care, which is whoever walks into your emergency room. you cannot manage that to a specific number. we cannot hit an exact number with precision. we want the ability to catch up in the following year. that is all that is. >> it sounds like a bit of a cap to me. they can kick over the over just to make up the number in a second year. >> i do want to make a point that that ability to do the overage is limited. it is not unlimited. we put a lot -- we put a cap on how much they can get credit for the previous year. it is really meant to adjust for that and ability to steer exactly right. >> there are a lot of cops in this agreement -- caps in this agreement. >> i think it is unfortunate for

the city. i think eighit is a cap on how we're going to take care of san franciscans. it is structured as a cap. what is your estimate on how many of those will be in a hospital? >> we did some modeling on those areas, populations that would be enrolled, seniors and persons with disabilities, single adults. it depends on the population. there are different utilization histories for each of those populations. i do not have the information in front of me, but i want to set a third of those need hospitalization.

an average of the third that would need hospitalization. >> what do you estimate is going to be the expenditure for that commitment? >> in the modeling over the 10- year periods, we found they would fall just below the 9.5 million at the end of the 10- year period. >> at the end of the 10-year period. in the first four years, nothing kicks in, right? >> that is right. >> they are required to take every life up to 10,000 made available to them through the system. it is our understanding that the system will not make that money available until you're four. -- year 4. >> they have to stay at 10,000, yes. >> at the end of the time periods, the commitment ends.

>> there are rules about their ability. they cannot drop active patients, i believe. >> they cannot stop serving patients, they can lead -- cannot stop serving patients. one of the reason we focused on the managed care is that really engages them any more meaningful way. participation -- our hope is that this is an integrated part of their system. >> we have 150 cards of people that are waiting. we have several more. if we could try to wrap this up. let's try to keep this succinct. >> of the negotiated on behalf of the city with cpmc -- who negotiated on behalf of the city

would cpmc? >> everyone you see at the table. president chiu: given the lack of information around finances and all of these ceilings are triggered by a very specific financial assumptions, it is important for us to understand what assumptions you are working non. -- working on. my apologies to my colleagues. i have a prior commitment that i need to go to and did is budget season and we have a lot going on. i hope to come back later. and look for to getting more information. one thing i want to mention, a week and a half ago, we had a hearing on jobs. we made a number of requests and we have not received anything yet. >> you should get it in the next day or two. we spent more time than we expected dealing with what you

heard earlier today. we will have that for you in the next day or two. president chiu: it is important that we did this still right. if we are going to move forward. i want to make sure we have enough time to do that. we do have hearing schedules forward -- moving forward, but we have to get this right. if we are wrong, this will have major implications on our health care system. i really hope that we do take the time to get the -- get this right. >> excuse me, i am sorry. i saw the response to your question. the admissions per -- for the 10,000, it is 500 admissions per 1000 enrollees. that is what is estimated at the end of the term. president chiu: if we are right below this cap, it is possible that we could end up hitting this cap.

that is a possibility under this agreement. >> it is a possibility, but given the modeling that we did, it is not a likely scenario. we do not think it is likely. president chiu: just three minutes ago, you said you did the calculations and it fell below 9.5. now you are also saying that there is headroom. either there is had room or there is not had room. >> -- headroom. >> they are very conservative assumptions. an increase in cost would exceed the increase in inflation. >> the 9.5 goes up by inflation every year. in year 10, if it is 12, or

something like that, and we think -- what i am understanding is even without inflation, we would be barely ok. with inflation, we would be quite comfortable. president chiu: i think that understand. what i would suggest is the value that cpmc is providing is a bit less than 9.5 million. if it is right at headroom, we might have some issues. i am happy to engage with you. >> we will double check the model by the end of this hearing. it influenced by inflation every year, so every year that cap goes up by a little bit. >> we can share with you. president chiu: i look forward to at least that information. supervisor mar: let's go back to the formal presentation.

