ness construction. >> are you presuming you'll be able to sequence a portion in conjunction with cpmc? in other words, you're going to do a one to four-block section at a time, i would presume, which is a normal way of doing it. there is the tunnel going in as well. what would you presume there is as to any additional thoughts in handling this type of sequencing and coordination? >> you are correct. we have three blocks segments but that is how van ness is being sequence. we will be coordinating closely with cpmc. we do not anticipate additional costs within our cost estimate. the goal would be to coordinate inappropriately so all work and occurred during a similar time period, so hopefully we can

leverage production to have to be as quick and low impact as possible for that portion of the van ness brt construction. >> and that -- commissioner miguel: i assume there will be a lot of trucks running between the two of you. >> there are fewer trucks with the van ness brt because we do not have excavation needs. but, yes, we will be coordinating closely. there is a traffic management plan. we're working closely with caltrans as well, and they're very concerned with what the traffic sequencing will be along van ness avenue during construction. this is something that is very exciting, but we're getting much more zeroed in on with the construction phase will look like, and we will get many more details of how we will be coordinating the cpmc and for the van ness brt implementation in general. commissioner miguel: very good. i approve -- i presume there

will be a great deal of more detail on may 10. >> correct. commissioner antonini: i would like to jump back to health care for a second. denise? talking about the psych acute- care and just a clarification -- correct me if i am wrong. what you said is when there is a red situation, in general, they found that of the patients in need of psychiatric care, only 30% of them needed any excuse hospitalization as opposed to 70%. to amplify that, later on we talked about the situation where, in general, not during a red period, but in general, only 1% of the patients, psych patients, needed hospital care,

and 99% needed lower care. am i correct? >> there are two levels of care. the site the emergency, pes, that is the only psychiatric- receiving emergency rooms in the san francisco right now. our psych emergency services, when we are on code red, it means we are on divert ambulances go to other paused -- other hospitals to take psychiatric patients. of the ones that are in pes prison with the psychiatric emergency, only 30% are admitted into our acute inpatient hospital beds. for all of those, and i looked up the data on monday, on monday, there were 63 people in our acute in inpatient beds, and seven of the more acute patients. that means 99% of them or not a cute and did not need to be in an acute psychiatric bed. they could have been receiving

care in a lower level facility if there were one available for them, if there was another option for them. commissioner antonini: ok, thank you. that is probably closer to 93%. >> i am sorry. commissioner antonini: but you're right. it is is significantly lower number than the actual need. the other important point you made was that cal is a bit, langley porter, st. mary's, and st. luke's are providing lower capacity of acute care psychiatric beds at this time. >> let me say that they are a stand-alone psychiatric hospital, but they are operating below capacity. commissioner antonini: that is important. i am glad you're able to clarify that. >> thank you for catching my math, too. >> still sadecki lower and a significantly smaller percentage of the total patients, and the

care has to be outpatient care. that is the big demand. >> and when a patient is a non- acute but they are in an acute bed, we do not get reimbursed for them. why would an insurance agency paid for a level of care that is not necessary. it is not a financially sound way to go to put a non-acute patients in an acute bed. commissioner antonini: but on the financial side, that treatment is not necessary, and they are better off having the outpatient kind of care. >> if there is one available, that is true. commissioner antonini: thank you. i had a couple other questions. one is for rhonda simmons if she is here. commissioner fong: we want to keep on the topic. we're going to get to work force after this. commissioner antonini: ok. transportation. we will do that. thank you. commissioner fong: the you have any questions about

transportation? commissioner antonini: i do not. commissioner borden: i have a question about excavation. the planner mentioned the bustling would be closed on kerry during the excavation period -- closed on geary during the excavation period as lisagor closures. how long? >> i do not exactly how long the closure of the geary transit lane would be. i do not know it the construction has developed that level of detail yet. i would imagine a leak during the excavation phase, the first year or two years. not the entire sequencing period. muni would have to operate in a mixed lane, so it will cause some delay for muni and traffic on geary. but it is a temporary situation. the point would be during the detailed construction planning to minimize the transit lane closure. commissioner borden: you're saying it will be like a year? >> i do not know of the top of

