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 not pay for things that are not health care related and asking its employees if they'd want to return their watches to help pay for this. i found that reprehensible a nurse, someone who is not politically involved and is a regular person who had a baby and this is what she heard from her nurse. i thought it was a terrible public relations campaign to have a hospital try to pit the city against employees who have worked somewhere for a long time and asking them to return a gift they've got phone their years of service. even if it's a joke, it's inappropriate. so i find the overall public relations campaign around trying to ville phi the city's asks if they were completely unreasonable and then to the overall impact and principles we're here to uphold would ask you to do is a bit disingenuous. that's where i'm going to leave it.

applause. >> commissioner fong. commissioner fong: and i've got to follow that. you know, as i tend to do, i'm trying to keep my comments broad and long-ranging and i feel like part of our responsibility as planning commissioner is to think really what's best for san francisco in 20, 30 years out. so i'm supportive of a hospital for sure. we need to get our hospital size extremely upgraded. but it disturbs me a little bit and i think all members of the community in different groups that have come out and spoke and is a little concerning how far apart people seem to be at this point. hospitals to me really is a be places of healing and i don't get that sense it's happening right now. i also understand that -- and feel that hospitals should be part of the daily fabric of a community and interact with the community on a daily basis but their primary function is really to heal those who aren't well and hopefully none of us

find ourselves there but when we do go there and it's our turn to be in that bed, i want a hospital that's successfully running and maybe one profitable that might be slightly overstaffed or adequately staffed and when i push the help button someone will be there. i'm sympathetic to the nurses. i know you're trying to provide the best service as possible for your patients. and you wouldn't be nurses without having that care and passion for human life. so i'm going to keep it broad and hope that over the next few weeks or when we see you next things get a little bit closer together. again, i do feel it's a very important project we need to get done. i also don't think we should break the bank and hit a group too hard so they can't operate when we actually really physically need them in time of need, whether it's ourselves or our family. those are my comments and i'm looking forward to a closer discussion next time. >> thank you. commissioner sugaya.

commissioner sugaya: ok. thank you. i'm in agreement with commissioners borden and the others. mr. miguel and also commissioner fong. the healing reminded me, i was just taking a look at the mission statement for cmpc while he was mentioning healing and it doesn't mention healing. it's a nice statement -- no, no, i didn't mean to belittle him but it reminded me i should take a look at this and it's a nice statement but the one thing that's kind of interesting is that it ends by saying that after providing cost-effective health care and being compassionate and respectful, having compassionate and respectful environment, those are supported and stimulated by education and research. for me it would have been much more a better statement if it

had said it had been supported by the community that it serves and think a number of us are having some issues as well as some of the testimony that was given. charitable care. i don't think we should go around and compare cmpc to st. fran francis and others and those are nice statistics to look at and have comparative things but as commissioner antonini pointed out some other hospitals are different animals and maybe are apples and oranges. but from that standpoint the city needs to drive what the level of care should be and not rely on other examples, stamford or marin or whoever else. and that's where i think we're lacking that overall kind of health care master plan that has been discussed earlier this year and earlier last year and since we don't have one, we don't have a kind of mechanism

to kind of hold all the hospitals to the fire in some respects. so i think that if we can kind of through health care and through the mayor's office look at that and, you know, i'm quite comfortable with the mayor's numbers though sometimes i think we should operate from a position of strength. and that's why i don't like the word "ask." when i saw that in the paper, i thought ask, ask what? we should be demanding these things. they should be requirements. cmpc should be using the word "ask" because they're asking the city for all these concessions. they're going to try to get us to increase the height along van ness avenue from the current 165 feet and double it. you know. and as commissioner borden was saying, i had the same thought, you know, who decided that that site was the best site given all the zoning, transportation,

and other issues surrounding that particular property? and didn't anybody ever go to the city and say hey, you think that the commission and the board of supervisors and everybody going to really give us another 160 feet along a corridor that's been highly planned for a number of years that have all these requirements for residential and everything else and setbacks and whatnot? no. maybe you did and maybe the then planning director, whoever it was, said ok, yeah, maybe it will work. but i don't know if that happened. anyway, mental health issues and psychiatric beds. i think those should be part of the development agreement. and maybe you should start thinking about how much that increase should be if there are indeed 18 beds or whatever was mentioned. and i think that -- and i don't know if this is true, the planning department or the mayor's office, but we heard a

number of people testify that they would like community benefits. i know the mayor's plan have what are called community benefits on an ongoing basis. the majority of it, $32 million versus $1.4 million, are all health related community benefits, which is fine. and then $1.4 million is identified solely for transportation. i don't think that's what the people from the tenderloin and -- were talking about. and my understanding has been from their representatives of an extremely difficult for them to get p, you know, what they want into the mix of things. so whether that happens through the mayor's office or whether it happens through planning staff, i would like to see some movement on satisfying or at least bringing them to the table to discuss what it is they specifically want. because in the testimony one of the -- i guess one of the

disappointing thing to me is they didn't get down and say this is exactly what we want, they mentioned community benefits a lot but i didn't hear anything specifically but maybe, you know, the level of testimony here is kind of such that that's how people present things. but i think they must know what kinds of things they would like to have as part of a community benefits package that would be part of the development agreement. so i think before that draft comes back, i personally at least would like to see something along those lines in there or at least we can have some report back that said there was a discussion about it, and you know, the community still is not happy with it or whatever. p so -- i think that's it for now. >> commissioner moore. commissioner moore: thank you, commissioners, miguel, borden,

