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HomeMy WebLinkAbout4.05 Gateway Med Center PD Need for Another Tri-Valley Hospital. Issues raised regarding the need foranother hospital in the Tri- Valley and the Applicants level of experience in building hospitals are outside the realm of land use and zoning. However, it may be worth noting that the City of Dublin does not currently have a hospital facility within its jurisdictional boundary; residents seeking medical care travel to San Ramon Regional Medical Center in San Ramon, ValleyCare in Pleasanton, Eden Medical Center in Castro Valley or Kaiser Permanente in Walnut Creek or Hayward. The Project proposes to provide a 100-bed hospital adjacent to recently constructed medical office buildings in Dublin where currently no such facility exists. Traffic, Parking and Security. While the Applicant does not currently know who the hospital tenant will be, Staff has reviewed and analyzed traffic, parking and security as part of the Project. A traffic analysis was performed by TJKM Transportation Consultants and reviewed by the City's Traffic Engineer. The analysis concluded that the Project would generate 22 more AM. trips and 21 less P.M. trips resulting in a net increase of 1 A.M. vehicular trip. Vehicular trip analysis was based on the number of patient beds. Staff has concluded that a net increase of 1 AM. vehicular trip is not a significant impact on the community. With respect to parking, the Project complies with the City's Off-Street Parking and Loading Regulations for a hospital use which requires 1 parking space for every 3 patient beds, 1 parking space for every doctor (on the largest shift) and 1 parking space for every 3 employees on the largest shift. Additionally, the Project proposes to have a surplus of 85 parking spaces above and beyond what the Zoning Ordinance requires. Furthermore, Conditions of Approval have been applied to the Project to ensure that adequate parking is provided once a hospital tenant has been selected. Additional parking would be required if there were an increase in the number of patient beds, an increase in the number of doctors, or an increase in the number of employees. Changes such as these to the Project would require, at a minimum, an amendment to the Project's Conditional Use Permit. The Project has been conditioned to comply with the City of Dublin Non-Residential Security Ordinance requirements. Additionally, the Conditions of Approval for the Project require that the Applicant work with Dublin Police Services to establish an effective theft prevention and security program. These requirements are in addition to any security requirements which may be imposed by the State of California Office of Statewide Health and Planning Development (OSHPD); OSHPD is the responsible agency for reviewing and permitting the construction and operation ofthe Project. Ambiguous Nature of Project Plans. Because a tenant for the Project is currently unknown, the floor plans for the Project are general; however, the Project approvals are for a 100-bed hospital and the use of the building is limited to such. The Applicant is aware and has agreed that the construction of a 6-story building is limited to the Project approvals and cannot be utilized solely for medical office uses without obtaining additional approvals. Should the Applicant decide to pursue medical offices, a 3-story 58,000 square foot building has already been approved. Identification of Specific Facility Needs. The specific needs of the facility will be identified once the hospital user has been selected. OSHPD will review the construction plans and ensure that the size of the patient rooms and the provision of negative pressure rooms, surgery rooms, laboratory space, radiology rooms, storage rooms, etc. meet State requirements. Fire and life safety, emergency room access, noise, loading dock operations, handling of bio-hazardous waste, power, and sewer. Staff has consulted with Dublin Fire Prevention and Dublin Police Services during the review of the Project and all comments and Conditions of Approval submitted by these departments have been incorporated into the Project plans or added as Conditions of Approval. The 4of8 Public Works Department has reviewed access and circulation for the Project including the loading dock configuration and determined that adequate access and circulation has been proposed. The Project has been conditioned to provide a loading dock operations plan once a hospital tenant has been identified to ensure that loading dock operations will comply with the Project as proposed. The environmental review prepared for the Project adequately and thoroughly analyzed noise and the provision of public services to the Project and found no significant environmental impacts. The storage, handling and disposal of bio- hazardous waste are regulated by OSHPD. Weinberg, Roger & Rosenfeld Letter The second letter submitted at the May 15, 2007 City Council meeting from Weinberg, Roger & Rosenfeld on behalf of Service Employees International Union, United Health Care Workers West ("SEIU-UHW") (see Attachment 5) asserted that the Initial Study prepared for the Project did not adequately address significant impacts related to: 1) hazards and hazardous materials, 2) noise, 3) aesthetics, 4) seismicity,S) housing, 6) growth inducing impacts, 7) cumulative impacts, and 8) construction related impacts. The letter also suggests that a supplemental Environmental Impact Report (EIR) should be prepared. A discussion of the concerns expressed in the letter is addressed below. Hazardous Materials. SEIU-UHW takes issue with the Initial Study's determination that the Project will not "create a significant hazard to the public or the environment through the routine transport, use or disposal of hazardous materials." SEIU-UHW argues that "an emergency room is bound to produce significant amounts of medical waste" and from that apparently concludes that the mere presence of hazardous materials at the Project site would constitute a significant impact. It is not the case that the mere presence of hazardous materials creates a significant hazard. The Initial Study concluded that State regulations concerning the handling, storage and disposal of hazardous materials would ensure that the presence of hazardous materials on the site would not "create a significant hazard." With regard to "medical waste," the proposed hospital would be subject to the Medical Waste Management Act (California Health and Safety Code sections 117600-118360), which requires generators of medical waste to obtain permits from an enforcement agency and to comply with State standards for containment and storage of medical waste. SEIU-UHW goes on to criticize the failure to impose mitigation measures and in particular the City's reliance upon the Project's "compliance with State regulations." However, under CEQA, mitigation measures are only required to mitigate significant impacts. The Initial Study concluded that there would be no significant hazard created by the project through the routine transport, use or disposal of hazardous waste (and therefore no associated significant impact) because State regulations strictly regulate the handling, storage, and disposal of hazardous materials by hospitals. Accordingly, since there is no significant impact, the City is not obligated by CEQA to mitigate the Project's insignificant impacts. (See Leonoffv. Monterey County (1990) 222 Cal.App.3d 1337, p. 1356.) Noise Associated with Ambulances. SEIU-UHW takes issue with the Initial Study's analysis of the noise associated with ambulance trips coming to the proposed hospital. SEIU-UHW argues that ambulances coming to the proposed hospital will use sirens and that ambulances that used to go elsewhere will come to the site of the proposed hospital. SEIU-UHW argues that this new source of noise will impact the residences 200 feet across Dublin Boulevard from the Project site. The Initial Study noted these impacts as well but deemed them to be insignificant because of the existence of other adjacent noise sources (Dublin Boulevard, Tassajara Road, and Interstate 580) and the State law limitations on the use of sirens. In addition, the residences across Dublin Boulevard are acoustically shielded from traffic noise along Dublin Boulevard by an 8-foot tall sound wall and through the incorporation of sound rated windows and doors in order to achieve an indoor noise level of 45 decibels (as required by Eastern Dublin EIR 5of8 Mitigation Measure 3.1012.0). Moreover, the project will pay a noise mitigation fee to pay for on-site and off-site noise mitigations. Accordingly, the impacts associated with noise from sirens will be less than significant. Aesthetics. SEIU-UHW argues that the Initial Study fails to adequately analyze significant impacts related to aesthetics. SEIU-UHW states that a "more systematic approach" to reviewing aesthetic impacts is necessary. It then suggests an "accepted approach" to analyzing visual and aesthetic impacts, but by whom the approach is accepted is not disclosed. In any event, Staff believes that the Initial Study's analysis, which concludes that the project would result in an aesthetic enhancement of the overall surroundings, is adequate under CEQA Staffs view, reflected in the Initial Study, is that the project would not "substantially degrade the existing visual character or quality of the site and its surroundings." Nothing the SEIU-UHW letter suggests that the Project would substantially degrade the existing visual character or quality of the site. Finally, where the issue is whether the proposed building is aesthetically pleasing in the eyes of local residents, that issue is to be resolved in the design review process, not CEQA (Bowman v. City of Berkeley (2004) 122 Cal.AppAth 572, 593.) Seismicity. SEIU-UHW asserts that the Initial Study's analysis of the potential impacts due to seismic events is lacking. SEIU-UHW's assertion fails to recognize the nature of Initial Study's project-level review. As the introduction to the Initial Study describes, this Project level analysis was prepared for the purpose of determining "whether there will be any potentially significant site-specific environmental impacts resulting from the Project which were not examined in previous environmental reviews and if so, whether those impacts can be reduced to a less-than-significant level through mitigation measures." With regard to seismicity, the Initial Study notes that the Eastern Dublin EIR had previously considered the impacts associated with seismicity and adopted mitigation measures to address those potentially significant impacts. Nonetheless, because the primary effects of groundshaking could not be mitigated to a less than significant level, a Statement of Overriding Considerations was adopted by the City Council in 1993 when it approve the Eastern Dublin General Plan Amendment and Specific Plan. SEIU-UHW somehow asserts that the impacts are more significant because of the number of in-patients and caregivers on site. However, the question under CEQA is not how many people would be exposed to seismicity, but simply whether "people or structures" would be exposed to seismicity. Thus, the impacts associated with seismicity are the same as those analyzed in 1993, and contrary to SEIU-UHW's assertions, the intensity of the use ofthe site has no impact on the significance of those impacts. Population and Housing. SEIU-UHW asserts that the initial study fails to analyze asserted significant impacts related to population and housing. SEIU-UHW asserts that the expected generation of 525 new jobs would create demand to additional housing and, in particular, affordable housing for those working at the proposed hospital. The Initial Study correctly noted that the increased square footage associated with the proposed hospital was within the scope of that already analyzed in the Eastern Dublin EIR. Therefore, the impacts related to population and housing resulting from that commercial square footage and the associated jobs are no different than that previously analyzed in the Eastern Dublin EIR. Accordingly, the proposed hospital project will not "induce substantial population growth" beyond that previously analyzed in the Eastern Dublin EIR. It should also be noted that the City has an inclusionary housing program that results in the creation of a number of affordable units and that developers will be required to pay the City's non-residential affordable housing fee, which generates revenue to create new affordable housing in the City. Growth-Inducing Impacts and Cumulative Impacts. SEIU-UHW asserts, separately, that the Initial Study fails to consider significant growth-inducing impacts and cumulative impacts. Once again, SEIU-UHW's assertions are based on the mistaken premise that the project proposes something that is beyond the scope of that previously analyzed in the Eastern Dublin EIR. The Eastern Dublin EIR previously analyzed the 6of8 growth-inducing impacts and cumulative impacts of development in Eastern Dublin, and the square footage associated with the proposed Project is within the scope of that previous analysis. Nothing in the SEIU-UHW's letter suggests that there is anything in particular about this Project site or the Project itself that would lead to impacts that were not previously analyzed. Construction-Related Noise and Air Quality Impacts. SEIU-UHW asserts that the Initial Study fails to properly analyze the construction-related noise and air-quality impacts associated with the increase in size from the previously approved medical office building. Once again, SEIU-UHW's assertion fails to recognize that the construction-related impacts are no different than the impacts previously analyzed in the Eastern Dublin EIR. Construction Noise. SEIU-UHW provides no evidence or discussion beyond its bare assertion that the project will involve a substantial increase in significant construction noise impacts. The City notes that the Eastern Dublin EIR identified and analyzed Impact 3/1 OlE, the potential for significant construction noise exposure to existing and proposed residences from development consistent with the general plan and Eastern Dublin Specific Plan. As noted in the Initial Study, adopted mitigation measure 3.10/4.0 requires developers to prepare a Construction Noise Management Program, to include features such as a grading schedule limiting grading activities, hours of grading, and construction vehicle access through residential neighborhoods. The previously adopted mitigation applies to development in Eastern Dublin, such as the project, and is implemented through proposed Conditions of Approval Nos. 92, 93 and 94. The proposed development is consistent with the development assumptions in the Eastern Dublin EIR; the commenter provides no evidence that additional review is necessary under CEQA section 21166 (and related Guidelines sections 15162, 15163). Construction Emissions. SEIU-UHW asserts various construction air quality impacts but continues to misunderstand the focus of subsequent review under CEQA and impacts previously analyzed. Construction particulates, equipment and vehicle emissions ranging from minor emissions to substantial emissions of NO X from diesel-powered equipment are analyzed in Impacts 3.11/ A and 3.11/B of the Eastern Dublin EIR. Related mitigations 3.11/1.0, 2.0, 3.0 and 4.0 were adopted to reduce the identified impacts to less than significant, but cumulative impacts would remain unavoidable and a Statement of Overriding Considerations was adopted upon approval of the Eastern Dublin General Plan Amendment and Specific Plan. The adopted mitigation measures call for comprehensive dust control measures during construction, limiting construction activities to active construction areas, limiting interference with non-construction traffic, and preparing a construction impact reduction plan to incorporate all proposed air quality mitigation strategies. These mitigations are implemented through numerous Conditions of Project Approval, including but not limited to Nos. 63, 68, 92, 94 and 111. The findings of the Initial Study that the project would have no significant construction air quality impacts beyond those previously identified is also consistent with the Bay Area Air Quality Management District (BAAQMD) CEQA Guidelines as to thresholds of significance for construction impacts (http://www.baaqmd.gov/pln/ceqa/index.htm). Construction air quality impact analysis is addressed in Sections 2.3,3.3,4.2 of the BAAQMD guidelines. The District does not identify quantified standards for construction emissions, instead focusing on implementation of dust and emissions control measures. The adopted mitigation measures from the Eastern Dublin EIR and implementing Conditions of Approval substantially include the basic and some enhanced feasible dust control measures recommended by the District in Table 2 of the Guidelines. With implementation ofthese control measures, the project would have no significant construction emissions impact beyond those previously identified. The more recent identification of PM 2.5 standards would not change this conclusion since particulate emissions were found significant and unavoidable in the Eastern Dublin EIR. 7of8 With respect to the other emissions mentioned by the commenter, the BAAQMD CEQA Guidelines Section 2.3, note 3 states as follows: "Construction equipment emits carbon monoxide and ozone precursors. However, these emissions are included in the emission inventory that is the basis for regional air quality plans, and are not expected to impede attainment or maintenance of ozone and carbon monoxide standards in the Bay Area." Therefore, under the District's CEQA Guidelines for analyzing air quality impacts, no quantification of construction emissions, including carbon monoxide or ozone precursors is required. ENVIRONMENTAL REVIEW: Pursuant to the California Environmental Quality Act (CEQA), an Initial Study has been prepared for the Project and a determination has been made that the proposed Project will not have a significant effect on the environment. The project has been found to be within the scope of the Program EIR for the Eastern Dublin General Plan Amendment and Specific Plan (the "Eastern Dublin EIR") (SCH No. 91103064); the Santa Rita Property Mitigated Negative Declaration (the "Santa Rita Property MND") (SCH No. 96082092); and, the Dublin Ranch West Environmental Impact Report (the "Dublin Ranch West EIR") (SCH No. 2004112094). Together, the Eastern Dublin EIR, Santa Rita Property MND, and the Dublin Ranch West EIR, adequately describe the total Project for the purpose of CEQA In accordance with CEQA Guidelines Sections 15162 and 15164 an Addendum has been prepared. RECOMMENDATION: Staff recommends that the City Council: 1) Waive the 2nd reading and adopt an Ordinance (Attachment 1) for a Planned Development Rezone with a Stage 1 and 2 Development Plan for the Dublin Gateway Medical Center Building 3 Hospital and Garage Project, with Stage 1 and 2 Development Plan attached as Exhibit A and 2) Waive the 2nd reading and adopt an Ordinance (Attachment 2) for a Development Agreement for the Dublin Gateway Medical Center Building 3 Hospital and Garage Project, with Development Agreement attached as Exhibit A 8of8 Ie:{ l?~ ORDINANCE NO. XX - 07 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF DUBLIN APPROVING A PLANNED DEVELOPMENT REZONE AND STAGE 1 AND 2 DEVELOPMENT PLAN FOR THE DUBLIN GATEWAY MEDICAL CENTER BUILDING 3 HOSPITAL AND GARAGE PROJECT LOCATED AT 4084 AND 4100 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 THE CITY COUNCIL OF THE CITY OF DUBLIN DOES HEREBY ORDAIN AS FOLLOWS: Section 1. RECITALS A By Ordinance No. 22-98 the City Council rezoned the approximately 35-acre area known as Koll Dublin Corporate Center to a Planned Development Zoning District and adopted a Stage 1 and 2 Development Plan for the entire proj ect area. B. This Ordinance adopts an amendment to the Stage 1 and 2 Development Plan approved for the Koll Dublin Corporate Center by the City Council on December 15, 1998. Section 2. FINDINGS AND DETERMINATIONS A. Pursuant to Section 8.32.070 ofthe Dublin Municipal Code, the City Council finds as follows: 1. The Planned Development Rezone and amended Stage 1 and 2 Development Plan for the Dublin Gateway Medical Center Building 3 Hospital and Garage project (the "Project"), meets the purpose and intent of Chapter 8.32 in that it provides maximum flexibility and diversification in the development of the property by allowing the development of either a 58,000 square foot medical office building or a 168,000 square foot, 100-bed hospital building depending upon market conditions and creates a desirable use of land that is sensitive to surrounding land uses by virtue of the layout and design, which is in close proximity to Dublin Boulevard, Tassajara Road and the 1-580 freeway. 2. The Planned Development Rezone and amended Stage 1 and 2 Development Plan for the Project will be harmonious and compatible with existing and future development in the surrounding area because: 1) the uses proposed as part of the Project are consistent with the 1998 Development Plan approved for the Koll Dublin Corporate Center; and 2) the Project is consistent with campus office development as envisioned in the Eastern Dublin Specific Plan. B. Pursuant to Section 8.120.050.A and B of the Dublin Municipal Code, the City Council finds as follows: 1. The Planned Development Rezone and amended Stage 1 and 2 Development Plan for the Project will be harmonious and compatible with existing and potential development in the surrounding area in that: 1) the land uses and site plan establish a comprehensive medical office complex; 2) the Project is consistent with the Eastern Dublin Specific Plan and the Stage 1 and 2 Development Plan, as amended; 3) the Project site has been designed to be compatible with adjacent professional and medical office uses and commercial uses; and 4) the Project site includes attractive landscaping and site elements including a location for public art, light n~ 4'~ ~l~ ATTACHMENT 1 (} Page 1 of3 2- 1 l z.. '2-- fixtures, benches, plazas and pedestrian paths to create an attractive landscape palette and material palette for the hospital and adjacent medical office buildings. 2. The Project site is physically suitable for the type and intensity of the zoning district being proposed in that: 1) the Project, in combination with the larger Koll Dublin Corporate Center, will not exceed the maximum Floor Area Ratio (FAR) of .80 which was established in the Eastern Dublin Specific Plan for Campus Office land uses; 2) the Project will include a hospital use which is consistent with the land use designations of General Commercial and Campus Office; 3) as amended, the Stage 1 and 2 Development Plan will permit a maximum of 168,000 square feet of gross floor area for a hospital; and 4) the Stage 1 and 2 Development Plan for the Project has been designed to accommodate the topography of the Project site which is currently developed with surface parking and landscaping and is suitable for the development of a hospital and therefore physically suitable for the type and intensity of the proposed Planned Development Zoning district. 3. The Planned Development Rezone and amended Stage 1 and 2 Development Plan for the Project will not adversely affect the health or safety of persons residing or working in the vicinity or be detrimental to the public health, safety and welfare because the Project will comply with all applicable development regulations and standards and will implement all adopted mitigation measures. 4. The Planned Development Rezone and amended Stage 1 and 2 Development Plan for the Project is consistent with the Dublin General Plan, Eastern Dublin Specific Plan and the Planned Development Zoning, as amended, in that: 1) the Project is consistent with the permitted, conditional and temporary use lists adopted by the City Council as part of the 1998 Stage 1 and 2 Development Plan for the Koll Dublin Corporate Center; 2) the proposed amendments to the Stage 1 and 2 Development Plan with respect to density provides for flexibility in development depending upon market conditions by allowing for either a 58,000 square foot medical office building or a 168,000 square foot hospital building on Lot 3 of Map 8524; and 3) the Project is consistent with the purpose and intent of the Eastern Dublin Specific Plan for the Tassajara Gateway subarea which encourages the development of land uses that will benefit from their location at the intersection of Dublin Boulevard and Tassajara Road and their close proximity to the 1-580 freeway. C. Pursuant to the California Environmental Quality Act, the City Council finds as follows: 1. Pursuant to the California Environmental Quality Act (CEQA), Sections 15162 and 15164 provide that an addendum to a previously certified Environmental Impact Report (EIR) may be prepared when a proj ect requires a minor technical change to an EIR and there are no new significant environmental effects and no substantial increase in the severity of previously identified significant effects. Section 3. MAP OF THE PROPERTY. Pursuant to Chapter 8.32, Title 8 of the City of Dublin Municipal Code, the Stage 1 and 2 Development Plan applies to the following property ("the Property"): Lot 3 and 4 of Vesting Tentative Parcel Map 8524, 1.545 acres and 1.585 acres respectively (also a portion of Lot 7 of Tract 7064) for PA 06-026 (APN 986-0016-021 & 986-0016-022) at the southwest comer of Dublin Boulevard and Glynnis Rose Drive and bordered by Dublin Boulevard to the north, Glynnis Rose Drive to the west and Koll Center Drive to the south. Page 2 of3 3c:f A vicinity map showing the area for a Stage 1 and 2 Development Plan is shown below: Section 4. APPROVAL The regulations for the use, development, improvement, and maintenance of the Property are set forth in the amended Stage 1 and 2 Development Plan as attached in Exhibit A which is hereby approved. Any amendments to the Stage 1 and 2 Planned Development Zoning Development Plan shall be in accordance with Section 8.32.080 and/or Chapter 8.120 of the Dublin Municipal Code or its successors. Section 5. EFFECTIVE DATE AND POSTING OF ORDINANCE This Ordinance shall take effect and be in force thirty (30) days from and after the date of its passage. The City Clerk of the City of Dublin shall cause the Ordinance to be posted in at least three (3) public places in the City of Dublin in accordance with Section 36933 of the Government Code of the State of California. PASSED, APPROVED AND ADOPTED BY the City Council of the City of Dublin, on this 5th day of June 2007 by the following vote: AYES: NOES: ABSENT: ABSTAIN: Janet Lockhart, Mayor ATTEST: City Clerk G:\P A#\2006\06-026 Dublin Gateway Bldg 3 Mod\Public Hearing Documents\CC\CC Ord PD Rezone_done.doc Page 3 of3 4~ Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (PA 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25, 2005 (P A 04-046) Amended by Ordinance _-_ by the City Council on _, 2007 (P A 06-026) EXHIBIT A DEVELOPMENT PLAN General Provisions This is a Development Plan pursuant to Chapter 8.32 of the Dublin Zoning Ordinance for the Koll Corporate Center project, located on the south side of Dublin Boulevard, east of Tassajara Creek, West of Tassajara Road, and north of Interstate 580 (APN 986-0001-001- 10, portion). This Development Plan meets all of the requirements for Stage 1 and Stage 2 review of the project. This Development Plan was subsequently amended by Planning Commission Resolution 04-55 for the Ulferts Center project on August 24, 2004. The amendments included the removal of the hotel designation on Lots 1 and 2 and allowed for the development of retail commercial uses on the entire property. This Development Plan was subsequently amended for the Dublin Gateway Medical Center project on January 25, 2005. The amendment allowed for massage establishments in conjunction with physical therapy to be a permitted use, rather than conditional use, consistent with the regulations set forth in the Dublin Zoning Ordinance. This Development Plan was subsequently amended for the Dublin Gateway Medical Center Building 3 Hospital and Garage project on _, 2007. The amendments allowed for am alternative development project on a portion of Lot 7 of Map 7064 otherwise known as Lots 3 & 4 of Map 8524; an increase in square footage on Lot 7 of Map 7064; revisions to the site plan and landscape plan; and, revisions to the development regulations. This Development Plan is also represented by the following: · Tentative Map 7064 and Site Development Review plans, Landscape plans, and other plans, exhibits, and written statements contained in the document dated received October 30, 1998, labeled Exhibit A-I to the Ordinance approving this Development Plan (City Council Ordinance No. 22-98), on file in the Planning Division. · Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the project approved as part of Planning Commission Resolution 04-55 for the Ulferts Center (P A 03-064), on file in the Planning Division. · Tentative Map 8524 and Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the project approved as part of Planning Commission Resolution 05-06 for the Dublin Gateway Medical Center (P A 04-046), on file in the 'Planning Division. · Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the project approved as part of Ordinance _ for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06-026), on file in the Planning Division. lof6 Exhibit A [) 1 122.--' Amended by Resolution 04-55 by the Planning Commission on August 24, 2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25,2005 (PA 04-046) Amended by Ordinance _-_ by the City Council on _, 2007 (P A 06-026) This Planned Development Zoning District, as amended, allows the flexibility needed to encourage innovative development while ensuring that the goals, policies, and action programs of the General Plan, Eastern Dublin Specific Plan, and provisions of Section 8.32 of the Zoning Ordinance are satisfied. 1. Permitted Uses. The following uses are permitted for this "PD / C-2 / C-O" (Planned Development/General Commercial/Campus Office) Zoning District. * a) Banks & Financial Services; b) Contractor's Office; c) Copying & Blueprinting; d) Eating & Drinking Establishments; e) Health Services/Clinics; f) Laboratory; g) Professional/ Administrative Offices; h) Parking Lot/Garage - Commercial; i) Retail- General; j) Retail- Neighborhood; k) Retail - Service; I) Day Care of 14 or fewer children; m) School- trade school, college, university; n) Similar and related uses as determined by the Director of Community Development; and, 0) Massage Establishments, in conjunction with physical therapy. Amended by PC Reso. 05-06 (01/25/05) *See "**NOTE" on Page 5 regarding uses on Lot 3 of Map 8524. 2. Conditional Uses. * a) AutomobileN ehicle Brokerage, Rental; b) Building Materials Sales; c) Mini-Storage; d) Storage of petroleum products for on-site use; e) Warehousing and distribution; f) Community Facility; g) Massage Establishments, in conjunction with a gymnasium/health club; Amended by PC Reso. 05-06 (01/25/05) h) Day Care Center - 15+ children; i) Outdoor Mobile Vendor; j) Outdoor Seating; k) Temporary Outdoor Sale not related to on-site established business (sidewalk sale); I) Caretaker Residence; m) Hospital/Medical Center; 2of6 b ~ 12"'2.--' Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25,2005 (PA 04-046) Amended by Ordinance _-_ by the City Council on _' 2007 (P A 06-026) n) Animal Sales and Services; 0) Auction Yard; p) AutomobileN ehicle Sales and Service; q) Bed and Breakfast inn; r) Car Wash/Detailing; s) Community Care Facility - Large; t) Dance Floor; u) Drive-in/Drive-through business; v) Hotel/Motel; w) Plant Nursery; x) Recreational Facility/Indoor; y) Recreational Facility/Outdoor; z) Retail- outdoor storage; aa) Service Station; bb) Shopping Center; and, cc) Similar and related uses as determined by the Director of Community Development. *See n**NOTE" on Page 5 regarding uses on Lot 3 of Map 8524. 3. Dublin Zoning Ordinance, Applicable Requirements. Except as specifically modified by the provisions of this PD District Rezone/Development Plan, all applicable general requirements and procedures of the Dublin Zoning Ordinance shall be applied to the land uses designated in this PD District Rezone. 4. Site Plan & Architecture. This Development Plan applies to the approximately 37-acre site generally located south of Dublin Boulevard, north of Interstate 580, west of Tassajara Road and east of John Monego Court. Any modifications to the project, or development on the future hotel/retail site (Phase 3), shall be substantially consistent with these plans and of equal or superior materials and design quality. Development on the future hotel/retail site (Phase 3) requires approval of Site Development Review by the City of Dublin. The development of the future hotel/retail site (Phase 3) was modified by Planning Commission Resolution 04-55 for the Ulferts Center. The following site plans and elevations are hereby incorporated by reference: Amended by Ord. _ -_ (Date) · Ordinance 22-98 for the Koll Dublin Corporate Center, Exhibit A-I (P A 98-047). · Planning Commission Resolution 04-55 for the Ulferts Center (P A 03-064). · Planning Commission Resolution 05-06 for the Dublin Gateway Medical Center (P A 04-046). · Ordinance _-_ and Planning Commission Resolution _-_ for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06-026). 