Supervisor Campos pushes citywide health care services master plan; commission backs amended measure

Supervisor David Campos urged the San Francisco Planning Commission on Oct. 28 to adopt an ordinance creating a citywide Health Care Services Master Plan that would guide land-use decisions affecting hospitals, clinics and other medical facilities. Campos told commissioners the measure grew from months of stakeholder outreach and is intended to give the city better information on neighborhood- and citywide health-care needs before major development approvals.

Planning Department staff described a set of amendments aimed at making the ordinance more implementable. Staff recommended increasing size thresholds for mandatory consistency review to 10,000 gross square feet for new projects or 5,000 gross square feet for additions; adding a cost-recovery mechanism to fund plan development and three-year updates; simplifying the required content of the master plan so scope could be set through a public scoping process; and, where feasible, making the Department of Public Health the lead agency for consistency determinations.

Speakers at the hearing were divided. Hospital and provider representatives including the San Francisco Medical Society and the Hospital Council cautioned that a prescriptive review process could slow construction, raise costs and hinder providers'ability to adapt to federal reforms. Several hospital and provider speakers said rapidly evolving care models and accountable care arrangements could make a static plan outdated quickly. Labor and community groups, neighborhood organizations and local advocacy groups, including the California Nurses Association and the Chinese Progressive Association, supported the ordinance as a tool to identify gaps in services and promote more equitable distribution of care.

Commissioners pressed staff and Campos'office on several issues: the appropriate square-footage threshold, whether projects in the pipeline should be exempt, funding for plan production and updates, and which city agency should make consistency findings. Several commissioners said they prefer the higher thresholds recommended by staff and want the Department of Public Health to play a central role in evaluating clinical need. Others emphasized the plan should be dynamic and updated regularly.

The commission voted to approve a recommendation that incorporated staff modifications (including the higher thresholds and funding discussion) and to remove an exemption for pipeline projects from the resolution; the motion passed 5 to 1. The commission's approval forwards the amended ordinance and findings to the Board of Supervisors for further action. The ordinance, if enacted, would require the creation of a master plan within 12 months of adoption and periodic updates thereafter.