not served that well. clearly not served that well. we have to deal with the real work. that is up with of the thicks you get from the city having its own plan and not saying here is my institution. thank you. >> thank you. i represent san francisco tomorrow and we very much want san francisco to succeed and i also insist that the master plan and the acute care disaster must

be addressed now. there is existing criteria and need to make it happen in the short term. so there it was and institutions are in the pipeline today to bed a asked to make prior commitments regarding that operation and to deal with the immediacies with the public and private institutions together to make that decision. secondly, it's been alleged that health institutions and federal legislation and the act that you referred to earlier and with the regions and not a monopoly and

therefore, let's deal with public services including land. and finally i take some umbrage with whether the planning department is the proper agency as it's now to deal with this provision. thank you. president miguel: thank you. is there further public comment on this item? >> neighborhood networks and we want to speak strongly in support of the legislation. and in addition to the amendments in the pipeline. we first started with the proposed institutional master plan in 2005 and with the survey

of future hospitals in san francisco and of the nine hospitals in san francisco, seven of them are within a walkiwal walking distance and on the other side of the market street in the southern part of the city, there's only two hospitals. san francisco general and st. luke's. so if we are looking at a developer to sponsor the institutional plans and the business plan for the health care institution, using that point of view saying we have two sites and we could build a large hospital with the small hospital and that would seem to make sense. and two large hospitals and other hospitals and it would be more equitable, but instead, it was proposed by the institution.

and the reason is health care institutions are competing for quality health care dollars. there is a competition for all the major hospitals in san francisco to seek out the highly insured, more well-to-do patient. and when we ask the health care institutions to voluntarily comply with the health care plan, that means all the hospitals are in one place and no health care in other parts of the city and has to be a compliance for us to have health care planning and equitable geographically and for the business needs in san francisco. president miguel: thank you. is there further public comment on this item? if not, public comment is closed. we thank you, supervisor campos, for coming. and i also want to let people

know that i appreciated your quoting me and we did not get together on this. actually, i don't think i even discussed the master plan with you prior to comment. i have a couple of comments first and i may have more later. one is you have a situation that i don't think the public is aware of with the veterans administration has issued it institutional plan and is embarking on the e.i.f. and there are basically alternatives that are mentioned and one is staying at this campus totally. and the other is splitting the campus and putting at least half

of the operations somewhere else in the city and the third is abandons the campus and putting the whole thing somewhere else and being a federal institution we have no control over them whatsoever. and i think they are looking at mission bay, but i'm not sure. so there are institutions around that we don't have control over and that goes the same obviously with what you ucfs and so those, what they end up doing will impact the plan. and the only other thing to comment on is i am looking at i think was mentioned by staff that this will take an e.i.r. and taking a look at the large e.i.r.'s that have been done by the department in recent times,

all together possible that that will be challenged and appealed and may end up actually having legal action taken against it. and we have the concept in my mind with an overall sign. and just judging from the large studies we have seen before. the comment from the department as to funding has to be a very serious consideration with everything we do in this regard. >> thank you again. and thank you to the members of the public for their comments. i think that we will learn something and everything that was brought forward and we have

thought very carefully about this issue and in the original pbl when we first drafted the legislation, we were thinking about creating a fee that would be applied to the institutions and after discussions with a number of individuals including the advice of the health care for the city we decided not to include that because we heard a number of concerns about the financial impact that would have and we wanted to be as responsive to the concerns as possible and we felt the moment you went down that road, you created that possibility. and the suggestion that makes sense is in developing this we have to have that conversation and staff discussion and this cannot be a nonfunded avenue and

you have my commitment to make sure that is the case as we are talking about what the budgets for each department looks like and i think it's an important consideration but there is a reason we purposely did not include a fee. and the fee is also something we believe can be revisit ed if it can be addressed through the budget process and we wanted to avoid the charges that would come with adding that service. president miguel: and i don't know about where the money comes from. thank you. >> thank you. >> there's a lot of questions. commissioner olague.