3of6 -7 ~ Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (PA 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25, 2005 (P A 04-046) Amended by Ordinance _-_ by the City Council on _, 2007 (P A 06-026) 5. Density. The maximum square footage of the proposed development for the parcels covered under this Development Plan (as shown on the applicable site plans) is as follows: Lot 1 & 3, Tract 7064 (Retail site): 1.6 acres & 2.6 acres, respectively 50,530 square feet building area* Amended by PC Reso. 04-55 (August 24, 2004) Lot 2, Tract 7064 (Retail site): 1.6 acres 7,000 square feet building area* Lot 4, Tract 7064 (4-story office building): 5.53 acres 139,285 square feet building area Lot 5, Tract 7064 (4-story office building): 6.67 acres 139,285 square feet building area Lot 6, Tract 7064 (4-story office building): 6.42 acres 139,285 square feet building area Lot 7, Tract 7064: 7.11 acres Lot 7 of Tract 7064 has been further divided as follows: Amended by CDD Reso. 05-01 (February 28, 2005) Amended by PC Reso. 05-06 (January 25, 2005) Amended by Ord. - (Date) Lot 1, Map 8524 (3-story office building) 3.000 acres 62,300 square feet building area Lot 2, Map 8524 (3-story office building) 1.009 acres 57,700 square feet building area Lot 3, Map 8524 (3-story office building) 1.545 acres 58,000 square feet building area OR 168,000 square feet building area** Lot 4, Map 8524 1.585 acres 4-level parking garage OR 5-level parking garage** Total Building Area: 178,000 square feet OR 292,000 square feet** Lot 8, (Park & Ride facility): 1. 74 acres No building area (parking only) *NOTE: Densities for Lots 1, 2, and 3 may be combined and re-allocated among these three lots in any manner within this portion of the project site, but must be used for General Commercial/Retail uses and a hotel, unless an amendment to this Planned 4of6 ~ 0;/. Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25, 2005 (P A 04-046) Amended by Ordinance _ -_ by the City Council on _, 2007 (P A 06-026) Development is approved. An amendment to the Planned Development was approved by Planning Commission Resolution 04-55 on August 24, 2004. This amendment removed the hotel designation from Lots 1 and 3 and allowed for the development of retail commercial uses instead. **NOTE: This Development Plan allows for the development of either: 1) a 3-story, 58,000 square foot medical office building on Lot 3 of Map 8524 and 4-level above ground parking garage on Lot 4 of Map 8524 OR 2) a 6-story, 168,000 square foot, 100- bed hospital on Lot 3 of Map 8524 and 5-1evel parking garage on Lot 4 of Map 8524 with one level below ground and 4-levels above ground. At no time shall the 6-story hospital building on Lot 3 of Map 8524 be utilized for any other use than a hospital without an amendment to this Development Plan. 6. Phasing Plan. The Corporate Center will be developed in three phases. The First phase will include the three, four-story office buildings, Park & Ride lot, perimeter landscaping, on-site entrance roads, and associated site work. The Second phase will be the signature, six-story office building at the comer of Dublin Boulevard and Tassajara Road (Amended by Planning Commission Resolution 05-06 on January 25,2005). The Third phase will include the HotellRetail parcel, which will likely be sold to a separate hotel developer (Amended by Planning Commission Resolution 04-55 on August 24, 2004). Third phase uses could be constructed after the first phase when a critical mass of on-site customer support is created. Any hotel/retail uses proposed for the vacant parcel (Lots 1, 2, and 3) must be consistent with the standards established by this Development Plan, and will require approval of a Site Development Review by the City of Dublin Planning Commission (Amended by Planning Commission Resolution 04-55 on August 24, 2004). 7. Landscaping Plan. The following landscaping plans are hereby incorporated by reference: · Ordinance 22-98 for the Koll Dublin Corporate Center, Exhibit A-I (PA 98-047). · Pinewave Design and Engineering, 3 sheets, dated received by the Planning Division on August 17,2004 for the Ulferts Center (PA 03-064). Amended by PC Reso. 04-55 (August 24, 2004) · Ware Malcomb, 3 sheets, dated received by the Planning Division on January 11, 2005 for the Dublin Gateway Medical Center (P A 04-046). Amended by PC Reso. 05-06 (01/25/05) · Ware Malcomb and Ridge Landscape Architects, dated received by the Planning Division on February 26,2007 for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06-026). Amended by Ord. _ -_ (Date) 8. Development Standards. The development regulations for the project are hereby incorporated by reference: · Ordinance 22-98 for the Koll Dublin Corporate Center, Exhibit A-I (P A 98-047). 5of6 q~ Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25,2005 (PA 04-046) Amended by Ordinance _-_ by the City Council on _' 2007 (P A 06-026) . Pinewave Design and Engineering dated received by the Planning Division on August 17, 2004 for the Ulferts Center (PA 03-064). Amended by PC Reso. 04- 55 (August 24, 2004) . Ware Malcomb, dated received by the Planning Division on January 11,2005 for the Dublin Gateway Medical Center (P A 04-046). Amended by PC Reso. 05-06 (01/25/05) . Ware Malcomb, dated received by the Planning Division on February 26, 2007 for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06- 026). Amended by Ord. _ -_ (Date) The development of Lots 3 and 4 of Parcel Map 8524 (formerly a portion of Lot 7 of Tract Map 7064) shall be permitted to have: . A 3-story, 58,000 square foot medical office building (Lot 3) and 4-level above ground parking garage (Lot 4) approved as part of Planning Commission Resolution 05-06, OR . A 6-story, 168,000 square foot, 100-bed hospital building (Lot 3) and 5-level parking garage (Lot 4) with one level below ground and 4 levels above ground approved as part of Ordinance _ and Planning Commission Resolution _' The 5-level parking garage approved in conjunction with the 6-story hospital building may also be constructed with the 3-story medical office building so long as one level of parking remains underground and only 4-levels of parking above ground. NOTE: Any increase in the maximum square footage on Lot 3 of Map 8524, including the addition of a basement for equipment or any other use, shall require an amendment to this Development Plan and shall be subject to review by the Planning Commission with a recommendation to City Council. 9. General Provisions. A) The project applicant/developer shall enter into a Development Agreement with the City of Dublin prior to Final Map approval, which shall contain, but not be limited to, provisions for financing and timing of on and off-site infrastructure, payment of traffic, noise and public facilities impact fees, ownership and maintenance of creek and open space areas, and other provisions deemed necessary by the City to find the project consistent with the Eastern Dublin Specific Plan. B) The project applicant/developer shall be required to pay a Public Facilities Fee in the amounts and at the times set forth in City of Dublin Resolution No. 32-96, adopted by the City Council on March 26, 1996, or in the amounts and at the times set forth in any resolution revising the amount of the Public Facilities Fee. 6of6 )0 ~, l ~L./ ORDINANCE NO. XX - 07 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF DUBLIN APPROVING A DEVELOPMENT AGREEMENT FOR THE DUBLIN GATEWAY MEDICAL CENTER BUILDING 3 HOSPITAL AND GARAGE PROJECT LOCATED AT 4084 AND 4100 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 THE CITY COUNCIL OF THE CITY OF DUBLIN DOES HEREBY ORDAIN AS FOLLOWS: Section 1. RECITALS A The Dublin Gateway Medical Center Building 3 Hospital and Garage project (the "Project") is located within the boundaries of the Eastern Dublin Specific Plan ("Specific Plan") in an area designated Campus Office on the General Plan Land Use Element Map and Eastern Dublin Specific Plan Land Use Map with an allowance for General Commercial land uses pursuant to Planned Development Zoning. B. Pursuant to the California Environmental Quality Act (CEQA), Sections 15162 and 15164 provide that an addendum to a previously certified Environmental Impact Report (EIR) may be prepared when a project requires a minor technical change to an EIR and there are no new significant environmental effects and no substantial increase in the severity of previously identified significant effects. C. A public hearing on the proposed Development Agreement was held before the Planning Commission on April 24, 2007 and May 8,2007, for which public notice was given as provided by law. D. The Planning Commission has made its recommendation to the City Council for approval of the Development Agreement. F. A public hearing on the proposed Development Agreement was held before the City Council on May 15, 2007 and June 5, 2007 for which public notice was given as provided by law. G. The City Council has considered the recommendation of the Planning Commission who considered the item at the April 24, 2007 and May 8, 2007 meetings, including the Planning Commission's reasons for its recommendation, the Agenda Statement, all comments received in writing and all testimony received at the public hearing. Section 2. FINDINGS AND DETERMINATIONS Therefore, on the basis of (a) the foregoing Recitals which are incorporated herein, (b) the City of Dublin's General Plan, (c) the Eastern Dublin Specific Plan, (e) the Eastern Dublin EIR, (d) the 1996 Mitigated Negative Declaration for the Santa Rita Property, (e) the CEQA Addendum (f) the Agenda Statement, and on the basis of the specific conclusions set forth below, the City Council finds and determines that: Page 1 of3 Attachment 2 ({ 1- 1. The Project is consistent with the objectives, policies, general land uses and programs specified and contained in the City's General Plan and in the Eastern Dublin Specific Plan in that: (a) the General Plan and Specific Plan land use designations for the Project site are Campus Office with an allowance for General Commercial land uses pursuant to Planned Development Zoning and the proposed Project is a project consistent with those land uses; (b) the Project, as conditioned, is consistent with the fiscal policies of the General Plan and Specific Plan with respect to provision of infrastructure and public services; (c) the Project is consistent with the Stage 1 and 2 Planned Development Zoning Development Plan adopted for the Koll Dublin Corporate Center in 1998 by the City Council, as amended for the Project and approved by the City Council; and (d) the Triad Dublin Gateway L.P. Development Agreement includes provisions relating to vesting of development rights, and similar provisions set forth in the Specific Plan. 2. The Triad Dublin Gateway L.P. Development Agreement is compatible with the uses authorized in, and the regulations prescribed for, the land use districts in which the real property is located in that the Project approvals include Planned Development Rezone and amended Stage 1 and 2 Development Plan, Conditional Use Permit and Site Development Review. 3. The Triad Dublin Gateway L.P. Development Agreement is in conformity with public convenience, general welfare and good land use policies in that the Project will implement land use guidelines set forth in the Eastern Dublin Specific Plan and the General Plan which have planned for campus office and general commercial uses at this location. 4. The Triad Dublin Gateway L.P. Development Agreement will not be detrimental to the health, safety and general welfare in that the Project will proceed in accordance with all the programs and policies of the Eastern Dublin Specific Plan. 5. The Triad Dublin Gateway L.P. Development Agreement will not adversely affect the orderly development of property or the preservation of property values in that the Project will be consistent with the General Plan and with the Eastern Dublin Specific Plan. Section 3. APPROVAL The City Council hereby approves the Development Agreement attached hereto as Exhibit A and authorizes the Mayor to execute it. Section 4. RECORDATION Within ten (10) days after the Development Agreement is fully executed by all parties, the City Clerk shall submit the Agreement to the County Recorder for recordation. Section 5. EFFECTIVE DATE AND POSTING OF ORDINANCE This Ordinance shall take effect and be in force thirty (30) days from and after the date of its passage. The City Clerk of the City of Dublin shall cause the Ordinance to be posted in at least three (3) public places in the City of Dublin in accordance with Section 36933 of the Government Code of the State of California. Page 2 of3 12-~ PASSED, APPROVED AND ADOPTED BY the City Council of the City of Dublin, on this 5th day of June 2007 by the following vote: AYES: NOES: ABSENT: ABSTAIN: Mayor ATTEST: City Clerk G:\PA#\2006\06-026 Dublin Gateway Bldg 3 Mod\Public Hearing Documents\CC\CC Ord DA_done.doc Page 3 of3 RECORDING REQUESTED BY: CITY OF DUBLIN When Recorded Mail To: City Clerk City of Dublin 100 Civic Plaza Dublin, CA 94568 Fee waived per GC 27383 I~~ Space above this line for Recorder's use DEVELOPMENT AGREEMENT BETWEEN THE CITY OF DUBLI N AND TRIAD DUBLIN GATEWAY, L.P. FOR THE DUBLIN GATEWAY MEDICAL CENTER PROJECT (HOSPITAL ALTERNATIVE) EXHIBIT A /41, THIS DEVELOPMENT AGREEMENT ("Agreement") is made and entered in the City of Dublin on this 15th day of May, 2007, by and between the City of Dublin, a Municipal Corporation (hereafter "City"), and Triad Dublin Gateway, L.P., a California limited partnership (hereafter "Developer"), pursuant to the authority of SS 65864 et seq. of the California Government Code and Dublin Municipal Code, Chapter 8.56. RECITALS A. California Government Code SS 65864 et seq. and Chapter 8.56 of the Dublin Municipal Code (hereafter "Chapter 8.56") authorize the City to enter into an agreement for the development of real property with any person having a legal or equitable interest in such property in order to establish certain development rights in such property; and B. Developer owns fee title to four separate legal parcels of real property consisting of approximately 7.139 acres located in the City of Dublin, County of Alameda, State of California. These four parcels are sometimes referred to individually herein as Parcel 1, Parcel 2, Parcel 3 and Parcel 4, respectively. The property subject to this Agreement consists of Parcel 3 and Parcel 4, the size of which is 3.13 total acres and which is legally described in Exhibit A attached hereto (the "Property"). Parcel 1, Parcel 2, Parcel 3 and Parcel 4 are sometimes each individually referred to herein as a "Parcel" and collectively as the "Parcels"; and C. On February 28,2005, the City granted a Vesting Tentative Parcel Map for Tract 8524 for Dublin Gateway Medical Center (Community Development Director Resolution No. 05-01) and on January 25, 2005, the City granted a Conditional Use Permit (Planning Commission Resolution No.05-06) and Site Development Review (Planning Commission Resolution No.05-06) for the development of the Parcels (these approvals are hereinafter collectively referred to as the "Original Approvals"). Under these Original Approvals, the original plan was to develop the Parcels in two phases, with Phase I consisting of two medical/professional office buildings totaling approximately 120,000 square feet, and Phase II consisting of a third approximately 58,000 square-foot medical/professional office building of three stories and a 427 -space, 4-level parking structure. Building 1 on Parcel 1 is approximately 65,295 square feet, Building 2 on Parcel 2 is approximately 57,786 square feet and Building 3 on Parcel 3 is approximately 58,000 square feet. Phase I and Phase II of the project, as configured under the Original Approvals, are depicted on the Site Plan attached hereto as Exhibit C. The plan proposed by the Original Approvals is commonly referred to as the "Dublin Gateway Medical Center"; and D. Developer has completed construction of Phase I contemplated under the Original Approvals. Developer now desires to provide for an alternate Dublin/Triad Dublin Gateway, L.P. Development Agreement Page 2 of 16 for the Dublin Gateway Medical Center Project June 5, 2007 CLEAN_DA Dublin Gateway Medical Center_041007.DOC 15~ Phase II development plan, which will provide the Developer with the flexibility to develop either the original Phase II plan, as described in Recital C (the "Original Plan") or the alternate Phase II development plan (the "Alternate Plan"). The Alternate Plan consists of a six-story, approximately 168,000 square-foot, 100- bed hospital building and a five-level parking structure, of which one level will be located below-ground. The Site Plan for the Alternate Plan, which also depicts Phase I of the Project, is attached hereto as Exhibit D. Developer has applied for, and City has approved or is processing various land use approvals in connection with the Alternate Plan, including a Conditional Use Permit (City Council Resolution No. _), a Site Development Review (City Council Resolution No._), and an amended Stage 1 and Stage 2 Development Plan (Planning Commission Resolution No._), (collectively, together with any approvals or permits now or hereafter issued with respect to the Project, the "Alternate Approvals"). Any reference in the remainder of this Agreement to the "Project" or to the "Hospital" shall mean the development contemplated in the Alternate Plan that was approved by the Alternate Approvals. In addition, any reference in this Agreement to the Project shall mean and include the Property, and any reference in this Agreement to the Property shall mean and include the Project; and E. City desires the timely, efficient, orderly and proper development of the Project; and F. The Property is located within the Eastern Dublin Specific Plan and General Plan Amendment area. The Eastern Dublin Specific Plan requires Developer to enter into this development agreement for the development of the Project contemplated in the Alternate Approvals, and City has agreed to extend the term of the Agreement beyond the standard five-year term that the City offers for development agreements required by the Eastern Dublin Specific Plan in exchange for the Developer's making a community benefit payment to the City, as set forth in Exhibit B. A previous development agreement satisfies the Eastern Dublin Specific Plan's development agreement requirement as to the Original Approvals. The City Council has found that, among other things, this Agreement, which applies to the Alternate Approvals, is consistent with the General Plan and the Eastern Dublin Specific Plan, and has been reviewed and evaluated in accordance with Chapter 8.56; and G. The Project is located in the Dublin General Plan Eastern Extended Planning Area and the Eastern Dublin Specific Plan area, for which a Program EIR was certified pursuant to the California Environmental Quality Act (CEQA) (SCH No. 91-103064, Resolution 53-93); the City also approved a Mitigated Negative Declaration (SCH No. 1996082092) for the Santa Rita Specific Plan Amendment, of which the Project is a part (collectively, "CEQA Compliance Documentation"). The City prepared an Initial Study for the Project to determine Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 2 of 16 June 5, 2007 /61 whether supplemental environmental impacts would occur as a result of the project beyond or different from those already addressed in the CEQA Compliance Documentation, and concluded that it did not. Thus, an Addendum has been prepared in accordance with CEQA Guidelines Sections 15162 and 15164 (City Council Resolution No._). H. City and Developer have reached agreement, and desire to express herein a development agreement that will facilitate development of the Alternate Plan subject to conditions set forth herein; and I. On ,2007, the City Council of the City of Dublin adopted Ordinance No. _ -_approving this Agreement. The Ordinance took effect on , 2007 ("the Approval Date"). NOW, THEREFORE, with reference to the foregoing recitals and in consideration of the mutual promises, obligations and covenants contained herein, City and Developer agree as follows: AGREEMENT 1. Description of Property. The Property that is the subject of this Agreement is described in Exhibit A attached hereto. 2. Interest of Developer. The Developer has a legal or equitable interest in the Property in that it owns or holds a right to purchase the Property. 3. Relationship of City and Developer. It is understood that this Agreement is a contract that has been negotiated and voluntarily entered into by City and Developer, and that the Developer is not an agent of City. The City and Developer hereby renounce the existence of any form of joint venture or partnership between them. Nothing contained herein or in any document executed in connection herewith shall be construed as making the City and Developer joint venturers or partners. 4. Effective Date and Term. 4.1. Effective Date. The effective date of this Agreement shall be the date ("the Effective Date") upon which this Agreement is signed by the City. Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 3 of 16 June 5, 2007 /7 '1- 4.2. Term. The "Term" of this Agreement shall commence on the Effective Date and extend ten (10) years thereafter, unless said Term is otherwise terminated or modified by circumstances set forth in this Agreement. 5. Use of the Property. 5.1. Rioht to Develop. Developer shall have the vested right to develop and use the Project on the Property in accordance with the terms and conditions of this Agreement, the Alternate Approvals (as and when issued), and any amendments to any of them as shall, from time to time, be approved pursuant to this Agreement. 5.2. Permitted Uses. The permitted uses of the Property, the density and intensity of use, the maximum height, bulk and size of proposed buildings, provisions for reservation or dedication of land for public purposes and location and maintenance of on-site and off-site improvements, location of public utilities (operated by City) and other terms and conditions of development applicable to the Property, shall be those set forth in this Agreement, the Alternate Approvals and any amendments to this Agreement or the Alternate Approvals. 5.3. Additional Conditions. Provisions for the following ("Additional Conditions") are set forth in Exhibit 8 attached hereto and incorporated herein by reference. 5.3.1. Subsequent Discretionary Approvals. Conditions, terms, restrictions, and requirements for subsequent discretionary actions. (These conditions do not affect Developer's responsibility to obtain all other land use approvals required by the ordinances of the City of Dublin to be obtained from other regulatory agencies.) Currently, no future discretionary approvals (beyond the Alternate Approvals) are needed from City to develop the Project. None 5.3.2. Mitiqation Conditions. Additional or modified conditions agreed upon by the parties in order to eliminate or mitigate adverse environmental impacts of the Project or otherwise relating to development of the Project. See Exhibit B 5.3.3. Phasino. Timinq. Provisions that the Project be constructed in specified phases, that construction shall commence within a specified time, and that the Project or any phase thereof be completed within a specified time. Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 4 of 16 June 5, 2007 181 See Exhibit B 5.3.4. Financinq Plan. Financial plans which identify necessary capital improvements such as streets and utilities and sources of funding. See Exhibit B 5.3.5. Fees, Dedications. Terms relating to payment of fees or dedication of property. See Exhibit B 5.3.6. Reimbursement. Terms relating to subsequent reimbursement over time for financing of necessary public facilities. See Exhibit B 5.3.7. Miscellaneous. Miscellaneous terms. See Exhibit B 6. Applicable Rules, Requlations and Official Policies. 6.1. Rules re Permitted Uses. For the Term of this Agreement, the City's ordinances, resolutions, rules, regulations and official policies governing the permitted uses of the Property, governing density and intensity of use of the Property and the maximum height, bulk and size of proposed buildings shall be those in force and effect on the effective date of this Agreement. 6.2. Rules re Desiqn and Construction. Unless otherwise expressly provided in paragraph 5 of this Agreement, the ordinances, resolutions, rules, regulations and official policies governing design, improvement and construction standards and specifications applicable to the Project shall be those in force and effect at the time of the applicable discretionary approval, whether the date of that approval is prior to or after the effective date of this Agreement. Currently, no future discretionary approvals (beyond the Alternate Approvals) are needed from City to develop the Project. Ordinances, resolutions, rules, regulations and official policies governing design, improvement and construction standards and specifications applicable to public improvements to be constructed by Developer shall be those in force and effect at the time of the applicable discretionary approval, whether that date of approval is prior to or after the date of this Agreement. 6.3. Uniform Codes Applicable. Unless expressly provided in paragraph 5 of this Agreement, the Project shall be constructed in accordance DublinlTriad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 5 of 16 June 5, 2007 /0; '1 with the provisions of the Uniform Building, Mechanical, Plumbing, Electrical and Fire Codes and Title 24 of the California Code of Regulations, relating to Building Standards, in effect at the time of approval of the appropriate building, grading, or other construction permits for the Project. 7. Subsequently Enacted Rules and Requlations. 7.1. New Rules and Requlations. During the Term of this Agreement, the City may apply new or modified ordinances, resolutions, rules, regulations and official policies of the City to the Property which were not in force and effect on the effective date of this Agreement and which are not in conflict with those applicable to the Property as set forth in this Agreement if: (a) the application of such new or modified ordinances, resolutions, rules, regulations or official policies would not prevent, impose a substantial financial burden on, or materially delay development of the Property as contemplated by this Agreement and the Alternate Approvals, and (b) if such ordinances, resolutions, rules, regulations or official policies have general applicability. 7.2. Approval of Application. Nothing in this Agreement shall prevent the City from denying or conditionally approving any subsequent land use permit or authorization for the Project on the basis of such new or modified ordinances, resolutions, rules, regulations and policies except that such subsequent actions shall be subject to any conditions, terms, restrictions, and requirements expressly set forth herein. 7.3. Moratorium Not Applicable. Notwithstanding anything to the contrary contained herein, in the event an ordinance, resolution or other measure is enacted, whether by action of City, by initiative, referendum, or otherwise, that imposes a building moratorium, a limit on the rate of development or a voter- approval requirement which affects the Project on all or any part of the Property, such ordinance, resolution or other measure shall not apply to the Project, the Property, this Agreement or the Alternate Approvals, unless the building moratorium is imposed as part of a declaration of a local emergency or state of emergency as defined in Government Code 9 8558. 8. Subsequently Enacted or Revised Fees. Assessments and Taxes. 8.1. Fees. Exactions. Dedications. City and Developer agree that the fees payable and exactions required in connection with the development of the Project for purposes of mitigating environmental and other impacts of the Project, providing infrastructure for the Project and complying with the Eastern Dublin Specific Plan shall be those set forth in the Alternate Approvals and in this Agreement (including Exhibit B). The City shall not impose or require payment of any other fees, dedications of land, or construction of any public improvement or DublinlTriad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 6 of 16 June 5, 2007 201 facilities, shall not increase or accelerate existing fees, dedications of land or construction of public improvements, or impose other exactions in connection with the Alternate Approvals or any subsequent discretionary approval for the Property, except as set forth in the Alternate Approvals and this Agreement (including Exhibit B, subparagraph 5.3.5). 8.2. Revised Application Fees. Any existing application, processing and inspection fees that are revised during the Term of this Agreement shall apply to the Project provided that (1) such fees have general applicability; (2) the application of such fees to the Property is prospective only; and (3) the application of such fees would not prevent, impose a substantial financial burden on, or materially delay development in accordance with this Agreement. Developer has no vested right against such revised application, processing and inspection fees, but Developer does not waive its right to challenge the legality of any such application, processing and/or inspection fees under the controlling law then in place. 8.3. New Taxes. Any subsequently enacted city-wide taxes shall apply to the Project provided that: (1) the application of such taxes to the Property is prospective; and (2) the application of such taxes would not prevent, impose a substantial financial burden on, or materially delay development in accordance with this Agreement. Developer has no vested right against such new taxes, but Developer does not waive its right to challenge the legality of any such taxes under the controlling law then in place. 8.4. Assessments. Nothing herein shall be construed to relieve the Property from assessments levied against it by City pursuant to any statutory procedure for the assessment of property to pay for infrastructure and/or services which benefit the Property. 8.5. Vote on Future Assessments and Fees. In the event that any assessment, fee or charge which is applicable to the Property is subject to Article XIIID of the Constitution and Developer does not return its ballot, City may, only after providing reasonable notice to Developer (30 days minimum) of the assessment, fee or charge, count Developer's ballot as affirmatively voting in favor of such assessment, fee or charge. 9. Amendment or Cancellation. 9.1. Modification Because of Conflict with State or Federal Laws. In the event that state or federal laws or regulations enacted after the effective date of this Agreement prevent or preclude compliance with one or more provisions of this Agreement or require changes in plans, maps or permits approved by the City, the parties shall meet and confer in good faith in a reasonable attempt to Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 7 of 16 June 5, 2007 2/1- modify this Agreement to comply with such federal or state law or regulation. Any such amendment or suspension of the Agreement shall be approved by the City Council in accordance with Chapter 8.56. 9.2. Amendment bv Mutual Consent. This Agreement may be amended in writing from time to time by mutual consent of the parties hereto and in accordance with the procedures of state law and Chapter 8.56. 9.3. Insubstantial Amendments. Notwithstanding the provisions of the preceding subparagraph 9.2, any amendments to this Agreement which do not relate to (a) the Term of the Agreement as provided in subparagraph 4.2; (b) the permitted uses of the Property as provided in subparagraph 5.2; (c) provisions for "significant" reservation or dedication of land as provided in Exhibit B; (d) conditions, terms, restrictions or requirements for subsequent discretionary actions; (e) the density or intensity of use of the Project; (f) the maximum height or size of proposed buildings; or (g) monetary contributions by Developer as provided in this Agreement, shall not, except to the extent otherwise required by law, require notice or public hearing before either the Planning Commission or the City Council before the parties may execute an amendment hereto. City's Public Works Director shall determine whether a reservation or dedication is "significant" . 9.4. Cancellation bv Mutual Consent. Except as otherwise permitted herein, this Agreement may be canceled in whole or in part only by the mutual consent of the parties or their successors in interest, in accordance with the provisions of Chapter 8.56. Any fees paid pursuant to subparagraph 5.3 and Exhibit B of this Agreement prior to the date of cancellation shall be retained by City. 10. Term of Alternate Approvals. Notwithstanding Dublin Municipal Code section 8.96.020.D, the term of all of the Alternate Approvals shall be extended to and until the end of the Term of this Agreement. 11. Annual Review. 11.1. Review Date. The annual review date for this Agreement shall be between July 15 and August 15, 2008 and each July 15 to August 15 thereafter. 11.2. Initiation of Review. The City's Community Development Director shall initiate the annual review, as required under Section 8.56.140 of Chapter 8.56, by giving to Developer thirty (30) days' written notice that the City intends to DublinlTriad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 8 of 16 June 5, 2007 2-2--1 undertake such review. Developer shall provide evidence to the Community Development Director prior to the hearing on the annual review, as and when reasonably determined necessary by the Community Development Director, to demonstrate good faith compliance with the provisions of the Agreement. The burden of proof by substantial evidence of compliance is upon the Developer. 11.3. Staff Reports. To the extent practical, City shall deposit in the mail and fax to Developer a copy of all staff reports, and related exhibits concerning contract performance at least five (5) days prior to any annual review. 