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consider that we have an innovative health planning process that does not create an extensive document that is outdated before it is completed.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 institution. and the west part of the city is 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 movingi