[applause]

supervisor chiu: that concludes our special commendation. with that, if we could move to our committee reports. specifically calling up item 47. >> item 47 was considered by the land use and economic development committee at a regular meeting on monday november 15. they recommended as amended as a committee report bearing a new title as an ordinance amended the planning code requiring that any change of use to a medical use that will occupy a space exceeding 10,000 gross square feet of floor area containing consistency from the planning department or commission promotes the goals as recommended with the master plan. supervisor chiu: if i could ask

everyone to walk out as quietly as a ballerina. with that, i would like to acknowledge supervisor campos on this item. supervisor campos: it is interesting that we have a tutu issue followed by legislation introduced by a gay supervisor. thank you very much, colleagues. i want to begin by thanking the co-sponsors of this legislation who have very patiently worked with us for the last few months -- actually, more than seven months that we have been working on this legislation. so i want to begin by thanking supervisors maxwell, chiu,

mirkarimi, daly, avalos, mar for their co sponsorship -- co- sponsorship. i want to thank my staff for all the work they have done putting this legislation together. this legislation has been vetted through a long process. it came out of land use yesterday with a recommendation. prior to that, it was supported by the health commission, which supported the legislation on a 6-1 vote and support it as well by the planning commission on a 5-1 vote. i do not want to repeat what has

been said about this legislation, but needless to say, there has been many discussions with a large number of stakeholders, and we have repeatedly tried to be inclusive, transparent, and this process could not have gotten us to this point without the input of so many people, beginning with the director wrote public health, mitch katz, the incoming director, and their staff, as well as the planning director and his staff, as well as so many stakeholders, including members of the industry. the hospital council, and community members. so to all of them, thank you. a number of amendments have been made to the legislation that we believe have allowed us to strike the right balance between

all of the competing interests and i know that we have a pretty full agenda, so i do not want to belabor the point. i would simply ask colleagues for your support of this legislation today. thank you very much. supervisor dufty: thank you. i want to thank supervisor campos. there were times at which some of our major health care institutions and hospitals have expressed concern about the implications of this legislation. truthfully, i looked at it as what i see as a very important tool for the future of the city and a process that i believe in retrospect 20 or 30 years from now will be seen as a significant step to comprehensive look at health care -- comprehensively look at health care in san francisco. it was way back in 1974 that the

requirement was begun at the state level the counties have to have hearings about potential cuts in public health services and in health care, and it was very controversial at the time. there were efforts made to curtail the process, and over many years, we have become commonplace a round of hearings that have taken place, and i think they have provided a mechanism which helped us as a legislative body of the city and county of san francisco to be sensitive and attuned to the implications of health cuts, and i think it helped to establish the role of the budget process here in protecting those vital services and to think about what would happen in counties around california if there was not that tool that people could publicly challenged the reduction of health services. this is a significant measure to get the city to look comprehensively, and going forward, to ensure that we consider what those decisions

are that bring together health policy and land use policy. i'm especially appreciative that supervisor campos has made this perspective. from the standpoint of some of the upcoming renovations required for seismic services, it is clear that we want to see projects happen, and that there will be full vetting and consideration by the board of supervisors, but i want to commend him and acknowledged that many of the stakeholders sat down with us from cpmc, the hospital council, and i think they recognize that this is a prospective process that will be helpful for the city. i appreciate the support from our outgoing health director and our incoming director of public health, who really see this as a valuable tool, as well as members of the planning commission and health commission, who have almost

unanimously spoken up about this process and seen as extremely helpful. i really appreciate the amendments that supervisor campos has offered, and i look forward to supporting this legislation. supervisor maxwell: san francisco -- first of all, let me thank supervisor campos and all the community and all the folks from our different hospitals. san francisco is positioning itself to be a very important medical help. because of that, we need to be especially aware of our own medical facilities and what we have and how we treat the people that live in san francisco. how can we go out and say, "this is the place you need to be," and the folks that need the help the most do not have that kind of care? we are positioning ourselves to truly be a model and saying that every place in san francisco, every person can get to the care they need in the time they need it.

