that and get health care. president chiu: thank you very much. next speaker, please. >> hello, supervisors. nato. i'd like to thank supe1 nato. i'd like to thank supervisor compose for your leadership on this and all of you for your -- campos and all of you for your leadership. the question is do we believe as a city that our health care system should be left to the trusting in the fate of all the private providers or do we believe that there's a role for public oversight and regulation and in the city of healthy san francisco, we believe as a city that there is. and the question is, what is it? this legislation is not -- is disappointing in that it's not as radical as some of the things that we pride ourselves on in san francisco, that make people on fox news upset. this goes back to programs that we had in place 20 and 30 years ago with the west bay health systems agency, lots of communities all over the

country are using the land use process in different forms, to promote access to health care. this is one version that works for our injuries dux. but it's consistent with a lot of that work that's happened all over the country.

>> if we look at our hospitals in san francisco, st. luke's is 100 year's old. children's hospital is 100

years old. when we do planning for health care, it's a really important kind of planning. and if there are facilities that are going to be providing service and determining service for the next 100 years, so it's important to have the best information we can to do this kind of planning. i don't think it's enough for people to simply take this under advice there. has to be some teeth in it. some regulatory compliance for the city of san francisco and for the developers on how health care is distributed. right now i can walk to seven hospitals.

personally in san francisco. but if i cross market, there's hospitals. personally in san francisco. but if i cross market, there's only two hospitals. san francisco general and st. luke's. which is going to be proposed to be significantly downsized. that's not an equitable distribution of health care. and a lot of our speakers are speaking about the shortage of health care in the southeastern neighborhoods. well the impact of creating a health care -- [inaudible] commue chiu thank you. next speaker, -- president chiu: thank you. next speaker, please. >> good afternoon, supervisors. ron smith of the hospital council. first we want to applaud supervisor campos for the whole concept of a health service -- health care service master plan. what we would like to propose to the supervisor and i would love to meet with you tomorrow morning or as soon as you can, is that we follow the suggestions of the planning commission and the health commission, that the health commission does the planning, the planning commission does the land use, that there is a

required determination process which is in the current legislation, we're proposing that that continue. and of course the board of supervisors have final decision over both the planning and the health care. and supervisor, we would loove to meet with you at your earlier convenience to look at that plan. we think there's a legal way to do it. president chiu: i think that we have been -- our door has been open from the very beginning and we have made met a number of times -- we have met nam of times. if we haven't met it's because you haven't sought to meet. >> you're absolutery right. we didn't come up. we didn't realize how this could be done until very recently and it's our fault, not yours. president chiu: next speaker, please. >> good evening, supervisors. rob black with the san francisco chamber of commerce. we do believe that there is a role in regards to planning or in regards to looking at a gap

analysis of where we need to incentivize future growth for services until the health care community in san francisco -- in the health care community in san francisco. however, we have very strong reservations about doing that in a regimented planning structure. we believe, especially given that we have just seen in this year a dramatic piece of legislation that has come through the united states in reforming our health care system. to put something that sets in stone, even historically in stone types of medical procedures, ways of delivering services, that will be changed and that we will be stuck in a plan that is three years out that we need to wait to go back to. deliveries of services will change dramatically. doctors will be probably going into pod there. will be a whole new structure about how medical services are provided, which this plan will be outdated before it even gets

started. so we have concerns about that. if you look at that as a gap analysis we don't think that will be the same case. there are roles and we've heard some tonight. access, cultural access, those sorts of things are important. but based on geography, most likely health services will not be delivered primarily around geography, especially for specialty services. we've done a very good job of using clinics in san francisco and we should continue to do that and build that out. but for specialty services, that's probably not going to be the model. it also doesn't look as regional care. san francisco is an economic driver around the medical industry. we bring people -- people come here for medical services. it doesn't talk about that at all. we need to be dealing with those issues. so we would love that this get -- [inaudible] so we have more time to discuss shoots with you. president chiu: thank you. next speaker, please. -- discuss the issues with you. president chiu: thank you. next speaker, please. we also have randy and abby.

and any member of the public who would like to speak. >> good evening. jerry crowly. i'm as tired as you are, sitting here all afternoon. and -- however i'm representing the neighborhood network and refer you back to three years ago, i think you would remember when there was an appeal at the board of supervisors involved in an institution and some plans in the triangle area. the board of supervisors sent the institution back to develop an institutional master plan. which in

as i sat here this afternoon thinking about health care services, i thought, why have we waited this long. we have great respect for your leadership. >> thank you. next speaker please. >> i am here to say kaiser permanent stasupports planning r health care.

kaiser permanente is opposed to this as it was written. we believe it will limit access to health care, causing delays. san francisco is already one of the top cities to build a hospital, and it could limit the ability to continue providing services to residents, including those in healthy san francisco that we care for. the determination from planning department would place an undue weight on geography.

the ordinance could push health- care services and their quality of life out of the city. we attract patients from all over northern california, which brings a concentration of medical services to the city and the quality paying jobs to the city would not have if we have smaller political centers. >> you have done a great job at hospitals.

