members of the commission. i'm the c.e.o. of california pacific medical center is a city-wide integrated hospital system that has been serving san francisco's health care years for the past 150 years. and i would like to thank the mayor and its staff for all the hard work they have done and for their support to build two new earthquake-safe hospitals. my comments will be brief. the first informational hearing at health care delivery and seismic safety back in march and second hearing in design in may, cpmc is committed to the people of san francisco. we deliver 7,000 babies in a year. and we provide one-third of the hospitalizations and one-third of emergency room visits here in the city and we are continuing to work with the city family to

find common ground that allows our project to move forward without delay so we can continue to serve the health care needs of san francisco. now while we appreciate the city's draft development agreement in that it has propelled the process forward, the magnitude of what's being asked for is frankly unrealistic, by our math, the city-asked approach is $2 billion over a 50-year horizon doubling the cost of construction. we can't get anywhere near this number. stanford hospital, which is a project double our size was approved earlier this week and the ask totaled $175 million over a 51-year span, majority of which was provided to transportation benefits to stanford's own employees. we recognize the need to contribute our fair share to the city to address the impacts from

our project and provide health care to the poor and underserved. we need to be realistic. we are a not-for-profit hospital system and provide health care services in a compassionate environment that is supported by and stimulated by education and research. we currently provide before any of these asks, over$100 million every year in services to the poor and underserved. our project is about rebuilding st. luke's at a cost of over $270 million and building a new hospital to replace our existing california and pacific campuses in all in response to a state seismic mandate to continually serve the citizens of san francisco or be threatend with delicensing. we reviewed the city's proposal in detail and it does contain a framework for us to move forward.

and based in our review and discussions with the mayor's staff and i would call them frank discussions, we have resolved about half of those requests and the other half is going to require more discussion and little bit of flexibility. before we submit our formal response to the city -- president olague: i'm sorry, i have to ask folks that are standing to please -- those who are not members of staff and i do see a staff member there, to please go to room 416, which is the overflow room. unless you can find a seat in here. there are a couple of seats here. i'm sorry about that. >> before we submit a formal response, i want to walk through a few critical areas. one of our primary concerns is that many of the requested items and services are in fact for indefinite periods. we aren't sure what the future

holds but health care delivery is going to change significantly and become much more challenging for providers. the impacts of national health care reform in 2014 come with great uncertainty. we see ourselves as a steward of an important health care legacy and we need to make sure any agreement we reach provides an operational flexibility to respond to future health care needs. we want to continue to serve san francisco for another 150 years. our proposal will address our ability to respond to emerging challenges in health care. some of you may recall that our organization was actually in significant financial distress, nearly bankrupt only a short 20 years ago. as i said, cpmc believes in doing our fair share, but i have to suggest that a comparison of our efforts to very dissystem hospitals is unappropriate and frankly unfair. we recognize that we may not

have done our fair share in previous years, but our services to the poor and underserved, including charity care and other benefits are now very fair at more than $100 million a year and we would like to work with the city staff to find the appropriate benchmarks to measure our ongoing effort. in relation to targeted community health programs near our proposed hospitals, cp mmp c is a thoughtful and well developed program at st. luke's and we have a strong unique program at bayview. today we have focus programs in pediatric health in the tenderloin and our partnerships with glide and others and these programs are effective, accessible and we would say measurable. we would like to continue to assist these strong programs. and with the new hospital, we would like to add van ness and geary, which we will staff with

case management and social work resources to facilitate access to the uninsured and underinsured. we appreciate the role that the consortium plays, which is why we currently partner and support nine of the 10 clinics in that consortium. we provided $1.5 million in supports and services to the clinic last year and we would like to work with those clinics to take care of their patients. as you know, we are committed to st. luke's as part of our city-wide system of care and supporting san francisco general and san francisco city's health care safety net and to operating the hospital according to the recommendations in the blue ribbon panel. as part of these commitments, we are going to invest $272 million for the construction of the new

