the current health care inventory and needs into the future and then it requires that projects that are being proposed in the city if they meet certain requirements they're compared against the master plan to determine whether they're consistent or not with the recommendations and the guidelines in the master plan so what you have before is a consistency application determination by healthright360 and so i'm going to go over a little bit about the projects and the process that follows. so projects that are subject to a consistency determination are those that are for medical use and i will define medical use in a second, that are more than 10,000 square feet so you're changing from some other use like a retail use to a medical use that is more than 10,000 square feet or expanding an existing use by 5,000 square

feet and expanding a clinic there and adding another 5,000 square feet that is also subject to a determination and medical use is basically any place where services are offered by health care professionals that are licensed by a state board, so physicians, surgeons, dentists, et cetera. includes clinics providing out patient care and it also includes hospitals. there are three possible -- to the way that we structured the health care services master plan there are three possible outcome frs any project secretary to a consistency determination. >> >> the first it's consistent and recommended fortives. this means the projects that are qualified and on balance meet the recommendations in the master plan eligible for incentives and those eligible for incentives are those that

at an actual facility by the correction of its project can seek to accomplish, so for example increasing information -- improving information technology. it's not necessary that a specific project build is going to increase information technology access but it might increase vulnerable populations so that's why it's eligible for incentives and others might not be eligible for incentives. the second outcome is just consistent so it's on balance, positively going to impact health care access in san francisco. doesn't necessarily meet any of the guidelines highlighted for instance or doesn't meet them to a sufficient extent and then finally they could be inconsistent. those that don't address any of the recommendations or guidelines in the master plan or adversely affect a service as needed in

san francisco. and i should say -- i should have said in the last slide consistent and eligible for incentives means incentives in the planning process so in the entitlement process managed by the planning department and we have a representative here should you have any questions about incentives or the planning process. so the review process is as follows. applicant submit an application so healthright360 submitted to us an application for consistency determination. the planning department -- they submit to the planning department staff. planning looks at it and makes sure they meet the requirements for the project. do they meet the size threshold? are they changing medical use? if they do they forward that application to the health department and the third step in the process is the health department reviews the application and the accompanying justification to determine whether it is or isn't

consistent with the master plan. when we brought the master plan to you for your review and endorsement you asked us to deal with the three different types of determinations in this way, so consistent applications, those that are plain consistent will be presented to the health commission as an informational item and forwarded to the planning department so the department of public health's recommendation would stand and you would be informed of our recommendation and finding. for those consistent and recommended for incentives however we would present the items to you for public review and your final determination at a public hearing and the same for applications and if the department considers it inconsistent and deem its that way we would have a public hearing and you would make the determination. that's an overview of the process. now i

will get into healthright360's specific application. healthright360 is proposing to relocate two of its sites. the current site on mission to a new site at mission and van ness. it is two and three blocks away respectfully from the sites they're relocate to the new site and expected to open in june of 2016 and will have 50,000 square feet. 30,000 is medical services. 10,000 is social services and 10,000 will be administration. healthright360 has long been a partner of the department of public health so you may know some of the data already but they have a long history of providing care to low income and vulnerable populations in our city. as an example they provided information on their current patient population at their

clinic at 1735 mission and in 2013 they served approximately 3,000 patients at that clinic. nearly 70% of them were below 100% of the poverty level and [inaudible] were below 200% of the poverty level. the vast majority were uninsured and a third were residents of two zip codes listed and that is important because the data on health disparities and vulnerable populations in those zip codes show great disparityings which i will go over in a moment. so what are they proposed to provide and to whom? they propose to provide 18,000 medical visits, 5,000 dental visits -- i won't go through all of them listed here. more

alcohol and medical services and they propose to add new providers. >> >> four medical providers, two dental providers and behavioral health staff. they will have multilanguage capacity and they provide in spanish and portuguese and will have additional languages available and will care for low income and vulnerable populations and based on medi-cal eligibility and necessity and their residents of those two zip codes will combliez about a third of the population of patients. this shows the patient population and the disparities that exist for the population they propose to serve so in the very left darker bar is the 94103 bar and then the 94102 zip code and orange

is san francisco overall and the zip codes that conprize a third of the patient population and more individuals under 200% of poverty and 125% below poverty and likely to rely on food stamps and other funds. they are likely to have medi-cal or no insurance coverage and on par with the city is the diversity of these neighborhoods language other than english spoken at home and foreign born are on par with the diversity across the city. south of market residents also experience disparitys in health care and crime, so the graph on the left shows preventible emergency room visits. this is often an

indicator of limited access to primary care. the theory being if you had access to primary care you would avoid san francisco general hospital visits and you can see in the south of. >> >> market here and the identified in this area there are far higher rates of preventible emergency room visits among the population there. crime is also another one of the indicators that is part of the recommendation and guidelines and you can see that in the southern district station that includes the south of market area the rate of violent crimes far exceeds that anywhere across the city. and this is just another snapshot of a few health indicators to indicate health disparities exist for these populations. the emergency room rates for alcohol

