suffering from a variety of problems. we currently don't have any way to build for r viable future. i am not complaining about taking care of these people, because they need more care than any other part of the population. we welcome people from bayview, we welcome people from the mission, but they are among the most pork and most socioeconomic -- they're among the most poor and most socioeconomicsally sensitive. i would also like to mention about st. luke's having a better survey. that is true. we did very well couple years ago, but i want to quote what one of the survey are said, saying that st. luke's is a jewel in needs to be invested in. i believe we need to build for the future.

if we continue to contract services to take service out of st. luke's instead of building a way to take care of patients and are sensitive neighborhoods, we're doomed to close and a short amount of time. i would also ask the commission to please look at what the blue ribbon commission suggested. i have not heard any mention of the plans for our other patients who number 40. any time they tell you they have 47, 57, 67 patients, automatically what is taken away is the subacute patients and a skilled nursing patients. i don't know what will happen to that very sensitive group of patients that basically have nowhere to go. thank you very much. >> hi, my name is jason.

i am a founding member of the coalition for planning san francisco. you notice a lot of people wearing a button. this is what the committee -- what the committee is looking at having. you listen to the committee for the alternatives. there are a few things that still need to be added. i know the land use attorneys are looking at submitting what it actually means, and i will leave it up to them because they can speak in the language that needs to be spoken to, but i encourage you to take that seriously. i encourage you to take a radical approach. that would be, there are discussions about the blaze. why don't we take the approach and do a full draft eir around that. at the same time you do what cpmc wants, to the eir.

that way if for some reason you decide there are too many variants engine cannot go forward or the board of supervisors says they are too wide, we have a backup plan, something the community wants and something that will work for cpmc. will it cost them money? sure, but they already make $250 million per year, said they're not hurting for money. they would continue to be a profitable organization even though they are nonprofit. let's look at doing a full eir on that approach, make sure -- the last thing any of us want to do is delay the hospital. we're not trying to stop hospitals altogether. we want our brothers and sisters in the building trade putting shovels and the ground and getting to work let's make sure that we do a smart approach, not something that says, guess what, the alternative is not going to

work, we cut back, and then we spent three years going to the process again. i have seen this process go through, and it took three years to get here. let's not waste another three years. let's do an approach that has something in mind for the community, and hopefully one of these days cpmc sutter health will wake up and understand this is what the committee will give them and this will be a good, viable option for them. one thing that always frustrates me when i hear somebody from cpmc say we only have 40 beds. remember, they used to have a higher census until they started pulling the service out of the hospital. he put the centers back in there, and there would be multiple centers of excellence and st. luke's. you build the beds and you would have what you need there. i would encourage you to do a multipronged approach.

we need this bill. thank you. president miguel: that is all the names i have on cards. it is there any further public comment? -- is there any further public comment? >> thank you. you have heard all of the issues and concerns tonight, and i guess at this point what is important is that the dialogue continued between cpmc and the neighborhoods and the various groups. that is the key to this. the people will make this hospital go, and it is very important. with working together, we can make this possible, because it is a great project. obviously for the city and county of san francisco, and we want that to move forward. we want a dialogue to continue between the various groups and

neighborhood and cpmc. with that, thank you very much, and go, giants. commissioner lee: president miguel: thank you. >> i also turned in a paper. he gave me a statement, and that was one of the papers i turned in. thank you. president miguel: is there further public comment? if not, public, disclosed. i would like to remind everyone here or listening to us that comments can be submitted until the close of business on october 19, either submitted to the planning department -- submitted to the planning department, and if you have material with you today, you can leave it with the commission secretary.

with that, commissioner antonini? commissioner antonini: just a few reflections on a long day of interest in comments. thank you for your input. i cannot help but believe that a new hospital at cathedral hill will not improve access for people in the area. it is a hospital for all of san francisco, of course, but it is very important that those close by have the advantage, and as everyone probably knows, in emergency situations, hospitals are obliged to take anyone in critical condition or with critical needs. i think with an area that has the highest concentration of children and people where that might be a consideration, more often than not, i think that is a big benefit. as is the case with any hospital, although you may receive your emergency care there for some care, you may end up, if hospitalization it is

necessary, at another facility, just as i have had keyser and i haven't occasion to have to go to the hospitals with family members -- and i have had occasion to have to go to other hospitals. i think it is a big advantage to have that hospital there. there are also a lot of concerns voiced about parking. in reading the deir, it appears parking is being increased at all the facilities that are part of the hospital, other than the one that is california, which is slated to be closed in the distant future. i think that is important because we have heard about the amount of traffic involved. it certainly while we encourage people to take public transit, realistically a lot of people will be driving to all of the hospitals and we need to be able to accommodate them. as i see being a kaiser member,

there are people who have limited mobility and you have to be able to drive right to the facility, even for outpatient services. that is an important consideration. [bell] commissioner antonini: i guess that is it. commissioner lee: commissioner antonini: -- [laughter] commissioner antonini: i guess that is it. i guess you look at the number of licensed beds relative to the present situation, you have an increased and outpatient services and square footage. i think that is really important because we are seeing a situation where people are living longer, being more active, to a greater age, and i think a lot of the problems we have in health care today are things that will not require hospitalization but will require outpatient services, particularly some of the problems that we see with some

of the diseases caused by obesity or diabetes or other things, substance problems. they will be treated on an outpatient basis, and hopefully we will keep them from having to be an acute hospital care. i think when you look at the entire system of hospitals throughout san francisco, which is what a lot of people asked us to do, and i think it is a port to look at the entire thing, i think we are adding a new hospital, the women's and children's hospital at mission bay, which was not mentioned, that is important separation in will provide services for people geographically on the east side of the city. we have seen additions to st. mary's. i think we have to look at the entire picture. there were a couple mentions of other things. the first, within the document, we talk about the school of nursing that now exists at st.

