this one was to do the m.o.b. in the second phase. many of us did not trust them to do the development. the concurrent obligations solve that one quite well. i am very satisfied with that. on charity care, i am pleased -- let me put it this way. you go through the development agreement and read the entire thing a couple of times and realize without question that exhibits e, f, and g are where the meat of it is. there 10 times for lehman to read and make sense of than the development agreement itself. and went over and over and decided i will have to rely as we often do at the planning

commission on what we consider credible experts in the field. i was very pleased to hear many of the comments of barbara garcia and also of kathriarin -- catherine dodd. i was pleased to hear she was in negotiations with the san francisco health plan. in my mind, those negotiations are extremely valuable. the city and county of san francisco, its employees constitutes a major employment sector of our population. that is the coverage for them. it is not just cpmc handlin one- third of the health care.

it is the actual major employer in san francisco that i am concerned with here which is our own city employees. i think ms. simmons gave an excellent explanation on the work force development. i was pleased with the comments from the various speakers from mission hiring hall and the manner in which they work with the contractor on this one, and through them with cpmc. we have to realize those obligations, although they are within the agreement, with cpmc, really end up with an agreement that concerns the trade unions who have spoken today in san francisco, and the contractors. that is where it rests. it does not really rest either

with the city or with cpmc. it rests down there, and the monitoring is going to be even more difficult because it is another layer involved and i'm going to also trust the next -- an expert in the field, ms. simmons because i do not have that expertise. i do appreciate the testimony that she has given to us on that. ok. at first, i questioned the idea of a $29 million in downpayment a system -- downpayment assistance for cpmc employees. the concept of someone working in san francisco being more likely to stay in the city then

move around, someone who owns is more likely to stay then someone her rents. so that have not been mentioned before. i think it is in -- an important consideration and it gives more weight in my mind to breaking up those numbers. i think that is a good thing. my biggest disappointment was from the gentleman from mta. all we get from mta here is we do not know. i am very sorry, that is just how it is. we have been getting on the van ness quarter -- ben ai have no a if you ever will. the van ness corridor is very simple in comparison.

extremely simple in comparison. to come and say we have no idea, we have no numbers, we have no figure, we have no time line, to me, borders on the ridiculous. i have to say that. and so there is no way to evaluate. make all the changes you want on streetcorners. i have no way to evaluate the transit impacts of this one. because mta obviously has no information whatsoever for us. >> if i might, commissioner, in somewhat of defense of our friends at mta, we do not have the transportation authority who is in charge of that planning. they are very late -- in the eir process. the problem is there is not a full funding agreement for that project yet. that is why we cannot

specifically say, here is the time line. i think we can get you that time line on the completed d.r. and the preferred alternative but it is not known when the funding will be available. commissioner antonini: we were not even able to get a figure on a timeline on when a preferred alternative would be chosen. ok. that would be greatly appreciated. >> i wanted to make sure, we will at the next hearing or before, get you every bit of information we can get on that. commissioner antonini: rick, i appreciate that. it is hard to evaluate the transportation element if we do not know what we're talking about. in my mind. i was interested to see that there is a vision and community -- visioning committee, that fifth wheel sitting out there in

limbo in effect and has been in all the discussions we have had here at this commission. one on one for the last eight years since they abandoned the idea of building out there in california. i have mentioned the idea of beds, which garcia was talking about. and commissioner borden was discussing the psych bed need, which is important in san francisco as well as the rest of the sea. i was interested in the concept of an urgent care center so again, i pushed the concept of this facility -- it is not a primary hospital, does not seek

-- need to meet the same seismic standards. it has been sitting out there for some time. it is sizeable. even has its own parking grudge. it does not disturb the neighborhood -- in that it would be a continuation of the same general medical use, and so i bring that up to say if you are going to have something out there, or have a need for additional beds for an urgent care center, i still have to push the concept there. i thought it was interesting, some of the speakers we have today that we have not heard from before. i really appreciated them, even mild friend -- my old friend jerry adams, as a san francisco

reporter, wrote on land use for many years and it was nice to see jerry up here as well. i know there is more to say on this one. we're going to have it in front of us a number of times in the future. what we have and what the secretary announced was on the agenda for this session is the initiation, and as much as i would have liked to have seen a finalization of this development agreement, i think we are pretty far along. and i think it is just about there. that is the impression i'm getting from everyone. so, although i do not do this to cut off any discussion,

really to put the matter on the table, i will move to initiate. -- mayor lmerely to put the matn the table, i will move to initiate. >> not initiate the d.a. commissioner antonini: no. what we are initiating is detailed in one -- 1b and c. which is what the secretary called as the item. >> which is what the secretary called. i will second that. commissioner sugaya: i have a list of things but i will hold off until next week. i have a couple questions, one for the project sponsor. cpmc is part of, according to something i have here, just to understand the structure of your

relationship with sutter health, it is part of sutter health west bay. that is part of the larger organization group. >> sutter health was babe consists of santa rosa, west bay consists of santa rosa and part of the larger network. >> and as reported in "the business times," the account is -- i just took that out of the newspaper. cpmc's net income was around

