as a low-income family of six, i am very concerned about the hospital sturgeon higher rates. my concern is also the concern of most residents. the plan of constructing a hospital and the neighborhood will not solve the problem. given the fact that they are here addressing the issues being raised by the community. they own a one-third of the market share. it is considered the largest hospital in the city. it is 44%, a virtual monopoly. we know that monopoly is equal to control and dominance. who will stop them from hiking. they charge 37% more than the

state average while they operate st. francis and st. mary's in san francisco. i think we believe the health care is not a commodity that can be traded. what san francisco residents and workers need is access to affordable health care. they're showing a willingness to communicate and to have not said they will make their hospitals accessible. we in the community association are asking our government officials to stand behind the people. supervisor campos: i appreciate you taking the time. next speaker.

>> i lived at 1711 of the bill. -- oakdale. we plan the daily routine for the whole month. given where we accept the nation's, we also save some money for senior programs. my concern is the cost of health care. which is too much. i have a medication of five different ones for preventive medicine.

it cost me about a dollar and 10 cents for 90 pieces. the pricing is shown, i have an eyedropper. it used to cost me $11.99. once they came, it was increased to 4099. -- $14.99. then again to $16.99. probably it will not be army alone. a lot of people also that are

like me. supervisor campos: i know there were a number of seniors that had to leave. we appreciate you. >> think you very much for having this hearing and listening to public comment. i find it quite shocking that the ceo had a 59% increase in his salary in 2009 and another when he was promoted to vice president. all employees including nurses and health care workers have their wages frozen in 2009.

there was a hiring freeze put in place and all departments were asked to cut their budgets by 10%. this resulted in layoffs and services that directly affects our patients as well as the nurses that provide that care. we lost to the consultants that helped premature berries -- babies. we lost the translators. they basically lost the full time positions. they do all of the staff and supply and of stocks that are needed for nurses to do their job. all of these fell on to the remaining nurses. it increased our workload. nurses have observed practices that management has never fully explained and could call into question how billing is done.

and practices that have nothing to do with recent allegations regarding false anesthesia billings. supervisor campos: don't be shy. >> the experience that my family has had with services for very young children, my daughter was born premature. we looked at the facility. every aspect of the care that they need is essential. losing a specialist is something that can really put a family in jeopardy of losing a life. it is the critical and they are so young and so small. they want to provide the high quality care.

they rely on the care to live more peaceably with what the outcomes will be about. it is really unfortunate that these of the conditions being forced upon you. i think we can do better as a society. >> and the evening, supervisors. my name is donald armstrong. by working with a lot of the populations, i am seeing the effects of the high cost of the health-care field. some are going without procedures because of the high cost. they either can't afford it. some of the other things i am saying as far as identical vision, they can't even get glasses now or even get dental

care. it is getting a little ridiculous. i hope that we can work together and the supervisors can have some type of oversight that is going on. and to make health care more available to a lot of the demographics we're working with. it is quite disturbing when you go to a home and you can't get a certain procedure. i see a lot of things going on. maybe a year ago. those facilities are very important. that is all i have to say. >> both of my parents are

retired and both have chronic health problems. i am the only child currently working to support them. sometimes we have to choose between their medical care and essentials because medical costs are so high. a mom would rather suffer back pain because we simply can't afford it. that is not fair at all. there is a 70% difference that one gentleman mentioned earlier. because the health care providers are more consolidated in the biggest health care provider has the power to charge higher premiums. and what they don't expect me and my family to move just to get medical care. listening to the presentations, i heard a 3 million of executive pay. how much can they serve the

community? they are basically a nonprofit, but why are they concerned about making the most profit on their care? shouldn't they give more back to the community? it is actually very low. some of francisco should not approve any development until they meet the needs of the community and residence including medical costs. >> we have been joined by president chiu. president chiu: i wanted to apologize to folks. typically our meetings last around a couple of hours and we didn't realize a couple of us has scheduled something at noon. i appreciate all the members of

