oh, davies. >> next speaker. thank you. my name is [speaker not understood], a member of the first unitearian universalist church. thank you, supervisor chiu, for working towards a nuanced arrangement where members of the public, general public can use the parking late into the evening as they might attend events that are hosted at the unitearian church. i'd like to just add a little bit of history to this. we have had a symbiotic relationship in the city of san francisco since the 1960s when we reconfigured the streets and we reconfigured the church property. we entered into an agreement with the city of san francisco to make our urban center available to any responsible groups or individuals planning to rent the space. and, so, the parking arrangement that we have goes far beyond the individual members of any one church. it goes to a wide variety of

organizations and many activities that serve the life of this community. and emilie wilson of our staff will be here in just a second to give you more detail on that. we're grateful. we thank you for the consideration. we know that this has been an overwhelmingly complex project and we're in the 11th hour and we do very much appreciate your consideration. the only thing more i could add, i'm sawyer, is that we were right across the street from this hospital. if we had our druthers, we wouldn't have the inconveniences that come with a large hospital. we're going to hear a lot of sirens. we're going to hear truck engines, going to have to pump oxygen in the hospital tanks. we chose not to become nimbis on that. a critical part of the expectation was we would have access to the public parking just as we have had access from public parking at the hotel that we previously operated.

thank you so much. >> next speaker. thank you, speakers. i'm emilie wilson, the director of administration for the first unitearian universalist church of san francisco. this is located directly across the intersection from the new cpmc hospital location. our church is proud to host events and meetings by many organizations that serve much larger communities than just the neighborhood our church is located in. these events and meetings are often held at night when public transportation is limited or simply not available. i am here today to let you know some of these organizations that use our facility that will greatly benefit from the use of the parking garage in the later hours of the evening. some of these organizations are kqed, the larkin street youth services, amnesty international, institute for

responsible technology, the california institute of integral studies, democratic women in action, global healing fund, san francisco department of public health, and the university of california san francisco, just to name a few. having garage access at night, which we have at the hotel on that property was in operation, allows us to better serve these vital organizations who are doing such important work for the larger san fran is co-community and beyond. we thank the board of supervisors for considering allowing public access to this parking garage to the later hours. ~ san francisco thank you so much. >> thank you very much. next speaker. supervisor kim, supervisor wiener, supervisor chiu, my name is eddie chin and i am here to speak on behalf of apa

family support services. i'm a board member of that agency. apa family support has been in long partnership with cpmc for a long time. and for the past couple years we have in collaboration reached out to different facets of all community to promote free health services. many of our clients were born in cpmc and were given linguistic and cultural chairs, appropriate chairs. our clients live in tenderloin, live in the mission, live in bayview, live in visitacion valley. our clients of 7,000 duly deserve to have a world class health care center.

we here urge you to rebuild cpmc. i thank you very much for moving this project forward. thank you. >> thank you. next speaker. thank you, supervisors, for hearing this item today. my name is annie chow, the [speaker not understood] coordinator from self-help for the elderly. i'm here to urge the supervisors to support cpmc's proposal to rebuild cpmc. as a long-time community partner, cpmc has been extremely supportive of senior services in the community. rebuilding the cpmc hospitals is crucial and will only strengthen cpmc's ability to serve our seniors and the san francisco community as a whole. natural disasters are unpredictable. our cities should do what it can to plan for the unpredictable and protect our

residents and our seniors. we need hospitals with strong infrastructure that can withstand a major earthquake in the future. as a resident of san francisco and on behalf of the 35,000 seniors served by self-help for the elderly, i ask you to vote in support of rebuilding cpmc. thank you. >> thank you very much. next speaker. good afternoon, supervisors. thank you for allowing us to be here. thank you for all your hard work. my name is fernando reyes and i'm here on behalf of my employer [speaker not understood]. i'm here to show support today for cpmc project. i want to tell you the importance of this project going forward. [speaker not understood] close its doors, the neighborhood has changed. with businesses closing their doors, and and the ones that managed to stay afloat have done so sacrificing the work force. opening the garage late at night will improve the safety