vice president olague: i want to thank you supervisor campos for for the level where there has been a lot of frustrations and we don't feel we have the appropriate tools to determine the value of health institutions and represent to the city. and as someone mentioned, they were making the decisions in a vacuum and it is critical that you mention the citigroups getting together for what the need of the citizen of the city are with that discussion as opposed to the corporate model which seems to me that this is making it away from the value on

health care. and we start to get into considerations about emergency rooms and those type of issues and it didn't always feel that was necessarily what was driving the conversation. it is not a singular issue that should be based on an isolated, singular land use. it is something that is koch i will -- it is something that is complicated and these are the issues that have been raised and when we looked at some of the challenges that we soefshed and looking at the issue of

preservation recently the main thing that seems to be coming up there is the reservation doesn't consider other issues. and the purpose of the planning commission is to be responsible to make this decision. and we can't be making those decisions responsibly if you are not provided with the necessary tools and the necessary information that will allow us to engage in these type of conversations and analysis that we should bring. other wise it seems that we are just making these decisions not irresponsibly but there are more things we need to be looking at than a business model or whatever is driven by the fact the institution has to look t an and everything is driven by

these factors stin ode of the health needs of the city. when i see this, and i don't think this legislation is mandating anything. it's mandating more analysis and more information and more dialogue and the issue of health in the city. it is always interesting to me when there is a lot of hysteria around an issue because this isn't concluding anything other than we need to talk to each other more and need to be looking at more analysis and when we make decision about how we will do certain institutions or land use. i don't think that's asking too much or asking anything revolutionary here. and is to nonrevolutionary that the tools in place before 1980 and what are we saying? that in 2010 we're doing

something that's so unheard of? i don't think so. we may be going back in time. i think this is long overdue and in the convictions that the supervisor was quoting commissioner sugaya and supervisor sugaya and commissioner miguel, and i think we've all kind of developed that kind of frustration up here. we're ill equipped and we need more and we should be basing the decisions on the comprehensive look at what the health care needs of the city are. and that should be really what is driving everything to land use and health care planning. and i know some of the amendments were one that were raised at the health commission and i am open to some of those. and i believe you spoke with ms. watson and i was concerned to know what the health commission

has to say about that stuff and i believe they thought it might have a negative impact on the clinics and the aids clinics and the smaller uses and would make those type of uses go through certain hoops that may actually be detrimental to the city ultimately. and i think that for the most part some of the staff recommendations i am pretty okay with. i didn't know there was a concern about cost. that is stuff we have time to work on. it's not like we are at the end of the discussion yet. i think at the end of the day i actually support the idea of exempting any pipeline or project and with why this

started and was given by that they were making decisions and the institution attica theed ral hill -- at cathedral hill and st. luke's and because of this gigantic and at the time it wasn't introduce d. and with the tools that we would like to see in place to make sound decisions as it relates to the institution.

and to have this get into the entitlement discussions around that project. and may not be like ly that we included these and apply it to others and won't see a project that significant in years. i think if anything we need to try to get this moving in time for that conversation. and some. o'er others who have been working on it for a long time. and it's great timing. and with the projects in the

next few months. >> and i want to express the belief that this presentation made it more meaningful and there is a source to make me confident that this will proceed together with the suggestions with a lot more to be discussed and that is where the effort lies. and i believe we are in support of other tools and i believe that working with policies, goals, and controls and programs that allow us to look more rationally at future decision making will be exactly what we need. i think we are noo n a time that will be only 20 or 30 years or longer and these are all

long-term buildings which have life cycles that go beyond the normal decisions we are making that will affect the residents. and i just would like to suggest this staff that we don't make decisions too quickly and i am in full support of some of the discussions and would like to see work on those including the reflection and with what people are talking about and on the other hand, i am not in support at this moment of a pipeline project that would be exempt. i really cannot support and for the particular reason that other institutions i understand that you are supporting it, but i