11.4. Costs. Costs reasonably incurred by City in connection with the annual review shall be paid by Developer in accordance with the City's schedule of fees in effect at the time of review. 12. Default. 12.1. Other Remedies Available. Upon the occurrence of an event of default, the parties may pursue all other remedies at law or in equity which are not otherwise provided for in this Agreement or in City's regulations governing development agreements, expressly including the remedy of specific performance of this Agreement. 12.2. Notice and Cure. Upon the occurrence of an event of default by either party, the nondefaulting party shall serve written notice of such default upon the defaulting party. If the default is not cured by the defaulting party within thirty (30) days after service of such notice of default, the nondefaulting party may then commence any legal or equitable action to enforce its rights under this Agreement; provided, however, that if the default cannot be cured within such thirty (30) day period, the nondefaulting party shall refrain from any such legal or equitable action so long as the defaulting party begins to cure such default within such thirty (30) day period and diligently pursues such cure to completion. Failure to give notice shall not constitute a waiver of any default. 12.3. No Damaqes Aqainst City. In no event shall damages be awarded against City upon an event of default or upon termination of this Agreement. 13. Estoppel Certificate. Either party may, at any time, and from time to time, request written notice from the other party requesting such party to certify in writing that, (a) this Agreement is in full force and effect and a binding obligation of the parties, (b) this Agreement has not been amended or modified either orally or in writing, or if so amended, identifying the amendments, and (c) to the knowledge of the certifying party the requesting party is not in default in the performance of its Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 9 of 16 June 5, 2007 2-3 ~ obligations under this Agreement, or if in default, to describe therein the nature and amount of any such defaults. A party receiving a request hereunder shall execute and return such certificate within thirty (30) days following the receipt thereof, or such longer period as may reasonably be agreed to by the parties. City Manager of City shall be authorized to execute any certificate requested by Developer. Should the party receiving the request not execute and return such certificate within the applicable period, this shall not be deemed to be a default, provided that such party shall be deemed to have certified that the statements in clauses (a) through (c) of this paragraph are true, and any party may rely on such deemed certification. 14. Mortqaqee Protection; Certain Riqhts of Cure. 14.1. Mortqaqee Protection. This Agreement shall be superior and senior to any lien placed upon the Property, or any portion thereof after the date of recording this Agreement, including the lien for any deed of trust or mortgage ("Mortgage"). Notwithstanding the foregoing, no breach hereof shall defeat, render invalid, diminish or impair the lien of any Mortgage made in good faith and for value, but all the terms and conditions contained in this Agreement shall be binding upon and effective against any person or entity, including any deed of trust beneficiary or mortgagee ("Mortgagee") who acquires title to the Property, or any portion thereof, by foreclosure, trustee's sale, deed in lieu of foreclosure, or otherwise. 14.2. Mortqaqee Not Obliqated. Notwithstanding the provisions of subparagraph 14.1 above, no Mortgagee shall have any obligation or duty under this Agreement, before or after foreclosure or a deed in lieu of foreclosure, to construct or complete the construction of improvements, or to guarantee such construction of improvements, or to guarantee such construction or completion, or to pay, perform or provide any fee, dedication, improvements or other exaction or imposition; provided, however, that a Mortgagee shall not be entitled to devote the Property to any uses or to construct any improvements thereon other than those uses or improvements provided for or authorized by the Alternate Approvals or by this Agreement. 14.3. Notice of Default to Mortqaqee and Extension of Riqht to Cure. If City receives notice from a Mortgagee requesting a copy of any notice of default given Developer hereunder and specifying the address for service thereof, then City shall deliver to such Mortgagee, concurrently with service thereon to Developer, any notice given to Developer with respect to any claim by City that Developer has committed an event of default. Each Mortgagee shall have the right during the same period available to Developer to cure or remedy, or to commence to cure or remedy, the event of default claimed set forth in the City's notice. City, through its City Manager, may extend the thirty-day cure period Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 10 of 16 June 5, 2007 2-Lf ~. provided in subparagraph 12.2 for not more than an additional sixty (60) days upon request of Developer or a Mortgagee. 15. Severabilitv. The unenforceability, invalidity or illegality of any provisions, covenant, condition or Term of this Agreement shall not render the other provisions unenforceable, invalid or illegal. 16. Attornevs' Fees and Costs. If City or Developer initiates any action at law or in equity to enforce or interpret the terms and conditions of this Agreement, the prevailing party shall be entitled to recover reasonable attorneys' fees and costs in addition to any other relief to which it may otherwise be entitled. If any person or entity not a party to this Agreement initiates an action at law or in equity to challenge the validity of any provision of this Agreement or the Alternate Approvals, the parties shall cooperate in defending such action. Developer shall bear its own costs of defense as a real party in interest in any such action, and shall reimburse City for all reasonable court costs and attorneys' fees expended by City in defense of any such action or other proceeding. 17. Transfers and Assiqnments. 17.1 Developer's Riqht to Assiqn. All of Developer's rights, interests and obligations hereunder may be transferred, sold or assigned in conjunction with the transfer, sale, or assignment of the Property subject hereto, or any portion thereof, at any time during the Term of this Agreement, provided that no transfer, sale or assignment of Developer's rights, interests and obligations hereunder shall occur without the prior written notice to City and approval by the City Manager of City, which approval shall not be unreasonably withheld or delayed. The City Manager shall consider and decide the matter within ten (10) working days after Developer's notice is given to City and receipt by City Manager of all necessary documents, certifications and other information required by City Manager to decide the matter. In considering the request, the City Manager shall base the decision upon the proposed assignee's reputation, experience, financial resources and access to credit and capability to successfully carry out the development of the Property to completion. The City Manager's approval shall be for the purposes of: (a) providing notice to City; (b) assuring that all obligations of Developer are fully allocated as between Developer and the proposed purchaser, transferee or assignee; and (c) assuring City that the proposed purchaser, transferee or assignee is capable of performing Developer's obligations hereunder not withheld by Developer pursuant to Paragraph 17.3. Notwithstanding the foregoing, provided notice is given as Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 11 of 16 June 5, 2007 251 specified in Paragraph 23, no City approval shall be required for any transfer, sale, or assignment of this Agreement to: (1) any entity which either (i) is an affiliate or subsidiary of Developer or (ii) results from the merger of Developer or its parent or is the purchaser of all, or substantially all, of the assets of Developer or its parent; (2) any Mortgagee; or (3) any transferee of a Mortgagee. 17.2 Release Upon Transfer. Upon the transfer, sale, or assignment of all of Developer's rights, interests and obligations hereunder pursuant to Paragraph 17.1 of this Agreement, Developer shall be released from the obligations under this Agreement, with respect to the Property transferred, sold, or assigned, arising subsequent to the date of City Manager approval of such transfer, sale, or assignment; provided, however, that if any transferee, purchaser, or assignee approved by the City Manager expressly assumes all of the rights, interests and obligations of Developer under this Agreement, Developer shall be released with respect to all such rights, interests and assumed obligations. In any event, the transferee, purchaser, or assignee shall be subject to all the provisions hereof and shall provide all necessary documents, certifications and other necessary information prior to City Manager approval. 17.3 Developer's Riqht to Retain Specified Riqhts or Obliqations. Notwithstanding Paragraphs 17.1 and 17.2 and Paragraph 18, Developer may withhold from a sale, transfer or assignment of this Agreement certain rights, interests and/or obligations which Developer shall retain, provided that Developer specifies such rights, interests and/or obligations in a written document to be appended to this Agreement and recorded with the Alameda County Recorder prior to the sale, transfer or assignment of the Property. Developer's purchaser, transferee or assignee shall then have no interest or obligations for such rights, interests and obligations and this Agreement shall remain applicable to Developer with respect to such retained rights, interests and/or obligations. 18. Aqreement Runs with the Land. All of the provisions, rights, terms, covenants, and obligations contained in this Agreement shall be binding upon the parties and their respective heirs, successors and assignees, representatives, lessees, and all other persons acquiring the Property, or any portion thereof, or any interest therein, whether by operation of law or in any manner whatsoever. All of the provisions of this Agreement shall be enforceable as equitable servitudes and shall constitute covenants running with the land pursuant to applicable laws, including, but not limited to, Section 1468 of the Civil Code of the State of California. Each covenant to do, or refrain from doing, some act on the Property hereunder, or with respect to any owned property, (a) is for the benefit of such properties and is Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 12 of 16 June 5, 2007 261 a burden upon such properties, (b) runs with such properties, and (c) is binding upon each party and each successive owner during its ownership of such properties or any portion thereof, and shall be a benefit to and a burden upon each party and its property hereunder and each other person succeeding to an interest in such properties. Developer may assign its benefits and burdens under this Agreement, subject to the provisions set forth above in paragraph 16 of this Agreement. 19. Bankruptcy. The obligations of this Agreement shall not be dischargeable in bankruptcy. 20. Indemnification. Developer agrees to indemnify, defend and hold harmless City, and its elected and appointed councils, boards, commissions, officers, agents, employees, and representatives from any and all claims, costs (including legal fees and costs) and liability for any personal injury or property damage which may arise directly or indirectly as a result of any actions or inactions by the Developer, or any actions or inactions of Developer's contractors, subcontractors, agents, or employees in connection with the construction, improvement, operation, or maintenance of the Project, provided that Developer shall have no indemnification obligation with respect to negligence or wrongful conduct of City, its contractors, subcontractors, agents or employees or with respect to the maintenance, use or condition of any improvement after the time it has been dedicated to and accepted by the City or another public entity (except as provided in an improvement agreement or maintenance bond). If City is named as a party to any legal action, City shall cooperate with Developer, shall appear in such action and shall not unreasonably withhold approval of a settlement otherwise acceptable to Developer. 21. Insurance. 21.1. Public Liability and Property Damaqe Insurance. During construction of the Project, Developer shall maintain in effect a policy of comprehensive general liability insurance with a per-occurrence combined single limit of not less than One Million Dollars ($1,000,000.00). The policy so maintained by Developer shall name the City as an additional insured and shall include either a severability of interest clause or cross-liability endorsement. 21.2. Workers Compensation Insurance. During construction, Developer shall maintain Worker's Compensation insurance for all persons employed by Developer for work at the Project site. Developer shall require each contractor DublinlTriad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 13 of 16 June 5, 2007 271 and subcontractor similarly to provide Worker's Compensation insurance for its respective employees. Developer shall indemnify the City for any damage resulting from Developer's failure to maintain any such insurance. 21.3. Evidence of Insurance. Prior to City Council approval of this Agreement, Developer shall furnish City satisfactory evidence of the insurance required in subparagraphs 20.1 and 20.2 and evidence that the carrier is required to give the City at least fifteen days prior written notice of the cancellation or reduction in coverage of a policy. The insurance shall extend to the City, its elective and appointive boards, commissions, officers, agents, employees and representatives and to Developer performing work on the Project. 22. Sewer and Water. Developer acknowledges that it must obtain water and sewer permits from the Dublin San Ramon Services District (UDSRSD") which is another public agency not within the control of City. 23. Notices. 23.1. All notices required or provided for under this Agreement shall be in writing. Notices required to be given to City shall be addressed as follows: City Manager City of Dublin 100 Civic Plaza Dublin, CA 94568 FAX No. (925) 833-6651 Notices required to be given to Developer shall be addressed as follows: Joseph D. Carroll Triad Partners, Inc. 8001 Irvine Center Drive, Suite 1000 Irvine, CA 92618 FAX No. (949) 679-4242 A party may change address by giving notice in writing to the other party and thereafter all notices shall be addressed and transmitted to the new address. Notices shall be deemed given and received upon personal delivery, or if mailed, upon the expiration of 48 hours after being deposited in the United States Mail. Notices may also be given by overnight courier which shall be deemed given the Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 14 of 16 June 5, 2007 :29 l' following day or by facsimile transmission which shall be deemed given upon verification of receipt. 24. Recitals. The foregoing Recitals are true and correct and are made a part hereof. 25. Aqreement is Entire Understandinq. This Agreement constitutes the entire understanding and agreement of the parties. 26. Exhibits. The following documents are referred to in this Agreement and are attached hereto and incorporated herein as though set forth in full: Exhibit A Legal Description of Property Exhibit B Additional Conditions Exhibit C Site Plan of Phase I and II Under the Original Approvals Exhibit D Site Plan of Phase I and II Under the Alternate Approvals 27. Counterparts. This Agreement is executed in two (2) duplicate originals, each of which is deemed to be an original. 28. Recordation. City shall record a copy of this Agreement within ten days following execution by all parties. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as of the date and year first above written. CITY OF DUBLIN: By: Date: Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC Page 15 of 16 June 5, 2007 Janet Lockhart, Mayor ATTEST: By: Date: Fawn Holman, City Clerk APPROVED AS TO FORM: Elizabeth H. Silver, City Attorney TRIAD DUBLIN GATEWAY, L.P., a California limited partnership By: Triad Partners, Inc., a California corporation, General Partner By: Joseph D. Carroll, President By: Richard T. Needham, Senior Vice President (NOTARIZATION ATTACHED) Dublin/Triad Dublin Gateway, L.P. Development Agreement for the Dublin Gateway Medical Center Project CLEAN_DA Dublin Gateway Medical Center_041007.DOC 2-1 1 Page 16 of 16 June 5, 2007 2'0 ~ Exhibit A Legal Description of the Property Parcels 3 and 4, as shown on Parcel Map 8524, filed November 23, 2005, in book 286 of Parcel Maps, pages 38-41 in the Office of the Recorder of Alameda County. Assessor Parcel Numbers 986-0016-021 and 986-0016-022, respectively. Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT A 3/ '1 {Z0 EXHIBIT B Additional Conditions The following Additional Conditions are hereby imposed pursuant to paragraph 5.3 of this Agreement. Subparaaraph 5.3.1 -- Subseauent Discretionary Approvals None. Subparaaraph 5.3.2 -- Mitiaation Conditions Subsection a. Infrastructure Seauencina Proaram The Infrastructure Sequencing Program for the Project is set forth below. (i) Roads: The project-specific roadway improvements (and offers of dedication) identified in Resolution No. 07-_ of the City Council of the City of Dublin approving Site Development Review (hereafter "SDR Resolution") shall be completed by Developer to the satisfaction of the Public Works Director at the times and in the manner specified in the SDR Resolution unless otherwise provided below. All such roadway improvements shall be constructed to the satisfaction and requirements of City's Public Works Director. (ii) Sewer. All sanitary sewer improvements to serve the project site (or any recorded phase of the Project) shall be completed in accordance with DSRSD requirements. (iii) Water. An all weather roadway and an approved hydrant and water supply system shall be available and in service at the site in accordance with the tentative map conditions of approval to the satisfaction and requirements of the City's fire department. All potable water system components to serve the project site shall be completed in accordance with the DSRSD requirements. Recycled water lines shall be installed in accordance with the SDR Resolution. (iv) Storm Drainaae. Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B 32- 't (A) The storm drainage systems off-site, as well as on- site drainage systems for the areas to be occupied, shall be improved consistent with the Drainage Plan and conditions of approval and to the satisfaction and requirements of the Dublin Public Works Department applying City's and Zone 7 (Alameda County Flood Control and Water Conservation District, Zone 7) standards and policies which are in force and effect at the time of issuance of the permit for the proposed improvements. Pursuant to Alameda County's National Pollution Discharge Elimination Permit (NPDES) No. CAS0029831 with the California Regional Water Quality Control Board, all grading, construction, and development activities within the City of Dublin must comply with the provisions of the Clean Water Act. Proper erosion control measures must be installed at development sites within the City during construction, and all activities shall adhere to Best Management Practices. (v) Other Utilities (e.a. aas. electricitv. cable televisions. telephone) Construction shall be completed by phase prior to issuance of the first Certificate of Occupancy for any building within that specific phase of occupancy. Subsection b. Miscellaneous (i) Completion Mav Be Deferred. Notwithstanding the foregoing, City's Public Works Director may, in his or her sole discretion and upon receipt of documentation in a form satisfactory to the Public Works Director that assures completion, allow 'Developer to defer completion of discrete portions of any public improvements for the Project if the Public Works Director determines that to do so would not jeopardize the public health, safety or welfare. Subparaaraph 5.3.3 -- Phasina. Timina This Agreement contains no requirements that Developer must initiate or complete development of the Project within any period of time set by City. It is the intention of this provision that Developer be able to develop the Property in accordance with its own time schedules and the Alternate Approvals. Subparaaraph 5.3.4 -- Financina Plan Developer will install all improvements necessary for the Project at its own cost (subject to credits for any improvements which qualify for credits as provided in subparagraph 5.3.6 below). DublinlTriad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B 33 ~ Other infrastructure necessary to provide sewer, potable water, and recycled water services to the Project will be made available by the Dublin San Ramon Services District. Developer will enter into an "Area Wide Facilities Agreement" with the Dublin San Ramon Services District to pay for the cost of extending such services to the Project. Such services shall be provided as set forth in subparagraph 5.3.2(a)(ii) and (iii) above. Subparaaraph 5.3.5 -- Fees. Dedications Subsection a. Traffic Impact Fees. Developer shall pay the Eastern Dublin Traffic Impact Fee ("TIF") established by Resolution No. 111-04, including any future amendments to such fee. Developer will pay such fees, in cash or credits: 1) no later than the time of issuance of grading/sitework permits for the hospital building and in the amount of the impact fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the impact fee in effect at time of building permit issuance for the parking structure. Developer further agrees that it will pay eleven percent (11 %) of the "Section 1/Category 1" portion of the TIF in cash. Developer also agrees that it will pay twenty-five percent (25%) of the "Section 2/Category 2" portion of the TIF in cash. If City amends its TIF fee and as a result the City's outstanding balance due on loans is less than 25% of total Section 2/Category 2 improvements, the Developer shall pay such reduced percentage of the "Section 2/Category 2" portion of the TIF in cash. Subsection b. Traffic Impact Fee to Reimburse Pleasanton for Freewav Interchanaes. Developer shall pay the Eastern Dublin 1-580 Interchange Fee established by City of Dublin Resolution No. 11-96 as amended by Resolution No. 155-98 and by any subsequent resolution which revises such Fee. Developer will pay such fee: 1) no later than the time of issuance of grading/sitework permits for the hospital building and in the amount of the impact fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the impact fee in effect at time of building permit issuance for the parking structure. Subsection c. Public Facilities Fees. Developer shall pay a Public Facilities Fee established by City of Dublin Resolution No. 214-02, including any future amendments to such fee. Developer will pay such fees: 1) no later than the time of issuance of grading/sitework DublinlTriad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B 61f~ permits for the hospital building and in the amount of the fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the fee in effect at time of building permit issuance for the parking structure. Subsection d. Noise Mitiaation Fee. Developer shall pay a Noise Mitigation Fee established by City of Dublin Resolution No. 33-96, including any future amendments to such fee. Developer will pay such fees: 1) no later than the time of issuance of grading/sitework permits for the hospital building and in the amount of the fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the fee in effect at time of building permit issuance for the parking structure. Subsection e. School Impact Fees. School impact fees shall be paid by Developer in accordance with Government Code section 53080 and the agreement between Developer's predecessor in interest and the Dublin Unified School District regarding payment of mitigation fees. Subsection f. Fire Impact Fees. Developer shall pay a fire facilities fee established by City of Dublin Resolution No. 12-03 including any future amendments to such fee. Developer will pay such fees: 1) no later than the time of issuance of grading/sitework permits for the hospital building and in the amount of the impact fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the impact fee in effect at time of building permit issuance for the parking structure. Subsection g. Tri-Valley Transportation Development Fee. Developer shall pay the Tri-Valley Transportation Development Fee in the amount and at the times set forth in City of Dublin Resolution No. 89-98 or any subsequent resolution which revises such fee. Developer will pay such fees: 1) no later than the time of issuance of grading/sitework permits for the hospital building and in the amount of the fee in effect at time of grading/sitework permit for the hospital building; and 2) no later than the time of issuance of building permits for the parking structure and in the amount of the fee in effect at time of building permit issuance for the parking structure. Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B 35 11Zz/ Subparaaraph 5.3.6 -- Credit Subsection a. Traffic Impact Fee Improvements -- Credit City shall provide a credit to Developer for those improvements described in the resolution establishing the Eastern Dublin Traffic Impact Fee if such improvements are constructed by the Developer in their ultimate location. All aspects of the credit shall be covered by City's Administrative Guidelines for Eastern Dublin Traffic Impact Fees (Resolution No. 23-99 ("TIF Guidelines")). Subsection b. Traffic Impact Fee Riaht-of-Way Dedications -- Credit City shall provide a credit to Developer for any TIF area right-of-way to be dedicated by Developer to City which is required for improvements which are described in the resolution establishing the Eastern Dublin Traffic Impact Fee. All aspects of the credits shall be governed by the TIF Guidelines. Subparaaraph 5.3.7 - Miscellaneous Subsection a. Community Benefit Payment. Developer, as a means of ensuring compliance with Section 10.4 and Policy 10-1 of the Eastern Dublin Specific Plan, has offered to pay to City a community benefit payment in the amount of two million ninety-three thousand eight-hundred and seventy-two dollars ($2,093,872.00) (the "Community Benefit Payment"). The EIR prepared for the Eastern Dublin EIR assumed that project- generated revenues, including property tax revenues, would be sufficient to pay for city services necessary to serve new development and determined that no mitigations were necessary. The Community Benefit Payment is designed to mitigate the potential impact of the loss of property tax that may result if the owner or operator of the Hospital were to apply for a property tax exemption and the Hospital were to be taken off the property tax rolls. Therefore, in addition to any other fees and payments due and payable, Developer hereby agrees to, at the time of the issuance of a grading permit to facilitate the construction of the Hospital under the Alternate Plan, make the Community Benefit Payment, which shall be non-refundable. If Developer fails to make the Community Benefit Payment as set forth in this subsection, then Developer agrees that the City may withhold the issuance of such grading permit. Notwithstanding the foregoing, Developer shall not be required to make the Community Benefit Payment at the time of the issuance of a grading permit to facilitate the construction of the Hospital under the Alternate Plan, if Developer provides evidence satisfactory to the City Manager that the owner of the Property, when the Hospital commences operation, will not be eligible for a welfare exemption under Revenue and Taxation Code section 214. However, if during the Term of this Agreement the Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B 36 ~ Property becomes exempt from taxation under Revenue and Taxation Code section 214, then Developer shall be obligated to make the Community Benefit Payment. Developer, on behalf of itself and its approved successors and assigns, acknowledges that failure to pay the Community Benefit Payment as required by this subsection shall constitute grounds for revocation of the Hospital Conditional Use Permit referenced in Recital D. Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT B ~71 EXHIBIT C Site Plan of Phase I and II Under the Original Approvals Jr'" I 11,/ r/' r~ III .L !I TL "! Illllllllllllr ~ lJ'li\iW,ll.:lU JtJ\I'{~ tl'~ :'%'1' , ,~l' I -"''''~,- '...,......"..<> ...,," """,,,. ."u"'HR. '''''''''_0 '.",."'...., NN~" / = ~ .. I.4\l OJ ~ DUBUN CATEWAY MEDICAl CENTER Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT C 081 EXHIBIT D Site Plan of Phase I and Phase II Under the Alternate Approvals DUBLIN BOULEVARD ......1 t:::l ~ Cl:: ~ ~ l:li (,) ~ "" ') Dublin/Triad Dublin Gateway, L.P. Development Agreement For the Dublin Gateway Medical Center Project-EXHIBIT D dCJ~ I;).r Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25. 2005 (P A 04-046) Amended by Ordinance by the City Council on , 2007 (P A 06-026) EXHIBIT A DEVELOPMENT PLAN General Provisions This is a Development Plan pursuant to Chapter 8.32 of the Dublin Zoning Ordinance for the Koll Corporate Center project, located on the south side of Dublin Boulevard, east of Tassajara Creek, West of Tassajara Road, and north of Interstate 580 (APN 986-0001-001- 10, portion). This Development Plan meets all of the requirements for Stage 1 and Stage 2 review of the project. This De'o'elopment Plan is also represented by the Tentati'/e Map and Site Development R&'/iew plans, the Landscape Plans, other plans, exhibits, and vmtten statements contained in the document dated received October 30, 1998, labeled Exhibit ,^.. 1 to the Resolution approving this Developmeftt Plan (City Council Resolution ,\'0. 98 ), and on file in the Planning Department. The Planned Development District allows the flexibility needed to enCOlH'age innovative development while ensuring that the goals, policies and action programs of the General Plan, Eastern Dablin Specific Plan, and provisions of Section 8.32 of the Zoning Ordinance are satisfied. This Development Plan was subseQuently amended by Planninl! Commission Resolution 04-55 for the Ulferts Center project on AUl!ust 24. 2004. The amendments included the removal of the hotel desil!nation on Lots 1 and 2 and allowed for the development of retail commercial uses on the entire property. This Development Plan was subseQuently amended for the Dublin Gateway Medical Center project on January 25. 2005. The amendment allowed for massal!e establishments in conjunction with physical therapy to be a permitted use. rather than conditional use. consistent with the rel!ulations set forth in the Dublin Zoninl! Ordinance. This Development Plan was subseQuently amended for the Dublin Gateway Medical Center Buildinl! 3 Hospital and Garal!e project on rINSERT DATE1. 2007. The amendments allowed for am alternative development proiect on a portion of Lot 7 of Map 7064 otherwise known as Lots 3 & 4 of Map 8524: an increase in SQuare footal!e on Lot 7 of Map 7064: revisions to the site plan and landscape plan: and. revisions to the development ret!Ulations. This Development Plan is also represented by the following: · Tentative Map 7064 and Site Development Review plans, Landscape plans, and other plans, exhibits, and written statements contained in the document dated received October 30, 1998, labeled Exhibit A-I to the Ordinance approving this Development Plan (City lof8 Attachment 3 /.jO 1- Amended by Resolution 04-55 by the Planning Commission on August 24.2004 (PA 03-064) Amended bv Resolution 05-06 by the Planning Commission on January 25. 2005 (P A 04-046) Amended by Ordinance by the City Council on . 2007 (P A 06-026) Council Ordinance No. 22-98), on file in the Planning Division. · Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the proiect approved as part of Planning Commission Resolution 04-55 for the Ulferts Center (P A 03-064), on file in the Plarming Division. . Tentative Map 8524 and Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the proiect approved as part of Planning Commission Resolution 05-06 for the Dublin Gateway Medical Center (P A 04-046), on file in the Planning Division. · Site Development Review plans, Landscape plans, and other plans, exhibits and written statements relating to the proiect approved as part of Ordinance rINSERT ORDINANCE NO.1 for the Dublin Gateway Medical Center Building 3 Hospital and Garage (PA 06- 026), on file in the Planning Division. This Planned Development Zoning District, as amended, allows the flexibility needed to encourage innovative development while ensuring that the goals, policies, and action programs of the General Plan, Eastern Dublin Specific Plan, and provisions of Section 8.32 of the Zoning Ordinance are satisfied. 1. Permitted Uses. The following uses are permitted for this "PD / C-2 / C-O" (Planned Development/General Commercial/Campus Office) Zoning District site.:: a) BarIks & Financial Services; b) Contractor's Office; c) Copying & Blueprinting; d) Eating & Drinking Establishments; e) Health Services/Clinics; f) Laboratory; g) Professional/Administrative Offices; h) Parking Lot/Garage - Commercial; i) Retail- General; j) Retail- Neighborhood; k) Retail - Service; I) Day Care of 14 or fewer children; m) School- trade school, college, university; n) Similar and related uses as determined by the Director of Community Development; and, 0) Massage Establishments, in coni unction with physical therapy. Amended bv PC Reso. 05-06 (01/25/05) *See "**NOTE" on Paf!e 5 ref!ardinf! uses on Lot 3 of Map 8524. 