in the community. cpm operated 18 psych alkylation trick beds and they would agree they can use those beds more effectively if they had more services in the community and step down services they can use to ensure people are moving to those bed and keeping at the level of acute. several years ago, med-cal lowered the threshold so they're not getting paid for lower levels of care, and acute levels of care is what cms is paying for and so as in san francisco general we do have people that are add and denied days because we can't get them out fast enough. cpmc provides other health services and our representative can speak about the services and you'll hear those shortly. the development agreement doesn't change the current mental health services,

it address the needs to have committee base option and the da specifically allows to have psychiatric care. i've been working with cpnc to look at a partnership to look at the community's need for the health services so we come up with the plan to link our door urgent care service center which will provide and what we hope to do is provide on sight services at saint luke and the emergency room who maybe in a need of high mental services and counseling, but who do not need to be in the hospital to receive these services. urgent care is a program we funded for the last five years and it's a

crisis stabilization unit that partners with general hospital. we provide the same amount of services on a volunteer patient. door urgent care serves individuals in psychiatric crisis who does not need is a collusion of restraint. those are the urgent crisis beds that cpmc have. they're on sight or on call and patients stay for up to 24 hours. door urgent care has two components, one of the things that we looked at when we set up urgent care crisis, there's a need to post an urgent care program and they have a door house, they call it, a short term residential treatment program that's located at the same site. once

they've stabilized patients who need additional services maybe transported and the average length of dora health is three to five-days, and from dora house, we have other placement services, residential programs, outpatient settings for individuals. i really believe this is a good partnership for patients, i think it's an important process and i believe it's the least restrictive and the cost effective setting for our saint luke patients. moving onto the monitoring of health care in the da. rich can provide more details on the monetary provision, but i want to give specific details of the components of the development agreement. the development agreement provides department of public health and our health commissioner who have had five

years in the cmpn process with the health care commru znswer -- compliance. it recognized the dh staff, but the role of the health care. they'll be required to fire a compliance report that details the performance on the da's key health care commitment and upon receipt of the health care compliance report, our staff will prepare analysis of cpmc compliance with the health care committee in the da. and any reduction in service lines that the hospital will also have additional subject to public notice, requirements under the city's proposition cube process that the health commission manages and independent paid by cpmc will review the compliance with the baseline health care commitment. this was included

because this information cannot otherwise be independently verified but public available data. the report and the results of their analysis will be in a public hearing before the health commission and it should return the cpmc compliance and i do understand the plan of commission has been support the collateral agreement. i want you to know the committee coalition, i've been involved with from the very beginning of this process. i believe we'll be involved with this coalition, but i believe the structure of the health department and the health commission, this responsibility falls under the health commission and the health commission is open to hear, to work with, and to be partnering with the coalition, but the health commission is to provide the over sight and i'll continue myself to work with the coalition as needed. i will be leaving shortly and my

deputy director colien shalla will stay throughout this hearing so any questions you you have, i'll stay for another 20, or 30 minutes. thank you. >> thank you. >> commissioner caninni. >> can i ask a question. you talked about the community outreach accomplished for psychiatric patients who were released from acute care and i wondered, what kind of ongoing situation would exist because one of the biggest problems is just relapse of patients after their released into their on devices, is there monitoring of these patients. >> absolutely. part of the role we'll play is they have their own services that wrap around these patients for

dischashlg. if they're at saint luke, we'll wrap around them, those who do not need to be in psychiatric beds and that's cpmc role, if they hit saint luke's hospital, they can use the beds and we have the responsibility of mental health services throughout the city and we'll work closely with this area, cpmc and the general are the psychiatric level and we make sure they do leave. part of health care reform is insuring the people do not get rehospitaled and manage hospital, we're obligated to make sure people try to stabilize in the community and do not get re-hospitalized and that's a major growth we have. so i'll commit to the planning commission to the board of

supervisors that we're going to work closely with them with the rate services we have in community. >> thank you. >> i wanted to briefly touch on the parking at cathedral hill. as part of the development agreement the amount of parking has been reduced. the previous project utilize the provision and the planning code that allows parking the rc 4 district to be right up to 150 percent of the minimum requirement. it's a maximum of 990 spaces or 125 percent of the codes minimum requirement which ever is less. 990 spaces is the lesser of the two and this is 237 fewer spaces than the previous project. and i'll turn it back to ken. >> before we go on i want to say no less than four people