of the ones that live nearby and those who patronize [speaker not understood]. let the neighborhood flourish. please approve cpmc. thank you. >> thank you very much. next speaker. good afternoon. my name is thomas robert simpson. i am the founder and artistic director of an arts organization afro solo. a lot of our work takes place in the western addition cultural complex. a part of our work in the arts, we connect health and the arts. in particular, to try to help alleviate some of the health disparities in the african-american community. initially that involved with cpmc and i hope that you will move forward on this project, about seven years ago as part of a health fair. ~ there was a young lady who worked at the african-american art and culture complex who was

40 years old, african-american, who had never had a mammogram. she was always afraid to get one. she would plan them, but something would always happen to interfere. i met the person who ran at that time the african-american breast health program who talked to her, counseled her, set up appointments for and with her, went on the appointment with her to have the exam. and bless pete if they didn't find something that was abnormal. of course, the young lady was petrified. so, they set up another session. they went again and found out it was a false positive. that's the kind much relation i've had with cpmc in terms of their concern ask support of the people in the african-american people in particular. but san francisco's health. i hope that we can move forward with the rebuild so the hospital can move beyond the planning, organizing and meeting such as this and do

what they really want to do and that is support people, help heal people and help save lives. thank you. >> thank you very much. next speaker. good afternoon, supervisors. my name is patty lee. i work as a community organizer in the de la hoyactionv neighborhood [speaker not understood] and also a member of the coalition san francisco need for housing jobs and justice. as so many people have said, we just want to thank you so much for the amazing work that has gone into making this agreement happen and to rebuild cpmc the right way. we -- the cmec, we serve a lot of low-income immigrant families and seniors and folks who really need the health care. a lot of them are looking forward to accessing this new hospital and being able to access the world class health care that every san franciscan deserves. even though a lot are not able to because they come from low-income. they look forward to working

with the city and the mayor's office and all the city departments to make that happen. and we also want to thank you, obviously lou girardo and sutter cpmc staff who have been so cooperative in making the development agreement move forward and rebuilding cpmc right away. and we just want to say that the community and the community coalition and the labor folks, it's because we've worked together that we are here and it's not just expertise from the legal -- the lawyers or the city attorney's office or the supervisors office. although all work is amazing. it's uniting and making sure folks are aware these are happening and bringing the voices to the table that this agreement is happening and we really look forward to working with cpmc and the board of supervisors office in making this move forward right away.

>> thank you. next speaker. good afternoon, supervisors. my name is dr. amor santiago and i'm the executive director of apa family support services. i'm also on the faculty of san jose state in health policy. and this has been a long process and i'm glad it's coming to you. all the deliberations and all of the good work of the city, city staff and the good role of the community has come together and i would like to urge you to support the rebuild of cpmc. ~ will of the community as my board member eddie chin mentioned, we had a long relationship with cpmc. they supported us with our general operating costs, but also our efforts to touch the community. we serve families, immigrants, low-income in various communities, and the lob we just had our third family day that they supported, a chance for children and families on the last day of school to

experience a petting zoo and for their staff to do a health screening and for children to receive teddy bears where they learn to you to do examinations that hopefully will eliminate some of the barriers that can frighten some of these children and families around medical care. they've been good partners, a billing nonprofit sister organization and they continue to support us. it's very complex, but in terms of economic development, in terms of safety and quality services, this is going to be an amazing -- there is going to be an amazing impact. and, again, i urge you to support cpmc with all of your due deliberation and all your due consideration is going to be a great thing. thank you. >> thank you very much. if there are any additional public comments? seeing none, public comment is closed. ~ is there any [gavel] >> so, colleagues, the items are in the hands of the committee.

