City Council and Concurrent Authorities
September 26, 2023

Name Company Page #s
Lofgren, Martha Brewer Lofgren (Sierra Club)ͲCorrespondence #2 1 Lofgren, Martha Brewer Lofgren (Sierra Club)ͲCorrespondence #1 2Ͳ25 Gill, Ricky Gill Medical CenterͲCorrespondence #2 26
Gill, Jasbir Gill Medical CenterͲCorrespondence #1 27Ͳ164 Acosta, James St. Joseph's Foundation Board of SJ 165Ͳ166 Bajwa, Randeep Dignity Health 167
Balestracci, Paul Neumiller & Beardslee 168Ͳ169
Bechtel, Timothy Dignity Health 170
Bott, Anthony St. Joseph's Foundation Board of SJ 171Ͳ172 Buhari, Shiraz Dignity Health 173
Clifford, Alex SJ Regional Transit District (RTD) 174Ͳ175 Funghi, Cristina Dignity Health 176
Grupe, Fritz The Grupe Company 177Ͳ178
Hamilton, Katherine St Joseph Foundation of SJ 179
Jensen, David Dignity Health 180
Johnston, Ann The Balloonery 181
Kawaguchi, Alan Alpine Orthopaedic Medical Group 182Ͳ183 Khanna, Pavan Dignity Health 184
Linden, Petra St. Mary's Dining Room 185Ͳ188
Morales, Steve 189
Patmon, Charles Patmon Company, Inc 190Ͳ193
Quinn, Timm Greater Stockton Chamber of Commerce 194Ͳ196 Rishwain, Mark Rishwain & Rishwain 197Ͳ198
Rodriguez, Jose El Concilio 199
Russo, Christopher Dignity Health 200
Sabino, Alan Dignity Health 201
(San Joaquin Partnership) San Joaquin Partnership 202Ͳ203 Seawood, Lueathel African American Chamber of Comm & Chamber Fdtn 204 Shalvey, Sue 205Ͳ206
Silva, Dave Silva Trucking 207
Spaugh, Gary 208Ͳ209
Stephens, Annette St. Joseph's Foundation Board of SJ 210Ͳ211 Suen, Denise St. Joseph's Foundation Board of SJ 212Ͳ213 Talamantes Eggman, Susan CA State Senate 214Ͳ215
Vela, Lisa San Joaquin County Hispanic Chamber of Comm 216Ͳ217 Velasquez, Patrick Chase Chevrolet 218Ͳ219
Waters, Richard Dignity Health 220
Wilson, Betty Business Council of San Joaquin County 221Ͳ223 Wong, Cindy St. Joseph's Foundation Board of SJ 224Ͳ225

ATTACHMENT G
1 From: Martha Lofgren <[email protected]>
Sent: Wednesday, September 13, 2023 3:17 PM
To: Stephanie Ocasio <[email protected]>
Cc: [email protected]; Lori Asuncion <[email protected]>; Michael McDowell <[email protected]>; Bradley Wall <[email protected]>; Nicole Moore.Ctr <[email protected]>; Heather M. Minner <[email protected]>; [email protected]; Martha Lofgren <[email protected]>
Subject: St. Joseph's Expansion ProjectͲPlanning Commission Agenda Item 5.1 (September 14, 2023 Agenda), City Project No. 23Ͳ0685
CAUTION: This email originated from outside the City of Stockton.Do not click any links or open aƩachments if this is unsolicited email.

Dear Stephanie,
I am wriƟng to advise you of a seƩlement between the Sierra Club and Paul Plathe that was concluded today regarding comments made by each enƟty on the DraŌEnvironmental Impact Report for the St. Joseph’s Expansion Project.St.

Joseph’s has agreed to certain modiĮcaƟons in the project descripƟon related to the parking structure and also to addiƟonal enhanced miƟgaƟon measures.I would appreciate it if you would include noƟĮcaƟon of the seƩlement in the staī’s Planning Commission report tomorrow evening, and also forward this correspondence along with all aƩachments to each of the Planning Commission Members as soon as possible.I will be prepared to review the speciĮc terms of the seƩlement in the applicant’s presentaƟon.

I am copying legal counsel to the Sierra Club, Heather Minner, and also Mr. Plathe on this communicaƟon to you.

Please let me know if you have any quesƟons.
Thank you and best regards,
Martha Lofgren
Martha Clark Lofgren
Brewer Lofgren LLP
[email protected]
(916) 221Ͳ8621 mobile

ATTACHMENT G

ATTACHMENT G

ATTACHMENT G
Attachment: St. Joseph’s Expansion Project Enhanced Mitigation Measures

ATTACHMENT G
ST. JOSEPH’S EXPANSION PROJECT ENHANCED MITIGATION MEASURES AND OTHER EDITS TO

EIR AND MASTER DEVELOPMENT PLAN
PARKING:

The Project Description in the EIR and the Master Development Plan shall each be revised to provide an Option B Parking Structure, which shall not exceed six tiers above ground; approximately 1,368-1,400 parking spaces, not to exceed 1,400 parking spaces (including EV capable and EVCS spaces). SJMC’s acceptance of Option B is premised on the execution by all Parties of the Agreement. Upon confirmation of execution of the Agreement by all Parties, SJMC shall notify the City in writing and shall verbally notify the Planning Commission and City Council at public hearings on the Project Approvals, and will also then amend the MDP to specify that it no longer seeks to construct the originally proposed nine-story parking structure, and that any approval of the MDP by the City will be for the specified Parking Option B instead of the originally proposed parking structure.

SOLAR PANELS:

Mitigation Measure 4.7-1 shall be amended to include the following:

Structural support for and the installation of rooftop solar panels shall be included in the Request for Proposal for the design and construction of the Parking Structure. If proposals indicated that installation of a PV solar energy system is feasible, as defined in CEQA Guidelines section 15364, SJMC shall contract for their installation. SJMC shall then ensure that all equipment is timely ordered and that the system is installed when the City has approved building permits and the necessary equipment has arrived. SJMC shall ensure that PV solar energy system commences operation when it has received permission to operate from the utility. SJMC shall ensure that the system is maintained at not less than 80 percent of the rated power for 20 years and at the end of the 20-year period it shall install a new PV solar energy system, or continue to maintain the existing system, at the same standards, for the life of the parking structure. Nothing in this measure is intended to discourage or limit the efforts of SJMC to explore serving SJMC power needs through PV solar energy systems or other renewable energy sources in other locations.

ELECTRIC VEHICLE CHARGING STATIONS (EVCS)
Mitigation Measure 4.7-1 shall be amended to include the following:

The Parking Structure shall meet the minimum requirements of the 2022 California Green Building Standards Code (“State CalGreen”) 5.106.5.3 (Electric vehicle (EV) charging), i.e., 20% of parking structure spaces EV capable; 25% of preceding number EVCS with charging equipment (EVSE) actually installed, with the installation of EVSE, but not the installation of required EV capable equipment, subject to the exceptions stated in Cal Green section 5.106.5.3(1)(a)-(c); or unless otherwise authorized by CalGreen Section 5.106.5.3.2 as to both EV capable and EVSE.

ATTACHMENT G
Mitigation Measure Related to Transportation Demand Management Program (“TDM Plan”) to be added, as follows:

The following programs are proposed in the context of St. Joseph’s Hospital, only, and within the context of reasonably available programs for a not-for-profit medical center with a high percentage of lower income patients. St. Joseph will request acknowledgement by Sierra Club that transportation demand management programs must be tailored to a particular medical facility, and also to different types of employers (e.g., programs are different for profit and notfor-profit commercial uses).

Expand upon existing alternative transportation programs through the following:
a. increase prime spaces for carpool parking based on current demand (i.e., 8) to projected future demand (i.e, 16). Review annually and increase as necessary to ensure sufficient spaces for carpools;
b. evaluate use of electrical vehicle charging stations (for bicycles and vehicles) prior to the certificate of occupancy for each phase to determine if demand has exceeded supply and identify in the TDM Plan the timeline for phased increases to electric charging stations when needed with the goal that supply remains slightly larger than demand to help incentivize electric vehicle purchases;
c. establish an incentives-based commuter program to encourage employees to carpool and take alternative modes of travel to the hospital (see, e.g., subparagraphs a, e, and f) d. increase availability and access to bicycle parking facilities; review annually and increase as necessary to ensure sufficient spaces for bicycles;
e. provide a free or low-cost ride home in cases of emergency for employees who use alternative transportation, such as carpooling, vanpooling, public transit, bicycling, and walking; f. provide a transit bus pass to participating employees who agree to commute by transit rather than by single occupancy vehicle;
g. engage with Regional Transit to enhance bus schedules and “VanGo” (i.e., dial-a-ride) services to the Medical Center and support these enhanced services to Regional Transit staff and/or Board of Directors;
h. through the wayfinding and signage program, include directions for employees, patients, and visitors to identify locations for carpool, bicycles, shuttles, and bus stops; i. provide shuttle service during construction to transport employees or visitors from off-site parking locations to the Medical Center;
j. rotate existing Medical Center fleet (consisting of automobiles and service vans) with electric vehicles on a standardized replacement schedule with details specified in the TDM Plan (e.g., the earlier of a need for a repair that is not cost effective given the age of a vehicle or, alternatively, a mileage threshold), and which includes consideration of commercial availability, cost, the general driving range for a vehicle, and the availability of EV charging stations for vehicles with longer driving ranges, as well as other reasonable limitations as set forth in the TDM Plan;

ATTACHMENT G
k. add TDM Plan information to both visitor and patient portions of the St. Joseph’s public webpage, with focus on improving content to better publicize alternative transportation options to the public;
l. provide information to employees about TDM Plan programs through (1) internal newsletter and (2) communication boards in employee gathering rooms (e.g., cafeteria, break rooms); and m. set a reasonable goal for reduced single occupancy employee vehicle trips to and from the Medical Center and report progress towards that goal as part of the Development Agreement reports based on results of good faith surveys of employees.

SJMC will provide public notice via the St. Joseph’s web page of the availability of a draft TDM Plan, a link on that web page to the draft TDM Plan, and reasonable period of time for an opportunity for interested members of the public to comment on the draft TDM Plan before it is finalized.
1680830.2

ATTACHMENT G
ATTACHMENT – MASTER DEVELOPMENT PLAN CHANGE PAGES RELATED PARKING STRUCTURE

ATTACHMENT G
same parcel.8
Accessory uses are allowed if (a) identified in Table 2-2 of the Municipal Code as an allowed use if it were a “primary use” or (b) if the accessory use meets other specified criteria in the Municipal Code.9
These are described below.

3.2.3 Parking
The Medical Center includes both surface and underground parking. There are approximately 1,354 surface parking spaces distributed throughout the campus. Underground parking is located at the corner of E. Maple Street and Cemetery Lane and houses 266 stalls. Existing parking areas are shown on Figure 3.2.3-1 and an existing parking count summary is provided in Table 3.2.3-1.

The current parking was approved by the City through a series of Commission Use Permits. (See Table 3.2.6-1, Item Nos. 12, 13, 18, 19, 23, and 25.)
Table 3.2.3-1 Existing Parking Summary
Parking Lot Parking Stalls
Sanger 74
ED Lot 21
Underground Garage 266
North Lot 606
Administration Lot 7
Administration Overflow Lot 9
McCloud Avenue 24
HCCL North 29
HCCL South 21
Vendor/Maintenance 7
Other Parking 290
Total 1,354
All available lots, as well as curbside parking at surrounding streets, are fully used on a daily basis.

The Plan proposes flexibility to allow per patient parking ratios from the code minimum of 2.0 stalls per licensed bed. Parking Option A includes up to 5.6 stalls per licensed bed as medical care may require to accommodate for seasonal surges, such as respiratory illnesses, and pandemics such as with the 2020 Pandemic.

In response to comments on the Draft EIR received from stakeholders, St. Joseph’s has also prepared an alternative parking option; i.e. Parking Option B, which reduces the size of the Parking Structure. St. Joseph’s has agreed to update the Master Development Plan to select Parking Option B, and Chapters 4 and 6 of the Master Development Plan, as well as the attached Parking Plan, reflect Option B as the applicant’s parking structure option for approval. The Master Development Plan does not, however, reduce the stated maximum parking ratio, and 8 Municipal Code Section 16.240.020.
9 Municipal Code Section 16.80.020(C) governs Accessory Uses and subsection (1)(b) details criteria for accessory uses that are not an allowed use.

ATTACHMENT G
acknowledges that additional, yet to be identified, off-site parking may be required if the smaller Parking Structure is insufficient. Under Parking Option B, “Other Parking” is reduced by 110 stalls due to the longer-term placement of modular structures at the site located at E. Harding Way and Maple Street. Tables 4.2.5-1 and 4.2.5-2 include the parking counts under each parking option.

3.2.4 Physical Plant
The Medical Center campus includes a Plant Maintenance building, a utility plant, emergency generators, fuel tanks, water well, bulk oxygen tank, hazardous materials storage, and loading docks.

3.2.5 Heliport
The Medical Center presently includes one heliport located on top of the Southeast Wing of the Main Hospital. The heliport was approved through a conditional use permit (see Section 3.2.6) and is also permitted by the California Department of Transportation Aviation Division. A hospital heliport is defined as a restricted use airfield by the Municipal Code.10 The heliport currently receives approximately 15 unscheduled flights per month for emergency medical transport.

3.2.6 Emergency and Supplemental Services on a Temporary Basis During the 2020 Pandemic and as needed during other health care surges, the Medical Center has conducted certain temporary activities in the exterior portions of the Medical Center campus.

This primarily occurs over parking areas. Mobile imaging equipment and tents used for testing or vaccinations are common examples of such temporary uses.

3.2.7 Existing Use Permits
As discussed above, the primary land use for the Medical Center is an acute care hospital, which is an allowed use with approval of a Commission Use Permit (formerly a Conditional Use Permit; the Commission Use Permits and Conditional Use Permits are referred to collectively as “Use Permits.”). As the medical services expanded over the 120-year history of the Medical Center, the City issued a series of Use Permits dating back to 1953. The Use Permits attached to buildings that will not be demolished to accommodate the Medical Center expansion will remain in place.

The City records reflect Use Permits on buildings either never constructed or that have been demolished prior to approval of the Plan. In addition, the Plan contemplates removal of some buildings with existing, valid Use Permits. The Plan is intended to consolidate the remaining Use Permits for reference in one document and update City records regarding Use Permits that are no longer necessary and which will be terminated with Master Development Plan approval via a condition of approval. New or modified hospital uses and ancillary uses will be permitted under the plans, policies and standards of the Plan.

Table 3.2.7-1 describes Use Permits that will remain in place with the reference numbers corresponding to the labels on Figures 3.1-1 and 3.1-2. Table 3.2.7-2 identifies the Use Permits no longer necessary (facilities not constructed, previously demolished, or identified for removal under this Plan).
10 Municipal Code Section 16.240.020 (Definitions).

ATTACHMENT G
Table 4.1-2 Expansion Building Summary
Initial Expansion1 (Phases 1-4)
# Building Name Approx. Building
Area3
Approx.