fong and sugaya. i think we're all building on the similar line of arguments. i look at cmpc really more like a development transaction, i have to be really plain about that. because if cmpc would indeed not eliminate three additional or four additional institutions, but would build a hospital just on their own for the very purpose which they seem to be postulatting would be fine for me. but since they're choosing to somewhat turn the existing health care system in this city upside down, i think we have all the right for every possible scrutiny and every possible ability to ask what normally a developer would have to do is build a large, oversized building for all the reasons which ms. hester and

all of you have pretty much outlined. so i feel we're in a strong position, not at all intimidated by making it clear that the expectation of the minimum of what they should be asking for. the transformational impact of the district or phenomenal. you do not have any idea, although we have the health commission standing side by side with us but the long-range effects are in health care delivery and equitable health care delivery for the city as a whole including all of us sitting in this room. i with an to commend the staff for an extremely good job today. for the first time i'm sitting here and all the questions to which i wanted like statistics, illustrations, comparisons, the way it is, the way it could be and what's in between, these questions are clearly and

actually quite clearly answered. some of the things, until you see them explained as today, you don't fully understand because words can be interpreted a number of ways. the facts are here. and that is what we ultimately need to look at page by page relative to what we're asking for and what we're willing to give. and at this moment based on whatever today, and i was going to take a broad version of hostile comment, i think we haven't even asked for enough, because some of these statistics and some of what's explained in here seems to be somewhat unresolveable to me. . there are big, big questions for me. i had a discussion earlier and was talking about mr. rich and perhaps the two of you could come to the lectern if at all possible, the issue of psychiatric beds was brought to our attention in our last

meeting, the day mr. rich issued a statement, a draft statement to us about the mayor's list which was developed at the time and i called him back and said please don't forget the issue about psych beds which again is standing big in the room today. . and speaking about it, i don't want to paraphrase and maybe you could explain it to the rest of the commission, if you don't mind, that we might need to take a step back on that issue and reopen a more informed discussion about why it has been kept somewhat in the corner. you always have to have the ability to keep people out of the psych bed.

and we just opened up an urgent care mental health center on door street two years ago. >> it's not only an urgent care center but have 20 beds of an acute unit. we wanted to do that at the front end. for full disclosure, we also cut psych beds in the last several years due to our budget issue. we are responsible for the mental health status for all of san francisco. every hospital is, also. because as we go on diversion, these mental health clients do get diverted. we have to work closer with the hospitals and ensure people are brought out of those acute units as soon as they can because of the issue of cost and being able to continue to provide that service. and we have to have places to go after they leave the hospital. if we're going to ask cmpc to look at it not just from a psych bed but the comprehensiveness of those beds. as a background to these beds, i wanted to at least from the research i've done in terms of

2005 when these beds were closed, it was brought at the prop 2 hearing at the closer of the 32 bed at the behavior health unit st. luke's the health commission passed a resolution finding it would have a detrimental impact on health services of san francisco. the testimony that was received indicated the decision to close the unit was not a sutter and cmpc decision but was a st. luke's decision prior to obtaining that and st. luke's is ongoing financially distressed low volume changes in the community standard of care. if we are going to ask for that, i don't have an opposing issue regarding additional psych beds but we do have to have the other complimentary services attached to that or what we end up doing is keeping people in the hospital longer and that's not healthy for clients either. so i would look to talking about a community health care of excellence and they brought

up the tenderloin clinic and that might be the place we can do the outpatient programming. if you're going to ought inpatient beds, you have to add the rest of them. you can't just have an inpatient bed by themselves or we're not doing the right -- our goal is to always get people out of the hospital as soon as possible and keep them in the right level of care and commu feel is healthier for individuals. commissioner moore: i appreciate you stating it and if there are other questions, we can continue the discussion. >> we'll continue to work on cmpc on the issues. commissioner moore: i'd like to make one more point and that is about the projected use of the newly building, seismically upgraded for st. luke's. on that building, you meant 200 years, i assume. i don't think we build a quansa hut or other building for 10

years let alone anything else and is in itself really a -- it's almost laughable. you don't build a home -- you can build a doghouse for less than 10 years, let alone building a hospital for 20 years, that just doesn't have any credibility. and i would appreciate if that number gets updated but there's a real resemblance of commitment to building a hospital which brings me to the point i am still very uncomfortable about the size of st. luke's. i think it is undersized and i believe that the general overall shifting in numbers does not have credibility. [applause] >> i want to thank staff for such an excellent presentation and also dr. garcia and her

assistance for remaining here. frequently we have these hearings and department heads don't stay for the entire hearing so we appreciate your willingness to stay and listen to concerns that were raised at our round here which frequently intersect with health, even because of the nature obviously of the project, it's hard to separate the two. i think the whole mental health issue is one that the city has to look at comprehensive itly, and that is not our per view here, but as it relates to this issue, certainly, it is something that we feel compelled at least to learn more on the delivery of those services to people in this city, particularly those who are indigent and not able to be insured. i work next to six street, so i encor