2of8 .4/1 Amended by Resolution 04-55 by the Planning Commission on August 24, 2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25, 2005 (P A 04-046) Amended by Ordinance by the City Council on , 2007 (P A 06-026) 2. Conditional Uses.~ a) AutomobileN ehicle Brokerage, Rental; b) Building Materials Sales; c) Mini-Storage; d) Storage of petroleum products for on-site use; e) Warehousing and distribution; f) Community Facility; g) Massage Establishments, in conjunction with a gymnasium/health club, physical therapy; Amended bv PC Reso. 05-06 (01/25/05) h) Day Care Center - 15+ children; i) Outdoor Mobile Vendor; j) Outdoor Seating; k) Temporary Outdoor Sale not related to on-site established business (sidewalk sale); I) Caretaker Residence; m) Hospital/Medical Center; n) Animal Sales and Services; 0) Auction Yard; p) AutomobileN ehicle Sales and Service; q) Bed and Breakfast inn; r) Car Wash/Detailing; s) Community Care Facility - Large; t) Dance Floor; u) Drive-inlDrive-through business; v) Hotel/Motel; w) Plant Nursery; x) Recreational Facility/Indoor; y) Recreational Facility/Outdoor; z) Retail- outdoor storage; aa) Service Station; bb) Shopping Center; and, cc) Similar and related uses as determined by the Director of Community Development. *See "**NOTE" on Paf!e 5 ref!ardinf! uses on Lot 3 of Map 8524. 3. Dublin Zoning Ordinance, Applicable Requirements. Except as specifically modified by the provisions of this PD District Rezone/Development Plan, all applicable general requirements and procedures of the Dublin Zoning Ordinance shall be applied to the land 3of8 if 2- ':/ Amended by Resolution 04-55 by the Planning Commission on August 24. 2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25. 2005 (P A 04-046) Amended by Ordinance by the City Council on . 2007 (P A 06-026) uses designated in this PD District Rezone. 4. Site Plan & Architecture. See attached site and eleyation plans contained in Exhibit .^.. 1, De-yelopment Plan. This De','elopment Plan applies to the approximately 37 acre site ShO'lI11 on this plan on the south side of Dublin Boule'iard, ,;,'est side of Tassajara Road. This Development Plan applies to the approximately 37-acre site generally located south of Dublin Boulevard. north of Interstate 580. west of Tassaiara Road and east of John Monego Court. Any modifications to the project, or development on the future hotel/retail site (Phase 3), shall be substantially consistent with these plans and of equal or superior materials and design quality. Development on the future hotel/retail site (Phase 3) requires approval of Site Development Review by the City of Dublin. The development of the future hotel/retail site (Phase 3) was modified bv Planninfl Commission Resolution 04-55 for the Ulferts Center. The following site plans and elevations are hereby incorporated by reference: Amended bv Ord. flNSERT ORDINANCE NO.1 (INSERT DATE) . Ordinance 22-98 for the Koll Dublin Corporate Center. Exhibit A-I (P A 98-047). . Planning Commission Resolution 04-55 for the Ulferts Center (P A 03-064). . Planning Commission Resolution 05-06 for the Dublin Gateway Medical Center (P A 04-046). . Ordinance [INSERT ORDINANCE NO.1 and Planning Commission Resolution [INSERT RESOLUTION NO.] for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06-026). 5. Density. The maximum square footage of the proposed development for the parcels covered under this Development Plan (as shown on the applicable site plan~) is as follows: Lot 1, Tract 7064 (FutlHe retail site): 1.6 aeres 7,000 square f~et building area* Lot 1 & 3. Tract 7064 (Retail site): 1.6 acres & 2.6 acres. respectively 50.530 square feet building area* Amended bv PC Reso. 04-55 (AUflust 24. 2004) Lot 2, Tract 7064 (Future Retail site): 1.6 acres 7~000 square feet building area* Lot 3, Tract 7064 (Future hotel site): 2.6 acres 85,000 square feet building area* Lot 4, Tract 7064 (4-story office building): 5.53 acres 139,285 square feet building area 4of8 Lf.3 rJ Amended by Resolution 04-55 by the Planning Commission on August 24.2004 (PA 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25.2005 (PA 04-046) Amended by Ordinance by the City Council on . 2007 (P A 06-026) Lot 5, Tract 7064 (4-story office building): 6.67 acres 139,285 square feet building area Lot 6, Tract 7064 (4-story office building): 6.42 acres 139,285 square feet building area Lot 7, Tract 7064, (6 story office building): 7.11 acres 178,849 square feet building area Lot 7 of Tract 7064 has been further divided as follows: Amended bv CDD Reso. 05-01 (Februarv 28. 2005) Amended bv PC Reso. 05-06 (Januarv 25.2005) Amended bv Ord. {INSERT ORD. NO. AND DATEl Lot 1. Map 8524 (3-storv office building) 3.000 acres 62.300 square feet building area Lot 2. Map 8524 (3-story office building) 1.009 acres 57.700 square feet building area Lot 3. Map 8524 (3-story office building) 1.545 acres 58.000 square feet building area OR 168.000 square feet building area** Lot 4. Map 8524 1.585 acres 4-level parking garage OR 5-level parking garage** Total Building Area: 178.000 square feet OR 292.000 square feet** Lot 8, (Park & Ride facility): 1. 74 acres No building area (parking only) *NOTE: Densities for Lots 1, 2, and 3 may be combined and re-allocated among these three lots in any manner within this portion of the project site, but must be used for General Commercial/Retail uses and a hotel, unless an amendment to this Planned Development is approved. An amendment to the Planned Development was approved bv Plannin1! Commission Resolution 04-55 on AU/lust 24. 2004. This amendment removed the hotel desi1!nation from Lots 1 and 3 and allowed for the development of retail commercial uses instead. **NOTE: This Development Plan allows for the development of either: 1) a 3-story. 58.000 square foot medical office building on Lot 3 of Map 8524 and 4-level above ground parking garage on Lot 4 of Map 8524 OR 2) a 6-story. 168.000 square foot. 100- bed hospital on Lot 3 of Map 8524 and 5-level parking garage on Lot 4 of Map 8524 with 5of8 YL( ~/ Amended by Resolution 04-55 by the Planning Commission on August 24.2004 CPA 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25.2005 CPA 04-046) Amended by Ordinance by the City Council on . 2007 CPA 06-026) one level below ground and 4-levels above ground. At no time shall the 6-story hospital building on Lot 3 of Map 8524 be utilized for any other use than a hospital without an amendment to this Development Plan. 6. Phasing Plan. The Corporate Center will be developed in three phases. The First phase will include the three, four-story office buildings, Park & Ride lot, perimeter landscaping, on-site entrance roads, and associated site work. The Second phase will be the signature, six-story office building at the comer of Dublin Boulevard and Tassajara Road (Amended bv Plannim! Commission Resolution 05-06 on Januarv 25, 2005). The Third phase will include the Hotel/Retail parcel, which will likely be sold to a separate hotel developer (Amended bv Planninf! Commission Resolution 04-55 on AUf!ust 24, 2004). Third phase uses could be constructed after the first phase when a critical mass of on-site customer support is created. Any hotel/retail uses proposed for the vacant parcel (Lots 1, 2, and 3) must be consistent with the standards established by this Development Plan, and will require approval of a Site Development Review by the City of Dublin Planning Commission (Amended bv Planninf! Commission Resolution 04-55 on AUf!ust 24, 2004). 7. Landscaping Plan. Development Plan. reference: Refer to attachod landscaping plans included in Exhibit .^.. 1, The following landscaping plans are hereby incorporated by . Ordinance 22-98 for the Koll Dublin Corporate Center. Exhibit A-I (P A 98-047). . Pinewave Design and Engineering. 3 sheets. dated received by the Planning Division on August 17.2004 for the Ulferts Center (PA 03-064). Amended bv PC Reso. 04-55 (Auf!ust 24, 2004) . Ware Malcomb. 3 sheets. dated received by the Planning Division on January 11. 2005 for the Dublin Gateway Medical Center (P A 04-046). Amended bv PC Reso. 05-06 (01/25/05) . Ware Malcomb and Ridge Landscape Architects. dated received by the Planning Division on February 26.2007 for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06-026). Amended bv Ord. (Date) 8. Development Standards. Refer to attached Deyelopment Regulations included in Exhibit A 1, De'.'elopment Plan. The development regulations for the proiect are hereby incorporated by reference: . Ordinance 22-98 for the Koll Dublin Corporate Center. Exhibit A-I (P A 98-047). 6of8 4-51 Amended by Resolution 04-55 by the Planning Commission on August 24,2004 (PA 03-064) Amended bv Resolution 05-06 by the Planning Commission on January 25,2005 (PA 04-046) Amended by Ordinance by the City Council on , 2007 (P A 06-026) . Pinewave Design and Engineering dated received by the Planning Division on August 17,2004 for the Ulferts Center (PA 03-064). Amended bv PC Reso. 04- 55 (Au!!ust 24. 2004) . Ware Malcomb. dated received by the Planning Division on January 1 L 2005 for the Dublin Gateway Medical Center (P A 04-046). Amended bv PC Reso. 05-06 (01/25/05) . Ware Malcomb. dated received by the Planning Division on February 26. 2007 for the Dublin Gateway Medical Center Building 3 Hospital and Garage (P A 06- 026). Amended bv Ord. - (Date) The development of Lots 3 and 4 of Parcel Map 8524 (formerly a portion of Lot 7 of Tract Map 7064) shall be peimitted to have: . A 3-story. 58.000 square foot medical office building (Lot 3) and 4-level above ground parking garage (Lot 4) approved as part of Planning Commission Resolution 05-06. OR . A 6-story. 168.000 square foot. 100-bed hospital building (Lot 3) and 5-level parking garage (Lot 4) with one level below ground and 4 levels above ground approved as part of Ordinance - and Planning Commission Resolution - . The 5-level parking garage approved in coni unction with the 6-story hospital building may also be constructed with the 3-story medical office building so long as one level of parking remains underground and only 4-1evels of parking above ground. NOTE: Any increase in the maximum square footage on Lot 3 of Map 8524. including the addition of a basement for equipment or any other use. shall require an amendment to this Development Plan and shall be subiect to review by the Planning Commission with a recommendation to City Council. 9. General Provisions. A) The project applicant/developer shall enter into a Development Agreement with the City of Dublin prior to Final Map approval, which shall contain, but not be limited to, provisions for financing and timing of on and off-site infrastructure, payment of traffic, noise and public facilities impact fees, ownership and maintenance of creek and open space areas, and other provisions deemed necessary by the City to find the project consistent with the Eastern Dublin Specific Plan. B) The project applicant/developer shall be required to pay a Public Facilities Fee in the amounts and at the times set forth in City of Dublin Resolution No. 32-96, adopted 7of8 qC:> ~ Amended by Resolution 04-55 by the Planning Commission on August 24. 2004 (P A 03-064) Amended by Resolution 05-06 by the Planning Commission on January 25. 2005 (P A 04-046) Amended by Ordinance by the City Council on . 2007 (P A 06-026) by the City Council on March 26, 1996, or in the amounts and at the times set forth in any resolution revising the amount of the Public Facilities Fee. 8of8 4111;;>1" (!J DUBLIN CITY COUNCIL PROPOSED HOSPITAL In considering the proposal to develop a new hospital in Dublin, it is my sincere hope that the council will consider the following issues in their deliberations: 1. Hospital Need: Valley Medical Center (137) and San Ramon Regional Medical Center (123) currently provide for the health care needs of the greater Tri- Valley area. Should the City Council evaluate the unmet community health needs? Should the City Council discuss those needs with the existing local hospitals to address current perceived health care delivery deficiencies? Has the Council examined current and future bed and service needs? 2. Hospital Services: The type of hospital proposed will have a dramatic impact on the City Council's evaluations. If the hospital has a high outpatient component, higher traffic and parking needs will be required. If the hospital fills the need for psychiatric and substance abuse, security and admission severity should be scrutinized to a higher degree. If the hospital features a single specialty, the City should consider if its community needs will be met if}t is an orthopedic or a cardiology specialty service only. 3. Builder Experience: Hospitals are complex, highly regulated entities. The applicant has indicated that he has no experience in building a hospital and is unfamiliar with regulations and safety features inherent in all hospitals. The Council will want some assurance that an experienced architect and builder will provide the City with something other than a pretty building which may end up being dysfunctional and not meet the needs of your constituents. Attachment 4 lIB '} cD . . ", ,.~ 4. Facility Ambiguity: The Council should receive unambiguous plans from the builder since it is unclear from the current drawings whether the building will be used exclusively for Hospital services or a combination of Medical Office Building and Hospital functions. It appears that the builder is seeking approval to construct a hospital dressed as a Medical Office Building without the basic components of a working hospital. 5. Facility Deficiencies: . All single rooms must have a minimum floor capacity of 110 square feet and have sufficient space to accommodate toilet rooms, wardrobe, entry vestibules and fixed furnishings or equipment. There is not enough detail in the submitted drawings to fulfill the Title 24 requirements. . There is a requirement for one negative pressure isolation room per 35 beds with separate anteroom, hand washing fixtures, work counter, stored clean and soiled materials and an adjoining toilet. It is not clear that the proposed hospital could accommodate these square foot requirements and no such required rooms are shown. . There is no space for surgery, Clinical lab, Radiology, pharmaceutical and dietetic services required of all hospitals of 100 beds or more. . Even the minimum central supply and sterilizing areas are not designated on the plan. Rooms and spaces must accommodate soiled work areas, clean work areas, sterilizing and storage space. !; q '{)/. ~ (]) . Hospital codes require 20 square feet of general storage per bed (2,000 sq ft for this 100 bed hospital and specialized storage for linen, sterile and unsterile supplies must be provided. . A host of other requirements focused on patient and employee safety are not addressed in this plan 6. Facility Circulation and Community Impact Issues. . Has the City conferred with Fire, Police and Emergency Services to determine fire and life safety issues. . The location of the Emergency Department is critical to the affect on traffic, emergency access and can have a direct impact on patient lives. What will the noise impact be on the surrounding neighborhood? . A great deal of time was spent in the Planning Commission regarding the location and capacity of the truck dock. The Council may wish to examine this component more closely as it appears to be undersized and the number of transports was underestimated. . The Council may wish a closer look at how bio-hazardous waste will be handled and disposed both in terms of location and access. . Hospitals require a large amount of power. Will there be a co-generation plant on site and has emergency power issues been fully explored. . Can the existing sewer system handle the additional capacity? t ' 150 Gf /f @ "r"" . THERE ARE ruST TOO MANY UNANSWERED QUESTIONS IN THIS PROJECT FOR THE CITY COUNCIL TO MOVE FORWARD AND APPROVE THIS PROJECT AT THIS TIME. I KNOW THE COUNCIL'S PRIMARY CONCERNS ARE MEETING THE NEEDS OF THE COMMUNITY AND PROVIDING THE NECESSARY SAFEGUARDS TO THE CITIZENS OF DUBLIN. THEREFORE, I URGE THE COUNCIL TONIGHT TO ENGAGE A KNOWLEDGEABLE HEALTH CARE EXPERT TO ASSIST IN YOUR DELIBERATIONS AND EV ALUA TION OF THIS PROJECT. ;t;~ 51 of /2-7-- STEWART WEINBERG DAVID A ROSENFELD WilLIAM A. SOKOL VINCENT A. HARRiNGTON, JR. iN, DANIEL BOONE BLYTHE MICKELSON BARRY E HINKLE JAMES RUTKOWSKI. SANDRA RAE BENSON CHRISTIAN L. RAtSNER JAMES J, WESSER THEODORE FRANKLIN ANTONIO RUIZ MATTHEW J, GAUGER ASHLEY K. IKEDA .. LINDA BALDWIN JONES PATRICIA A. DAVIS ALAN G. CROWLEY J. FELIX DE LA TORRE KRISTINA L. HILUvtAN... ANDREA LAIACONA EMILY P RICH WEINBERG, ROGER & ROSENFELD A PROFESSIONAL CORPORATION 1001 Marina Village Parkway, Suite 200 Alameda, CA 94501-1091 TELEPHONE 510.337.1001 FAX 510.337.1023 LORI K. AQUINO .. ANNE I. YEN NICOLE M. PHILLIPS BROOKE D PIERMAN... BRUCE A. HARLAND CONCEPCION E. LOZANO~BATISTA CAREN P. SENCER LlNELLE S. MOGADO MANJARI CHAWLA KRISTINA M. ZINNEN PATRICIA M. GATES, Of Counsel ROBERT A D. PERKINS, Of Counsel JOHN PLOTZ, Of Counsel . Also admiRed in Arizona .. Admitted in Hawaii ... Also admitted in Nevada May 15,2007 VIA HAND DELIVERY Mamie R. Nuccio, Associate Planner City of Dublin Community Development Department, Planning Division 100 Civic Plaza, Dublin CA 94568 Re: P A 06-026 Dublin Gatewav Medical Center Building 3 Hospital and Garage Dear Ms. Nuccio: This letter comments on the Initial Study for the Dublin Gateway Medical Center Building 3 Hospital and Garage ("Project") for which the applicant, Joseph D. Carroll on behalf of the Triad Dublin Gateway, L.P. ("the Developer") seeks approval of a Planned Development Rezone, Conditional Use Permit, Site Development Agreement, and an addendum to a prior Environmental Impact Report ("EIR"). We write on behalf of Service Employees International Union, United Health Care Workers West ("SEIU-UHW"), a union of over 140,000 California healthcare workers, pursuant to 14 Cal. Code Regs S 15204. Although SEIU-UHW recognizes the important role that a new hospital may play in providing necessary and essential services to the community, there are serious deficiencies in the Initial Study that need to be addressed by a supplemental EIR before the Project proceeds further. The Initial Study does not comply with the requirements of the California Environmental Quality Act ("CEQA"), Public Resources Code S 21000 et seq., as explained more fully below. Unless an adequate EIR is prepared and circulated for public review and comment, the City may not approve the Project or grant any permits for the Project. Along with many thousands of members of the general public, SEIU-UHW members live, work, and pay taxes in the area affected by the Project. They are concerned about sustainable land use and development in the City of Dublin and the development of health care facilities that embody sound environmental principles. Poorly planned and environmentally detrimental projects may jeopardize future jobs by inspiring a backlash against necessary and appropriate expansion of health care facilities that may employ SEIU-UHW's members. Additionally, SEIU-UHW's members live in thecommunitiesthatsuffertheimpacts of environmentally detrimental projects. Union members breathe the same polluted air, encounter the same traffic congestion, endure the same noise pollution, and suffer the same health impacts as other members of the nearby community. Furthermore, SEIU-UHW members are also patients and caregivers in the East Bay LOS ANGELES OFFICE 3435 Wilshire Boulevard. Suite 620 Los Angeles, CA 90010-1907 TEL 213.380.2344 FAX 213.381.1088 SACRAMENTO OFFICE 428 J Street, Suite 520 Sacramento. CA 95814-2341 TEL 916.443.6600 FAX 916.442.0244 HONOLULU OFFICE 1099 AJakea Street, Suite 1602 Honolulu, HI 96813-4500 TEL 808.528~8880 FAX 808.528.8881 Attachment 5 52- 1- I),.. :2.- May 15, 2007 Mamie R. Nuecio;- Associate Planner Page 2 community. SEIU-UHW wishes to ensure that expanded medical facilities are constructed in a manner that safeguards the health and safety of patients and employees. Upon review, we have concluded that the Initial Study fails to correctly analyze the need for a supplemental EIR and, therefore, does not comply with the requirements of CEQA and its implementing regulations, the CEQA Guidelines, California Code of Regulations, title 14, S 15000 et seq. ("CEQA Guidelines"). Accordingly, we conclude that action on the project should be deferred until a supplemental EIR is prepared thatfully complies with CEQA. Background In 2005, the Planning Commission approved Phase Two of the Dublin Gateway Medical Center project providing for the construction of a 3-story, 58,000-square-foot medical office building and a 4-level parking garage. The Project now proposed by the applicant is a 6-story, 168,000- square-foot, 100-bed hospital and a 5-1evel parking garage. The proposed resolution appro vi rig the Project rests on a series of prior environmental reviews of different projects from the one now proposed: namely, an Eastern Dublin EIR approved in 1994, a Mitigated Negative Declaration approved in 1996, a State 1 and Stage 2 Development Plan for Koll Dublin Corporate Center approved in 1998, and a General Plan/Eastern Dublin Specific Plan Amendment for Dublin Ranch West and a related Supplemental EIR approved in 2005. None of the prior approvals contemplated the construction of a hospital at the site. CEQA provides that a subsequent or supplemental EIR may be required if "[s]ubstantial changes occur with respect to the circumstances under which the project is being undertaken which will require major revisions in the environmental impact report." Pub. Res. Code S 21166(b). Under the CEQA regulations, a further EIR is required where major revisions are needed to account for "new significant environmental effects or a substantial increase in the severity of previously identified significant effects." CEQA Guidelines, S 15162(a). That is precisely the situation here. The Supplemental EIR approved in 2005 reviewed the environmental impacts of the 3-story, 58,000-square-foot medical office building and a 4-leve1 parking garage, referred to above. As we shall explain below, the near tripling in size of the facility and the proposed change in use from medical offices to a hospital clearly involve substantial changes that will result in new and more severe significant environmental impacts than those analyzed in 2005, and hence trigger the need for a supplemental EIR to analyze the new and more severe environmental impacts of the expanded and repurposed Project. The Agenda Statement ("Staff Report") prepared for the Planning Commission meeting of April 24,2007, at which the Planning Commission reviewed the Project, and the Initial Study upon which the Staff Report is based set forth the City's reasons why no subsequent or supplemental EIR should be required. These documents and the reasons set forth in them provide an entirely inadequate basis for the public and the City Council to determine whether the modification to the project will result in new and more severe environmental impacts that were not adequately considered in 2005. In fact, the documents demonstrate that such impacts will occur in such areas as hazardous materials and noise while completely failing to discuss other impacts, such as 5~ J I ~2- May 15,2007 Mamie R. Nuccio, Associate Planner Page 3 the increased emission of air pollutants that will necessarily result from construction of a much larger facility, the risks oflocating a hospital (rather than a medical office building) in an active seismic zone on a parcel with a higher than average risk of liquefaction, as well as greatly increased construction impacts resulting from a much larger project than the one previously analyzed in an EIR. CEQA has two basic purposes, neither of which the Initial Study satisfies. First, CEQA is designed to inform decision-makers and the public about the potential, significant environmental effects of a project. I "Its purpose is to inform the public and its responsible officials of the . environmental consequences of their decisions before they are made. Thus, the EIR 'protects not only the environment but also informed self-government.",2 The EIR has been described as "an environmental 'alarm bell' whose purpose it is to alert the public and its responsible officials to environmental changes before they have reached ecological points of no return.,,3 Second, CEQA directs public agencies to avoid or reduce environmental damage when possible by requiring alternatives or mitigation measures.4 The EIR serves to provide public agencies and the public in general with information about the effect that a proposed project is likely to have on the environment and to "identify ways that environmental damage can be avoided or significantly reduced.,,5 Public agencies must deny approval of a project with significant adverse effects when feasible alternatives and mitigation measures can substantially lessen such effects. 6 CEQA section 21002 requires agencies to adopt feasible mitigation measures in order to substantially lessen or avoid otherwise significant adverse environmental impacts of a proposed project.7 To effectuate this requirement, EIRs must set forth mitigation measures that decision- makers can adopt at the findings stage of the process.8 For each significant effect, the EIR must identify specific mitigation measures. Where several potential mitigation measures are available, each should be discussed separately and the reasons for choosing one over the other should be stated.9 Mitigation measures should be capable of "avoiding the impact altogether," "minimizing impacts," "rectifying the impact," or "reducing the impact."1O Decision-makers must fulfill the state's policy that "public agencies should not approve projects as proposed if there are feasible alternatives or feasible mitigation measures available which would substantially lessen the significant environmental effects of such projects. "II Each public 1 CEQA Guidelines ~ 15002(a)(1). 2 Citizens of Goleta Valley v. Board of Supervisors (1990) 52 Cal.3d 553, 564. 3 Berkeley Keep Jets Over the Bay v. Bd. of Port Comm 'rs. (2001) 91 Cal. App. 4th 1344,1354 ("Berkeley Jets"); County ofInyo v. Yorty (1973) 32 Cal.App.3d 795,810. 4 CEQA Guidelines S 15002(a)(2) and (3). See also, Berkeley Jets, supra, 91 Cal. App. 4th, at p. 1354; Citizens of Goleta Valley v. Board of Supervisors (1990) 52 Cal.3d 553, 564; Laurel Heights Improvement Ass 'n v. Regents of the University of California (1988) 47 Ca1.3d 376, 400. 5 CEQA Guidelines S 15002(a)(2) 6Sierra Club v. GilroyCity Council(1990) 222 Cal.App.3d 30, 41. 7See also, Pub.Res.Code ~ 21081(a); CEQA Guidelines ~ 15370. 8 CEQA Guidelines S 15126(c). 9 CEQA Guidelines S 15126(c). JO CEQA Guidelines II. 15370. J] 1'/ Pub. Res. Code S 21002. 54 1 12-2-, May 15, 2007 'Mamie R. Nuccio, Associate Planner Page 4 agency is required to "mitigate or avoid the significant effects on the environment of projects that it carries out or approves whenever it is feasible to do so.,,12 By denying the existence of significant impacts altogether, the Initial Study fails at disclosure and leads the City to make inadequate provision for feasible alternatives or feasible mitigation measures that would substantially lessen the significant environmental effect of the Developer's proposed hospital. The Initial Study Fails to Adequately Disclose and Analyze Significant Impacts Relating to Hazards and Hazardous Materials As the Initial Study explains, the Project will require the transport, use, and disposal of hazardous materials such as pharmaceuticals and bio-hazardous waste. After mentioning that the hospital has a license from the state and must comply with strict regulations for the handling, storage, and disposal of hazardous materials, the Initial Study breezily concludes that "the Project will not have any significant impacts as a result of hazards and hazardous materials." The Initial Study makes two fundamental errors in adopting this errone01:lS conclusion: 1) it disregards the fact that a 168,000-square-foot hospital will create "new significant environmental effects or a substantial increase in the severity of previously identified significant effects" relative to a previously approved 58,000-square-foot medical office building; and 2) it incorrectly assumes that the existence of state regulations governing hazardous medical waste eliminate the need for mandatory mitigation measures under CEQA. First, the hospital with 100 patient beds is obviously going to produce an order of magnitude more medical waste than an outpatient facility one-third its size. Furthermore, it appears that medical waste was not analyzed in the previous EIRs. See Initial Study, at p. 44 ("The Eastern Dublin EIR (Source 12) did not analyze hazards and hazardous materials.") The Initial Study identifies no prior analysis of medical waste in any other environmental document and, hence, the public and the City Council must assume that the analysis contained in the Initial Study is all there is. Even if the much smaller amount of medical waste that would have been produced by a much smaller outpatient facility had been previously analyzed, the substantial increase in the severity of this significant effect would require an EIR to analyze the feasibility of all available mitigation measures. On page 26 of the Initial Study, in response to the question whether the Project would create a significant hazard to the public through the routine transport, use, or disposal of hazardous materials, the City erroneously checked the box indicating that the Project would have "less than significant impact." This is simply wrong. A hospital with an emergency room is bound to produce significant amounts of medical waste. Even if the Conditions of Approval contained sufficient mitigation to reduce the hazard from medical waste to nonsignificance, the City should have checked the box "less than significant with mitigation," rather than "less than significant impact." That, however, would have been a red flag that would undermine the conclusion that the project has "no significant impacts." In reaching its pollyannish conclusion; the Initial Study sites four "sources": "staff review,"the City of Dublin General Plan, the City of Dublin Easter Dublin Specific Plan, and the City of Dublin Zoning Ordinance. See Initial Study, at pp. 26, 33. The public and decision-makers are left to guess 12 Pub. Res. Code * 21002.1 (b) 55 ~ }2"V May 15, 2007 Mamie R. Nuccio,-Associate Planner Page 5 what possible relevance any of these sources has to the determination that a 100-bed hospital does not produce significant amounts of hazardous materials. Second, mere compliance with state regulations does not satisfy CEQA's independent requirement that all feasible mitigation measures be implemented where a significant environmental impact would result if no mitigation were required. The City's duty is to require as a condition of approval that the Applicant undertake all feasible measures to mitigate the substantially increased significant impact of hazardous medical waste that will be generated by its proposed hospital. Instead, the City attempts to defer enforcement entirely to the State of California.13 The State of California enforces the Medical Waste Management Act (Health & Safety Code, SS 117600-118360); however, conditioning CEQA approval on another agency's future review of effective mitigation is insufficient to support a determination by the lead agency that potentially significant impacts will be mitigated. Sundstrom v. County of Mendocino (1988) 202 Cal.App.3d 296. Such avoidance of hard analysis at the approval stage also thwarts the CEQA requirement that mitigation measures be subject to informed public review. Gentry v. City of Murrieta, 36 Cal.App.4th 1359, 1393 (1995) ("members of the public and other agencies must be given an opportunity to review mitigation measures before they are approved"). Furthermore, the substance of the mitigation measures proposed-presumably, compliance with State regulations-is inadequate as well. The State of Califomia itself recognizes that there are many feasible measures to reduce hazardous medical waste that are not required by law. In its 2002 publication Hospital Pollution Prevention (P-2) Strategies (attached hereto as Exhibit A), the California Department of Health Services recommends that all hospitals implement voluntary P-2 programs in order to provide a safer workplace, reduce lost time due to injuries, lessen adverse impacts on health and the environment, and reduce the impact on overburdened waste sites. See Strategies at p. 2. Although the implementation of a P-2 program and many of the specific recommendations contained in the State's publication are not required by regulations enforced by the Department of Health Services, they are all mitigation measures that should be evaluated in an EIR and required, if feasible, to prevent significant impacts from the transport, use, and disposal of hazardous waste. The Initial Study Fails to Adequately Disclose and Analyze Significant Impacts Relating to Noise The Staff Report asserts that ambulance noise will not be a significant impact on the environment near the new hospital. This finding of insignificance is not supported by substantial evidence. The Initial Study reveals the presence of residences approximately 200-feet north of the Project site. Initial Study, at p. 51. The City explains that ambulances with sirens blaring will be mostly incoming, rather than outgoing, as no ambulances will be stored at the site, that there are two other emergency care facilities in nearby cities, and that the use of sirens is regulated by the California Highway Patrol. How any of these facts will reduce the noise to nonsignificance is a mystery. Certain facts are 13 This is no more satisfactory than letting an applicant off the hook for analyzing a danger to wildlife because he holds a hunting license and the state prohibits his taking of endangered species. 