that is extremely important. all the hospitals have done a great job. they have helped us with everything we needed. without them, we could not have had it. they have a lot of planners on their staff. i look forward to them being a huge part of this process as well as our community. again, i want to thank everyone that has participated in this, and i look forward to everyone spoke -- everyone's vote and san francisco moving forward. >> can you explain the appeal process in this legislation? tell me how this works with conditional use appeals and environmental appeals. talk to me about the three tracks. >> kate stacy from the city attorney's office. the legislation has the hearing

and determination at the same time. it does not address the ceqa process at all in the legislation. the appeals process section 342.6 has an appeal either to the board of supervisors if the board of supervisors has authority over the entitlement, or if the board of supervisors does not have authority, it would go to the board of appeals. >> "authority over entitlement" means potential use permit needs to be approved? >> i think the entitlement refers to the actual approval, like a conditional use permit legislation. the ceqa process is a separate process not directly addressed in this legislation. >> to appeal something with conditional use, there is one standard to appeal the environmental determination. what is the standard to appeal this consistency determination?

four signatures? one signature? how do you get it to board? >> it is within 30 days of the issuance or denial of the consistency. any person may file an appeal. it may be one person. >> it mirrors the ceqa appeal route instead of the conditional use route, which means a certain percentage of the people within a radius, correct? >> that is correct. it is more like the ceqa appeal process where one person could appeal within that 30 days. >> so any individual, regardless of whether or not 11 supervisors and seven commissioners think it is consistent, and any person regardless of where they live, could appeal it? >> that is correct. >> or one person testifying as an organization. for example, the california nurses association would like to

appeal consistency. do they have the ability to appeal? >> the legislation says any person may file an appeal. >> so an individual from the group could. if the conditional use permit is unanimously approved, if the ceqa documents are unanimously approved, it would not matter if there was an argument that there was no consistency? in other words, you could have three things appealed to the board -- conditional use gets approved, environmental doctrine gets approved, the six board members find that there's not consistency, the project has to go back to figure out how to find consistency. is that fair? it is not as if one of these appeals could trump the other. they are all equal. >> supervisors, the legislation in section 342.6 says that the board of supervisors may reverse

the decision, and that decision is final. there is no discussion as to what actions would come next, but theoretically, an applicant could go back and change the project application in order to address the concerns and achieve consistency. >> i just the subject of the appeal, theoretically, you could have one individual who does not even live in san francisco appeal this. the conditional use permit could be approved. the environmental document could be approved, but if six members find there is no consistency, and the project cannot move forward, even though it is environmentally sound and meets all the requirements of a conditional use permit? >> the legislation has as a prerequisite -- it provides that the planning department, zoning administrator, and all other involved city agencies shall not approve entitlement for medical use unless the medical use has obtained a consistency

determination from the planning department or planning commission. the planning commission has the option of finding that countervailing public policy decision justifying a full of that application, not withstanding possible inconsistency with the health care master plan. >> it might be consistent but not been finally approved. i get that. what i'm trying to point out is the reverse. it could absolutely crystal clear, legal under ceqa, a crystal clear under our conditional use guidelines, but if it is not consistent with this master plan, environmental does not matter. conditional use does not matter. >> the consistency determination is a separate requirement for approval, except in cases where -- >> there is the very real scenario that sequel would be supported it to this, that conditional use guidelines would be supported to this, and that any individual, if they feel that way and are able to

convince the majority of the board. i do not think this appeals process has been thoroughly -- you're shaking your head. tell me that i'm wrong. tell me that a scenario i just pointed out is incorrect. i have not heard back from the city attorney. maybe you could point that out. supervisor chiu: if it is ok, supervisor campos for a response. supervisor campos: a couple points. first of all, in terms of the significance of the consistency finding by the planning commission in consultation with the health commission, it is an advisory finding by the health commission that goes to planning, which can decide that even if there is a finding of inconsistency, that on the finding of inconsistency, on the whole, the project should be approved. it is not as you indicate that the consistency finding trump

seekwa, trump everything else, in fact, even if there is a finding of inconsistency, the planning commission can decide to approve the project elsbernd commissioner ecialsb elsbernd: could approve the c.e.u. but then could. >> we drafted this in consultation with the city attorney's office and our understanding and the intent of the legislation is should the appeal come before the board of supervisors, that the board of supervisors will have the ultimate say based on the powers it already has, it doesn't change any of those powers, so the board is free, if there is a finding of inconsistency, the board could very well decide