my head. commissioner borden: i am just curious. do we have a signal prioritization for muni already along the geary corridor? >> mta is looking for a signal prioritization and priority city-wide. i am guessing that would be coordinated as part of the van ness avenue brt indeed geary project. i cannot speak to the details of how lakari and van ness -- how that would work, especially during construction. but i think the priority will mostly be for van ness, because it will have the upgrades. it is tough to have signaled priority in two directions at an intersection. commissioner borden: it would help. >> yes, it would. certainly minimizing the closure of that transit lane will be a priority during construction. >> there is signal partition on geary west of presidio. beyond that, i do not know.

>> i think that mta is looking at signal prioritization on geary east of van ness. hopefully there will be an opportunity to make up some of the time of the delay with construction for these projects and the hospital will have the opportunity to reconcile that elsewhere. during construction, there will be disruptions. commissioner borden: i do not know if you have an answer about the excavation period, approximately? >> i am the planner for california pacific medical center. the excavation period will take up boards of a year, but the year overall period will be upwards of three years, actually. no more than. during that time, the parking lane on the south side of geary street will be given over to a travel lane. when we take the bus lane on the north side, everything shifts

down one lane. the building goes under the cyberassaults all the way to the street. that needs to be demolished and rebuilt -- the building does under the sidewalk all the way to the street. that needs to be demolished and rebuilt. commissioner sugaya: back to health care. i had a question -- cpmc, in the memo that was given to us, says that they currently operate 18 licensed inpatient psychiatric beds at the campus. it says no changes proposed. is the requirement to maintain as 18 in the development agreement? >> i do not believe that is specifically in the development agreement. commissioner sugaya: is it appropriate or not appropriate to include that, do you think? i understand that given these statistics we were just talking

about with commissioner antonini, the level of care kind of fluctuates. i am just trying to think -- i would hate for cpmc to drop the 18 at some point, even though they are still saying they are going to be there. >> there are a couple reasons we did not go there in terms of putting it into the development agreement. as you heard, there actually is not generally a demand for all 18. it is not something we would want to force them to do. secondly, to remind you, and dph staff can go into this in more detail, but i cannot close those without the prop q process. so there is some level of process behind doing that. we did not think that it was something that we needed to require them to do. remember that in terms of running health facilities, the requirements, as i think we have

said before, unusual to require something like this on and develop agreement. we're doing this would save lives but not necessarily the rest of the facilities. commissioner sugaya: ok. i am not quite sure how to ask the question, because i am not quite sure what i am trying to say. you said that cpmc, you had the comment that cpmc was a nonprofit and at the margin it would generally go back into improving the hospital. however, cpmc's profits, as we were told previously in the initiation, actually go to southern health. and it was my understanding then that cpmc asked for some type of rock or however you want to characterize it. such is not necessarily true that -- so it is not necessarily true that cpmc has control over

its own profit margins. is that correct? >> i am not a financial expert, but i would say that in terms of that, you could replace cpmc with sutter which is the parent organization and a nonprofit. commissioner sugaya: an extension of that is the legal question of legalsute -- the legal question of whether sutter is the holding to this agreement or not. >> i am a from the city attorney's office. there is a legal entity that owns the property. sutter west doing business as cpmc. the provisions you are concerned about relate to all cpmc's activities within san francisco. when we deal with the financial issues, we always look at all of their numbers as it relates to all of their activities in the city of san francisco. commissioner sugaya: i

understand that. so you're confident that whoever signs this, it is going to be -- all the provisions will have to be respected by sutter health? >> yes, correct. commissioner sugaya: thank you. commissioner borden: i want to follow up on the prop q process. maybe director garcia can explain what that is. >> anytime a hospital facility changes or moves or reduces or closes service, they must provide public notice to the health commission, and the health commission holds a hearing on the proposed change. and i think that happens at least 30 days in advance of the potential change. commissioner borden: does the commission had the ability to stop the change? you hold a hearing. what happens? >> more of a public forum for the change. commissioner borden: there is

