thank you. president fong: next speaker, please. >> good afternoon. i'm representing george wu and i'll go into it right now. i'm on the board of physicians organize committee and received, retired last year from st. luke's as chief of plastic surgery and hand surgery after 31 years on staff. st. luke is the only other hospital south of market, which often overruns, thank you, often runs over capacity and diverts patients to st. luke's. the argument that you cannot pull all of your police stations or fire departments north of market remains as valid now as it did when the blue ribbon panel concluded the need to rebuild st. luke's. the bay area is due for major earthquake. we must have redundancy of health care access points. please strike out the prerogative in determining the

operating commitments based upon two consecutive years of less than 1% operating margin revenue. st. luke's provides emergency services for orthopedic injuries without the ability of a cast cart orcas technician to facilitate the care. this would easily -- this would be easy to remedy the administrators if the administrators have the will. if you break your arm and go to st. luke's, they can give you a splint, but no cast. without a nearby skilled nursing community, care by physicians and needed family contact with the patient is sacrificed. this must adequately be addressed. finally, psychiatric illnesses is an enormous problem in our society. witness the recent mass shootings due to lack of early intervention. hospitalization is necessary for the violently in klein. we cannot afford hospitals to deny need. before this agreement can proceed, it needs three weeks

including psychiatric care, skilled nursing beds and the elimination of the 1% clause. thank you and again, as a citizen, i got to urge you all the talk about earthquakes, the worst thing to happen is an earthquake clogging up that congested area. i would move, again, everybody wants jobs, wants to do it right, possibly a block or two away, get an access point underground for emergency vehicles. as a patient, my dad and i live actually on the south end of the city. he has congestive heart failure. a window, i had to nearly, i had to run red lights, put other people in danger to get my dad there on time before he died of congestive heart failure. i would also move at the end of the city when any of you have meetings or plans on that end of the city and fate steps in, you might get hit by another car, car crash, drunk driver. if you're on that end of the city and it falls on you to come into this hospital, where would you want to be, hospital access at this point or having to fight the whole city to get

to cpmc? so, again, please don't ignore a large part of the city and the demographics are changing as well as drug use, san francisco is one of the highest drug use cities in the nation, possibly the world. people from all over the world getting addicted causing mental health illness. if they don't have any access, the prison population will rise and those people will be in prison. thank you. president fong: thank you very much. next speaker. >> thank you. president fong, members of the commission, my name is david meckel. i'm the director of research and planning at california college of the arts where i founded san francisco's first professional architectural program 27 years ago. my expertise is in city planning, urban design, and architecture. in my professional opinion, cpmc's plan for the architecture urban design and

public ground improvements of this public are smart, sustainable, and urbanistcally sophisticated. it puts hospital beds and services where transit and people are located and done so in a way that enhances streetscapes, roofscapes and solar access. cpmc's plan has enhancements that are appropriate to the pacific heights, the triangle and neighborhoods while concentrating the highest density of beds and service at the van ess and gerrie location where the highest density of people and urban infrastructure will best be accommodated by them. the intersection of these two arrest teerls and they're direction to the high-rise buildings is a good location. the van ess location used an innovative drive threw and drop-off to efficiently absorb traffic on surrounding streets.

an emergency drop-off plaza, an internal loading dock and a front door facing van ess avenue are all smartly placed access points in the design of the building. the sustain act initiatives are ambitious and admirable, daylighting, nontoxic building materials, green roofs for both people and missing species habitats, irrigation demand met by stormwater capture and the resulting diversion of that runoff from the city's storm and sewer system signal a design approach that will advance san francisco's climate commitment while also creating significantly improved environments of health and healing for our communities. the fact that this building consolidates a vast array of medical services in a compact design place in the heart of the city with limited parking for staff encouraging public transit use for daily commuting

makes this a standout hospital. i respectfully request that the planning commission certify the e.i.r. and move cpmc's architecture, urban design, and public ground commitments forward so that our city and citizens can be served as soon as possible by the seismically safe and smartly designed facilities. thank you. president fong: thank you. >> good afternoon, pilar, california nurses association. thank you, president fong and commissioners for your attention to this matter. we understand it's been a very long day. we understand this has been a struggle for many years for many of us in this room and so we really appreciate that you're giving the attention that it deserves because this project really has huge impact in the city and in the shape of health care really for san

