good morning, this is a special meeting of the planning commission for thursday, april 12. before i take role, let me just repeat some of the ground rules. for those of you who are in the room, again, if you leave your seat, you have lost your seat. the sheriff's department will let someone else come in and take back seat. turn off your cell phones. there is to be no extra talking to because we need to be able to hear. this is a crowded room. the commissioners need to hear what is going on so they make -- can make informed decisions. for those of you who are in the south course, as we call your name, we will give you time to come upstairs. once you come in, just let the sheriff's department know that your name has been called, and you will be allowed to come in so you can speak. with that, roll call.

[reading roll] commissioner cindy wu is absent today. commissioners, i am going to -- i need my glasses. ok, commissioners, the special calendar today is all about this, and the commission will hold one hearing for the public to provide testimony on all items listed below, including consideration as to whether to certify the eir. following the public hearing, with they will consider action on certifying the final environmental impact report following action on that item, the commission will consider all other actions and entitlements with the long-range development plan project. i am going to call all of the items, commissioners, which includes all of the components, and then we will have staff

presentation followed by the project sponsor and their consultants, followed by the request for blocks of time, followed by special accommodations, followed by the general public. item one is case number 2005. 0555e, the california pacific medical center long ridge development plan. this is a certification of the final environmental impact report. item two, case number 2005.0555, 2004.0603, 2009.8885, 2009.0886, 2012.0403, the california pacific medical center long ridge plan development plan projects. item 2a is the proposed adoption

of the findings of the california development plan act, item 2b is the campus, and c is the campus amendment, and 2d is with the planning to a policy is with section 101.1. 2e is for the amendments and a request for the planning code text amendment, to ask if they request for a conditional use for f, and 2g is the statements request for authorization, 2h is a consideration of the general plan referral, 2i is the

cathedral hill campus, a request for a planning code text amendment and a request for a plane could zoning map amendment, 2j is the van ness campus, requesting for a conditional use authorization, 2k a request for the office of development authorization. 2l is cathedral hill, consideration for a motion for the general plan referral. 2m is the davies campus request for conditional use authorization, and 2n is also, ok, this is the medical center long-range development plan, a request that the board of supervisors approve a development agreement pursuant to chapter 56 of the san francisco administrative code. commissioners, with that, the matter is in hands of staff. the staff presentation.

>> good morning, president fong and members of the commission. this is the first item before you. planning department staff. the first item before you is the certification of the final environmental impact report or eir for the long-range development plan. certification of the final eir is required before any action can be taken. a copy of the draft eir certification motion is before you. the draft dnr was published on july 21, 2010. the public hearing on the draft was held in september 2010. it closed after a 90-day comment period in october 2010. this was published march 29, 2012. you also have before you a supplemental informational packet for today that contains a

sheet that presents minor revisions to the eir related to the clarification of the significant threshold for analyzing interior noise levels for nonresidential uses and correcting the eir text to say that the noise level standards for the residential uses is 45 instead of 45 of another measure. this change does not present any news in the information and does not result in the determination that any news in the impact would occur or that there would be an increase in the severity of previously disclosed in packs. -- impatcs. -- impacts. yesterday afternoon, we received two letters on response for the documents. the first comment letter, april 25, 2012 letter submitted by engineers raises a number of

comments related to potential traffic conflicts on the alley with the development of the cathedral hill campus. these comments are substantially the same as those that are raised during the draft eir, period by the same organization, and these comments have been fully responded to in the document. for example, 43 from the engineers, in the document, which was submitted on september 26, 2010, and the response to that is 22 starting on page 3721 in the document. accordingly, no new information is presented, and no new issues were raised in the april letter from the engineers that change the conclusions of the eir. the second, the letter we received was the april letter submitted by the california nurses association which raises a number of comments related to

population, housing, and employment, air quality, greenhouse gas emissions, and hazardous materials. these are substantially the same during the draft eir by the same organization. these comments have been fully responded to in the document. please see the comment letters and the document, which are submitted by the california nurses association on october 19 and 20, 2010, respectively, and the comments contained in these letters can be found throughout the documents. no substantive new information is presented, and no substantive new issues have been raised in the california nurses association, a letter that would change the analysis or conclusions. during the draft eir hearing,

commission members and members of the public raised questions and comments which we have tried to fully address in the document. i want to take a few minutes to highlight our responses to the issue, based on the letters received and the testimony heard which appeared to be of particular concern to the commission and members of the public. some commissioners have questions about the project impact on housing. especially of affordable housing, and with the van ness special use district 3 to 1 housing requirement. as discussed in the land use and planning and population and employment subsections and the response document, starting with pages the environmental analysis did not find any significant impact related to housing, and there is no change to the finding in the document. i do know that through the development agreement, they have

agreed to make a contribution towards housing. we also have from the mayor's office of economic development and the mayor's office on housing which can speak more about the housing proposals in the development agreement. we also received a number of questions and comments about the need to discover additional alternatives other than the ones analyzed in the draft eir or what was contained in the er, such as alternatives. the document addressed his comments in detail in the alternative subsections. as explained here, the study revealed alternatives that would affect the significant or no impact on meeting some of the project sponsor all objectives. document -- the cnr document