abuse exceed the city's average as well as asthma and copd. also san francisco general hospitalization rates due to heart failure, copd and diabetes -- i didn't list them all but this shows some of the health disparities in these areas and not only do they propose to serve these zip codes they're in the 94103 zip code. so this is the final slide and it contains our recommendations. the department of public health staff recommend a finding of consistent and recommended for incentives for healthright360. we believe that this proposed project increases the availability of and accessibility of primary care in these neighborhoods and rates with higher health disparities that the plan identified. it increases the availability and

accessibility of culturally competent primary area in the areas and availability and accessibility of dental care and demonstrates the commitment that healthright360 demonstrated the commitment to give access and care through the transportation programs and that they will expand community behavioral health ?fers the area that needs them so you have also a resolution for your consideration that was attached to your memo that would agree with this recommendation and the executive director of healthright360 is here if you have questions and also staff from the planning department. >> and i will note that the vote will take place on november 2. it will want happen today. >> would the executive director

of hr -- sorry, of 360 like to make some comments. and as you're commenting and the findings show the services you're providing but i see it you're moving from two buildings that have 67,000 square feet to a smaller area and -- [inaudible] from findings of staff. >> thank you. i am the ceo for healthright360 and i am actually honored to be the first application before you and i want to say in when the master plan came before you i was anxious because i thought it was hard for organizations and [inaudible] facilities and serve the population we're committed to serving and i thought it was

going to be an impediment and going through the experience i don't think it is and i know you support us and i am glad to be the test case. our intent -- we rent the properties in the two locations on mission street. we rent those properties. we will vacate one of them and reducing our usage of the 1735 mission site and we have other services that we will be moving from other locations into the 1735 site so there is no reduction of services. there will be an expansion in enhanced care. that is the plan. some expansion and enhancement of care

and this will facilitate the clients that come to us for any service to access the other service. for example some of the social services mentioned have to do with housing and employment supports, educational supports for people who come to our care typically for behavioral health locate it where a primary care is and primary patients want to access the housing hospitals and they can do that so it will facilitate care so there is no reduction but expansion. >> thank you. commissioners any questions? sure please commissioner. you're first. >> thank you very much. i appreciate the fact what you're taking on is huge and i commend you for the services that you provide for vulnerable populations. when we look at sort of the number of objectives none of them seem to be measure

annual. for example with the increase of culturally competent care and providers and i also note in the resolution you will be asked to come back in a year and give a report on that, so what i am curious about in the interim how do you do that? what specific kinds of activities -- and you don't have to give me a big picture here but i am looking for a big picture -- [inaudible] but how do you do that because it seems to me when we think about the declining number of culturally competent providers in this particular health care environment i am curious how do you make that happen and what kinds of measures do you use to do that? >> well, we define it broadly so it's linguistic capacity. it's providers that come from the population we serve. we do have -- we have -- given a lot

of client vs history of substance abuse disorder or a conflict with the law so we have a fair number of our staff members are former consumers. we probably have a higher number than other organizations of consumers and we have a continued commitment to do that so by increasing services we add the opportunity for consumers to be employed in our service. in terms of how we measure that we do keep data -- demographic data on the staff and where they came and by what path they came to us, so we would be able to report on that and if you're interested in a change we could benchmark that today and operate as usual and look at it when we come back a year from now and these are the changes that happened as a result of us occupying the site. >> right. but in this

particular marketplace currently that we're in is that a challenge to find culturally competent providers? i mean what is the marketplace -- >> it is a challenge because we are dependent on public funds and often our contracts stay the same dollar amount but the demand for folks, the salary requirements have gone up higher so it's increasingly a challenge. it's a challenge to find primary care providers period. i think all of us in health care find that as a major challenge so to the degree they're multilingual the cost goes up so it's a challenge but we have been fairly successful. people come because they love the mission and the clients. what we're unable to provide in

salary we have people that really want to do that work. it's not easy. it demands a particular commitment. >> thank you. all right. commissioner singer. >> congratulations. >> thank you. >> we see very few organizations that find buildings in the area that you secured a new building in the current economic climate for the work you're doing so i think that is great and seems like it's tucked up closer to the tenderloin area which is not yet quite as vibrant as the soma area. i was wondering if i remember colleen's slide correctly there were high 38 or 37% of your clients are from those two zip codes. >> right. >> that we had all of the comparative data from. where are the rest from? >> tenderloin. a large

percentage of clients come from the tenderloin so i would say tenderloin, the two zip codes you saw, the western edition and bay view hunter's point so that's where we draw the client base from typically. i would say after the two listed is the tenderloin. a lot of the clients live in the sros in the tenderloin. >> so 94102 isn't the tenderloin? >> it is the tenderloin so the mission -- because we're in the mission so the mission which i didn't list that one. sorry. i thought thats of was mission. mission district and the western edition and nine two one 04. >> thanks. >> we do feel pretty lucky to get the building there. there are big fancy condos going up around us. >> commissioner sanchez -- i

