rationale being that it's appropriate to locate your most intense development close to services, very close to some of the best transit on the west coast, within relatively small, discrete area, really maximizing infrastructure, trying to minimize regional sprawl and the like. so this is very much envisioned in the zoning, very much enables the type of office and high intensity residential development that you see. commissioner maxwell: when you say high intensity residential, what do you mean? >> higher density, taller office towers, mixed with, you know, higher intensity residential towers -- density residential towers. sort of the development of a complete neighborhood but very much again a recognition of the fact that office development is really going to be focused within the downtown core. commissioner maxwell: thank you. then without objection on items

four and five. so moved. thank you. all right. item number six. would you read that, please? >> item number six. ordinance amending the planning code from preparation of a health care services master plan. commissioner maxwell: well, we will continue this item for a week. but i believe the supervisor intends to join us and those of you who would like to comment may and those of you who would like to come back, you may come back and comment as well. yes. i was trying to wait for david. yeah. you can.

i was waiting for the sponsor. i was giving him an opportunity to come here and comment. there's a door opening right there. thank you for joining us. i just mentioned that we will continue this item for a week. however we are going to have public comment and we will probably have public comment again next week. >> thank you, madam chair. thank you for giving me the opportunity to address the land use committee. we actually have a number of members of the community who have been waiting for quite some time and i would begin my presentation by asking you to re-assess your decision to continue this item because quite frankly this is an item that has been before the board and before the citi government

for quite some time. and we have been working on it for a few months and to the extent that a continuance was something we were open to, it was with the understanding at the time that given the nature and some of the amendments that may be procedurally a continuance was required, but we understand from the city attorney's office that in fact it is not the case. so with that said, i'd like to -- first of all, i know that there are members of the audience who might be in the other room, if they could come here so that we can see their faces, but i'd like to begin by thanking the co-sponsors of this legislation, my colleagues on the board of supervisors, beginning with superviser eric mar who i know had to leave. supervisor maxwell, superviser mirkarimi, president david chiu and superviser chris daly. this is a piece of legislation that we introduced a couple of

months ago and in fact it's something that we've been working on for a few months now. and i can tell you, having worked on a number of pieces of legislation, that -- i think that the way that we have approached the drafting of this legislation is unprecedented in terms of a level of inclusiveness that we had, with respect to the different players. not only within this city government but also within the industry and within the community. from the very beginning we have indicated that because of the complexity of the issues that are involved, we are open to suggestions and i in fact have made a number of changes along the way based on the input of a number of individuals, beginning with the health director, but also the department of planning, the public health department and a number of stakeholders. this legislation came to be because of the work of a number of community organizations and community leaders who have,

from the very beginning of looking at this issue, expressed a need for better planning on the part of the city. if i may, without belaboring the point, because i know we have a game that we all want to watch, i'd like to identify those individuals who aren't here. the neighborhood center, the chinese progressive association, and i know wheeve a number of seniors and young people who had to leave, who have been waiting here for a number of hours, who wanted to come here and express the need to move quickly on this legislation. the california nurses association, the cathedral hill neighbors, community housing partnership, and others that are also a part of the coalition for health planning. in terms of why this legislation is needed, i don't want to belabor what has been said before, when it was first introduced at the board, there's been a lot of work around health care planning that has been done by

individuals like the chairwoman, superviser maxwell, who has done a lot of great work on this. we have also assembly member tom and from our perspective we believe that this adds to that work and it builds upon what has already been accomplished. and the reason is that right now there is no mechanism in place as we're being asked to make decisions and to land use context for taking into consideration the health care implications of some of those projects. and if i may, i just want to echo actually, point out some comment wes heard from the planning commission, which is the one that's being asked to decide on some of these project -- projects. thank you. it's being zod decide on these projects. this is commissioner sugaya saying it's ill-equipped to analyze the need of this particular project.

