with it and encouraging its employees to purchase a clipper card in paying -- sharing the cost of that cardi equally with the employees. 4.25 million for the pedestrian and sidewalk widening and $600,000 to the city to save passage program. 1.55 million for transity and safety improvements around cathedral hill. on the pacific in california campuses, $3 million to the city to fmca for enforcement and safety around

those two existing campuses, at saint like -- saint lukes it has been there. as i pointed out before, there's a list of improvements they may do even if the cost is higher, it has to be completed. that is a very quick over view and i'm happy if anything was glossed over too quickly to answer questions about it, but what we thought we would do is go back to three or four topics to be of concern raised by the commissioners or by the public and i'll ask city satisfy to help me do that. to begin on the first one which was a question that came up last time about the construction scheduled, relative to each other of the brt and the cpt, i'm going to ask peter take us

through how those two relate to each other. >> good afternoon commissioners, my name is peter and i'm the project manager at the fsmtta. as you can -- as you can see from the slide the cathedral hill hospital is ahead of us in schedule and will be in the construction depending on the portion of the work between a year and two years before we break ground to the vaness and we've been coordinating our efforts with cpmc and at this time i don't believe there's going to be any difficulty in staying out of each other's way. most of the heavy work will be done by the time we start work and in the

case of possible interference, we're building a two mile corridor and you can start either north or the south end and schedule our work to avoid any major conflicts of the hospital. if you have any questions, i'll be happy to answer them for you. >> possibly later. >> yeah. >> thank you. >> thank you peter. the next issue that has been up, and it has always been an issue is traffic level around cathedral hill from the medical office and one key new set of terms in the da that was particularly spear headed by supervisor chew when we had the negotiation sessions was the idea of some enhanced monitoring of traffic around the cathedral hill hospital so i was going to have nickleson from the planning department to tell you how that

will work and how we'll keep it under control. >> department staff, president commissioners. as kim mentioned, there's eye it items that we'll be doing. i want to focus on the components of those. but cpnc has a system wide goal of reducing single occupancy. and in order to monitor whether cpnc is meeting this goal, they'll conduct surveys of employees and report those to the city. if the goal is not met, they'll work with the staff to strengthen their tdm program. with respect to the cathedral hill campus because it was for the entire system, we put additional monitoring items in the agreement. this include, monitoring congestion in campus operation through the funding of three funding studies at

$40,000 each and if the stud owe shows the congestion exceeds into participating level, cpmc will work with the city to address those circulation concerns, secondly at the employee and survey that i mentioned earlier, if it's higher than what was predicted, if more people are driving that we didn't anticipate, then cpmc will pay $75,000 to the mta to implement travel demands strategies of their own. i want to point out while the annual and three surveys are for larger projects, they still monitor congestion and campus operations and the confirmation of the anticipated [inaudible]. and the new items added. we feel the surveys and the studies had help insure that cpmc meets their goals and that

they will be reduced to the greatest extent possible. i and other city staff are available for questions after the presentation if you have them. and with that, i'll turn it over to -- >> commissioner sugia. >> mr. rich produced a bullet that said they will provide 40,000 and your bullets says funding, does that mean we're funding three transportations three years apart? >> is there a timing set? >> let me. >> it doesn't matter. >> we can confirm. >> we'll take a look. i think what you said was right but let me look in the document and tell you in a moment. >> thank you. >> the next subject we want to hit on, a couple of things is the public health department

and we'll talk about issues around mental health care and preshadowing some comments i'm going to make in a couple of minutes she's going to talk about how her department will monitor the health care portions of the da wants. >> thank you ken. good afternoon commissioners, director, barbara garcia, director of health. mental health services was a sensitive issue to you and it is to public health and over the last 18 years that i've been at the health department, i can tell you most of my career has been how do we manage our mental health beds within the hospital and the lessons that we have learned there, particularly with health care reform that's going to emphasize committee health and not hospital beds, they want to see us use our hospital bed and help people get back into the committee where they live for most of their lives. and so i do want

to acknowledge the sensitivity of it, but also the fact that we have found if we don't have a robust committee system of care for people to leave the hospital very quickly once they stabilized that what we found and we still find and i work on this even still as the director of health is we have to have and continue to work on trying to move people in the best certificate vuss best services in the community. cpm operated 18 psych alkylation trick beds and they would agree they can use those beds more effectively if they had more services in the community and step down services they can use to ensure people are moving to those bed and keeping at the level of acute. several years ago, med-cal lowered the threshold so they're not getting paid for lower levels of care, and acute levels of care is what cms is