since you do understand the importance of what we are saying, have you figured out -- are there things we can do? this only makes sense -- we are about to be the real medical hub of the west coast. we are very proud of that. we have to plan, because without planning, there is chaos. you need to help us figure out, so i need you to write it down and show mae how it is going to

have the affect and what we can do to change that. you will plan for years. we need to do the same thing. >> what we are asking is for more time. we would love to describe how this would best work. what i was describing is how the kaiser permanent model is based on integration of care, and that requires a medical center campus, and that is what has developed in the northern sector of the city. we need a certain level of scale, because the specialty services are part of a network of services. if you have an oncology

department, there are other functional -- >> if we do of planning exercise, people could understand. we do not understand, and we do not have a clear view. if we have a plan, it is clear to navigate the. we have to understand how to bring the best health care. >> we are definitely in support of planning. goo>> we do not have a lot of t.

we have things so we can get something done. >> i am also trying to understand how it is legislation that requires planning would get in the way of all the things you talked about. have you had specific changes you have incorporated through the hospital council? we have been getting feedback from them, and we have not seen anything specific. is there something specific but was not included. >> there is some alternative language. >> we are very much on the same

page in all this. thank you for your leadership. i think what we're trying to describe as a very complex planning process. it took 18 months to come up with the health bill for a reason. it is pretty complex. we need to table to figure this out forever. and we have not taken the time to sit down and the fine. there are several ideas as to how this could be done. i know our organization has many

individuals dedicated full time to doing strategic planning on an ongoing basis, because it is constantly changing. the challenge will be for our health department, who is accustomed for planning for 20% of the population to engage in private providers and how we can really looked at this. health care reform is asking us to do accountable care. we all do it a little differently, so the charge of how we are going to do everything from dental care to providing services is very complex. it is not like a board game where we are going to know all this in short order, because a lot of is going to change over time.

we are doing lots of outpatient care. to be able to put this together will take a concerted effort by a partnership of all private and public providers. >> i welcome those comments, but the frustration i have is that we have been talking to this industry and talking to people for at least six months, and we have been opened to change after change and getting specific language from them, so of some point we have to act, because the planning commission is being asked to take positions that have health care implications without the tools they need. note toolboxes going to be perfect, but at some point we have to take action.

it has been six months. >> the planning department past 1 through 5. that means they feel something needs to happen to them. we have got to be a model. >> i totally agree. i know some of the frustration comes from the health committee itself. one of the suggestions i have made most recently was related -- was looking at the charge they have. i understand the concerns the

planning department put forward. i have been in private health care for 30 years. we have to try to figure this out. there are opportunities to work together better. i know we are concerned it will drive up costs at the time we are being asked to drive down costs by increasing delays. i am not sure the supervisors fully appreciate the statewide planning process we have to go through >> if you were here you

heard us talking about the planning department.

maybe we can figure something out. that is what we are trying to do. >> next speaker please. >> my name is elizabeth. i want to say thank you for bringing of the health care issue and really listening to the people. planning is important but health care is an urgent need. i believe as a youth program manager who listens and here's the use gunmen -- the youth come in, that we support this, because we need to take the blindfold off the city process. the city does not have a

comprehensive understanding of our needs. the city cannot adjust investigates based on each particular need. we need a big picture approach. we believe the monster plan will provide the big picture approach by making recommendations. the decisions made impact the services we are able to receive. we have to make sure the families you serve will hold of voice in the process. >> next speaker please.

>> i want to thank you for taking the time to listen to public testimony i am here to support the master plan. health care is one of the top priorities. many are not insured by their employers and depend on the safety net to stay healthy. they can determine what are the health care needs. they should also prioritize the need of san franciscans. currently they are drawn to specialized care to be competitive on a regional, international, and national basis. it places an increased burden on the department of health. thank you for your time. >> next speaker please.

>> i am with the chinese grants student association, and we work with a lot of community residents in the southeast. one impact of not having a master plan is that in the southeast where the members bear the biggest brunt of pollution from the freeways, whether the community has the highest asthma rate, the highest hospitalization, there is also the least access to health care resources. that is part of not having the tools for your -- having the

tools. everyone supports the plan, but not everyone wants to go along with it. and when i hear the planning processes could but the determination is bad, i hear that it is great to have something on important new -- on paper, but it is not important. it is not necessary for institutions to go along with the. i have a problem, because we need to hold health care development responsible for providing health care to an entire community. i think it is important that we continue to move ahead with the process.

the industry could have been provided -- involved as well. >> good evening. >> we have been working for many months, but we have been working on this issue for many years. they are facing the brunt of health disparities and air pollution in that area. it is not anything new, but the fact there is an objection now to start planning is outrageous.

there have been many opportunities to way in on the process. a lot of amendments have been changed. they have been nothing but flexible and have helped the community. we wanted to restate that the process has been very good. there have been many opportunities to weigh in on this, to have testimony taken into account this is an urgent issue, and i believe they need to weigh in on it. we need to have a plan by the

time national health care starts to come down. we do not have -- need to have anything shoved down our throats. hopefully you do not delay this plan, because it is sorely needed. >> i am with the coalition. i want to read a statement from our staff person. she coordinates for the housing developments throughout the city. she says the health care- related developments should be based on the needs of all residents. residents need health care. it is important in addressing the needs of all san franciscans.