we have no community san francisco health care plan. we have no idea in this particular case of how it works in the city. president miguel notes, although san francisco has put into affect healthy san francisco, from my reports that i've had, it's starting to workworks we've failed miserably. the city of san francisco has failed to address the health distribution and the city. basically a health care master plan. my experience, even though i have repeatedly said that this legislation transcends an individual project, my experience is that when it comes to health care planning, that people that are usually left out are the people that probably have the greatest need. and we certainly is seen that throughout the city. and we see by the representation of who's here that that impact is the case. it is districts like district nine, like district 11, like district 10, like district three, where that kind of planning has not fully and

appropriately addressed the needs of those communities. and that's why these folks are here. i also want to point out that there was -- in the course of this process, there have been a number of things that have been said and manl a number of things that will be said about this legislation and know that a number of meetings have been had and you have a letter that's dated october 29, 2010, from the hospital council of northern and central california and think that -- i think that even though i have a lot of respect for the individuals who represent the council and who have been working with us, i am quite disappointed with the content of the letter because i do think that it provides a lot of misinformation. and i think it's important to set the record straight. the notion that somehow we scheduled this hearing on november 1 so that we could minimize public input to make sure that it happened when people were not paying attention is something that

quite frankly i think that -- i think it's beneath the council to make that assertion. we have followed this legislative process in an open, transparent and inclusive way. and we have met repeatedly with them and we have actually taken a lot of their input and a lot of the changes that we have made are a reflection of the our real interest in making sure their deserve kerns are addressed as much as possible. the notion that somehow -- concerns are addressed as much as possible. the notion that somehow this will prevent existing hospitals from where he building or expanding is something that i think completely misinforms the public about the substance of this legislation. to the contrary, by creating a health services master plan, it is our intent to actually expedite these projects. because right now these projects, as the planning commission indicated, are being viewed as, being looked at in a

vam aum. there is no way to know for sure if an individual project is actually consistent with the needs of the city. if a master plan outlines what those needs are, that creates a road map that these institutions can follow to more expeditiously get their projects approved. it's actually something that will have the opposite affect -- effect. likewise, there's a notion that somehow the alignment of responsibilities is misguided, this in terms of the agencies that are involved, from the beginning what this legislation has tried to do is create better communication between the planning department and the health department. something that unfortunately has not happened to the level that is needed and that is what this legislation does. it provided a structure within the planning context, which is legally where we have the authority to take action, but it does so in way that incorporates the advice and expertise of the health department. and so i know that the hospital

council has a specific role to play. they represent more than 185 hospitals and their goal as stated in their website is to represent the best interests of their members. we recognize that and respect that. what our job is to represent the best interests of san franciscans and to the extent that those interests are alined with the interests of the members, we will be on the same page. but where those interests of those members are not protecting the interests of san francisco ans, we have a responsibility -- san franciscans, we have a responsibility to too what we were elected to do, which is to make sure that all san frans a -- san franciscans have access to health care. the final point i will make is that, and i will hand out this -- a revised version of the legislation, actually, some copies, and i know that there are copies that will be made available to members of the public, that incorporates a

number of changes that are actually made in response to some of the issues that have come up. in this long legislative practice that has included a number of hearings at the planning commission and at the health commission. the first change that i would simply briefly high slight that on pages -- on page -- highlight is that on pages four, the definition of medical institution has been replaced with the definition of medical use, to mirror essentially -- when it exists in a planning code, there are other changes on pages seven and nine that make that change, to make that consistent. and then there are some specific changes that are made in response to some suggestions from the planning department. and we want to make sure that we highlight those to make sure that people know that we were listening to what the planning

commission was saying. one of the things that came up was the need to increase the threshold that triggers when this legislation is applied to a specific project and we have made in this amended version the change and changed the threshold from 6,000 occupied square feet to 10,000 gross square feet which is what the planning department recommended. we also heard that they had a concern about being too specific about what was included in the master plan, which is why we were trying to balance that concern with the need to make sure that certain components were included, by adding language that essentially provides flexibility so that whatever is required is done to the extent feasible, to give that flexibility to the planning department and the other point that came up was the issue of

who has the final say about the consistency determination. that has to be with the planning department. however we agree, as i've previously noted, that the health department should have -- it must have a role in the consistency determination. it is for that reason that for any applications that appear to be on their face consistent with the needs of the city, with the health care needs of the city, it would be consultation with the health department, which we believe is important. and i know that there has been discussion about how long it's going to take to finalize this plan and, you know, if there's a need to go beyond the 12 months that is currently pried for by the legislation -- prescribed for by the legislation, the legislation allows the agency to seek an extension, to make sure that you have the flexibility to do that. so with that i will conclude my

remarks and simply say that we believe that we have been as transparent and as inclusive as we can be, as anyone can be in this process. we feel that it's time to move forward. we have a number of community members who have been waiting for this action to happen for quite some time. and i hope that the committee acts as quickly as possible. thank you very much. for your time. commissioner maxwell: ok. thank you for being here. comments? >> thank you. john ram with the planning department. i want to thank superviser campos for working with my staff on this issue. this is an important piece of legislation. i will reiterate what the superviser said about the planning commission's concerns about their decision making process for medical uses.

