increasing -- charity care has been increasing. i think the ideas for the long-term work in that area is something that we want to know more about particularly as it pertained to neighboring community of the -- the other thing is the health care cost. i did see that story when it was in the news, i guess it was last week about health care costs in northern california being higher and i would love to better understand -- in the story it said costs of labor and other things were involved. but just better to understand why overall health care costs are higher in northern california and particularly within the health system, that would be very interesting to just better understand that. and then also i would like to know more about your distribution model. it seems that looking at the charts there is a lot more charity care underserved at st. luke's and understand about your distribution care model and how

it is that that facility is overly, you know, burdensome. it might say and the other facility is not. i would like those issues addressed at a future hearing. >> commissioner miguel. >> yes, i'm not going to go -- >> april 1. after that, i appreciate the work you have done with the health center. i worked with the doctors in san francisco free clinic and i appreciated the work you're doing there. i cannot help but presume that the increase in charity care has been directed entirely from this project. it was not altruistic. as far as i'm concerned. still, it is -- as far as the percentages. regardless of -- when you take a

look at the statistics, it doesn't measure up 3789 i would like to speak to someone from cpmc who is familiar with the march 16 health commission resolution memorializing the agreements reached. there is a section in n there that i'm total anyone from cpmc who is familiar with that? i'm looking at a health resolution. memorializing the agreements reached by the medical center regarding the master plan. reached on march 16 of last year. a series of recommendations. it was provided by robert

garcia. >> commissioner, i'm frankly not sure i understand the question. we addressed many of the -- in fact all of the recommendations with the -- >> should increase its care of patients to -- with other hospitals. the agreement will continue to serve medicare patients throughout the system maintaining its medicaid contract with the state of california providing access through suddener pacific medical foundation clinics and the st. luke's health care center. it doesn't say a word about cathedral hill. why not? >> the issue has to do with

private commissioners. many who practice at cpmc frankly do not take medical in their offices. however we have made a commitment. we have always had medical for every patient who shows up in one of our facilities. >> point out st. luke's and you ignore your main prized campus. >> again, it is an outpatient clinic that is part of cpmc. again, the vast majority of the patients who come to have have don't go to doctors who work for cpmc. they go to doctors who admit to cpmc. if a patient comes to crp to our emergency room or is admitted to our hospital or has any service performed at our hospital, we take that medical and always have taken medical and always will take medical at all of our campuses.

we're happy to spell it out in more detail with the health department. >> since the commissioners antonini and scalia have spoken i'm going to ask the commissioners to. >> yeah. i want to keep it short because i think there have been some items that have come up that i like to take back to the health commission and discuss it with the rest of the health commission. i appreciate excisioner in moore's pointing out the whole question of traffic in that area because very recently, the commission health commission was given a report on pedestrian safety, especially in the tenderloin and in that area. and so we really need to look at this and i would like to bring it back to our commission to further look into some of the issues that were discussed tonight.

>> about access to care for poor people. our concern is that every hospital. she does not have a history of provi people at the california pacific and davis campus. the answer here is a development agreement that is very specific and as you saw in the pact that she gave you, there is an example that very specific about the amount of money, overtime, devoted and i would suggest that this commission, planning commission, when you approve the

entitlements, you have a specific development agreement that embodies all of our recommendations that we have been working with this hospital on for three years. we have had far more than three hearings. it has been six. it is wonderful to hear these people again pointing out the good things that cpmc has done and the areas where they have come up short and i think it is a real issue in the tenderloin that people in the tenderloin are not going to feel comfortable going to this massive hospital like they do feel comfortable going to st. luke's. st. frances, rather. you see that result in the charts barbara garcia provided. i would like to see. if -- cpmc match that level of care in their emergency room and i don't think that is going to happen unless you hold them accountable. >> i want to thank first of all director garcia and the health commissioners for coming out tonight.

