. we have from the beginning of this process, had an open-door policy in terms of making changes to this legislation, and we believe we have an incredibly strong piece of legislation that to the maximum extent possible has taken into consideration the concerns of the citizens. we believe we have addressed those as much as possible. i see representatives of uhw here, and their feedback was also very useful. we feel that we have reached a point in finalizing and drafting this legislation that we have addressed every possible issue that could be addressed except for one very important distinction or difference of opinion.

i think that you will hear from a number of folks who believe that planning is good, but the planning should not be tied to any kind of relation, that we should engage in creating a master plan, but that there should be no land use applications tied to them. while we recognize that perspective, we have a fundamental difference of opinion because the fact remains that the planning commission and planning policy makers are already being asked to make land-use decisions that have health care implications. this legislation ultimately tries to create a process that allows both planning policy makers and health policy makers to come together and create a process and make decisions that are ultimately the best decisions for the city. to the extent the opposition some people have is because they

do not want to see that, we do have a fundamental difference of opinion. the last thing i would say is that this legislation has throughout the beginning of this process then drafted in close consultation with the city attorney's office. we began this process, making it very clear that we wanted to have a piece of legislation that was as legally sound as possible and that provided each policymaker a responsible role as the law allows. that is what this legislation has done. it provides a role for the health commission and health policy maker -- policymakers to influence land use decisions and does so to the maximum extent that the law allows. there have been proposals and changes that have been made, and based on our interaction with

the attorney's office, we believe we have gone as far as the law allows and second, that we have gone as far as good public policy-making allows because you are talking about decisions that necessarily involve land use and health care. with that, that concludes my introductory remarks about this legislation. there is an amendment that i would like to introduce, but if it is ok with the committee, i would like to do the following public comment. supervisor maxwell: i usually like the public to be able to comment on the amendments so that everything is out there for them. right now, i would like to say the if you do not have a seat, there is an overflow room, and it is set up in the chamber, and i will have to ask all of you not sitting down in the seat to please go into the chamber, and

we will call you at public comment if you have a card in, and you will be able to speak. i have to ask all of you who are standing up to please -- there are some seats available up here. if you do not have a seat -- thank you. supervisor campos: if that is the case, before i go into that, i would like to make two points. we have in the audience members of the planning commission. the planning commission voted in support of this legislation. the health commission voted in support of this legislation, and i think that the planning commissioners or any other commissioners who are here can tell you for themselves why they are in support of this legislation, but the one change

that we wanted to make is on page nine, line 10. in response to a concern that has been raised and the issue that has been brought forward as a really important issue is the issue of to which projects does this legislation apply? that is a policy question that was presented to the planning commission, which in approving or recommending approval of the legislation made it clear that they did not want specific projects to be exempted from the legislation. what this amendment is, and the amendment reads on page nine, line 10, "on january 2, 2013, or upon adoption of the health-care services master plan, whichever date is later." this essentially creates an

effective date for the legislation. it basically makes it so that the legislation would go into effect on january 2, 2013. what that does is notwithstanding the recommendation not to exempt specific projects, it actually allows certain institutions that are facing a looming deadline, by which certain seismic retrofits have to be made, to comply with their state law obligations, it provides them a window during which to complete that work, and in so doing, we believe the legislation goes pretty far in addressing one of the key concerns that have been raised. in fact, it does so in a way that i think addresses some of the issues that were raised by some of our labor partners who want to see that seismic work be completed as quickly as possible. this essentially creates an incentive for any project currently facing that deadline

to do the work as expeditiously as possible. we believe that this is yet another example of this legislation going out of its way to address the concerns that have been raised. supervisor maxwell: so then, if i'm considering doing seismic retrofit or replacing a hospital, does it mean that if i have -- if i get my plans and everything in before january 13, that i'm basically extent from this legislation? supervisor campos: yes, supervisor. what it means is that we have repeatedly heard that earthquakes can happen in san francisco at any time and that there is a public safety interest in making sure that the seismic work is done as quickly as possible and that something like this could potentially get

in the way of that. this allows those institutions to have a window during which they can complete that work because we recognize the urgency of finalizing that work, which is why, instead of speaking about specific exemptions of individual projects, which creates a number of problems -- legal ones, potentially -- that instead of talking about specific exceptions, we are talking about giving them a window of time during which they could complete the work to ensure that those concerns are addressed. supervisor maxwell: thank you. questions or comments on this? >> thank you, supervisors. i just wanted to summarize for you again with the planning commission did on october 28. the commission did force the