luke's, not part of the california pacific ownership, but the school of nursing. it may be why is to encourage their continuance -- it may be wise to encourage their continuance. many people who want to get into nursing are forced to go out of san francisco to get their training, and i think where we encourage that, it is beneficial. particulate at st. luke's, looking at the numbers, it looks like the outpatient square footage is going from 50,000 to 200,000. and a lot of ways, while the number of beds are fewer, there is a fourth time increase in the outpatient service -- for time increase in the operation service and medical office space, and that really benefits the neighborhood, in my mind, more than the number of hospital beds, assuming you meet the demand for those who need critical care.

let's see. a few other things. i think there was a question about the whole subacute issue and skilled nursing, and i was somebody -- i was happy that somebody came up and mentioned that. although the documents referred to a number in the 80's of skilled nursing, they were committed to 100, i think it was said, and i think it has to be worked out that whenever the need is is the need we should be able to meet in the system, but it does not mean if there are situations where one does not need to be hospitalized -- and is always a difficult situation because a patient may need hospitalization for a while and may be able to go home or go to a traditional convalescence -- convalescent facility, it has to be worked out. there needs to may be the intermediary care someplace to bridge that gap, and also work

with other facilities that have those available. with the subacute care, we talked about this the other time, i think it was said there are only three hospitals in the bay area, only one in san francisco, and that is six. i think somehow this responsibility has to be spread -- and that is at st. luke's. i think somehow this responsibility has to be spread among all the hospital groups, because it is a situation that is probably very costly and i think it should not only be st. luke's and cal pacific that has to do this. that has to be balanced, and that is where the city could get involved. i think it mentioned 15 out of 20 of the buildings are spc-1 or worse, which means they are in bad shape now, existing facilities, so it is important

those upgraded or replaced if necessary by 2015. and, let's see, a couple other things. there was not talk about the van ness special use district, and actually it is mentioned in the documents and it talks about situations where the commission has the ability to exempt the hospital from this requirement by either c.u. or establishment of what would be a van ness avenue at medical special use district. that might be something. i did the research and i have heard a number of facilities are not hospitals have been exempted and the past were given the modification such as the movie theaters, the amc theaters at 1000 van ness had a c.u. that

allow that to be converted. there is some housing, but not nearly the three-one ratio. there was the recent conversion of the building at van ness and california to a ford automobile dealership. i think the use for a hospital is one of the highest and best we can have, and certainly what we need housing, we have to look at this and figure out what will work, what makes sense, and can we afford it to work out? that is something we have to consider as we go through the process. because there is no guarantee, quite frankly, that the solder firm and cal pacific -- that the sutter firm and cal pacific have to build a hospital in san francisco. we're very lucky.

it could be built outside of the city. you talk about the number of jobs, 3000 full-time equivalent increase. that is a huge number of jobs provided by this. i think we have to make sure that what we make sure the project sponsor does what is correct and the eir is complete and everything is analyzed that we also be careful that we are weighing it against the benefits. those are the main things that i spot it in here. certainly, traffic is a big issue. i think that was really brought up very well by a number of speakers that made the point that people will cut through the tenderloin, and we have to figure out a way to route the traffic, even without the new hospital on cathedral hill, it is an area we have to look at because there are traffic problems already and there might be ways that can be dealt with a something that parking and

traffic will have to try to deal with. i also heard concerns from japantown and those sorts of things. finally, there is a little bit of mentioned about some kind of development agreement. hopefully, whatever needs to be done to ensure that whatever is promised is actually done, it should be done. there should be some ways that is worked out. so those are the things. we talked about the st. luke's situation, the dialysis, the skilled nursing, the intermediary facility. i thought it was a very good commentary and i am looking for two comments and responses and hearing more comments submitted in writing in the next, i believe, seven days? president miguel: october 19. commissioner antonini: okay, the

document said sometime in september. good, it was extended, very good. commissioner sugaya: i think commissioner antonini raised some interesting questions, which have been going through my mind also when he was talking about meeting would ever the need might be. and discussing things that might have to do with intermediate care that we are not too sure about. and i am not in the medical profession, so i don't know anything about subacute care and all that stuff, but mentioning something like that i think is what the commissioner was referring to. it just points out that this commission is ill-equipped to analyze the needs of this particular hospital. we have no community san francisco health care plan. we have no idea how subacute works in the city.