>can we have the microphone on the computer? it should work. >> thank you for having us. i am a staff nurse at st. luke's. i've been a nurse there for 26 years. supervisor mar: we need the main microphone working. >> if i was a physician at st. luke's until i left there this past january. however, i was involved -- i was a member of the blue-ribbon panel. thank you. cpmc is staking its future of st. luke's on winning approval of its 555 bed cathedral hill

hospital. in return for agreement between cpmc and the mayor's office to build this hospital, cpmc will rebuild st. luke's with 80 beds. in 2007, after the expiration of the attorney general's conditions of the sale of st. luke's to sutter health, cpmc announced its intention to close st. luke's. the hospital staff, the community were mobilized. there began a campaign to save st. luke's. there was an outcry from the hospital staff, from community leaders, and city officials, which prompted cpmc to convene a blue-ribbon panel i consider the

future of st. luke's. -- and consider the future of st. luke's. the panel recommended that st. luke's be rebuilt as a full- service hospital and the board approved this. >> i have spent a good deal of my non work time attempting to ensure that the hospital i which i worked for 26 years, st. luke's, remains a viable acute- care facility in this city. i am an emergency room nurse and i continue to fight for st. luke's that will be vibrant and viable over the years. once we were a thriving acute- care hospital, we now function at a fraction of the size to use to be. what has happened is the starting of a hospital and there is no logical conclusion that the starvation will lead to its demise. the record at st. luke's shows

there must be an agreement to halt the service cutbacks and elimination. if, as stated in the original proposal, there needs to exist and acute-care hospital in the southeast sector of the city. what services are concentrated at what locations have ramifications for a host of other treatments. the domino effect of the shedding of one type of service will negatively impact others. contrary to what needs to happen, in order to maintain a vibrant hospital, much less any center of excellence, the following cuts represent what is actually happening. skilled the nursing, which now functions with one-third of the 40 beds it used to. soon the patients to hospital. infusion department, which

provides essential team of services and blood transfusions. it is scheduled to be shot. dialysis unit, which have been downsized. intensive care nursery, which has been eliminated, with acutely sick babies now treated at the california campus. interventional radiology has been closed with patient still treated at specific campus for these services. cardiac catheterization lab. endoscopy departments, downsized last year. intensive care unit, were higher acuity i see patients are now routinely transferred to the pacific campus. the list does not represent the desert -- the population. they're rather represents the business decisions the drive all health care is delivered and more patients must go for care. the community needs --there is

little or no specificity of what will happen with nursing. what we do know is that the cutbacks and elimination of these units is historic. and continues. these units have been eliminated. beds have been reduced and the california campus of cpmc. yestea necessary anchor for st. louis would be a behavioral health unit. instead, inpatient psychiatric units were closed several years ago, consistent with the closure and cutbacks of other behavioral health units throughout sutter.

>> let's look at some fiction and some facts about the blue- ribbon panel report. fiction -- the blue-ribbon panel recommended rebuilding st. luke's as an 80-bed hospital. fact -- the blue ribbon panel took no position on the size of the new st. luke's pending further evaluation of the health care needs and consultations with community stakeholders, both of which never took place. fact -- to help physicians took note position on size. pledging to work to ensure that it is a vibrant campus and seeking to maine -- maintain the facility for 20 years. fact -- cpmc and immediately after the blue-ribbon panel concluded its work proposed a 60-bed hospital on the st. luke's site without a skilled

nursing facility as had been recommended and then raised the beds to 80 under intense community pressure. the hope commission and its cpmc taskforce -- health commission and the cpmc taskforce provide more specificity about the centers of excellence, a plan for the new medical office building, and other elements of the proposed plan add mou forward -- and move forward with other hospitals in the proportion of charitable care it provides. let's look at the assumptions underlying the current proposals for both st. luke's and cathedral hill. all of cpmc's specialized services are best concentrated add one single location. the cathedral hill hospital site

is extensible to residents from southeastern san francisco. st. luke's recent census is below 80 and accurately reflects the need for hospital care at that location. supervisor mar: i would like to ask you to please try to be succinct. >> ok. contrary to the underlying assumptions, a secondary care hospitals still need specialists and those specialist still need available beds to practice. st. louis now has the problem attracting specialist -- st. luke's and now has the problem of attractive -- attracting specialist. if we look at ucsf, they are in three locations. in addition, since this does not

reflect need. there are no patience at cathedral hill, but cpmc plans to fill 555 beds. a larger st. luke's contract well insured patients. as has been mentioned, if health care reform survives, many newly insured patients might find the st. luke's an attractive alternative. the proposal for a new medical office building is flawed. the current medical office building is well below capacity. the new office building will not be built unless it reaches 90% capacity and there are leasing agreement of 75%. it has been mentioned about the profit margin falling below 1%. it seems to me that there really

should be no escape clause whatsoever. there should be no ability to closed st. luke's and keep it open for a least 20 years. brief comments on the centers of excellence -- the center of excellence in committed to help, rather than serving the entire southeastern portion of the city, and hosting far-reaching programs that promote equity and expand access to primary care, behavioral health, prevention, has been reduced to following up 800 patients with the community and team approach. it seems to me that the proposed centers of excellence are read branting services that already exist at st. luke's. -- rebranding services that already exist at st. luke's.

it should be supported by an expanded in patient units devoted to these issues. there is also no mention whatsoever of the blue-ribbon panel's recommendation for establishment of centers of excellence and gynecology and low intervention obstetrics. the current centers as proposed have no dedicated budgets, no named directors, and no staff. there is no known plan to replace the skilled nursing facility as well as the st. luke's subacute. supervisor mar: please try to wrap up right away. >> we just have concluding remarks.

