neighborhood improvements, and work force development. as you've heard, we could not have can you have to this place today without the willingness of the mayor's office, especially ken, and supervisors chiu, campos, and farrell to engage in countless hours of negotiations under the leadership and mentor ship of lou gerardo. now that we've reached agreement on a term sheet, we hope the board will vote to move this project forward, thus enabling us to build these two new world class hospitals. we look forward to moving quickly toward beginning construction and getting shovels into the ground. thank you. >> thank you, dr. bronner. back to mr. rich. >> some general points about the term sheet as we start to go through it. the resolution before you is a nonbinding endorsement of the term sheet that we've negotiated with cpmc. it directs staff to go back and

complete or revise development agreement based on these terms. today is not a final approval from the board. the project under the development agreement must still go back to the planning commission and then come back to the board of supervisors, and i'll show a schedule for that at the end. so, these are the key points of the new agreement. first, a significantly larger st. luke's hospital, 120 versus 80 beds, and a significantly smaller cathedral hill hospital, 2 74, up to 304 beds versus 555. st. luke's hospital will be an integral part of the cpmc system 25% of the bed in the city. cpmc will be obligate today continue providing specified level of charity care to the needy san franciscans with no reference to cpmc's financial conditions or projections. and last, about 80 million in cash for community benefits is part of the agreement related to health care, transportation,

work force training, affordable housing and pedestrian safety. so, starting with st. luke's, which has always been the center point of this whole agreement, st. luke's will be a 120-bed general acute care hospital with an emergency department. cpmc must open st. luke's hospital within a specified number of months after opening the new cathedral hill hospital. instead of the previous 80 beds st. luke's hospital with a 20-year operating covenant, st. luke's at 120 beds is a more sustainable and comprises almost 25% of cpmc's beds in the city. st. luke's will be required to have service of excellence in senior and community health with services specified in the development agreement. and st. luke's will be required to provide all the standard services found in general acute care hospital as specified under state law. moving on to the st. luke's medical office building, a

medical office building at st. luke's is entitled as part of this process. cpmc is obligated under the term sheet and the development agreement within five years at the latest to begin construction of a new medical office building on the site of the old hospital. or offer the site to the city for the purpose of constructing such a facility. and this is essentially the same as in the previous agreement. like st. luke's, provision of baseline care for the poor and under served is a central part of this agreement. this time around we have negotiated a new and we think better way of defining this obligation. instead of using a dollar amount subject to inflation and link to cpmc's financial performance, we have negotiated a set number of patients. either charity care or medi-cal with cpmc must care for every year. this is defined as the average number of patients cared for in

the last three years and is approximately 30,000 patients a year. in addition to -- for this 30,000 patients per year, cpmc is obligate today provide $8 million per year in cash for services to the poor and under served. and again, just to reiterate, these commitments are absolute and do not depend on any external circumstances. going on to the new medi-cal [speaker not understood], you will remember in the last agreement cpmc was responsible for being the hospital partner for a number of new -- of net new medi-cal beneficiaries. this is over and above the baseline commitment discussed on the last slide. this means that cpmc will work with primary health care providers and provide care for medi-cal patients when they need hospitalization. the obligation and the term sheet is 5400 beneficiaries for 10 years, at least 1500 of which must come through a provider that serves the tenderloin.

expenditures for this are capped at 5 million per year, increasing each year. and i do want to note before moving on to the next subject that this is sort of an arcane health care issue and if anyone has questions on what we mean by the medi-cal [speaker not understood], we have myself and staff from public health here to answer those. so, the next thing is the health karin ovation fund. like in the last agreement, there is a health karin ovation fund to be jointly controlled by the san francisco foundation, cpmc and the city, cpmc will endow this fund with $9 million. two uses for the fund have already been identified as shown on the slide. one is the development of a primary care provider network in the tenderloin which will help provide those medicare -- medi-cal, excuse me, patients for cpmc from the tenderloin. another is community-based mental health services and again, we have our public

health staff here to answer any questions on those. next is the health serve system. so, the term sheet specifies that cpmc will help protect the health service system from premium increases by capping rates for 10 years. this limits premium increases to ensure for hss. and i want to note a typo on the slide. what this should say and what it says in the term sheet is years 1 through 2 at 5% annually. and years 4 through 10 no more than the medical rate of inflation plus 1.5%. so, that should be noted as a 6. moving off of health care to the other set of community benefits that are contained in the term sheet, we start with affordable housing. the term sheet includes two different affordable housing payments. the first is 4.1 million to compensate for 25 units that will be displaced by the construction of the cathedral