paying for and so as in san francisco general we do have people that are add and denied days because we can't get them out fast enough. cpmc provides other health services and our representative can speak about the services and you'll hear those shortly. the development agreement doesn't change the current mental health services, it address the needs to have committee base option and the da specifically allows to have psychiatric care. i've been working with cpnc to look at a partnership to look at the community's need for the health services so we come up with the plan to link our door urgent care service center which will provide and what we hope to do

is provide on sight services at saint luke and the emergency room who maybe in a need of high mental services and counseling, but who do not need to be in the hospital to receive these services. urgent care is a program we funded for the last five years and it's a crisis stabilization unit that partners with general hospital. we provide the same amount of services on a volunteer patient. door urgent care serves individuals in psychiatric crisis who does not need is a collusion of restraint. those are the urgent crisis beds that cpmc have. they're on sight or on call and patients stay for up

to 24 hours. door urgent care has two components, one of the things that we looked at when we set up urgent care crisis, there's a need to post an urgent care program and they have a door house, they call it, a short term residential treatment program that's located at the same site. once they've stabilized patients who need additional services maybe transported and the average length of dora health is three to five-days, and from dora house, we have other placement services, residential programs, outpatient settings for individuals. i really believe this is a good partnership for patients, i think it's an important process and i believe it's the least restrictive and the cost effective setting for

our saint luke patients. moving onto the monitoring of health care in the da. rich can provide more details on the monetary provision, but i want to give specific details of the components of the development agreement. the development agreement provides department of public health and our health commissioner who have had five years in the cmpn process with the health care commru znswer -- compliance. it recognized the dh staff, but the role of the health care. they'll be required to fire a compliance report that details the performance on the da's key health care commitment and upon receipt of the health care compliance report, our staff will prepare analysis of cpmc compliance with the health care committee in the da. and any

reduction in service lines that the hospital will also have additional subject to public notice, requirements under the city's proposition cube process that the health commission manages and independent paid by cpmc will review the compliance with the baseline health care commitment. this was included because this information cannot otherwise be independently verified but public available data. the report and the results of their analysis will be in a public hearing before the health commission and it should return the cpmc compliance and i do understand the plan of commission has been support the collateral agreement. i want you to know the committee coalition, i've been involved with from the very beginning of this process. i believe we'll be involved with this coalition, but i

believe the structure of the health department and the health commission, this responsibility falls under the health commission and the health commission is open to hear, to work with, and to be partnering with the coalition, but the health commission is to provide the over sight and i'll continue myself to work with the coalition as needed. i will be leaving shortly and my deputy director colien shalla will stay throughout this hearing so any questions you you have, i'll stay for another 20, or 30 minutes. thank you. >> thank you. >> commissioner caninni. >> can i ask a question. you talked about the community outreach accomplished for psychiatric patients who were released from acute care and i wondered, what kind of ongoing situation would exist because one of the biggest problems is

just relapse of patients after their released into their on devices, is there monitoring of these patients. >> absolutely. part of the role we'll play is they have their own services that wrap around these patients for dischashlg. if they're at saint luke, we'll wrap around them, those who do not need to be in psychiatric beds and that's cpmc role, if they hit saint luke's hospital, they can use the beds and we have the responsibility of mental health services throughout the city and we'll work closely with this area, cpmc and the general

are the psychiatric level and we make sure they do leave. part of health care reform is insuring the people do not get rehospitaled and manage hospital, we're obligated to make sure people try to stabilize in the community and do not get re-hospitalized and that's a major growth we have. so i'll commit to the planning commission to the board of supervisors that we're going to work closely with them with the rate services we have in community. >> thank you. >> i wanted to briefly touch on the parking at cathedral hill. as part of the development agreement the amount of parking has been reduced. the previous project utilize the provision and the planning code that allows parking the rc 4 district to be right up to 150 percent of the minimum

requirement. it's a maximum of 990 spaces or 125 percent of the codes minimum requirement which ever is less. 990 spaces is the lesser of the two and this is 237 fewer spaces than the previous project. and i'll turn it back to ken. >> before we go on i want to say no less than four people texted me the answer to cagaya questions. >> it's three years up to 40,000 each and the other thing i want to point out, relative to the drt conversation, we need to say that the brt project is not approved and the schedule you were shown is the assumed schedule if it's approved on schedule, but we need to make sure people understand it's not approved yet. to continue on, i think

the topic that has the most conversation the last time we were in front of you, was the independent forcement of monitor and we want to talk on that. the new language -- sorry. i'm on the wrong slide. so we understand that the development agreement has a variety of obligations, that's for sure. the majority of those obligations are cash obligation and nobody is worried about monitoring those. you make sure the check is written and it's easy enforce that. some performance obligation requires more over sight. those are the health care ones and the work force ones and the traffic and transportation ones that you've heard about. we think that the city department as you've heard from barbara with the relevant expertise are well equipped, my department, the work force and the planning department, the dr requires an annual report as you heard from cpmc on compliance with all