we have no idea how sickbeds work in the city. and now we're are being asked to look at these kinds of things in the context of an environmental impact report. the environmental impact report is extremely clumsy way to be able to get at these kinds of issues, because it is basically looking at physical activities and the manifestation of all of the programs and policies in a physical kind of context. at least that is the way that i see it. it is very difficult to get at the programmatic aspects of this through the eir. i know the long-range institutional master plan was presented to us, but even then it has no context either because we have no overall community health care plan. so trying to fit this into some kind of context is really difficult, at least for me.

i can comment, and will comment on very specific things. i believe distort resource evaluation -- historic resources of valuation is totally inadequate. i will tell the staff why i think it needs some work. and i think the issues that were raised with respect to the cathedral hill hospital proposal and transportation through the tender line -- -- through the tenderloin, i have only read a portion of the analysis, but there is a heavy use on van ness ave. just to repeat what everybody else said, if i am south of market, going north, i would never use van ness. that analysis, and i think staff

has notes on that. there are other areas that i think we should probably get some insightp0vfñ on. one thing i was wondering, which i will also put in my notes and comments, is whether or not other communities have a health care plan -- it is probably not required under state law, so why would anyone do one otherwise because nobody has money, but i am curious if other california cities have done such a thing. if they have done something like a health care plan for their community, how has it been used an integrated into any kind of environmental analysis on hospitals, either long-range plans for hospitals or for specific hospital facilities? that is all i have for now. i will have more comments before the 19th. i appreciate everybody coming out. it was not that long of a

hearing. we were paired for 9:00, i think. president miguel: -- we were prepared for 9:00, i think. president miguel: commissioner moore. commissioner moore: thank you. thank you for everybody and the community who came out. it is very difficult with so many moving pieces to respond to the comments of what the eir would have required, and i hope that our staff knows how to put it into questions and those kinds of answers, which need to be derived. i think there are many parts about this draft eir that are fine and right on. however, it is the magnitude of too many moving pieces, which makes it almost impossible to create a complete set of answers. commissioner sugaya just made

several comments, and i would say that the lack of a van ness plan is of concern to me. so is the inability to come to terms with the planning, including the original intent to convert or transform van ness ave and a more presidentially express grand boulevard -- residential the express grand boulevard of the city. that is not an expression against the building, per se. it is somewhat a contradiction. and smart growth facilities, there locally unacceptable land use. i think many of the comments today speak to that issue. i would easily say we are at 70%, 80% of people expressing

major concerns and a relatively small orchestrated number of people who i think we're well prompted to say what they need to say. i am sorry to put it that way. i am in principle not against a medical facility, but i believe it needs to be sized appropriate to where it is. if it is too big, it needs to be someplace else. i also believe is very difficult for this commission to fully evaluate the health care needs and the balanced health care needs and the 21st century changing health care field and make sure we are on target, doing what city's only do it every 50 or whatever years. i am very concerned that st. luke's, its location is a need from an economic and -- if

hospitals need to operate by have bottom line, then we need to make sure that what is provided in that hospital creates profitability for that to occur. together with the need to provide charity care at the larger rate, given the location where is. i am concerned that traffic analysis does not fully address the secondary ripple effects of alternative routing beyond what is described. i know for a fact that the effects of people needing to go to the new van ness cpmc facility will also affect all streets coming up from the freeway and from the south part of the city, coming up taylor,

mason, etc., which even now are alternative routes for people to move across the city, which as far as i am concerned, the level of service on van ness is what i would call impossible. given we have short blocks, i believe if cpmc is not putting a tunnel underneath a state highway, which is a very difficult thing to do and will not occur, given the short blocks that we are creating other impacts on people on foot moving across a rather difficult street, rather relevant to movement of traffic. i think the analysis does not adequately address this, and i think cpmc needs to either it disclosed that they are 90% on track with getting the tunnel or not.

i think after so many years of having considered the van ness avenue location, he should be closer to disclosing to everybody -- you should be closer to disclosing to everybody what is possible. we have equal major utilities below van ness that need to be disclosed, because what kind of tunnel, what level, etc., does that occur. i will leave it to that. i think there are a number of written comments that i will submit. i am not against a hospital, by a long shot, but it needs to be inbounds with a lot of other things. president miguel: commissioner olague? vice president olague: i apologize in advance, because i have a cold. i will try to get through this quickly.

i will also be submitting written comments for the staff. i guess the glaring omission for me was the fact that the van ness special use district was not presented in it any of the alternatives, really, or in the project itself. what i guess bothered me was the van ness sud housing requirements were ignored in the environmental impact report. i hear a lot of justic vacation for that being that, well, -- i hear a lot of justification for that being that we will be approving at the board and that we would somehow be accommodating of the conditional use, which is one of the options, i guess, as far as the the sud and housing on van ness

is concerned, but because that is not really conclusive, hypothetical, i think it is problematic. analysis of that is not provided in the environmental impact report. so there's no analysis in the housing department and how it complies with s.e.d. the affordable housing reductions were up to, i guess, 50% of the overall required 3-1 housing i believe is what's mandated by the s.u.d. so there isn't any calculation requirements of this project should s.u.d. not be adopted or a conditional use not be al