texted me the answer to cagaya questions. >> it's three years up to 40,000 each and the other thing i want to point out, relative to the drt conversation, we need to say that the brt project is not approved and the schedule you were shown is the assumed schedule if it's approved on schedule, but we need to make sure people understand it's not approved yet. to continue on, i think the topic that has the most conversation the last time we were in front of you, was the independent forcement of monitor and we want to talk on that. the new language -- sorry. i'm on the wrong slide. so we understand that the development agreement has a variety of obligations, that's for sure. the majority of those obligations are cash obligation and nobody is worried about monitoring those.

you make sure the check is written and it's easy enforce that. some performance obligation requires more over sight. those are the health care ones and the work force ones and the traffic and transportation ones that you've heard about. we think that the city department as you've heard from barbara with the relevant expertise are well equipped, my department, the work force and the planning department, the dr requires an annual report as you heard from cpmc on compliance with all obligations. with appropriate back up documentation and we wanted to highlight as a third party audit on the health care and that's in the health care exhibit to the da. the city attorney as you know can initial enforcement action if the director of planning or

public find non compliance with the da and this has been asked and we con fermed that the board of supervisors under the city attorney to initiate an accident on whether the other part of the city does anything. moving forward we think it's not add advisable on any community groups but we do recognize a more robust process and enforcing the da and we're proposing to make that process more robust which leads me and i'm sorry, there's one thing i wanted to mention because it's a fact buried in the da. material changes, so the da distinguishes between material and non material changes should the city ever want to make changes and the da hear sets a

low threshold on what is a material change and specifically any change whatsoever to a community benefit, even if the undupe mri indicated patients goes from 20,000 is a change that needs to go to the board. it's going to be very minimal and minor things, actually have to come to the commission but not to the board. so there is no change to the da, whatsoever. that doesn't go to you and any material change even if it's a -- which is a pretty low threshold as described in the da goes to you and the board. i wanted to put that out there. you have in front of you the text and proposed new language and i want to make sure the commissioners have it. section 8.2.2. there's a clean copy and a copy that's marked to

show changes to the existing section 8.2.2. i'll paus if you need a minute to get it in front of you. so i want to go over what this does and this is the proposal that staff has for you to adopt much more monitoring procedures. this was negotiated over the last few years with cpmc and the mediator help us get back to this point and supervisors campos so all of those folks signed off on this. section 8.2.21, the one we're proposing to change has a compliance report, exhibit f section b already requires the audit. so the things that cpmc has to do is set, so the rest is about what the city has to do that and that's section 8.8.2 and

the five things this language does to change the old language and make it more robust are when the city receives the compliance report from cpmc and the third party review or audit of the baseline health care, that must be put on the department's website immediately. so that the public can review it. secondly nobody can do anything for 30 days after that material has been put on website, so the public can review and given an avenue to comment on those -- on whatever is on those documented and whether the public feels that cpmc has demonstrated compliance or not and it requires a city report which is basically the planning director and the health director in corporation with work force and mta primarily to the city reports back on whether cpmc is in compliance

and evaluates the compliance report. that was required. what this does is make sure that city report covers a list of issues that you have in front of you that are the kind of key issues. so it requires that report to be complete and then the next thing that is different from what's in the current section is there was an optional hearing basically where you and or the health commission could hear compliance every year, and it's mandatory so the director of planning must bring this to you every year, it must bring it to the health commissioner every year and there is the last piece is it establishes a third party monitoring who is identified as mr. drarado, and the way that would work, after the process is done and the commission hearings are done, it will forward to mr. drarado,

the materials and report of public comment and the responsibility would be to write a letter to the board of supervisors to say i agree or disagree with the conclusions and the board of supervisors had the right to call a hearing and if they don't think that cpmc is in compliance, they can take action. this connects the board and to these proceedings to the board doesn't have to be watching and decide that they've got a prompt coming from mr. drarado saying this is okay or look at these. those were added in as several more robust layers of public process and we think that those things cover the concerns and i would interested to hear from the commission if you think we covered the concerns around changes to the da which are -- must go through a public process, if they're anything more than a comma and the idea