too congratulate you and your colleagues and providing an exceptional service. i guess i was thinking too about how soma has changed in many ways, yet in many ways it hasn't changed because you still have at risk populations. you still have a significant primarily filipino population. many of the families live in the area, the filipino receiving center there in south park that burned down, the school -- st. pats changed from spanish to new languages. you have a unique culture there with many families at risk and you have a large filipino veteran association active near your folks so the fact you're expanding services and providing services to the outward areas

and va programs both in soma and [inaudible] and latino and others who are a lot of the health and feeding programs are working together with the vets and their families so i think it's really an excellent work of documenting what has been done and what you propose to do and we look forward to voting on it september 2. >> thank you. >> were there any public comments? >> i didn't receive any requests for public comment. >> okay. so commissioners what we did was follow a prop q process to allow for public comment to be brought to our attention over what would have been a two week period but because we're having the planning session next meeting then it's deferred for final resolution, passage of the resolution and further additions would be made to the resolution so then it would be passed at the following meeting. we've

heard the testimony. my comments would be that i think as we're now learning this process it would be stronger from the standpoint of a resolution from us to then quantify more rather than they met certain guidelines and having increase of this or adding this but i will ask you to work with the resolution so when we submit this and the plan planning commission has a stronger reason for looking at incentives so this rephrases what the guideline was and i think in those it would be nice for us to then quantify more exactly what it is, you know, and i think our executive director spoke to that, additional cultural providers that would be coming in, the combining of their services and enhancement of dental services because it's not clear in the resolution itself, and i think

that would strengthen the fact we're not only supporting a consistency which you say we need it, but we need to make a case for then why the incentives, so that would be my suggestion in terms of strengthening our resolution. >> is there any further comment? if not we will proceed on to the next item. thank you and we will look forward to taking this up again at our next regular business meeting. thank you. >> item 8 is the san francisco general hospital san francisco master plan and voted on at the september 2 meeting. >> okay. thank you. >> san francisco general . >> >> good afternoon commissioners. i am kathy john associated administrator at san

francisco general. so this is an update for san francisco general. i'm good. all right. thanks mark. so the submission of a current update of our institutional master plan is actually a city planning code requirement of all medical and post secondary educational institutions in the city and county of san francisco, so our last update was about 2008, so it's time for us to resubmit. i want to make sure you understand this and there is a lot of confusion and different from a campus facility master plan.

the imp is a high level document that has the context to develop the future update of the campus master plan which we will be later this here hopefully at san francisco general. so in terms of objectives of the plan it provides a general overview of what has been done in the past several years on the campus as well as gives you intent of what we're trying to do in the future, so the following -- we have highlighted several item . >> >> s in the plan and including since the last update. we have the current scope of the proposed 2015dph bond which will include items of upgrade for sfgh and seismic upgrades,

building improvements, chillers, fan wall systems, that type of thing and addressing the 101 growth seismic needs, the expansion and retrofit and proposed research building has been highlighted in the plan and part of the -- research building, i'm sorry and expand the garage. the plan also is an opportunity for us to reaffirm that future developments on the campus is consistent with what we had already proposed in the 2008 environmental impact report for the rebuild project and it provides the guidelines for future development of a more detailed campus master plan. next step is once you have approved to be submitted to the

planning department which will happen in september we will submit it. we will probably be on the calendar for the planning commission in october and it's a non actionable item. we're just required to submit the plan for their approval. so if you have questions. >> commissioners the plan is before you and because it does describe the potentials of what both sf general and peripherally what the department is going to be doing it is being submitted to you for further discussion, attention, and then a passage of a resolution at our next regular business meeting. is there any public comment on this? >> i have not received any requests for public comment. >> okay. >> yes commissioner singer. >> i have a procedural question so in what you showed us, and in the [inaudible] in front of us

there are assumptions about what the 2015 bond measure will include. are we -- if we were to approve this resolution on september 2 are we then basically saying here's what we think should be in the bond measure? how does this work? >> it's a good question. it's really expressing intent but there is no final agreement in terms what's in it, so we're obligated to provide some idea of what we have been looking at at this point and time when we submit the imp. >> who is "we" ? is it general hospital? >> yeah i think we should segregate this because the commissioner has a good question. the resolution is in regards to the institutional master plan that does not discuss the other elements that were listed on the bond issue except for those that were on

the campus, and i ask that our acting director that what the resolution and what the subject is is the document and not the substance of a bond issue is. is that not correct? >> that's right. the item before you is the institutional master plan and not the bond issue. >> because i guess they're two issues both of which -- one is outside of sfgh there are things on the list that should require discussion and prioritization. it may look like how it's presented or not, and then within sfgh there is also a discussion needed to happen about the priority stack of what goes where and i'm not so in approving this are we saying -- because i don't think we discuss said it at length at the jcc

and what are the priorities for the campus, so it's a procedural question so when we do this it's outside of their purview and they don't have responsibility for it or how does this work? >> proceed. >> [inaudible] >> yeah, it's a little confusing because this is sort of a statutory -- it was developed to let people understand what was happening on campuses which is separate and apart of a more detailed effort when we did the rebuild when we met with each of the department heads at the hospital and work through programsing. we're going to do that again. we're trying to get a green light from city hall on the 2015 bond, what is included. there is fierce competition currently with other