Building
Footprint4
Use Maximum
Building Height2
A New Acute
Care Hospital
Tower
281,000 SF – 331,000
SF
78,730 SF Medical
Services
115ft
excluding
mech. screen
B New Parking
Structure4
Up to 1,980 1,400
parking stalls
Up to 800,000
600,000 SF
90,000 SF Parking and
Heliports
115ft 80ft top
of parking
deck parapet
C New Central
Utility Plant
25,000 SF – 30,000
SF
15,100 SF Support 60ft
D New Fuel Tank
Yard
2,500 SF – 3,500 SF 2,000 SF Support 55ft
E New Generator
Building
Addition
2,000 SF – 3,500 SF 2,000 SF Support 55ft
F New Plant
Maintenance
Building
15,000 SF – 18,000
SF
10,500 SF Support 55ft
Phase 5 Expansion
G Acute Care
Hospital Tower
Potential expansion
up to 150,000 SF
35,000 SF Medical
Services
115ft
excluding
mech. screen
H Parking
Structure
(location to be
determined)
Stall count to be
determined per Plan
standards
To be
determined
Parking To be
determined
1 All buildings are under the jurisdiction of the Department of Health Care Access and Information (HCAI) – formerly OSHPD.
2 Roof mounted structures are not included in building heights. See section 6.3.5. 3 Site coverage and FAR limits indicated in section 6.3.2 and 6.3.3 are based on calculations using these ranges and areas. Building area and building footprint of individual buildings shall be allowed flexibility to meet compliance with the Plan within the overall stated parameters for Site Coverage and FAR calculations. 4 In response to comments on the Draft EIR received from stakeholders, St. Joseph’s also prepared a agreed to Parking Option B that would reduce the size of the Parking Structure as identified in the table. Parking Option B is below the maximum areas and height laid out in table 4.1-2. Parking Option B shows approximately 1,368 parking stalls, a total area of approximately 512,395 sf, and a maximum height of 80ft to the top of the parking deck parapet, excluding roof mounted structures and heliport. To accommodate design flexibility, Parking Option B is presented as a range of 1,368 to 1,400 spaces.

ATTACHMENT G
• If two towers, roof top naturally landscaped area for patient viewing may be located in the courtyard of towers

4.2.5 Parking Structure and Surface Level Parking
The Medical Center presently utilizes both below surface level and street level parking, with approximately 1,354 parking spaces devoted to surface and underground parking distributed on and around the Medical Center. Parking presently available on the Medical Center campus is fully used under the existing operational setting and off-campus parking is necessary and used by current staff even prior to any planned expansions.

To maximize the available land within the Medical Center and to centralize parking in a location more convenient to all buildings on the Medical Center, a new Parking Structure with a maximum of nine (9) elevated tiers (excluding roof trauma elevator over-run and heliport areas) will be constructed to accommodate a maximum of 1,980 new parking spaces.

Parking Option A for the new Parking Structure, (the initial application) was is designed as a four (4) bay, nine (9)-elevated tier structure. The four (4) bays include two (2) flat bays and two (2) internal ramp bays. This affords the circulation to move in a rotating pattern independently of each other. This in turn decreases vehicular parking and exiting times. The structure includes up to 1,980 stalls of which approximately 10% are accessible stalls. Those stalls are located on the same bay on every floor. The primary vertical circulation is located on the south bay of the structure (closer to the Acute Care Hospital Tower), and it encompasses five (5) elevators in two (2) banks. There are four (4) pedestrian exit stairs primarily located toward each corner to facilitate code required exiting. The floor-to-floor heights are 12ft and include ample room to meet the required 8’-2” clear height required for accessible stalls. The uppermost parking deck of the structure was is at approximately 108ft above grade with perimeter parapet at approximately 115ft. The elevator over-runs and heliport exceed these heights (but are excluded from building height per section 6.3.4). A potential photovoltaic array is proposed to be installed on rooftop or the side of the Parking Structure for energy generation and is also excluded from the overall building height. This maximum structure size was evaluated in the DEIR.

In response to comments on the Draft EIR received from stakeholders, St. Joseph’s also prepared a Parking Option B that would agreed to reduce the size of the Parking Structure. Parking Option B for the new Parking Structure is designed as a six (6)-elevated tier structure. The structure includes a range of between 1,368 and no more than 1,400 stalls, of which approximately 10% are accessible stalls. The uppermost parking deck of the structure is at approximately 72ft above grade with perimeter parapet at approximately 80ft (excluding roof mounted structures and heliport). All design criteria regarding bays, ramps, elevators, and vehicle circulation are the same as outlined for Parking Option A.

The heliport structure will accommodate multiple helicopters and is designed so that vehicles can circulate below the heliport platform. Closely positioned with the heliports are a dual bank of dedicated elevators that are a two (2) stop design (top and bottom floor only).

The parking structure can accommodate bicycle parking and electric vehicle charging stations as required by the most recent code requirements and as described in Chapter 6.

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The number of tiers and building height of the Parking Structure is intended to support design flexibility, including pre-fabrication opportunities, as the overall Medical Center planning process continues through each phase. The final number of parking spaces (not to exceed 1,400) will be determined through the entitlement process and refined as part of the design of buildings, considering Municipal Code minimum parking requirements, hospital experiences with greater demand for parking spaces, as well as physical design to minimize building massing on adjacent streets. St. Joseph’s decades of operations experience, both with this Medical Center and with other facilities, indicates that patients and visitors benefit from extra parking above Municipal Code requirements. Patrons with mobility challenges and who do not have access to disabled parking placards require both closer short-term parking and wider parking spaces than may be required under minimum parking requirements. The number of parking spaces in the parking structure will not exceed 1,980 1,400 parking spaces. without analysis of additional environmental impacts under the procedures in Chapter 8, and particularly Section 8.3.1 (Subsequent Environmental Review).

The Project also includes new surface parking for the Emergency Department for approximately 70 spaces. This surface parking is located between the Acute Care Hospital Tower and the Parking Structure. A smaller surface lot north of the Parking Structure will hold approximately 16 stalls.

At final buildout of Phases 1-4, total maximum parking including underground, surface level, and Parking Structure is identified and summarized in Table 4.2.5-1 and 4.2.5-2.

Table 4.2.5-1 Parking Summary (Parking Option A)
Total Existing Parking
(Excluding Public right-of-way)
1,354
Existing Parking to be Removed by Area
North Lot -606
Administration Lot -7
Administration Overflow Lot -9
McCloud Avenue -24
HCCL North -6
HCCL South -21
Vendor/Maintenance -7
Total Parking Removed -680
New Parking Stalls Provided
New Parking Structure Stalls 1,980
North Surface Lot 16
ED Parking Lot 70
Parking Total
Phase 1-4 Buildout 2,740

ATTACHMENT G
Table 4.2.5-2 Parking Summary (Parking Option B)
Total Existing Parking
(Excluding Public right-of-way)
1,354
Existing Parking to be Removed by Area
North Lot -606
Administration Lot -7
Administration Overflow Lot -9
McCloud Avenue -24
HCCL North -6
HCCL South -21
Vendor/Maintenance -7
Total Parking Removed -680
New Parking Stalls Provided
New Parking Structure Stalls 1,400
North Surface Lot 16
ED Parking Lot 70
Parking Total
Phase 1-4 Buildout 2,160
The Parking Plan is included as Appendix, Attachment 15. The technical analysis supporting the Plan is included as Appendix, Attachment 16.

4.2.6 Heliports.

The existing heliport on the roof of the main hospital building at 1800 N. California will remain and is licensed to accommodate maximum weight capacity of 7,000 pounds. This existing heliport will be proximate to the surgery center and the Use Permit for this heliport will remain in place.

This existing heliport is located close to the newborn intensive care unit and provides vital aerial transport for some of the most vulnerable patients. The existing heliport is also anticipated to be used to provide back-up to the new heliport(s), or for transport of supplies or patients to or from the surgery center. As noted in Section 3.2.5, current heliport usage is approximately 15 unscheduled flights per month.

The existing heliport is a valuable resource. Retention of this landing area will provide operational flexibility and, at times, will limit community impacts from helicopter operations. Single heliport hospitals and surrounding areas sometimes experience impacts when helicopters hover waiting for a helicopter to depart a landing area. Having both heliports available will mitigate this condition. Further, there are instances when helicopters are dispatched to medical facilities with dispatch officers unaware that a heliport is occupied. The second heliport will minimize any disruption in medical service.

ATTACHMENT G
Plan. If hook-ups are used, there will still be a minimum of one (1) tank with at least 5,000 gallon capacity.15

4.6.6 Future Safety Retrofit Requirements
As building requirements and seismic and other safety standards evolve over time, additional retrofits (whether to achieve seismic protections or for other health/safety reasons) may be necessary and would be included within the scope of the development policies and design standards of the Plan. Safety retrofits may be presented for approval under the administrative procedures set forth in Chapter 8 and will include, but not be limited to, interior and exterior modifications, replacement of windows, and adjustments to building fenestrations. The Development Policies and Design Standards of the Plan will be applied to future building retrofits and those retrofits will also be subject to approval as “Minor Changes to the Plan” as authorized by Municipal Code Section 16.140.110B and in “substantial conformity” with the Plan if the criteria of Section 8.4.1 of the Plan are met.

4.7 Emergency Public Health Services, Disaster Management and Emergency Services Medical facilities are a central location for emergency public health services, as well as a crucial resource for disaster management and emergency preparedness for a community. St. Joseph’s has provided these services in the past and has identified the continuation of such services as a key objective for the expansion program.

Figure 4.7 identifies logical locations for emergency service facilities, which can range from tented treatment areas that may include testing or vaccination services (similar to what was in place at many medical facility locations during the 2020 Pandemic), to mobile technology treatment locations. Emergency public health service facilities will be located in close proximity to critical services provided within the buildings; i.e., radiology and emergency department.

Due to the available locations, emergency service facilities may temporarily impact available parking stalls which would reduce the current parking ratio of 3.7 stalls per licensed bed, and the maximum ratio of up to 5.6 stalls per licensed bed. (As noted in Section 4.2.5, Option B for the Parking Structure is the applicant’s request an alternative size of the Parking Structure is included in the Plan, which would result in an actual lower ratio per bed, with the potential for increased off-site parking, if necessary.) When these emergency services are being provided the parking ratio shall be allowed to be reduced temporarily for the duration of the services provided.

The Municipal Code provides an exemption to the requirement for a temporary use permit for “[e]mergency public health and safety needs and use activities.” Municipal Code section

16.164.030(A)(5). In light of this exemption and the intended nature of proposed temporary facilities for emergency public health services, disaster management and emergency preparedness, no additional City approval is anticipated to be required. Hospital management will continue to work closely with City staff, as it has in the past, to provide information on available resources in times of emergency needs.
15California Code of Regulations, Title 24, Section 615.4.1.

ATTACHMENT G
flow will be applied and submitted to the Fire Marshal for approval. If structures are reduced in size from the maximum allowed under the Plan, fire flow requirements will decrease.

Table 5.9.2-1 Proposed Building Fire Flow Summary
Building1 Total Building Area,
square feet
Fire Flow,
gpm3
Reduced 75% Fire
Flow, gpm4
Acute Care Hospital Tower 331,000 4,7505 1,500
Parking Structure 800,0008 3,2506 1,5009
Central Utility Plant 30,000 1,750 1,500
Generator Building Addition 3,500 1,500 1,500
Plant Maintenance Building 18,000 1,500 1,500
Phase 5 Acute Care Hospital
Tower
150,000 3,2507
1,500
Phase 5 Parking Structure 200,000 2,2508 1,500

1.All proposed buildings are assumed to be fully sprinklered and of Type IA type of construction. Each of the fire flow calculations is based on maximum building size and would be reduced if square footage is reduced during the design process

2. Fire Flow per CFC Table B105.1

3. 75% reduction for sprinklered building per CFC Table B105.2

4. Per CFC Section B104.3, for Type IA construction, building area shall be the area of the three largest successive floors. Assuming the Hospital Tower is five (5) stories, that equals 66,200 sf per floor, or 198,600 sf for three successive floors.

5. Per CFC Section B104.3, for Type IA construction, fire flow for parking garages shall be determined by the area of the largest floor. Assuming the Parking Structure is ten (10) levels (ground and nine (9) elevated levels). The approximate footprint of the parking garage is 90,000 sf, which is the size of the assumed largest floor.

6. Per CFC Section B104.3, for Type IA construction, building area shall be the area of the three largest successive floors. Assuming the Phase 5 Hospital Tower is five (5) stories,(see section 4.4) that equals 30,000 sf per floor, or 90,000 sf for three successive floors.

7. Per CFC Section B104.3, for Type IA construction, fire flow for parking garages shall be determined by the area of the largest floor. For purposes of the fire flow analysis, the 200,000 sf Phase 5 Parking Structure is assumed to be five (5) stories, and the largest floor would be 40,000 sf.

8.Option A for the Parking structure will be up to 800,000sf. Option B will be up to 512,395sf 600,000sf.

9. Fire Flow demands for the reduced size parking structure will be updated for City review prior to submittal of improvement plans, but will not increase because of the smaller size of the building.

A fire flow demand of 1,500-gpm was applied at an existing fire hydrant located at the northwest corner of McCloud Avenue and Cemetery Lane. Flowing this fire hydrant was found to give the lowest residual pressure results (worst case condition). The following table summarizes the fire flow demand and residual pressure at the flowing fire hydrant.

ATTACHMENT G

6.2.5 Medical Related
Allowed medical related uses include facilities for activities associated with medical treatment.

This includes acupuncture; offices of dentists, doctors, psychiatrists/psychologists, and other medical professionals; medical-related counseling services; pharmacies; and physical therapy.

Temporary medical-related uses shall be allowed, including mobile trailers, vaccination tents, and drive through vaccination and testing. (See also Section 4.7 of the Plan.)

6.2.6 Medical Administration
Medical administration facilities, including offices of doctors and medical professionals, are an allowed use.

Current administration buildings include the Main Hospital Wing, the Administration Wing, and the McCloud Building. Medical Administration facilities and business services may also be located in temporary (modular) structures.

6.2.7 Medical Education
Medical education is an allowed use and is integrated into the regular functions of the hospital.

Part of the hospital’s mission is to serve as a Graduate Medical Educational facility. This educational function (located in the HCCL Building) is integrated into the hospital facilities and provides resident physicians with training in a variety of specialties. Medical education also includes training for nurses and medical technicians.

6.2.8 Parking
Parking lots and structures are provided for in the Master Development Plan to support the primary land uses, as further described in Section 6.3.7 and 6.4.7. The Master Development Plan includes up to a Parking Structure with up to nine (9) six (6) tiers above ground to serve hospital employees and visitors. Off-campus parking may also be implemented to complement, as needed, on-campus parking spaces. Parking adjacent to modular structures will be allowed through the Temporary Activity Permit process (Municipal Code Section 16.164.030).

6.2.9 Physical Plant
The physical plant is an allowed ancillary use to support the overall Master Development Plan area. Physical plant uses may include utility plant (boiler/chiller), emergency generators, water wells, Plant Maintenance building, bulk oxygen tank storage, hazardous materials storage, fuel storage, loading docks, and similar elements required to support the Medical Center functions.

