the board of supervisors already has through the charter and had administrative code the ability to direct the city attorney independently of these city departments to take an action if the board so wishes. ~ and had there had been discussions throughout the last few weeks of having the city enter into some kind of contractual or collateral legal agreement with the community coalitions that have been helping us work through this in order to give them some kind of right to monitor or enforce, and changes we're going to get to. we don't think it's advisable to go the contractual route, but the conversation did really open our eyes to the fact there was a lot more that we could do around transparent and robust public process so that everyone can sort of see how the city is monitoring and enforcing the agreement. and, so, we worked with the three supervisors who had been doing the mediation and mr. girard owe, the mediator and

cpmc, to craft a more robust public process around compliance. ~ and i'm going to get to that in a moment. first, though, just to complete the background piece, i want to talk about the process of amending the da. ment da is a contract between the city and cpmc. contracts can be amend and this process is in place to determine how that happens. and in section 10.5 of the da, there is a discussion of how this da will govern amendments. so, in the process is a little bit different than the standard process and that's relevant to the conversation. so, i would just note that the da itself specifies that nonmaterial changes so that these are quote-unquote minor, and i'll get into that a little bit more, require approval of the planning director and the director of any affected city agencies, it may be mta, it may be another city agency that is affected by a part change. and the city administrator and

the planning commission, each in their full discretion. so, it's thai fairly onerous process to make a nonmaterial change. ~ particular, not part to make a material change, you add on to what i described the board of supervisors, and to be specific, it's bioadmin. the supervisors and the signature of the mayor. the da in section 1.68 also defines what a material change is and i'm going to get to that in a minute. but just -- i'll suffice it to say now that any change whatsoever to any of the public benefits is automatically a material change, you know. so, that would go to the board if anyone tried to change it. with all this in mind, we've worked through two or three sets of changes that i want to put before you to help make all this work better. and, again, noting that this was negotiated with the mediator and the three supervisors, also noting that section 8.2.1 of the da already requires an annual compliance

report from cpmc. and exhibit f which is the health care requirements in the da, section 13 b already requires the annual third-party audit. so, we're getting this from cpmc. the proposal that we worked out was to amend section 8.2.2 in the bold on your slide to require all of these things. i'll just quickly go through them. a compliance report and the third-party review which cpmc owes us every year, to be made available for public review immediately when the city receives it by putting it on the department website. i'll put it on my notice when i 2000s get to any a minute. requiring at that point the city can't do anything with those things until there is a 30-day comment period in which the public can opine on whether they believe cpmc is in compliance. ~ [speaker not understood] the da calls it city report, which is the city's annual response saying yes or no cpmc is in compliance, to comply with a list of specified issues which

is in front of you, to require annual hearings on compliance at both the planning and the health commission, the original where the da made that possible, this makes it mandatory. and also to establish a third-party monitor whose job it would be -- excuse me -- to wait until the city has done its process until the director of planning has written city reports, in consultation with the public and the other department heads. and then this special monitor -- excuse me one moment. this special monitor would receive the materials, would independently take a look at them, and would write a letter to the board of supervisors indicating his independent judgment about whether he agrees with the conditions of the city staff. and the purpose of this, this monitor wouldn't have any power other than to write that letter. the purpose of it is to link the board which always has the power to call a hearing and

direct the city attorney to do whatever they would like, to link the board with the activities of the city staff. so, that the board has the ability without a lot of extra effort to understand what the city staff is doing with the da every year. so, that was the first set of amendments that we brought to the planning commission. the planning commission liked those and accepted them. planning commission also added another piece to it which we believe makes a lot of sense, which is to deal with the issue of notice that might -- that -- notice to the concerned community that any change might be proposed. and, so, the planning commission added the stipulation that -- section 8.2.2 that the department shall maintain a list of interested individuals or community groups who are interested in following compliance with this da and that every year, when the compliance report is received

from cpmc based on a mandated schedule in the da, that these groups would receive notice. hey, we got the compliance report and we'll be going through a several-month long process which will culminate in the hearing at the planning commission and letting everyone know that that's starting. as well as whenever the planning commission has any other hearing regarding the cpmc dda, remembering that any change, material or nonmaterial, that proposed for the da must go to the planning commission if you have to notice everyone about that planning commission hearing. you kind of completed the loop, and, therefore, everyone who is interested will get notice that a change is proposed. so, this was also added by the planning commission. i want to point out before i get too much farther -- sorry, i should have done this a moment ago. you have in your packet a kind of thicker -- you have two sets of changes to language. you have a thicker one with red numbers on the bottom, corners, which are the actual language for the stuff i'm describing.

