state of the negotiations, and not to deal with some artificial deadlines. we remain committed to serious and thoughtful negotiations on the community side on all the issues. to be honest, we think the biggest issues will be the one you're dealing with tonight, health care, housing, affordable housing, and workforce issues, including preserving the rights of existing workers. thank you. >> hello. my name is steven. i'm a longtime resident. i live apartment hotel. most of us are on fixed incomes, as are large number of residents. i have spoken with them locally. we all feel that cpmc building on this proposed site, two blocks away, we deserve total

access to the hospital, period. on a more personal note, [unintelligible] i had skin cancer. two operations, and they got it all. i was told that if i were to start the process from scratch tomorrow, it would take three months to get my first appointment. things will only get worse for the uninsured. thank you. >> can i turn this thing on? ok. good evening. i am with a good neighbor coalition. i would like to summarize some of our concerns with the project and refute some of the data that

was described earlier. our concerns really resonate from cpmc's lack of serving the poor. there we go. i come from the tenderloin. i represent folks from the tenderloin. thanks. in our neighborhood, you may have heard anecdotally that our neighborhood has a variety of severe health care problems and needs. in our neighborhood alone, the tenderloin has the highest rate of preventable emergency room visits, second-highest rate in participation in healthy san francisco, five times the city average for hospitalization due to uncontrolled diabetes. our health care needs are very severe. the baby would be a very in which needs are most severe in the city -- the bayview would

be the second place in which means our most severe in the city. in addition, about 40% use medical. by contrast, sari, -- sorry, cpmc's three main campuses served extremely low amounts of medical patient. these are numbers from fiscal year 2009. less than 10% of cpmc's patients served were in medical -- were medical patients. when you talk about our concerns

of cpmc serving the poor, this gets to the heart of our concerns. they currently don't serve the poor. when we talk about being in opposition to the hospital, we are talking about being in opposition to a hospital that will be built in our neighborhood with no intentions of serving our people. 40% of the tenderloin is on medical. less than 10% of cpmc's patients in 2009 were medical. additionally, the charity care numbers of cpmc are very bad. they may make a serious effort to tell you how their dollar amounts of increased, but cpmc has a clear capacity to provide more charity care. less than 1% of cpmc's revenue

in 2009 was given back in charity care. that is one of the lowest in san francisco, half the state average. st. francis hospital, located in the tenderloin, serves significantly more charity care, about 4% of that net patient revenue is returned in charity care. while they may make an example of their increased dollar amount of charity care, the percentage of net patient revenue is not enough. the tenderloin has the low- income neighborhood where many people are uninsured and depend on charity care. this number is unacceptable. they have a greater capacity to provide more charity care. lastly, these are patient discharge members of cpmc from their institutional master plan

in 2007. this is the latest data we could find. a highlight the neighborhoods are the tenderloin and bayview, where the health care needs are the highest. combined, these neighborhoods, these patients were seen less at cpmc than patients from other areas. already, cpmc does not provide access to our community in their hospitals. what good is a hospital in our neighborhood if it is not going to provide services to our people? there is no way the tenderloin, and i can say this with good confidence, there's no way the tenderloin will want this hospital in its neighborhood if it is not going to serve the people of the tenderloin. [applause] president olague: is that -- how

many more seconds? six seconds. [tone] >> that fine. i am part of the next group. i'm nato greene. we started as a different coalition when cpmc tried to close st. luke's. it evolves to responding to the health care implications of the project as a whole. we're constituted around a set of principles. we now have more than 30 organizational endorsements from around the city that oppose new hospital development when they don't prioritize the health care needs of san francisco. we are not at the service of the private company's business plan. cpmc in this instance, you are being asked to make a big trade

offs. huge land use concessions. people do build 550-bed hospitals. people do not build them on a single city block in congested urban area. that is uncommon nationally. i have a chart i will show you that shows how much more parking and acreage is typically used for a hospital the size. the tradeoffs you are being asked to make are not actually justified. we did a review of the academic literature around hospital size. there's not overwhelming evidence that hospital size is related to quality or cost- efficiency or anything like that. there is a value of specialization and capel volume, but that volume in a particular area does not correspond with overall hospital size. you can have a lot of one thing,

but that does not mean you have to put something clinically unrelated in the same building. if you want to bore yourselves, you can read through all of those studies. the evidence does not overwhelmingly support concentration of services. we do have a need for more services in the southeast. cpmc identified a set of zip codes, the primary st. luke's service area, that generates 85% of st. luke's discharges. you see a plan of these hospitals that is explicit segregation of patients based on ability to pay. i would think we would be beyond an argument about whether we believe in segregation. the plan is come a 10% private insurance. the justifies the hospital based on current utilization.