the public that are here and commenting on this important issue. >> i am a direct care registered nurse as well as president of the california nurses association. thank you, supervisors for convening this important hearing. we believe is important to know there is a cost like the previous speaker has mentioned between northern and southern california. various factors might play a role in the disparity. we believe the the market dominance does play a bigger role. secondly, the assertion that labor costs are largely responsible for the higher cost of health care are quite frankly

preposterous. the only grain of truth to that assertion can be found in the salaries. as an example, and the ceo is now the highest paid and ceo of the sacramento valley. that is because after a wage increase of 43%, there are over two dozen corporate officials just in the sacramento area that earned over a million dollars apiece. here in san francisco, the wage increases for officials have surged dramatically in the past several years. the latest available data shows that the corporate salaries jumped from anywhere from 40% to 50% a year. i want to make it very clear

that no registered nurse, housekeeper, a nurse's aide, a dietary worker, or any other management hospital employee has ever nor will ever in the future have their salaries of words in the same manner. supervisor campos: next speaker. mr. smith, thank you for waiting to speak. >> thank you for this very interesting hearing. we take it as a very sincere question of how we can cut costs. one way that we can tell you is cutting $40 million of the city costs by doing one then. but you asked for an economic

figure. i called my office and they brought it over. what do i do, but this sunday -- i want to make clear that these are zero well-deserved wages. we have an effect of work force. the hospitals in northern california, particularly in the bay area are the most effective anywhere in the country. that is because of our incredibly effective work force. here is the information you have asked for. nurses received about -- ken dollars more an hour. i want to look forward to

working with you on reducing costs. supervisor campos: is there any member of the public that would like to speak? >> of what to say thank you for organizing this hearing. it comes at a very timely point in the city's development. i was blown away by some of these statistics. quality doesn't change. it is a factor of looking at the market. then made a statement that what we need is more transparency. an understanding how it is charging consumers and looking and thinking creatively.

we should be asking to see what the rates of success are in terms of the health care services. and we need to know that in order to provide health care to our residents in san francisco employees. i think what this all shows, it shows community residents that in light of what we have seen today, they are making huge profits this year and they are providing only 10% of their services to medical patients. they are getting pushed to sf general. i think it is just another sign

that it is not about labor costs. a lot of the evidence shows that they are looking at not just providing the best affordable care, but looking at the bottom line to change services. [chime] supervisor campos: any other member of the public that would like to speak on this item? public comment is close. colleagues, let me make a couple of brief remarks about this hearing. i started hearing by noting that one of the most difficult issues facing the city and county of san francisco is the fact that as we are facing a pretty difficult budget year a city, for the incoming fiscal

year, the protection is $491 million,. it is a very serious issue. these are truly some of the most knowledgeable people on this issue. we heard from them about different factors, there is market consolidation by hospitals. we heard from experts today that since francisco is among the most consolidated if not the most consolidated market in the state. in trying to understand why it

is that it costs a patient $7,349 a day, why it costs a patient other places 3931, consolidation is an issue. we heard from the doctor today that testified that consolidation and it definitely drives the prices. even when taking into account higher labor costs, even when factoring in the cost of living, you still have a very significant difference. it is an issue and it is something that we have to deal with. it is something that is not going to be resolved in the near future. i thought was important for us to have this discussion.

there is a lot of discussion going on around pension reform. it is directly tied to health care costs. we need to make sure that we have a better understanding of why we are where we are. this is not happening in a vacuum, which is a larger regional state context. this gives us a better sense of that. how to think the city officials have been working. kathryn testified and talked about some of the measures that have been taken by the health services system to address these issues. live heard from representatives that they have also taken some very important steps including the issue of narrowing the hospital network that they utilize. those are all things that have to be considered. the final thing that is very disturbing is that some of the

allegations that are found in the lawsuit and and was recently joined by the california insurance commissioner points to possible fraudulent practices, those are very serious allegations. in the complaint, they also point to an alleged practice of working with insurers and having provisions in their contracts were their billing will not be questioned. that leaves patients throughout the region very vulnerable. i of know of my colleagues want to add anything to the hearing. president chiu: a couple of quick things as the chair just said. a lot of our pension and health care benefit costs, the fact that they're going up as directly related to the topic of today's discussion.

