new state with a hospital. excuse me. once they open six weeks, they must continue to operate it for 20 years as a general acute-care hospital with an emergency room. the on the way out of this is it operating margin goes below 1% for two successive fiscal years. please note that this is the operating margin as a whole, not just six weeks, and in a moment, greg will be showing you some historical data on that figure. the operating margin is simply the proportion of the company's revenue that exceeds its cost of doing business. in the case of cpmc, which as a nonprofit does not assure holders, these are typically reinvested in the business. we will show you some historical data. the effect of this provision on the agreement as if their financial health were to start to decline, they would use savings elsewhere, so what i would like to do is call up the chief financial officer at the department of public health, gregg, to go over in more detail with you some of the aspects of this. >> good morning, commissioners.

in accordance with state law, all hospitals, including our very own san francisco general hospital, are on the way to meeting strand it -- stringent safety standards. the hospitals will operate as a cohesive system to give patients the access to care they need on campus and health providers meet san francisco's health care needs. that includes the care of low- income, under-insured, and publicly-insured san franciscans. specifically, there is access to cpmc's new cathedral killed campus. i would like to acknowledge the health care commission, because they engaged with cpmc on these issues related to under-served populations. identified the need to increase cpmc responsibility and accountability. about 12 years ago, they agreed on specific measurable goals to improve performance. i am pleased to say that cpmc has continued to achieve their goals in health care services. it was important to build a body of significant work that the health commission had already done. at the core of the recommendations of both the health commission and the blue ribbon panel, the motion that our nonprofits

hospitalization is necessary for the violently in klein. we cannot afford hospitals to deny need. before this agreement can proceed, it needs three weeks including psychiatric care, skilled nursing beds and the elimination of the 1% clause. thank you and again, as a citizen, i got to urge you all the talk about earthquakes, the worst thing to happen is an earthquake clogging up that congested area. i would move, again, everybody wants jobs, wants to do it right, possibly a block or two away, get an access point underground for emergency vehicles. as a patient, my dad and i live actually on the south end of the city. he has congestive heart failure. a window, i had to nearly, i had to run red lights, put other people in danger to get my dad there on time before he died of congestive heart failure. i would also move at the end of the city when any of you have meetings or plans on that end of the city and fate steps in, you might get hit by another car, car crash, drunk driver. if you're on that end of the city and it falls on you to come into this hospital, where would you want to b

the hospital is divided. we have placed the bed tower on the southern extreme of the site along gary to the rear of the slide. that arrangement provides a number of urban design and planning attributes. planning the tower along the south minimizes the amount of shade and shadow onto the surrounding buildings. we are casting a shadow on to ourselves. by pushing the building to the south, it allows the lower podium to be more efficient. we are actually one floor lower across the podium, which produces street walls on the majority of van ness and frankly -- franklin. these are actually lower than the existing buildings on the site today. this also improves the sideline, obviously from the neighbors to the north for the tower is more removed, and also the east and west with the thin shape of the tower is subdivided is easier to see by. the design of the medical office building has been completely changed. very much thanks to your comments from the informational hearings and working close with a stop after that. g

or seemed to be afraid to go to hospital. and we came up with poor bed manners and this sort of thing and each of those incidents there are bed matters, the doctors and nurses, the complete staff, bed manners were superb. so i ask you to support it if you can. president fong: thank you. >> hello, thank you, supervisor fong and the rest of the chair. i'm james mabrey owner of the everyday janitorial service. i speak as a san francisco resident and a san francisco small business owner and a trade partner to both cpmc projects. both projects are in need of upgrading, seismic upgrades and just new facilities, period. i think the residents of san francisco deserve it. the projects would help revitalize our cities -- city's economy. it would boost hiring jobs for san francisco natives and all sorts of progress for the city in a failing economy right now, you know. i vote yes and encourage the chair to do us well to vote yes and get this project going so we can have some safe hospital facilities in the city and county of san francis

