been asked for a range of agreement. are breaking point is all too near. our primary obligation is and always will be providing health care for our patients. we are optimistic this will soon be resolved in a mutually agreeable way, and we plan to share the details as soon as we have them. we know of no other size and rebuild and has undergone the level of scrutiny ours has raised. we know of no other hospital in the united states that has agreed to the level of community

benefit they have agreed to. we stand on the precipices, ready to move this project forward, of building 635 earthquake-proof beds in san francisco, revitalizing two neighborhoods, and injecting $2 billion into the economy please move this into the project so we can continue providing high- quality health care for san francisco. [applause] >> thank you, dr. if i could ask that people can keep their applause down so we can try to move through the process. dr. lee was going to present as well. we now have a number of speakers from community groups.

goo>> i did have a question. if i may, very quickly, i thank you for your presentation, and i have appreciated the conversations we have had about this topic, and i am sure there will be many more, but going back to the point that you are confident you're not going to reach the 1% operating margin with the city. the best way to provide us with confidence is for those of us being asked to approve this project to see the numbers that show about, so why not share the numbers?

i think we are trying to be responsible. you talk about how you have an obligation to be fiscally responsible. we have an obligation to be responsible, so why not just show us that information? >> i am sorry supervisor chu is not here to hear me say this. we look forward to crafting a solution, and i am not so naive as to thing that will not involve providing additional information to the board of supervisors. i did not grow up yesterday. >> thank you, mr. chairman. goo>> [list of names]

fax good afternoon, supervisors. thank you for having us here. and we are one of the 50 organizations in stamford siskins for health care, jobs, and just as spirited we have coalitions across the city and many in our districts. we are here to talk about three main concerns for this proposed project, and you have heard some of it already. gooone is the track record but compels us to be assured of any agreements for this corp. stereo -- for this corporation.

we can ensure there is a future for st. luke's hospital. there are already concerned about whether doctors possible with a current agreement. i am going to introduce a couple of young leaders, because some have to go home. i am going to introduce a couple of members of the progressive association. i have damien and eric -- jamie and eric. >> we are trying to move this along. >> i am from the chinese progressive association. i just want to make a comment about the practice thos zes.

my mom has been a patient for a while, and she has had a good experience, but a few years back she'd mysteriously disappeared for what she called a business trip. i found out she needed surgery to remove of benign tumor in her breast, and cpc denied her on the basis she had medical and not private insurance, and recently she needed surgery on her ankle but was denied again because she had medical. i find this they are going to be true to their word they should not turn away medical patients, especially in serious condition like this and should also committed to bringing in more charity care. good = =they paid $101 million,e

agreement says they only have to pay $96 million, which is not enough to begin with. >> i am eric, and i wanted to comment on the disparity in the number of hospitals in the northeast and southeast of san francisco. there are eight hospitals, but in the southeast, there are only two, whereas the southeast requires a lot more medical services, because there is a high rate of pollution, and there is a high rate of families that are low income minority groups. this is why the cpsmc project makes no sense. it will decrease the prosperity even further by reducing st.

luke's hospital. it will cut the number of events from 230 to 80. in san francisco where we need more medical services, not less, we should rethink this. >> thank you. pleased with hold your applause, and we will get through this more quickly. good >> it is a pleasure to be here today, and i will try to keep this in a brief in respect to your time. good i want to start by challenging the assertion that this is about health care. we believe the nature of this particular development proposal is primarily about profits and that they have designed this with that in mind. give we have a power point.