obligations. with appropriate back up documentation and we wanted to highlight as a third party audit on the health care and that's in the health care exhibit to the da. the city attorney as you know can initial enforcement action if the director of planning or public find non compliance with the da and this has been asked and we con fermed that the board of supervisors under the city attorney to initiate an accident on whether the other part of the city does anything. moving forward we think it's not add advisable on any community groups but we do recognize a more robust process and enforcing the da and we're

proposing to make that process more robust which leads me and i'm sorry, there's one thing i wanted to mention because it's a fact buried in the da. material changes, so the da distinguishes between material and non material changes should the city ever want to make changes and the da hear sets a low threshold on what is a material change and specifically any change whatsoever to a community benefit, even if the undupe mri indicated patients goes from 20,000 is a change that needs to go to the board. it's going to be very minimal and minor things, actually have to come to the commission but not to the board. so there is no change to the da, whatsoever. that doesn't go to you and any material change even if it's a -- which is a pretty low

threshold as described in the da goes to you and the board. i wanted to put that out there. you have in front of you the text and proposed new language and i want to make sure the commissioners have it. section 8.2.2. there's a clean copy and a copy that's marked to show changes to the existing section 8.2.2. i'll paus if you need a minute to get it in front of you. so i want to go over what this does and this is the proposal that staff has for you to adopt much more monitoring procedures. this was negotiated over the last few years with cpmc and the mediator help us get back to this point and supervisors campos so all of those folks

signed off on this. section 8.2.21, the one we're proposing to change has a compliance report, exhibit f section b already requires the audit. so the things that cpmc has to do is set, so the rest is about what the city has to do that and that's section 8.8.2 and the five things this language does to change the old language and make it more robust are when the city receives the compliance report from cpmc and the third party review or audit of the baseline health care, that must be put on the department's website immediately. so that the public can review it. secondly nobody can do anything for 30 days after that material has been put on website, so the public can review and given an avenue to comment on those --

on whatever is on those documented and whether the public feels that cpmc has demonstrated compliance or not and it requires a city report which is basically the planning director and the health director in corporation with work force and mta primarily to the city reports back on whether cpmc is in compliance and evaluates the compliance report. that was required. what this does is make sure that city report covers a list of issues that you have in front of you that are the kind of key issues. so it requires that report to be complete and then the next thing that is different from what's in the current section is there was an optional hearing basically where you and or the health commission could hear compliance every year, and it's mandatory so the director of planning must bring this to you every year, it must bring it to the health commissioner every

year and there is the last piece is it establishes a third party monitoring who is identified as mr. drarado, and the way that would work, after the process is done and the commission hearings are done, it will forward to mr. drarado, the materials and report of public comment and the responsibility would be to write a letter to the board of supervisors to say i agree or disagree with the conclusions and the board of supervisors had the right to call a hearing and if they don't think that cpmc is in compliance, they can take action. this connects the board and to these proceedings to the board doesn't have to be watching and decide that they've got a prompt coming from mr. drarado saying this is okay or look at these. those

were added in as several more robust layers of public process and we think that those things cover the concerns and i would interested to hear from the commission if you think we covered the concerns around changes to the da which are -- must go through a public process, if they're anything more than a comma and the idea of enforcing and monitoring and making sure any member of the public can get access to the information that the city staff has and evaluate it and let you know through comments to staff and through public hearings which they think things are going the right way. i also want to know on another subject and i apologize. this did not get to you in advance but it's pretty simple and i'm going to go over it quickly. there's a

section 4.2.1 and it's something we're changing. i apologize. it's mislabeled on the slide. section 4.2.1. it's about the concept of delay payment. let me go over that. in the old da with the old hospitals there was a requirement for cpmc to open saint luke's no later than the same day it opened cathedral hill and that was an important part of the agreement. when we looked at resizing the hospitals and up sizing saint luke and down siding cathedral hill, the process going back to the state health -- i don't know what it stands for -- the process to go back to them because saint luke is a different building, it really is treated by the state as a new building and the state does a lot of new permitting, down

sizing cathedral hill is simpler because it has fewer floors so it doesn't take as long to get through the process. we took a look at the scheduling processing and we called in to general hospital who is far with construction schedules for hospital and we determine in general -- we determined that cpmc would need one to two years extra to get saint luke open and that seem like a fair request. we took those liquidated damages that used to occur at the day after cathedral hill opened and started 10,000 a day and go up to 25,000 a day. so basically there's a two year period after cathedral hill opens that they can still -- they're not in violation or in default of the agreement as long