hill medical office building. and this payment is defined in the planning and the administrative codes. these funds will be paid at the time that cpmc pulls a demolition permit for the existing buildings. the second is $36.5 million to the mayor's office of housing, affordable housing fund. this is in furtherance of the van ness special use district which as you know calls for housing to be a part of all large projects developed on van ness avenue. moving to local hire and work force training, their provisions are 30% local hire for construction jobs, including 50% local hire for new apprentice positions. this is on the construction of the five buildings that are included in the project before you. 40% local hire for entry level permanent jobs for 10 years, $4

million paid by cpmc to the city for work force training programs, and then the other provisions that were in the previous agreement remain in effect. on transportation, we have three pots of funds which will go to sfmta for use in improving transportation services around cpmc's facilities. these are, one, a fee in lieu of tid, transportation impact development fee. and that is in the amount of $6.5 million. number two, funding for bit fa shipments to be built at geary and van ness in the amount of $5 million. and third, a parking surcharge to be imposed on parkers in the cathedral hill garages and that is it' 50 cents for every entry and exit off peak and 75 at peak times. obviously we can't predict the exact amount of money generated by that, but our guess is $3 million over 10 years, or

300,000 a year. in addition to this, there are some new provisions regarding ongoing monitoring of transportation conditions around all of cpmc's campuses with a particular focus on cathedral hill conditions. in short, cpnc is obligated to work with the city to monitor percentages on campuses and overall congestion at cathedral hill. if after these monitorings the drive alone or overall congestion is found to be substandard, cpmc must provide cooperation and some additional funding to address these conditions with the city. and lastly, cpmc will use a variety of outreach means at their disposal to encourage their employees to produce -- excuse me, to purchase a clipper card and will subsidize half the cost of the clipper card for all employees who wish to have one.

moving on to streetscape and pedestrian safety, in terms of streetscape and pedestrian safety, cpmc will pay the city $4.25 million for pedestrian safety and sidewalk widening in the tenderloin, $200,000 to fund a safe passage pilot program in the tenderloin, and $1.55 million for transit and safety improvements in the neighborhoods directly adjoining the cathedral hill campus. in addition, cpmc will pay 3 million to the city for enforcement and traffic safety improvements around the pacific and california campuses. around st. luke's and davies, the agreement calls for cpmc to build a specified program of improvement themselves along with building a new facility rather than paying the city cash. and these programs of improvements are valued at $475,000 for st. luke's and

$3.3 million -- i'm sorry, $475,000 for davies and $3.3 million for st. luke's. so, the agreement also contains a payment schedule for the cash payments as noted on the slide above. in summary, about $7 million is payable to the city as soon as the project is approved by the board and signed by the mayor. the remainder of the payments come over a period of five years , once approvals are finally granted. which means any mitigation period -- any litigation has been settled or time period for filing such litigation has passed. i also want to note that a couple of payments have their own schedule not part of what i just mentioned, including the payment for displaced housing units, the in-kind improvements at st. luke's and davies, and any funds that are payable due to the result of traffic studies that identify additional congestion.

and this, my last slide, just to talk about moving the project forward. if you move the project forward today, it will need to go back to the planning commission because the project and the development agreement are substantively different than what the commission previously approved. we expect to have new approvals at the planning commission in may of this year and be back before the board in june and early july. that concludes my run through of the term sheet. i was going to ask barbara garcia, our direct r of public health to say a couple of words from the perspective of the public health department, and then staff will be available for any questions or clarifications. i realize i went through this fast so i'm very happy to go back over anything you wish me to. >> thank you. director garcia. >> president chiu and board of supervisors, very happy to be here today to support this agreement. i wanted you to know that since 2008 our health commission laid out some major principles for our discussion on this issue. one was to ensure its secure

st. luke's, to ensure access to cpmc for medi-cal and charity care patients consisting with the changing health care environment -- consistent and focus on cpmc benefits to san francisco's most vulnerable. we believe this development agreement does meet these principles ~ and has continued to do that through a similar agreement you heard today on health care. first and foremost, two [speaker not understood] hospitals st. luke's campus and at cathedral hill. a continuation of the baseline level of care for 30,000 vulnerable san franciscans. hospital care for 5400 new medi-cal managed care beneficiaries. $9 million innovation fund managed by the san francisco foundation along with the department of public health as well as with cpmc. and this will provide primary care network for tenderloin. this is going to allow for one of the clinics in the tenderloin to really step up to

be able to provide more for medi-cal managed care patients. through our work with the san francisco clinic consortium. we also will provide dollars for the expansion of mental health services for the community. and there will be other community based services that our community agencies can apply to for this innovation fund. the oversight and the continuation future of this agreement will be audited annually by independent third-party for the medi-cal patients to ensure that we do meet those numbers. the innovation fund will be managed again by the san francisco foundation along with cpmc and dph. we worked out many of those agreements in the previous conversation that we had here at the board. and as well, our health commission will be hearing annually on the update of this development agreement through their health commission meeting. so, we want to thank the board for their involvement, particularly the president of

the supervisors along with supervisor campos and supervisor farrell, lou gerardo and particularly to ken rich for their incredible work in finalizing this process. the department would like to provide their utmost support for this development agreement. so, thank you very much. >> thank you. colleagues, any questions to staff? supervisor campos. >> thank you very much. and, colleagues, i apologize and i would appreciate your indulgence. i just wanted to ask a quick question to our director of public health. and i'm asking this as the district 9 supervisor that includes st. luke's. and this has been a topic of discussion for so many years. but one of the things that i'm very confident of is the fact that this agreement will allow for the rebuild of a world class hospital at st. luke's that will be a viable hospital that will remain viable for the community for many, many years to come.