i know this is not your usual schedule. so i want to thank you for indulging us in that way to be part of this discussion. i also share a similar concerns that were expressed by commissioners illic and commissioner borden. for me, it is not that comp i indicated -- complicated of a question. it is not even -- i'll keep it to five minutes. that is you know, when we heard from the residents of the tenderloin, it is about land use to me. this isn't -- not just purely a health care issue. that you had several -- many, obviously immigrant senior residents at tenderloin, many who acknowledge they have been living in the tenderloin for 10 years or more. filipino residents.

chinese-american residents. elderly, some youth. very diverse population of people who are committed to staying and living in that community and they are concerned that they won't have access to an institution that is going to establish itself in an area that is adjacent to where they live. so i also want to understand the access issue to -- the charity care or to care. the -- that would be provided at this institution as it relates to the health needs of the residents who live in the adjacent neighborhood to have tenderloin and that's just a very simple question. i don't think it is that complicated. i'm glad to hear that there have been, you know, some support of clinics and the bayview and other neighborhoods but i think as it itself relates to land use

and adjacent si and health care needs being addressed by an institution that will be requesting of this commission several acts above and beyond what is allowed as of right in the planning code, i think then we need to look at, you know, some of the mitigations and really balance out all of these issues and as we have with other projects, even though the development agreement is something that is drafted between the project sponsor and the mayor's office and in other words the city of san francisco, it is not really the planning commission, i acknowledge that, we do want to be able to have some guarantees that the institutions that we're going to be engaging with and looking at, you know, agree to certain exceptions and variances and

conditional uses and the rest of it that the mitigations are in place. to balance out this whole issue. so i hope that we have director garcia, director -- the mayor's office. everyone in this city is very -- very much paying attention to this issue and i just hope that we really get a sincere conversation, sincere gestures from cpmc and that we don't have to -- deal with the level of -- that we have been dealing with so far in our engagement with this institution and this project sponsor which i think really does far surpass other experiences that we have had in our dealings with other -- huge developments that have these --

this little of impact on the city. you know, if you don't you can't admit patients that you don't have. so that might be responseable for some of the statistics. even the central city statistics which were quoted today and i won't name the two hospitals, that have lower levels of admission than do the cal pacific campuses not including st. lukes. i think there's movement in the direction clearly. i tend to think there is been a lot of problems, have been through these hearings before and i think some have been sats

-- satisfactorily answered. they've agreed to this thing. if i'm reading it wrong -- ok. it certainly reads according to this document that i have from barbara garcia it looks like these are in the process of being reached. i'm happy and i certainly am very much want cal pacific to work with people in the mediate neighborhood but in my -- immediate neighbor, but this is a hospital for our entire city, region and that we have to make sure that we address everyone's concerns and the concerns of the tenderloin ress dents are -- residents are just as severe with the campus less than a mile away than at vaness where

it's going to be. the concerns are just as critical despite the location of the hotel, -- the hospital. the timetable, i think we've been at this for a long time and i think we can make it hopefully through the time disable that we have tonight. i want to clarify that the report that we gave to the commissioners were only the resolutions and that in the near next couple of days by early next week, we will have a finalized report that culminate this is information along with that. all you is the resolution to say the number eight thing. you do not have the report out. >> i thought those were agreed to. >> you do not have to report on how they will accomplish it. >> ok. thank you. >> commissioner sugaya? >> one was mentioned that perhaps we might have received

a development agreement example but we don't have that in our package. mr. rich do you have access to that stanford -- >> it's part of the packet. >> that's coming from you guys, ok, great. i still have to make a comment on the presentation that was made by cpmc where they show a map of the city and the street as a divider. that was fine for illustrating their particular needs. but if you draw the line north south and separate the city east west, there's no hospital on the west side at all. i found that a little -- never mind, i won't go there. >> commissioner illy? commissioner moore? >> i wanted to ask the commissioner if he will look attendser loin and traffic issue -- tenderloin and traffic issues along vaness at pine --

along vaness at broadway. we have very large housing projects for seniors. vaness as it is, it's extremely difficult to cross. you've got to be really running in order to make it across. it's primarily geared towards fast-moving traffic going on highway 1 enroute to san francisco. it's basically the thorough fair -- faer which is not pedestrian friendly. i'm just asking that when you look at it, move the study to the north. >> commissioner? >> i just wanted to say that as we wrap up the hearing which we really are going to do -- start