that notwithstanding that finding, that it still would approve the project. it doesn't change any of the board of supervisors' deliberations. >> it could, but it could also very well disapprove. >> i think that the board of supervisors, that the issue of consistency with the healthcare needs of the city is a factor for the board of supervisors to consider. it is ultimately within the power and jurisdiction of the board of supervisors to decide if, as a whole, given everything into -- taking everything into account to approve or not approve a project, it's the same analysis that currently exists for the board. the only difference is that healthcare is now a piece of that analysis. >> you've said absolutely nothing that refutes the scenario i put forward -- a board could approve seekwa, could approve the c.u., and reject the consistency.

>> what i would say, supervisor, is that the board could look at a project and take everything into consideration with healthcare factors being one of the factors to approve or not approve a project. >> the healthcare master plan is done by the planning commission, the health commission, they make the determination. the board retains power to handle appeals on environmental granted to us by the state and c.u. and there is no right of the board of supervisors. otherwise, we're giving seekwa the ability to be subordinate to the law we're creating. that's the situation we're creating. >> i would respectfully disagree with that characterization and with respect to the appeal and your statement that somehow this creates an additional appeal prose, what we have tried to do from the beginning with the city attorney's office is to incorporate the appeal into the

existing land use appeal to the extent that there is any -- and that's been the intent and remains the intent -- to the extent that that's an issue, we are certainly happy to provide clarifying language to make sure that's the case. >> let me throw out another suggestion, if you want to inner corporate it into the appeal to come to the board of supervisors, make this a factor that is part of the conditional use. make it a part of the second appeal that can already come to the board but you're creating a third scenario. if it's truly about incorporating it into what's already here, then actually do that, put it into the conditional use appeal, don't create a third appeal. >> i don't think that we are creating a separate appeal. i think we're talking about incorporating the process of consistency determination into the existing land use appeal process. that's the intent. that's what this language tries

to do. president chiu: supervisor alioto-pier? supervisor alioto-pier: thank you, supervisor chiu. let me start by thanking supervisors campos and elsbernd for that dialogue. i really, you know, it's an interesting issue. back in 2008 when we formed the blue ribbon panel to look at cpmc and what cpmc was doing, particularly with the rebuild of cathedral hill and at that time the closure of st. luke's and the project on the california street and presbyterian street specific campus, this was a big topic of conversation, what are the healthcare needs of san francisco, where are we going to go, how are we going to know what san franciscans need, particularly in a city as small as ours and divided as ours

physically, geographically and the fact that we live in an earthquake zone and in many ways need to assure that our healthcare providers are across the city equally not only to make sure everyone's covered but to make sure that in case of a disaster, we have the type of coverage in different parts of the city that we need, not knowing if one part of san francisco might at some part be closed for reasons related to any type of natural disaster. that being said, when we went through the blue ribbon panel, it was an eye-opening experience and i think that the open and the free dialogue through it, we accomplished a lot. the biggest accomplishment was far and away the quiment from cpmc not to close st. luke's hospital but to invest $250 million into rebuilding it and

it was through a lot of those open conversations. right now, we're dealing with the issue of skiff beds, the fact that san francisco needs more than we currently have allotted. i understand that the type of healthcare proposal for the city would help us focus in on the needs of san francisco and figure out where we would place different facilities to cover essentially our voids and holes. i think that the topic of sniff beds is something that would probably benefit greatly from an institutionalized plan for san francisco healthcare. that being said, i still have concerns with this particular process. supervisor elsbernd touched on a number of things i was going to bring up. this did go through committee yesterday and there were amendments made yesterday, amendments sent out with the committee report. i do think that this is the type of issue that probably should not have been sent out as a committee report, quite frankly.

