take that into consideration as you make your decision and ultimately where the health commission has made a finding of inconsistency, you may decide on balance the project could be approved. so i actually think that the point you make of something that's already embedded in this legislation. what we also, though, try to do is make sure that there is collaboration between the health department and the planning department because i don't think that the city can make wise policy choices if the two are operating in a vacuum. it's important that they work to inform both and that is what we're trying to do and if you have specific ways that that collaboration can be enhanced through this legislation and be open to that, that's why it was drafted the way it was drafted.

commissioner antonini: thank you, supervisor. and one follow-up on the threshhold. presently anything over 10,000 square feet has to have a ceqa determination and almost anything has some reason for conditional use and most of it does even at lower levels and i just don't understand why the square footage is lower for this than would be the case than what it presently is. >> sorry to interrupt. that threshhold was originally provided by planning and we are open to discussing what it should be. we are open to that discussion and certainly do not want to create inconsistency in how projects are treated, so we're open to that. thank you for that suggestion. president miguel: commissioner moore. commissioner moore: without preempting the suggestion, i would like to add the department of the environment and i believe that chemical and waste management is a very strong consideration which goes into land use but beyond it i would

also suggest that traffic and transportation are being asked because given the size of some of these facilities that requires really very, very strong coordination relative to parking and public access and emergency access, etc. and obviously emergency responsibility as an independent entity that i think should be very well involved given when it comes to the larger size facility. >> if i may, commissioner, and welcome to the suggestion and we had a meeting with the human services agency and and there are functions that would be impacted and we want the entire agencies to be involved. president miguel: thank you very much. >> thank you very much for your time and consideration and as the person in the audience said, go giants. president miguel: very good.

>> good afternoon, president miguel and members of the commission. the item before you is an ordinance that would require the creation and implementation of a health care services master plan. specifically as proposed to be amended, it would do the following. first, it would require the creation of the citywide health care services master plan within 12 months of the adoption of the ordinance. creation will be a joint effort between the department of public health or the designated consultants as planning department. the final master plan would be approved by the board of supervisors with recommendations from the planning and health commission. and second, it outlines the process for implementation of the health care services master plan once adopted. as proposed, any change of use to the medical use facility over 6,000 square feet of occupied floor area or any addition of more than 3,000 square feet would require a medical facility to file an evaluation to

determine whether the medical facility is consistent with the master plan. thirdly, the ordinance would apply to all applicable projects once the master plan was adopted. projects in that project would not be exempt from undergoing this consistency determination process. lastly, the ordinance would require the plan at the minimum of every three years. and as supervisor campos mentioned, our department has been working to make the ordinance more equitable and implementable with the focus on medical facilities with the following modification. first, increase the change of use size threshold to 10,000 growth square feet or an addition of 5,000 growth square feet. as commissioner antonini mentioned, 10,000 is the threshhold at the planning department for several other purposes including a more instant level of ceqa review and gross square footage

calculations are much simpler to make than occupied floor calculations. and a previous version of this ordinance charged an impact fee on medical service providers to go towards the development and upkeep of this plan. the department believes this is under the ordinance is plan is mandated to be updated ef three years that will be costly. even the smallest plan produced by the planning department costs several hundred thousand dollars to produce. further more, it is likely that the master plan would require the e.i.r. which could be double the budget creation needed for the plan. the department recommends that the ordinance include a funding source to cover the production and the funding cost of the plan with a surcharge on the medical facility or for other sufficient funds for those departments. third, the content of the health care services master plan. the ordinance currently includes very detailed language about the contents of the master plan and believes that the scope of the

master plan should be created in the separate process to discuss the content and layout rather than mandating the inclusion of certain areas. fourth, make d.p.h. and the department of public health is better equipped to determine whether or not newer and expanded medical uses is consistent with the health care master services plan. fifth, exempt pipeline projects. the planning department recommends you modify the ordinance so that projects who have already filed applications would not be subject to the consistency determination. only those with projects who file the further application on or after the adoption date of the master plan should be subject to this consistency determination process. and that you amend other sections that are crossreferenced to improve the of all itmplementation success. with these changes the

department would encourage approval. this concludes the presentation and i am happy to answer any questions about this ordinance. thank you. president miguel: thank you. i have a number of speaker cards. dr. mickey rocaich. ron smith. >> good afternoon. thank you for allowing me to speak here. my name is mickey rocaich and i am the president of the san francisco mental society. we are pleased to have the opportunity to offer this testimony on the campos ordinance to the san francisco planning commission. san francisco medical society was founded in 1868 in a nonprofit organization that unites and supports the local physician community and works to improve the health of all san francisco san francisco residents. we currently have over 1,100

members from a diverse cultural and ethnic base practicing in a variety of settings that include very large practices such as kaiser, medium group, solo, academia, public health, residents, and medical students. my testimony to you today would focus on the impact of the ordinance on san francisco physicians and consequently the patients. san francisco medical society is keenly aware of the disparities of health care access to the different neighborhoods in san francisco. we understand the desire of the city in creating a plan to identify the goals and gaps in the care of our residents. however, as the medical society we disagree on the method proposed by the campos ordinance. we propose developing a continually improving set of health care goals to address these disparities. the task of health care delivery and any major metro area is more