6.2.10 Heliport
Heliports associated with the hospital shall be an allowed use. A hospital heliport is defined as a restricted use airfield by the Municipal Code.28 The California Department of Transportation, Aviation Division, will also provide a heliport license upon approval of the land use authorities (i.e., the City) and, prior to activation of a heliport, receipt of a letter from the Federal Aviation 28 Municipal Code Section 16.240.020.

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Table 6.9-1 Design Deviations
Setbacks
(Deviation from 16.24.200 Table 2-3)
Descriptor
Municipal Code Requirement
CO Zone CG Zone MDP Guidelines
Setbacks
Front 10 ft 10 ft 0 ft1
Side 5 ft 0 ft1 0 ft1
Side, Street 10 ft 10 ft 0 ft1
Rear 10 ft 0 ft1 0 ft1
Building Heights
(Deviation from 16.24.200 Table 2-3 and 16.36.090-B4)
Height 45 ft 45 ft 115 ft2 – hospital
115 ft2
– Parking
Structure Option A
or 80 ft2 – Parking
Structure Option B
75 ft2
– support
buildings
Roof-Mounting Screening
(Deviation from 16.36.090-B1)
Height As required to screen roof-mounted HVAC equipment Site Coverage and Floor Area Ratio (FAR)
(Deviation from 16.24.200 Table 2-3)
Max. Lot Coverage 60% 60% 95%
Floor Area Ratio (FAR) 0.3 0.3 Current Medical Center
has a FAR of 0.84.

Proposed deviation of

3.0 Bicycle Parking
(Deviation from 16.64.100-B)
Bike Racks 10% of
off-street
stalls
10% of
off-street
stalls
1% of off-street parking
stalls
Bike Lockers (Longterm)
10% of bike racks shall be for long-term bike parking

ATTACHMENT G
Attachment 15
St. Joseph’s Medical Center, Hospital Expansion Project Parking Plan, September 2023

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ST. JOSEPH’S MEDICAL CENTER OF STOCKTON

HOSPITAL EXPANSION PROJECT

MASTER DEVELOPMENT PLAN
ATTACHMENT 15

PARKING PLAN

ATTACHMENT G

PARKING PLAN

1. Purpose of the Parking Plan
This Parking Plan for the St. Joseph’s Medical Center of Stockton – Hospital Expansion Project (the “Project”) is approved as part of the Master Development Plan (the “Plan”) for the Project. This Parking Plan identifies the initial anticipated parking demands both during construction (i.e., the Temporary Parking) and the parking that will be provided to serve the expanded facilities after completion of the Project (i.e., the Permanent Parking).

Through the approval of the Parking Plan as part of the Project, St. Joseph’s1 will be afforded flexibility should the need arise for modification of this Parking Plan, whether due to unanticipated circumstances during construction or as the Project is developed. This Parking Plan may be amended as part of the Administrative Procedures in Chapter 8 of the Plan. Revisions to this Parking Plan will not require an amendment of the Master Development Plan.

2. Parking Demand Requirements
Parking demand requirements are estimated based upon maximum Project buildout and are set forth in Sections 4.2.5 and 6.3.7 of the Plan. The Parking Summary (both existing and maximum anticipated) is listed in Table 4.2.5-1 of the Plan, copied below. 1 Capitalized terms that are not defined in this Parking Plan will have the meaning used in the Master Development Plan.

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Total Existing Parking
(Excluding Public right-of-way)
1,354
Existing Parking to be Removed by Area
North Lot -606
Administration Lot -7
Administration Overflow Lot -9
McCloud Avenue -24
HCCL North -6
HCCL South -21
Vendor/Maintenance -7
Total Parking Removed -680
New Parking Stalls Provided
New Parking Structure Stalls 1,980 1,4001
North Surface Lot 16
ED Parking Lot 70
Parking Total
Phase 1-4 Buildout 2,740
1 Option A will provide up to 1,980 parking stalls, Option B includes a range of between 1,368 and 1,400 parking stalls.

This Parking Summary provides a reference to existing and anticipated additional parking spaces at various lots on the Medical Center Campus (the “Campus”) and also within the new parking structure that will provide permanent parking once the expansion is complete. The anticipated total parking for Option A upon completion of Phases 1-4 is approximately 2,740 spaces within the boundaries of the Campus (both within parking structures and on surface lots).

The parking yield information included in Table 4.2.5-1 and the demand requirements in Section

6.3.7 of the Plan were used as the basis for environmental analysis of the Project. If a revision to this Parking Plan results in a change to the parking yield analysis, the City will evaluate whether additional environmental analysis is necessary pursuant to Section 8.3 of the Plan.

3. Permanent Parking
The Master Development Plan identifies a requirement of a minimum of two (2) stalls per licensed bed consistent with Municipal Code section 16.64.040, Table 3.9. (See Master Development Plan,

ATTACHMENT G
Section 6.3.7) St. Joseph’s requested and the Plan incorporates flexibility to include up to 5.6 parking stalls per licensed bed. The locations for new parking stalls to meet the anticipated demand for Permanent Parking are set forth in Section 4.2.5 of the Plan, and include existing and new surface parking lots, an existing parking structure adjacent to the Women and Children’s Pavilion, and the new parking structure immediately north of the new Acute Care Hospital Tower. Street parking is not included in the analysis of available parking to serve the expanded Campus services.

The design standards for the new parking structure are set forth in Sections 4.2.5, 6.3.7, and 6.4.7 of the Plan. Except for the modifications noted below relative to capacity of the new parking structure and location of surface level parking, the design standards of the Master Development Plan shall be applied to Permanent Parking in this Parking Plan, unless an amendment is approved pursuant to the administrative procedures of Chapter 8 of the Plan.

Parking Option A as outlined in the Master Development Plan, includes a new parking structure of up to nine (9) six (6) elevated tiers (excluding roof trauma elevator over-run and heliport areas) that will accommodate a maximum of 1,980 1,400 new parking spaces. During the design of the new Acute Care Hospital Tower, if St. Joseph’s determines that a smaller structure meets service requirements (for patients, visitors and staff), the new parking structure may, at the election of St.

Joseph’s, be reduced in size so long as the alternative size meets the minimum parking requirements for a hospital as stated in Municipal Code section 16.64.040, Table 3.9. In other words, if St.

Joseph’s determines that the estimated 5.6 parking stalls per bed is not necessary due to changes in driving patterns, particularly of families and friends of patients, St. Joseph’s may construct a smaller parking structure so long as the minimum Code requirement of two (2) stalls per bed is satisfied.

Final size of the parking structure shall be identified on the Site Plan, submitted for review as provided for in Section 8.2.2 of the Plan. In response to comments on the Draft EIR received from stakeholders, St. Joseph’s agreed to implement also prepared a Parking Option B that would reduce the size of the Parking Structure. The Master Development Plan does not, however, reduce the stated maximum parking ratio, and acknowledges that additional, yet to be identified, off-site parking may be required if the smaller Parking Structure is insufficient.

While the location of the new parking structure is not likely to change during the buildout of Phases 1-4, the construction of Phase 5 as outlined in the Plan (see Section 4.4 of the Master Development Plan) is likely to impact on-site surface level parking that is included in the calculation of Permanent Parking in Table 4.2.5-1. St. Joseph’s will provide to the City an analysis of parking capacity and parking demand with the submittal of building plans for Phase 5 to allow for complete analysis (including environmental review, if necessary) to determine if additional parking is required to service Phase 5. If it is determined that the new parking structure has sufficient capacity for Phase 5 building(s), no additional parking may be required.

4. Temporary Parking
Construction of the expansion of the Medical Center will span multiple years and will occur in phases. (See Master Development Plan, Section 4.3, for a description of the anticipated phasing of the Project construction.) As each phase occurs, existing parking will be displaced, and temporary parking must be provided in a safe location that adequately serves patients, visitors, and staff. In addition, temporary parking will be needed to accommodate construction workers. Although street parking was not counted as part of the allocation of new parking spaces, street parking that is

ATTACHMENT G
currently in use (i.e., on Cemetery Lane and McCloud Avenue) is counted in the total number of displaced parking spaces.

At the start of each new phase of construction, temporary parking demands will be updated to identify adequate parking during each phase of construction. Under the current construction plan, the new parking structure will be built during Phase 2, which is anticipated to alleviate any parking shortages by the time the construction of the new Acute Care Hospital Tower begins as part of Phase 3.

Figure A depicts graphically the displacement of parking during construction.

The summary of spaces that will be displaced during construction by location is as follows:

Existing Parking to be Removed by Area
North Lot -606
Administration Lot -7
Administration Overflow Lot -9
McCloud Avenue -24
HCCL North -6
HCCL South -21
Vendor/Maintenance -7
Total Parking Removed -680
An estimated total of 680 parking spaces will be displaced, although the disruption will vary by phase. The anticipated parking needs by phase, which also includes anticipated needs for parking for construction workers, are identified in Figure B “Conceptual Project Parking Schedule.” The Conceptual Parking Schedule is based on current known data at the time of approval of the Project. The exact numbers of displaced parking stalls and employees who need off-site parking will vary as the final building designs are developed. Required temporary parking stalls may decrease in number. Alternatively, if the construction schedule requires an adjustment in the phased schedule or if additional parking becomes necessary either to accommodate construction workers or improve access to medical facilities, the Project Parking Schedule will be revised and provided to the City as a revision to this Parking Plan.

The Project Parking Schedule identifies shortages of on-site parking during Phases 1 and 2. The onsite parking shortages will be satisfied by off-site parking, whether on property owned by St.

Joseph’s or an affiliated entity or through lease of parking through third parties.

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The environmental impact report evaluated potential sites for temporary parking that would be within a short shuttle ride to the St. Joseph’s Medical Center. Several sites are possible locations that would be within approximately 0.7 to 0.9 miles to the closest drop off points at the Campus.

Drop off points and frequency of shuttle services to and from the off-site temporary parking areas will be determined and adjusted as needed to accommodate employee shifts, construction worker shifts, and parking for family and friends of patients.

St. Joseph’s will continue to identify temporary parking opportunities, along with suitable transport by shuttle, to meet each level of parking demand by phase as set forth in Figure B. This Parking Plan will be revised to include additional off-site parking as those locations are secured by St. Joseph’s.

The construction of all temporary off-site parking lots will meet all local ordinances, including the materials used, installation, striping and other surface markings, and lighting. If a temporary parking area identified in the future is unimproved, the surface of this temporary parking area shall be improved per the Municipal Code requirements.

This process also will be used for temporary parking for construction personnel. Potential sites that are located within a mile of the Medical Center Campus were identified for purposes of the evaluation of environmental impacts. When actual sites are secured for construction personnel, those parking areas will meet City requirements for temporary construction paring. Temporary lighting also shall be provided and meet safety standards under the Municipal Code.

5. Phase 5 Parking
Figure B identifies anticipated parking shortage for Phase 5. The analysis for Phase 5 assumes full build out of Phases 1 – 4 at the maximum capacities identified in the Master Development Plan. The Project Parking Schedule will be updated prior to issuance of a building permit for any Phase 5 building(s) to ensure that (a) actual parking demands are incorporated into the analysis for Temporary and Permanent Parking related to Phase 5 and (b) that adequate parking during and after construction of Phase 5 is available at the time the parking is needed. The estimates for Phase 5 are presented as estimates, only, and the actual demands for Temporary and Permanent Parking will be reviewed under the Administrative Procedures of Chapter 8 of the Plan.

ATTACHMENT G
1 From: Ricky Gill <[email protected]>
Sent: Thursday, September 14, 2023 11:13 AM
To: CCͲCity Clerk <[email protected]>; Stephanie Ocasio <[email protected]>; Michael McDowell <[email protected]>; Waqar Rizvi <[email protected]>; Rajan Nathaniel <[email protected]>; Gurneel Boparai <[email protected]>; Brenda Jones <[email protected]>; Greg Thompson <[email protected]>; Terry Hull <[email protected]>; Anne Mallett <[email protected]>; Harry Black <[email protected]>; William Crew <[email protected]> Cc: John Conger <[email protected]>; Colin Hunter <[email protected]>; Brett S. S. Jolley <[email protected]>; Chaman Gill <[email protected]>; [email protected]; [email protected]; Ricky Gill <[email protected]> Subject: Gill Medical Center / St. Joseph's Hospital Expansion: Withdrawal of Objections CAUTION: This email originated from outside the City of Stockton.Do not click any links or open attachments if this is unsolicited email.

Dear Planning Commissioners and City leadership:

I wanted to inform you that Gill Medical Center, LLC (GMC) and Dignity Health/St. Joseph’s Medical Center (SJMC) have resolved all concerns GMC and the Gill family have previously raised with regard to the SJMC expansion on the California Street corridor, including those concerns I raised in my email of September 11, 2023, the enclosed August 15 letter addressed to Stockton Planning Commissioners, and any related communications with City staff or officials. GMC and the Gill family hereby withdraw all such objections.
Our counsel, Brett Jolley, will appear at the Planning Commission meeting this evening to confirm that GMC has withdrawn all objections to the SJMC expansion.

Thank you for your consideration.

All the best,
Ricky Gill

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1 From: Ricky Gill <[email protected]>
Sent: Monday, September 11, 2023 1:15 PM
To: CC - City Clerk; Stephanie Ocasio; Michael McDowell Cc: Harry Black; William Crew; Waqar Rizvi; Rajan Nathaniel; Terry Hull; Anne Mallett; Gurneel Boparai; Brenda Jones; Greg Thompson
Subject: Official Communication for the Record / 9-14-23 Planning Commission Meeting Attachments: GMC PC Ltr RE SJMC Expansion.pdf; Attachment A - GMC Comment Letter on SJMC EIR (Final with Exhibits) (GMC Comment Letter on SJMC EIR (Final with Exhibits).pdf_1).pdf; Attachment B - 1707 N California St. Aerial.jpg; Attachment C - St. Joseph's Expansion.pptx; Attachment D - 23.03.01 Site Plan.pdf
CAUTION: This email originated from outside the City of Stockton.Do not click any links or open attachments if this is unsolicited email.

Dear City Clerk and Planning Commission Staff: Attached, you will find official communication from Gill Medical Center (GMC) regarding the proposed St. Joseph's Medical Center expansion, which will be considered by the City of Stockton Planning Commission on Thursday, September 14th, 2023. GMC notes this communication was omitted from attachment J of the upcoming 9/14 Planning Commission Agenda / meeting packet. This correspondence and all relevant enclosures were conveyed to Stockton Planning Commissioners via their official email addresses on August 15th, and this material was additionally transmitted to the City Manager through official email on August 16th. Please enter the attached into the record in advance of this Thursday's session and print for the Commissioners' review.

Thank you,
Ricky Gill

ATTACHMENT G
1 Gill Medical Center, LLC P.O. Box 1450
Lodi, CA 95241
Phone (209) 334-6583
Fax (209) 334-5007
[email protected]
Stockton Planning Commission
425 N. El Dorado St.