determine this would not differ in scope in connection with the alternative, and therefore, the alternative would not further reduce or have additional significant impact compared to the eir analyzed. some commissioners and the members of the public raised concerns regarding the project routing, distribution and traffic analysis in the draft eir. in particular come in relation to the implementation for the campus. just to clarify, the project tripped distribution was based on a variety to and from the development site, consistent with the guidelines and travel conducted. this included more streets, including streets to the east of the tenderloin area. additionally, based on comments received from commissioners and members of the public, supplemental analysis was done

regarding the impact on the tenderloin little saigon area. this analysis, which is included in the document, looked at an additional intersection in and around the tenor line, and a summary of this analysis is presented in the document, 124, and as discussed, it was found it would not have substantial traffic, pedestrian, or bicycle impact in the tenderloin area. nor does it affect the significant environmental impacts or affect the draft eir findings. in addition to the traffic analysis, we also conducted a trip distribution sensitivity analysis. as described in the document, on certain pages, which increased by 64% the proportion of overall

project trips going through the south of market and tenderloin areas. even with the distribution, the majority of the projects were assigned to south of market and the tenderloin area, and most of these intersections continue to operate at the same levels of service with impact similar to those discussed in the draft eir. the sensitivity analysis therefore did not affect about tuition of the significant environmental impact of the project or change the findings of the draft eir. i have with me susan and greg from the planning department it commissioners have specific transportation-related questions. i also want to point out that based upon the review of the environmental review guidance from the bay area quality

management district, the supplemental air quality analysis was conducted. this analysis was presented in the document in the air quality subsection responses, starting at a certain page, and this analysis does not affect our about the mission of the significant to environmental impacts of the project or result in any new or more severe impact than those identified in the draft eir. the commission and the members of the public in the emergency services provided. we address these comments in the document, and the other issue, the health care subsection, starting at page 323-1. we also have something from the department of public health if commissioners have a specific child care and health-care related questions. finally, i want to note that the

staff has reviewed what was published in march 2012 and found that the provisions in the agreement, to the extent that they include physical changes to the environment are adequately covered in the eir or other review documents. questions were also raised regarding potential -- draft eir. as discussed in the document on pages -- we circulation is only required when new information is significant. the draft eir is fundamentally adequate and conclusory. the ceqa guidelines document what is a new substantial impact, including the increase in impacts that cannot be mitigated, declining to adopt feasible mitigation measures, differing from one previously analyzed, new information

included in the document does not meet the definition of significant new information. the ceqa guidelines state that we circulation is not warranted when new information merely clarifies, amplifies, or makes any significant modifications to the eir. as detailed in the findings before you, evaluation issues contained in the eir found that implementation of the project would result in significant unavoidable in a carnival impacts that could not be mitigated to below significant levels. in a certain number of years. air quality and greenhouse gas emissions and another. the eir is an informational document come and it is supposed to inform you and the public about the potential impact that could result if the project were implemented and ways to reduce or avoid these impacts. certification of the eir is not an action to approve or

disapprove the project. the move to certify the eir basically means you believe the eir has provided you with sufficient information about and our model impact and potential mitigation measures. the information presented in the eir is accurate, and eir has come to a proper conclusion supported by appropriate evidence. we therefore recommend that you adopt this before you, certifying that the eir is accurate and adequate, and that it complies with ceqa, the ceqa guidelines, and chapter 31 of the administrative code. this concludes my presentation on this matter, and if any commissioners have any questions, i will turn the stage over to the next item. thank you.

commissioner: thank you. >> thank you, good morning, president fong, members of the commission. items 2a through 2n gather constitute the required approvals for the long-range develop a plan projects. they will provide updates on the development agreement, this is an overview of the actions being

requested it. for the contiguous public spaces. and most of these items are technical cleanup type of corrections, and staff is proposing one revision to the conditions of approval in response to commissioner borden's comments about creating advisory groups for the near term projects. these were previously proposed at campuses with a long-range project. there are several extra hard copies available for the public, and we will turn this over. >> good morning, commissioners. i am ken, oewe.

what we plan to do is amplify on the topics. the hearing elicited the most questions and comments from you. you will see the topics we propose -- sorry, on that slide. usd the topics proposed on the screen. in a few cases, we are proposing some changes to the development agreement. these are fairly minor in scope, and we will go over them when we get to them. before we go forward, i wanted knowledge two documents that we sent to you in the past few days. the first is a comprehensive memo that was sent out last week. the presentation today is basically a subset of that memo, and we are, of course, happy and willing to address other issues that may be of interest to you during the question period. the other documents sent out was a sheet, one of a couple that you got. this document contains the rundown of all the suggested changes to the agreement since

the version you saw at the last hearing. the majority of these are clean up in nature and other clarifications. they are not substantive. a few are more substantive, and we will be going over those. we will be asking you if you adopt them as part of the motion later on, and they will become part of the above agreement that goes to the board. at this point now, i want to ask the deputy director to come up and began going through some of the health-related provisions. >> good morning, commissioners. one of the -- can i have the overhead back, please? one of the issues that was raised at the initiation hearing had to do with the size of st. luke's hospital. i am going to paraphrase from a letter you may have seen written by dr. katz, garacia's