seismicically-safe and planning to the future of st.'s luke's. and we are committed to contributing amounts to the city to offset potential impacts of transit, pedestrian safety and housing. with that said, the current asks for affordable housing assumes a ratio that would be appropriate to a condo developer, but they are not appropriate for a hospital seeking to provide a community health benefit. we believe the number may be higher than our actual impacts and committed to work with the city to resolve these items. we agree with mayor lee that it is critical to reach a prompt agreement. to that end we will meet with the city staff and mayor and work towards finding common ground for all of these issues. my goal is to have an agreement in place prior to the july 14

informational hearing to ensure we can stay on schedule. many in our organization are questioning whether this project is feasible. a delay of this magnitude at this time would only increase the pressure for us to consider alternative solutions to continue our commitment in health care in san francisco and the greater bay area region. thank you for your time and we look forward to continuing discussions with you and the mayor's office. president olague: at this time, do any members of the commission have questions for rhonda or members of the m.t.a.? commissioner antonini. commissioner antonini: if i could ask a little bit about the employment goals and i'm very much impressed in support of hiring the people of san francisco. however, being a private employer in the medical field myself, oftentimes we give

preference to san francisco residents and tell new hires that if you move to san francisco, you have a lot better chance of being hired or maybe a condition of hire. i guess when you talk about a san francisco resident, how long do they have to have been a resident here and can they move as a terms of their employer to be counted as a san francisco resident? president olague: the way -- >> it is if you are a san francisco resident. all of the training programs that are run, the individuals are san francisco residents at the time we train. and generally at the time of placement. now if they move after place mncht did you to a number of circumstances, so about it. so it really starts at that initial time. commissioner antonini: thank you. i was more asking the question in regards to employment within the hospital, not necessarily those who are going through your

programs, but somebody who is just a possible employee of the hospital of which we want to have a certain percentage and i think that would be a little bit more flexible. >> if they are already employed, you know, what i'm talking about here really has no bearing. my work is more on new hires. i'm really talking about folks where there are potentials to bring in new employees that we want to try to ensure that a portion of those opportunities go to san francisco residents, not necessarily existing employees. commissioner antonini: i was talking about new residents but not necessarily anyone who goes through your program. you have to have a percentage of hires in your program and certain percentage of hires. residents -- >> correct. commissioner antonini: that clarifies that. i appreciate it. and i did have one other

question for the transportation folks. i light rail -- it would be better for the van ness b.r.t. if you want to mention -- answer questions about -- the way it's invisioned and i don't know if this is considered, some sort of tunnels to reach the middle of the street, which was not shown in the visual but it would be helpful for people trying to get to the b.r.t. or light rail hopefully in the future if they don't have to negotiate van ness avenue. i'm not sure if that is part of your plan. but as we move forward with this hospital plan, the most heavily congested area will will be in the mid-van ness area. so i would ask if you consider that or if you ever looked at that sort of idea.

>> improving pedestrian safety getting to the station platforms is important and important part of our design. that's why at each station platform we are including extensions of the curb to shorten the crossing distance from the crosswalks to the center platforms. we hadded pedestrian countdown signals and audible pedestrian signals at every location, not just at the station platform but every location. and we did not consider installing tunnels such as pedestrian tunnels to access the platforms. there isn't the right-of-way. for a couple of reasons. cost and the lack of right-of -way access and emergens on the station platform.

but we do think that the pedestrian crossings will be safe. we don't have any data supporting differential safety outcomes for center median operations versus transit station platforms at the side. ultimately folks who are making a round trip do need to cross van ness whether the bus is on the side or in the center. we will be monitoring pedestrian situations with any of the alternatives put in. but we do think the alternatives will improve pedestrian safety. commissioner antonini: and my final question is, i see the bus areas, the zones on the side, presumably there will be other buses running on van ness in addition to the bus rapid transit. >> great question. there would not be.