they have very frequently commented that they feel they are making these decisions outside of a real context for planning for med kayecal care in the city -- medical care in the city. with that the planning commission did indeed vote to recommend approval of this legislation. and did so with four recommended changes. now i will also say that the supervisor, i think, as he has said, has tried to address many of these changes. but just to tell you what those were, i will just run over those quickly. one recommend -- recommended change was that, and this is clearly what the supervisor was just talking about, is who reviews projects for consistency with the proposed master plan? because of the nature of the plan, which is largely around medical care. we were hoping there was a way legally to have the department of public health be in the lead on that, to make that recommendation to the planning commission and to the department. i would hope there would still

be a way to do. that i totally understand the legal advice that the supervisor mentioned. but we're hoping that there is a way that the health department can make that determination and make that recommendation to us. commissioner maxwell: right now it would rest with you. >> with the planning department, that's correct. the second issue was also referenced by the supervisor which was the level of detail about the contents of the plan that were in the legislation. our hope was to frankly have less detail in the legislation and we had recommended a process whereby we established the contents in more detail through a process. it's not dissimilar to what we do when we start a neighborhood process. we sit down and say, what should the scope be of that project? of that process? and so, our recommendation and the planning commission's recommendation have been -- have less detail in the legislation and developed that detail as we start the planning process. the third issue had to do with the actual cost of preparing this plan, the subsequent

e.i.r. that would probably be required. although whether it's an e.i.r. or not would rely on the spess ity of the plan. i think i'd be happy to work with him. commissioner maxwell: the more detail it is, the more it triggers something else? if it's less detailed -- >> that's correct. because of the nature of an e.i.r. and what it would -- it all depends on what the plan would cover to understand what level of environmental review is needed. having said that, we know from recent history with the bicycle plan and the housing development that those types of broad citywide plans are rising to the level of requiring a full e.i.r. and there is a fairly substantial cost associated with that. commissioner maxwell: as well. ok. >> and the final issue is a fairly minor technical point -- commissioner maxwell: getting back to that, what are you saying, it doesn't matter? if it's detailed it's

expensive, if it's broad it's extensive -- it's expense snve >> part of it is about the regulatory requirement. commissioner maxwell: wlts broad or specific. >> correct. and then finally the final issue is simply a detailed issue on the language and the plan relative to cross referencing sections of the code. we hope we can work on those details with you in the next few days. >> thank you. i forgot to highlight one very, very important amendment that we're also included in here. it was something that we believe has been imbedded in the legislation all along. but we recognize that there is a historical role that certain institutions have played in terms of providing or addressing the health care needs of different communities. and if you look at line six, i'm sorry, page six, line 17, to 20, we actually have language to thank clarifies that the health care services master plan should consider the historical role that different medical uses have played in

particular neighborhoods. and the term use is the language that is being used because that's consistent with how health practitioners describe this. but it's essentially the role that certain institutions have played, especially in historically underserved groups. commissioner maxwell: will you give me an example? >> the example that i would say, for instance, there are two examples. we believe that in considering crafting the health care services master plan, we would need to take into consideration that institutions like the -- that chinese hospital has provided to certain services to the chinese immigrant population in chinetown, for instance, for quite some time, that it would also take into account the role that st. francis has played in terms of serving low income communities. so we believe from talking to health experts such as doctor

the doctor that this legislation -- language allows for that role that these institutions have played in these communities in deciding what the needs of the city are and deciding whether or not any specific project is consistent with those needs. and so i just wanted to make sure that we highlight that because i think that's a very important consideration as we're trying to think about what this master plan looks like. president chiu: i want to thank you for including that language around the assessment. you happened to name two hospitals that are in my district. could you talk for a moment about how this language will be balanced? obviously there are a number of different assessments. you're saying that this is going to be one of the factors that's included in this. but there's really no -- what's the mechanism by which planning or the health department would

balance various ainsurgent sessments and the various competing needs? >> i think that's one of a couple of things. first of all, president chiu, we are -- we continue and remain open in terms of finalizing this language or including any additional language that you or any superviser think would be necessary to address any specific concern. about individual projects. the way that legislation is drafted, you actually cannot expressly identify a project, but we recognize that there is a group of institutions that we are concerned about, that we want to make sure that we account for the very unique role that they have played. i think a lot of it is in the devil's in the detail, if you will, in terms of what this house master plan service looks like. i've had this conversation with drt a number of times and there has been concern expressed by the planning department in terms of their ability to make these determinations. but the way that the master plan is envisioned is not that