it has been pointed out quite accurately that community hospitals and smaller hospitals treat normal medical problems and normal deliveries. there will be full service at st. luke's, so most of the things that you might have our routine surgery, routine procedures that require hospitalization. if there are a specialty problems and an at-risk deliverer -- and delivery, you want a center with an anesthesiologist for this specialize in that kind of care. all the other specialties the deal without risk mothers and infants. i came from the east bay originally and i know that people have to travel 15 or 20 miles from one acute-care hospital to another, even areas that are fairly affluent because there aren't as many hospitals. a lot of these places don't even have a smaller community hospitals. have outpatient clinics where they can go for emergency care and be transferred to a hospital. huge miles and a number of people between those hospitals. we have a lot of different hospitals in san francisco, so this access issue is not one that resonates through much with me. the last thing is a nu

i think the hospital will be a wonderful job, because we need more hospitals in our community. also, we, as san francisco residents, can come together and provide healthcare, more jobs, and a safe work environment. thank you again. >> if you are not on the list, you must allow the president to call those and have those people speak first. we announced that at the very beginning of this hearing that that was going to be the order. if your name has been called, you are on the list of people who have requested special accommodation or in become poor. if your name has not been called, this people come first and then it will call your name. i know your name is on the west. -- the west. -- the list. >> good afternoon, commissioners. i'm one of several thousand residents, many of whom are seniors like myself. it is an unusual neighborhood. just a few of the major housing complexes. most residents minimize their use because of our central location. we had green connections drop our neighborhood. our circulation will be degraded. intersections will be less safe for pedestrians. transit

luke's hospital. the obligation to build a new openness it looks begins once cpmc begins construction on cathedral hill. the other obligations -- and there are many -- are triggered once legal challenges or resolve or when cpmc begins building. vesting of cpmc development rights is a major focus of the city. most of the obligations are obligations cpmc of. -- most of the obligations are obligations of cpmc. approval for the five-year term projects are bested by the d.a.. impact and application fees for these projects are frozen. long-term projects, which are those other projects identified in the long-range development plan, but not the five we describe today. these to not have approval invested by the daa.. however, the city may not create new categories of impact fees. new categories would not. the d.a., together with a separate vacation ordinance and transfer agreement also affects the street portion that has been closed for many years, ands

we work with the number of hospitals here in san francisco, cpmc is one of a group of hospitals that provide employment to our health care academy. commissioner antonini: thank you very much. very impressive. one area here and that is on the housing field. there were some comments as to the level of housing and the number of dollars spent. there was this figure thrown out of $73 million based on -- they began a special use district requirement -- the van ness special use district agreement -- requirement. there have been some considerable amounts talked about here. my math is there is $29 million to moh and another $21.20 $9 million -- $29 million, to people that qualifies as a for both housing and another 35 that would be money that would come back, $35 million that would come back as these are resaled from appreciation. i have that -- i add that up, it comes up to [unintelligible] >> thankyou fok you for raisingt point. i would agree with your characterization of the uses of the money. that is what we have negotiated in the development agreement. a $29 million payment that would co

the trigger for hospital closures are -- for hospital closure is the 1% cause. this must be removed. the system-wide operating margin is not likely to fall below 1% for two years in a row. it is not an impossibility. in the east bay, a very similar cause to identify the closing of another hospital, announcing they will shut down in 90 days. why are they not shutting down any other campus? that is what we are in this fight about currently. to stop the closing of st. luke's. why did they get $90 million in tax breaks each year if not to maintain charity care? they claim they will increase charity care, but how? they are downsizing at st. luke's, chasing a longstanding doctors out of practice or into the foundation model with exorbitant rent hikes and their foundation practices turn away patients from groups such as health the san francisco and medicale. one of our doctors, they refuse to show hurt the only empty office space they knew she could afford. that suite is still empty today. how is it that st. luke's provides more -- claims to be able to provide more cha