this is really kind of an image we think encapsulates that truth, and the question before this body is can you trust san franciscans access to health care services to these projections? i would submit today is a very good example of why you cannot, and these listings of patient care costs reflect other -- affect other communities that have put their trust in sutter health. they have delayed the announcement, pending approval of the project, so about closure, which is of a broken promise, will not affect deliberations. you can see nursing care just on

the east bay. all series of cutbacks and pediatric care, dialysis, and other services in sacramento. it is not listed there. we have of berthing system that is closed. they are in litigation in the north bay and. you heard about the litigation. they have been in litigation over san leandro. ever where this corporation goes, the community and up in court against them. during the question with regard to st. luke's issues this is a reduction in patient care services in the southern part of san francisco. there is one typo during this presentation. it should be between 75 and 90,

but it still reflects a reduction in 2/3. it was created to increase the portion of injured patients that this is the model. the insistence on a radical reducing to only 80 beds is designed to eliminate future competition. 20 years is a paltry timeline for the new facility, and i would suggest, if you want to

service for another 150 years, you will commit to keeping st. luke's open for another 150 years. what is the health insurancare ? we have learned sutter health has engaged in business practices designed to consolidate hospital services and eliminate competition to leverage control in price setting in the health-care market. that is what they are doing -- leveraging control to set prices triggered an article published in the "los angeles times" last see your contributed who did last year contributed higher prices to a few systems, particularly senator. much of the reason for higher costs northern california lies

with solder. goo-- sutter. the consolidation is a serious problem, and finally, the federal trade commission in 2008 determined when merger in the east bay was anti-competitive. you have three respected authorities. did you not take our word for it. consolidation leads to higher prices. it is designed to create consumer demand so health insurance plans to do not include the hospital in their networks will be less popular.

it was the same objective when they merged in oakland. it raises questions about what is the optimal size of the hospital. gthe literature review showed te optimal size between 200 and 400 beds. the economy of scale exist, but they declined after 10,000 annual discharges. profits rose between 500 and 550 beds to over 88,000 in a 550-bed hospital. this is the explanation for the size of the hospital. you could achieve the care efficiency with a 200-bed

hospital. would you achieve is more of the double -- more than double the cost of beds. the eir could have addressed this issue about the type of service makes and size of st. luke's -- service makes and size of same lyrict. luke's but rathn providing you something you can review it made a comparison of about if we conduct that, we will disrupt continuity of care. that is not allowable in c. " pure good -- that is not allowed

in ceqa. they cited they would not be allowed to meet deadlines, a survey site seismic deadline as a problem, yet continually try to extend those deadlines. finally, let's look of the geographical distribution of the number of beds. good i was on the blue ribbon panel of your good -- blue ribbon panel. did not endorse the approach. it did not specify the number of eventbeds. it was the used to buttress that is going on here.

it is not an actual reflection. they want to maintain services in the part of the city said they are not doing anything further about that in this presentation, and here we have a change that includes all general acute-care hospitals, and it shows there is a withdrawal of denbeds and a concentration in e most heavily used and who corridor of the city. that cannot possibly expand services in those areas where they are most needed, so i would conclude by saying that other communities have trusted sutter, and they have paid the price, and it is a prize to high today.

good >> before the next speaker, supervisor weaner house to speak -- wiener has to speak, so let me give him his closing remarks. >> i was not able to reschedule, so i'm going to go and come back. i will be watching the video of any of the presentations i missed along the way. >> is out for the remainder of this project? >> no. gooprice we have about 120 spear cards, and so do your best to keep it succinct. >> we appreciate the opportunity to be here. did i am with the national union of health-care workers, and i commiserate with representatives from the mayor's office in negotiating a.

i have the experience of doing that since 1997, and i understand them to be one of the most difficult employers to deal with, so what transpired is certainly consistent with our experience, and i remember the strike in 2005 where we had an agreement that was negotiated that they renamed yangon -- renigged on. the ability to renegotiate certainly would ask us to urge you to consider revisiting the terrible care provisions of the agreement, and i want to walk through our take on. cpmc is one of the most profitable of our hospitals. we have a power point theory go