it's one thing for me as an elected official to say that. it's another one to have our director of public health, and i just wanted to ask you specifically for st. luke's. as i know, there are many people in that community and that surrounding neighborhood that, that may be asking about that, if you are confident that this will ensure that we have a long-term, viable hospital. >> i believe that the agreement that has been made with the additional beds for st. lukes will be a very viable component of cpmc's overall health care system of care. i think that this will not only -- there will be also two centers of excellence at st. luke's that will be focused on geriatric kara long with community health. ~ care along at st. luke's, i believe very important services will be

integrated within the hospital. it will be an integral part of cpmc's service system. it will be necessary for cpmc to utilize st. luke's to maximum ability for the community within the southeast sector. >> thank you very much for that. and again, thank you to your staff for helping to make that happen. and, of course, i was remiss in saying thank you to lou gerardo. you know, today is actually very historic day in rome. you're having a conclave and selecting a pope. here we have a tentative agreement on cpmc. i don't know which one is more monumental in a way. [laughter] >> they may need lou gerardo to help them out if they can't agree on a candidate. but thank you, lou, and everyone who was involved. >> thank you, brother campos. supervisor mar. >> thank you, president chiu. i wanted to acknowledge besides all the other accolades to our mediator and the three amigos,

chiu, farrell, and campos. i didn't think we would make it this far. there was tremendous dispair on land use and committees of the whole. i also wanted to say three formerly coalitions of community and workers organization and neighborhood groups that united to form the san francisco -- san franciscans for health care, housing, jobs and justice, did a tremendous job working to make sure we could be proud of this deal that ensures $80 million of community benefits really impressive local hire and work force training that's much, much improved from the previous efforts. i'll just repeat that it's 30% local hire for construction jobs and 50% local hire for new apprentice positions. and then for the end use jobs which was a really tiny number initially, it's in our 40% local hire for entry level permanent jobs for 10 years. that's major, major progress

made from initially. i also wanted to say that i think the community coalition that demanded fairer proposals from sutter and cpmc sutter, they clearly were right to hold the board accountable and to keep the pressure on. and i really wanted to thank judy lee and dr. browner and others from cpmc for staying at the table and really coming up with i think a proposal that i'm very proud we can stand behind today. i also wanted to comment similarly to supervisor campos' comments that i think it's really important that there is unfinished business and i'm disappointed that not all the different issues got worked out specifically with the nurses. and i hope that there is a continuation of dialogue so that we can encourage not only a great community benefit package for the city, but also that we treat with respect the nurses that were in the hospitals for cpmc.

i wanted to just lastly say that i feel that with the many hearings that we held at land use and at the board of supervisors and the very public and open and transparent process that we're now at a place where we have a great development agreement, and i'll be strongly supporting this today. but thank you. >> supervisor kim. >> thank you. i just want to echo all the same sentiments that have already been expressed. i think on the board of supervisors end it's a particular shout out of course goes to president chiu, supervisor farrell and supervisor campos. and i know they spent countless, countless hours in negotiation unexpectedly and i appreciate all the months that were spent to bring forward a much stronger deal. and, of course, all of our community groups that have been working on this for many years and cpmc for really sticking it out. i think that what we have before us is a much stronger plan and i think something that is more beneficial to the city.

i did have some questions for dph, to director barbara garcia. i had been visited by several different members around the need for psychiatric beds within cpmc. and you learn that 34 psych beds were lost when it was closed in 2006 and 2007 and those beds were never replaced. several doctors and members of our community coalition are concerned and want to see an overall plan to address mental health care needs, both inpatient and outpatient as some needs can't be addressed appropriately in an outpatient setting. something we've been approaching a lot i hear from, constituents throughout our district, particularly tenderloin and sixth street. so, i'm curious as to your thinking on psychiatric beds that may or may not be created within st. luke's and cathedral hill. the term sheet is silent on those so i was hoping you could address this issue.