of enforcing and monitoring and making sure any member of the public can get access to the information that the city staff has and evaluate it and let you know through comments to staff and through public hearings which they think things are going the right way. i also want to know on another subject and i apologize. this did not get to you in advance but it's pretty simple and i'm going to go over it quickly. there's a section 4.2.1 and it's something we're changing. i apologize. it's mislabeled on the slide. section 4.2.1. it's about the concept of delay payment. let me go over that. in the old da with the old hospitals there was a requirement for cpmc to open saint luke's no later than the

same day it opened cathedral hill and that was an important part of the agreement. when we looked at resizing the hospitals and up sizing saint luke and down siding cathedral hill, the process going back to the state health -- i don't know what it stands for -- the process to go back to them because saint luke is a different building, it really is treated by the state as a new building and the state does a lot of new permitting, down sizing cathedral hill is simpler because it has fewer floors so it doesn't take as long to get through the process. we took a look at the scheduling processing and we called in to general hospital who is far with construction schedules for hospital and we determine in general -- we

determined that cpmc would need one to two years extra to get saint luke open and that seem like a fair request. we took those liquidated damages that used to occur at the day after cathedral hill opened and started 10,000 a day and go up to 25,000 a day. so basically there's a two year period after cathedral hill opens that they can still -- they're not in violation or in default of the agreement as long as they get saint luke open no more than 24 months earlier. we want to get saint luke open and they have a different named call delay payment. bcpmc is required and has agreed under the contract if you adopt these changes to be responsible or liable to the

city to 2,500 a day for the first month. so just to say it another way from when cathedral open, there's 12 months when nothing happen and another seven months where the delay payments kick in and the liquidated damages which is default of the agreement which is more expensive, so we added these to give a level of comfort and we would ask you to amend those into the da. that ends my presentation. happy to answer questions or wait until after public comment. >> thank you. >> thank you, ken. >> now we're going to move on the langgy approval. there's many requires for the cpmc five new buildings, i'm going to go through the key at a high level. and they're in detail

in your pocket. the approval before you today includes april mrikable to the new buildings and general plan for the cathedral hill planning. and section 101.5 findings for the five buildings and saint luke, conditional youth authorization at all three near term campuses, office allocation at saint luke and general plan referral at saint luke and the da that covers all the systems. at the saint luek campus, it will create the chavez medical use and would allow the floor area of ratio 2.6 to 1. it would allow a hike to 145 feet at the tour and 105 feet for the balance the campus. the map will be updated to reflect

this new sud. at the cathedral hill campus, the amendment would create the medical use sub district and allow deviation from planning code through a conditional use and allow an frr for the medical office. the planning code would allow an increase to 230 feet for the hospital site and show the boundaries of this district. i'm happy to go through the planning deviation but in short these deviations are typical of deviations that are often rebelieved through a develop -- it's rebelieved through a development or various process. the staff made a decision to say it's better to incore rate it into text amendment rather than requiring one more entitlement. there's others proposed that

was covered during the hearing last month and the revised project before you today eliminates the need for one of the planned amendment for the cathedral hill project and that's map four that was required under the previous oject last year. moving onto conditional use of authorization that's before you today. at the saint luke campus, there's a building over 40 feet tall and the kwerments, both limitations, parking, minimum and certain obstruction. at the cathedral hill campus, there's authorizations requires and those to allow medical center to demolish units and allow wind speeds greater than 5 miles per hour and allow the code and curb cut and active ground floor uses and to modify the three to one residential to

non residential square foot requirements. lastly at the davis campus there's two uses required to allow modification to the existing pud and the yard requirements. the department recommends that the commission take the required actions in order to approve cpmc long range development project. the department determined it's a -- this prosect is routed in the approval of the agreement that tim went over which provides benefit to the city. the project would provide two new safe hospitals doubling the number of earthquake beds in san francisco and secure saint luke homes and provide jobs and retain one of the city's major

employers and increase access for low income and san franciscons and providing improve. this would be at no cost to the city. it's unbalance, necessary, compatible with the neighborhood and it's beneficial to the city. in summary the department recommends that the commission approve 8 a through 8 n and allow the long plan project to move forward to board of supervisors for final. that concludes and i'll turn it to dr. warner browner, thank you.

>> proposes to build a new hospital and an integrated hospital building from the cedar