Stockton, CA 95202
August 15, 2023
Dear Planning Commissioners:

I’m writing to address the Environmental Impact Report (EIR) relating to the expansion of St. Joseph’s Medical Center (SJMC), which I understand the Planning Commission intends to consider at one of its upcoming meetings.

In considering the proposed expansion of SJMC described in its EIR, my family and I believe the Planning Commission has a unique opportunity to support our growing community’s needs for clinical healthcare expansion and more housing, while also meeting the City’s legal obligation to mitigate the significant associated serious environmental impacts it presents.

I note at the outset that my family and I have been longstanding partners and supporters of SJMC.1 We continue to support and partner with SJMC today, and—to be clear—we believe its expansion has the potential to greatly improve the availability of certain clinical healthcare services in our community. Nonetheless, we believe the hospital’s EIR suffers from serious deficiencies that will, if left unaddressed, have a significant negative impact on the California Street corridor that will persist for decades and expose the City to undue legal risk. Many of these issues were first raised in the draft EIR comment letter Gill Medical Center, LLC (GMC) submitted on June 1, 2023.2 First, SJMC (and its parent, Dignity Health) systematically failed to consider the possibility of including the nearly 3-acre property that GMC owns at 1707 N. California St.3—which GMC purchased from SJMC in 2006—as part of its expansion. As early as 2017, GMC specifically discussed the possibility of using its property to the west of N. California St.—including the parcel at 1707 N. California St.—as part of the hospital’s eventual expansion.4
GMC believed then, and we continue to believe now, that integrating our property into the hospital campus would render unnecessary the enormous 2,000- stall, roughly 12-story garage that SJMC is proposing to construct east of California Street. SJMC’s failure to analyze this alternative—namely, expanding SJMC to the west, onto property that GMC specifically offered to make available for that purpose—is a glaring omission in this EIR. GMC also believes that SJMC’s expansion will put an enormous strain on utilities, including by placing the sewer system on N. California St. at or near its capacity, a matter that is not adequately addressed in the EIR.
1 I initiated the hospital’s laparoscopic surgery program for women in the early 1990s, and I later served as a board member for the hospital foundation. My wife, Dr. Param Gill, is proud to have served as one of the first female chiefs of staff at SJMC.
2 Attachment A: GMC comment letter on the SJMC DEIR, dated June 1, 2023. 3 Attachment B: Aerial image of the GMC property (1707 N. California St.) and SJMC. 4 Attachment C: Hospital expansion plan involving 1707 N. California St. as presented by GMC to SJMC leadership in 2017.

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2 In addition, SJMC remains untenably opposed to GMC’s proposal to construct workforce housing on the 1707 N. California St. property, even though incorporating housing would serve as an environmental mitigation for its massive project, including by allowing SJMC employees to sustainably walk to work. SJMC irrationally contends that any multi-family residential component on the GMC property would be detrimental to the community, which is contradicted by the City’s designation of this parcel as a Housing Action Plan top-ten priority site. Dignity has invoked obsolete deed restrictions and withheld required site plan approval for GMC’s mixed-use building5 because it
incorporates multi-family residential, a position that runs counter to California’s environmental laws requiring project applicants to take reasonable measures to reduce greenhouse gas emissions.

As a community, we have one chance to make a generational change on the California Street corridor. Patients, visitors, and employees of SJMC, along with our fellow community members, are depending on the Planning Commission to exercise its authority responsibly to shape this project for the betterment of Stockton. Rather than embracing this opportunity for positive change, the current version of SJMC’s proposed expansion—including its 12-story parking garage—would saddle the community with an unworkable, inefficient development for decades to come. Therefore, I urge you to pause consideration of the SJMC expansion unless and until the hospital lifts its inexplicable objections to housing on the GMC property and fully considers GMC’s longstanding offer to collaborate on better solutions using its property at 1707 N. California St. This includes the possibility of constructing a second garage at 1707 N. California St.—an option that hospital leadership solicited from GMC as recently as late July 2023 to avoid constructing a single, enormous garage east of California St., which would deposit everyone exiting the garage onto a single lane of a street that will soon be reduced to two lanes.6

Since purchasing the 1707 N. California St. property in 2006, GMC has attempted to partner with SJMC on at least five projects over 16 years that would provide medical office and clinical space, but ultimately the hospital’s non-participation and opposition rendered each project nonviable. Given the hospital’s lack of interest in those projects, GMC in the 2021-22 timeframe instead proposed a mixed-use development, including multi-family residential, that it believes would be in the best interest of the property, California Street and the City of Stockton. GMC’s property could accommodate both a mixed-use building on the eastern edge and a secondary garage for SJMC on the western portion, simultaneously fulfilling the need for housing and additional hospital parking on the California St. corridor.

GMC also has a track record of enhancing the neighborhood around the hospital, and it would be pleased to work with SJMC to continue doing so. GMC has worked diligently to consolidate and improve the property at 1707 N. California St. over the past decade, including by purchasing two homes at 415 and 417 E. Walnut Ave. from third party sellers, to allow for the consolidation of the 3- acre block between Walnut and Chestnut Streets under a single owner for the first time. (In the years since then, GMC has leased much of that block to SJMC for its employees’ parking.) GMC’s principals also developed a multi-tenant, Starbucks-anchored retail center known as “Gill Grove” directly to the south of 1707 N. California St., which has greatly enriched the surrounding area, addressed the prevailing food desert around the hospital and improved the patient and employee experience at SJMC.

We continue to believe that the development of multi-family residential on the 1707 N. California St. property, which would primarily be occupied by SJMC staff and physician residents living within 5 Attachment D: Mixed-use site plan, submitted by GMC to Dignity Health, on March 1, 2023. 6 https://siegfriedeng.com/portfolio/city-of-stockton-california-street-road-diet-phase-i/

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3 walking distance of the hospital, is a feasible environmental mitigation that would naturally reduce greenhouse gas emissions from a hospital expansion involving the addition of hundreds of new employees. As SJMC’s development documents point out, the hospital is attracting over 200 new physician residents to the hospital as part of its graduate medical education programs; market-rate housing made available to these residents on the GMC property would certainly assist with recruitment and retention of these doctors, helping alleviate the provider shortages in our community. But for Dignity’s arbitrary refusal to provide site plan approval, GMC would be eligible for an over the counter, ministerial permit for this mixed-use project under the City’s zoning code. In fact, the City Council voted in the summer of 2022 to zone the entirety of the GMC property Commercial Office (“CO”), paving the way for a modern, mixed-use development to proceed on site.

Unfortunately, this has not prevented Dignity from making erroneous statements about the GMC property, including in an April 13, 2023, public workshop where SJMC land-use counsel stated incorrectly that multi-family residential is prohibited in the “CO” zone. Moreover, the City initiative to label the GMC property as a top-ten Housing Action Plan priority site, where infill residential should be encouraged, highlights the mixed-use project’s consistency with the Stockton General Plan goals.

The most problematic aspect of the SJMC expansion was and remains avoidable: the mammoth 12- story, 2000-stall parking garage that will aggravate traffic on California St., itself in the process of a road diet approved by the City in 2017. SJMC leadership not only willfully failed to explore the prospect of long-term parking on the GMC property; they even misled the public on this point. In that same April 13, 2023, public workshop, SJMC representatives said that the GMC property was never made available to the hospital for its expansion. In fact, GMC principals and hospital leadership had discussed incorporating the GMC property into the medical campus as early as 2017, including discussing proposals for a garage that would roughly halve the size of the proposed parking structure east of California St.

Under CEQA guidelines, the threshold for including a site among the EIR alternatives is whether it will feasibly attain most of the project objectives and would avert or substantially lessen environmental impacts, a standard that was certainly met and exceeded when GMC and SJMC discussed integrating this parcel into the medical campus. We continue to believe there is no legally valid basis for its exclusion from the EIR alternatives analysis. GMC continues to believe that locating a significant portion of SJMC’s parking needs on the 1707 N. California St. property will mitigate environmental impacts and benefit the hospital’s patients, employees, and visitors tremendously - including by allowing easier parking and expedited patient transport to points on the southern end of the SJMC campus where important clinical services exist, such as the Cancer Center, Heart Center, Outpatient Surgery, NICU and Women & Children’s Pavilion.

It is worth noting that SJMC currently leases roughly 145 parking stalls from GMC on the western portion of the 1707 N. California St. property, meaning the hospital has already deemed its location suitable for employee parking. It also stands to reason that the accumulation of traffic from a single parking structure east of California St. will negatively impact the ability of ambulances to access the medical center, when minutes count to save lives. Adding a secondary garage on the GMC property would not only address those operational inefficiencies, but also would allow patients, employees, and visitors to exit much more smoothly onto both sides of N. California St. – which is particularly significant, again, because the City is presently reducing California St. to one lane in each direction.

We believe the Planning Commission has a responsibility to address the numerous deficiencies with the SJMC EIR, ensuring that the California Street corridor gets the properly integrated medical

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4 campus and workforce housing that Stockton deserves and the City’s Housing Action Plan endorses.

To be clear, GMC is not asking you to reject the SJMC expansion, but rather to pause its consideration so the hospital and City can further examine the serious traffic impacts posed by the 2,000-stall garage on an imminently narrowed California Street and evaluate the alternative of longterm parking on the GMC property. Doing so will not only contribute to the health and well-being of our community, but it will also protect the City by ensuring its approval of the SJMC expansion will withstand any legal challenges that may be brought.

Sincerely,
Jasbir S. Gill, MD Diplomate of the American Board of Obstetrics and Gynecology

ATTACHMENT G

GILL MEDICAL CENTER, LLC
P.O. BOX 1450
LODI, CA95241
June 1, 2023
Via Email
Nicole D. Moore, LEED-AP
Current Planning Manager
Community Development Department
345 N. El Dorado Street
Stockton CA 95202
nicole.moore[email protected]
Christine Kronenberg, AICP
Senior Project Manager
Dudek
1810 13th Street, Ste. 110
Sacramento, California 95811
[email protected]
Re: Comments of Gill Medical Center, LLC on Draft Environmental Impact Report for St. Joseph’s Medical Center Hospital Expansion Project (SCH No. 2021120439) Dear Planning Manager Moore and Senior Project Manager Kronenberg:

Gill Medical Center, LLC (“GMC”) respectfully submits these comments on the Draft Environmental Impact Report (“DEIR”) prepared for the proposed St. Joseph’s Medical Center Hospital Expansion Project (“Project”). GMC owns real property located directly across California Street from the Project, commonly known as 1707 N. California Street (hereafter the “GMC Property”; see aerial image attached as Exhibit A).

While GMC supports the development of further hospital services at this location, GMC also believes it is in all parties’ interests to ensure such development is consistent with the City’s General Plan, zoning ordinance, and Housing Action Plan; that the public and decisionmakers fully understand the Project’s impacts to housing availability and the Applicant’s role in affecting such availability; and that significant environmental impacts from the Project are fully considered through proposed mitigation measures and project alternatives as required by the California Environmental Quality Act (Pub. Res. C. §§21000 et seq. and Tit. 14 Cal. Code of Regs. §§15000, et seq., hereafter “CEQA”).

The DEIR Must Consider the Project’s Impacts to Housing Availability in the City of Stockton
The DEIR notes that “[a]t full project build-out, the Medical Center would include approximately 3,230 employees, including doctors, nurses, and administrative staff; this represents an increase of 365 employees from the current total of 2,865.” (DEIR at 4.7- 29). But the EIR never addresses the environmental setting of housing under-supply and how this Project will impact that supply. Nor does it address mitigating significant

ATTACHMENT G
Nicole D. Moore
Christine Kronenberg
June 1, 2023

{00196817.}
environmental impacts from the project by including housing development as part of the Project’s master plan.

1. Environmental Setting – undersupply of housing.
“An EIR must describe existing environmental conditions in the vicinity of the proposed project, which is referred to as the ‘environmental setting’ for the project...

This description of existing environmental conditions ordinarily serves as the ‘baseline’ for measuring the changes to the environment that will result from the project and for determining whether those environmental effects are significant.” (Kostka & Zischke, Practice Under the California Environmental Quality Act, §12.16; see also CEQA Guidelines §15125(a).) The California Supreme Court explains the EIR “must delineate environmental conditions prevailing absent the project, defining a ‘baseline’ against which predicted effects can be described and quantified.” (Neighbors for Smart Rail v.

Exposition Metro Line Construction Authority (2013) 57 Cal.4th 439,447.) Stockton suffers from a severe housing shortage, and the City is currently updating the General Plan Housing Element and preparing a Housing Action Plan (“HAP”) to “increase housing production by serving as a toolkit for residents, housing developers, and nonprofits identifying future potential housing locations.”1 The DEIR does not address what impact the Project will have on available housing stock in the City.

Though not disclosed, presumably a substantial portion of the 365 new employees will be skilled workers/physicians-in-training/medical professionals who will come from outside the area and require housing. The DEIR acknowledges this increase in employees will lead to significant physical impacts, such as exceeding GHG emissions (DEIR 4.7-29 to 30) but does not address how this substantial increase in employees in the City will affect housing availability. At the same time, Section 5.6, (growth inducing impacts) provides, “As described above, the proposed project would result in approximately 365 new employees, medical residents, and students. This represents a moderate number of people that would likely be hired from the regional workforce.” (DEIR 5-5).

Importantly, the City’s update to the General Plan Housing Element acknowledges that the City needs thousands of additional housing units, and the HAP includes a focus on identifying parcels in the City for higher density and affordable housing development.2
1 www.stocktongov.com/government/departments/communityDevelop/Shape/actionPlan.html 2 The Background Report for the current (2015-2023) City of Stockton General Plan Housing Element states that “Countywide, the total housing need is 40,360 new units, of which the City received 11,824 units (29.3 percent).” www.stocktonca.gov/files/HousingElementBackgroundReport.pdf at p. 4BR-56 to 57. The Background Report also notes the “need to be satisfied during the Housing Element planning period is 4,343 lower income units. This remaining RHNA for lower-income units must be accommodated by vacant and underutilized sites.” (Id. at 4BR-61)

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Nicole D. Moore
Christine Kronenberg
June 1, 2023

{00196817.}
GMC respectfully suggests that, as part of the Project Setting and impacts analysis, the EIR should identify the extent to which these housing obligations have been satisfied and, if there remains a shortage of housing stock under the RHNA or other standards, explain what impact the development of this Project will have on that environmental setting.

2. Project mitigation or alternatives should incorporate housing In addition, GMC believes the Project should incorporate housing into the master development plan as a means of not only reducing impacts to housing supply through construction of the Project, but also as a means of mitigating significant environmental effects. Such a concept is fully consistent with Stockton General Plan Policy TR-2.2., which provides that new development should “Connect housing and employment development in areas with good transit access.” (DEIR 4.11-14) In a 2019 white paper published by the American Hospital Association (“AHA”) titled, “Making the Case for Hospitals to Invest in Housing” (a copy of which is attached hereto as Exhibit B), the AHA notes:

While hospitals and health systems have a long history of contributing crucial services in communities, innovative approaches are needed to address systemic barriers to creating truly thriving communities. Applying tactics from across sectors, such as community development and investing, may activate systemic change that health care driven strategies have not yet been able to accomplish. Housing is one upstream determinant of health that hospitals and health systems are focused on more and more.