legislation by a vote of 3-1, and the changes mentioned were partially in response to the recommendations of the planning commission. first was, as the supervisor said, the issue of the to -- the issue of who determines consistency with the master plan. the legislation would have the planning department do that. the addition -- the planning commission of the health department was better equipped to do that. i understand fully that it is difficult to separate health care and land use decisions when one is talking about building something, so we will certainly be involved in that, but the commission felt that depending on the content of the plan, the health department might be in a better position to make that decision. that brings me to the second point, which is related to the contents of the plan. the commission recommended that there be less detail in the legislation and the process for determining what is in the plant happen in a subsequent

process for there to be a process for actually bearing out the details of the plan. the third issue had to do with the cost of preparing the plan. we are concerned about the cost of the plan preparation itself as well as the necessary environmental review work that would be required. they did make the commitment that when it goes through the budget process, we would have the discussion and try to figure out how to fund the work. with those recommendations, the committee did vote in favor of the legislation. supervisor maxwell: i'm sure the hospital councils and hospitals were there, and they spoke to you about their seismic issues, and the replacement issues, if they have an older building on your campus, then they want to replace your building. they would have to go through the legislation, and it might take more time, or maybe they could just be exempt. what did you think about that?

>> the discussion the commission has had and the discussions i have had with hospital representatives were about the decision that there had been an initial proposal to exempt pipeline projects, and i think the supervisor's change, as he mentioned, goes a long way to doing that. as i understand from what you just read, it is either a date for when the plan is adopted. supervisor campos: just for purposes of clarification, it is not the january 2, 2013, is the effective date of the legislation, but the date on which the consistency requirement would begin. after that, there would not be a need for consistency determination, depending on the projects before that. >> as i understand, specifically the way the state's work is that it would be the date of the entitlement of the project, which would be either planning commission or planning department -- specifically the way the dates work. supervisor maxwell: after

hearing those issues from those hospitals, you feel this legislation goes a long way to deal with that? >> i will have the hospital speak to that. i know they were concerned about the pipeline project. supervisor maxwell: i'm not asking about the hospital. i mean the planning department's concerns. >> the department was concerned about the pipeline project because they required so much time. i think that two-year time is probably sufficient to allow it to move forward. ou have any. supervisor maxwell: thank you. supervisor campos: i know that there are a number of people here for public comment, but it is ok, i know there are a couple people who probably need to leave. if i may begin, i would like to call on the planning commissioners who are here.

i do not know how much time you are giving each person. two minutes? i know we have here president miguel and commissioners sugaya and olague. >> thank you for the opportunity to speak. we fully support this legislation. my concern again, as it relates to the pipeline project very much differs from the department, and because i feel that cpmc is a major project, and st. luke's is as well, that i wish we had this type of analysis and information available to us as we move ahead in our decision making process. not just the planning commission, but i believe the health commission as well would benefit from this project.

i'm not sure there are many pipeline projects after cpmc that would equal this magnitude, really, and the potential impact and also benefits that it could be providing to the city, so i think when we look at the benefits and some of the impacts, i think it would help to have additional analysis. i really do. that is my only regret about the legislation. it may not be, because of the timeframe of it, it may not be in place in adequate time to address the issues that these very major projects are going to have. i'm very pleased with it, and i think it is something that the city will benefit from. >> -- supervisor campos: thank you, a commissioner. >> thank you, supervisor, for bringing this up originally, and i'm pleased to see several supervisors have signed on to

it. planning commission deals with policy matters of the city all the time. everything from parking ratios to transit-oriented development. we look for policy guidelines. this is a guideline we do not have. it is urgently needed. the reason, in my estimation, that i voted the way i did not to have exemptions on pipeline projects was because most of the projects deal with policy in this city, come along constantly -- apartment houses, office buildings. these things are always in the pipeline. this is a different situation. never again in the history of this city for at least another 50 years and maybe more on other

than state property or federal property will we have an opportunity to deal with this policy, so to exempt what is in the pipeline now, in my opinion, is wrong, and i do not believe that it is so onerous a burden that it will affect the seismic. i do not believe that. >> supervisors, thank you for inviting me to make a short presentation. the planning commission reviewed institutional master plans. these affect places like colleges, universities, and medical facilities. we have recently seen one from st. francis.

in each of these institutional master plans, we have had a difficult time grasping the overall picture of how or what they are presenting fits into the larger picture of health care services in san francisco. those concerns have been voiced in public hearings and also supervisor campos. it also affects the way we look at environmental impact reports under the california environmental quality act. there is a comprehensive look at proposed projects within the city, and i think it would be advantageous to have some kind of overall health care services master plan that we could take a look at or provide guidelines -- that would provide guidelines for the environmental impact report. decades ago, there was a health

services agency that provided some kind of overall planning effort. i do not know what kind of regulations they have, but it seems to me that authority sets a precedent. there are already other health care plans in effect in the u.s.. there are some regional aspects of this also, although san francisco may be in the lead on this. i was reading that seton medical, just across the border, is closing their medical facility. those kinds of things would have impacts directly on san francisco, and it would behoove us to look at conditions across the border from us. supervisor maxwell: thank you very much. thank you all for coming. supervisor campos: thank you. if i may call some speakers. [reading names]