president chiu. >> thank you again. i want to just thank all the members of the public who have been involved so diligently over the last couple of years and to get us to where we are today. as i mentioned before, i do want to first make an amendment with regards to the cathedral hill parking issue. let me just read the lapping wa into the record. i know mr. rich has this language as well. but we state that cpmc's cathedral hill campus garages shall be available only to visitors, employees, and staff of the campus after 9:00 p.m. however, nothing shall prohibit the use of parking after 9:00 p.m. by pre-arrangement, by residential neighborhoods or nearby institutions subject to availability as determined by cpmc. the intent of this language is to allow cpmc after 9:00 p.m., if it turns out that they have availability after taking into account the needs of their nighttime staff and visitors, to work with residential neighbors and nearby institutions such as the

unitearian church to allow for some parking after that hour. but otherwise, the intent is to ensure that the general public, particularly public members who are coming in to participate in nighttime activities along post street, that he that they wouldn't have kind of short-term one-time arrangement. is, first like to make that amendment. >> okay. all right, supervisor chiu -- excuse me, supervisor kim. [laughter] >> [speaker not understood]. >> i actually, you know, this is not an important issue for me, but for me i did want to get a better understanding of the nighttime parking issue. it seems actually it would be better if that were coming just for one time entertainment uses on polk street could have a place to go because then otherwise people just circle around polk street. i forgot to ask that question before public comment. that was just -- >> absolutely. i will say the one thing i think all neighbors were united around in the immediate neighborhoods, both cathedral

hill area as well as the middle and lower polk areas was that right now there is -- we have a lot of folks who come to this area and the idea was we didn't want to incent because there could potentially be close to a thousand parking spots, we didn't want to send the message out there are a thousand parking spots, come drive, come in after 11 o'clock, after you have your fun, get in your cars and leave the neighborhoodv. ~ neighborhoods. there is already a lot of [speaker not understood]. there were issues raised for current needs of residents as well as nearby institutions for the church that have dozens of organizations, usually sunday through thursday, that use the facility after 9 o'clock. and, so, my language is really to address that. >> okay. again, i know this is not our neighborhood issue, so, i'm happy to support that. but i do hope that over time that we and that because i

actually find it is very hard to park on polk street. i imagine it would actually provide relief. but i get the concerns of neighbors. i'm not sure parking lots create more demand for entertainment, but again, happy to support that. >> thanks. >> i should have the same reaction, but i'm also happy to defer to the compromise. any additional comment? >> i actually did have one additional comment on top of that. i wanted to just ask -- i know the department of public health is i believe here to answer a couple questions around the psych beds. and i want to just make it clear because it was mentioned in public comment that those of us who were from the board of supervisors at the negotiation table, we certainly raised this issue of psych beds and i think would have been open to different possibilities. but obviously today we heard cpmc's answer. i just want to ask from dph's perspective they did agree with cpmc's perspective. could you tell us why this was

not a priority in the discussions? because i know that's a question that a lot of members in the public have. >> thank you. collene, step difficult director of health and director garcia would be here today but she's out of town so she's asked me to be here on her behalf. and i appreciate the opportunity to speak to the psych bed issue. we really have engaged in discussions all along about expanding community-based alternatives to inpatient psychiatric care. and the development agreement does provide for a significant expansion of community-based mental health services. and specifically there's one program that we envisioned supporting that we detailed i think in a previous hearing that we had here, that really looks at emergency patients in crisis as an alternative to inpatient care when it is appropriate. so, we talked specifically about door street urgent care which has the same level of licensure as a psychiatric emergency room service, but it's community based and the difference only being that the

involuntary patients cannot go there. for patients who go on a voluntary basis, they provide the same level of care that is provided at a psychiatric emergency room. so, the trend for care is not hospital-based care. it's really community-based care. the least restrictive setting and we think that the development agreement and the innovation fund element that supports community based services real i do that. that said, we still understand there is a need for inpatient psychiatric care. we provide that at san francisco general hospital and director garcia respects that the negotiations didn't specifically address the inpatient psychiatric beds. but i communicated her feeling to mr. kozo when they spoke last week that these inpatient beds are important for cpmc's health care delivery system as well as for the city's. so, they agreed to continue discussions about addressing psychiatric needs for residents of san francisco and believe