francisco and san franciscans for decades to come. one of the faulty things about how this project has been looked at in a lot of ways, it's looked at a construction project rather than a hospital. it's creating construction jobs up front which is great, the jobs that are going to be here for the long term are nurses, health care workers, the engineers who spoke earlier. this actually could end up being a net job loss. with the current agreement before you. if you are talking about four san francisco residents, the only commitment that you have, that the city has is 40 jobs a year for five years, less than 5% of all of the jobs, right, so if you lose nurses from one hospital to the next hospital, other health care workers to the next hospital, this can actually be a job loser for the city of san francisco.

and this agreement is faulty not only in the area of jobs, but in health care and traffic, in transit, in housing and there is a trend in this project that shifts cost and responsibility and in providing health care to the city, san francisco taxpayers and your budget that the city of san francisco is currently struggling with right now. you know, there has been a lot of stories about the health care that people have received, which is great. it's a hospital. they're supposed to provide health care. it's like saying that our nurses took care of them in the hospital. they're supposed to do that. the problem is they still don't do enough, even with everything that they do, the deal says that they can do less charity care than they are currently doing now. so they actually can lower the bar when it comes to charity care and it's been a fight for

years to get them to do their fair share around charity care. in the area of cathedral hill, this is not an area where the environmental impacts can be mitigated in this plan. they cannot. you can't say that you increase traffic and somehow the impacts go down. there are so many faulty pieces in this plan that they have put forward that don't really explore the alternative where you would have a larger st. luke's, where you could actually -- that's really the only alternative that would mitigate the problems at the cathedral hill site and in terms of concerns for our nurses and the communities that we're representing as a coalition, there is a huge concern around emergency access that how on one of the busiest corners in the city of san francisco, people's lives are at stake in terms of being able

to get to that hospital. they are not producing a plan that shows how those emergency vehicles are actually going to get to the hospital. in terms of the housing jobs linkage, they're not doing their fair share around that. on issue after issue after issue, they're actually undermining city policy, undermining the city budget and in cpmc fashion as we know as people who have negotiated with them for decades, they drive a hard bargain and they make sure that their bottom line benefits in the end. this is exactly what is happening in this deal. it's a benefit for cpmc. it is not a benefit for the city on many different levels. it is not going to turn out, unless you have it on paper as the stationary engineer said earlier, unless you have this deal on paper right now, it's not going to get better. they will not get better. so we hope that you will really send us this project back, do

not certify the e.i.r. and please make sure that the alternative is fully explored to ensure that this is something that is really understood as a true alternative to mitigate the impacts that are happening at the cathedral hill site. i'll end even though i don't think i was timed. thank you. >> good evening, thank you, president fong and members of the planning commission. i'm kathleen carroll. i'm the director of workforce development and relations of the prime contractor for the two proposed hospitals. we heard a lot of people coming up here today who i have worked with, who we have committed our time and our effort to find the jobs in san francisco. they're san francisco residents. i had a whole speech planned. i'm not going to sit here and read it. what i am going to tell you is that i have never seen a level

of commitment and the ideal place that we would want to be with all of the people that we work with. we are not looking for one up jobs for people on the construction projects. we are looking to build long-term careers. that's what we're doing. that's why we work with city build academy. it's why we work with the construction admin program. that's why we have been collaborated with the office of economic workforce development for two years, city build, mission hiring hall, the unions and our other sub contractors. we have done a lot. it's what we want to do. it's what we want to continue to do. i really have just touched the surface of our commitment. there is a lot in the workforce agreement that you all have in front of you. this is my full time job. it's become much more than that for me. it's actually my calling. it's what i love to do. it's what i look forward to do for the next six years. on a more personal note.