it is the same with this hospital. the plan for emergency vehicles and supply trucks and emergency room drop box will create minimal impact on moving traffic. the hospital brings work for construction workers, four nurses, for doctors, and for the medical personnel, not to mention the businesses and services that will service these folks. thousands of permanent jobs. we have been told how the america's cup will bring jobs, too, and tourist dollars and two san francisco and how we will have to endure that traffic and the influx of tourists and people filling the city for just three months. three months. not years. not a new hospital that will enhance the lower polka area -- polk area. the america's cup will not be part of the community. it will not build low-cost housing or build -- bring long- term benefits. i urge you to consider a long- lasting solution and to build this hospital. thank you. president fong: if i have called your name, you can come up. >> in afternoon -- good afternoon. i'm a registered nurse at the c

we do need a new hospital. however, it needs to be an appropriate size to service the community that we are in charge of. that is all the way south of market. a great deal of the city. i just think they're being left behind. it is wonderful to have a state of the art facility at cathedral hill. if you fix all of the eir problems. we still need to look at st. luke's a little bit closer. thank you. [applause] president fong: any other names i have called? >> i am with the organization power. our organization make sure that san francisco had a very strong local hiring mandate. this product is only protecting a 5% increase in job growth. cpmc is one of the largest private employers in the city. they are using lack of jobs in the community as a way to pit health care needs against needs for jobs. we need to see a community agreement or there are permanent jobs. president fong: ok. [reading names] >> good afternoon, commissioners. i am the chair of the coalition of san francisco. we support the rebuild. if -- there a

hospital will give to the community. we also urge you to vote yes for the safety of the patients and the employees due to the fear of the earthquake calamity anytime. we thank cpmc for taking over st. luke's campus because cpmc give us good benefits and for agreeing to give us our jobs in the new hospitals. thank you. >> good afternoon and thank you, commissioners, for allowing everyone to speak here today. my name is rick oherro. i'm the owner of a contracting business, we're a local union business, local contractor here in san francisco for the last 57 years. of all of the contractors in the land, cpmc and sutter chose us to joint venture six years ago to form a partnership to bring this facility to life. i have never seen an owner so patient with the process in my life. so many of the projects that we start never get to the start line and to the finish line. i know there are many waity issues on your plate here, life safety, seismic, economic, physical, and mental health of the community. these are issues as waity as

luke's hospital. that is why we have gotten to this point in the hospital. and st.luke's needs cpmc. cpmc has committed to building as a new hospital. we need the institutional master plan to progress. right now, we're seeing tangible light at the end of the tunnel for our survival in the mission and our continued success. so we look forward to further in this process and hoping that this process continues expediently. thank you. >> thank you. >> mr. president, if that concludes the presentation, we should take a 15-minute block of time at this point. there is no standing in this room during this hearing. we have overflow on at the first floor. if you cannot find a seat at this time, please go to the first floor. thank you. the 15-minute block of time -- >> good morning, commissioners. my name is rachel. i am here with my colleagues at the san franciscans for health care, housing, jobs, and justice, a coalition of over 50 community and labor organizations, community members, and health care advocates across the city working to ensure that whatever course is set by t

ray's as an impact with regard to the hospitals, if you size down the hospital, you should be aware, the cesar chavez is going narrow it down from three lanes to two lanes, and anyone who advocates a change in the hospital is ignoring this. you have two major transit lines that are about to be upgraded, and you have one major transit line close to st. luke's, the 14-line. this is a line that i know well. and on san jose -- this gets very slow at other times of the day. i pass crowds of cars, and this is not a good place to increase the size of the hospital. thank you. >> the next speaker? >> thank you for hearing this item. i am the program manager at mission high -- where we serve san francisco residents with low-moderate income, and those looking to hire from the pool. i am a labor partner and i support the plan to rebuild two earthquake-safe hospitals. this will bring many job opportunities to our clients in the development and administration stations -- stages. they invested time and personnel to help upgrade this program and we are transitioning that into a professional service