fighting with the devil but we sometimes use language -- yeah, you do. but we -- sometimes we use language that is designed to bring home a point. i just want to say for whatever reason the amount of charity has gone up, certainly can go up more. we heard and know and understand that they provided 40% of care -- we -- the expression that we want you to operate in good faith and as someone who served on the planning committee on our side, there's lots to be done. there are certainly agreements that we want to have with you and on behalf of all the women that get their breast care at st. lukes and all the babies that are born in your hospital and the work you've done, we do believe -- i believe you have operated in good faith, that you will continue to do so and

you will make the changes needed to make to provide the best care for the citizens of fran -- san francisco. i do believe that you operated in good faith and been good partners with us in the last couple of years. >> commissioner sanchez? >> i just wanted to state that in reference to the health commission protocol, we've had numerous hearings and we've had a committee that's been ongoing which we will be following up on this, but i just wanted to share the fact that since our initial hearings there has been some significant outcomes and there has been a great deal of inclusion including and as a result of blue ribbon committee, etc., etc. when we first started the hearing, there's going to be a lot of things on the radar scope affecting the city. one of them, of course the

major one is starting for many institutions, july 1, with presidency requirements pertaining to hours, cutback on hours, training and also the mandate to increase primary care. as many of us know in the city and it's been reviewed both in the health commission particularly with the committees, we have a co-hort of primary care physicians and we have a shortage in the committee. and the st. luke motto was started with the a.c.m. and became part of our family practice residency program and then it was disengaged. what i'm saying is given the fact that we have a multitude of challenges how we're going to provide professional services in the city, it may be an opportunity to revisit some

models which at least work a number of years ago but could be modified now given the fact that our academic health science centers are facing a number of mandates where we really have to work even more closely together and partner a do a lot of things in a sharing mode rather than a separate mode. you know, the days of building five recent cancers is no longer a reality. it's a matter of how we're going to integrate and provide the highest health care. and that's been the experience pertaining to the rebuild of cpmc. a lot of positive things have been undertaken. we look forward to positive outcomes again. but as i said, there is unique opportunities which i think we could really grasp because the rubber's going to hit the road

very shortly. it's going to be challenges times and we really thank our colleagues here in the planning commission and many of the people who participated in the hearings. it's going to be an ongoing dialogue and it's going to affect not only the city and county of san francisco but the state and the nation because we are looked upon as one of the finest health, science centers given the diversity of our hospital and of our patients. we want to maintain that focus. thank you. >> director? >> just wanted to add my thanks for everyone for coming today and i my thanks to the health commission and the barbara and her staff for working so closely with us on this. the commission has pointed out and as i learned over the past few months actual it'sly difficult to separate the land use issue when you're dealing with a project of this size. one of the advantages that we have is being able to be on a

daily basis learning a whole new world. i hope that the health department are learning the crazy world of land use of san francisco. i just wanted to clarify that -- on the -- regarding the development agreement, it's come up several times tonight. and it has been staff recommendation that we work on a development agreement that would address the resolution of many of these issues if not all of these issues which seems be the primary and most beneficial mechanism that we can use to make this happen and whatever the resolution might be. and so at the hearing in may we have intended to give you the draft of that that addresses many of these issues. ken is working on that in the office of economic and workforce development is very much involved in that. so it is important. and that agreement as it is with other development projects that the planning commission

has seen an agreement that it doms the planning commission and your recommendation is forwarded to the board of supervisors. you don't necessarily aprove the final version but you certainly make the recommendation on the board on the specifics of that agreement and we will be sure to have a robust discussion about that at that hearing and subsequent hearings. >> commissioner moore? >> and i think that our goal is to definitely -- at least my goal is to get this done by june. 2012. but i think -- i'm sorry -- 2011. it's late. yeah. i think, though, that we asked a lot of questions here. i think we've asked, you know, for a certain thing and we'll just see what the progress -- hopefully progress is made and

we'll be ready to move on this by june. if not there are other projects we have to continue them out. i'm hoping we don't have to continue this beyond june. but here we are. >> we want a motion to adjourn.