Access to safe, affordable and stable housing is key for good health.” (Id. at p. 2)
Thus, AHA argues hospitals should utilize their role in communities to stimulate economic, social, and political will to increase availability of affordable housing.

The DEIR and Master Plan are, of course, silent on this point. In addition, GMC is concerned that the Applicant incorrectly believes—and has represented to the community—that zoning designations in the Project area do not allow for housing, when in fact they do. Specifically, during the April 13, 2023 Public Workshop hosted by the Applicant, representatives of St. Joseph’s parent company Dignity Health were asked about incorporating housing into the Master Development Plan. In response, a Dignity representative stated that much of the property on the Project site and surrounding area is zoned “CO” (commercial office) zoning, then incorrectly stated that this zoning designation does not allow for multifamily residential uses. In fact, it does.3 3 In this same April 13, 2023, public workshop, Dignity representatives also inaccurately stated that the GMC Property was never made available to St. Joseph’s for its expansion purposes. In fact, GMC has previously offered

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Christine Kronenberg
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As the City is aware, the CO designation expressly permits multifamily residential development in that zoning district – either as part of a mixed-use project or as a standalone residential project. Indeed, last year GMC worked with the City to rezone the entirety of the GMC Property to CO (the western portion was previously zoned for lowdensity residential) for purposes of developing that property as a mixed-use project that would incorporate commercial office space and multi-family residential uses.

Hospital representatives are certainly aware that the current “CO” zoning of the GMC Property supports multi-family residential, as GMC and Dignity are currently involved in litigation arising out of Dignity’s attempt to prevent construction of any type of multi-family residential uses at the GMC Property by invoking obsolete deed restrictions. A copy of the complaint filed and served in Gill Medical Center, LLC v.

Dignity Health, San Joaquin County Superior Court Case No. STK-CV-UCC-2022-0010368, is attached hereto as Exhibit C.

As background, in 2006 GMC purchased from Dignity’s predecessor several separate parcels that now form a substantial portion of the GMC Property. As part of that sale, Dignity’s predecessor recorded various restrictions purporting to require that the property be developed with a 30,000 sq. ft. medical office building and that Dignity shall have the authority to review and approve any site plan for development of those particular parcels.

In 2022, following several years of discussing various development options for that property with Dignity executives, GMC presented a site plan to Dignity for review and approval that proposed the development of 30,000 sq. ft. of medical office space along California Street (as Dignity claims the deed restrictions require) and which also included 10,000 sq. ft of commercial/administrative space, a 10,000 sq. ft. daycare, and 75 residential apartment units. The site plan also includes parking, which could be made available to Dignity.4 GMC proposed to Dignity that the residential units be designed to cater to Dignity physician residents, nurses, and other staff who would benefit from living adjacent to the St. Joseph’s hospital and forming a truly integrated hospital campus.

Dignity representatives rejected this site plan on the basis that mixed-use residential was detrimental to the community—a suggestion flatly contradicted by City staff’s designation of this property as a top-ten Housing Action Plan Priority Site. In response to Dignity’s refusal to approve its proposed development, GMC was forced to bring suit to request a declaration that Dignity’s deed restrictions are unreasonable and unenforceable and to allow a mixed-use project with a multi-family residential component to proceed. That litigation is ongoing at this time. to make that property available for St. Joseph’s expansion. Indeed, in 2016, St. Joseph’s leadership explicitly requested architectural renderings from GMC depicting a 250-bed hospital expansion on the property, only for the Hospital to pursue its expansion entirely to the east of California St., while refusing to participate in any project or to approve any site plan proposed by GMC since.)
4 Dignity currently leases the GMC Property for parking for its employees.

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These facts are relevant to the City’s consideration of the Project because not only are the DEIR and Master Development Plan devoid of any efforts to address housing impacts from the Project, but Dignity is actively and arbitrarily preventing development of a multi-family housing project adjacent to the Project site. GMC’s effort to construct multi-family housing could not only serve many of the hospital’s hundreds of new employees, but would also serve to mitigate other environmental impacts from the Project. And Dignity can easily implement this mitigation by simply working with GMC to withdraw its opposition to development of multi-family housing adjacent to the Project Site. Indeed, approval of multi-family residential on the GMC Property reinforces Stockton General Plan Policy LU-6.1, which prioritizes the development of vacant, underutilized infill parcels, such as the Gill Property. (DEIR 3-6) For example, even with all identified mitigation measures incorporated and all Project alternatives considered, the Project’s greenhouse gas emissions (“GHG”) impacts, as well as aesthetic impacts, will remain significant and unavoidable. Under CEQA, an EIR must propose and describe mitigation measures to minimize the significant environmental effects identified in that EIR. (King & Gardnier Farms, LLC v.

County of Kern (2020) 45 Cal.App.5th 814, 852) Likewise, the California Supreme Court has described the discussion of mitigation measures and alternatives as “the core of an EIR.” (Citizens of Goleta Valley v. Board of Supervisors (1990) 52 Cal.3d. 553, 564). In addition to a no-project alternative, an EIR must discuss a reasonable range of Project alternatives, that would feasibly attain most of the project’s basic objectives while reducing or avoiding any of its significant effects and evaluate the comparative merits of those alternatives. (CEQA Guidelines § 15126.6). Decisionmakers can approve an alternative to a project because they possess “the flexibility to implement that portion of a project which satisfies their environmental concerns.” (South of Market Community Action Network v. City & County of San Francisco (2019) 33 Cal.App.5th 321, 336) In this instance, doing something as simple as identifying the GMC Property as future multi-family housing development, and withdrawing its opposition to GMC’s proposed mixed-use development on that property, is a feasible project alternative or mitigation measure within Dignity’s control that would not only attain all of the Project’s basic objectives, but also would work to reduce potentially significant impacts to traffic (Impact 4.11-1) and GHG-based significant and unavoidable impacts from the Project (Impacts 4.7-1, 4.7-2, and 4.7-3) resulting from 365 new employees, including those traveling to work at the hospital.

While the DEIR unsuccessfully attempts to mitigate these significant impacts by including additional bicycle storage and e-bike charging facilities, preparing a future transportation demand management plan that encourages ridesharing and alternative transportation, and installing dedicated electric charging stations in the parking structure, the DEIR fails to discuss any mitigation measures or alternatives that would reduce the number of employees commuting to the Project in the first place.

Integrated and/or adjacent housing catering to hospital employees would do just that and could provide a feasible project change, mitigation measure, or alternative that

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would reduce these impacts to less-than-significant levels consistent with CEQA. (see Mitigation Measures 4.7-1 and 4.7-2)
Moreover, the proposed 115-foot tall parking structure contributes to significant and unavoidable aesthetic impacts from the Project. (DEIR 4.2-12) Alternative 3 proposed a “Reduced Parking Alternative” that would limit the parking tower to “ground plus 5 tiers” and a height of 65 feet (vs. 115 feet). The DEIR notes that this this alternative would attain all project objectives, but would be less effective than the proposed Project at attaining the objectives to “improve quantity, quality, and proximity of parking for patients, visitors, and staff” as well the objective of creating employment opportunities due to the reduced parking structure size and capacity (780 fewer spaces for a total of 1,200 spaces vs. 1,980 spaces). Of interest, if the Project included a residential component like that discussed above, the need for employee parking in the tower would be substantially reduced – leaving more parking available for visitors and patients.

Accordingly, GMC respectfully suggests that the EIR should include an alternative that incorporates a residential component as part of the master plan. The GMC Property, as a Housing Action Plan top-ten Priority Site in the City of Stockton, is ideally suited to mitigate the environmental, traffic and growth inducing effects that stem from this hospital expansion project.

Very truly yours,

RICKY GILL

GILL MEDICAL CENTER, LLC
Attachments:

EXHIBIT A: Aerial Image of 1707 N. California St. (the Gill Property) EXHIBIT B: “Making the Case for Hospitals to Invest in Housing”, AHA, 2019 EXHIBIT C: Complaint filed in Gill Medical Center, LLC v. Dignity Health (San Joaquin County Superior Court Case No. STK-CV-UCC-2022-0010368)

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EXHIBIT A

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EXHIBIT B

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Making the Case for Hospitals
to Invest in Housing
Improving the health of individuals—and their neighborhoods and communities as a whole—is one of the most complex and pressing challenges today in the United States. As anchor organizations, or place-based economic engines in our communities, hospitals and health systems have the opportunity to meet this challenge by making meaningful upstream investments to improve community health.

Many hospitals already are providing more than stand-alone acute care services and transforming to provide care across the continuum to promote health and well-being in their communities. Given the inextricable link between affordable, quality housing and good health, housing is one area that hospitals and health systems are starting to focus on more and more.

The American Hospital Association (AHA), in collaboration with NORC at the University of Chicago, is serving as the evaluation partner for a new initiative, Accelerating Investments for Healthy Communities (AIHC). This issue brief, the first in a series, discusses how hospitals are addressing social determinants through investments in affordable housing. It also outlines an innovative framework, the capital absorption framework, which the Center for Community Investment (CCI) developed and is now using to help health care organizations assess their local community investment system.

Accelerating Investments
for Healthy Communities
The Center for Community Investment (CCI) is leading
Accelerating Investments for Healthy Communities
(AIHC), an initiative designed to increase health system investments in upstream determinants of health, with an emphasis on affordable housing. Launched in January
2018 and funded by the Robert Wood Johnson Foundation,
the initiative is providing intensive training to a cohort of hospitals and health systems on how to refine investment strategies around affordable housing in order to leverage existing resources with community partners—and make the greatest impact on the health of the community.

During phase one (January 2018–December 2018), eight nonprofit health organizations that already were investing outside their walls were chosen to participate in an intensive series of learning labs and receive individualized consultation and support to formulate and refine strategies for affordable housing investment. Six hospitals and health systems moved on to phase two (January 2019–December 2020) and will work with CCI and local partners to expand the availability of affordable housing in their communities. (See Table 2 on page 7 for a list of the participating hospitals and health systems.) The American Hospital Association (AHA), in collaboration with NORC at the University of Chicago, is serving as the evaluation partner to learn about investments by hospitals and health systems in their communities to improve the health of the population. The work is guided by the overarching question, “What will it take for leading health organizations to devote more and different assets to investments in affordable housing and other upstream factors that improve community health?” The AHA and NORC will conduct a mixed-methods evaluation and synthesize findings in a series of issue briefs throughout the project as well as a final report.

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AIHC, led by CCI, is helping hospitals refine their community investment strategies around affordable housing. By collaborating with community partners and leveraging assets such as financial resources, land and expertise, health care organizations can make the greatest impact on the health of their communities.

During the initial phase of the project, the AHA and NORC identified two emerging themes for getting buy-in and making the case for investing in affordable housing:
• Mission-driven commitment to address health equity and social determinants • Strategic alignment with care and payment models
The AHA and NORC, with funding from the Robert Wood Johnson Foundation, will continue to follow participating hospitals and health systems during the next two years, learning more and sharing observations about what drives hospitals to invest in affordable housing and what makes such initiatives successful.

Focusing on innovation as hospitals and health systems invest in affordable housing creates an opportunity to catalyze community revitalization efforts. The ongoing work of the AIHC initiative can inform and encourage other hospitals and health systems to invest in affordable housing and advance the health and well-being of their communities.

Addressing Social Determinants by Investing in Affordable Housing Improving the health of communities is one of the most complex and important challenges in the United States today. Given the myriad social, environmental and economic factors that contribute to health, making meaningful and sustainable improvements in the health and well-being of individuals and creating healthy communities cannot be accomplished by one organization or sector alone.

Hospitals and health systems—as anchor organizations, or placed-based economic engines in their communities—have the opportunity to make meaningful upstream investments to improve community health. (See Addressing Social Determinants of Health sidebar on page 3.) While hospitals and health systems have a long history of contributing crucial services in communities, innovative approaches are needed to address systemic barriers to creating truly thriving communities. Applying tactics from across sectors, such as community development and investing, may activate systemic change that health care-driven strategies have not yet been able to accomplish.

Housing is one upstream determinant of health that hospitals and health systems are focused on more and more. Access to safe, affordable and stable housing is key for good health. “Housing instability” is an umbrella term for the continuum between homelessness and stable, secure housing. (See Figure 1, Range of Housing Types, on page 4.) It can take many forms, such as substandard physical conditions—e.g., leaky roof, poor heating and cooling, exposure to allergens or pests—severe rent burden, or homelessness. Studies have associated housing instability with poor health and increased health care utilization. (See Table 1, Housing Instability and Health, on page 4.)

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Research shows approximately 80
percent of health outcomes are
attributed to factors outside of
medical care, including socioeconomic factors, the physical environment and health behaviors.1 Social
determinants of health include
factors such as access to healthy
food, access to transportation,
housing status, social isolation and
community safety.

Efforts to address these nonmedical needs are crucial to individual health and well-being and community health. As the health care field transforms from providing more than
stand-alone acute care services to
promoting health and well-being,
hospitals and health systems are
adapting their models of care to
partner with communities and
address the conditions in which
people are born, grow, live, work
and age.

Adopting population health
strategies, often supported by
alternative payment models, creates
new opportunities for hospitals
and health systems to proactively
align social determinants of health
initiatives, address health disparities and advance their mission.

In 2009, health inequities cost the
health care system $82 billion, and
costs are projected to reach $126
billion by 2020.2
Understanding that a person’s ability
to reach their highest potential for
health is tied to more than access
to and the quality of health care
they receive is important. However,
addressing the social needs of individual patients does not address the structural and systemic root causes
of poor health. Advancing health
in America will require a systemic
transformation in our health care
system and communities, where
health organizations are active
participants in helping their communities thrive.
10%
30%
20 %
40%
Addressing Social Determinants of Health
Source: University of Wisconsin Population Health Institute, County Health Rankings and Roadmaps, 2019. www.countyhealthrankings.org

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Emergency
Shelter
Home
Ownership
Market
Rental
Housing
Supportive
Housing
Transitional
Housing
Homeless to Housing Stability Strategy
Affordable Housing Strategy
Market
Affordable
Housing
(rental &
ownership)
Public
Housing
Subsidized and
unsubsidized
Target Populations:

Workforce
Low-income adults and families
Low-income seniors
People with disabilities, behavioral health issues
FIGURE 1: Range of Housing Types
Source: Center for Community Investment, 2019. Adapted from Housing continuum by SixEightFour, 2009. http://sixeightfour.blogspot.com/2009/03/housing-continuum.html?m=1 TABLE 1
Housing Instability and Health
Forms of housing instability include: Are associated with:
• Homelessness
• High housing costs
relative to income
• Overcrowding
• Poor housing quality
• Multiple moves
Health risks for children:
• General poor health
• Asthma
• Low weight
• Development delays
• Increased lifetime risk of depression
Health risks for adults:
• Reduced access to care
• Postponing needed health care
• Postponing needed medications
• Mental distress
• Difficulty sleeping
• Incidents of depression
Source: Enterprise Community Partners, Inc., 2019. Adapted from Impact of affordable housing on communities: A review of the evidence base, 2014. https://homeforallsmc.org/wp-content/uploads/2017/05/Impact-of-Affordable-Housing-on-Families-and-Communities.pdf

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Challenges for affordable housing initiatives
Supporting affordable housing is an emerging strategy for many hospitals and health systems, though some already are doing it through housing preservation, development and advocacy efforts.3 Existing and emerging
affordable housing initiatives are designed to address the growing mismatch between people’s income levels and housing costs by preserving or building homes that are not being produced by traditional market dynamics. As such, many of these initiatives focus on disadvantaged communities where the need is great but the conventional market is not able to meet that need. However, funding streams that hospitals have historically used to address affordable housing, such as community or philanthropic grants, may be neither sustainable nor adequate for scaling the project or truly revitalizing the community.