65% private insurance to other campuses, 10% medi-cal. these are people from around the central city in the southeast going to st. luke's. if people from the southeast go to cathedral hill. that does not make sense. 40% of the emergency room cities -- visits come from around the st. luke's area. what happens there puts a burden on sf general hospital. the approach we're taking to davies we believe should be the approach to st. luke's. it works when there is a clinical anchor to generate investment. they are not designed as a permanent charity write-off. davies has a community-serving function and an anchor of clinical services. we believe that should be the approach to st. luke's, where they cluster services related to

some set of specialties for all the patients at st. luke's. i would like to turn it over -- i would like to share with you these other documents and turn it over to my colleague. >> good evening, commissioners. i attended city arts and technology high school. it is important to not only me, but community members and families that st. luke's remain open. i am medi-cal insurance. cpmc has put the attention on making this new hospital. i am making sure it is -- not making sure it is providing the

services for the southeast part of the city. how can you allow them to build that they are not paying attention to what the community needs? like the ceo of cpmc said, it has been around for 150 years. why not give the hospital would need to continue providing those services? thank you for listening to the community. >> good evening. my name is emily. i want to talk with you tonight about our concerns around the rising cost of health care. i have packets of information. pass these out. there should be enough. ok. we are ecstatic that it was said that the commitment to san francisco is to control rising health care costs. we are glad to hear that and we would like to hear specifically how they plan to do that. if you could put the first chart

-- one of our concerns is that the plans will result in increased costs for residents and workers as they gain an even larger share of the pie. in general, a recent article came out saying that northern telecom hospitals are charging higher rates for the same services provided at southern california hospitals. you can see here that on average, northern california hospitals are collecting 56% more in revenue per patient, per day. one of the driving forces in northern california is sutter health. as one of the largest hospital chains, with 24 hospitals, 5000 doctors that operate in 100 cities and towns, they are everywhere. they are a huge force. we know that sutter charges 37%

more than the state average, which is concerning to us. they are trying to control rising health care costs. we would like to see that number much lower. in contrast, a different companies charges 4% below the state average. we have two hospitals, two different systems, providing the same care, but at different rates. one of the questions we have is, with these beautiful, single- room patient rooms, it looks like a hotel. it looks really nice. it looks like a nice place to stay overnight. is that what we need? do we need luxury care? is that what the cost is so high? does that justify it? what does this translate to 4 san francisco? we are paying increased rates for employee health care benefits. we're having to pay for more

expensive health plans. sutter controls a huge portion of the market and they can dictate how much they will charge for services. this is not acceptable. the city of san francisco needs to be looking at these rates and how consumers are able to access to hospitals and doctors they want at affordable rates. this is 2007 market share. cpmc already controls about 1/3 of the market share. with this new, 550-bed hospital planned, what will that do to the rest of the market? they are dominating the market. what is that going to do to the rest of our rates? as a question of antitrust issues, how will this play out with one provider dominating the market? what will happen?

there's a disproportionate share of beds in north of market. why are you adding more beds? why? use of the split line? why would you need to add more luxury beds? it is such a close proximity of other hospitals. we want to mention that san francisco health care costs are already among the highest in the state. you can see on the start that the average price in the west bay, $35,225 as the average net revenue paid in 2009 for an in- patient day. we already know that we have the priciest areas around. what does this mean? how will the proposed plans affect our high costs? how was it proposing to control those costs? we asked the question, how can cpmc justify its non-profit

status with the lowest percentage of medi-cal patience and justify getting those millions of dollars in tax breaks? we urge the planning commission and health commission to consider some of these questions and we thank you for your time. >> our next speaker is carol. carol? >> good evening, commissioners. my name is carol. i have lived in the tenderloin for the past 20 years. this is our position about the proposal. for seniors in low-income

families, we need a hospital to serve us. the record of serving our residents is very poor. only 710 patient coming from tenderloin neighborhood. this is very small compared to the number of people who need affordable health care in tenderloin. our community needs access to affordable care. the hospital should open its doors to the community. how can we support this project when cpmc has a record in supporting our community? what we need is equal access to affordable health care.