1484 summer. >> that is approximately correct. >> can you tell me what is the relationship between the 148 and 634? >> the 148 is proof -- part of the income of the organization. >> does sutter health , money back into -- pump money back into organizations or are you limited to using what the 148 or your own net income is? >> sutter health has an obligated group and they transfer money to sacramento and romany down. the money will come from center -- treasury -- central treasury in sacramento. commissioner sugaya: thank you. this is by way of understanding the 20 million -- 29 millions

and other obligations. >> there is a fundamental total flop in the way this thing has been approached. -- flaw in the way this thing has been approached. the 1% is in there to make sure if something happened cpmc -- happened to cpmc, we could sacrifice st. luke's. this -- it took a huge community effort and the appointment of a blue-ribbon committee to get them to accept the fact that they wanted st. luke's to stay open or we would have a new hospital under this particular arrangement. then what has happened is that st. luke's becomes a stepchild

of the entire organization and is not an integral part of the health system cpmc within -- part of the health system within cpmc. it of -- it would be part of the total health system package and if you wanted to apply the 1%, and say they could start to close things at the cathedral hill campus incidents such -- shutting down st. luke's, that is my fundamental problem. without the development agreement, i cannot initiate. commissioner moore: a wide to take a second attack -- i wanted to take a second tack. the majority of points remained -- raised by commissioner borden and miguel i do not want to

repeat. the implied commitment is like a one legged stool. why would you build an expensive facility with the 20 year commitment when cpmc promises to become a major comprehensive health care provider? that one which commissioner sugaya @ identified as a stepchild has a commitment of -- has identified as a chat -- as a step child has a commitment of 20 years. there are bed going down to 80. that is a pretty strong reduction for the future, more decentralized distribution of health care throughout the city of san francisco. you get a fine facility which probably has a life span of a building of 50 or 60 years, we

have some architects sitting in the room who could answer that question. the commitment is only 20 years. what is the city asking themselves to do after 20 years when the agreement you are entering into, you will be taking this offer of -- off of cpmc's hands to do what? >> i am not quite clear if this will be responsive but i will give it a try. to begin with, the point we're trying to make with the 1% operating margin is absent any contractual commitment, if any organization such as cpmc is on the brink of financial insolvency, they have the power to solve things however the can. they have said if we're there, and we do not have the operating

margin threshold out of st. luke's, we cannot do anything there. we do not know what they would do if there were about to go broke. they said in the unlikely event that happens, we need a tool so we have not lost the normal control over our facilities that we have as an organization want. that is the philosophy behind the operating margin. i will not rehash old stuff. we worked very carefully to make sure that is a very unlikely threshold to be met. in terms of what happens after 20 years, we're not required -- they're not required or expected to close after 20 years. the interesting thing to think about is it is an ironclad commitment and it would seem to me that using logic, the hospital would want to make st. luke's as profitable and successful as possible. they have to operate it and it has to have an emergency room

and it has to have the facilities opened by the state in acute-care hospitals. as long as they have got it, the logic is, let's make it work and after 20 years, why would they close it? >commissioner moore: the larger the hospital, the larger the possibility of making it profitable. the equipment which is [unintelligible] basic it has to work at 200% efficiency. almost a 24-hour operation of operating rooms with only eight beds, that is hard to achieve. it is almost impossible. which would mean that somewhere along the line, there should be another plan of 160, 170 beds being billed as an expansion to properly utilize the investment in equipment and infrastructure. since an economic model -- the

absence of a comprehensive health plan which we do not have in order to measure this against would leave many questions open. we understand that cpmc might want to leave on a contingency for profitability not being met at that facility. the existence of the facility as an investment which comes out of mutual sacrifice of the community and institution would require we have a contingency plan of how we look at this thing just in case after 20 years, this facility does not work to the investors' satisfaction. that is to say we're also looking at growth centers and community anticipation -- intensification in that part of town. in the st. luke's area and beyond. a major attachment would be in

that area. a contingency plan that the city would have somewhere in the back of their mind would have to make more comfortable for us to take the 80 beds as phase one of a future center. >> i would point out in response there is a health care master plan that is being developed and will be before you, i am not sure of the schedule. in terms of the long -- people should not take 20 years as meaning it will close in 20 years, that is a guarantee that is in the document. after that, i am beyond my scope in terms of hospital planning which is not something i can speak to. i can -- i do not know if someone from dph wants to speak. commissioner moore: perhaps director garcia could touch on it. this still leaves uncertainty for me to propose to support. >> i think a contingency plan