commissioner antonini: oh, good. >> these alternatives for van ness and i believe it is true for geary also, true for both b.r.t. projects. all of the transit would go into the b.r.t. lanes and that includes golden gate transit and will not only benefit all the transit services but will remove the conflicts between autos and transit. no one wants to drive in the right-hand lane because you will have a bus in front of you going in and out. commissioner antonini: that's very good and makes a lot of sense because you are losing a lane as i see any way. and right now the buses actually never make it into the bus zones but in the right-hand lanes. president olague: commissioner sugaya. commissioner sugaya: i do have a

question. i have always been curious and maybe i haven't looked at the plans close enough, geary b.r.t. when you get to van ness or before you get to van ness, splits between geary -- does that mean we will have dedicated bus lanes on those streets? >> let me ask the project manager for the geary b.r.t. address your question. commissioner sugaya: also along geary, only going to be one way west, which means people coming to the hospital will have to take -- walk a block to the hospital, is that right? >> yes, correct. we aren't planning to change the one-way configuration, simply to delineate the bus lane a little

bit better and make pedestrian improvements. for your first question, we are looking at what's called a transition area and specifically looking at the area between polk and franklin to understand how the bus moves from the side running in the one way cuplet to running on geary, particularly if it is the alternative, and that analysis is under way and not complete but we are looking at what the design treatment needs to be as well as the technology of the signal in order to make sure it happens both efficiently and safely. commissioner sugaya: is the e.i.r. -- this isn't related to cpmc, but are any of the alternatives being considered in the e.i.r. looking at making geary downtown totally bus rapid

transit without any cars and running buses in both directions. >> making geary into a transit mall? commissioner sugaya: yes. >> that is not being considered at this level of analysis. geary does have to be designed as a rail-ready configuration. we reserve the right-of-way and operating envelope and if that decision is made at that point, that is something that can be stut yesterday but not part of the b.r.t. project at this point. president olague: commissioner moore. commissioner moore: would we be able to schedule a separate meeting discussing both b.r.t.? they are very important discussions relative to cpmc but there are important discussions focusing on transportation and

operations and i have a large number of questions but i don't believe it is the right forum. and there are a lot of people sitting here with questions. president olague: i think we will have to do that. >> we wanted to give you a brief overview. commissioner moore: we could do that in a reasonably short time ranking member -- short time frame and focus on transportation? president olague: parking was alluded to but the intensity of use will be different than what we see there currently. so maybe -- they covered some things. we will want to see all of those issues looked at more. that would be great. that's perfect. we will work on monday to try to schedule something that will elaborate on those issues more.

and i have a question to miss simmons regarding the project. is this relying on good faith local hiring? >> yes. it falls under the first source good faith policy. we done i think with given the policy, we've done some added things because cpmc -- on the construction side in a p.l.a. agreement which gets to 30% by trade, which is harder than just a straight out first source. president olague: the city has move towards stronger requirements for contractors. i wonder if there is a way of strengthening that. >> we intended to get to that through the p.l.a. agreements and the key is the negotiations of the trades, the 30% by trade

is getting close to some analogy what we were doing with local hire. president olague: so then we will actually continue to talk about whether we can make something stronger than just good faith? >> yes. president olague: thank you for all the good work. clearly the board has moved in that direction. it would be debate to see if we could implement that with this project. if you could continue to keep us informed how those conversations are going, we would appreciate it. at this time -- commissioner sugaya. commissioner sugaya: we aren't asking questions of other staff? president olague: that's towards the end. that request was made earlier because some of the other staffers will be here for the entire hearing, so it allows us to hear from the public who have

been here for some time. we are are going to take us a 10-minute recess and there are two groups that requested 10-minute blocks of time, the good neighbor coalition and the physicians organizing committee. that will give them time, whoever is in the overflow room who is participating to make their way back here. and i'm not sure which group is going first but also some time to start to set up and after that, we have some reasonable request, accommodations of seniors. so they will go after both 10-minute blocks of time. we'll take -- and we will be limiting public comment to two minutes. >> commission is president olague: ok. the planning commission is back in session. if everyone can find a seat and be quiet and remember to turn

off your cell phones. thank you. commissioners, i believe we had just finished with the ã questions the commissioners had of the presenters that had to leave and we were about to start public comment from the two specified groups. >> we will be hearing from the physician's committee who requested a block of time. they will go first, so they can step up to the mic. and they will be followed by the good neighbors coalition. >> thank you, good evening president olague and commissioners. my name is dr. john rouse and i'm speaking on behalf of those who work in psychiatry at san francisco general hospital and the emergency service, where i have worked for 30 years. p.e.s. is the only 51/50