>> the psych bed issue is one of difficulty particularly because our medi-cal system has changed the way that they're allowing for acutity paid for in psych beds. that has caused a real challenge throughout the psychiatric community who are providing these beds to really make it work financially. and, so, that is one of the reasons we really pushed and supervisor campos really pushed the mental health services. we believe that people should be at the least restricted level of care. cpmc does have psychiatric beds. and they will use those to the best that they can. and then we will connect our mental health services that we're providing for, the innovation fund and all the other services that we try to provide within the city and county of san francisco to support those clients going through their program. we did not recommend psych beds because particularly at st. luke's because of the financial viability that we thought st.

luke's really needed to have. i can tell you from looking at the psych beds that we have in the city today at san francisco general hospital, we have a hard time trying to manage our acute beds because of the financial circumstances of being paid for those services from the federal government. so, to try to push more psych beds that could cause financial problems for st. luke's is not something we are in support of and we wanted to ensure that there were community mental health services when those individuals did leave the psych beds at cpmc, that they were having -- they would have services to go to. >> if i could just follow-up on that question. and i completely understand the rationale behind the thinking. when there is a need, though, for inpatient psych beds, what are the options that we have in the city? i understand that the federal government has recently been cutting funding towards behavioral treatment beds unfortunately within hospitals. i'm not an expert on this, but

i know it's a big issue in our city and our district. so, i'm curious as to how we may be able to fill that need. >> we have presently about 40 beds at san francisco general hospital, and today we have about 12 acute patients in those acute beds. so, just from that alone, it is a difficult process to continue to maintain psych acute beds and be able to continue to pay for those. so, when people are in need of psych beds, they do -- there is availability throughout the system. pes is our first line of defense and that is our psych emergency service. and that provides a triage to determine whether or not an individual needs to be put into a psych bed or to be able to be cleared through other seices and provide outpatient services. so, when there is a need, our beds are not filled at present and that was one of the concerns that putting psych beds in another hospital where

they would not be full and then you would have, again, staffing beds that you do not have revenue for. so, people who are in need of psych beds do get those beds, but the level of acutity and what the federal government will pay for is limited. so, the most important process that we go through in the health department is to ensure that people are ready to leave, that they are able to get into lower levels of care of service. we also provide placement services outside of the hospital itself, and we also have a 24-hour psych emergency -- psych urgent care center that's run by one of our community members door street on progress foundation. so, it is a concern, but it's also a issue of financial viability being able to afford those kinds of beds. >> thank you for your response. and i'm very interested in this issue and look forward to working with you on this. my last question was just in term of enforcability.

in terms of ensuring the 30,000 medi-cal lives or even how we would ensure that 1500 of the beneficiary must come through a primary care provider serving the tenderloin. i'm curious as to how we're going to monitor and enforce those numbers are actually being met. >> one is there will be an annual audit of an outside independent group that will be looking at that. but our staff will be working very closely with the san francisco clinic consortium and monitoring that on a regular basis as well. >> so, we will be hiring -- we will be looking at an independent audit on a yearly basis that's included in the development agreement to ensure that those numbers are met, as well that i work closely with the clinic consortium and i will continue to work with them to ensure that this is met. it's a real important process for the viability of our clinics in the city and some of these dollars are going to help them support a structure to support the managed care system

of care. >> and just to follow-up on that, if the lives aren't being met, if the numbers aren't being reached, what is, then, the following action? >> so, a couple comments on that, supervisor. just generally in terms of enforcement of a development agreement on the way that the law provides is the primary enforcement agency for development agreements is the planning department and, so, there is an annual report to the planning director and the planning commission on this particular one because it is so health focused. the development agreement specifically includes an annual report to the planning -- to the health commission. so, basically mange and health are together monitoring the document. if they find and discover with the help of that audit that barbara mentioned that the obligations aren't being lived up to, there are provisions in the agreement on the health care obligations for liquidated damages to ensue if they're not being met. i will say out of sort of

fairness, we don't look -- we look at a willing average of every two or three years. if they miss by 10 one year, they can do 10 more the next year. over that period of time they've got to make the numbers or else the city can get liquidated damages. >> and how are we funding the independent auditor? >> cpmc i believe is funding -- the auditor is jointly -- correct me if i'm wrong. the auditor is jointly selected by cpmc and funded by cpmc. >> thank you. >> supervisor breed. >> thank you. i hope i can get to the heart of the matter without completely taking this deal apart. i know that supervisor chiu and supervisor farrell and supervisor campos have worked really hard on this and i wish i had been in office when the negotiation started, especially because it impacts, you know, the residents surrounding district 5. but also more importantly, we

have had so many of our residents who have been actively involved and really interested in the outcomes and how this particular project can serve the western he edition community. when looking at projects of this magnitude, i realize that they are city-wide ~ and will have fortunately really positive impacts throughout the city. with that, i think what i'd like to see a little bit more of in the agreement is making sure that there are significant efforts towards supporting developing the appropriate training capacity for the work force that's being proposed here. i notice that there's $4 million being proposed for work force. i also notice that at one time before this renegotiation, a