with hospital planners, that you should have community hospitals that are widely accessible and connected to a single specialty hospital, where people who are too sick at the committed to a hospital can rapidly transferred to. how does that impact the viability of st. luke's? the reason the committee did not recommend this for a rebuilt st. luke's is that they felt that the right bedsides needed to be based on demand. it does no good for a hospital to have more beds that will be occupied. by making statements and it will part -- and into parts, we do not have to worry that is viable on its own, but rather the viability of the whole system is what is at question. also addressed by you at your last meeting was the issue of mental health and psychiatric care. i thought it might be helpful to talk a little bit about hospital-based mental health- care services to give you a little background. psychiatric emergency services is help people in psychiatric crisis entered the hospital system. psychiatric emergency services are provided only at san francisco general hospital here in san francisco. p

i was thinking as a person born in a hospital that does not exist anymore, that hospital is gone. the hospital that was rebuilt on that site needs to be replaced. the children's hospital on california street became the california campus, a new hospital that has three to be -- has to be replaced. we are constructing our second laguna honda hospital. these buildings have to change because of delivery of medical services and public safety in such as seismically vulnerable area. so the chamber and the alliance for jobs urges this commission to address swiftlet -- act swiftly and get this underway. we have done studies with the loss bull council of northern california. we like to sit in a colored woman industry is tourism, ou number one industry isa our nums tourism. this is an important leg of that stool. thank you. >> our next speaker. -- speakers. >> good afternoon, commissioners. i am a dream and carpenter. i represent the brotherhood of carpenters and [unintelligible] i represent that we have a good hospital here that is seismically fit in case of emergency. and we can all go to w

once the new hospital is operating, the existing hospital will be demolished. after is demolished, cpmc will construct a new five-story medical office building at the corner of cesar chavez and valencia. on the west side of the van ness, between geary and post, cpmc proposes construction of a new 555 bed full-service acute- care hospital. 15 stories and approximately 265 feet tall. across the street, the east side of the van ness, cmc proposes construction of a new nine- story, approximately 130-foot tall medical office building. the two new buildings will be connected underground by a tunnel at the garage level. once construction is complete, cpmc plans to transfer the acute-care services at the california pacific campuses to the new cathedral hills hospital. at the davies campus, and a portion of the surface parking lot, cpmc proposes construction of a new four-story medical office building, the neuroscience institute. this project was originally approved by the planning commission in 2007. it was overturned by the board of supervisors. there have been no sub

that's where the old hospital was. this is the new hospital. they built this in 2000. this one opened in 2002. tore the old building down in 2003. and they pull into the emergency room. reagan, they drive up. limo pulls up. parr jumps out. reagan, indicates to parr, i want to get out on my own. i don't need a hand out, don't need to be carried. he comes out. reagan, parr, he want to be a cowboy. so reagan gets up, walks out. hitches up his pants even to get them right. walks to the door. everyone follows him. an agent scouted ahead of them. medical crews are getting there. the nurse is asking how he is doing. he looks ashen. doesn't look very good. he collapses, bam, just falls on the ground. his knees hit the ground, but ray and jerry catch him. suddenly a whole hoard of people are carrying hum im to the trau bay. they throw him on the gurney. nurse, paramedic, doctor initially treat him, thought he was going to die. thee looks that bad. this guy is dead. their nightmare. their hand are shaking. president of the united states. we have to treat him. doing medical proto

when the new hospital is built, will the union employees be offered union jobs in that new hospital? right now, local 39 is on strike and without a contract for the past 18 months. california campus nurses have been working without a contract for over five years. the campus has non-union employees and are paid more than their california campus counterparts. is there construction money from -- is the construction money coming from the backs of employees? this was confirmed by a cpmc spokeswoman in an article in the san francisco bay guardian. that is available online, entitled "cpmc strike linked to a new hospital." she was asked if the cost of the hospital was a factor in lowering wages. she said the primary issue is equity, but we have a $1 billion rebuild that we have to fund? yes. because of the way health care is going, we have to rebuild. basically, we ask that you ask the questions, the right questions, and receive the right answers. thank you. commissioner borden: thank you. >> commissioners, my name is lee. i am an owner -- a homeowner in san francisco at inner sunset. i am a