we need cpmc to support the community. a community will not support this project if it does not serve the poor. i urge the commissioners not to approve this project unless cpmc agrees to sign a community benefit agreement. thank you very much. dori jimenez. >> good evening, commissioners. i am here today to express my position about the proposed cpmc hospital. our community lacks access to affordable health care. we're not sure that cpmc can do

this. it has a very poor record in serving the poor. the tenderloin needs a hospital that provides hospital care for our residents that are not available or accessible in this community. our community needs access to affordable care. our community cannot support this project unless it serves the poor. what we need is a project that is responsive to our needs. according to the department of public health, charity care report of 2009, cpmc's ratio of charity care, the patient revenue is very low, less than 1%. compared to the state average, it is 1.75%. what will happen to the elderly

who really need help? we, the community members, we deserve to be happy, healthy, and live longer so we can enjoy life with our family in our society. thank you very much. >> i will show you real quick. >> good evening, commissioners. i have lived in tenderloin for almost 25 years. i want to express my opposition to the proposal of cpmc

hospital. they do not plan to serve low- income patients. we in the community cannot accept this project, cpmc serves our needs. cpmc should increase access to all kinds of hospital care. it should be for seniors and low-income families. they should increase access to health care. if cpmc continues to operate for low-income families, it will be better. thank you, your honor. >> [reading names]

>> good evening, commissioners. i live in the tenderloin. i'm here to express my opposition to cpmc hospital that does not serve the community. in the tenderloin, lots of seniors and low-income people use medi-cal. less than 10% patients seen were under medi-cal. how can the community approve this hospital when they do not also, i understand that cpmc is a non-profit organization. that exempts them from paying taxes. they're one of the most profitable hospitals in the state. cpmc charges the most money for their services compared to other hospitals in san francisco. how can they be a nonprofit?

what we need is a project that is responsive to our needs. the tenderloin has the most real health care problems in the city. in 2007, more than twice the numbers of patients from knob hill were seen a than patients from the tenderloin. this does not make sense for us. the tenderloin has the highest need for health care in the city. we urged the commissioners not to approve this project without the community support. the tenderloin does not want this hospital unless cpmc opens its doors to our community. thank you. president olague: thank you. please come up to the mic if your name was called, in whatever order.

>> good evening, commissioners. i am a senior living in the tenderloin area for 25 years. i am here tonight to express my deep concern about the proposed cathedral hill hospital. we need a hospital that provides quality care and services to ensure that seniors and all people with disabilities and low-income families will have equal opportunities in health care. at this point, it is unclear that cpmc will accommodate seniors and low-income families

from tenderloin, especially. we want to make sure that medi- cal patients can use this cpmc facility. the tenderloin and central city residents will not support this project unless cpmc addresses our concerns. this will be no project without community support.

thank you. >> thank you. >> good evening, commissioners. i am a resident of tenderloin. i am here today to express my opposition about the proposed cpmc cathedral hill hospital. the proposed hospital must also serve the needs of the poorer because it is a non-profit. the ratio of charity care to patients is very low at .94%. i realize -- rely on my medi- cal. i went to cpmc emergency room to find a doctor specialist for my sickness. they found out i was on medi-cal and told me to go back to my

primary care doctor. no wonder cpmc has the lowest ratio, less than 10%. how can they explain this to the poor people like us, if they are in non-profit? the tenderloin community does not want this hospital on the cpmc provides their share of medi-cal care. we need a hospital that will except seniors and low-income families. we want to make sure that medi- cal patients can avail love the cpmc facilities. our community will not support this project, cpmc addresses our concerns.

we demand that cpmc signed a benefit agreement for our community. thank you. >> thank you. [reading names] [tone] >> hello. good evening, commissioners. i volunteer for a senior center. i am a resident for more than 10 years. cpmc's new hospital is not here to serve the community. it is for profit. i am an uninsured patient dependent on free clinics and charity care. i would not receive this care from cpmc. from cpmc. i'm sure of that