Opportunities for upstream investment
This is where upstream investment comes into play. Investing—paying for goods and services that will have value over time, with the expectation of some form of return—as compared to spending is an emerging tactic for addressing social determinants of health. An overall system of community investment has developed to help overcome market failures and transform disadvantaged communities. Hospital-driven investment in affordable housing initiatives can contribute to this system. To be effective, upstream investment to improve community health requires action by health care organizations as well as the existence or creation of threshold conditions in communities.

The Center for Community Investment
at the Lincoln Institute of Land Policy has
developed the capital absorption framework4
to help improve a community’s ability
to attract needed resources. By working
through three core functions – establishing
shared priorities, creating a pipeline of
investable projects, and strengthening the
enabling environment of policies and practices that facilitate successful investment – communities can engage new stakeholders, attract new capital, and increase the speed and scale of investments. (See
Figure 2, What Is the Capital Absorption
Framework? on page 6.) This framework
can help hospitals and health systems
assess their local community investment
system. In turn they can explore potential
roles to play in bringing new ideas, assets,
and partnerships to help strengthen the
system and accelerate efforts to address
the social determinants of health.

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Accelerating Investments for Healthy Communities
CCI launched the AIHC initiative with support from the Robert Wood Johnson Foundation to help a group of hospitals and health systems already investing in affordable housing expand the scale and impact of their work, using the capital absorption framework. AIHC aims to help participating organizations:
• think strategically and systematically about how to deploy financial resources, land and expertise; • advance affordable housing as a platform for creating more equitable, healthier communities; and • adopt sustainable financing mechanisms.

The focus is on leading hospitals and health systems to better understand what it takes to get started on this work and any barriers to implementation. This knowledge will light the path for other hospitals and health systems to invest in affordable housing and advance the health and well-being of their communities.

Since 2011, the founders of CCI have been testing and refining a framework for better organizing and deploying community investment. The center designed the capital absorption framework to encourage a more systemic approach to this work and better direct investment capital to areas of need.

The capital absorption framework consists of three key components:

1. Establishing shared priorities across stakeholders. Participants identify the community’s highest priorities, define their targeted results and agree on a strategy to achieve them.

2. Creating a pipeline of deals and projects. By examining deals in progress, analyzing whether they support the priorities and considering where there may be gaps, participants build a pipeline of deals and develop a strategy for moving them forward together to achieve greater impact and efficiency.

3. Strengthening the enabling environment. Armed with a clear sense of shared priorities and a pipeline of deals and projects, participants determine whether the necessary policies, practices and capacities exist to facilitate those deals and then strategize ways to address missing components.

FIGURE 2:What Is the Capital Absorption Framework?4
Source: Center for Community Investment, 2018.

Capital Absorption Framework
Shared Priorities Pipeline Enabling Environment

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AIHC Phase One: Observations and Emerging Themes
Investing in affordable housing in the manner and scale described here is new work for many hospitals and health systems. During phase one of Accelerating Investments for Healthy Communities, participating hospitals and health systems were introduced to the capital absorption framework and began building crossdisciplinary core project teams.

As evaluation partners, the AHA and NORC followed the cohort of hospitals during this learning process and began preliminary analysis, through collection of baseline data and introductory interviews, to gain insight into what it takes for hospitals to do this work. Two major themes arose during this initial evaluation period, as demonstrated by hospitals and health systems in the cohort:
• Mission-driven commitment to address health equity and social determinants • Strategic alignment with payment and care models
Methodology
During the fall of 2018, AHA and NORC completed introductory interviews with the eight hospitals participating in phase one. Interviewees received a list of discussion topics in advance that included (1) motivating factors for investing in affordable housing, (2) the AIHC team and its structure, (3) developing an investment strategy and (4) challenges and lessons learned to date. A highlevel analysis of these interviews and supporting secondary data sources† provided the foundation for the emerging themes identified in this issue brief.

The project seeks to engage leading hospitals with the purpose of gleaning insights for the rest of the field. As such, certain characteristics are common across the cohort, including:

1. The participating hospitals and health systems all have some history in addressing social determinants of health—and in particular, housing—with several having extensive track records investing in affordable housing.

2. Participants were seeking to expand their strategies of supporting underinvested areas and vulnerable populations.

3. Project teams included individuals with diverse roles in the hospital or health system, such as vice president of mission, vice president of philanthropy, director of community health, strategy and chief operating officer, grants officer, and manager of community benefits.
† Secondary data sources included the AIHC phase one applications, phase one learning lab homework assignments, and community health needs assessments.

TABLE 2
AIHC Participants
• Bon Secours Mercy Health**
• Boston Medical Center
• Dignity Health**
• Henry Ford Health System*
• Kaiser Permanente
• Nationwide Children’s Hospital
• ProMedica*
• UPMC
*Participation in phase one only
**Recent and/or pending merger

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Mission-driven commitment to address health equity and social determinants All of the participating hospitals and health systems demonstrated an underlying commitment and drive to address the social determinants of health, with an emphasis on housing. They expressed widespread acceptance that, if their goal was to advance equity and improve health, it was their responsibility to support their communities. This mission-driven commitment was linked to certain characteristics of the different types of organizations, including:

Anchor organizations. As place-based organizations that are physically rooted in their local communities, these hospitals and health
systems described a sense of responsibility
and commitment to their neighborhood or
community. This dedication manifests itself
through the desire to be an active participant
in community revitalization, partner with other
community stakeholders and invest in the wellbeing of the community.

Nonprofit. Addressing social determinants
of health connects to the core mission of
nonprofit hospitals and health systems. They
are required to conduct community health
needs assessments (CHNAs) and implement
strategies to address priority health needs
in their communities. This process necessitates a level of engagement and community health focus for the health care organization.

While not all of the participating hospitals
prioritized housing in their CHNAs, their status
as nonprofit hospitals provides a platform to
address community health needs.

Safety-net. As safety-net hospitals or health
systems caring for vulnerable populations,
these participants described a commitment to look upstream at the root causes of health and illness to address health equity issues for their patients and in the community at large.

Faith-based. These hospitals and health systems described their commitment to address equity and affordable housing in the context of their spiritual conviction and that of their founders.

The augmented focus on social determinants of health across the health care field is a component of the evolving concept of what it means to be a hospital or health system. Hospitals are providing more than standalone acute care services and are transforming to provide care across the continuum and promote health and well-being in their communities.

What AIHC Participants Are Saying
“Is the role of a safety net hospital…
charity or is it equity? Because if you have
an opportunity to go beyond filling a gap
for a person that quite frankly becomes
a gap again once the filler is removed, if
you can alter the life course of a person
so that you eliminate that gap and sort of
send that person toward independence
versus perpetual dependence, why
wouldn’t we do that?”
“We want to think of ourselves as
health care providers second, in service
to our main work of developing healthy
communities.”

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All participating hospitals and health systems noted that their ability to do this work is an outgrowth of their long-standing organizational commitment to addressing social determinants of health. Some of the hospitals chose to join the AIHC initiative for the “acceleration effect” of being part of such a cohort: They were seeking new tools and strategies to elevate the impact of their work. All participants recognized they had room to grow in how their organizations address affordable housing.

Strategic alignment with care and payment models
While mission is a driving factor for hospitals and health systems investing in affordable housing, the old mantra, “no margin, no mission” also applies for many. New care delivery and payment models are creating the strategic
alignment to augment support for affordable housing.

Across participating hospitals, interviewees described the alignment of affordable housing with their organization’s strategy, particularly when they had a health insurance plan or accountable care organization (ACO). Hospitals that are part of an ACO or have their own health plan are charged with addressing the drivers of poor outcomes and high
costs, which link to social determinants of health.

The shift from providing care to also addressing social determinants can be challenging for hospitals and providers. By framing social determinants as part of the care redesign strategy, hospitals can start to conceptualize their core strategic mission to include social determinants. This strategic connection appears crucial for getting buy-in and making the case that investing in affordable housing is both sustainable and strategically important.

Next Steps
The AHA and NORC will spend the next two years learning what drives hospitals to invest in affordable housing and what makes initiatives successful. We will explore several areas, including how hospitals are building a culture that makes addressing social determinants of health an organizational priority. We will continue to explore the evolution of the work around the following areas:
• Building the will. Participants described various ways in which they are generating the “will” to advance affordable housing efforts within their hospital or health system. We will further explore how hospitals are building the will in their organizations and communities. • Organizational structure and changes. Organizational characteristics, such as those identified in this brief around mission and payment and care models, will continue to be areas for exploration as we tease out how structure serves as a mechanism and facilitates the work and also can serve as a lever for community investment. In addition, some of the participating health systems are going through major organizational changes, such as mergers, which we anticipate will influence their work. We will track how these mergers impact the implementation of work on affordable housing at the hospital and system levels.

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• Community alignment. Several hospitals cited project alignment with existing citywide or neighborhood revitalization and civic activity. We will explore how local will and momentum impact affordable housing initiatives.
• Team structure and engagement.The teams draw on the expertise of a variety of stakeholders from across the hospitals (e.g., community benefit manager, treasurer, health plan director, etc.) and community. We will continue to monitor which roles are most beneficial for advancing affordable housing work.
• Identifying roles. The roles that the hospital or health system play in affordable housing vary and include investor, developer, convener and manager. We will continue to explore the extent to which these labels capture the role played by hospitals and health systems, and how the participants determine what role to play in their community.

Focusing on innovation as hospitals and health systems invest in affordable housing creates an opportunity to demonstrate their value as anchor organizations in their communities and offers tremendous potential to catalyze community revitalization efforts. Over the next two years, AIHC project partners hope that learnings from the Accelerating Investments for Healthy Communities program can serve as a path forward for other hospitals looking to invest in addressing the social determinants of health.

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Read More About AIHC
Project Press Release
Center for Community Investment. (2019, February 20). Announcing AIHC participants: Six hospitals and health systems step up efforts to increase affordable housing in their regions [Blog post].

Retrieved from https://centerforcommunityinvestment.org/blog/announcing-aihc-participants-sixhospitals-and-health-systems-step-efforts-increase-affordable Project Write-ups and Relevant Articles
Abrams, A. (2019, February 25). Putting health care dollars to work. Retrieved from https:// shelterforce.org/2019/02/25/putting-health-care-dollars-to-work/ Gaskins, A. (2018, May 16). AIHC on site: Learning from Bon Secours in West Baltimore [Blog post]. Cambridge, MA: Center for Community Investment. Retrieved from https:// centerforcommunityinvestment.org/blog/aihc-site-learning-bon-secours-west-baltimore.

Gaskins, A. (2019, January 11). Hospital system helps housing partners unlock capital. Shelterforce.

Retrieved from https://shelterforce.org/2019/01/11/hospital-system-helps-housing-partners-unlockcapital/ Hacke, R. & Gaskins, A. (2019). How can clinicians catalyze investments to improve community health? AMA Journal of Ethics, 21(3), 262-268. doi:10.1001/amajethics.2019.262. Retrieved from https://journalofethics.ama-assn.org/article/how-can-clinicians-catalyze-investments-improvecommunity-health/2019-03 Capital Absorption Framework
Center for Community Investment. (2019, January). Analyzing, building, and executing a pipeline: The capital absorption framework part 2. Retrieved from https://centerforcommunityinvestment.org/sites/ default/files/2019-01/Analyzing%2C%20Building%2C%20and%20Executing%20the%20Pipeline.pdf Center for Community Investment. (2019, January). Defining shared priorities: The capital absorption framework part 1. Retrieved from https://centerforcommunityinvestment.org/sites/default/ files/2019-01/Defining%20Shared%20Priorities_0.pdf
Center for Community Investment. (2019, January). Strengthening the enabling environment: The capital absorption framework part 2. Retrieved from https://centerforcommunityinvestment.org/sites/ default/files/2019-01/Strengthening%20the%20Enabling%20Environment.pdf Hacke, R., Wood, D., & Urquilla, M. (Revised 2018, March). Community investment: Focusing on the system, a working paper. Retrieved from https://centerforcommunityinvestment.org/sites/default/ files/2018-03/CIFocusingOnTheSystem.pdf

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Endnotes
1 Artiga, S. & Hinton, E. (2018, May 10). Beyond health care: The role of social determinants in promoting health and health equity.

Retrieved from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promotinghealth-and-health-equity/ 2 PwC Health Research Institute. (2015, June). Medical cost trend: Behind the numbers 2016. Retrieved from https://www.achp.org/ wp-content/uploads/pwc-hri-medical-cost-trend-2016.pdf
3 A number of guides and organizations have tracked hospitals and health systems work in affordable housing including:
• American Hospital Association. (2017, August). Social determinants of health series: Housing and the role of hospitals.

Retrieved from https://www.aha.org/ahahret-guides/2017-08-22-social-determinants-health-series-housing-and-role-hospitals • Hacke, R. & Deane, KG. (2017, March). Improving community health by strengthening community investment. Retrieved from https://www.rwjf.org/en/library/research/2017/03/improving-community-health-by-strengthening-community-investment.html • Healthcare Anchor Network coordinated by the Democracy Collaborative https://www.healthcareanchor.network/ • Build Healthy Places Network https://www.buildhealthyplaces.org/ • Urban Institute’s Emerging Strategies for Integrating Health and Housing https://www.urban.org/policy-centers/cross-center-initiatives/social-determinants-health/projects/emerging-strategies-integrating-health-and-housing 4 Hacke, R., Wood, D., & Urquilla, M. (Revised 2018, March). Community investment: Focusing on the system, a working paper.

Retrieved from https://centerforcommunityinvestment.org/sites/default/files/2018-03/CIFocusingOnTheSystem.pdf

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N California St.

E Harding Way
E Chestnut St
Walnut St
E Maple St Cemetery Ln

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E Harding Way
E Chestnut St
Walnut St
E Maple St
California St.

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St. Joseph’s
Hospital
Patient
Pavilion
E Harding Way
E Chestnut St
Walnut St
E Maple St
California St.

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Pending Demolition:

E Harding Way
E Chestnut St
Walnut St
E Maple St
St. Joseph’s
Hospital
Patient
Pavilion
California St.
- Seismic deficiencies
- Remove from Acute Care
- January 1, 2030 deadline

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Hospital Expansion:

E Harding Way
E Chestnut St
E Maple St
California St.