and you have one sheet which i'm going to go through in a moment. so, all those amendments i just described were things that came through the planning commission. there's one last piece in further conversations that happened very recently after the planning commission. some further concerns of the community coalitions we wanted to try and address. so, if you look at the slide and you look at the single sheet, this language is on the single sheet. it was after we did this larger set of amendments. and those are to amend sections 1.68 which is the definition of material change. we have not made it clear in the definition of a material change that any change in the downward direction in the size of st. luke's, the st. luke's that's built would be a material change. but obviously since there is an obligation to build a 120-bed

general acute bed hospital at st. luke's, if cpmc were to propose before they built it to change the da to say there is some other size hospital, that would obviously be a material change. we believe that probably would be considered a material change, but this is just about standards of approach to make it clear that this is a material change. the second piece here is this is i think just an oversight, that when we worked with the planning commission to add that notice requirement, we didn't give a number of days. so, we are proposing that that notice be a 60-day notice before any planning commission hearing. and then the last one is a little bit complicated. we had to answer questions if i don't do justice in explaining it, but we, as i mentioned earlier, the development agreement kind of had its own process for dealing with amendments and which was intended when we all wrote it to be more onerous than what is in the administrative code. but the community coalition has

indicated to us that they were more comfortable with using the chapter 56, which is the development agreement section of the admin code that they're more comfortable using that as the process. and we're fine with that [speaker not understood]. the one thing i did want to point out is we were very clear with the planning commission that any change, material or nonmaterial to this da, would go before them. in fact, chapter 56 does not take material -- sorry, does not take nonmaterial changes to the planning commission, and i think we would be going back on our word to them. so, the staff report is go back to chapter 56, but to say on top of that you have to go to the planning commission because we told them that we would. so, i'm happy with the help of the city attorney to go into that more if it wasn't clear. the last slide really quick is just a little graphic showing the period of time that or the

kind of process from when the cpmc fiscal year ends, they have 150 days to get the compliance report and the third-party audit. and then there's a 30-day public comment period. this shows [speaker not understood]. we will be spending half a year or year reviewing the past year's compliance [speaker not understood]. it is a fairly robust procedure. so, with that, i believe i'm at the end of my presentation. i realize that there are some step in the weeds there and please bring me back to any you want more of. >> thank you, mr. rich. president chiu. >> thank you, mr. rich. i want to thank you and everyone in the room about where we are. we have come a long way from the initial proposal put forth last spring. i have always said, and many in this room have always said, that we have wanted to support

rebuilding the cpmc hospitals and do it the right way. it is my perspective what we have in front us does it the right way around how the hospitals are sized to how we invest in our future 21st century san francisco health care system, to how we're going to be dealing with issues around housing and jobs and transit, our neighborhoods, our community. i'm really proud of where we are. and i want to take a moment and really just thank a number of folks, starting first with all the members of the community, from all of the organizations and networks and neighborhood associations that work together to get us to where we are today. thank you. i of course want to say thank you to our leadership from cpmc, dr. braner, mike co-hill and others. we had many meetings together. ~ i have to say i almost miss those meeting, but i want to thank you for all the hard work we did over many, many months. of course, want to thank my

colleagues, supervisors campos and farrell for the months of investment that we all spent on this. ken rich. my guess is from the city side, you probably spent more time on this than anyone of the 27,000 employees in the city and county of san francisco. so, thank you for that. and, of course, i want to thank one individual who is not here who really was instrumental in this, and that is lou girardo who was the mediator, trusted by all parties. and without his involvement, we would not be here. mr. rich, thank you for summarizing where we are. i want to just thank you also and thank cpmc for adding all the additional provisions around monitoring and enforcement, particularly the final additions around chapter 56 administrative code requirements. i do think and hope this goes a long way at ensuring and reassuring the community that the commitments that have been made by both sides will actually be delivered on and we will certainly be monitoring this for many months and years to come. cpmc knows this. our city officials know this. and hopefully with these