let's get a hospital mist -- a hospital bill that can prepare the city. an earthquake will come. it is just a matter of when. i would hate to see us caught short-handed. president fong: next speaker, please, if your name has been called. >> good afternoon. my name is leonard. i am a native of san francisco. i was an employee with cpmc's california campus for 16 years on march 26 of last month. what we do is provide patient care and safety. what you do see, you see the options in line, the nurse calls, the vital monitors. that is what we maintain. behind the scenes, we maintain the power plants, the emergency generator, the critical equipment, nitrous oxide, air- conditioning, heating. on my campus, i have engineers that have been there for over 30 years. under our watch, for 24-7 for 30 + years, we have never had a patient been injured or worse under our watch. during the strike, we of been on strike for about 35 weeks now. our replacement is there. they have no clue the commitment that we maintain. for example, yesterday, we have a major flood. it flooded over seven floors. the

they go to the hospital. now at about this time marion gordon, kind of an unsung hero this day, one of the few female agents in the secret service. she's -- she devised the motorcade that day in routes and even drove the routes to the hilton and to the hospital and to the white house and wanted to make sure all the routes were clear. weren't blockages. they wanted to make sure they knew where everyone was going. drew had driven a motorcade to the hilton not too long before that so he knew all the routes and didn't have to practice them, but he already knew them, so they are heading down and marion gordon realizes she doesn't have a radio to communicate with the police cars in front. she's in the front right seat of the spare limousine, armored limousine, and she says these cars are going to keep going to the white house because they didn't know where we're going. we better get up in front of presidential limousin right now. sells the driver you better get in front of the presidential limousine because if he's

san francisco has rebuilt laguna honda hospital. ucf is building hospitals in mission bay.mpus would be a fabulous addition to the city. a structured rate stays seismic addition that needs to happen. -- a structurally safe seismic addition that needs to happen. we need to be able to provide safe medical care for all the residents of san francisco. there is no hospital in the outer son said. -- sunset. i am not concerned with the fact i do not have something right next to me. my family has been born here in san francisco at the hospital i needed to get to. i effort a lot of arguments about the area and the effects on the area and traffic. if you are a resident, you do not use van ness avenue to get anywhere. that is common knowledge. they are coming from the golden gate bridge and headed to the bay bridge. if you are bored about transit, that is not the case. -- if you are worried about transit, that is not the case. it has all been very hard work, it continues to move this project. i urge you to continue to move this project forward. there is no way to put a timeline to beg

we are going to end up if this is approved as presented, three hospitals, new or rebuilt hospitals will be at the highest seismic levels, replacing for us ones that are not at an acceptable level seismically. another fact that has not been brought out but it is important is the quality of cal pacific attract many of their patients from outside of san francisco also. we have heard a lot about the development agreement and the good things it will do within san francisco as it should, but it is important because there is this 30% who comes in, mostly private patients, bringing resident -- revenue in that we can use as san franciscans. they perceive the quality of care to be superior. unless we move forward with something like this, we risk the fact of having a loss of patients who could go elsewhere. it is important this move forward. i had a few comments and questions. maybe mr. rich could answer these. we have heard about the part of affordable care which involves care by cal pacific of 10,000 new metical lives that will be a product of health reform -- medical lives that will be a produ

hospital stays.ld other communities and other medical practices use this to save money? i think absolutely. take a look at the medicine cabinet in any american home and you'll see that our country spends hugely on prescription drugs. the doctors at the everett clinic did something about that, too. the most expensive pills are the brand name drugs, you know, like prozac and viagra -- which are protected by a patent. but for most medications, there's a cheaper version as well. it's called a generic drug. and those bargain-basement pills are chemically the same as the big-ticket brand names. the usa spends a quarter of a trillion dollars each year on prescription drugs. so the docs at everett realized that this could be a ripe target for cost cutting. and so we looked at what we were doing, and at that time, we were different from any other organizations across the country. pharmaceutical representatives were here frequently. if you went into the drawers in our offices, they were filled with samples. th