predecessor. it was said that a smaller one could be built. this makes sense because one would think we would want an equitable distribution of hospital beds across the city. however, that is not really feasible because highly specialized services cannot exist in all areas of the city. for one thing, it is because there are not enough specialists. secondly, to be very, very good at something, you have to do it a lot. there is not high demand for every service -- every possible to maintain competence. additionally, when people are very sick, they made services from a range of specialists, not just one, and they need to be available on site at the time needed. this is a reason why some large hospitals, such as the mayo clinic, have a broad range of services at one place. with hospital planners, that you should have community hospitals that are widely accessible and connected to a single specialty

hospital, where people who are too sick at the committed to a hospital can rapidly transferred to. how does that impact the viability of st. luke's? the reason the committee did not recommend this for a rebuilt st. luke's is that they felt that the right bedsides needed to be based on demand. it does no good for a hospital to have more beds that will be occupied. by making statements and it will part -- and into parts, we do not have to worry that is viable on its own, but rather the viability of the whole system is what is at question. also addressed by you at your last meeting was the issue of mental health and psychiatric care. i thought it might be helpful to talk a little bit about hospital-based mental health- care services to give you a little background. psychiatric emergency services is help people in psychiatric crisis entered the hospital system.

psychiatric emergency services are provided only at san francisco general hospital here in san francisco. patients are often brought in by law enforcement under what is known as a 5150, which is when they are deemed a danger to themselves, a danger to others, or gravely disabled. patients are taken by law enforcement and others to the closest hospital emergency room. of the patients at san francisco general hospital that way, 30% are admitted to psychiatry. however, the majority of patients are waiting to stabilize on medication or are awaiting transfer to another type of treatment program that is more appropriate for their needs. the next level of hospital-based care, psychiatric care, is acute inpatient psychiatric care. this is an indication bed in a hospital. the many hospitals provide psychiatric care, talking about

this specifically since this is the most talked-about. there currently operating 54 psychiatric beds, acute psychiatric inpatient beds in san francisco. while those psychiatric beds are often filled to capacity, the vast majority of those patients could receive a lower level of care. the acute psychiatric beds on monday of this week, only 1% required acute-care. that means that 99% of the patients in those beds are eligible for other levels of services if they were available for them to move into. it is also important to note that the hospital does not get reimbursed for acute-care patients that do not need acute care. these non acute patients remain in the hospital because they need to stabilize on medication or because they are waiting for another more appropriate level of care, much like the patient waiting. lastly, i want to talk about the

other hospital experiences with psychiatric care. acute in patients psychiatry is provided at san francisco hospital, including st. francis, st. mary's, and also b. langley porter psychiatric hospital and another. all of these hospitals have acute beds that are operating below capacity. as mentioned previously, hospitals also receive psychiatric emergency patients in the emergency room when they are on condition red, and, of course, patients with psychiatric disorders may also present in the emergency room, not routed through the psychiatric emergency services. as with san francisco general and another acute unit, patients in the emirate since the rams of these other hospitals, whether because they are on diversion or because they presented in some other way to the emergency room, the majority of these patients need to stabilize on medication or need to be transferred to a different type of treatment

program. so the tick away here is that it is not really more psychiatric beds that are needed in san francisco but rather a lower level of care that is an appropriate place for people to stabilize or wait for transport to another type of treatment program. as i mentioned previously, there are 18 licenced inpatient beds at the pacific campus, which serves all the campuses, and that will continue after the rebuilt projects are complete. the draft development agreement amendment does not propose to change that. rather, it addresses the need i just expressed to create additional options for those hospital based psychiatric services i just described, whether acute psychiatric services or another. the amended to limit agreement specifically allows for the innovation fund to support partnerships with the liberal health service providers to

support community-based alternatives to inpatient psychiatric care that allows patients to receive services in the most appropriate and least restrictive setting. under this model, a community- based urgent-care center will be available 24 hours a day, seven days a week to accept patients who may be in need of high level services, such as medication support or counseling, but who do not need to be in a hospital to receive these services. the urgent care center, which currently partners with san francisco general hospital, is a good example of what we are envisioning. it was designed to assist san francisco general and other hospital emergency services by accessing patience with psychiatric crisis that do not need hospitalization but are currently taken there for evaluation. this is an alternative to hospitalization providing comprehensive, 24-hour on-site

services. they have two components. domenica's staffed urgent care clinic and a short-term crisis residential treatment program. the clinic serves individuals in psychiatric crisis that do not require hospitalization or involuntary treatment. they have a position on site or on call 24/7, and patients generally stay for up to 24 hours. once they are stabilized at the clinic, patients may be transferred there, which is a short-term residential treatment program located on the very same site. the average linked -- length of stay is three days. they both provide crisis intervention, medical support, psychiatric counseling, assessment for the next level of treatment, and referral to that treatment. now, i'm going to turn the situation over to the financial officer, greg wagner.