-- we have a power point villaraigos. the annual profits of $949 million were almost 12 times the average of combined profits for comparable hospitals. the operating margin over the same time was 13.3%, making it one of the most profitable hospitals in the entire country, but they provide the least of charitable care of its these hospitals, ooffloading millions of dollars in cost soon taxpayers. in 2010, cpmc provided charity care equal to 1.4% of revenue.

comparable care was almost double. good in 2010, 14.3% of indications recovered by metta account -- recover by medical. 14.8% and were covered by medical. they should provide an amount of terror devotes care equal to the amount of comparable hospitals, as the mayor originally off, and the progress of a revival would require them to provide even more, as they are far more profitable. under the proposed agreement they would commit less charitable care than they provide today.

in 2010 they provided $101 million in charitable care. it will be subject to a variety of loopholes. under the proposed agreement, rather than additional resources to address the problem, they will commit no less charitable care than currently provided today. cpmc's baseline commitment will provide $86,000 plus inflation of charitable care up to 40% of san francisco affiliates. they will provide hospital care for 10,000 of the projected 30,000 who come on line as a result of health care reform.

the baseline commitment is subject to a cap of 40% sign, a cap cpmc made barely a scene today. youthis chart shows could barely exceeds the threshold beyond which it would be pared back. while this does not account for all affiliate's in san francisco, some of those affiliates may be structured in a way that produces-, worsening the problem triggered the baseline commitment also allows them to provide any spending of the amount needed to meet the requirements for the prior year or the year ahead, and treating it as a maximum rather than a

minimum here it is capped at $9.5 million a year above that, the number of lives will cut back to your good -- will cut five. the city will see less than the $9 million in benefits. the new benefit also allows requirements to be met with a two-year running average, treating it like a maximum, rather than a minimum. the full caseload will only come on line three years into the agreement. exxon'what happens after 10 yea?

what does this terrible problem really cost san francisco? the proposed agreement is flawed. good it must be fixed to ensure they provide not fair care and stop offloading on other health- care providers. if they had provided at the average level of comparable hospitals, it would have provided $125 million a year, nearly $30 million more than it has committed going forward. over 10 years, letting it off the hook now for its share care will save $300 million, much more than the total is committing, and shift $300 million of the cost to san francisco taxpayers and other health-care providers. it is for those reasons we think the provisions are flawed and should be renegotiated.

for its thank you. next speaker. please hold your applause. >> you mind if i asked a couple questions? you just heard from this passed presentation of the estimate, but the deal we have the does been proposed is $30 million less than what would be required if they were asked to provide an average level of charity care, their fair share for the city. why is it the number is $30 million lasess? by its the most important thing, we want to make sure we get specific services the city needs. we are not necessarily as brokers on the dollar amount. good an example is mexico. that is what our health department realized early on, what we need from cpmc, ahoy so

it is the service but is important. of we are much more focused on getting what is needed during your region in what is needed. it is more a bargaining -- more about getting what is needed. good >> i understand the mayor had of principle of requiring they contribute to other terroc. my concern is if we are talking about $300 million worth of assistance to the city, at some point someone is going to have to pay for the. it could be the city. it could be employers, and that is troubling. i am wondering how do you

respond to that? >> one of issues we negotiated a round was the fact that under the new affordable care act that is how we did that. we also looked at the average of that going forward. we tried to negotiate a going forward example, knowing that charity care may be smaller due to the fact that more people will have insurance. >> we continue to hear from cpmc that they view these commitments as a floor. they hope to provide more overtime. the contract itself frames a lot of these commitments as ceilings. you have carryover requirements

cannot allow any excess to be used in a subsequent year. was that the intent of what you wanted to do? >> not at all. i would not agree with you that the 40% cac is a maximum. cpmc said u.s. -- i can only take them on their words, that it is quite likely they will exceed the requirements. there is nothing that would disincentive buys them or have them not -- disincentivize them. >> some portion of that can get used in a subsequent year? >> i was about to get to that. that is to respond to the fact, and this is what we are working and this is what we are working -- we have learned, is it