5lo 1[2-2-, May 15, 2007 Mamie E.. Nuccio, Associate Planner Page 6 undeniable. Sirens will be used by incoming ambulances. Ambulances which used to go elsewhere will now come to the site. The City denies the obvious conclusion that significant noise will be generated by sirens in an effort to avoid a more thorough analysis of feasible mitigation measures that might be implemented. The City's approach to noise frustrates both of the major purposes of CEQA: 1) to inform the public and decision-makers of the consequences of environmental decision before those decisions are made; and 2) to require public agencies to adopt feasible mitigation measures to lessen the environmental impacts of the projects they approve. A supplemental EIR is required to examine the impact of noise on local residents and to require the implementation of feasible mitigation measures. The Initial Study Fails to Adequately Analyze Significant Impacts on Aesthetics Under CEQA, it is the state's policy to "[tJake all action necessary to provide the people of this state with. . . enjoyment of aesthetic, natural, scenic, and historic environmental qualities." Pub. Res. Code S 21001(b) (emphasis added). Thus, courts have recognized that aesthetic issues "are properly studied in an EIR to assess the impacts of a project." The Pocket Protectors v. City of Sacramento, 124 Cal.App.4th 903,937 (2004) (overturning a mitigated negative declaration and requiring an EIR where proposed project potentially affected street-level aesthetics). "The opinions of area residents, if based on direct observation, may be relevant as to aesthetic impact and may constitute substantial evidence in support of a fair argument; no special expertise is required on this topic." Id. Here, the Staff Report's discussion of aesthetic impacts is cursory, and apparently met with significant criticism from the Planning Commission that resulted in significant ad hoc changes. A more systematic approach is needed. The accepted approach to analyzing visual and aesthetic impacts is as follows a. Describe the criteria for significance thresholds. b. Characterize the existing conditions of the project site and the surrounding area by photograph and description, and select key viewpoints within the area, including scenic corridors and landscapes. c. Use photomontages or visual simulations, to illustrate the change in character of the project site before and after project implementation. d. Identify feasible mitigation measures and alternatives to reduce or eliminate significant impacts. e. Where mitigation measures are proposed, use the simulations to illustrate the change in character before and after project mitigation measures are imposed (e.g., landscaping at various stages of growth, setbacks, clustering, reduced scale and height, building color mQgif19ati()1l)._ An analysis consistent with this approach would allow decision-makers and the public to evaluate the aesthetic impacts of the project more fully and easily than the sparse and completely unhelpful narrative currently provided in the Initial Study. The City has failed to take almost all 57 ~rz,1/ May 15, 2007 Mamie R. NucciQ, Associate Planner Page 7 of these steps, and therefore the conclusion in the Initial Study that all aesthetic impacts will be less than significant after mitigation is unsupported. The Initial Study Fails to Adequately Disclose and Analyze Significant Impacts Relating to Seismicity Although the Proposed Hospital lies near recognized fault lines and within a liquefaction zone, the Initial Study fails to analyze alternatives to the Project that would not involve similar risks. The Association of Bay Area Governments maintains maps on its website that show areas at risk of liquefaction. (A copy is attached hereto as Exhibit B.) The hospital site is in a yellow zone, indicating that it is located on land with a heightened risk ofliquefaction in an earthquake. In response to the question of whether the Project would expose people or structures to potentially substantial adverse effects, including the risk of loss, injury, or death involving rupture ofa known earthquake fault, strong seismic ground shaking, or liquefaction, the City simply. checked the box for "less than significant impact." This defies common sense and misrepresents the situation to the public and decision-makers. Indeed, the proposed Statement of Overriding Considerations contains; the more frank, and contradictory, statement appears that there will be "significant environmental impacts" from seismic activity: "Even with seismic design, future development of the Dublin Gateway Medical Center Building 3 Hospital and Garage project could be subject to damage from large earthquakes, much like the rest of the Eastern Dublin planning area." Statement of Overriding Considerations, at p. 2. Apparently, the City believes it can check a box asserting that the project entails no significant effects in the Initial Study because seismic effects relating to the Project were already analyzed in 2005 when the project being evaluated was an outpatient medical office building. This would be an error. The new Project is a 24-hour-per-day hospital with an emergency room and 100 beds. The difference between the effect of a large earthquake on a daytime-use medical office building compared to the effect on a much larger hospital is obvious. With as many as 100 in- patients and their caregivers at risk, a hospital clearly requires a more substantial analysis of seismic issues. An EIR would inform the public and the City Council of the consequences, the possible alternatives, and the full range of mitigation measures that consultants and the public might suggest. Merely piggybacking onto the prior review of seismic issues raised by a different project is an unacceptable dodge of the very specific questions raised by selecting the site for a hospital. Furthermore, simply requiring compliance with building codes is not adequate mitigation under CEQA Obviously, all new construction is required to comply with building codes. CEQA requires decision-makers to look at a broader range of feasible measures to mitigate significant impacts. An EIR is needed to discuss whether another location for a new hospital or another use of the proposed location would be more appropriate fromthe standpoint of public safety. Both hospitals would undoubtedly be required to meet current building codes, but the environmental consequences of the locations may nonetheless differ substantially. t;8 '1 r:~~;2 May 15, 2007 Mamie R. Nuccio, Associate Planner Page 8 Furthermore, the procrastinator's methodology of deferring definition and enforcement of specific mitigation measures to another body at another time is unacceptable under CEQA The formulation of mitigation measures may not properly be defenoed until after Project approval; Sundstrom v. Mendocino County, 202 Cal.App.3d 296, 306 (1988) ("The requirement that the applicant adopt mitigation measures recommended in a future study is in direct conflict with the guidelines implementing CEQA"). Moreover, CEQA requires that "feasible mitigation measures will actually be implemented as a condition of development, and not merely adopted and then neglected or disregarded." Federation of Hillside & Canyon Ass 'ns v. Los Angeles, 83 Cal.App.4th 1252, 1261-62 (2000) (vacating project approval because City failed to make "a binding commitment to implement the [traffic] mitigation measures. . . in a manner that will ensure their implementation"). See also Kings County, 221 Cal.App.3d at 729-30 (agency may not rely on mitigation measures of uncertain efficacy); CEQA Guidelines S 15126.4(a)(2) (mitigation measures must be fully enforceable through permit conditions, agreements, or other legally binding instruments). The Initial Study Fails to Adequately Disclose and Analyze Significant Impacts Relating to Housing Under CEQA, any environmental review must analyze the proposed project's potential impacts related to population, housing, and jobs. Although the Initial Study says little about these issues, it appears that the Project is expected to generate 525 new jobs. Although some jobs would no doubt have been created by the much smaller medical office building that was approved in 2005, many occupants of the medical office building would likely move from existing smaller offices in nearby communities. The proposed hospital, by contrast, would be a completely new employer. Thus, it is specious to assume that the effects of building the hospital or the medical office building on population, housing, and jobs would be the same. The hospital could well result in double or more the net impact of the medical office building. Accordingly, the Initial Study's quick conclusion that such impacts are insignificant or already analyzed is unwarranted. The likelihood is that the proposed hospital will place an increased demand on the local housing market. The increase in employment and consequent demand for additional housing are considered to be "economic and social effects" under CEQA, and therefore may not, by themselves, constitute a significant environmental impact. However, where these impacts directly lead to significant, physical environmental impacts, they must be considered in an EIR. (CEQA Guidelines SS 15131, 15064(f) and 15382.) The Project will increase the demand for additional housing by generating new jobs. This is a potentially significant adverse physical environmental impact that must be addressed in the EIR. ' The questions posed in CEQA Guidelines Appendix G, Section IX ("Population and Housing") indicate that direct or indirect growth-inducement caused by new businesses or the creation of a need for the construction of more housing, can be considered significant environmental impacts. Because of the-severe lack ofaffotdable hOUSing near Dublin, another criterion would also appropriately be considered as a threshold of significance: Would the project increase the demand for affordable housing? Although 75 of the projected employees would be (presumably high-paid) physicians, the average income of the other 450 employees would be considerably 51 ~ }J.,~ May 15, 2007 Mamie R. Nuccio, Associate Planner Page 9 less. The Project would increase demand for affordable housing in the area, and a detailed analysis of this impact must be conducted in an EIR. This Project, by creating new jobs, will also increase the demand for housing and decrease the availability of rental units in the area. Based on conservative assumptions and excluding secondary growth inducement, the Project is likely to generate a demand for approximately 250 or more housing units.14 This increase in demand for housing in the area is significant because in the Dublin area where the Project is located, and in the greater Bay area, there is already a lack of adequate housing, particularly housing that would be affordable to the new workforce created by the Project. The Initial Study ignores these impacts. Other potential impacts related to population and housing include, but are not limited to, the following: . The project will further reduce the "jobs - housing" balance, resulting in longer commutes, significant vehicle trips and air quality impacts not disclosed or analyzed in the Initial Study. . Cumulative impacts resulting from the increase in population, housing demand and employment caused by this and other projects. None of these potentially significant impacts are analyzed in the Initial Study. . In order to analyze and accurately characterize these population and housing impacts, an EIR must be prepared which includes, at the very least, the following information: o Total new housing demand generated by the Project, secondary growth and cumulative projects; o The housing affordability range for that new demand; o The number of new employees of the medical center expected to reside in the Dublin area; o Housing available to accommodate total new demand in Dublin and neighboring communities caused by the Project; o All potential impacts associated with new housing demand within the region; o The expected new traffic and transit trips based on where employees will reside and details of those trips, including geographic range; impacts to road/transit capacity. This information should be used to revise traffic and transit analyses in the EIR; o Additional air quality impacts associated with commute patterns. This information should be used to revise air quality information in the EIR; 14 This estimate of housing demand is based on an assumption that Y2 of all new full-time employees generated by the project will require housing in the area. I~() 112-~ May 15,2007 Mamie R. Nuccio, Associate Planner Page 10 o The extent to which new employees will need general public assistance (e.g. food stamps), health care, and housing assistance, among other social services. In the absence of this information and analysis it is not possible to conclude that impacts related to population increases, housing and employment will be less than significant. The Initial Study Fails to Adequately Disclose and Analyze Significant Growth-Inducing Impacts CEQA requires that an environmental document include a "detailed statement" setting forth the growth-inducing impacts of the proposed project. See Public Resources Code S 2ll00(b)(5); City of Antioch v. City Council of Pittsburg, 187 Cal.App.3d 1325, 1337 (1986) (invalidating negative declaration that failed to consider growth-inducing impacts). The statement must "[ d]iscuss the ways in which the proposed project could foster economic growth, or the construction of additional housing, either directly or indirectly, in the surrounding environment." CEQA Guidelines S 15l26.2(d). It must also discuss how a project may "encourage and facilitate other activities that could significantly affect the environment, either individually or . cumulatively" or "remove obstacles to population growth." id. The proposed Project, which, if completed, will create hundreds of new jobs, and will thereby have a significant growth-inducing impact. The Initial Study did not even raise the issue of the Project's growth-inducing impacts, much less demonstrate that these impacts will be less-than- significant. An EIR must be prepared that analyzes the growth-inducing impacts of this Project. The Initial Study Fails to Adequately Disclose and Analyze the Project's Cumulative Impacts CEQA unequivocally requires lead agencies to disclose and analyze a project's "cumulative impacts," defined as "two or more individual effects which, when considered together, are considerable or which compound or increase other environmental impacts." CEQA Guidelines S 15355. A lead agency must prepare an EIR if a project's possible impacts, though "individually limited," prove "cumulatively considerable." S 21 083(b); CEQA Guidelines S 15064(i). The Initial Study fails to provide any information about other projects planned or proposed in the area (other than those discussed in prior EIRs from 2005 and earlier) that, along with the proposed Proj ect, could have potentially significant cumulative impacts. The proposed Project, when considered in conjunction with new residential, commercial, and other developments, could have potentially significant environmental impacts, including traffic, aesthetic, air quality, and land use and planning impacts. Accordingly, the City must prepare an EIR to analyze these cumulative impacts. 0/ 1 J~~ May 15,2007 Mamie R. Nuccio, Associate Planner Page 11 The Initial Study Fails to Disclose and Analyze the Substantial Increase in the Severity of Construction-Related Impacts Resulting from the Threefold Increase in Project Size The three-fold increase in the size of the hospital over the previously approved medical office building will, of course, involve a substantial increase in the significant noise and air quality impacts of construction. That is sufficient to require a supplemental EIR. Whether construction occurs over a longer period of time or is greater in intensity, these impacts will be significantly greater than those analyzed in 2005. Because the description of the project in the Initial Study does not provide any account of how the hospital will he built-i.e., no construction schedule, no complement of equipment that will be used, no references to fuels that will be used in the diesel engines required for construction, etc.-the public and decision-makers are left without any way to evaluate precisely the highly improbable conclusion that expanding the project to a 168,000- square- foot hospital will result in no significant impacts during the construction of the hospital. See Initial Study, Checklist items III(b)-III(d) at p. 24 and XI(d) at p. 29. However, a threefold increase in overall air pollution seems to be a fair estimate of the consequences of a threefold increase in the size of the project. The increase in size of the project will result in increased particulate matter, sulfur dioxides, reactive organic gases, carbon monoxide, and toxic air contaminants. A supplemental EIR is needed to disclose and analyze these emissions, their effects, and their possible remediation. Particulate Matter Particulate matter during construction is emitted from two sources, engine exhaust and fugitive dust. The health impacts of particulate matter depend on its size, and the size depends on its source. Combustion sources, such as vehicle exhaust, predominantly emit particulate matter with an aerodynamic diameter ofless than or equal to 2.5 micrometers ("PM2.5"), while fugitive dust consists predominantly of particulate matter less than 10 micrometers ("PMI0"). Historically, health impacts due to particulate matter were regulated through ambient air quality standards for PMl O. However, a substantial amount of important new research has been published, documenting new health impacts at much lower concentrations and for different size fractions of particulate matter than was previously known and reflected in ambient air quality standards. This new research documents that the inhalation of particulate matter, particularly the smallest particles, causes a variety of health effects, including premature mortality, aggravation of respiratory (e.g., cough, shortness of breath, wheezing, bron.chitis, asthma attacks) and cardiovascular disease, declines in lung function, changes to lung tissues and structure, altered respiratory defense mechanisms, and cancer, among others. Particulate matter is a non-threshold pollutant, which means that there is some possibility of an adverse health impact at any concentration.ls This new information led the U.S. Environmental Protection Agency ("U.S. EPA") and the State of California to adopt new ambient air quality standards for PM2.5. These standards are notsubsetsofthe old PMIOstandards, but new standards for a separate pollutant with distinguishable impacts. 15 See American Trucking v. EPA: Unjustified Revival of the Nondelegation Doctrine, 23-SPG Environs Envtl. L & Pol'y J. 17,26. o 2-~, I?- May 15, 2007 Mamie R. Nuccio, Associate Planner Page 12 The new annual PM2.5 standard of 12 Jlg/m3 was adopted by the California Air Resources Board ("CARB") on June 20, 2002 and became effective on July 5, 2003. At the same time, California lowered its annual PMlO standard from 30 Jlg/m2 to 20 Jlg/m3. (CARB 0910516.) Sulfur Dioxides A supplemental EIR is also required to address that increased S02 emissions from Project construction and to discuss the resulting air quality impacts. S02 causes a wide variety of health and environmental impacts because of the way it reacts with other substances in the air. irritates the respiratory system of animals and humans and injures many plant species as well. S02 reacts with other chemicals in the air to form tiny sulfate particles. When these are breathed, they gather in the lungs and are associated with increased respiratory symptom and disease. Particularly sensitive groups include people with asthma who are active outdoors and children, the elderly, and people with heart or lung disease. Haze produced by sulfate particles is a major cause of reduced visibility. S02 combines with other compounds to produce acid rain which damages plants and buildings downwind. Reactive Organic Gases A supplemental EIR is also required to analyze the increased emission of Reactive Organic Gases (ROGs) caused by the expansion of the project. ROGs will be emitted with combustion exhaust from construction equipment, haul trucks, and construction worker vehicles. ROGs are also released in large quantities from architectural coatings. (Id.) ROGs, also known as volatile organic compounds (VOCs), can cause cancer, birth defects, nerve damage and kidney and heart disease. ROGs also pose a danger as ozone precursors. Ozone, the principal element of smog, is a secondary pollutant produced when two precursor air pollutants - ROGs and nitrogen oxides ("NOx") - react in sunlight: 17 ROGs and NOx are emitted by a variety of sources, including cars, trucks, industrial facilities, petroleum-based solvents, and diesel engines. The human health and associated societal costs from ozone pollution are extreme. In proposing a new rulemaking limiting emissions of NO x from certain diesel engines, EP A summarized the effects of ozone on public health: "A large body of evidence shows that ozone can cause harmful respiratory effects, including chest pain, coughing and shortness of breath, which. affect people with compromised respiratory systems most severely. When inhaled, ozone can cause acute respiratory problems; aggravate asthma; cause significant temporary decreases in lung function of 15 to over 20 percent in some healthy adults; cause inflammation of lung tissue, produce changes in lung tissue and structure; may increase hospital admissions and 16 California Air Resources Board, Review of the Ambient Air Quality Standards for Particulate Matter and Sulfates, http://www.arb.ca.gov/research/aaqs/std-rs/std-rs.htm. accessed September 8, 2005. 17 American Petroleum Institute v. Costle, 665 F.2d 1176, 1181 (D.C. Cir. 1981). (, 31 I 2-- 1.-- May 15,2007 Mamie R. Nuccio, Associate Planner Page 13 emergency room visits; and impair the body's immune sy,stem defenses, making people more susceptible to respiratory illnesses.,,18 Moreover, ozone is not an equal opportunity pollutant, striking hardest the most vulnerable segments of our population: children, the elderly, and people with respiratory ailments. (Id.) Children are at greater risk because their lung capacity is still developing, because they spend significantly more time outdoors than adults - especially in the summertime when ozone levels are the highest, and because they are generally engaged in relatively intense physical activity that causes them to breathe more ozone pollution. (!d.) Ozone has severe impacts on millions of Americans with asthma. While it is as yet unclear whether smog actually causes asthma, there is no doubt that it exacerbates the condition.19 Moreover, as EP A observes, the impacts of ozone on "asthmatics are of special concern particularly in light of the growing asthma problem in the United States and the increased rates of asthma-related mortality and hospitalizations, especially in children in general and black children in particular."zo In fact: "[A]sthma is one of the most common and costly diseases in the United States. ... Today, more than 5 percent of the US population has asthma [and] [o]n average 15 people died every day from asthma in 1995. . .. In 1998, the cost of asthma to the U.S. economy was estimated to be $11.3 billion, with hospitalizations accounting for the largest single portion of the costS."ZI The health and societal costs of asthma are wreaking havoc in California. There are currently 2.2 million Californians suffering from asthma.22 In 1997 alone, nearly 56,413 residents, including 16,705 children, required hospitalization because their asthma attacks were so severe. Shockingly, asthma is now the leading cause of hospital admissions of young children in Califomia.z3 Asthma hospitalizations reflect massive human suffering and also impose a huge financial drain on the state's health care system. The most recent data indicate that the statewide financial cost of these hospitalizations was nearly $350,000,000, with nearly a third of the bill paid by the State Medi-Cal program.24 A supplemental EIR is required to analyze increased emissions of ROGs in view of their key role as ozone precursors. ]866 Fed. Reg. 5002, 5012 (Jan. 18,2001). 19 See 66 Fed. Reg. 5002,5012 (Jan. 18,2001) (EPA points to "strong and convincing evidence that exposure to ozone is associated with exacerbation of asthma-related symptoms"). . 2062 Fed. Reg. at 38864. "j - 66 Fed. Reg. at 5012. 22 California Department of Health Services, California County Asthma Hospitalization Chart Book, August 1, 2000. 23 Id., at 1. 24 Id., at 4. GLf Pi J2f-, May 15,2007 Mamie R. Nuccio, Associate Planner Page 14 Carbon Monoxide The supplemental EIR must also analyze increased carbon monoxide (CO) emissions analysis during the construction phase of the Project. CO is a colorless, odorless gas that is formed when carbon in fuel is not burned completely. Although motor vehicles contribute about 56 percent of all CO emissions nationwide; other non-road engines and vehicles (such as construction equipment) contribute about 22 percent of all CO emissions nationwide. Toxic Air Contaminants ("TACs") From Diesel-Fueled Equipment A supplemental EIR must analyze combustion emissions of toxic air contaminants ("T ACs") from diesel-fueled equipment for both the construction and operational phases of the Project. These unanalyzed emissions are significant and require a health assessment. CONCLUSION Prior to granting approval of the Project, the City is required to make its own findings as to the adequacy of the environmental review on which the approval is based. These finding must represent the City's own, independent judgment, and must be based on the analysis conducted in the Initial Study and any public comments submitted to the City. The Draft Resolution, prepared for adoption by the City Council, states that "an Initial Study has been prepared for the Project and a determination has been made that the proposed Project will not have a significant effect on the environment." The City Council cannot make this determination based on the tangled and incomplete record before it. For the reasons set forth above, the only prudent course for the City is to defer action on the Dublin Gateway Medical Center Building 3 Hospital and Garage until a supplemental EIR is prepared that fully complies with CEQA The Initial Study is lacking in many essentials and cannot provide a legally defensible basis for approval of the project. Sincerely, /fCQ..-. ~UL:- Theodore Franklin TF/x Enclosures 01>51/2--'2/ EXHIBIT A 0G~}?~~. b7112-l- Hospital Pollution Prevention (P-2) Strategies California Department of Health Services Gray Davis, Governor STATE OF CALIFORNIA Diana M. Bonta, R.N. Dr.P.H., Director DEPARTMENT OF HEALTH SERVICES Grantland Johnson, Secretary HEALTH AND HUMAN SERVICES AGENCY 09- oP J,2)'/ --f Hospital Pollution Prevention (P-2) Strategies December 2002 Prepared by: California Department of Health Services Environmental Management Branch Jack McGurk, Chief and Darice Bailey Cindy Garcia Steve Kubo Mike Schott Additional copies of this publication can be obtained through requests made by mail, fax, or phone to: Environmental Management Branch Medical Waste Management Program P.O. Box 942732 MS 396 Sacramento, CA 94234-7320 Phone: (916) 327-6904 FAX: (916) 323-9869 Or viathelnternet at: http://www.dhs.ca.gov/MedicaIWaste Co OJ C9;f I 2-- ~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies TABLE OF CONTENTS CHAPTER I .................................................................................. ........................1 INTRODUCTION.... .......... ................... .......... .................... ........ ...........................1 CHAPTER II ........................................... ..............................................................3 P-2 PROGRAM PLANNING AND IMPLEMENTATION .......................................3 PLANNING P-2 PROGRAMS........................................................................... 3 UNDERSTANDING THE WASTE SYSTEMS WITHIN THE FACILlTY............4 RECOGNIZING THE NEED TO REDUCE WASTES .......................................5 P-2 PROGRAM IMPLEMENTATION......... ............... .................. ............ .......... 7 CHAPTER III .. ................................................... ............... .................. ................... 9 HAZARDOUS WASTE MINIMIZATION............................................................... 9 HOSPITAL EQUIPMENT AND DEVICES CONTAINING MERCURY..............9 Sphygmomanometers................,................................................................. 9 Baumanometer@ Safety Devices. .......... ................................................10 Sphygmomanometer Service Kit............................................................ 12 Esophageal Dilators (Bougies) and Feeding Tubes ...................................13 Gastro/Esophageal Tubes Containing Mercury .......................................... 13 Barometers in Respiratory Therapy......... .......... .................. ....................... 14 Thermometers...................... ........................ .............................................. 14 Intraocular Pressure Devices.............................................................. .... ...16 B-5 Fixative............. ............................ .......................................................17 Mercury-Free Cleaning Products..................... ......... ............................ ...... 17 MERCURY CONCERNS IN HOSPITAL OPERATIONS ................................17 Mercury-Containing Devices In Medical Waste or Sharps Containers ........18 Mercury Collection Areas.............................................. .............................18 Transporting Mercury Devices................. ..................... ....... ...............,. ......18 Spill Clean Up........ .......... ........................................................................... 19 Spill Clean Up Kit .......................................................................................19 Keeping Mercury Out of the Hospital..........................................................20 Mercury Assessment................................................................... ...............20 Plumbing Traps....................................... .......... ........ .... .......................... ... 20 Fluorescent Lighting... ......................................................................... .......20 Electrical Supplies................................................................ ......................21 Calculations and Quantification .......................................... ................. ....... 21 Business Plan............................................................................................. 22 FOLLOW UP .................................................................................................. 22 HAZARDOUS MATERIALS MINIMIZATION ....................................... ...........23 State of California Department of Health Services December 2002 10 ~ ,tZ--v Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER IV............ ........ .... ..... .......... ......... ......... .... ................ ............. ..... .......27 SOLID WASTE MINIMIZATION ....... ............ ............... ..... ......... ........................ .27 PERFORMING THE SOLID WASTE AUDIT .............................:....................28 SUCCESSFUL SOLID WASTE REDUCTION STRATEGIES ........................28 CHAPTER V ....................................................................................................... 32 MEDICAL WASTE MINIMIZATION............ ......... ....... ......... .................... ...........32 MEDICAL WASTE MANAGEMENT LEADERSHIP........................................32 SUCCESS THROUGH STAFF PROCESS OWNERSHIP .............................33 DEVELOPING STRATEGIES TO MINIMIZE MEDICAL WASTES................. 33 MEDICAL WASTE MINIMIZATION PLANNING .............................................35 MEDICAL WASTE MINIMIZATION ASSESSMENT .......................................35 MEDICAL WASTE MINIMIZATION IMPLEMENTATION................................35 SUCCESSFUL MEDICAL WASTE REDUCTION STRATEGIES ...................36 State of California Department of Health Services December 2002 i1i 1/ 1 } 2-- 7.-- Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER I INTRODUCTION This document was prepared in partial fulfillment of a pollution prevention (P-2) grant received by the Environmental Management Branch (EMB) within the California Department of Health Services from Region IX of the U.S. Environmental Protection Agency (U.S. EPA). EMB implemented the P-2 Project in six participating Bay Area hospitals to reduce their medical and solid waste streams and to eliminate mercury from their wastes. Additional hospitals have joined with EMB to implement P-2 program activities. The lessons learned from the participating hospitals have been used in developing this document. EMB and the California Healthcare Association partnered in developing the Self- Assessment Manual for Proper Management of Medical Waste that was printed during 1998. As part of the P-2 Project, EMB published A Guide to Mercury Assessment and Elimination in Healthcare Facilities during 2000. Information from those two documents, as well as information from the solid and medical waste reports that were prepared for the participating facilities, have been used in creating this document. A systems approach has been undertaken through the P-2 Project, as it is recognized that waste generation is an integral part of the healthcare system. Patients come into the hospital, services are provided, and wastes are generated in the process. To achieve desired outcomes the systems within a facility must be working harmoniously and not against each other. Although this sounds very straight forward, it is surprising how many systems are not aligned and actually are working against each other. The late quality guru W. Edwards Deming indicated that we must optimize the operations of the interdependent components within an organization to accomplish the aim of the system.1 To ensure that wastes are handled, containerized, and stored properly, the environmental services staff within the hospital must work across professional boundaries with doctors, nurses, laboratory staff, and other generators. Unanticipated fiscal benefits were realized from the P-2 Project when systems were studied and improved. Systems improvement has become an area of focus within the P-2 process. Additional benefits can accrue to the hospital when P-2 and systems improvement activities are implemented. Waste disposal costs can be lowered as waste volumes are reduced or eliminated. Income can be generated through some recycling efforts. The hospital can enhance its image through the following P-2 and systems improvement outcomes: · Providing a safer workplace o Reducing workers' compensation claims 1 berning, w. Edwards, The New Economics For Industry, Government, Education, Massachusetts Institute of Technology, 1993, page 98. State of California Department of Health Services December 2002 72-- 112-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies o Reducing lost time to injuries o Improving worker satisfaction because the hospital has reduced causes of injuries . Enhancing regulatory compliance . Lessening adverse impacts on health and the environment . Reducing the impact on overburdened waste sites . Gaining recognition as a "good neighbor" to the community . Gaining recognition as an industry leader in pollution prevention . Increasing morale and pride as a member of an organization focused on P-2 These potential benefits should be sufficient to stimulate more hospital administrators to provide the leadership for their facilities to move into P-2 and systems improvement activities. This document provides the required information to institute a P-2 and systems improvement program in the hospital setting. State of California Department of Health Services December 2002 2 73 ~ /2-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER II P-2 PROGRAM PLANNING AND IMPLEMENTATION PLANNING P-2 PROGRAMS If a P-2 program is to be successful within a hospital, top administrators within that facility must support it. The P-2 Project required written approval by the hospital administrator for the facility before that hospital could be a participant. The administrator also designated a staff member that would be the point person for the P-2 Project within the hospital. The approval form also indicated that staff would be given time to participate in P-2 activities. This process helped to ensure that the P-2 Project would be initiated within the facility. The P-2 Project staff worked with the designated coordinators within each hospital facility. The P-2 coordinator was responsible for gaining project support from others throughout the hospital to join and become part of the P-2 team. It was found to be beneficial to create a P-2 team with representation from the various disciplines across the facility such as: . Environmental Services/Housekeeping . Infection Control Nursing . Health and Safety/Hazardous Materials · Risk Management . Purchasing Partnering with suppliers and regulators can also be beneficial and help ensure the success of the P-2 program. Suppliers can bring the latest technologies to the facility and can assist in developing cost-efficiencies in the products purchased by the hospital. Some suppliers can provide crucial services to the hospital to implement environmental improvements. For example, some suppliers will take mercury-containing sphygmomanometers from the hospital for recycling when mercury-free aneroid sphygmomanometers are purchased from them. In addition to selling products, suppliers often are able to provide essential training in the proper use of the equipment and supplies they sell. EMS's P-2 Project staff and the participating hospitals utilized a "safe harbor" arrangement that relieved anxiety of hospital staff that the regulatory agency might document violations while at their facility. EMS committed not to document violations at the facility while they were present conducting P-2 Project activities; these findings instead were discussed with the hospital staff and corrective actions implemented. The safe harbor did not apply during regular medical waste inspections or in response to complaintsthCit untreat~(:trn~c:iiGal\IIJCi~te hag been improperly handled and/or disposed. EMS first used the safe harbor concept when it developed the self-assessment manual. ' State of California Department of Health Services December 2002 3 7Lf<?/I2-Y Department of Health Services Hospital Pollution Prevention (P-2) Strategies Figure 1 A soap dispenser supplier gives a presentation to hospital representatives. (Pollution Prevention Project Photograph) Consultation and collaboration between the regulatory agency and the generator develops the best means for quickly solving problems. In its January 26, 1996 edition, the Los Angeles Daily Journal described this self-assessment project as the "Most promising new program for 1996.,,2 UNDERSTANDING THE WASTE SYSTEMS WITHIN THE FACILITY To successfully reduce or minimize waste generation one must first understand why the wastes were created; where they arise; the special waste handling processes for worker and public safety; regulatory compliance governing the handling of the waste stream; and the varying costs of handling, treating, and disposing of these wastes. The following represent the six major waste streams generated within hospitals: 1. Liquid wastes 2. Solid wastes. 3. Hazardous wastes 4. Radioactive wastes 5. Air emissions 6. Medical wastes Each of these waste streams is governed by a specialized set of laws and regulations to ensure worker and public safety, as well as environmental protection. Some of these wastes may be found in different physical forms such as the liquid and solid states of medical wastes. Wastes are unwanted items that are generated by the various systems and processes in operation within the hospital. The treatment technologies and disposal costs vary from one waste stream to another, making it fiscally prudent to handle the waste in the cheapest waste category legally allowed; 2 Hsiao, Peter, "Prize Policies-Evaluating Environmental Amnesty Programs," Los Angeles Daily Journal, January 26,1996. State of California Department of Health Services December 2002 4 rlS ~ ) 2-2- Department of Health Services Hospital Pollution Prevention (P-2) Strategies RECOGNIZING THE NEED TO REDUCE WASTES The handling, storage, transportation, treatment, and disposal of wastes are a cost of doing business for the hospital. Improper management of the various regulated waste streams can result in additional expenditures for failing to comply with the laws and regulations governing these wastes. Segregation of the wastes requires employees to identify hazards associated with the various wastes. If employees are unable to recognize the various waste streams they not only increase the cost of disposal but also increase the likelihood of personal or public injury. Added to this situation is the unknown cost created by bad publicity and possible enforcement actions for failing to properly handle the waste stream. Regulators classify mixed waste and specify the required manner of its disposal according to the most highly regulated component in the mix. Thus, solid waste mixed with medical waste is classified as medical waste and hospitals must dispose of it as such. This may increase the cost of disposal by at least 20 times over the cost if the waste streams had not been commingled. Management and staff must be committed to waste minimization in order to successfully implement waste reduction within the hospital setting. Management must communicate the need for waste minimization in a manner that inspires staff to implement positive actions towards waste reduction. This can be achieved by publishing a "waste minimization strategy" to guide these efforts within the facility. State of California Department of Health Services 5 Figure 2 Pollution prevention display at a hospital's "Earth Day" Fair. (Pollution Prevention Project Photograph) December 2002 ,10 ~/~, Department of Health Services Hospital Pollution Prevention (P-2) Strategies The strategy should state the goal of the waste minimization program and identify new policies and directives for handling and discarding the various waste streams. Waste reduction comprises any practice that reduces the amount of waste generated. At the heart of waste minimization are activities that: . Prevent waste generation, . Reduce waste generation, · Reuse waste that has been generated, and . Recycle waste. An additional component is purchasing recycled-content products or developing new products that utilize recycled materials. This assists in perpetuating the recycling process. Technology is assisting hospitals in preventing the generation of some wastes. The change to electronic data storage for patient records is reducing the generation of paper wastes while speeding access to the records. Kaiser hospitals use plastic totes for shipping supplies from their central warehouse to hospitals to reduce the need for cardboard containers. Supply trucks pick up the empty plastic totes from the back docks of the hospitals on a scheduled basis for return to the central warehouse for reuse. Figure 3 The Bio Elite red bag contains 30 percent recycled plastics and weighs less than standard red bags. (Pollution Prevention Project Photograph) State of California Department of Health Services Hospitals are composting yard and food wastes and using the resultant mulch as a soil amendment. Hospitals are also baling cardboard wastes for reuse. The Bio Elite Bag Company in Southern California is manufacturing red bags for medical wastes, as well as laundry and solid waste bags, using at least 30 percent recycled plastics. These high-density bags also weigh less and are stronger than the traditional low- density bags that have been in use, thus offering additional savings in waste reduction and costly spill cleanups. December 2002 6 /7 112--v Department of Health Services Hospital Pollution Prevention (P-2) Strategies P-2 PROGRAM IMPLEMENTATION To be successful, waste minimization efforts must begin with formulation of implementation strategies. The strategies should describe how the hospital's waste minimization goal would be achieved. Formal strategies contain the following elements: . Goals to be achieved, . Policies that guide or limit action regarding those goals, and . Action sequences or programs that strive to accomplish the goals.3 The waste minimization strategy should be formally approved by top management within the hospital as a commitment to the program. Top management should next assign responsibility for the program to an individual, department head, team, or council. The individual or team responsible for implementing and coordinating the waste minimization program must be empowered by management to work across organizational boundaries in carrying out the program. When management announces the waste minimization strategy and assignment of responsibility they should include an expectation of cooperation from every operational unit and individual throughout the hospital. Once management has announced the waste minimization strategy and assigned responsibility for implementation, the next task is to gather data as to the current waste streams being generated within the hospital. These data should include the quantities of waste being generated for each of the waste streams and the costs associated with handling and treatment of these wastes. This information can be utilized to help plan where to initiate waste minimization strategies, as well as to document the status of the wastes being generated at the start of the waste minimization project. These data will also provide the baseline from which to demonstrate the amount of change that has been achieved from implementation strategies. The ability to document success requires that accurate initial assessment data have been gathered. The status of waste minimization projects and results achieved from these activities should be communicated throughout the facility. Several hospitals have included information about their P-2 activities and achievements for waste minimization in staff and patient newsletters. Charts showing achievements should be prominently displayed throughout the hospital to encourage further actions in waste minimization. Success should be shared with the surrounding community to demonstrate that the hospital is a good environmental steward. 3 Dean, James W., Jr. and James R. Evans, Total Quality Management, Organization, and Strategy, West Publishing Company, 1994, page 260. State of Califomia Department of Health Services December 2002 7 7& ~~ Jz-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies 14000 12000 10000 Cl :J: - 0 8000 /II E e C) 6000 4000 2000 0 Mercury Reduction 11953 8594 1155 1155 Figure 4 Waste being weighed and the results entered into a computer for tracking to the point of generation. (Pollution Prevention Project Photograph) 1015 GI Devices Lights 0' 120 o o o Non-clinical Thermometer Sphygs ! .before .after (1 year) Figure 5 Chart showing "before" and "after" mercury assessment and removal results from a hospital. (Pollution Prevention Project Photograph State of California Department of Health Services 8 December 2002 71 1 )~2- Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER III HAZARDOUS WASTE MINIMIZATION HOSPITAL EQUIPMENT AND DEVICES CONTAINING MERCURY Sphygmomanometers The sphygmomanometer that traditionally has been used in hospitals to monitor blood pressure contains mercury. Until recently, this was the only accurate sphygmomanometer on the market. Although technical developments have given the mercury-free aneroid sphygmomanometers an accuracy rating similar to the mercury units, it is often difficult to convince some practitioners to change. Arguments are made that aneroid sphygmomanometers add to the burden of hospital maintenance staff because of the need for periodic calibration. However, mercury sphygmomanometers also need periodic maintenance. The expense and time of managing maintenance, spills, and disposal of mercury sphygmomanometers can outweigh the time needed for calibrating the aneroid units. Many hospitals are replacing mercury sphygmomanometers and have found that companies that manufacture aneroid sphygmomanometers have policies that make replacement more economically feasible. These companies may take back and recycle mercury units on a one-for-one basis when their aneroid units are purchased. The purchasing department of a hospital can negotiate with these companies to get the best price for the number of mercury sphygmomanometers they want to replace and not to be burdened with additional mercury disposal costs. State of California Department of Health Services 9 Figure 6 Bedside mercury sphygmomanometer commonly found in hospitals. (Pollution Prevention Project Photograph) December 2002 g-o ~ )t--V Department of Health Services Hospital Pollution Prevention (P-2) Strategies Baumanometer@ Safety Devices Figure 7 The bedside mercury sphygmomanometer has been replaced with an aneroid unit. (Pollution Prevention Project Photograph) By far the most commonly used sphygmomanometer found in hospitals is the Baum brand wall-mounted sphygmomanometer. Manufactured in New York since 1916, the Baum sphygmomanometer was a technological breakthrough at that time. Since then, it has undergone many modifications and improvements and is considered by some a standard for blood pressure measurement. Indeed, a testament to the quality of this instrument is the fact that many in use are up to 30 years old. However, this is also one of the problems with the "Baumanometers." The majority of instruments in use in the hospitals visited by California pollution prevention staff were manufactured before Baum began including safety features that greatly diminish the chance of a mercury spill. Baumanometers are found in many uncharacteristic places. In fact, many patient areas that have been turned into offices may still be found with the Baumanometers mounted on the walls next to desks. Additionally, alternative types of sphygmomanometers may be found, but the Baumanometers are not removed from the walls. These wall-mounted sphygmomanometers are seen in many emergency rooms, treatment rooms, and doctors' offices. The safety issues with these older model sphygmomanometers include two items that are inexpensive and easy to fix. One is replacement of the glass mercury tube with a mylar-coated tube. The other is the insertion of a small "L" shaped metal "lever lock" that prevents accidental release of the mercury from the tube. Both are included on new Baumanometers. Older models of the Baum sphygmomanometers used a clear glass tube. Although it is somewhat recessed in the instrument's face, it has always been a potential source of a spill if the tube were broken. Now, hospital personnel can replace the State of California Department of Health Services 10 December 2002 g I 1 ' 2--~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies glass tube with one coated with mylar. If the tube breaks, the mylar coating will prevent shattering and maintain the integrity of the tube. The mylar sheath ends close to the tube's top end, and a fingernail can detect the change in the tube's outer diameter. This check can be used to see if existing tubes are mylar coated. The mylar coated tubes can be purchased from Baum and replacement is not difficult. They are available for all models of Baum brand sphygmomanometers. The second safety device is provided free of charge from Baum. On the wall mounted Baumanometer, the mercury-containing tube is held in place by a lever on top of the device. The lever is only supposed to be moved when the sphygmomanometer is removed from the wall and lying on its right side. If this lever is inadvertently flipped back while the instrument is upright on the wall, the tube is released and the mercury spills out of the bottom of the tube. The "L" shaped lever lock is a simple strip of angled metal that is easily slipped behind the lever to immobilize it. The lock can be removed with no problem using a screwdriver, but spills are prevented because patients cannot remove the lever lock without some effort. The lock eliminates the potential to idly flip the lever, which bored and/or curious patients may do. Vigorous cleaning of the sphygmomanometer can also allow inadvertent flipping of the lever. Figure 8 Unless recycled, the 90 sphygmomanometers, along with thermometers and bougies (not pictured), would have to be managed as hazardous waste at great expense. There are programs to exchange both bougies and sphygmomanometers. (Pollution Prevention Project Photograph) Another benefit of inserting these lever locks is that one person in the facility can make a detailed accounting of where and how many Baumanometers are in the hospital, and can make a quick visual maintenance check as well. State of California Department of Health Services 11 December 2002 fS 2- ~ 1~2- Department of Health Services Hospital Pollution Prevention (P-2) Strategies Sphygmomanometer Service Kit One significant source of mercury that must not be overlooked when conducting a mercury audit of a hospital is contained in the sphygmomanometer service kit. Typically, along with spare parts and fittings, such a repair kit will come with one or more one-pound bottles of triple-distilled mercury. If the service kit has been used, there may well be another bottle of waste mercury. The service kit may be all that remains at a facility that has changed out all its mercury sphygmomanometers. Extra bottles of mercury have also been discovered separate from the kit. One pound of mercury is about 33 milliliters, or about the volume of a nasal or ophthalmic solution bottle. The engineering department of a large hospital could easily overlook such a small container. State of California Department of Health Services 12 Figure 9 This style sphygmomanometer service kit is provided for the Baum sphygmomanometer. The mercury from this kit may be consolidated with that from other sources to be recycled. Sphygmomanometer exchange programs may agree to accept this source of mercury. (Pollution Prevention Project Photograph) Figure 10 The bottle of "new" mercury (left) weighs 500 grams (454 grams is a pound). The waste mercury (right) was estimated at 0.3 pound. (Pollution Prevention Project Photograph) December 2002 '33 ~ J2--~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies Esophageal Dilators (Bougies) and Feeding Tubes Esophageal dilators, feeding tubes, and other devices may use mercury as a weight. Non-mercury replacements are available for all the mercury-containing devices that have historically been used in hospital endoscopy departments. The most common of these is the esophageal dilator or bougie. This device is a long, flexible tube containing mercury. It is passed down the patient's esophagus and used to dilate this structure if there are constrictions from various disease processes. Patients may return periodically to the hospital for this procedure if they have a chronic problem. A mercury-free alternative is available, containing tungsten gel for weight instead of the mercury. Additionally, the outside surface is silicone, which is non-slip when dry, and slippery when wet, making handling easier. The mercury-containing bougies are made of rubber. Figure 11 A complete set of tungsten gel-weighted bougies, stored in the leather zippered case that formerly held the mercury ones. (Pollution Prevention Project Photograph) The silicone tungsten gel bougies are green, easily differentiating them from the orange rubber mercury bougies. At least one company has a trade-in policy that gives a ten percent rebate toward purchase of a new mercury-free bougie and also includes free recycling of the old one. Gastro/Esophageal Tubes Containing Mercury Miller Abbott tubes are passed down a patient's esophagus, through the stomach, and into the small intestine to help unblock intestinal obstructions. Historically, these tubes had a balloon containing mercury to guide the tube into place through gravity. The mercury balloon can be replaced with a water-filled balloon, or a different procedure used. Most practitioners have stopped using the Miller Abbott tubes in favor of a combination of drugs and surgery for obstructions. The f3lakemorfnube(Sengslakei1=BlaRemofEffObeltshownbelow) is a-device used to stop the bleeding of esophageal varices (dilated veins in the esophagus). The tube consists of two balloons; one inflated in the stomach to hold the device in place, the other inflated inside the esophagus to compress the bleeding vessels. The State of California Department of Health Services December 2002 13 gY1J2-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies Blakemore tube is an absolute necessity in the emergency room. Older Blakemore devices have a mercury-weighted tube allowing them to be placed in a similar fashion as the Miller Abbot tube. A solid rubber weight replaces the mercury in the mercury-free device. Figure 12 A Blakemore tube has three connections. One inflates the bulb. one inflates the tube. and one is for gastric lavage and administering fluids. (Pollution Prevention Project Photograph) Figure 13 This mercury barometer, used to standardize blood gas measurements. can be replaced with an aneroid device. (Pollution Prevention Project Photograph) Barometers in Respiratory Therapy In several hospitals visited, the respiratory therapy department had one of the largest repositories of mercury in the hospital. Hospitals have historically used mercury barometers to calibrate blood gas analyzers. One popular brand of barometer in use holds 14 ounces of elemental mercury. The manufacturer does not sell any safety devices for this barometer. Some hospitals have replaced barometers with aneroid units, or simply call their local airport periodically for a barometric pressure reading. Thermometers A possible source of mercury thermometers in the household can be newborn nurseries. Most hospitals give the new mother a kit with commonly needed baby items upon discharge after delivery. Previously, these kits would typically include a new rTl~rC:;LJry tbermQrDeteLThis practice is nQ longeras common,. and hospitals should provide non-mercury substitutes. A potential method to "get the word out" about mercury is through childbirth classes. Many hospitals require classes on childbirth and newborn care prior to delivery. Educators can be encouraged to teach expectant mothers about alternatives to mercury thermometer use in the home. State of California Department of Health Services 14 December 2002 26 O;j )22,- Department of Health Services Hospital Pollution Prevention (P-2) Strategies Mercury thermometers may also be found in refrigerators used throughout the hospital. Hospital refrigerators must have thermometers, but mercury Figure 14 Every hospital refrigerator must have a thermometer. This mercury thermometer could easily be replaced with an alcohol/spirit thermometer. (Pollution Prevention Project Photograph) Figure 15 On the bottom shelf of this refrigerator are (left) a mercury minimum/maximum thermometer, and (center) a non- mercury recording thermometer. Upper shelf, at 1 o'clock, a home refrigerator alcohol/spirit thermometer. At 11o'clock, a "lab quality" mercury one. Mercury thermometers should be replaced with non-mercury thermometers and the number of thermometers in use could be reduced. (Pollution Prevention Project Photograph) thermometers may easily be replaced with alcohol/spirit thermometers. When conducting the mercury audit an explanation about the P-2 Project and the need to find all mercury-containing devices such as thermometers helped to encourage laboratory staff to find all mercury thermometers within their labs. State of California Department of Health Services 15 December 2002 21a 112-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies Intraocular Pressure Devices Prior to ophthalmic surgery, pressure within the eyeball can be reduced to simplify surgery. Mercury-filled devices, such as the "Wee Bag O'Mercury," have been used for this procedure. The egg-shaped device contains approximately 600 grams of elemental mercury. When placed on the eye for 30-45 minutes prior to surgery, the weight of the mercury on the eyeball keeps fluid from accumulating at the normal rate, softening the eyeball. Newer micro-surgical procedures have relegated this device to forgotten drawers in most facilities because pressure reduction is not always necessary. The stored pressure reducer may create a waste problem because it may be easily discarded inappropriately due to its small and inconspicuous size. Staff from the P-2 Project found a Wee Bag O'Mercury that had not been in use for 14 years stored in the back of a drawer in one hospital. Effort must be exerted to search for these unused items and to properly dispose of them while the hospital is actively involved in its mercury elimination project. No manufacturer could be found that is still making mercury pressure reducers and no recycling programs are in place for them. It is the responsibility of the facility to find, recycle, and replace these devices. Figure 16 Wee Bag O'Mercury ocular pressure reducing device contains over 600 grams of mercury. (Pollution Prevention Project Photograph) A similar device consists of a hard, formed plastic egg with one convex side that snapped to a headband. Many staff consider the device inferior to the Wee Bag O'Mercury, raising concerns that staff may revert to using mercury-filled devices. Without a replacement available, physicians may request repair of one of the old- style mercury pressure reducers, unnecessarily exposing staff and patients to possible elemental mercury. If a replacement is desired, the Lebanon Corporation offers the Honan Intraocular Pressure Reducer or Eye Softener.llis.a pneumatic devicewith a pressure gauge to maintain even pressure on the eyeball. State of California Department of Health Services December 2002 16 8 'I ~ rz.,~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies B-5 Fixative Laboratories widely use a compound called 8-5 fixative. This mercury-containing fixative has been used in histology to aid in identification of certain cell types. The tissue is placed in a container with the 8-5 fixative and left until the solution has penetrated the tissue. Then the tissue is stained and placed onto a slide for microscopic examination. During the rinse process some mercury is discharged into the facility sewer system. Several brands of 8-5 fixative use zinc chloride instead of mercury. Laboratory suppliers should be able to provide a listing of possible substitute brands. .^'MDU{~!N iM~~riI'r.<<"j Sdm~~:;!:1,r!~c.. .1fNc.. i~....}..,J.;.''''' ~~. l:a<h;~.t.,~.w ~ai~imjif;J;;i;;;~ii jii!;'J1JiN':~;:;lr(j],urI1N B*5Fixntlve , . WITH ZING CHL(lHlD~; 4 NON.U'\ZAHf){){Js AJin;flN.