it's big enough where the amendment should have sat and we should have had a little more time to discuss them with stakeholders. at this point, i am not prepared to support this particular proposal. i will be having my own conversations over the next week, i do think that it is an extremely important issue. i think that it helps get very close to solving some of issuesd problems we have but i need to make sure that in trying to solve problems we're not creating more drastic ones in the process and there has been a lot of conversation with cpmc and the hospitals and the rebuild project of cpmc, in part because it's such a big one of the but i have not had the type of conversations that i need to have with st. francis and catholic healthcare west and the other hospitals that will be impacted by this. i think we have to be careful that we're not setting up a d.r. process for our hospitals, much like the d.r. process we have

for our private homes. i am not prepared to support this. i would like to support some type of -- some type of citywide healthcare plan, but at this point, this is not the one that i'm able to support. president chiu: supervisor campos. supervisor campos: thank you, mr. president. i thank everyone for their comments and i understand where supervisor alioto-pier is coming from. it is disappointing, nonetheless, not to have your support, because i think this legislation, in fact, does codify a lot of the work you've been doing around a number of issues involving healthcare. be that as it may, we believe that the legislation as currently drafted addresses this issue and that's on the issue of the appeal that the intent of the legislation, including, as currently written, is for any appeal to join an existing land

use appeal. nevertheless, to make sure that that is as clear as possible, we have worked with the city attorney's office. there is language that you should just have received from the clerk of the board, that, again, reiterates that very point about the appeal. again, we believe that the legislation as currently written already does that, but to the extent that there is any question, this language, basically, says -- and i will read it, the "the board of supervisors or board of appeal as applicable shall act on the appeal of a consistency determination at the same time it acts another entitlements for the proposed use. the board of supervisors or board of appeal as applicable may find countervailing public policy considerations justify approval of the entitlement despite any inconsistency with the healthcare services master plan." again, it confirms and clarifies

what we have been saying all along in the event that there is any question that someone may have about that. so i make a motion to make that amendment. president chiu: supervisor campos has made a motion. seconded by supervisor dufty. without objection, it is accepted. now we go to supervisor mirkarimi. supervisor mirkarimi: i want to express by compliments to supervisor campos and supervisor maxwell and for the advocate union and private sector for their input in the composition of this ordinance in this master plan. second, is that, proudly, we all stood in celebrating the good work of then supervisor and then assembly member tom amiano and darren newsome in the birth of healthy san francisco and healthy san francisco was born out of the principle that there

should be access to healthcare, no matter of your income, and that access shall not ever be impeded and this is on the wave of national thinking about healthcare reform. but there is no reform in healthcare if it is misplaced or misguided especially in its land use strategy and from time to time over the last few decades when we have considered in big swaths tracts of land about redeveloping certain areas of the city, great mistakes have been made and i don't see a master plan as it sort of assigns what is the future of san francisco's healthcare epicenter. my district, district five, is essentially ground zero for the high majority of healthcare in san francisco. we have ucsf, we have kaiser, ucsf mount zion, pacific presbyterian and soon to be,

we'll border on cpmc most likely. i think a healthcare master plan in the past would have been extremely informative and instructive in terms of exactly what it is we're about to embark on in this sector of our city. so i think it's a welcome addition and i thank the authors who put this forward. president chiu: supervisor elsbernd? any final comments? supervisor elsbernd: i appreciate this amendment, this amendment does absolutely nothing to change the scenario i presented. all the amendment does is say that the appeals have to come together procedurally. that's all it does, and frankly, i don't know if there's a need for that because we don't have that requirement for seekwa and for the c.u.'s, but procedurally that's how we handle things anyway. so thank you, but it does nothing to address the scenario i presented.

president chiu: any final comments, colleagues? supervisor clu? supervisor chu: a question for the city attorney, given the language proposed here, it sounds to me the question that was proposed before, supervisor campos said the idea was to merge it so it's one process, one appeal, but the way this reads is likely we could potentially hear the items at the same time and have them acted upon at the same board meeting but hypothetically, we could have different results for each of the different appeals so we could have an appeal for the conditional use that might or might not be overturned, we could have it for environmental, but in terms of the consistency component, it could be a completely different result and in that situation, given what this language says, the board of supervisors could potentially act upon that inconsistency or consistency and say, yes, we approve it or we don't approve it, correct? >> that's right. it would still be three separate