>> thank you, supervisors. i am a longtime independent consultant for health planning and policy based in san francisco. i support the legislation to initiate city-wide planning for health services. long ago, such planning first enabled and then mandated under federal law. i served as a consumer volunteer on the san francisco sub area council of the west bay health systems agency. i co-chaired the committee for several years, holding hearings and making recommendations to the state planning agency concerning certificate of need and help service grants channeled through the hsa. this planning strongly influenced local and institutional decisions about

future investment. for example, many empty beds and underutilized services, which we term at that time excess capacity, were a major cost driver in that era as a result of leverage exerted by the hsa. in the course of the reviews, many were closed. the problem of competition to lower costs while preserving access to quality, legislative in california in 1982, exerted a new discipline on health care managers with some salutary effects. for example, new attention to data and analysis to bolster their decisions. it also, however, creates incentives for growth independent of community needs as defined by a public planning process. cost of care, access to services, and quality are institutional concerns. republicans are coming late in

the process if at all. the proposed legislation will revise a public planning process and provide a baseline of information that institutions, san francisco residents, and public officials used to identify community needs -- supervisor campos: thank you. next speaker. >> [speaking foreign language] >> good afternoon, everyone. i'm a member of the chinese progress of association. i really strongly support the health care masters plan. i was here last time speaking

before you because as new immigrants, we face so many problems, access to health care because of language issues as well as lack of affordability. actually, just earlier this month, i was with a group of parents meeting with people who were on healthy san francisco, talking about how that plan could better serve the community and their health care needs.

francisco, and at present, i have a son with special needs. he was born with a genetic disease, and i am thankful for the health care that he has received so far, but yet, worried if i would think he would be one of those children or infants out there who would not have that kind of health care available to them. at present, we are even being warned or told that we might have some services cut, and we do not know what to do or how to go about it. actually, he has a problem with his breathing.

he was sent home with oxygen, but then, we were not able to be issued a monitor to be able to see how his oxygen level is. we thought it was like being sent home with a bottle of pills, but with no instructions of how to take the medicine. maybe there is instruction are around a bottle telling us what time and how to take the pills. we do not necessarily know when we need the oxygen to be able to give it to them -- to him. it is true that an ounce of prevention is better than a pound of cure. we would hope that it could be addressed and that we would not be avoided, and that the city does take into consideration

what the needs are of the people. thank you. supervisor campos: thank you very much. next speaker please. >> good afternoon. ron smith of the hospital council. first, i want to really thank the supervisors, particularly supervisor campos, maxwell, chiu, and mar and all the supervisors for allowing us to work over the last several months. as a 49-year resident, i want to say i was particularly moved, supervisor maxwell, by your question two weeks ago at this committee hearing, when you were probing hospitals to try to find the very best answer. i was so proud of our city with the interchange. i know you met with both those

hospitals. i want to thank you so much. we also want to thank supervisor campos for realizing how important is to protect our hospitals and citizens. there is a seismic deadline coming up, and the hospitals have to be built and opened by then, or they will be close. we have two concerns -- one is the appeal process, by having an extra layer of appeal process, we think it will increase costs and time without adding quality. the other thing is there are hospitals that have historically served underserved and needy populations. as they rebuild, we think that they should have special consideration because they have served such a remarkable role in san francisco and continue to. with that, we want to thank you very much for all of your caring and listening to us. thank you.

supervisor campos: thank you. let me read a few more names. [reading names] please come forward. >> good afternoon. i represent the good neighbor coalition and the housing corporation. i would like to remind you, supervisor maxwell -- you may remember this -- in 2002, at higher -- kaiser hired to promote the plan for a very drastic change in their services and also demolishing a bit of housing thanks to a strong message at the board and also the community members that were outraged as well. that plan never went anywhere, but had it gone anywhere, a lot of these same debates would have happened around kaiser instead of cpmc. the point being that in times like this, we actually need more planning, we need more community

input, and we need to be intentional about our vital resources. housing is one of the few parts of the -- is one of the parts of the formula. there are health care, jobs, impact on the neighborhoods, and this goes quite a long way in addressing our health care needs. to quote the song from the 1970's, "you think this song is about you." it is not. >> thank you for the work you have been doing. looking at this more openly because i am a nurse, and we need to look at all the service from the top