for its least 20 years. 20 years is nothing in the life of a major medical institution. for meat, and minimum of 35 to -- for me, a minimum of 35 years or 50 years is what is required. we know the residential expansion is going to shift population to the south, and we only have sf general and st. luke's to take care of it. from their own press release , cpmc plans to be in san francisco for the next 150 years. next, begin construction of st. luke's prior to constructing cathedral hill and operate cathedral hill only after opening st. luke's.

only logical. the construction time is less than st. louis, and the need is even greater. concurrent on new operations are absolutely essential, because they argue that the specialty care to be provided is needed to supplement what will not be available at st. luke's. they have to be concurred. next, implement the recommendations of the blue ribbon panel. i think we have gone over this, and that is pretty well-settled, as well as i can tell. the office building should be operating no later than three years after the hospital opened, and we continue to refurbish the building. i have a slight disagreement with the mayor. i fear in my mind for years is too long. i would like to see that open no

later than two years after the hospital is constructed at st. luke's. i think it is vital to the st. luke's operation, and i am going to have more to say about that later. the next section is the charity care and community benefits. to provide charity at a level consistent with nonprofit hospitals in san francisco for as long as they operate. absolutely. cpmc's record on charity care is abysmal. that is the nicest thing i can say. the average unt for nonprofit institutions is 2.36% of revenue. cpmc stands at less than 1%, around 194 or 499.

cedar siding akin los angeles -- stay . around9 -- stands around .94 or .99. in his press release, he is saying is $2 million. that sounds like a pr firm told him to use that. i year agreed the only way to arrive at that number is to project forward 50 years, so if i took his own computational message, how about the way back 50 years and computing the amount of charity and community care they would have to provide san francisco in that time to be a good citizen. i have not done the math, but i think they would be so far in a hole they could not climb out of

it in 50 years. next is providing outpatient services consistent other private hospitals in san francisco as long as they operate here. no question, and that same computation going back 50 years would provide another interesting result, and last, a partner with san francisco community health clinic consortiums to expand care for low-income residents, focusing on surrounding neighborhoods of cathedral hill and save lives, continued active participation -- and st. luke's, continued active producer patient. i do not see a problem with it. it does not need any further explanation, but i want everyone to understand what we are really

talking about in this section. all private nonprofit hospitals assume a social obligation to provide community benefits and the public interest in exchange for their tax-exempt status. this includes charity care, metical, and programs for the communities they cpmc servethey -- they serve. cpmc is nonprofit by illegal -- by a legal entity. the next section is housing. contribute $4.1 million suit in the wake of -- to moh with rent- controlled units being displaced, contribute 73 million

for the 20% inclusionary portion as required, as they did two or three terms, "as required by special use." this is totally consistent with the requirements for any developer in the special use district, and cpmc is nothing, despite his protests, nothing more or less than our real estate developer here. that is exactly what they are. the next section is workforce development, local hires for the facilities, at least 40 new hires each year.

30% san francisco residents. i year they had a slight disagreement with the mayor. i believe the requirement should be for at least 10 years if not longer. the last thing is pedestrian safety. one of dozens cpmc -- of the major arguments is transport plans. it is only consistent with their location concept to enhance the major corridors. 25 cents, depending on peak times, to of least 60% of employees.

if you increase traffic, you should be required to mitigate those problems. last, an $11 million for streetscape and the tenderloin as well as about 7 million in the neighborhood. ahoy this is the exact same thing as other transit-related items. this calls for street improvements as needed in mitigation. -- and needed mitigation. is this out of line? not as far as i'm concerned. take a look of stanford hospital's expansion proposal, where they have $2 million only for transit improvement. transit improvement calls for only $1.4 million common -- $1.4

million, plus the fact that if you compare the locations of stanford hospital, where it sees as a teaching hospital region where it sees as a teaching hospital and who -- where it is in the middle of a teaching hospital, you will find a vast difference. the plan to rebuild conquered crete, this is a state entity, exempt from local land-use regulations. it is going to contribute about 60 million against $1.5 million mission they produce. before i finish, three other quick items regarding the project. i am still not completely satisfied with st. louis's proposal being large enough, and