no -- >> there is no ability for the health commission. the hospitals are overseen at the state level and not the local level. commissioner fong: commissioners, any questions related to the topic of workforce? commissioner antonini: i had questions for rhonda simmons on the work force issue. more than a question, just a clarification of my understanding of the situation. correct me if i am wrong, but there are now 6200 jobs in the system, and those are going to be retained. but we're projecting of those 6200, about 600 to 700 per year will change because of attrition. of those 600 to 700 per year, about 100 could be considered entry-level, and the entry

level qualifier is no more than a two-year education -- >> i believe that is correct, yes. commissioner antonini: ok, good. of this group, we are saying that no less than 40 will have to be san francisco residents. and i think coming from situations such as the health care cut -- academy or the community benefits organizations. >> correct. the 40 that i am focus on of that 100 is mostly in entry- level health care. so there might be other kinds of areas of, not so much health care, but entry level that is not captured, but we would still work with cpmc to capture as many additional entry level as we could. it is just the focus is really on entry-level health care to really move that, because that is a growing sector here, a

booming sector. commissioner antonini: we also have another 1500 new jobs projected to be created, permanent jobs, over 10 years, of which we are saying 222 will be entry level under the previous qualifier or about 22 per year. that is above and beyond the ones we talked about in the attrition situation. >> correct. yes. commissioner antonini: ok, good. the other thing i want to point out. when you look in this whole thing, being in the health-care field myself, even in the entry level, a number of these positions might be someone like a technician who would have had a couple of years of training. so it is not as if you can, you know, it is harder to hire. you have to have some training. what i am is suggesting in this might be a possibility, first of all, we have said at least 40. there could be more.

second of all, there might be situations where someone who does not have the training necessary could receive the training and be given preferential treatment for hiring a year or two years from then, when the training is complete. >> that is the idea. we have already started the work with cpmc. our health care academy is already up and going. we're in our fourth cycle. we will graduate a group of this june. so, yes, to the degree that that group of folks that is not so skilled can get into this opportunity and others, that is the goal here. we also work with a number of other local hospitals in this way, but this one is particularly unique in this agreement. commissioner antonini: thank you, and i understand what you are saying. i would presume that as a move forward into years two, three, four, and five, one would believe that as we start this pattern of perhaps training people for employment in the future, that we would be able to

increase the number hopefully above the 40 out of 100. >> i mean, that would be the goal. that would certainly be my goal. thank you. commissioner antonini: thank you. commissioner moore: while you're there, would you clarify for me, with these 40 people, is it over five years or 40 -- or 40 per year over five years? >> 40 per year over five years, for a total of 200. commissioner moore: ok, thank you. >> commissioners, any questions related to the topic of housing? commissioner borden: i just wanted to be clear on one program. you said when the money is paid back because of the natural attrition and people pay off the loans, with that money go back to the general program for all of san francisco, not just into a program for cpmc employees?

>> the repayment would go into a general fund at the mayor's office, and we would invest that in rental housing. the transaction is broken up into two affordable housing components. one for the traditional affordable housing, primarily rental housing, and then the cpmc downpayment assistance program. when somebody sells their unit and we received our principal plus a share of appreciation, we'll take those proceeds and put them back into the traditional affordable housing pot. commissioner sugaya: yes, on the program again, it says that the 14 cpmc is pattered -- the one for cpmc is patterned from the existing program. what is the difference? >> the major difference is the amount of downpayment assistance. currently, the office a

downpayment assistance program, we have limited the down payment to $70,000 but this has a much higher limit, up to $200,000. the current program recycles. it goes back into the same downpayment assistance pool. these are proceeds from a house and bought a few years back. they recycle for the purposes of down payment. again, the cpmc down payment repayments will go back to assist affordable rental housing. >> the special district requires at least 220 units. the in lieu fee is about $73 million. and that resulted from a calculation of multiplying 220 times approximately $334,000.