provisions, the public knows it. i do want to address one, i guess in the scheme of things, relatively minor issue but an important issue for many of my neighbors. there was initially in the development agreement a provision that stated that the cathedral hill garages, about 990 garage spots, would only be available to visitors and cpmc employees and staff after 7:00 p.m.. and the reason we had put those provisions in was to really deal with ~ a lot of congestion and traffic and neighborhood quality of life issues that were related to the entertainment corridor that is on the polk street area. as you know particularly thursday, friday, saturday nights, the thought of adding another destination from 90 potential cars to be driven to those neighborhoods were fairly daunting. so, we put that initial requirement in. i understand the planning department heard some feedback from the public about how there was some parking beyond 7:00 p.m.. that's not entertainment

related. so, their recommendation was we take that provision out completely. what i'd like to propose, and certainly we'll hear public comment on this, is that we have a bit more of a nuanced approach to how we deal with that and that the language read instead that the cathedral hill campus garages shall be available to visitors and cpmc employees and staff after 9:00 p.m., but also to state that nothing shall prohibit the use of parking after 9:00 p.m. by pre-arrangement by residential neighborhoods -- by residential neighborhoods or nearby institutions subject to availability as determined by cpmc. in other words, that cpmc could work with residential neighbors and other nearby institutions as decided before hand for possible parking after 9:00 p.m. the thrust and intent is we are not creating an incentive for already saturated incentive for parking to get worse on the weekends.

obviously i'll be listening to public comment on that point and other points, but i want to close again by thanking everyone for being here. we look forward to public comment. but hope that we'll be able to move these items from committee today to continue progress and making sure that we are building the greatest 21st century public health system that we can here in san francisco with, of course, new cpmc hospitals. >> thank you, president chiu. supervisor campos who has joined us. >> thank you, mr. chairman. i'm not on this committee, but i wanted to take this opportunity to come and speak in support of the items that are before the committee. i want to echo everything that president chiu said. there are many people that need to be thanked for making this happen. beginning, of course, with members of the community who have been advocating for years to make sure that we have a project that addresses the needs of the entire city, and i'm very proud of the fact that

this project does that. besides the work that was done by the mayor's office and, of course, ken rich who has been working for i don't know how many years, but it's been a long time. my colleagues, president chiu, and supervisor farrell and, of course, cpmc and sutter who i think did a lot of heavy lifting to get us to this point. and i do sort of miss those meetings and maybe we can just do it once in a while for all-time sake. [laughter] >> we'll figure it out. but i do want to thank dr. browner, mr. cohill for all the work that you and your team have done. and, of course, it goes without saying that without lou girardo playing the role of mediator, this would not have happened. i always joke with lou that now that this is done, now let's send him over to the middle east and maybe he can work his magic over there because he has

the talent to bring people together, which is what happened here. i know that there have been a number of issues that have been raised over the last few weeks. you know, following the announcement of a tentative agreement. i believe that everyone who has worked on this project has taken the issues that have been raised very seriously. i actually think that some of the issues and concerns that were raised by the members of the community which were very important points deal more with sort of how the inner workings of the city, how that takes place. and i think that what we have tried to do, the three of us on the board of supervisors in working with mr. girardo and everyone else involved, threshing out the many protections that are already in place and the oversight and transparency that's ready, embed i in this deal. in that respect it's really not

asking anything else of sutter or cpmc. it's simply trying to flesh out the unprecedented level of transparency and accountability that's already embedded in this deal. and, again, i want to thank the members of the community who have been working on this. i want to thank sutter, cpmc for their willingness to continue to engage in dialogue and all the city folks who have worked to make this happen. i'm very proud of this deal. the only thing that i wish was for the construction to actually start yesterday. and hopefully we'll get to a point where that will happen very, very quickly. and, you know, there are very few things in this building where you have when for everyone, this is one of those examples. i think that we all should pat ourselves on the back for