would be a good idea. there is a lot of concern in the community about what happens after 20 years. i have concerns about what happens after 20 years and i do not think that is a bad idea to think about what would happen after 20 years. it is difficult to think about what is going to happen in five years, considering what is happening in the supreme court right now. it is hard pressed to think about 20 years. i think that is what is the tension in the room, not knowing the future of health care. having a contingency plan for the city after 20 years is a reasonable request. commissioner moore: i will leave you whether or not cpmc has addressed an emergency response plan for cpmc and van ness quarter. >> from the city perspective, we have a responsibility to ensure their part of the plan and part of the response network. commissioner moore: would that

be part of the development agreement or independent? >> it is an obligation dependent. it is part of our hospitals search programs we have within the city, part of the department of urgency management and it is an emergency management process the department should be managed -- responsible for. commissioner moore: but ask one more time, is it possible for you to assure us the considerations of psychiatric beds are being addressed somewhere? we have firsthand witnessing the quex the city is under. all commissioners observe it. we cannot just basically say it does not exist, but i do think that a hospital of this size has to answer it. >>w we will explore that again. an area i think is important is the emergence need along with the community need. i feel that cpmc will be --

should be participating. commissioner wu: i wanted to be clear for my comments before. i do think that there is a need to come to the $73 million as a baseline for the housing. i want to echo commissioner miguel's comments around transit. there will be lots of employers coming to the cathedral hill site. there will -- people will drive if they need to drive. i think there needs to be more investment in public transit there. that is the only way i see that can alleviate the way traffic will happen. i would like to see more support from charity care if it is that last year. charity care was up to $100 million. i understand the comment that there is not that much control over who comes through the door but there is control over how much a hospital is accessible to people, how much a hospital is

welcoming or low-income. that follows on the discussion around what is the role of st. luke's and the entire hospital system. the last thing i wanted to ask for was the request from the public, see a special workshop on development. if we could do some sort of public forum to talk about development, it is difficult to go through. we have had a week with it. there is a lot for the public to ask questions about. commissioner sugaya: i would like to support commissioner wu's comments and commissioner miguel's comments on housing. the amount for housing and also to support commissioner moore and borden who have mentioned

the need to address the psychiatric treatment within the development agreement. specifically for this hospital. not talking about the program that public health may have outside that may result in something in additional or outside negotiations apart from the development agreement. we would like to see it as part of the development agreement in some form. i do not know what that is. i understand your priorities, you know what the priorities are. i would like to have that addressed. i support an additional workshop on the d.a. commissioner borden: i also support the workshop. we could have more public on --

understanding of the document. i also wanted to say that the hhs issue, i feel that assuming we approved the initiation today, a lot of these questions we put out there, we want an answer on prior to looking at project approval. i think it is very important. as it is, we are hamstrung around the land use decisions because of the nature of the development agreement. to the extent that the issues we have concerns about can be dealt with, hearing project approval would help for the best outcome. that is commissioner fong: commissioner antonini. commissioner antonini: i am generally happy with the development agreement, and we have to remember it is a development for a very specific, very large project, but it is not meant to solve all the health problems or other problems within san francisco, which are a larger subject.

we are cognizant of all these other needs, and these can still be addressed in the future. the development agreement can only do with so many things. i think it might be instructive when we come back to have some comparison to some of the things other hospitals of comparable size -- there are too many to compare them to, but you think about stanford, recently, has had approvals regarding the hospital down there, the babies hospital, i believe, and a fairly significant hospital which went through a process not unlike this. but we have to kind of look at what sort -- what development agreement was in place there. what sort of things were given to the city. i think you will find when you evaluate this against others that it is a very appropriate and well-written development agreement relative to some of the others that have happened in the past. those are some of my main

comments. i'm not sure what the, about a workshop will be. i do not know that it would be part of our format. is that what is being implied? >> in my opinion, it does not have to be at the commission, if that is what you are asking. i just think there should be a public meeting. does not have to be at the commission. that just to be clear and to be honest, we are looking at an april 26 date to bring the project back to you for action. this commission does not approve the development agreement. you make recommendations. i would compare it to a piece of legislation. what you often have in front of you, where you act on it with recommendations to the board. that is the same role you play on the da, which you have always played.

it is certainly within your rights entirely to act on the development agreement with recommendations for changes to the board. one of those recommendations could be that they have a public workshop of sorts as well. >> that might be the most appropriate. commissioner sugaya: i would speak against another session here, particularly if it bounces our approval beyond the end of april. i am not sure how our calendar is. if the rest of the commissioners feel that is of benefit, i am certainly always interested in hearing things, but it would seem that the board of supervisors is the approving agency, as was pointed out. certainly, those questions could be answered at a discussion before it comes before the body that is approving