that their discussions that occurred as part of the development agreement created the start for that dialogue to continue going on. >> do you expect those conversations to finish up in the next couple weeks or give us a sense because, again, there are so many members of the public that are concerned about this. >> i mean more post implementation of the development agreement. i think in has created a dialogue between cpmc and the department of health that was started by the health commission ~ that was created a ground for continuing discussions and knowing this issue was important to the board and also the community. ~ this, not in >> and i did understand at general there were risk managers who thought dph -- who were were concerned about the reduction in acute and subacute bed. you feel differently from how some folks view the situation within general? >> so, as mr. singh spoke earlier about the psychiatric beds at general being full off, they are full.

but they'renot necessarily full with people who need to be in an inpatient setting. to the extent we can create community based settings that are more appropriate for care, that frees up beds for people who really need inpatient psychiatric care. >> i just want to conclude, and thank you for those answers. i know this is an ongoing issue. this was the topic of discussion. it was resolved in the way it was resolved, but i certainly -- and i am going to support the agreement as we have come to it, but i am trusting that the department of public health and cpmc will be continuing these conversations in a way that will address the long-term needs that we talked about. i think certainly with [speaker not understood] going on, certainly with the affordable care act and that impact it will have on our local mental health population, we have to have a real plan city-wide to deal with this. supervisor kim and other colleagues agree with that as well, but did just want to mention our work is certainly not going to be done with whatever we decide upon with regards to this particular set

of cpmc agreements. >> supervisor kim. >> since dph is here, i just thought i would ask. i'm glad there is going to be continued discussion. and i understand that the move right now is to more outpatient and kind of least restrictive care, but there is still going to be a need for some acute and subacute beds on-site. , and so, i was curious what dph's response is. let's say cpmc does keep it to 18 beds. how many are at general today? >> we have about 60. i don't know exactly. >> 60, okay. if we ever find that other beds are widely used and at capacity, what is the response when we have patients above and beyond that number? >> to the extent they come in in the emergency room, they go -- psychiatric emergency services or if they're full, then this go to other hospitals throughout the city. so, other hospitals throughout the city would accept psychiatric patients if they were in crisis at the time. >> but if all the beds were full because they're not -- the

movement seems to be reducing the number of psych beds. so, if we're at capacity city-wide, what would then be the response for dpr if there were folk that really needed -- >> at the moment or kind of in a planning? >> at the moment, and then i guess your thoughts in the future. >> well, certainly at the moment as i said, i think that they would be received into emergency rooms throughout the city and in their ability to handle them and would be held there until they would be able to be stabilize and had placed into a bed that was available for them. the door street emergency urgent care center that i mentioned would be an alternative place for them to go that might be preferable to an emergency room if it was appropriate for them to be transferred there. and in fact, the partnership that we're talking about to be funded by the innovation fund would have a specific partner that would be with cpmc partner to take patients on a 24/7 basis when they're in psychiatric basis. >> so, that would be one option. planning wise we could look at

the trends and utilization over time and aloe if there was an increased demand for psychiatric beds. certainly the master plan would be an appropriate place to do that. ~ and see >> [speaker not understood]. i hope we really look at what an adequate response is from our city. i mean, not only -- i think all of us see folks out on the street every day. you know, we also -- when they don't get beds and they're at capacity at our hospitals, they come to our offices, too. and the unfortunate part of that is we're not -- we don't have the expertise or the training to manage or respond to folks with severe mental health issues. we had an incident really recently at our office and one of the issues was -- sometimes people refuse care and that's one issue, too. and the other is we weren't able to find him, this individual, a place of care. and, so, it just continues to be a concern for our office and i'm sure many other folks here. >> i understand. thank you. >> thank you.