helping to make that happen. so, with that, i thank you. i can't stay for the whole hearing because i have other meetings, but i wanted to make sure that i came here to express my support for this deal. >> thank you, supervisor campos. supervisor kim. >> thank you. a lot of thank yous have been made and i think they are well deserved. i actually remember watching a land use committee at around this time exactly one year ago and feeling very optimistic about whether this project would move forward at all. and thought actually from that very meeting itself this project was not going to move forward. so, i'm glad to see that it is on track and that a lot of -- a great deal of work went into really resurrecting it, i believe. so, i just wanted to acknowledge all that supervisor chiu and campos have acknowledged. i think that a lot of the provisions that were put in were fought hard for by the community and i'm glad that they are all in place. i think the one issue that came up -- and you know i wasn't

involved in the negotiations, but i wanted to bring up the issue of the psych beds. i'm not sure who the correct person to address that would be, if it's cpmc or dph, but it is something that continues to come up. you know, my main concern around it, of course, is in our district. but i think throughout the city we see a lot of folks out there who are clearly in need of in-hospital treatment for mental health issues. and i hear about it over and over again from our constituents who just feel like there are folks who need to be somewhere where they're getting the care they need. and i also hear it from our police officers at southern and tenderloin station not having enough places to go. i know that cpmc has reduced the number of psych beds that they have. i believe that they have reduced quite a number at two of their hospital sites and now have 18 beds, in-patient beds at the campus. and just wanted to have an understanding of what sort of guarantees we can have in keeping those beds in place first.

and, two, i'm not sure who is here from dph, but just a general plan around how we want to be able to make sure we have enough resources, not just cpmc, but all our hospitals for this very name. >> so, if you would like someone to come up now and address this, we have mike cohill who is president of sutter west bay and can address that issue from a sutter cpmc with your permission. ~ perspective with your permission. >> that would be great. thank you. >> good afternoon, supervisors. i'm mike cohill. i'm the president of the sutter health west bay region. i want to thank you for your kind words earlier today. all of you, and supervisor kim, i'm here to specifically address the psychiatric services issue. i spoke last week with director garcia about this issue. we certainly recognize that it's an important issue to the

community. psychiatry is an important component of cpmc's delivery system. we have 18 in-patient beds at our pacific campus and extensive set of outpatient mental health services and a psychiatry residency program. we're committed to be a part of the mental health solution for san francisco now and into the future. we also expect to continue our dialogue with director garcia about how we can work together to address the mental health challenges in the city. in fact, the development agreement, we have provided for new outpatient mental health programs which [speaker not understood] has discussed or will discuss discuss in more depth. we all agree inpatient is important. outpatient community based programs are critical to psych services in san francisco. i'll be happy to answer any questions. thank you. >> i just wanted to ask one question. i want to be very sensitive to

the fact that a lot of work was being put in order to bring this forward before us. so, this may not have come up during the negotiations and i completely agree that outpatient services are incredibly important and probably an affordable way of addressing psychiatric needs. but there is clearly a need for some, you know, in-patient psych beds. and, so, i was wondering if cpmc is committed to these 18 beds, if there is some sort of thinking long term. i know the innovation fund could also possibly be utilized for. this but i was wondering in terms of cpmc's commitments or thoughts around this issue what they would be. i'm certainly not asking for an increase. i'm just wondering about the existing beds. >> well, we have no plan to change the current delivery of psychiatric services at cpmc. >> okay. >> any further questions, supervisor kim? >> thank you. >> okay, thank you very much.