i have been receiving care at cpmc before it was even cpmc, 1986, my son was born there in 2001. he had four successful surgeries there. in 2009, i was diagnosed with early stage breast cancer and i was treated at cpmc. amazing care, amazing doctors and surgeons and nurses, no doubt about it. i can't imagine what it would be like if we were to continue with the hospitals the way they are, the cpmc hospitals, the california campus, st. luke's. i fully support rebuilding the project and i hope you vote yes tonight, thank you. president fong: thank you. >> good evening, my name is yanika brooks. i'm a registered nurse at cpmc. i just came from work. i feel quite vulnerable in my uniform. i work mostly with the elderly or, i don't know, those over 65 and medicare patients.

it was six, seven years ago, the first e.i.r. where skilled nursing beds would be eliminated from cpmc. and we nurses were quite concerned about that so it's a community and we have fought and testified in this building for years to keep the skilled nursing beds, the medicare beds in cpmc opened. we finally got a commitment from cpmc to keep 100 open, but, you know, it's 100 open in the community and frankly, i would like to see something a little clearer, with a little more commitment on what those 100 beds, where those 100 beds will be in san francisco and what they will look like in san francisco since we are, san francisco is a population of,

with a greater proportion of retiring people and we need those skilled nursing beds. if we don't have those skilled nursing beds or enough met in san francisco, we will have to go outside san francisco to get our care for medicare patients and we need skilled nursing. so this is still a concern with the nurses and i would like you to please look at that carefully, that portion carefully since we do talk a lot about births and heart attacks and the more glamorous parts of the nursing in the hospital and i don't want to see the elderly and the medicare and the medical patients neglected here. thank you. president fong: is there any additional public comment? ok. seeing none -- [laughter] president fong: the six-hour

public comment session is closed. [applause] president fong: there are a number of speaker cards that didn't turn up. i'll be sure to pass these along to the commissioners. we'll open it up for commissioner questions and comments and if it's ok with you, we'll try to maybe go through the same order, if that makes sense by topic. so we'll go through, it's a little harder to do. we'll be boughsing around if we -- bouncing around if we don't. we'll go through workforce and the project description. commissioner antonini. commissioner antonini: ok, let's see. the first thing i had was in regards to the issue of charitable care which i believe falls into our category here. again, there is representation made about the amount that is being pledged and the fact that

it was lower than the year before. well, this is an average of the three years and the $86 million is a floor. it does not include the additional 10,000 medical recipients that will have to be cared for by california pacific as part of the dream, at least 1,500 of which come from the tenderloin and then $20 million to the tenderloin community care innovation fund. as audited fanning has point the out, the charitable things they are doing, the hepb and c and the chinese hospital contributions and multitude of others and other very comparable, from my research looking at other hospitals within san francisco and outside of san francisco, very comparable in terms of charitable care. that's not actually a statement, not a question, but if you disagree with me, certainly, you have anything else to add, you certainly can.

>> i think you did my job great. the only thing i would add is that because health reform is coming and people will be moving from status of being uninsured, people who rely on charity care to insured will be people who rely more on medical, that is another reason that the description the description that you pointed out makes sense in the way that we drafted it. commissioner antonini: i know there is a floor to the which -- if national health is different than what is being promoted now, there is still a floor that they will have to negotiate or have to provide it the equivalent of the 10,000 new medicare or medical recipients. >> we would have to discuss what happened if they made it so that they were unable.

>> it is true that they have implemented health reform in the absence -- commissioner antonini: i have another statement or question, the development agreement. of course, this is a minimum of 20 years. no other hospitals, public or private, they have some sort of commitment of operation that is mandatory. i think this is sort of an extraordinary thing. and we have provisions for that if it were to happen. the other thing is the master

plan for health, and the question that some people have brought up is the delay that we can't really afford with the seismic question, and it could be a few years before we have the plan city-wide. 33% or more come from outside san francisco. we have a patient base that transcends and franciscos needs, and those needs have to be met equally by all the hospitals here, and we're building a new one out of mission bay right now. i am in favor of moving this forward and it is good to look at san francisco's needs city- wide in a health care master plan, but it does not control individual hospitals. >> of the master plan is not anticipated to be final for