~l'l~. Mercury-Free Cleaning Products Figure 17 "8-5" Fixative previously containing mercuric chloride has been replaced with zinc chloride as noted on the label. (Pollution Prevention Project Photograph) . Small, and potentially overlooked, sources of mercury in the hospital are cleaning products. The electrolytic process of chloralkali production (manufacture of chlorine products and sodium hydroxide products) often relies on mercury electrodes, resulting in mercury contamination of the products. Many cleaning products consequently contain low levels of mercury. Although these products contain mercury in quantities that are in parts per million or billion, the amount of cleansers used in hospitals can result in a contribution to mercury in wastewater through normal use. Hospital purchasing departments should be aware of this situation and request mercury-free product verification from their suppliers. MERCURY CONCERNS IN HOSPITAL OPERATIONS To ensure safety and contamination control, activities that remove mercury from the facility must be consistent and predetermined. This may involve establishing a facility-wide, dedicated mercury management program. The suggested elements of State of Califomia Department of Health Services 17 December 2002 )} ~ ,'1 f~:- Department of Health Services Hospital Pollution Prevention (P-2) Strategies such a program, which would also include spill reaction and mercury exclusion policies, are set forth below. Mercury-Containing Devices In Medical Waste or Sharps Containers Staff must clearly understand that any broken mercury-containing device must be managed as hazardous waste even if contaminated by medical waste. Whether broken or intact, mercury devices must never be placed in red bag medical waste containers or sharps containers, but rather collected for recycling or hazardous waste disposal. Even though the increased use of digital and other non-mercury substitutes has drastically reduced the incidence of broken fever thermometers, this principle applies to clinical, laboratory, and all other sources within the healthcare facility. Mercury Collection Areas Mercury-containing material will ultimately either be recycled or disposed as hazardous waste. To assure all devices earmarked for removal actually leave the hospital, a single, dedicated, secure pre-collection location for consolidation of mercury, mercury-contaminated waste from spills, and mercury-containing devices is a necessity. Procedures for removal of mercury-containing material to consolidation locations must also be established. Some practitioners may be reluctant to switch from familiar and trusted mercury- containing devices to mercury-free models. To prevent these practitioners from retaining mercury-containing devices when the hospital is trying to replace them, change-out procedures must dovetail with the transport system. Transporting Mercury Devices Change-out activities, whether for bedside sphygmomanometers, mercury thermostats, or mercury devices in the boiler room, should also be coordinated with planned secondary containment and transportation to a prescribed storage location arranged in advance. Ad hoc improvements or changes are to be discouraged. Ultimately, mercury-containing items will be consolidated at the facility's hazardous waste storage area for recycling. Procedures should clearly state proper storage methods at each storage area and scheduled transportation to the consolidation area. State of California Department of Health Services December 2002 18 S<J ~//~~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies Spill Clean Up It is important to have individuals available at all times who are trained and familiar with management of mercury spills and the use of a spill kit. Notices should be adequately posted throughout the facility listing these individuals and how they may be contacted. A mercury spill must be treated as a hazardous waste spill. Staff throughout the hospital must be informed of procedures for notifying of the trained personnel for mercury clean up. Training and clear communication on the importance of proper procedures in mercury clean up are imperative. Spill Clean Up Kit Spill clean up kits should be easily accessible to staff on call for mercury clean up. Any laboratory or safety supplier will have choices of spill clean up kits available. Some of the components the kits should contain are: . Mercury Suppressant - a solution that will prevent vaporization of elemental mercury. . Mercury Indicator - a powder that changes color to indicate the presence of mercury . . Mercury Absorbent - a powder that amalgamates with mercury to facilitate clean up. . Mercury Aspirator or Vacuum - a syringe to a dedicated vacuum for mercury and used to suction mercury from surfaces. It is very important that regular vacuum cleaners are not used on spilled mercury, as they spread the contamination through aerosolization of the mercury particles. . Clean up materials - gloves, safety glasses, screw cap containers, plastic bags, paper towels, and similar clean up aids. Mercury spill clean up kits can be made in-house or purchased from a safety equipment supplier. The cost of a vacuum specifically for mercury may be prohibitive for small facilities. Hospital groups may purchase one to share between facilities. Hospitals in a city or region could also cooperatively purchase one mercury vacuum to share. Some governmental agencies and university hazardous materials emergency response departments or companies have mercury vacuums available. Be prepared and know whom to contact beforetb~_~i11 ~ccurs. State of California .Department of Health Services December 2002 19 901122-- Department of Health Services Hospital Pollution Prevention (P-2) Strategies Keeping Mercury Out of the Hospital After removal of mercury sources from the hospital it is important to keep new sources from entering the hospital. To help keep mercury from entering the hospital, purchasing personnel need to become knowledgeable and committed to buying mercury-free items when available. Facilities should require their departments to inform the purchasing department when items requested. contain mercury and why available alternatives are not appropriate. Conversely, personnel involved in purchasing must continually update their familiarity with the availability and applicability of new mercury-free alternatives. Mercury Assessment The mercury assessments conducted as part of the P-2 Project were much more thorough and effective when a limited number of people conducted the assessment. A three-person team is ideal for conducting the assessments, as that number does not crowd the area being surveyed or, more importantly, stifle staff interaction. Incidental comments from staff working in the area being surveyed often led to the discovery of mercury-containing devices that may have been overlooked without their input. Where larger assessment teams were used, comments from staff and supervisory personnel were reduced. The smaller team also was able to cover more areas of the facility in a rapid fashion. When smaller teams were used, they surveyed areas not previously targeted, in addition to the areas staff had planned to visit. These more comprehensive surveys often resulted in fewer follow-up activities needed by the hospital staff. Plumbing Traps Residual mercury from past disposal practices in hospitals has been known to collect in plumbing traps. Lack of awareness of this hidden mercury may result in spills during plumbing or demolition activities if the appropriate staff does not provide secondary containment when disassembling a trap. This can easily be accomplished by placing a shallow bucket or other similar container below the plumbing traps prior to disassembling the trap. Staff training greatly lessens the risk of uncontained contamination. Fluorescent Lighting Measuring mercury contributed by fluorescent lighting is a formidable task. The engineering department from one of the hospitals participating in the P-2 Project provided a complete inventory of all fluorescent fixtures, from which project staff could calculate a conversion factor of 0.57 milligrams per square foot (mg/ft2) for use throughoutallthe hospitals. This was based on the . premise Ihat,diJelOmutl.lal compliance with a wide variety of regulations, lighting in each of the participating hospitals could justifiably be approximated to be the same level as found at the hospital that undertook the inventory of fluorescent fixtures. State of California Department of Health Services December 2002 20 0/ ~ }?'), Department of Health Services Hospital Pollution Prevention (P-2) Strategies Effective March 7, 2000, the California Department of Toxic Substances Control adopted emergency regulations (the universal waste rule) that require all fluorescent tubes be either recycled or disposed of as hazardous waste. Electrical Supplies The electrical supply for a large hospital may employ certain mercury-containing devices such as high-current service cutoff switches, relays, and mercury vapor circuit breakers. These devices are not hospital specific, and there are no substitutes available. These devices, common to many large commercial and industrial facilities, are self-contained and physically isolated, minimizing risk of mercury escape. They are also very long-lived, so their replacement, and the resultant generation of waste mercury, typically occurs coincidentally with other major electrical changes. The facility plan should reference any such devices in use in the facility, and prescribe procedures for recycling or disposal at time of replacement. Calculations and Quantification The P-2 Project relied on several sources for quantifying mercury contained in a particular device. The capacities of the two kinds of barometers found were also estimated volumetrically, by calculation from the measured heights and internal diameters of the cisterns and columns. Although no mercury was actually found, measurement of bulk mercury from plumbing traps was to be done volumetrically. The following procedure should be followed if mercury is found. Decant the majority of the trap aqueous liquid, pour the mercury and any remaining water into a graduated cylinder and note the volume of the denser mercury. The weight of mercury for light fixtures was based on an actual fixture inventory performed by one participant facility. Published information from a manufacturer of low-mercury f1uorescents states that conventional fluorescent tube production technology could achieve no less than 22 milligrams of mercury per four-foot tube. Since an underestimate would be counter to the best interests of their advertising, the P-2 Project accepted that number as a conservative minimum. The facility inventory yielded a multiplier of 24,156 linear feet of tube. The facility calculated its mercury total from fluorescent lights to be 133 grams. With 233,900 square feet of floor area in the facility, the mercury in fluorescent lights was 0.57 mg/ft2. The P-2 Project staff assumed that all hospitals would be required to meet the same lighting standards and therefore used the 0.57 mg/ft2 factor in calculating fluorescent tube mercury for all other facilities based upon their square footage. FactQry~p~GifiQC:1!iQI1?,^,~r~j)articularly difficult to acquire. Contrary to the project goal of eliminating mercury-containing devlcesfOffaciIities, the device manufacturers continue to sell mercury-containing products. State of California Department of Health Services December 2002 21 ql?- '1J2-~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies Business Plan The 1999 Memorandum of Understanding between the U.S. EPA and the American Hospital Association targeted 2005 for the virtual elimination of mercury in waste streams from hospitals. All hospitals should ascribe to that goal. Following a mercury audit, hospitals should develop a business plan for replacing mercury- containing devices with mercury-free devices. The business plan should be based on the findings and utilize the data generated from the audit. The business plan should consider three matters of fact that may impact on the processes that they choose in eliminating mercury from their hospital. . The practical feasibility, based on use, change-out and disposal costs and the ability to overcome resistance to new devices may drive the rate at which change can occur. . Certain devices or products, particularly diagnostic lab packs and multi-dose vaccines (preserved with thimerosal) are often not available without mercury. Mercury reduction can proceed only at a pace determined by the emergence of suitable substitutes in the marketplace. . New earthquake standards developed by the Office of Statewide Health Planning and Development may require structural changes that include demolition or remodeling of the facility. If demolition or remodeling of the facility is undertaken, caution must be exercised for the removal of mercury- containing fixtures. Many of these mercury-containing fixtures may be presently unknown, such as mercury in plumbing traps and silent mercury light switches that are virtually indistinguishable from their non-mercury counterparts. Discovery and change-out of such fixtures where appropriate is advised, so that they are not present when demolition or reconstruction commences. FOLLOW UP Along with reduced use of mercury-containing items, and their removal from the hospital, comes another responsibility-keeping out new mercury sources. Educate the purchasing department in each facility to be alert for the possibility of reintroduction of mercury and to scrutinize vendor agreements. In addition, other departments must be alert that devices that have been removed are not replaced with other mercury-containing devices. The laboratory must continue to use zinc- based fixatives, and to be alert for thimerosal preservatives in commercially prepared stains. Wherever possible the pharmacy should encourage the use of tl"limeresaf-free vaccines; Rarely ,resistanceto these changesftbh1professional staff has been observed. Administration staff at each hospital must be ready to step in if mercury-containing devices reappear following removal. State of California Department of Health Services December 2002 22 13 aj 12-)., Department of Health Services Hospital Pollution Prevention (P-2) Strategies HAZARDOUS MATERIALS MINIMIZATION Wherever possible hospitals should reduce the use of hazardous materials in an effort to curtail the generation of hazardous waste. Hospitals will continue to need devices containing hazardous materials, but in an increasing number of cases recycling is being required after use. New universal waste regulations require fluorescent lights and cathode ray tubes to be sent for recycling instead of to the landfill. Additionally, several easy to implement practical steps can be initiated within the hospital to help achieve a reduction in the hazardous waste stream. The first step is to develop a formal mission statement outlining the hospital's commitment to source reduction. It is important to encourage employees to participate in hazardous materials source reduction as a way to reduce or eliminate hazardous waste generation. Hospitals should consider an incentive program to encourage employees to follow good housekeeping practices that reduce hazardous materials use. An incentive program can easily be instituted through an employee or team recognition or awards program. A second step involves training employees on source reduction techniques and encouraging them to develop innovative ideas to reduce hazardous materials use within the hospital. Training should include proper handling and storage of hazardous materials so that spills can be prevented or immediately responded to so as to minimize their impact. Trade associations, equipment vendors, and local environmental health programs often sponsor employee training on this subject as part of the services they provide to hospitals. An on-going commitment to employee training in hazardous materials source reduction must be made and include periodic training sessions held to keep employees current so that they can perform their duties more efficiently. A third step to reduce the hazardous waste stream is to implement a program of inventory controls for hazardous materials. A computerized inventory enables policies that facilitate sharing of materials among departments and prevent duplicate purchases. Such policies save money and reduce the amounts of hazardous waste generated from leftover materials. Figure 18 Environmental Services staff using the MicroScrub mop system. (Pollution Prevention Project Photograph) A fourth step involves using improved technologies that reduce hazardous wastes. The MicroScrub mop system is replacing the traditional wringer mop that was patented in 1893 and has been in use since then. The wringer mop system uses State of California Department of Health Services December 2002 23 Cfl.! ~ 12~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies disinfectants in a bucket containing two to three gallons of water, mopping three to four rooms before emptying the bucket in a janitor's sink and refilling for use in another three to four rooms. The MicroScrub system uses a single flat cloth mop per room, with the cloths stored until use in a gallon bucket with a third of a gallon of water covering the cloths. When a cloth is needed it is pulled from the bucket and used in a single room. When the floor of the room is finished being mopped, the mop cloth is removed Figure 19 Chemical dispensing unit mounted in a janitorial closet ensures precise arnount of chernical is used. (Pollution Prevention Project Photograph) and placed in a bag and a new one used for the next room. At the end of the day all the dirty cloths are laundered and dried for use the next day. String mops last approximately a month before needing to be replaced. MicroScrub mop cloths have been in use at Sacramento's Mercy General Hospital for over three years with no signs of wear. Additionally the MicroScrub system is lighter and easier to use, thus reducing repetitive motion injuries. Some hospitals have paid for implementing the system through risk management funds from anticipated ergonomic injury reduction savings. The use of chemical dispensing units within hospitals can reduce the amount of chemicals used by removing the "human factor" in "eye-balling" the quantity of chemicals to be used. Suppliers install chemical dispensing units within janitor's closets where chemical-using equipment is filled. Different sized dispensing heads meter out a measured amount of chemicals as required for the cleaning procedure being performed. Facilities realize cost savings by reducing the amounts of chemicals used. SubstituUng.. non-t'lazardous or less-hazardous materials for hazardous materials can reduce or eliminate the hazardous waste stream. Some hospitals have routinely used hepatitis B quaternary disinfectants daily on floors. Infection control specialists have recently directed that this process should only be used for cleaning and disinfecting blood spills, and that daily floor cleaning can be accomplished using a State of California Department of Health Services December 2002 24 150;} 12-1- Department of Health Services Hospital Pollution Prevention (P-2) Strategies floor soap or clear water. This process will assist infection control within the hospital by reducing the possibility of developing resistant strains of pathogens from the continued use of hepatitis B quaternary disinfectant cleaners. Additionally, this reduces the amounts of chemicals used within the facility and the cost associated with their use. Hospitals can substitute gelled electrolyte lead-acid batteries (commonly called "gel cells") for traditional wet cell lead-acid batteries in several sizes of floor scrubbing and polishing machines. The gel cell is a "recombinant" battery. The oxygen that is normally produced on the positive plate in all lead-acid batteries recombines with the hydrogen given off the negative plate. The recombination of hydrogen and oxygen produces water that replaces the moisture in the battery. This makes the gel cell battery maintenance-free because it need not be topped off with water like wet cell batteries. A gel cell battery is pressurized and sealed using special valves. This self-contained feature prevents battery acid spills and the need for special cleanup kits. Recharging does not produce fumes, which is very beneficial in hospitals. Figure 20 Gel cell batteries installed on a floor scrubbing machine. (Pollution Prevention Project Photograph) A fifth step to reduce hazardous wastes is to prepare and implement a hazardous materials spill response plan. An immediate response to hazardous materials spills or improper storage of hazardous wastes can minimize employee or patient exposure, damage to the hospital facility and surrounding environment, liability, and disposal costs. Routine inspections of hazardous materials containers and hazardous waste storage drums can identify potential problems such as leaks and improper storage practices that could result in costly remediation if action is not taken to remedy the situation. Periodic drills to respond to hazardous materials spills can improve the readiness of hospital response staff to take appropriate action during an emergency. .A quick and appropriate response will reduce the amount of hazardous wastes generated during a spill and reduce the cost of the cleanup. Hazardous-materials shouTdbest6red' separately from non-hazardous materialsto prevent the creation of larger amounts of hazardous waste if a spill takes place in the storage area. Hazardous materials are best protected in a covered area where they are not exposed to the elements. Sunlight has the potential to degrade some State of California Department of Health Services December 2002 25 q& '1 ! 2-t- Departrnent of Health Services Hospital Pollution Prevention (P-2) Strategies hazardous materials and absorbed heat can raise the pressure inside containers, creating potentially dangerous conditions. State of California Department of Health Services December 2002 26 q7~ /22,: Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER IV SOLID WASTE MINIMIZATION Health care facilities generate approximately two million tons of solid wastes per year. This represents one percent of the Nation's solid waste stream. Table 1 represents a breakdown of the typical hospital solid waste stream. Table 1. Composition of a typical hospital solid waste stream 54% 19% 15 % 3% 2% 7% 100.0 % Paper represents the largest portion of the hospital solid waste stream and is composed of cardboard, kraft, high-grade paper, newspaper, ma~zines, phone books, directories, and other mixed paper. Many hospitals have instituted programs to bale and recycle cardboard. Figure 21 Many hospitals recycle cardboard. (Pollution Prevention Project Photograph) The second highest percentage of the hospital solid waste stream is organic wastes including yard wastes. The largest component of the organic waste stream from hospitals is food wastes. Plastics; at 14.6 percerit,-represent the third highest percentage of the hospital solId waste stream. If significant reductions in the solid waste stream are to be achieved, these portions of the waste stream are the leading candidates for intervention strategies. State of California Department of Health Services December 2002 27 121'zv Departrnent of Health Services Hospital Pollution Prevention (P-2) Strategies PERFORMING THE SOLID WASTE AUDIT Hospitals should select the solid waste audit team from staff knowledgeable with the layout and waste operations of the facility. Candidates for the team are managers, supervisors or others from housekeeping, environmental management, and health and safety, as well as infection control. The team should be small enough so as not to disrupt the operations of the areas being reviewed. The major difference between the mercury assessment discussed in the preceding chapter and the solid waste audit is that the mercury assessment looks for fixed or transient locations of mercury-containing devices, equipment or materials, whereas the solid waste audit reviews the solid waste stream that is being generated and moving through the facility. A team of three to four individuals works best in conducting the solid waste audit. The team walks through the facility and notes solid waste handling practices and observes what wastes are being disposed of in the waste receptacles. The team needs also to gather pertinent data as to the amount of solid wastes being generated and the solid waste company handling the waste stream. Note must be made of the amount of material being diverted from disposal through reduction, reuse, and recycling activities as the total amount of waste generated equals the amount disposed plus the amount diverted. The audit should note how wastes are handled and stored. The team should document the location of recycling containers and other devices, such as cardboard balers. If possible, the cost of the recycling activities should be obtained. This information can be valuable should reduction strategies eliminate the need for recycling of specific products. Documenting the success of solid waste minimization efforts requires knowledge of the costs before the minimization interventions. SUCCESSFUL SOLID WASTE REDUCTION STRATEGIES Most of the hospitals that participate in the P-2 Project had already instituted cardboard recycling prior to joining the program. However, there is a cost to recycling the cardboard. Staff must breakdown the cardboard containers, haul them to a baler, and bale them. The Northern California Kaiser Hospitals use plastic totes to send materials from their central supply warehouse to the participating hospitals. The totes replace the cardboard containers and greatly reduce the amount of cardboard needing to be baled for recycling. When empty, the plastic totes stack within each other and are easily stored while awaiting pickup and return to the warehouse for reuse. Color-coding the plastic totes assists the receiving facilities in knowing where to send the supplies (such as medicines in yellow totes to the pharmacy). Gray totes are packaged for specific floors designated on a three-by- five card placed in an address area on the tote. This expedites supply delivery and reduces the cost-of processing thematertal thrbugh cehtral. supplY. State of California Department of Health Services December 2002 28 qq ~ (2-V Department of Health Services Hospital Pollution Prevention (P-2) Strategies Figure 22 Empty plastic totes nested and ready for return to warehouse for reuse. (Pollution Prevention Project Photograph) Most communities within California have instituted recycling programs for households, and employees often have commented that when they come to work at the hospital they are surprised to find that little recycling is being done. Hospitals in many California localities can work with their waste authorities and refuse companies to implement recycling programs for aluminum cans, paper, and glass. The waste authorities often have lists of recyclers for various types of materials and can even be a source of small grants to assist the hospital in getting their recycling program underway. California hospitals have recently been presented with an opportunity to recycle blue wrap and other plastic films such as shrink-wrap, stretch wrap, bubble wrap/blister pack, and plastic bags. Marthon Recovery is a raw material recovery program initiated by Boise Cascade Corporation to procure polyethylene and polypropylene plastic films waste. They have established a receiving center in Oakland, California, and are building a plant in the State of Washington where the recovered plastic film waste will be used to produce a wood/plastic composite building material that will be in the marketplace in the near future. Through this process, hospitals avoid the cost of solid waste disposal for their plastic wrap waste and it in turn is converted into a new building material. Clean Source, a hospital supply company, is assisting this process by backhauling blue wrap and plastic films from the hospitals they service so that waste stream can be easily taken to Marathon's Oakland receiving center. Blue wrap, which is ubiquitous in hospitals, and other plastic film products are being converted from a waste stream component into a valuable recycled product. State of California Department of Health Services December 2002 29 } trO 1 )~.v Department of Health Services Hospital Pollution Prevention (P-2) Strategies Figure 23 Blue wrap used to wrap surgery equipment for sterilization is being recycled and used with wood chips to make wood siding. (Pollution Prevention Project Photograph) Many communities in California have instituted yard waste composting to remove this component of the solid waste stream. Hospitals should check with their waste authority to obtain information about possibilities within their locality for diverting yard wastes from the solid waste stream. Norcal Waste Systems, Incorporated, has instituted a program for composting yard wastes, pallets, and food scrap wastes from San Francisco restaurants at one of their landfill sites in Northern California. Norcal runs the wastes from these three waste streams through a chipper and then places it in plastic silage bags (capable of holding 200 tons of material) for eight weeks of composting, with controlled temperatures aiding the process. The compost that results from this process has been used as a soil amendment in agricultural and horticultural operations. Norcal sends the used plastic silage bags to Marathon for use in their plastic film recovery program. Norcal is exploring the feasibility of using this process for handling the food waste from hospitals. By composting the yard and food wastes, which compose the second largest category of solid wastes from hospitals, this process could reduce the hospital's solid waste stream by approximately 19.1 percent. Figure 24 Food waste composting is chipped and rnixed with yard wastes and pallets in silage bags to create a soil amendrnent. (Pollution Prevention Project Photograph) All activities to reduce the solid waste stream in hospitals must be closely tracked so that progress can be measured. The reduction of the solid waste stream should be State of California Department of Health Services 30 December 2002 /0/ <r;f /2,,?/ Department of Health Services Hospital Pollution Prevention (P-2) Strategies prominently displayed in graphic form in the hospital so that staff and the public can see the achievements. State of California Department of Health Services Decernber 2002 31 102- ~ J 2-,~ Department of Health Services Hospital Pollution Prevention (P-2) Strategies CHAPTER V MEDICAL WASTE MINIMIZATION Although medical waste management practices will vary from one hospital to another, a common ingredient in all effectively managed medical waste systems is leadership. Effective management of medical waste requires the hospital to meet all legal obligations, achieve public and environmental protection, and accomplish this in a cost-efficient manner. Overlaying the proper management of medical waste is the increasing attention on reducing the medical waste stream through pollution prevention activities. Balancing these issues is a challenge that requires a commitment from the highest levels of management and from staff entrusted to carry out the medical waste handling activities throughout the hospital. MEDICAL WASTE MANAGEMENT LEADERSHIP Many people think that the terms leadership and management are interchangeable. University of Southern California professor, Warren Bennis, provides the distinction between leaders and managers as follows: "Leaders are people who do the right things; managers are the people who do things right." He acknowledges that both play critical roles within the organization; but they differ profoundly. People in top positions are often found doing the wrong things well. 4 Knowing what is right for the hospital is at the heart of the leader's responsibilities. Burt Nanus in his book, Visionary Leadership, emphasizes that twenty-first-century organizations demand visionary leadership. He indicates that most organizations are faced with accelerating technological changes, a diverse staff of intelligent workers, and a variety of customer and constituency needs that would cause most organizations to self-destruct if not for a sense of direction provided through management's vision of the future. Visionary leadership is vital to align the thousands of disparate tasks and tap the energies of the workers within the organization.s This is especially true in attempting to reduce medical waste while ensuring its proper handling in a complex organization such as the hospital setting. Proper management of medical waste is just one of many systems driving the hospital towards fulfilling its overall vision of providing excellent health care to its clients and the greater community at large. The vision helps to frame the "right things" upon which the hospital should be focused. Absent a picture of a future state to strive towards, we are condemned to the paradigm of: "This is how we have always done it around here." Visionary leadership also supports the concept of continuous improvement in the ways systems are operated. The P-2 Project always requires the approval of the top management of the hospital before activities are initiated SQ that tb~irQLJy-in isassLJJed. 4 Bennis, Warren, Why Leaders Can't Lead - The Unconscious Conspiracy Continues, Jossey- Bass Publishers, 1991, page 18. 5 Nanus, Burt, Visionary Leadership, Jossey-Bass Publishers, 1992, pages 178-179. State of California Department of Health Services December 2002 32 IDJ 0/ t2-2- Department of Health Services Hospital Pollution Prevention (P-2) Strategies SUCCESS THROUGH STAFF PROCESS OWNERSHIP An unnecessary burden is placed upon managers if they shoulder the sole responsibility for the performance of their programs. A great deal of wasted effort and inefficiency results when intelligent workers must wait to be commanded or directed to carry out their work tasks. In their national bestseller book, Flight of the Buffalo - Soaring To Excel/ence, Learning To Let Employees Lead, James Belasco and Ralph Stayer indicate, "... that the key to organizational success today is in getting the people to want to own the responsibility for their own performance.,,6 Effective and successful management of the medical waste system within a hospital can best be accomplished when everyone involved is allowed to take responsibility and ownership for the process. . Representatives from the various groups of staff involved with the medical waste stream throughout the hospital can participate on teams to establish strategies for reducing the amounts of medical wastes generated and for handling the remaining medical waste stream. Such team participation can increase coordination across the spectrum of professional classifications within the hospital. The team should consist of those generating the waste, those handling it within a designated area or floor, those responsible for infection control, those moving it through the facility to treatment or storage, and those responsible for purchasing or contracting for these waste services. Representatives from these groups can jointly develop strategies that are understood by staff in all the various organizational groups within the hospital who are involved with the medical waste stream. When employees from these groups own the process, improvements and increased accountability are likely to follow. Most of the principles of medical waste minimization can be applied to other systems within the health care facility, resulting in more cost-efficient operations and an improved bottom line on the balance sheet. Medical waste minimization centers on eliminating or reducing the medical waste stream. There are several measures that can be instituted to achieve medical waste minimization including the following: . Waste prevention - eliminating the generation of medical waste Source reduction - reducing the amounts of medical waste generated Re-use - finding another use for a component so it does not become part of the medical waste stream Recycling - handling or treating the material so it can be used in another process . . . DEVELOPING STRATEGIES TO MINIMIZE MEDICAL WASTES Essential activities in implementing a medicalwaste minimization program are to recognize the various waste streams, to initiate strategies to ensure that staff is 6 Belasco, James A., and Ralph C. Stayer, Flight of the Buffalo - Soaring To Excellence, Learning To Let Employees Lead, Warner Books, Inc., 1993, page 249. State of California Departrnent of Health Services December 2002 33 ! 0 Ii 1'tll.