i have constantly mentioned there is additional, nearly vacant land in the and media it area, which i feel should be used -- in the immediate area, which i feel should be used to enlarge a hospital. i still think that can be done. number two, and it was mentioned tonight -- there is a failure to address the bed. lastly, there is an item that has not been publicly aired, and that is the disposition of their california campus, the oldest children's hospital where i was born. i suggested it might be considered a skilled nursing facility bed, operated by some

entity. i have seen increases, but so far this large campus in the middle of heavy residential neighborhood and commercial districts has been without neighborhood involvement. it is inconceivable to me that serious thought has not been given to its disposition, and i am confused as to why sutter every statement they've made to me is we'll get to it later. as far as i'm concerned, the development agreement must include mention of the california street campus or will not be complete. it isn't invisible, not going away, and in my mind is an integral to the total process as are the davies and pacific emphasis. and that's enough for me. [applause]

commissioner antonini? >> i read an editorial in today's chronicle i'm in agreement with and was written by vince cart any who was a labor -- vince courtney and is very supportive of the project as i think we all should be. we may be different on parts of it and points out what is really essential. and i think i speak for the vast majority of patients at cal pacific and those who pay for medical insurance or their employers. i personally go to kaiser but they have the ability to go to where they want to and choose their own doctors. and if we don't build state-of-the-art hospitals, there's a good chance many of these people will go elsewhere, even outside san francisco.

ened you -- and you hear of people who go to other hospitals because they get care for a veert of -- variety of reasons. it's essential we do this to keep our employees employed, to make health care accessible to our san francisco residents and also for the 35% or so who come from outside san francisco for care at cal pacific. so i think it's really important that we compare this hospital with hospitals that are comparable to it, not hospitals that are not comparable. when we do comparisons we have to talk about stanford, mills peninsula, john pure and, you know, not compare them with hospitals that are not comparable with them. i think chinese, as we've dealt with, is a fine hospital but an entirely different thing. and in fact cal pacific provides some of the subsidy to help run chinese.

so i think we have to look at this. and as far as charitable care, my information is that in addition to the $100 million in charitable care dr. browner spoke about, if you add in the medical care, whatever the percentage, it's at least another $100 million. the $200 million they do in charitable care a year is comparable to that which stanford does. when you say stanford is in a different place, there's a lot of challenges in that part of the peninsula as well, east palo alto, menlo park, there are many people with needs for charitable care there as well. we have to look at that. as far as the housing piece, i don't believe that you should hold an institution to the same rules of the van ness plan you do commercial development. i think we can exempt it by

c.u., and as was part of the mayor's plan, we will exempt it by c.u. the question is, what should be the price that they have to pay? and i think that, you know, the $73 million is an's -- is an unrealistically high figure. whatever ends up being negotiated is important but the important thing of what's negotiated, it should be applied as the nexus of the impact that the hospital has on the area. and we should -- this is a great opportunity to provide middle income housing that the city does not build, housing for nurses, housing for doctors, even though nurses, i understand in the sutter system, i may be wrong, the average salary is around $130,000 per year. well, i may have the wrong information. i may have the wrong information. >> how can you think that? >> ridiculous. commissioner antonini: i

believe i have the floor. whatever the salary is, and what the salaries of doctors are, it still is not enough to afford housing in san francisco. and i think that this is the whole problem we have. we have a situation where people are making too much to get affordable housing to be included in inclusionary housing but not enough to buy their own housing. and so by targeting whatever this number ends up being, and whether it's $73 million or whether it's a lower figure, it doesn't really matter. it should be targeted specifically by the mayor's office of housing towards providing housing in the van ness corridor that will address the housing needs of the people who are going to be working at this hospital. so i think that's really an important feature and there are also some entitlements we have already passed that are sitting, not being exercised like sutter and van ness, that glass box that should be demolished as soon as possible. there used to be a theater.