receiving unit for people deemed dangerous to themselves or others and brought in by the police and our job is to stabilize them and transfer them to appropriate facilities for follow-up. as i'm sure you all know, those facilities have been evaporating for many years, none more than the 52-bed unit closed by st. luke's in 2006. as a result, the patients back up in psych emergency and the patients winds up with 25 to 26 and patients stay there for days looking for an appropriate place to go. now, in the proposal that you have heard from cpmc you saw a lovely list of services all doubtless, important, useful by ms. withey. you heard from director garcia a list of the city's acts as far as mental health services, including an attempt to get cpmc to improve its somewhat disappointing record in charity care.

what you have not heard so far is a single word addressing the needs of the seriously and chronically mentally ill. as a matter of fact, that was brought up by our group at the blue ribon committee. those 16 beds do not serve the chronically ill as i try and present a patient to them. so what we have here is a proposal to create two new hospitals, two fully functioning emergency rooms and no psychiatric inpatient facilities on site. what is going to happen to

psychiatric patients who come to those emergency rooms or who are brought there by the police because psych emergency is on diversion 30% of the time? i can pretty much tell you, because i can tell you what happens at st. luke's, since they closed their psych unit in 2006. one of our members is an emergency room doc at st. luke's, and he says that on average of their 10 emergency room beds, one to three of them are occupied by psych patients who spend 24 to 48 hours strapped down to a gurney until someone decides to send them out. since you are the planning commission, i should maybe put this in transit terms. what they are proposing to build is two gigantic cull desacks for psychiatric patients, narrow way in, no way out. have to fight traffic upstream coming back out. >> so what can we do about

this? it's not adequate for the psychiatric needs of san francisco. we would request at a bare minimum, as a medical opinion, that st. lukas and cmmc should restore the 32 beds cut from st. lukas in 2006 with a 16-bed acute unit and five detox beds. we call on the san francisco planning commission to carry out its duty to represent the urgent psychiatric needs of san francisco residents and to reject the current plan until it addresses those needs. thank you very much. [applause] president olague: thank you. >> good evening. my name is dr. eugene gensel. i'm a retired physician who served this community for over 35 years and i'm a member of physicians organizing committee. i referred many patients to st.

luke's back when it was a full complement of services and was licensed for 227 beds. as the current census results from a decade of dismantling to the point where cpmc's planned hospital is a mere 80 beds, there are no fewer people living in the south market area than 10 years ago. they still suffer heart attacks, g.i. bleeds, strokes and severe asthma attacks. this is 2 1/2 times likely to die in the first year there as babies in the rest of the city. the hospital cares for patient occupations with a high incidence of work-related injuries, cooks, landscapers, truck drivers, warehouse workers. yet, the workmen's comp contract was not renewed. the clinic doctor was laid off,

the occupational and hand therapy services were closed. there was not even a casting room anymore for broken bones. the planning commission must ensure that these services are restored. bay view hunters point accounts for more children than any other zip code. the mission also contains significant numbers of children. before cpmc threatened to close st. luke's, the labor and delivery services were delivering 1,300 babies annually. demands on g.y.n. and peds can be expected to increase to approximately 1,400, yet, the plan eliminate inpatient pediatrics. the hospital used to maintain a seven-bed pediatric service beyond the two observation beds they are putting in the emergency room, we still need beds to care for those children after they are born. based on the diverting services like psych, occupational medicine, on codge, surgery and

others away from st. luke's to san francisco general or cpmc's north of market campuses, the can sustain is kept artificially low. you could say, sure, abeasy bed at st. luke's is adequate. that was the false logic used to justify closing the 32-bed inpatient psych unit after laying off three of the four psychiatrists and reducing the workload of the last one. dr. eugene lee to half time. without support for doctors who admit patients, the resulting census will remain low. 80 beds does not account for major disasters, such as earthquake or hini epidemic or a pg&e gas explosion. they were short