about another year. >> held the san francisco, understand the northeast medical service is one of the biggest providers for healthy san francisco. from what i have been told, they have the largest share of the healthy san francisco patients. i believe that is 13,000 patients. another charitable party that is not necessarily included in what we have seen so far. what were the other topics we were supposed to talk about? the other question is trying to make st. luke's larger in cathedral hill smaller. it has been pointed out quite accurately that community hospitals and smaller hospitals treat normal medical problems

and normal deliveries. there will be full service at st. luke's, so most of the things that you might have our routine surgery, routine procedures that require hospitalization. if there are a specialty problems and an at-risk deliverer -- and delivery, you want a center with an anesthesiologist for this specialize in that kind of care. all the other specialties the deal without risk mothers and infants. i came from the east bay originally and i know that people have to travel 15 or 20 miles from one acute-care hospital to another, even areas that are fairly affluent because there aren't as many hospitals. a lot of these places don't even have a smaller community hospitals. have outpatient clinics where they can go for emergency care and be transferred to a

hospital. huge miles and a number of people between those hospitals. we have a lot of different hospitals in san francisco, so this access issue is not one that resonates through much with me. the last thing is a number of beds at st. luke's. i understand we have about 150 beds of which, rooms, rather. the beds are crammed into multiple bedrooms. i think they will all the individual rooms. i believe it is required, and as we heard, the census was historical year-round 59 -- around 59. that sense is goes back quite a ways. those are my main questions and

concerns regarding health care, except maybe for the site needs. we heard earlier today and i brought it up the the head 18 site beds at the pacific, and oftentimes, there were only 11 patients, the same is true of the beds that were at st. francis, saint mary's, langley porter. a lot of the care, especially with the restrictions, the hospitalizations are somewhat limited. unless they are special circumstances, most of it is an outpatient. that is what i have heard everyone tell us. >> we try to be responsive to psychiatric care and creating the most effective programs in the least restrictive setting,

and that is what you see in the amended development agreement. commissioner antonini: what were other subjects? that pretty much takes care of it for health care. commissioner sugaya: on the health care master plan, tell me. if and when is adopted, will it have any impact on cpmc. >> only after the date is adopted. commissioner sugaya: because it is another year of, we're not going to make the decision, i can tell you the right now. the board of supervisors makes the decision and it gets approved. once the health care master plan is approved, there is no effect. it can stay within the city and county of san francisco. there are certain kinds of desires or goals put in place,

and it would be desirable to have whatever the facilities might be for the services or whatever. >> if it goes into effect, they will have other facilities after words that needed permits and entitlements that will be subject to what had already been entitled before you today. >> in terms of the answer i received on the status of the master plan, it looks like by the end of this month next month, the task force will have matter and they will have formulated recommendations, is that correct? >> in june, will be seeing something from them. >> the task force was charged to look at the impact of the health care services master plan on the city's vulnerable populations and make recommendations to planning as we draft a master plan. their report will be available to you and we can make sure that

you get a copy, but those recommendations are not the master plan itself, but the public input processed for development of the plan. commissioner sugaya: and whether the recommendations that affect this particular process? >> i have been part of the process all along and i don't think there was this level of specificity. >> wouldn't it be prudent for us to continue this out another six weeks until after we received those recommendations? >> i am not sure that they would have an impact the way that they are drafted, they are not yet finalized. commissioner sugaya: another question with the beds, i can't find it in my development agreement, but can you tell me how the wording does is set to

require those 100 beds? >> they are required to provide 100 beds in 10 years. the current thought is the thirty eighth of those will be ed the campus where 38 of them are now and that 62 will the new beds created elsewhere and would not take from existing stock. it is page 12. >> from the city's standpoint, is in equally desirable or not desirable, to have the beds within a hospital or within another location? >> often times nursing beds with a hospital facility are not long term -- the long term care beds, but a step down from an acute care episode. in the community, it is more

often long-term care in a residential care facility. much like in such jiechi -- and psychiatric care, the trend is going away from a facility based model to a community-based model. in fact, options for long-term care are also able to be funded in the innovation fund. in-houscommissioner sugaya: the arguments for the campus is that it needs to be this is it is because all of these specialized services and what ever can come together, including the children's hospital and everything. and if i get sick, i can be rushed down the hall and get whatever i needed. is there a standard? is there