St. Joseph’s
Hospital
Patient
Pavilion
- 337 bed capacity
- 505,500 SF
- 4 stories
Hospital
337 beds
Retail
Parking
Garage
Retail Retail /
Parking
Drop-off

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E Harding Way
E Chestnut St
E Maple St
St. Joseph’s
Hospital
Patient
Pavilion
California St.

Alternate Hospital Expansion:
- xxx bed capacity
- xxx,xxx SF
- 4 stories
Hospital
337 beds
MOB
Retail
Retail Retail /
Parking
Drop-off
Parking
Garage

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visualization

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- St. Joseph’s Hospital Expansion
337 beds
- Medical Office Building
Ground Floor Retail
- Patient Drop-off
- Pedestrian Bridges
- Parking Garage
Ground Floor Retail

ATTACHMENT G
- St. Joseph’s Hospital Expansion
337 beds
- Medical Office Building
Ground Floor Retail
- Garage
- Patient Drop-off
- Pedestrian Bridges
- Hospital Expansion
Ground Floor Retail

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N California St.

E Harding Way
E Chestnut St
Walnut St
E Maple St Cemetery Ln

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SITE PLAN
PROPOSED DE VELOPMENT AT 1707 N CALIFORNIA ST, STOCKTON 03.01.23 CONCEPTUAL DESIGN

PARKING LOT

BUILDING
PLAZA

ROOFTOP DECK

WALNUT STREET

N CALIFORNIA STREET

E CHESTNUT STREET

ATTACHMENT G

AERIAL VIEW
PROPOSED DE VELOPMENT AT 1707 N CALIFORNIA ST, STOCKTON 03.01.23 CONCEPTUAL DESIGN PARKING LOT = 180 STALLSMOB SPACE = 30,000 SFC O M M E R C I A L S PA C E = 1 0 , 0 0 0 S FD AY C A R E = 1 0 , 0 0 0 S FAPARTMENTS = 102 UNITSPARKING SUMMARYR E Q U I R E D PA R K I N G = 2 3 4 S TA L L SPA R K I N G P R O V I D E D = 2 6 0 S TA L L S

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The Balloonery, Inc.
1346 E. Harding Way ƒ Stockton, CA 95205 ƒ (209) 466-3601 ballooneryinc.com
TO: Stockton Planning Commission
FROM: Ann Johnston, Former Mayor
RE: Support Proposed Expansion Project at St. Joseph’s Medical Center Date: September 5, 2023
As the former Mayor of Stockton, a local business owner, and community volunteer, I am writing to express my support for the much needed proposed expansion of St. Joseph’s Medical Center in Stockton which has been an anchor in our community for 125 years and is vital to the health of our city and region. We all have benefited from the health care received at St. Joseph’s Medical Center and the quality of care given to patients over the years.

The expansion will increase physical capacity and improve the patient experience by adding 144 new, private, acute care beds in a New Acute Care Tower. The expansion also includes a state-of-the-art Emergency Department which is sorely needed to meet current & future needs.

California’s 2030 seismic retrofits will be completed as part of the expansion project. The expansion will also allow for growth of the Graduate Medical Education Residency Program to address the well-documented physician shortage in the San Joaquin Valley.

This program will be training well over 200 residents each year in nine different specialties.

St. Joseph’s Medical Center is a significant economic driver of our local economy with over 6,000 jobs supported; and thousands of jobs will be created over the construction period. The economic impact of over $1.6 billion annually will benefit the local economy once the project is completed.

St. Joseph’s Medical Center is committed to health equity and has a strong history of caring for all people, especially historically marginalized and vulnerable communities. As San Joaquin County’s largest hospital provider for Medi-Cal patients, St. Joseph’s is focused on improving health outcomes for everyone who comes through its doors.

As our region continues to grow it is critical that our health care network grows to support our residents. The proposed expansion of St. Joseph’s Medical Center will ensure our population has access to world-class care and the hospital can continue its mission of improving community health. I respectfully request the Stockton Planning Commission support, without delay, the expansion plans put forth by St. Joseph’s Medical Center.

Sincerely,
Ann Johnston
Former Mayor
City of Stockton

ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Michael McDowell; Stephanie Ocasio Cc: CC - City Clerk"s Office; Taryn Jones
Subject: Fwd: Support for Proposed Expansion Project at St. Joseph"s Medical Center Date: Saturday, September 9, 2023 11:19:01 AM
Attachments: SJ Expansion Support letter 9-2023.pdf
Commissioner Correspondence
From: Alan Kawaguchi <[email protected]> Sent: Thursday, September 7, 2023 10:13:25 PM
To: CC - City Clerk <[email protected]>
Subject: Support for Proposed Expansion Project at St. Joseph's Medical Center CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

To Whom It May Concern,
Please see attached letter in support of St. Joseph’s Medical Center’s plan for expansion.

Thank you,
Alan Kawaguchi, MD
Alpine Orthopaedic Medical Group
2488 N. California St.

Stockton, CA 95204
209-948-3333

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ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Stephanie Ocasio; Michael McDowell Cc: CC - City Clerk"s Office; Taryn Jones
Subject: Fwd: letter of support to the Planning Commission for St. Joseph"s Medical Center expansion Date: Monday, September 11, 2023 8:20:25 AM
Attachments: image001.png
image002.png
image003.jpg
image004.png
image005.gif
Letter of Support for St. Joseph"s Medical Center - Planning Commission - St. Mary"s Dining Room.pdf FYI commissioners correspondence
From: Petra Linden <[email protected]>
Sent: Monday, September 11, 2023 7:09:17 AM
To: CC - City Clerk <[email protected]>
Subject: letter of support to the Planning Commission for St. Joseph's Medical Center expansion CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Dear Planning Commission,
I am pleased to submit the attached letter of support for St. Joseph’s Medical Center expansion.

Please let me know if you have any questions or need additional information.

Thanks,
Petra
Petra Linden, MPH
Chief Executive Officer
545 W. Sonora Street, Stockton, CA 95203
O: (209) 467-0703 Ext: 3108
F: (209) 467-7795

OUR MISSION
St. Mary's Dining Room responds to poverty in San Joaquin County by feeding the hungry, caring for health issues and restoring human dignity to over 700 individuals each day.

CONFIDENTIALITY NOTICE
The information contained in this transmission is intended only for the person or entity to which it is

ATTACHMENT G
addressed and contains confidential and/or privileged material. If you are not the intended recipient of this information, do not review, retransmit, disclose, disseminate, use, or take any action in reliance upon, this information. If you received this transmission in error, please contact the sender and destroy all printed copies and delete the material from all computers.

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ATTACHMENT G
1 From: Steve Morales <[email protected]>
Sent: Tuesday, September 5, 2023 4:56 PM
To: Nicole Moore.Ctr <[email protected]>; CCͲCity Clerk <[email protected]> Cc: Steve Morales <[email protected]>
Subject: Planning CommissionersͲSt. Joseph's Medical Center Hospital Expansion ProjectͲP21Ͳ0958Ͳpublic comment CAUTION: This email originated from outside the City of Stockton.Do not click any links or open aƩachments if this is unsolicited email.

Hello again Nicole.Hoping your Labor Day Weekend was an enjoyable one.

Not sure if you give this to the Commissioners in advance or if you read this at the Planning Commission meeƟng on Sept 14th.Please share:

Dear Planning Commissioners and City Staī,
Firstly, I extend my graƟtude for your dedicated service to our community.As a proud Stocktonian and devoted community volunteer, I am wriƟng to support the expansion project of St. Joseph’s Medical Center.

The proposed expansion will not only increase the capacity for paƟent rooms, surgical faciliƟes, and a more comprehensive Emergency Room, but it will also posiƟon our community as a leading medical hub by aƩracƟng topͲƟer doctors and specialists vital to our healthcare landscape.

St. Joseph’s Medical Center's proposed investment is a testament to its commitment to enhancing our community's healthcare services. It's noteworthy that St. Joseph’s is already naƟonally recognized for its exemplary cancer and cardiac treatments. Their unwavering dedicaƟon to healthcare excellence, combined with their comprehensive approach in considering community health,illustrates their sincere desire to provide the best possible medical care in our community.They’ve welcomed feedback/parƟcipaƟon from the neighborhood, employees (they are the County’s largest private employer), and environmental groups, and this makes it evident that their staīhad been very diligent in approaching this expansion project. Moreover, their awareness and incorporaƟon of the neighborhood impact and feedback, further underscores their role as a responsible and proacƟve community partner.

AddiƟonally, their longstanding support for numerous nonͲproĮt organizaƟons, ranging from Įnancial contribuƟons to educaƟonal programs and community health iniƟaƟves, stands as evidence of their dedicaƟon to the broader welfare of Stockton.

I urge the Planning Commission to recognize this rare and valuable opportunity for our community.Endorsing this expansion would undoubtedly lead to improved healthcare services and overall community wellͲbeing.I, along with countless others in our community, eagerly anƟcipate the myriad of beneĮts this expansion promises.

Thank you for your consideraƟon.

Steve
Steve Morales
Caution: This email is both proprietary and confidential, and not intended for transmission to (or receipt by) any unauthorized person(s). If you believe that you have received this email in error, do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.

ATTACHMENT G
logo.jpg
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Stephanie Ocasio; Michael McDowell Cc: CC - City Clerk"s Office; Taryn Jones
Subject: Fwd: Letter of Support for the Proposed Expansion of St. Joseph’s Medical Center Date: Saturday, September 9, 2023 2:57:04 PM
Attachments: image001.jpg
image003.jpg
Letter of Support for the Proposed Expansion of St. Joseph’s Medical Center.pdf From: Pat Patmon <[email protected]>
Sent: Saturday, September 9, 2023 11:52:15 AM
To: CC - City Clerk <[email protected]>
Cc: Donald Wiley CA-Stockton <[email protected]>; Diane Bertilacchi CA-Stockton <[email protected]>
Subject: Letter of Support for the Proposed Expansion of St. Joseph’s Medical Center CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Ladies and Gentlemen
Please find attached my urgent request for a unanimous speedy approval of Saint Joseph’s Medical Center’s proposed expansion project.

Thanks
Pat
Charles “Pat” Patmon III
Founding Director / Board Chair
4780 West Lane Suite A
Stockton, California 95210
E-mail: [email protected]
Direct: (209) 463-5561
Office: (209) 951-4391

REAL ESTATE DEVELOPMENT AND OPERATION

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ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Stephanie Ocasio; Michael McDowell Cc: Taryn Jones; CC - City Clerk"s Office
Subject: FW: Letter of Support - Proposed Expansion of St. Joseph’s Medical Center (Planning Commission 9/14/23) Date: Tuesday, September 12, 2023 4:45:39 PM
Attachments: image004.png
image006.png
image010.png
St. Josephs Expansion September 2023 - letter of support Greater Stockton Chamber.pdf From: Timm Quinn <[email protected]>
Sent: Tuesday, September 12, 2023 4:16 PM
To: CC - City Clerk <[email protected]>
Subject: Letter of Support - Proposed Expansion of St. Joseph’s Medical Center (Planning Commission 9/14/23)
CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Please see attached for a letter of support from the Greater Stockton Chamber of Commerce for the proposed expansion of St. Joseph’s Medical Center for the September 14, 2023 Planning Commission Meeting.

Any questions, or if there is another procedure I need to take to submit just let me know.

Sincerely,
Timm Quinn
CEO
Greater Stockton Chamber of Commerce
445 W. Weber Ave. #220, Stockton, CA 95203
[email protected] | 209.292.8423

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ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Stephanie Ocasio; Michael McDowell Cc: Taryn Jones; CC - City Clerk"s Office
Subject: Fwd: 5/14/23 City Planning Commission Agenda Item 5.1 Date: Monday, September 11, 2023 11:58:06 AM
Attachments: Ltr COS Planning Commission (09 11 23).pdf Commissioner Correspondence
From: Mark Rishwain <[email protected]>
Sent: Monday, September 11, 2023 10:03:29 AM
To: CC - City Clerk <[email protected]>
Subject: 5/14/23 City Planning Commission Agenda Item 5.1 CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Good morning,
Attached please find my letter of support for approval of City of Stockton Planning Commission agenda item 5.1. Please deliver a copy of the letter to the Planning Commission members prior to Thursday’s meeting.

Thank you,
Mark Rishwain
Mark B. Rishwain, Esq.

RISHWAIN & RISHWAIN, P.C.
2800 West March Lane, Suite 220
Stockton, California 95219
(209) 473-2800 ext. 1224
(209) 473-2885 (fax)
[email protected]
IRS Circular 230 Notice: As required by the IRS, we are informing you that any federal tax advice contained in this communication (including any attachments) was not intended or written to be used, and that it cannot be used, for the purpose of (i) avoiding penalties that may be imposed under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any tax-related matter.

The information transmitted herein and/or herewith is intended only for the person or persons to whom it is addressed and may be non-public, confidential and/or attorney-client privileged. Any review, retransmission, dissemination, or other use of, or taking of any action in reliance upon, such information by persons or entities other than the intended recipient(s) is prohibited and may be unlawful. If you have received this transmission in error, please contact the sender at the above address immediately and delete the material from any computer.

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September 14, 2023
Planning Commission
City of Stockton
City Hall, 425 N. El Dorado St.

Stockton, CA 95202
Subject: Support for the Proposed Expansion Project at St. Joseph’s Medical Center Dear Members of the Planning Commission,
I am wriƟng to express my strong support for the proposed expansion project at St. Joseph’s Medical Center. This project, which aims to increase the number of beds and create significant job opportuniƟes for doctors, nurses, and medical support staff, is not only a much-needed boost to our healthcare infrastructure but also a vital investment in our local community.

St. Joseph’s Medical Center has been a pillar of healthcare excellence in our region for many years. Its commitment to delivering high-quality care and its dedicaƟon to the well-being of our community have earned it the trust and respect of countless residents. The proposed expansion project represents a responsible and forward-thinking approach to ensuring that this vital insƟtuƟon can conƟnue to meet the growing healthcare needs of our community.

The planned increase in the number of beds at St. Joseph’s Medical Center is parƟcularly significant. As our populaƟon conƟnues to grow, it is essenƟal that we have sufficient healthcare faciliƟes to accommodate the increasing demand for medical services. This expansion will not only improve access to care but also enhance the overall quality of healthcare services available in our area.

Furthermore, the expansion project promises to be a boon to job creaƟon. In addiƟon to providing employment opportuniƟes for skilled doctors, nurses, and medical support staff, the construcƟon phase of the project will generate jobs in the local construcƟon industry that will last for years. This means a posiƟve economic impact that extends beyond the healthcare sector, benefiƟng a wide range of workers and businesses in our community.

ATTACHMENT G
In conclusion, I urge you to wholeheartedly support the proposed expansion project at St.

Joseph’s Medical Center. It is an investment in our community's health and well-being, a catalyst for job creaƟon, and a model of responsible and sustainable development. The benefits of this project will be felt by all residents, and its posiƟve impact will be long-lasƟng.

The San Joaquin Partnership is the Economic Development CorporaƟon for the county at large and represents the ciƟes, county, and the business interest of communiƟes. As the promoter of our assets, job opportuniƟes, quality of life and pro-business approach to the recruitment and retenƟon of business in San Joaquin County, we are always looking at ways to aƩract new talent for the diverse industries we represent.

