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. >> good afternoon, commissioners. i am paul wormer and here today

to reflect the coalition to the neighborhoods. and first like to echo what roma guy has said. she has shortened my statement significantly. i am approaching this as an educated consumer of health care having dealt with aging parents and inlaws. this is manager that is absolutely need ed. i encourage this passing and certain things need to be reworked. i hear from the medical community that they have spoken and the fear that this is a five-year master plan and i don't think we're talking about that kind of a master plan here. i certainly don't see that in the language. but it's a great tactic. and i do want to comment on the

exemption request. the health care plan is not new. supervisor maxwell proposed that a while back and some legislation mraszed and assertion of the hospital and professional communities say we don't need this because we already know the informing. well, i have been trying to work with cpmc to ask them to understand why they are making the decisions or recommendations since 2002 and they have certainly not been able to provide any coherent information other than we're professionals, trust us. and unfortunately, as an educated consumer, professionals have a lot of good input and a lot of understanding and trusting them blindly leads them to a lot of trouble. i am encouraging you to support this legislation and look forward to seeing the continued

evolution in the process. thank you. >> good afternoon, commissioners. i am at st. francis and representing st. mary today as well. i'll have another hat i will share with you in a moment. i did want to commend the work of the supervisor with the stakeholders in the community and he has discovered and we have discovered with the providers and consumers and an incredibly complex issue. it took a year and a half to design health care reform and washington was a reason for that. health care is quite complex. we have had very local continuous learning process and amendments that effect that we haven't seen and is a little premature to recommend legislation that we haven't seen

in the full capacity yet. but one amendment i want to keep in mind is the drivers of health care reform were decreased cost and increased quality. we cannot afford any increase in health care cost and will drive ourselves out of business. and they broke rank early in the health care reform debate because we can't afford our own health care. that is true for the city employees and everyone. we have to find a way to drive down cost and we need to take that into consideration and develop a master plan process that is effective, efficient, fosters innovation, fosters collaboration, and drives down costs and increases quality and puts it in the hands of the consumer that knows it best. health care very complex. it does affect the other departments that we talked about trying to put this in the hand of the single department is not going to be helpful and we have

to think innovatively about how we look at health care in san francisco. and the other half i wanted to share with you is that i am with the community benefit partners in san francisco and we recently release released city vital sign with an electronic assessment of the health care of san francisco. we do know where emergency department visits are coming from. we know preventible emergency department visits are coming from and where ambulatory conditions are and diabetes and congestive heart failure is coming from and the economic sector that drives health care decisions and people's ability to get well. and we can put together as a community to do this. i ask the commission consider that we have an innovative health planning process that does not create an extensive document that is outdated before it is completed. we can do this with web-based tools that make that data available to all of us who need to make the decisions on a

regular basis. i am pleased with you to take a look at the website. this is just a sample of what we can do with the health master planning in san francisco. thank you. president miguel: thank you. joseph moore. kevin kitchener. >> good afternoonings commissioners. since the 1980's with the health services agent is, it has been an informal process and you have the imperfect proposals with the health department or the fairly other hearings with you guys and

i think it's time we provide a document that gives us the stability in the marketplace and that is why some of the criticisms about us to hold things up or make things inefficient, they seem so laughable and when you have to consider the source when you hear those. and quite honestly, that this provides that visibility in the marketplace and those corporate and provide the services in the marketplace so we can provide further access and create equity within health care. so urge you to approve this legislation. thank you. >> good afternoon, commissioners. i am here to support the

legislation and recognize the straf and that supervisor campos and staff have done. and to make remarks from a land perspective and what we're talking about with health care providers worried about to be more responsive to health care needs that they provide for the city which are important to get to the kind of triggers that would compel the city to provide consistency and you guys know that and you are the planning commission and you know that once the consistency determination is triggered, it is a project that will take at least a number of months and between from the time it is proposed to the land use basis and we are talking about development and professionals that have come up here in opposition coming from a health care perspective and obviously

trying to with the performance of the health care needs they see, and they see their own agencies responding in a nimble way, but once you get into the land use process, there is conditional use that triggers any kind of process and not a one or two week process. you are talking about the process that will take a number of months. and as kevin just said before me, to create predictability in that process for those who don't have tools and you remarked on that during the e.i.r. hearing and without being able to analyze the land use proposals that have been sent from the perspective and other ramifications. and you all have a housing element and have a general plan that does not address the issues we are talking about.

to understand the implications of the projects on a wholistic basis that impacts everybody in san francisco and make sure there is equity and access to health care with the plan that is in place for there to be predictability and to streamline the process. and the concept there needs to be an amendment and with the process that seems 180 degrees from the intent and with the legislation that is streamlined because you would have a tool to be able to evaluate the land use proposals. president miguel: thank you. >> good afternoon, commissioners. first of all, i want to thank you supervisor campos for the

job of the health care master plan. however, we have 1500 health care employees and workers and not 800 and we are talking about thousands and 90% of the health care employees work in the facilities and without the knowledge and input and the fast

track of the benefits and cost the employees actually working in those places day-to-day on those facilities will be particularly affected. and we want to have it put simply, my wife has worked with the designers to remodel a kitchen and my wife works 90% in the kitchen to cook. and those who actually work this those facilities and hospitals and long-term care and with the medical professionals and that will be a concern. we're not opposing the plan but we also are very concerned about the fact track to move on without the input.

and we do want to open it and want a say because we are the owners here. thank you, commission. president miguel: thank you. sue hester. >> in the 1970's, i was working on health care issue and zoning issues and i was on the comprehensive planning council and on the san francisco and regional health systems agency and was involved with others in drafting and getting through the institutional ordinances. san francisco at that time

operated under a federal planning commission at the health care system and because the planning department was faced with immense amounts of controversy of health care institution, huge. they decided it could be good to have input on health care institutions and thus, the institutional master plan which originally until it was drafted a couple of years ago were mandate when a hospital proposed the master plan, it was reviewed and when projects came through you have the input and i have sat there and was not on the panel, but sat through the entire evaluation at the facilities of children's

hospice. nancy walker was the supervisor and i was on the planning pod. and you had information that helps you sort through land use issues. that is still a need. and it is fortunate that they struggle with cpmc e.i.r. and the institution of the faster plan because the institutions with the comprehensive health care planning level are missing because no one cities back and says this is the city's needs. we need to have a steady wide frame work and not what is best for their