>> yes, the value for a two- bedroom unit. commissioner sugaya: ok. if we took the 73 million in your average subsidy is summer between $200,000 and $250,000 -- >> 365 units. >> we gave you sort of a range of how many units we would use. from 260 to -- let's see, to 320 permanent units. yes, we would have slightly more units given the specific dollar

amount, but the poll was based upon meeting the 220 bmr units, and we are exceeding those 220 bmr units. >> to gridley add something. the dollars a334,000 per unit fee is allocated with the gap between the cost of production and the resell cost of a bmr unit.the bmr program is for residents at the 90% level. at that level, there is actually very little -- in most cases, no other subsidy available in order to produce that unit. if we were producing units at that level, all $334,000 would have to be used to do one unit.

however, we're taking that payment and producing units for 60% ami below, and the recycle money would be for access to a significantly higher level of subsidy, meaning that we could leverage the money on a two to one basis. we're watching the money back into the 60% ami program and below, so we are in a better position to be able to produce more units. commissioner moore: if i understand you correctly, you'll be running both programs, correct? >> yes, we will. we will be administering the current program we have and administering this new cpmc program, plus clearly administering the traditional affordable housing subsidy program. commissioner moore: managing the

two different programs, i am concerned about what it says about public policy. it is a program that is treating people and working with people. i am concerned that it leaves certain questions open. i just wanted to put that on the record, that i am concerned about this. >> we have a variety of programs that get developed over time. as some of the commissioners know, i was formerly with the redeveloper of digits to be the we had a separate program called the limited equity program. we're blunting those programs together. each program, and even programs in the mayor's office of housing, they change over time. programs are created for specific purposes. our staff is pretty capable of identifying those programs and

getting them to the right people in the right manner. it will not be a difficult for us to handle these programs. they will be treated the same, regardless of the source of funding and regardless of the particular program. commissioner sugaya: with -- commissioner moore: with you being in charge, i believe that. but it is a stretch. redevelopment tax in the public interest, and this looks more like a private deal -- redevelopment acts in the public interest, and this looks more like a private deal. commissioner antonini: thank you. i thought the response for the two questions was very important about the buying power that is increased by this program. and, of course, we have always been concerned during my 10 years on the planning commission of that group of people who cannot afford housing, that

middle income group that is leaving san francisco. anyway, what was really interesting, if i am interpreting this correctly, is the normal buying power, $357,000, which only allows a person to access 15% of the properties in san francisco, has been raised to $402,000 and most recently to $460,000 because of the present program. in this program, because the amount is higher, i think we are raised up to $557,000 of buying power, which will allow access to 39% of the units available, which i think is -- i hope i am reading that correct, because that sounds like a very beneficial program. >> you have read that absolutely correct. clearly, the program is not intended to be able to buy every single unit in san francisco, but at that level, there is a large portion of san francisco that is a very affordable to those first-time home buyers.

commissioner antonini: what is most important that i interpreted is your impact of employees in that area. most ideally, they would live close to the hospitals where they're going to work. probably, looking at the cost of housing in that area, that is probably unrealistic figure that could for a residence there. as you say, this recycles back, and we will be able to generate up to 320 units of permanently affordable housing. >> again, the whole question of the traditional affordable rental housing is open to everybody, and it serves -- it will ultimately serve a lower- income group gets 60% median envelope. as the money recycle some of the other part of the money coming back is the ability to leverage the money with other resources,

because we typically leveraged 2-1 outside resources to build the affordable housing. >commissioner antonini: and eight-year turnover on the program typically, so that is what you are basing recycling figures on? >> that was based upon looking at the program from inception to the time the voters approved the bond issue to create a program and looking at the statistics. clearly we will go into the market at a time for the housing prices are particularly low. they are not at their peak. there will be an ability for the homeowner, as well as for the fund to share in some level of appreciation. our conservative estimate on the appreciation is 3% per year.

commissioner sugaya: are there demographics or statistic on which you base creating a program different? are cpmc's that much different in nature than the general public that we need a special program instead of folding it into the existing one? >> part of it is the ability to do the recycling of the particular fund. i would like to just caution that -- it is a limit in terms of the $200,000. you saw the slide earlier that is of limited to 45 percent signed. -- 45%. our history in termso