respectfully disagree with you and appreciate that we get the support on opening the door. and i believe that requires further examination and particularly the history of new health care buildings in the city is far and few between. and on pine street at franklin hospital, not much new has happened for many, many years. and i would support the department to continue to work with the supervisor. president miguel: commissioner antonini. commissioner antonini: thank you f i do support the fabrication

of the health care services master plan as an advisory document that we could use to evaluate land use issues that come before us regarding health care facilities. and one thing we have to be aware of is the regional nature and for other institutions here and attract patients from throughout northern california and beyond and i can talk from personal experience where i came to san francisco for care as a young boy and came for many other issues and that exist today. and it is particularly true with ucsf and catholic health care institution and kaiser. and in fact, being a kaiser member, it's regionalized. and if you have neurological needs, you go to one place.

and if the administration is in oakland and if a lot of deliveries are in san francisco or sacramento and that is how the whole thing works and anything we do when we make these recommendation we have to realize these institutions are large institutions and the needs are pred predicated to a population that goes beyond san francisco and that is to our benefit. these are not necessarily married to san francisco, either. there is no reason why they can't pull up stakes and go somewhere else if the needs are being better served somewhere else. we have to be careful we fabricate our policies in regards to the larger communities they serve and beyond. so that is when we do anything and we have to look at this document and when it is completed as a point that we can use in our evaluation but not as

a litmus test to what is good and what is bad. these are hospitals with regional scope. i don't have a problem wit and should be paid for without existing funding and maybe from the public health department. and certainly not passed on to those being evaluated by those and we would like to see that. and as far as the individual aspects of it, i do agree with the staff recommendation and the pipeline and i don't know if you can do that kind of business and a lot of times it's many projects and if we made a recommendation that the placed be located there and the project

sponsors know there and this is what we like to see. i think we have excellent health in san francisco and from the place i come from, i do not plan to be served there. and we have a lot of hospitals and a small geographic area and not that we couldn't improve that but we have to remember that the larger scope of the

health care problem and real hospitals and different entities and while we have total control over the former, the needs of the latter have other concerns other than just our public health needs. so this is good to know them but not a deciding factor. i would be supportive of staff but not the legislation as written. that would be my position. president miguel: commissioner borden. commissioner borden: and not too long ago we lamented looking at the institutional master plans with no basis for which to judge them that is a way to look at the institutional master plan

and just like what we do with our general plan. we are able to look at those and compare how that project compares and contrasts and does or doesn't meet the elements. i was a little surprised by the reaction by members of the medical community because i don't see anything being mandated in this legislation. it even states with inconsistency you can come forward and there is nowhere in the document and i like the idea with additional use and that is necessary or desirable which is very difficult determination in most projects, quite frankly, and what is ne or desirable is different and subjective and if there is something nice about having a playing field where people know what is in our citywide health master plan and

i did think that commissioner antonini brought up an interesting point and supervisor campos to talk and look at how it would be great to get a hands on the regional distribution of met cal service with the conglomerates and how they distribute their health care. >> i do have to be on a pan nell about 10 minutes, so i'll have to run, so i apologize, but that we will be more effective in terms of the regional involvement if we have a better sense of what our needs are and that is something like this would truly promote that level of regional planning. >> thank you very much for your time. actually, another thing talked

about with master plan so we can include and take time to put that information in. and a lot of the concerns that the public has raised can be helpful and the faster plan and i think that our goal is to say that you can only provide hospitals within a radius and we love to have everybody neighborhood to have medical facilities sand not realistic there with a full-scale hospital and the hysteria of things in a certain geographic area and we would haven't that discretion to say there's a vacant lot here, let's put it there. that is not what could happen. and we can figure out what the

goal should be and we have geographic equity and looking at the connections and things that make sense so that it is realistic of what is possible and what we are concerned about. >> and with the legislation and i think the issue about the pipeline and personally i don't think we're going to have that done in time for that and i don't think it's a real threat to the projects that are coming up in the next year. and i don't think that is something we need to address. >> thank you. >> and pretty much agree with most everything o the other commissioners thee