and maybe there's a way that the mayor's office can work with the developers there and help to build this work force housing in that area that will address our concerns. so i would -- whatever ends up being the issue here and then, you know, that's where the money should be targeted. as far as subcontracting by cal pacific, i think while there have been suggestions of exactly who they should subcontract with for charity care, i think they should be able to make their choices as to who they're going to subcontract with. i think we've talked about the skilled nursing beds. i think we've talked about the subacute care. i think there's agreement on that. i am happy to see that. i do have concerns about the psychiatric bed situation. i understand cal pacific has 18 psychiatric beds. i don't know how that compares with other private hospitals in san francisco today.

maybe they have more. pain they have fewer. but whatever it is, if there's a possibility of adding some more as part of the plan, it would not be the worst thing, so i would be supportive of looking at that type of situation. in terms of a lot of our discussion tonight in regards to labor agreements, i mean, my understanding, correct me if i'm wrong, but as city officials, we cannot make labor agreements. and so i don't believe that's before us. i hope that there's the ability for, you know, the nurses and other parties who want to work out things with cal pacific are able to work it out but that can't be part of our agreement. in terms of stanford, i did do research on comparisons and disagree a little bit with commissioner miguel on the numbers. my understanding is stamford's contribution to the city of palo alto is in the neighborhood of $170 million.

$70 million now and $100 million over a period of years up to 40 years. and what they're doing a lot of this is on giving cal train passes to their employees and representing a lot of it. there are a lot of other good things they're doing, too. and that is actually a larger project in terms of dollars and -- than is cal pacific. the cal pacific project, as you've heard, it's about $100 million, $1 10 million, i believe, in the current ask. and if you pro rate year by year the additional charitable care and other things that have been proposed in the mayor agreement, it could add up to $700 million or $8 unmillion. as stamford did the math, they're doing it the same way here. i think dr. browner made a good point, we really don't know what the future may bring and we really have to look at this and see what is appropriate? are we comparing apples to

apples? are we comparing hospitals that are not really comparable to cal pacific for charitable care. what about kaiser was not on the list that was -- i understand they had a fairly low charitable care, i'm sorry to say that, but that's what it looked like earlier and the same was true of a couple other hospitals that weren't on there. i think we have to look at gross numbers rather than percentages. i mean, how many -- in dollars, how much do all these hospitals contribute to charitable care? and as was mentioned earlier, the medical is the tougher thing because if your attending doctors do not accept medical patients which is harder to do, then it's harder for them to get that percentage of medical patients up. i'm perfectly willing to ask that they provide as much charitable care as possible, but i think they should have as much discretion as possible in how this is -- is rendered and what form it takes.

and let's see. finally, the transportation part i think we dealt with that earlier. there were some comparisons on the amount of the ask and they were trying to compare it to park merced and we're dealing with entirely different entities and park merced, if you get more actions from park merced, they raise the price of the condos they're going to sell or raise the rental amount and someone will buy them. if we make the ask higher and higher for cal pacific, somebody has to pay it, and it's the private individual with private insurance. the rates get higher and the money doesn't come from nowhere. so i think we have to make these asks realistic. and we have to address what's appropriate. remember, this is a different hospital than is a different situation with ucfs or chinese

or even to some degree with some of the catholic health care west hospitals, though a lot more analogous to them. so that's a summation of my feelings. one other point here, and this is the continuing argument for increasing the enrollment, or the size of st. luke's. everybody says there's only one other hospital south of market general which is undergoing extensive addition right now. there also is another hospital under construction at mission bay which nobody ever brought up but will add more bed there is and it's important we're getting that. so i think that, you know, we have to look at actually the location of the present hospital site at van ness and market is more accessible to people south of market and the southeastern part of the city than it is when they're now going to children's or to presbyterian, the other two cal pacific campuses.

so you can't have it both ways. it's either more available to the population, it's more centrally located, and then on the other half, there's the argument oh, we don't want it because it's disturbing our neighborhood. well, you know, it's got to be one way or the other. and finally, i think that separate groups have asked for separate approvals. i think the negotiation should go through the mayor's office and that is how the settlement should be made. and because otherwise, you start every group could come up saying that it's our neighborhood that we have the right to be answered, and i think you're setting a bad precedent by doing that. i think that they have a voice just like all the people who aren't here who live in the same neighborhood and, you know, have rights and have desires, too, that are not necessarily represented by the groups who spoke. so, you know, that's my feeling on it. i think that there's work to be done, but i think we have to look at it in a realistic way,