colleagues, any additional questions or comments tilt? ~ at this time? mr. rich, is there any other city staff presentation before we go to public comment? no. okay, we'll open up to public comment. public comment will be two minutes. i will note that there is an overflow room in room 400. and, so, we will be bringing down -- if your name is called and you're in room 400, you can come down. okay, i'll call the first batch of names. warren browner, tony rodriguez. terrance dunegan. linda chatman. jim lazarus. vivian imperial. michael mckenna. luis [speaker not understood]. gina lynn luna. bernie crow den. [speaker not understood]. [speaker not understood]. gordon mar. james tracy. and carol kumar. dr. bronner. good afternoon, supervisors wiener, kim, and chiu. it is nice to meet in the

afternoon rather than the morning, president chiu. we're pleased to be in front of you again and hopeful with your support we will 1850sly ~ finally be able to break ground and build two new hospitals for san francisco. it's been nearly a year before we were last before the committee with our rebuild cpmc project. as you all know it has been a long road. we have worked diligently with you and your colleagues on the board of supervisors, the mayor's office, the department of public health and other key stakeholders to present the project that fits the needs of san francisco's today and into the future. we're proud that cpmc has been serving san franciscans for more than 150 years. with the implementation of the affordable care act health care will change markedly over the next several years and we understand we must adapt to the changing health care landscape if we are to continue providing health care services in san francisco for the next 150 years. more patients will have access

to quality health care through insurance exchanges and expansion of the medi-cal program. hospitals like ours must find ways to reduce the cost of delivering care by focusing on prevention and outpatient services in a comprehensive network of care. if we are approved by the full board of supervisors, we will immediately -- emphasis, immediately begin the construction of our new facilities. that will mean 1500 construction jobs for the hard working trades men and women who have been some of the most steadfast supporters from the very beginning. it will also mean that over 6,000 of our employees will be able to work in modern earthquake safe facilities. as you know, the proposal differs from what we presented last year. these new facilities are a good fit for the future of health care and the future population growth in san francisco. we recognize the demographics of san francisco are changing and that more families are living and working south of market.

our revised plan of the larger hospital of st. luke's reflects those changes. we believe that our sustainably designed facilities will improve the quality of care while reducing costs. in closing, i urge you to support our rebuild cpmc project and vote for our plan to build more than 400 new earthquake safe beds in two new hospitals and three new medical office buildings. thank you again for your time today. i look forward to your comments and to moving this very important project forward. >> that was quite good timing there. [laughter] good timing. >> thank you, dr. bronner. next speaker. good afternoon, supervisors. my name is tony rodriguez and i'm here representing local 43 [speaker not understood] local union. as was said before, so many of our members have lost their homes. they've lost so much during the last recession it's truly affected them.

they're starting to go back to work. as you can see around the city there's a lot of projects. from one project they go to another project. i guess what i'm trying -- your job is to make sure these projects are good for the city and what i've heard here today, this is a project that the city needs and it will bring good to the city. i representative local 43. i'm also a resident of bernal heights. my friend and family lives in excelsior. my in-laws live in glenn park. most of the community that i deal with live in bernal heights and they've been waiting for a new hospital, a state-of-the-art hospital. and i guess the other thing is that we really need to look at why the hospitals are being redone. it's to retrofit them and make them safe for earthquakes. and i think the longer we roll the dice, the more chances there are of something going wrong. so, i just urge you, move this project forward and deal with the hospitals. thank you very much. >> thank you very much.

next speaker. hello, my name is [speaker not understood]. i am past president of the natural alliance on mental illness, both in san francisco and at the state level. i have 35 years experience in the field. the corporation appears before you with a plan to care for san franciscans needing hospitalization where they have bed for the 8% of people with cancer? yes. will they have beds for 11-1/2% of people with heart disease? certainly. sounding good, but wait, will they have beds for the 26% of those with psychiatric illness? no. no? in this day and age when we finally use the words mental illness and recovery in the same sentence, are we, in fact, witnessing institutional sigma

against mental illness? is this a deliberate omission or an oversight? the board of supervisors is charged with looking out for the good of our citizens. it makes no sense to approve a plan that is inexcusably exclusionary. we need a full-service hospital that shares in the responsibility for caring for all our citizens. quite simply, the brain is an organ. it, too, can get sick. >> thank you. next speaker. linda chatman. first, i want to say that the development agreement needs to be pulled because of the brown act violation and the violation of the sunshine act. there is nothing in any of the documentation or any agendas about the 2.46 million, i think it is, agreed on contract