the planning department would actually engage as they're reviewing individual projects, engage in the actual health care analysis, but that in fact the plan would provide that road map as to what the priorities are as individual projects come before planning. we recognize that planning will not have that thank expertise, but it really comes down -- that expertise, but it comes down to what the plan says. commissioner maxwell: you're saying that the analysis would have already been done? and what they would do is look at the analysis based on it having been done already. >> right. the example is, for instance, there may be an effort, for instance, to open a clinic where there is primary care physicians. right? the doctor will point out that give that we need primary care physicians everywhere in this city, such a project, irrespective of where it came, would probably go through an expedited consistency determination. because on its face you would look at a master plan that tells you, we do need primary

care physicians, so planning itself would not necessarily know that that's the case, but they will have a master plan that will tell them, yes, you know, this is something that we need and therefore you go through an expedited consistency determination and so that's one example. the same thing with, you know, h.i.v. services. it may be that there is a need for more services in some parts of the city and so maybe depending on what is proposed, that's something a consideration for them. so that's the idea of how this would work. in terms of the role that historic institutions play, i think that the idea would be that the master plan would outline what it is that they're providing, what it is that is needed in those neighborhoods and to the extent that a future project is consistent with that, i think that it would be something that is more clear cut. if there's specific language, though, that you think would

strengthen this, w though, that you think would strengthen this, we definitely want to work with you to make sure that happens. president chiu: if your staff could email me so i can let different stakeholders know what the changes are and we can hopefully get feedback on that, that would be great. >> great. thank you. commissioner maxwell: any public comment? why don't we open this up to the public. public comment on this item. if there's no public comment i'm sure -- >> yes, yes, i have cards that were given to me that i just realized i left in my office as i was rushed into -- commissioner maxwell: you know what? here are some cards. yeah. item six. sorry.

>> if i may actually, there's actually -- there are a number of people who wanted to speak first and i think it's bonnie lew is one of them. linda, deean. -- deanne. >> good afternoon. commissioner maxwell: just one second. he has the rest of the cards so he'll be calling off your names. so thank you. but you can still stand up. >> giants are right now 0-0, san francisco and texas. so, f.y.i. can >> good afternoon, supervisors. i'm a member of the chinese progressive association. i'm also a student at local high school and i live in the sunset district. i'm in support of the health care services master plan because i believe that there is a disproportion at amount of health services in san

francisco and i think that the master plan will fix that. it will also help those who need care the most and will contribute positively to the s.f. communities as a whole. health care is a human right and the master plan will carry out that right to its highest potential. i sincerely hope you will vote in support of the mast plarn. -- master plan. >> good afternoon, supervisors. i'm a member of the chinese progressive association. i am a student at lowell high school and currently live in the sunset district. we fight against local injustices. i'm in support of the health care service master plan, the health care service master plan will identify gaps in service and medical underserved areas and will help meet the health needs of all communities in the city. i had an incident when my grandma had hurt herself and my dad and uncle brought her to the chinatown hospital but because they lacked the right department she was sent to

ucsf. however, because they didn't speak english, my aunt was contacted whenever a translator was needed or she would stay at the hospital the whole day. more translation services are needed and the health care service master plan will identify this need. please vote in support of this master plan. it's time we had a plan in san francisco. thank you. >> thank you. i know that we have a number of high school students that need to get back to doing their homework. deann. sam lee. >> good afternoon, supervisors. i'm a member of the chinese progressive association. i eam a volunteer -- i'm a volunteer in a youth program. we campaign for health care and education issues. i am in support of the health care services master plan. health-related development should be based on the needs of all residents of san francisco. the part of san francisco right

now southeast san francisco is a part of san francisco with many low income and people of color only have two major hospitals while the richer side has many more. the master plan will ensure that the needy will get the services they deserve. thank you. i strongly encourage a vote in support of the master plan because health services need to benefit the entirety of san francisco instead of making the gap between the wealthy and the working class bigger. it's time we had a plan for san francisco. thank you. >> my name is sam. i'm a member of the chinese progressive association. i'm a high school student and i support the health care services master plan. [inaudible] the problem is that conversation tends