we really need all the difference stakeholders to think as hard as possible. there was an announcement this year by various health care providers about efforts that would be made to contain the costs. a lot to applaud that and encourage its. we still have a long ways to go. hopefully this hearing is a step in that direction to really understand what the cost drivers are, in getting a handle on that. i think it is important to have all of the partners, all of the people, all of the players involved. which is why i think it was important for us to hear not only from these experts, but from labor and the hospital council. i think everyone's voice needs to be heard. supervisor campos: 5 would ask

my colleagues to continue this item to the color of the chair in the event that we have the opportunity to come back have lived in these issues? is there any other business before the committee? hong >> there are no items. supervisor campos: the meeting is now adjourned. commissioner brandon: meeting is called to order. >> approval of minutes for the

april 12, 2011 meeting. all in favor? item three, public comment on executive session. no one here. item four, executive session. >> so move. >> second. >> all in favor? >> aye. >> move that we reconvene in open session. >> so moved. >> second. >> all in favor? >> aye. >> move that would not discuss any of the items discussed in executive session. >> second. >> all in favor. >> please be advised that the ringing of and use of cell phones, pagers, and similar sound producing electronic devices are prohibited at this meeting. be advised that the chair may order the removal from the meeting room of any person responsible for the ringing or use of a cell phone, pager, or other similar sound-producing

electronic device. be advised that a member of the public has up to three minutes to make pertinent public comments on each agenda item unless the port commission adopts a shorter time on any item. items on the consent calendar. request authorization to advertise for competitive bids for contracts to 7452 hyde street harbor joint operations credit. 70, request authorization to award construction contracts to 7465-year maintenance dredging project, in the initial amount of $4 million and increase the contract amount by 10% or $400,000 in the event of unanticipated contingencies and subject to available funding and authorization to increase the contract amount to a sum not to exceed $50,000,901 -- 51 -- $50,901,050.

word a construction contract for bayfront park project in an amount not to exceed $1,579,450, and authorization for a 10% contingency of $157,945. commissioner brandon: can we have a motion? is there any public comment on this item? all in favor? any of those? resolutions 1124, 1125, and 1126 have been approved. >> item 8a, informational presentation of the draft st. paul banner criteria, which would govern the design, placement, and fees for the placement of st. paul banners within the jurisdiction of the port of san francisco -- st. paul banners -- street pole

banners within the jurisdiction of the port of san francisco. >> good afternoon, commissioners. i'm here to speak to you about street pole better criteria. the city currently permits debtors to be held in utility poles for limited periods of time to inform the public about events as described in the public works code. the court has also allow banners on the center median of the embarcadero road way and on jefferson street for the past 10 years. the city uses an adopted public works code to define and regulate how this is done, and we propose that the port adopt criteria similar to the public works code, all the criteria that respond to the public trust

requirements and unique waterfront conditions. currently, the court uses an encroachment permit process to issue permits to hang banners. for your review are the draft st. paul banner criteria, which would regulate the design, placement, and fees. the purpose of regulating street: banners -- street pole is to create a dynamic and colorful appearance to the waterfront that furthers the objective rather than enhance it -- by enhance the attractiveness and objectives to the public while minimizing the visual blight. the draft better criteria are, to an extent, modeled after the city's public works code. the proposed criteria are specific to the port in the following ways. the port's draft better criteria would allow banners announcing any event, which is defined as an activity of general public interest to san francisco residents or visitors to the

port of san francisco that takes place in the city or within port jurisdiction and can reasonably be expected to have an in-person attendance of 500 or more persons. for a single event or 1000 or more for a series of events. the criteria defined specific streets. in addition to the center median of the embarcadero road way and jefferson street. be executive director may approve banners on of the streets have become appropriate, such as a newly developed pier 70 area. the criteria described banners in three categories. just some examples on the graphics here that you can look at as i talk. a banner announcing an event to the port or its tenants, a public agency banner, which is announcing an event sponsored or supported by the city or its departments or other government agency, and that furt