everybody wants a new hospital. we want a new hospital. but at what cost? when this hospital gets built, what happens to the california campus and the pacific campus and the employees that work there? they are not guaranteed jobs. we want the hospital to be built, but it to be built right. they are not going about it the right way. it is up to you to make sure that things go the right way. not having them under cut employees and the neighborhood and everything. thank you. >> how are you doing, commissioners? i am a san francisco resident. i am a member of 1 04. my wife worked at cpmc for four years. i attend a program designed to train and put san francisco residents to work in the construction field. i got an opportunity to join a great company. i recently became an apprentice local hire is important because it is important for families and it keeps the money into the community. what good is local hire if there is no work? cpmc will be able to continue to provide health care to san franciscans. the new building will be seismically safe. we need to keep the

and to have hospital stays, and to use hospital emergency departments. we also find that the -- it is higher hospital and post-hospital spending in skilled nursing facilities, short-term spending in skilled nursing facilities and by home health agencies that are the largest source of the extra spending that i've described to you for people with long-term care needs. the good news is that using new authorities in the affordable care act, the center for medicare and medicaid services is promoting delivery innovations that through care recognition aim to reduce this kind of excessive hospital and with it post-hospital service use. but past experience tells us that without effective targeting to beneficiaries, most at risk of inappropriate and high hospital use such as the long-term care users i've been describing, the coordination is not likely to produce significant savings. that's why it's so important that medicare target its innovations to people with chronic conditions and functional limitations and coordinate the full range of their service needs. alt

to hospital.rgely not it may be on your condition but on the location where a hospital with >> jamie was still in college when she was rushed to hospital with appendicitis >> we have really good insurance and i thought everything would be pretty much covered >> but it wasn't. possible charge $13,000 for a 1 day stay. her insurance picked up most of the charges but two years later she is still paying off $1,100. >> there were three different payments to keep track of >> it turns out her bill was on the low side. today a study looked at patients hospitalized in california for appendicitis without complications. there was a variation in cost from $1,500-$183,000. the median was about $33,000. the lead author of the study says that adds up the confusion for the patients >> hospitals can basically charge whatever they want because there is no guideline of how they come up with a charge >> that is because hospitals great lawn itemized bills for each service provided. in this patient was charged $4,500 f

fatima remains in the hospital and the hospital is working hard to find a solution for her family. >> some people might say it's very expensive to go to a hospital. it's expensive if you have insurance to go to a hospital. in cases like what's happening with your grandmother are driving up the costs for everyone else. if it were someone else's grandmother that we were talking about, would you think it's fair? >> but what's the choice? what can we do? i know that other people are paying, but there's no choice. >> what's going to happen to fatima? >> she's going to stay in the hospital unless we can find a spot for her. >> otherwise, she'll stay here potentially for the rest of her life? >> she could stay here potentially for the rest of her life. >> kate snow here with us in the studio. does any facet of the so-called obama care health care speak to this? >> it helps in this sense. if it goes through, we all have to have health coverage, insurance, right. it's a mandated health coverage. so that would help someone like garrick in arizona. it would help him because he would have to have

specifically for this hospital. not talking about the program that public health may have outside that may result in something in additional or outside negotiations apart from the development agreement. we would like to see it as part of the development agreement in some form. i do not know what that is. i understand your priorities, you know what the priorities are. i would like to have that addressed. i support an additional workshop on the d.a. commissioner borden: i also support the workshop. we could have more public on -- understanding of the document. i also wanted to say that the hhs issue, i feel that assuming we approved the initiation today, a lot of these questions we put out there, we want an answer on prior to looking at project approval. i think it is very important. as it is, we are hamstrung around the land use decisions because of the nature of the development agreement. to the extent that the issues we have concerns about can be dealt with, hearing project approval would help for the best outcome.