and i think that it's essential that it get approved, it get approved in a timely manner and hopefully we can get the mayor's office and cal pacific to reach an accord and all the stakeholders can, you know, find something they can agree upon. we all should be supporting this hospital. >> commissioner borden? commissioner borden: my sentiment more mirrors that of commissioner miguel. i think there are a lot of issues with this project. i'm very disappointed by the press release cnpc sent out and by the comments. i think it's very frustrating when an entity decides to purchase a piece of land, they choose the location, they choose the land, they know the zoning, then they come to us and say oh, but we're different and we should get all these things. you can't hold us accountable to all these other things. i think it's very disingenuous when you have that approach.

it's one thing when you're working with an existing footprint of land you've been in, like park merced. it's a whole other thing. when you have an opportunity to acquire a site and consult with a city prior to acquiring that site to pick a place that has more of the infrastructure, the zoning that you need for your project. but that is not the approach we're looking at it. so now we're told we picked this site, this is great for us so it has to be great for you. well, you know, we're trying to make it great for us but the problem all along the way, there's always roadblocks. you couldn't make it more difficult. whether it's the labor issues, the neighbor issues, there's no one that cnpc has adequately dealt with in this situation and i find extraordinarily frustrating. if i were to do a major development project, i would make sure i shored up my supporters and my base and did good things in the community prior to coming to the commission and it's really shocking to me there are all of these unresolved issues and many of them are very substantial. you know, it's not our place to get into labor but it really

does -- hearing this issue, i know too well about the issue of unions and different hospitals and sites and seniority and all those sort of things and i know that's not for us to decide, but i know what those issues are about. and it is not a good thing in the welfare of the city to have those issues existing. it's not my place to decide how that is resolved but it's not good for the health care of the city. it's not good for the general plan and the priority principles we care about to have those issues out there. it's also not great to have the transportation impact and the transportation issues we're talking about which we're trying to figure out how to mitigate resolve the issues. we can see the mental health issues. the number of people on the streets these days, mental health issues that escalated on our streets are very visible right now. so to tell us you cut your psych beds because they're not profitable, we know they're not profitable.

but we still have the priority for the city we have to figure out how to deal with. so we have to seriously look at mental health. i'm personally very passionate about this. my first job in department of health and mental hygiene. i worked at a mental institution and i saw the transformtive ability when you work at a facility that provides care for people. i was not in the high secure facility but more of a campus site facility were people were able to move freely about the campus and there was a canteen and reward system and people lived semiindependently within a campus and saw the way people were able to rebuild their lives and rejoin society. and it's a shame generally in california we don't have those things. that's been long gone. but the fact we don't have necessary beds to be able to separate out those with severe mental health issue with those with minor mental health issues that could be dealt with and treated and returned to the society is a major issue and cnpc which is a major health care provider in the city, i

think it's a 1/3 of our medical infrastructure, it's important as a 1/3 of the medical infrastructure that cnpc is dealing with the issue and still we haven't addressed even with what the mayor has asked. i'm also concerned about the fact there doesn't seem to be any forward momentum or progress on all of the different issues that have been raised over time. you know, i've been in, i don't know, six hearings at least on cmpc and there's been no resolution. whether it's something as minor as the daniel burnham people are talking about, etc. i feel like why is there no further momentum on these issues. if you're serious about a project approval sometime this year, i would think you would be trying to resolve these issues. i really can't understand why i'm sitting here having the same conversation i feel like we have every single hearing that there's no resolution of those issues and then we haven't even talked about the

major land use impacts which is why the mayor's asked that it's important you have to pay for. the impacts are the impacts a project has in a particular place. it's the impact of building a major hospital on the 101. we have to talk about these issues and i guess it floors me we can't get past even the smaller issues to tackle the larger issues. and that's really what is frustrating with me -- to me. the ad campaign, let's rebuild cmpc and more recently a patient at the california campus was told by her nurse that apparently after you're at cmpc a certain number of years you get a rolex watch. and apparently after you've been there that long -- and they were asking the patients to consider -- the nurses to consider returning their watches because the city is making these unreasonable demands and making the hospital