Thank you for your aƩenƟon to this important maƩer. I trust that you will make the right decision in favor of our community's health and prosperity.

Sincerely,

ATTACHMENT G








 


 


 
 



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ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Stephanie Ocasio; Michael McDowell Cc: CC - City Clerk"s Office; Taryn Jones
Subject: Fwd: Letter of Support for Proposed St. Joseph"s Expansion Date: Monday, September 11, 2023 3:16:49 PM
From: Sue Shalvey <[email protected]>
Sent: Monday, September 11, 2023 3:07:48 PM
To: CC - City Clerk <[email protected]>
Subject: Letter of Support for Proposed St. Joseph's Expansion CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Letter of Support for Proposed Expansion of St. Joseph’s Medical Center Date: September 9, 2023
To: Stockton Planning Commission
RE: Support Proposed Expansion Project at St. Joseph’s Medical Center My name is Sue Shalvey and I am a recent St. Joseph’s Foundation Board member. Along with my husband, Don Shalvey, we are proud to be donors and supporters of St. Joseph’s Medical Center and its Graduate Medical Education program. I am writing to express my support for the much needed proposed expansion of the St. Joseph’s Medical Center (SJMC), which has been an anchor in our community for 125 years and is vital to the health ecology of Stockton and our region. St. Joseph’s Medical Center has served our family for 100 of those years along with serving many other families in our community. We are counting on St.

Joseph’s continued capacity to meet our region’s growing health care needs as well as to provide specialized medical education for the future physicians who are needed to practice in our communities.

The expansion will increase physical capacity and improve the patient experience by adding 144 new, private, acute care beds in a New Acute Care Tower. The expansion also includes a state-of-the-art Emergency Department and enhanced surgical facilities signifying a commitment to meeting the evolving healthcare needs of our diverse and growing population in the region.

California’s 2030 seismic retrofits will be completed as part of the expansion project. Timing for construction of the new Acute Care Tower is critical as beds must be taken offline during the retrofit. The phasing of the project is designed to limit the impact to capacity and access to care, but to accomplish this goal this expansion cannot be delayed.

The proposed expansion allows for growth of the Graduate Medical Education Residency Program. There is a well-documented physician shortage in the San Joaquin Valley and growth of the residency program is vital to expand access to primary and specialty care for patients who would otherwise have to travel out of the area. This program will be training well over 200 residents each year in nine different specialties.

ATTACHMENT G
SJMC is a significant economic driver of our local economy with over 6,000 jobs supported.

During construction, economic activity will be generated and thousands of jobs will be created The ongoing economic impacts of over $1.6 billion, annually, will benefit the local economy once the project is completed.

The proposed expansion embodies Stockton’s vision, growth and development trajectory and will improve the local health care landscape and our overall quality of life. St. Joseph’s Medical Center’s strong history of caring for all people, especially historically marginalized and vulnerable communities, exemplifies its commitment to health equity. As our County’s largest hospital provider for Medi-Cal patients, SJMC is focused on improving health outcomes and addressing the social determinants of health for our community members. The proposed expansion of SJMC will ensure our population has access to world-class care and the hospital can continue its mission of improving community health.

I respectfully urge the Stockton Planning Commission to support, without delay, the expansion plans put forth by St. Joseph’s Medical Center.

Sincerely,
Sue Shalvey
5488 North Fine Road
Linden, CA 95236
e: [email protected]
c: 650-387-7168

ATTACHMENT G

ATTACHMENT G
1 From: GARY SPAUGH <[email protected]>
Sent: Thursday, September 7, 2023 8:03 AM
To: CCͲCity Clerk <[email protected]>
Subject: St. Joseph's Acute Care Expansion Project
CAUTION: This email originated from outside the City of Stockton.Do not click any links or open attachments if this is unsolicited email.

To: Stockton Planning Commission September 7,
2023
RE: Support for Proposed Expansion Project at St. Joseph’s Medical Center My name is Gary Spaugh and having lived in Stockton over the past 45 years, I am a longstanding member of the community concerned with the healthcare of our city and county. I also actively serve as a member of the St. Joseph’s Community Council, charged with representing the community with respect to how the needs of our people for healthcare services are met. For this reason, I am writing to express my support for the proposed expansion of St. Joseph’s Medical Center in Stockton, which has been an anchor in our community for 125 years and is vital to the health and well-being of all people in our city and region.

The expansion will increase physical capacity and improve the patient experience by adding 144 new, private, inpatient beds in a new acute care tower. The expansion also includes a state-of-the-art emergency department and enhanced surgical facilities signifying a commitment to meeting the evolving healthcare needs of our diverse and growing population in the region.

California’s 2030 required seismic retrofits will be completed as part of the expansion project.

Therefore, timing for construction of the new acute care tower is critical as beds must be taken offline during the retrofit. The phasing of the project is designed to limit the impact to capacity and access to care. Thus, this expansion must not be delayed.

The proposed expansion allows for growth of the Graduate Medical Education Residency Program.

There is a well-documented physician shortage in the San Joaquin Valley and growth of the residency program is vital to expand access to primary and specialty care for patients who would otherwise have to travel out of the area. This program will be training well over 200 residents each year in nine different specialties.
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ATTACHMENT G
2 As our region continues to grow it is critical that our health care capacity grows to support our residents. The proposed expansion of St. Joseph’s Medical Center will ensure our population has access to world-class care and the hospital can continue its mission of improving community health.

The proposed expansion embodies Stockton’s vision, growth and development trajectory and will improve the local health care landscape and our overall quality of life. I respectfully request the Stockton Planning Commission support, without delay, the expansion plans put forth by St.

Joseph’s Medical Center.

Sincerely,
Gary L. Spaugh
109 W. Knoles Way
Stockton, Ca. 95204
(209) 464-5923
[email protected]

ATTACHMENT G

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Executive Committee
Eddie Lira, President
BAC Community Bank
Luis Reyes, President-Elect
Wells Fargo
Angel Sepulveda, Secretary
State Farm
John Freeman, Past President
California Water Service
Board of Directors
Melissa Tong
Neumiller & Beardslee
Andrea Andrade
JP Morgan Chase
Tammy Shaff
Dignity Health St. Joseph's
Medical Center
Stephanie Riddle
Schwartz, Giannini, Lantsberger
& Adamson
Dylan George
Pacific Gas and Electric
Mark Apostolon
El Concilio CA
Ben Dominguez
Phoenix Roofing & Solar
Steve Morales
MAYACO Marketing & Internet
Mayra Cuevas
(Honorary Board Member)
Comerciantes Unidos
Chief Executive Officer
Lisa Vela
5637 N. Pershing Ave, Suite B-8, Stockton, CA 95207│Phone 209-943-6117│Fax 209-943-0114 www.sjchispanicchamber.com
September 14, 2023
To: Stockton Planning Commission
RE: Support Proposed Expansion Project at St. Joseph’s Medical Center My name is Lisa Vela, and I am Chief Executive Officer of the San Joaquin County Hispanic Chamber of Commerce (SJCHCC). I am writing to express our/my support for the much needed proposed expansion of the St.

Joseph’s Medical Center (SJMC) in Stockton, which has been an anchor in our community for 125 years and is vital to the health ecology of our city and region.

The expansion will increase physical capacity and improve the patient experience by adding 144 new, private, acute care beds in a New Acute Care Tower. The expansion also includes a state-of-the-art Emergency Department and enhanced surgical facilities signifying a commitment to meeting the evolving healthcare needs of our diverse and growing population in the region.

California’s 2030 seismic retrofits will be completed as part of the expansion project. Timing for construction of the new Acute Care Tower is critical as beds must be taken offline during the retrofit. The phasing of the project is designed to limit the impact to capacity and access to care, but to accomplish this goal this expansion cannot be delayed.

The proposed expansion allows for growth of the Graduate Medical Education Residency Program. There is a well-documented physician shortage in the San Joaquin Valley and growth of the residency program is vital to expand access to primary and specialty care for patients who would otherwise have to travel out of the area. This program will be training well over 200 residents each year in nine different specialties.

St. Joseph’s Medical Center is a significant economic driver of our local economy with over 6,000 jobs supported. During construction there will be a significant increase in economic activity and thousands of jobs will be created over the construction period. The ongoing economic impacts of over $1.6 billion, annually, will benefit the local economy once the project is completed.

Established in 1972, SJCHCC is a membership network of over 350 individuals, businesses, and professional associations working together to expand business opportunities for members and Hispanic businesses by encouraging mutually beneficial ties with the public and private sector. The mission of the San Joaquin County Hispanic Chamber of Commerce is to advocate on behalf of members and to encourage economic and business development throughout the region.

ATTACHMENT G
Executive Committee
Eddie Lira, President
BAC Community Bank
Luis Reyes, President-Elect
Wells Fargo
Angel Sepulveda, Secretary
State Farm
John Freeman, Past President
California Water Service
Board of Directors
Melissa Tong
Neumiller & Beardslee
Andrea Andrade
JP Morgan Chase
Tammy Shaff
Dignity Health St. Joseph's
Medical Center
Stephanie Riddle
Schwartz, Giannini, Lantsberger
& Adamson
Dylan George
Pacific Gas and Electric
Mark Apostolon
El Concilio CA
Ben Dominguez
Phoenix Roofing & Solar
Steve Morales
MAYACO Marketing & Internet
Mayra Cuevas
(Honorary Board Member)
Comerciantes Unidos
Chief Executive Officer
Lisa Vela
5637 N. Pershing Ave, Suite B-8, Stockton, CA 95207│Phone 209-943-6117│Fax 209-943-0114 www.sjchispanicchamber.com
St. Joseph’s Medical Center is committed to health equity and has a strong history of caring for all people, especially historically marginalized and vulnerable communities. As San Joaquin Counties largest hospital provider for Medi-Cal patients, St. Joseph’s Medical Center is focused on improving health outcomes and addressing the social determinants of health through innovative health programs, community benefits, and investments.

As our region continues to grow it is critical that our health care network grows to support our residents. The proposed expansion of St. Joseph’s Medical Center will ensure our population has access to world-class care and the hospital can continue its mission of improving community health.

The proposed expansion embodies Stockton’s vision, growth and development trajectory and will improve the local health care landscape and our overall quality of life. I respectfully request the Stockton Planning Commission support, without delay, the expansion plans put forth by St.

Joseph’s Medical Center.

Sincerely,
Lisa Vela, Chief Executive Officer
San Joaquin County Hispanic Chamber of Commerce

ATTACHMENT G
From: CC - City Clerk
To: Adriana Guerrero; Azelia Fuentes; Michael McDowell; Stephanie Ocasio Cc: CC - City Clerk"s Office; Taryn Jones
Subject: FW: Letter of Support
Date: Tuesday, September 12, 2023 10:21:04 AM
Attachments: Letter of Support.pdf
Commissioner Correspondence
From: [email protected] <[email protected]> Sent: Tuesday, September 12, 2023 10:06 AM
To: CC - City Clerk <[email protected]>
Subject: Letter of Support
CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Good morning,
Please see the attached.

Best regards,
Patrick Velasquez
Director & Corporate Secretary
Chase Chevrolet Co., Inc.
209-475-6663 Office
209-479-4229 Cell
209-476-6686 Fax

ATTACHMENT G

ATTACHMENT G

ATTACHMENT G
From: CC - City Clerk
To: Stephanie Ocasio; Michael McDowell; Adriana Guerrero; Azelia Fuentes Cc: CC - City Clerk"s Office; Taryn Jones
Subject: Fwd: Comment letter for St. Josephs.expansion. City.Planning.Meeting Date: Saturday, September 9, 2023 11:20:05 AM
Attachments: St.Josephs.expansion 2023.docx
Commissioner Correspondence
From: Betty Wilson <[email protected]>
Sent: Friday, September 8, 2023 8:46 AM
To: CC - City Clerk <[email protected]>
Subject: Comment letter for St. Josephs.expansion. City.Planning.Meeting CAUTION: This email originated from outside the City of Stockton. Do not click any links or open attachments if this is unsolicited email.

Attached is our comment letter for the St. Joseph’s Expansion. Please confirm receipt.

Thank you.

Betty Wilson
Executive Director
Business Council of San Joaquin County
6731 Herndon Place
Stockton, CA 95219
209.956.3389 Office
209.487.3700 Direct Line
[email protected]
[email protected]
PLEASE NOTE: This communication and any accompanying documents are confidential and privileged. They are intended for the sole use of the addressee. If you receive this transmission in error, you are advised that any disclosure, copying, distribution, or the taking of any action in reliance upon this communication is strictly prohibited. If you have received this communication in error, please contact me at the above email address. Thank you.

ATTACHMENT G
Date: September 8, 2023
To: Stockton Planning Commission
RE: Support Proposed Expansion Project at St. Joseph’s Medical Center My name is Betty Wilson, and I am the Executive Director for the Business Council San Joaquin County. We are writing to express our support for the much-needed proposed expansion of the St. Joseph’s Medical Center (SJMC) in Stockton, which has been an anchor in our community for 125 years and is vital to the health ecology of our city and region.

The expansion will increase physical capacity and improve the patient’s experience by adding 144 new, private, acute care beds in the New Acute Care Tower. The expansion also includes a state-of-the-art Emergency Department and enhanced surgical facilities signifying a commitment to meeting the evolving healthcare needs of our diverse and growing population in the region.

California’s 2030 seismic retrofits will be completed as part of the expansion project. Timing for construction of the new Acute Care Tower is critical as beds must be taken offline during the retrofit. The phasing of the project is designed to limit the impact to capacity and access to care, but to accomplish this goal this expansion cannot be delayed.

The proposed expansion allows for growth of the Graduate Medical Education Residency Program. There is a well-documented physician shortage in the San Joaquin Valley and growth of the residency program is vital to expand access to primary and specialty care for patients who would otherwise have to travel out of the area. This program will be training well over 200 residents each year in nine different specialties.

St. Joseph’s Medical Center is a significant economic driver of our local economy with over 6,000 jobs supported. During construction there will be a significant increase in economic activity and thousands of jobs will be created over the construction period. The ongoing economic impacts of over $1.6 billion annually will benefit the local economy once the project is completed.

ATTACHMENT G
St. Joseph’s Medical Center is committed to health equity and has a strong history of caring for all people, especially historically marginalized and vulnerable communities. As San Joaquin Counties largest hospital provider for Medi-Cal patients, St. Joseph’s Medical Center is focused on improving health outcomes and addressing the social determinants of health through innovative health programs, community benefits, and investments.

As our region continues to grow it is critical that our health care network grows to support our residents. The proposed expansion of St. Joseph’s Medical Center will ensure our population has access to world-class care and the hospital can continue its mission of improving community health.

The proposed expansion embodies Stockton’s vision, growth and development trajectory and will improve the local health care landscape and our overall quality of life. We respectfully request the Stockton Planning Commission support, without delay, the expansion plans put forth by St. Joseph’s Medical Center.

Sincerely,
Betty Wilson
Betty Wilson

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