>> in conclusion -- i will do the conclusion. the size of the composition of services at st. luke's and cpmc possibility to change them in the future are matters of critical importance to the future of health care in san francisco. the future of st. luke's must be considered on its own terms and not in reference to approval of cathedral held. it is important for all supporters of st. luke's do you see we have common goals, regardless of oppositions on cathedral hill. there must be a commitment to rebuild a strong and sustainable st. luke's as a reliable community resources. a full-service hospital for the

city's south eastern sector. now is the perfect time to negotiate a project. we can use this opportunity to win commitments for a sustainable st. luke's with the scope and volume of services that will best serve the needs of the community. i urge you to use this time wisely. supervisor mar: rachel is going to wrap up very quickly. >> we would like to be able to do what you would like to do, too, to trust an agreement that serves the best interest of the city and the information is verifiable and true. cpmc's questionable track record and business practices, their week provisions to remain --

they're all disconcerting to us. there are more responsible provider standing in line. let's look out for the future of what is best for san francisco. let's really look at the big picture. trust and verify, thank you so much. supervisor mar: that concludes the presentations we have had on this item. i know we have a question from supervisor cohen. supervisor casupervisor mar: i n alerted by the clerk that we have to do one housekeeping item. tom we were said the vote on item number one? -- tan we resent the vote on item number one? there is an amendment to item number one, it needs to state that the board will hold a hearing date of july 17, 2012.

can we move that item as amended -- can we take that amendment without objection? can we move this forward as a committee report to the full board for the june 26, 2012, meeting without objection? thank you. back to the 150 cards that we have. i will do my best to call people in groups. if people can come towards the center aisle, that would help. we're asking people to speak no more than two minutes. if somebody has said something, resist being redundant, if possible. it does not have to be this order. come up as your name is called. we're asking seniors and people with disabilities to come to the front is the kind. for people to be respectful of that. and young people who are in the audience as well. i will start calling the cars. -- cards.

[reading names] >> i am 84 years old, is that senior enough? i am with san francisco tomorrow and i want to raise focus on our previous approach on health and safety. the imperative morally and legally is that in case of seismic cities, we require --

two-thirds of the city that would be imperiled by the certain event haven't outreach collectively -- haven't outreach collectively providing effective locations for immediate disaster relief. i am going to suggest three means of financing that. to take the title under cpmc and make that assured the in case of failure, you end up -- the cash flow will pay for the outreach in those parts of the city that require location. you have a surplus of capital debt requirements for projects that do not have to be advanced.

i could provide about 100 -- that could provide about $100 billion a year. a recent audits indicates over $100 million a year slush funds. there are three of resources there. i could provide one more issue, if you do not mind. supervisor mar: thank you so much. we are asking people to do your best to be succinct. next speaker. >> i have been living in san francisco and getting to know its people my whole life. i live in the excelsior district. during the school year. at first, i thought everything was perfectly fine because of

the people i encountered every single day. they are always kind unwelcoming to everyone. later on, i realized that was not the case. everything was not fine. st. luke's might be in danger of closing down becauseproposals. i believe having a functional hospital gives as a security of every sentences in can say with pride -- every san franciscan can say with pride in has been part of the community for so long they know exactly what to expect. since a lot of them are low income, sometimes they can only pay with thank yous.

we feel we have overplays to rely on. >> i am going to call it a few more names. [list of names] >> i am with a community center operator and i attend high school, and i live in the neighborhood. in the times i am around, i have experienced this sense of welcome. goothe same luke's hospital has been very controversial, so i picked up many issues.

st. luke's has been long representing a medical service of community-based care, meaning all classes are welcome and in reach. they have great pride and gratitude. one of the proposals concentrates on building a 555- bed hospital at the cathedral hill, leading to cutting down on more apparent services. if they cannot be easily accessible, how can we prevent a likelihood needing seven assistants?