complex in comparison to other tasks of city government that fall under the purview of the planning departments. it is not appropriate or analogous to compare our services to those such as where city streets will be built, commercial or residential zoning located, proposed retail stores built, or where other freezing rain structure such as water mains or electric lines be constructed. one significant problem i see coming down the road is the accelerating speed of technological changes in our medical system and the creation of a new federal health care reform system. this will likely make any plan outdated by the time it is voted on. the campos ordinance limits choices by requiring any new medical facility. we are extremely concerned about the impact on quality of care that may occur should the planning commission be given authority over those type of

health care planning. primary care physicians will be of greater shortage area under health care reform. physicians are going to join accountable care organizations and will need to relocate in pods of medical offices. a logical location would be near a hospital such as st. mary's, st. francis, and the geographic requirements under the campos plans would place them miles away from hospitals. [bell ringing] >> and in no more locations. president miguel: thank you. >> and this will cause further access to those in san francisco. thank you. president miguel: thank you. >> thank you, commissioners. i am ron smith with the hospital and we represent all the hospitals in san francisco and are part of a coalition of long-term care facilities and medical society and mental

health and substance abuse treatment groups who are concerned about this ordinance. first, we want to applaud supervisor campos for proposing a master health care plan to identify goals and sets goals and identifies gaps. we're in favor of doing this. what our problem is is the process proposed in this ordinance which will hinder health care in the city, not help it. i think you were right when you said and supervisor campos said the decision to the health department and i can't tell you how important it is and the tremendous change happening in health care in the next five years. when managed care came to san francisco we had 22 hospitals. at the end of that, we were seven hospitals and that was a

small wave compared to the tsunami that is going to happen in health care in the next five years. what the federal government is going to do is going to say that everything is going to be run by the accountable health care organizations and what they're going to do is there's going to be one payment that covers medical care, hospital care, and physical places and everything is going to be different. and our knowledge, we just know that by the time any plan is done, it's going to be out of date. and it's going to have to be certified to a plan that is not going to work. communities, the federal government will be giving trillions of dollars to pilot program. the communities that will manage and help our city be a better place are those that are quick, nimble, and creative. they will be able ram the ideas and improve wit. the campos legislation as it is

written will only hinder that. i can't tell you -- let me just give one example of what our concern is. one of our greatest concerns is long-term care facilities. they care for 368 people outside the county because in fresno, modest modesto, and other place. i personally had to place my dear friend in peta luna, the nearest place i could find and having to replace the residence. we talked to those and they are not going pay fees in san francisco. so we support all your amendments but please let's protect -- president miguel: thank you.

>> good afternoon, commissioners. we want to thank you supervisor campos for the initiation of this legislation and the california nurses association is a big champion of health care for everybody regardless of ability to pay. and we need some of the effect of the health care reform that are a little bit overstated. one of the things that is likely to be with the international health care reform is people will have the health care whenever and wherever they need it. there may be other changes but national health care does not meet the need for health care planning. this legislation is not actually that radical. there are places all over the state where local government and counties are using land use to promote through using general plans for healthy communities

and bike lane and open spaces and there are a lot of plans in communities incorporated in health care services and city development requirements and there is some really interesting things in the city of richmond in this very area. they have done this in the past in san francisco and the city of san francisco should use all the policy pools available including land use to promote health care for everybody. it seems like that is a perfectly rational decision for the city to make. and this is a question that what it boils down to is do you believe the health care system should be left in the hands of the private enactors or for legislation that is public and we believe there is a rule. we have been through a number of information processes and when we have discussions and get studies and then they are still

able to say we want to do what we want to anyway. so this legislation creates a framework of accountability and talking about what the benefits are. demonstrated and for to meet the needs of the city and a reasonable requirement. just to give one example that the cpmc project is the biggest one to show case the legislation. we're not as concerned about whether it applies to cpmc because if it comes to it, everybody knows that it will not be land use based. there will be a health care discussion and one example, it affects the emergency rooms and the city has no data on where we need emergency rooms and where the emergency room visits are coming from and if you include homeless, 50% of the emergency room visits are coming from what cpmc identifies as the st. luke's service area where they are proposing to reduce services.

that would be useful information for the city to have to approve -- [bell ringing] president miguel: thank you. keith loring, randy whiter, emily lee. >> good afternoon, commissioners. go giants. my name is keith loring and i am an emergency physician in the city and worked at san francisco for over 15 years and st. mary's and i see things from a provider perspective and i think that what concerns -- i do have some concerns on the overall with the possibility of hamhocking the possibility to plan for health care in the city. i think as the arguments for or against whether we need a master plan, i think that is a very wise thing. how we structure that and how

that process goes forward, i think that is worth very careful thought because there is there where we are accelerating the change of the delivery of health care as mentioned by the commission here. and nowhere do you understand this more than on the front lines in the emergency departments of the city. we do take care of 50% of the homeless. and so any look at this legislation and i just want to make the comments brief and really needs to take a much broader look at purpose and goals and aim and not be so caught up in the details to drag us to slow down and increasing and rapidly changing delivery and payment for health care. thank you.