>> supervisor kim, did you have any -- >> yes, and i do have -- i also wanted to make an amendment to the development agreement as well, and this is something that has been discussed through the mayor's office. and that is that -- let me go to the page. at least -- this is part of the $4.2 million that would go towards pedestrian safety and lighting needs in the tenderloin. we do have some commitments from the public utilities commission for a portion of some of those lights including the study which amount to $800,000. and, so, i wanted to make one amendment -- one amendment to the da, just modifying that up to $800,000 of the tenderloin sidewalk widening and pedestrian lighting improvements, that that line item only could be, could be utilized by the mayor's office of economic and work force development for economic

development use in the tenderloin neighborhood specifically. and, so, this is just a direct swap out of what -- a commitment that we got from the puc for lighting used in the tenderloin. [speaker not understood] is another need in the neighborhood and going to be supporting that amendment. >> great. and i want to -- first of all, i want to thank everyone. i know this is a large group effort, my three colleagues, including president chiu, who worked very, very hard to make this deal happen, and i city staff, cpmc. for awhile, this was on life support to put it charitably. and i think people were pretty freaked out the whole thing was going to fall apart and st. luke's would close and we wouldn't get a new hospital, wouldn't get the positive changes at davies and so forth. and, so, it took a huge group

effort to pull back from the brink and to get what i think is a very, very good project for the city. i won't repeat what's been said about psych bed and the broader issue of mental health care in san francisco. we have seen our social safety net around mental health fray for years. it's not just the san francisco thing. this is all over the country and it started decades ago. we let it continue to deteriorate and i would go ahead and come to grips with how we provide effective care for people who need it and would see the results not just in our streets every day, but a lot of people who you never see on the streets. and i agree with my colleagues that this was well, well beyond cpmc and we put it on cpmc to fix this problem for us. this is something we have to come to grips with as a city in general.

we do this into emergency rooms all over the city every day. but with that said, i think this is a very good agreement. i look forward to supporting it. i, too, have one minor amendment relating to the, what we call the guerrero park which is one of the public -- one of the community benefits that cpmc will be providing close to st. luke's. i think there was a miss understanding, it was categorized. this has to do with the timing of the delivery. it what a phase iii implementation project and we're going to change it to be a phase i implementation project. so, we delivered to neighborhoods sooner rather than later. so it's an amendment to item 16. exhibit h schedule a section two-page 2, that change guerrero park from phase iii to phase 1 implementation. so, colleagues, first we have i guess under the one amendment

for supervisor -- that's not really a rule. we have three amendmented on the table. can we take those amendments without objection? [gavel] >> so ordered. and can we have a motion to forward items 7 through 19 to the board without recommendation? >> yes, i'm happy to make that motion. and just to clarify for the public, we need to do this without recommendation because we're still awaiting other appeals. >> and i just wanted to clarify, excuse me, the committee is forwarding the development agreement together with all amendments proposed by staff during the presentation -- >> actually, that's a good point. so, there are other amendments that staff have proposed in addition to the three that we proposed and we have a motion to take those amendments. >> i make the motion. >> okay. and we can take that without objection. [gavel] >> okay. now, because of the appeal period for the conditional use has not run, we're required to

forward this without a recommendation. so, the motion is to forward items 7 through 19 to the board without recommendation. ask can we take that without objection? >> but i just want too to make it clear if we didn't have that, i think all of us would hopefully be forward thing with recommendation to clarify that simply procedural, but again, i want to thank everyone for being here and look forward to moving this to the full board and hopefully getting this done in short order. >> i also say it myself with those remarks. can we take the motion without objection? ~ [gavel] >> that will be the order. madam clerk, is there any additional business before the committee? >> there are no further matters. >> okay, we're adjourned. [gavel] [adjourned]

test, test, test, test, test, test, test >> good morning, everyone welcome to the board of supervisors finance committee special meeting for june 17th. i'm supervisor mark farrell joined by erick moore and other