>> good afternoon, commissioners. i am the public affairs director for kaiser permanente and we do master planning for health care. we participated in the city's community needs assessment for many years along with the other hospitals. and the san francisco promotes the healthy san francisco programs very successfully and many community initiatives. how far, they are opposed to -- however, kaiser is opposed to the legislation as currently written because it will limit access to health care and causing the delay of construction and ultimately restricting the growth of health care facilities in san francisco. san francisco is already one of

the most costly cities in which to build a hospital and a rare project that would not be subject to this ordinance that could push health care service and the associated quality of life and benefits across the city line. the proposed legislation would seriously limit the entire medical community's ability to be nimble and continue providing services to these residents, including those already involved in healthy san francisco. the legislation consistent to determination involving the planning department would place undue weight on geography and wouldn't take into account the clinic needs. the success that integrating care and services in the medical setting which is a model that we have been developing for over 60 years. and also concerned about growing lack of skilled nursing facility as has already been mentioned and primary care services of the

city which within this community is very intervined and we are all dependent on. proposed legislation with the limitation of the growth of the services. currently this is already choosing not to expand in san francisco. and i would like to know how does this legislation with additional costs and review encourage more skilled nursing facilities in the city? to consider the legislation which would have a potential impact requires much more analysis which is not in place. this project has allowed all it needs to weigh in adequately in finding common ground and we believe there is a lot of common ground, but we're not there yet. we are fully supportive of moving forward in a collaborative way to develop the health care master plan. we also believe developing incentives for facilitating an expansion could be considered. and appreciate the consideration

in taking a thoughtful approach and encourage you to allow more for the community -- [bell ringing] thank you. president miguel: thank you. >> good afternoon, commissioners. i am emily lee with the chinese grass roots organization based in chinatown and we serve the chinese migrant working class families of the city. and we are here to stand in strong support of the health care master plan. we have been being supportive of it the whole time and supervisor campos has been working with the community and talking to many different professionals as well as folks on the ground that this concerns their lives. we believe that health care-related development of san francisco should meet the needs of san francisco and the pry

reads. and the health care master plan would identify gaps in services and in certain areas and make recommendations on how to promote distribution of service. and this is from of con kwens to all resident -- this is of consequence to all residents in san francisco. and many of the workers in san francisco do not get insurance from employers and are force to rely on a strong social safety net to see the doctor, get checkups and based on that research, we believe the master plan can better determine the other health needs of working class families in san francisco. and we don't think it's just a tool for residents and don't see why it can benefit that. the goal of the legislation is to encourage smart, equitable and effective health planning so in many ways it's directly as a health provider to give them recommendations on exactly what

san francisco wants to happen. and if the proposed develop clearly in mind, there is no reason why it should enter the process to go through the consistency determination with no objection. and we believe that the master plan includes the consistency determination in order for it to be an effective tool and without that component, the master plan is just another and can be ignored at will. we need to ensure that the public's interest is a priority. and we hope that it can be tool for providers as well as policy and residents. thank you. president miguel: mar coni province and roma guy.

>> good afternoon, commissioners. the principle with the plan and accountability of this nature and a policy driven process and i do have concerns about believe there may be unnecessary and unintended consequences from this plan if it is passed as is. and so we're trying to understand it more and i strongly believe and think there are a lot of efficient controls and many standards and regulations in place for compliance and for health care organizations and expanding and or moving with the process to be completed. still not really sure what this is going to assist us and there

is still about confusion of whether it was include and how we are impacted and to provide particular services and so certain services and not sure how the ordinance health or piece of this process to be more integrated. and in favor and agreement with the plan and in general in the era where we are trying to promote health care and seek services, messages from d.p.h. like open door and family access and any door is the right door, and this ordinance can provide in creating assisted health care and with the service delivery and with the health organizations and what door to create. and what door to have. and to open the door to the

public to serve our public's needs. thank you. >> good afternoon, commissioners, mr. president, and members. thank you for having this hearing today. and i want to approach this and even go further with supervisor campos' and -- president miguel: your name, please. >> i forgot. roma guy, former health care commissioner and supporter of this ordinance and have been involved in the process. i apologize for that part. and i want to say that i do believe you and supervisor campos have been very open and we need to work further for a

collaboration and not a hire hierarchy and to have other commissioners across the street with the proposal that has involved that data that we look at differently but need to look at together to come to some consensus about the health care needs of san francisco at least through the first phase of health care reform and maybe others. and so if not when, when? and when is around. and going on and i do think those who are so critical that this timing is inappropriate and we need to be nimble and do systemic planning that does allow for nimbleness, innovation, and creativity and to be open and accountable for

elected and appointed public policy people. and we have a history of weakness in that area. we have a lot of good health care and good health care collaborations as we started with healthy san francisco. for us i come from a commission background to have hope that they would look at anything is not the way to go. and if geography is a challenge, then let's see how that can be mitigated. and if there is a challenge, let's go for it, but 2010 is where it's at and now is now. thank you. president miguel: thank you.