- Department of Health Services Hospital Pollution Prevention (P-2) Strategies aggressively trained to minimize the generation of wastes in a higher waste stream, and to ensure that the wastes do not become unnecessarily combined. These tasks will require leadership by management in developing policies and training staff. For example, diapers from a nursery can be handled as solid waste; but when medical waste hampers are placed in the nursery, staff often utilize them for disposal of the diapers. This practice will unnecessarily increase the cost for disposing of the diapers because these items must now be handled as medical waste. Management can minimize the medical waste stream by implementing a policy directive that baby diapers are to be disposed as solid waste. This action should be reinforced through a training program on waste handling and waste stream monitoring. Management and staff must be committed to medical waste minimization to make it a successful program within the hospital. Management must communicate the need for medical waste minimization in a manner that inspires staff to implement positive actions in this direction. This can be done by publishing a "medical waste minimization strategy" to guide the waste minimization efforts within the facility. The strategy should state the goal of the medical waste minimization program and identify new policies for handling and discarding medical waste and the non-medical wastes generated in the same setting. Other possible elements of the medical waste minimization strategy include: . Plans for staff training and follow-up monitoring A monthly tracking mechanism for waste minimization Recognition or awards for achieving milestones in implementing the strategy Formation of a team or council to oversee and coordinate the medical waste minimization strategy Tangible reports, graphs and feedback to show results . . . . The use of bar coding systems can assist in the waste minimization efforts by measuring and recording the medical wastes being generated in the various units of the facility on an on-going basis. Storing the assessment data in a computer for retrospective analysis can be used to show progress as the medical waste minimization efforts are implemented. It is important to develop good baseline data of the amounts of waste generated prior to implementing the waste minimization program. Medical waste generation data from the various units within the health care facility should be recorded on a Pareto Chart with the amounts of waste displayed in descending order from the left side of the chart. Pareto analyses can easily determine the highest medical waste generating areas in which the minimization strategies should be initiated. Displaying the medical waste being generated by the various units in the facility can assist in developing "buy-in" for implementing waste minimization strategies. This information shou~d be--disI'layed" and communicated throughoutthefacitity. State of California Department of Health Services December 2002 34 I 05 OJ J Z:2.. Department of Health Services Hospital Pollution Prevention (P-2) Strategies MEDICAL WASTE MINIMIZATION PLANNING Top management within the health care facility should formally approve the medical waste minimization strategy and they should assign responsibility for the program. This responsibility can reside with an individual, a department head, team, or council. The individual or team responsible for implementing and coordinating the medical waste minimization program should be empowered by management to work across organizational boundaries in carrying out the program. Management should also communicate an expectation of cooperation from every operational unit and . individual throughout the organization. MEDICAL WASTE MINIMIZATION ASSESSMENT Data regarding the current waste streams generated within the health care facility need to be gathered during the assessment phase of the program. These data should include the amounts of waste generated for the various waste streams and the cost of disposal or treatment. For the analysis of the medical waste stream, the medical waste generated per patient population in the facility or served by the facility should be completed for future comparisons of the effectiveness of the waste minimization program. Assessments should provide useful information to assist in determining where to initiate the waste minimization program in order to obtain maximum waste reduction and cost efficiency. Plotting the amounts of wastes generated by the different parts of the health care system also gives staff from each of these areas knowledge as to the potential gains that can be recognized for waste minimization in their areas of the facility. The ability to document success stories at a later date is contingent on having accurate initial assessment data. MEDICAL WASTE MINIMIZATION IMPLEMENTATION Following completion of the medical waste minimization assessment the facility should be ready to implement the medical waste minimization program. Based on assessment data, the major medical waste generating areas of the facility should be targeted. These areas have the potential for the greatest accomplishments. There may be resistance to the waste minimization program because it is something new. Busy staff may build barriers to the successful performance of the waste minimization program because they may perceive it will create more work for them. To overcome these barriers will require excellent communications about the waste minimization program to everyone involved. Hospitals that have implemented aggressive medical waste minimization programs have achieved reductions of 30 to 40 percent in the medical waste stream. This degree of waste reduction results in sighificanfc6st savings. ._--~--- -. -_..~---- Documenting success requires a tracking program that measures the waste being generated in the various parts of the facility. As waste minimization strategies are State of California Department of Health Services December 2002 35 t1)C:, 1 /;2-2- Department of Health Services Hospital Pollution Prevention (P-2) Strategies initiated, their effectiveness can be measured by the tracking system. Impressive results may be achieved early in the program as easy-to-implement actions can yield big reductions. As the medical waste minimization program in the health care facility progresses, it may become harder to meet percent reduction goals because the easiest reductions have already been achieved. Reductions achieved over the life of the program should always be shown in order to give an indication of the overall accomplishments of the program since its inception. When a strategy for medical waste minimization is initiated and the results are less than expected, a thorough analysis should be made of the strategy. Learning from failures is important so that the same strategy will not be repeated. The ability to modify the strategy and test it again for effectiveness should be an integral part of any minimization program. Strategies that work well should likewise be studied for lessons that can be applied in other areas of the hospital, and shared with other facilities through technical publications or over the Internet. The workable medical waste minimization practices should be incorporated into the on-going operations of the health care facility through policy directives to staff. The status and results achieved should be communicated to all staff throughout the hospital and incorporated into new employee orientation. Charts showing achievements should be prominently displayed to encourage further waste minimization. Storyboards depicting the actions taken and results achieved within the various units of the facility should be developed. Success stories should be communicated to the neighboring community to demonstrate that the hospital is a good environmental steward. SUCCESSFUL MEDICAL WASTE REDUCTION STRATEGIES One of the most important factors in reducing medical waste is "location" of the medical waste container. Medical waste containers placed next to sinks will inevitably collect paper towels and other solid waste. Environmental services or house keeping staff must be properly trained as to placement of the containers in order to curtail improper disposal of solid waste. Staff that generate medical waste must also be trained in the need to keep solid waste out of the medical waste stream. Hospitals can emphasize the importance of segregating these two waste streams by producing a fact sheet comparing the high cost of disposing of medical waste versus solid waste. Figure 25 Medical Waste containers by the sink will be filled with paper towels instead of medical waste demonstrating theimportance of theJocation of . medical waste containers. (Pollution Prevention Project Photograph) State of California Departrnent of Health Services December 2002 36 J071' r~~ Departrnent of Health Services Hospital Pollution Prevention (P-2) Strategies Sometimes reductions come from unanticipated areas. The P..2 Project learned of a bag manufacturer that was interested in designing a new red bag for medical waste use. The manufacturer set up a meeting with P-2 Project staff to gain insight as to what they would like to see in a new red bag product. Several requests had been received by the P-2 staff members from hospitals interested in using red bags with recycled plastic content. No such bags were available and some manufacturers claimed they could not make them. The new bag manufacturer indicated that he thought it would be possible to use up to 20 percent recycled content in production of his red bags. Additionally, he would use a "star seal" at the bottom of the bag that strengthened the bag by distributing the weight of its contents against all sides. The manufacturer was provided with the strength requirements for approval of the bags that consisted of passing the American National Standards Institute (ANSI) 160 gram dropped dart test. The manufacturer developed a new bag that passed the ANSI test using a dart weighing 180 grams. The high-density plastic bag and initially contained 20 percent recycled plastics content. The bag weighed from 6 to 20.48 pounds less per 100 bags than the low-density plastic red bags typically in use and was approximately 15 percent cheaper. The manufacturer calls this new product the BioEJite bag. The bag has been well received by the hospitals using them. Through continuous improvement practices the manufacturer has raised the recycled plastic content of the BioEJite red bag to 30 percent. The company has also started manufacturing a BioEJite laundry bag with greater amounts of recycled plastic content. Several hospitals implemented a reusable sharps container program initiated by the Integrated Environmental Systems (IES) medical waste treatment company. However, this service was discontinued when the company was sold. Reusable sharps containers are approved as a medical device by the federal Food and Drug Administration and are thicker than conventional sharps containers. It is estimated that the reusable sharps containers can be used for five or more years before needing to be taken out of service. At an off-site medical waste treatment facility the reusable sharps containers are mechanically opened and their contents dumped into an autoclave cart for processing. The containers are washed, sanitized and reassembled for return to the hospital for reuse. Figure 26 BioElite high-density plastic red bag is made using 30 percent recycled plastic. It weighs less thanstandarG~low-densit-yred-bags, (Pollution ~- Prevention Project Photograph) State of California Department of Health Services December 2002 37 ) 08 <>})2-2- Departrnent of Health Services Hospital Pollution Prevention (P-2) Strategies P-2 Project staff studied a 250-bed hospital that was considering starting the program and found through purchasing department records that the hospital used 18,000 sharps containers in a year. Calculations based on the size and weight of the various containers revealed that the hospital could divert 13 tons of plastics from their medical waste stream by purchasing a reusable sharps container service. This has been shown to be the most significant methodology for reducing the medical waste stream. State of California Department of Health Services December 2002 38 J oq " 12-~ EXHIBIT B 1/21 J~:z.... DRAFT DRAFT Zanni Commission Minutes CALL TO ORDER/ROLL CALL A regular meeting of the City of Dublin Planning Commission was held on Tuesday, May 8, 2007, in the Council Chambers located at 100 Civic Plaza. Chair Schaub called the meeting to order at 7:02 p.m. Present: Chair Schaub, Vice Chair Wehrenberg, Commissioners Biddle, King, and Tomlinson; Mary Jo Wilson, Planning Manager; Mamie Nuccio, Associate Planer; and Rhonda Franklin, Recording Secretary. Absent: None ADDITIONS OR REVISIONS TO THE AGENDA - NONE MINUTES OF PREVIOUS MEETINGS The April 24, 2007 minutes were approved as submitted. ORAL COMMUNICATIONS - NONE CONSENT CALENDAR - NONE WRITTEN COMMUNICATIONS - NONE PUBLIC HEARINGS 8.1 Continuation of P A 06-026 Dublin Gateway Medical Center Building 3 Hospital and Garage - Planned Development Rezone and Stage 1 and 2 Development Plan, Conditional Use Permit, Site Development Review and Development Agreement (Adjudicatory and Legislative Actions). Chair Schaub stated that the Planning Commission is being asked to approve an application for a hospital, but is being provided project plans that title the project as a Medical Office Building. Chair Schaub asked for the Staff Report. Ms. Mamie Nuccio, Associate Planner, presented the specifics of the project as outlined in the Staff Report. Chair Schaub asked if any parking spaces were removed as a result of the relocation of the trash enclosures, and Ms. Nuccio stated that no parking spaces were removed. Chair Schaub pointed out that the excess of 84 parking stalls includes 17 motorcycle stalls. iPfanning CommUJ"ion fJ(f;[fltlar'Meetil1{j 47 'May 8, 2007 Attachment 6 DRAFT !!If 1 /~]./ DRAFT Chair Schaub sought clarification on the two construction options that would be granted to the Applicant should the project be approved. Ms. Nuccio explained that the Applicant could either construct a 3-story, 58,000 square foot medical office building with a 4-level parking garage; or a 6-story, 100-bed hospital building with a 5-level parking garage. Chair Schaub sought clarification that a project approval would only allow a 6-story hospital building to be built, and not a 6-story medical office building, even though the plans indicate that the 6-story building is a medical office building. Ms. Nuccio explained that although the project plans label the building as a medical office building, all of the approval documentation, including the Development Plan, specifies that if the 6-story building is constructed, it can only be used as a hospital building. If the Developer decides to not use the"'6-story building as a hospital building, the Developer would have to apply for a Planned Development Rezone and amend the Development Plan accordingly. Chair Schaub sought clarification that if the hospital building is constructed, would the project return to the Planning Commission with applications for the necessary amenities required for a hospital. He pointed out that the Planning Commission would have the authority to approve or deny the application at that time. Ms. Mary Jo Wilson, Planning Manager, explained that if the Applicant could install the amenities within the existing design of the building, the application may not need to return to the Planning Commission for review. Vice Chair Wehrenberg asked if the requirement of a Central Utility Plan would require the project to return to the Planning Commission for review. Ms. Wilson explained that the construction of a Central Utility Plan in a separate building is not a part of the Applicant's Planned Development Plan before the City at this time; therefore, an amended project could be subject to additional City review. Cm. Biddle asked about the review process of the State of California Office of Statewide Health Planning and Development (OSHPD). He expressed concern that the 100-bed configuration of the building could change based on OSHPD's review process. Ms. Nuccio explained that if the number of beds increases, the project would have to return to the City for review because all of the analysis on the project was based on a maximum of 100 beds. Chair Schaub stated that if there were less beds and more office use, there would be parking issues. Ms. Nuccio explained that the entire building must be used for hospital functions. She further stated that if portions of the hospital were converted for other uses, the project would have to return to the City for reVIew. Cm. Tomlinson asked about the anticipated size of trucks that would be trafficking the loading zone. Ms. Nuccio explained that the Applicant anticipates that the vast majority of deliveries would be made by bobtail trucks, with occasional semi trucks. She further explained that the loading zone was designed to accommodate semi trucks. Vice Chair Wehrenberg stated that she would like to add to the Initial Study that if generators or other noise generating sources are used, the project be brought back to the City for additional review. Ms. Nuccio explained that because generators are not part of the current application, the potential noise impact of generators was not analyzed as part of the Environmental Review. cp[anning Commission rJ?!;guIar'Meeti1l{j 48 'May 8,2007 DRAFT I J51 J2.--'2/ DRAFT She further explained that if the Applicant identifies the need for generators on the site plan, Staff would conduct a noise analysis and, if necessary, require the Applicant to attenuate impacts accordingly. If the Applicant can not attenuate impacts accordingly, then Staff would conduct additional environmental review and the project would return to the Planning Commission. Vice Chair Wehrenberg added that she would like to add the potential use of helicopters to the Initial Study as well. Cm. King expressed concern about whether the correct direction for trucks entering the loading zone would be obvious. Ms. Nuccio stated that signage can be installed at the entrance of the loading zone to guide the drivers. Cm. Tomlinson pointed out that most deliveries would probably be from the same companies, thus the drivers would gain familiarity with the navigation of the loading zone. Chair Schaub pointed out that the entrance to the loading zone is in the area of the egress for the Ulferts Shopping Center. He stated that to reduce the load on Glynnis Rose Drive, signage could easily be added to the Ulferts parking lot to direct consumers to exit in a different direction. Chair Schaub opened the public hearing. Mr. Rick Needham, with Triad Partners, spoke if favor of the project on behalf of the Applicant. Chair Schaub asked for Planning Commission feedback on the architectural changes to the building. The Planning Commissioners stated that they are pleased with the improvements. Chair asked for Planning Commission feedback on the changes to the loading zone. Cm. Biddle asked for clarification on truck routes into the loading zone. Staff explained that from Dublin Boulevard, trucks should take Tassajara Road, to Koll Center Drive, to Glynnis Rose Drive to the loading zone. From the 1-580 Tassajara ramps, trucks should take Koll Center Drive to Glynnis Rose Drive to the loading zone. Vice Chair Wehrenberg asked if signage for truck traffic would be addressed. Ms. Wilson explained that signage for truck traffic would be addressed as part of the Master Sign Program. Cm. King expressed concern about whether there would be enough space for forward movement in order for trucks to back out appropriately. Mr. Jim Terry, with Ware Malcolmb Architects, stated that the turning radius for the loading zone was designed for larger trucks; however, smaller trucks would most often frequent the loading zone. Mr. Needham stated that the larger trucks would typically arrive at the loading zone in the early morning. Chair Schaub asked about the quantity of truck deliveries per week. Ms. Cynthia Lee, Health Care Consultant, spoke in favor of the project on behalf of the Applicant. She stated that she contacted several comparable institutions to get an estimate of the number of deliveries per week. She stated that it is anticipated that 10-12 deliveries would be made per week. Vice Chair Wehrenberg asked if this number included food deliveries, and Ms. Lee said yes. Chair Schaub stated that without a cafeteria in the building, finished foods would also need to be delivered. Ms. Lee clarified that it is anticipated that the building would have a cafeteria, and thus would not need finished food deliveries. iPf4nmng C Otllm1sSioll tJ?!guJar :Meeting 49 'May 8, 2007 110~/22- DRAFT DRAFT Vice Chair Wehrenberg pointed out that the project plans for the hospital are missing key elements such as an operating room, cafeteria, and pharmacy. She asked if the project plans would change based on the needs of the tenant. Mr. Joseph Carroll, Applicant, spoke in favor of the project. He explained that the Development Team, knowing that the tenants would come at a later date, created project plans that depicted the most important factors of the project such as the bed count, circulation, the emergency department, and the loading zone. He stated that the Development Team did not want to propose project plans to the Planning Commission that would ultimately change based on the specific needs of a tenant. Mr. Carroll reiterated that the loading zone was sized for an IS-wheel semi truck; although bobtail trucks would frequent the loading zone 90% of the time. Cm. Biddle pointed out that a positive feature of the loading zone is that the area is large enough to accommodate two trucks. Cm. King asked about the view of the loading zone from Glynnis Rose Drive, and Mr. Carroll stated that it would look like the sides of building. Ms. Nuccio added that the loading zone was designed to accommodate two trucks. She also stated that the Conditions of Approval (COAs) were revised to include that should any activities related to the loading zone become a problem, the Applicant would be required to provide a plan that outlines loading zone activities subject to approval by the City. Chair Schaub stated that this loading zone is significant because it is located near a busy street; whereas most loading zones are not. Vice Chair Wehrenberg confirmed that the Applicant would locate a tenant before going too far with the project, and Mr. Carroll said yes. Vice Chair Wehrenberg pointed out that the loading zone would generate a lot of trash and that medical waste would need to be addressed as well. Chair Schaub asked for Planning Commission feedback on the changes to the trash enclosures. The Planning Commissioners stated that it is a big improvement. Cm. Biddle pointed out that, if necessary, it would be easy to enlarge the trash enclosures in this location. Cm. Biddle asked how hazardous waste would be handled. Ms. Lee stated that hazardous waste is typically disposed of in locked containers near the loading zone and is handled separately from regular trash. Chair Schaub asked for Planning Commission feedback on the changes to the parking structure. The Planning Commissioners stated that they are happy with the changes. Cm. Biddle expressed concern with the disparity of parking spaces allotted to the medical offices as opposed to the hospital. Mr. Carroll explained that the shared parking arrangement would provide for adequate parking. Vice Chair Wehrenberg pointed out that afternoon shift changes could potentially strain parking availability. Mr. Carroll stated that the demand for parking generally tails off in the afternoon. Vice Chair Wehrenberg asked about the potential to modify the parking based on the needs of future tenants. Mr. Carroll stated that it is anticipated that the current parking !Punning Commission fJ??gufar'Meeting 50 'May 8, 2007 ~11 :[ )~, DRAFT DRAFT would handle the needs of future tenants. Vice Chair Wehrenberg stated that in regard to the motorcycle spaces, there would probably be little demand for motorcycle parking at a hospital. Vice Chair Wehrenberg asked if they have had to display signage to distinguish employee parking from patient parking. Mr. Carroll stated that they designate parking spaces for employees and patients. Vice Chair Wehrenberg expressed concerned about parking overflowing into the Ulferts Shopping Center. Cm. Tomlinson stated that he is comfortable with the number of parking spaces at the project. He stated that his concern is that patrons from the shopping center might overflow into the project's parking areas. Vice Chair Wehrenberg asked if the Applicant would be allowed to add another level to the parking garage if parking spaces were eliminated due to the placement of mechanical equipment. Ms. Nuccio stated that in such a case, the Applicant would need to apply for an amendment to the Site Development Review. Cm. Biddle asked if the parking structure would be built before the hospital. Mr. Carroll stated that it is required that the parking structure be built before the hospital. Cm. King stated that he is concerned about the idea that the form of the building is following the function, instead of function following form. He asked if it is typical for a building shell to be constructed before tenants are identified. He further stated that he is concerned the future tenants might want to change the building to suit their needs. Mr. Carroll explained that the room plan was the critical factor in ensuring that the building would be compatible with the needs of potential tenants. Chair Schaub asked Mr. Carroll if he has built a hospital before, and Mr. Carroll said no. Vice Chair Wehrenberg expressed concerns that the OSHPD review process may require architectural changes to the building. Mr. Carroll stated that he does not think this will be the case; however, if changes are necessary, they would revisit the plans. Cm. Biddle expressed concern that double-occupancy rooms would be more desirable to future tenants instead of single occupancy rooms. Mr. Carroll stated that he believes that single occupancy rooms are more desirable. Vice Chair Wehrenberg added that patient satisfaction is higher in single occupancy rooms. Cm. Biddle expressed concern with whether various medical specialties would be able to function in the IOO-bed configuration of the building. He questioned whether the facility could accommodate amenities such as food service operations, pharmacy, operating room, morgue, etc. Mr. Needham explained that the Development Team modeled and tested three specific design plans for the building and all of the design plans were functional. Mr. Carroll explained that the Development Team has worked with consultants in the hospital field that have advised them that the current design is functional and would work with various tenants. Cm. Biddle asked about the process of finding a tenant. Mr. Carroll stated the he is currently talking with potential tenants. Cm. Biddle asked about the timeframe for completing the building, and Mr. Carroll stated that it could take 3-5 years. cpfanmng Commission fJ?JguIar'Meeting 51 'May 8, 2007 l/g~/2-1- DRAFT DRAFT Vice Chair Wehrenberg suggested that the Applicant submit plans to the City before submitting them to OSHPD to help alleviate potential issues. Mr. Carroll stated that he would work with the City during the design development. Chair Schaub asked about the Conditions, Covenants, and Restrictions (CCRs). Ms. Nuccio explained that the CCRs are in place to govern the relationship between the 4 parcels on the site. Mr. Gary Sloan, San Ramon Medical Center Chief Executive Officer, expressed concern about the impacts a new hospital could have on existing hospitals, as well as police and fire protection services, within the Tri-Valley. Mr. Sloan stated that the Planning Commission did not have enough information regarding the project to make an informed decision. He stated that the Planning Commission should know who the tenant will be before making a decision on the project. Cm. Biddle asked about the differences in hospital types and the associated impacts on parking, traffic, etc. Mr. Sloan gave several examples of various hospitals and their associated impacts. Chair Schaub closed the public hearing. Cm. Tomlinson stated that the project is worthy of support. He stated that the Applicant was responsive to the Planning Commission's concerns and recommendations. He further stated that he is satisfied with the amount of parking at the project, as well as Staff's research on parking at comparable facilities. He stated that the neighboring buildings are adequately parked per the Dublin Zoning Ordinance. He stated that the Conditions of Approval are appropriate and sufficient for the project and that it is the responsibility of the Applicant to find a tenant that can function within the approved project. Vice Chair Wehrenberg stated that the project is lacking the infrastructure needed to support a potential tenant. She asked if the project would return to the Planning Commission if the parking was impacted by future changes. Ms. Wilson explained that the Site Development Review (SDR) Findings are based on the current design of the site, including surface parking and access; therefore, if the site design changes, amended plans would have to be resubmitted and reviewed by the City. Vice Chair Wehrenberg stated that COA No. 18 should also require that loading dock activities be reviewed when a tenant is identified and prior to any plan submittals. Ms. Wilson suggested that the additional language be included as a part of COA No. 22. Vice Chair Wehrenberg expressed concern about screening oxygen tanks and stated that the potential use of oxygen tanks should be identified as early as possible. Chair Schaub added that the potential use of generators should also be identified as early as possible. Ms. Wilson suggested that those concerns be addressed in COA No. 22. She further stated that the addition of an oxygen tank and/ or generator to the plans could trigger additional review from the City. Vice Chair Wehrenberg suggested that the Fire Department COAs include a review of the hazardous materials plans. She pointed out that the City will own the building once OSHPD cpfanning Cmumi.'iswn CJ?!gu1ar :Meeting 52 :May 8, 2007 I)~ ~ 12-~ DRAFT DRAFT finals the building. Ms. Wilson suggested that the additional language be included as a part of COA No. 22. Vice Chair Wehrenberg suggested that the tenant be required to provide a staffing plan to confirm that the parking is adequate. Ms. Wilson stated that the condition can be added to the COAs. Chair Schaub reiterated that this project has a lot of open-ended issues. Vice Chair Wehrenberg stated that she does not feel that 3 acres is conducive for a hospitals site, including the parking garage. Vice Chair Wehrenberg suggested that a condition be added that requires any plans for helicopters and associated facilities be submitted to the City. Ms. Wilson stated that under CEQA, plans for a helicopter and associated facilities would have to be reviewed and analyzed. She stated that the application for the project indicates that there will not be a helicopter or associated facilities for the project. Cm. Biddle asked if the tenant would have to submit plans to the City each time plans are submitted to OSHPD. Ms. Nuccio explained that the requirement is currently in the COAs. Cm. Biddle stated that in general, he likes the concept of having a hospital in the City and he likes the architecture of the building. He stated he feels a little more comfortable with the project. Vice Chair Wehrenberg asked if the COAs could be attached to the tenant's lease agreement. Ms. Wilson stated that such a request could be asked of the Applicant. Ms. Wilson pointed out that there are multiple points in the process where Staff would notify the tenant of the COAs for the project. Cm. Tomlinson also pointed out that COA No. 15 seems to be a broad lever in which to ensure the project remains consistent with the COAs. Mr. Carroll stated that he would comply with the Planning Commission's request to attach the COAs to future tenants' lease agreement. Cm. King stated that he likes the design of the project. Chair Schaub stated that he likes the project. He stated that it is important to get the project finished they way the project is approved. He pointed out that COA No. 15 establishes that the project is subject to annual review. He stated that he does not want the project to be put in jeopardy because of significant infrastructure problems. The Planning Commission complemented Staff on the work done on this project. The Planning Commission also thanked the Development Team members for their work on the project. Vice Chair Wehrenberg stated that the project plans should be labeled Hospital and not Medical Office Building. iPf4nning Commission (]?Jouf4r'Meetill.{j 53 'May 8,2007 tw ~ IZ2- DRAFT DRAFT Ms. Wilson confirmed that the Applicant, Mr. Carroll, concurs with the amendments to the COAs. On a motion by Cm. Biddle, seconded by Cm. Tomlinson, with a suggestion to amend the Resolution of the City Council Approving a Conditional Use Permit and Site Development Review to amend Condition of Approval No. 22 to include: "The Applicant shall also submit a hazardous materials plan and a typical schedule of loading dock activities including types of deliveries, number of deliveries, and types of vehicles."; and with a suggestion to add Condition of Approval No. 22A to read: "Prior to the issuance of a building permit for the parking garage, the Applicant shall provide the City with a written statement identifying the hospital tenant and the specific staffing levels with respect to the number of doctors and employees on the largest shift. If the numbers of doctors or employees on the largest shift increases, a parking analysis shall be conducted to ensure that adequate parking will be provided in accordance with the Zoning Ordinance. If additional parking is needed, the Applicant shall apply for an amendment to the Conditional Use Permit and Site Development Review and such application shall be reviewed and approved prior to the issuance of a grading or building permit for the parking garage."; and with a suggestion to add Condition of Approval No. 26A to read: 'The Developer shall provide a copy of the approved Conditions of Approval to all future tenants.", and by a vote of 5-0-0, the Planning Commission unanimously adopted: RESOLUTION NO. 07 - 23 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF DUBLIN RECOMMENDING THAT THE CITY COUNCIL ADOPT A CEQA ADDENDUM FOR AN AMENDMENT TO THE STAGE 1 AND STAGE 2 DEVELOPMENT PLAN FOR PLANNED DEVELOPMENT ZONING DISTRICT (PA 98-047) AND FOR A CONDITIONAL USE PERMIT AND SITE DEVELOPMENT REVIEW FOR THE DUBLIN GA TEW A Y MEDICAL CENTER BUILDING 3 HOSPITAL AND GARAGE PROJECT LOCATED AT 4100 AND 4084 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 RESOLUTION NO. 07 - 24 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF DUBLIN RECOMMENDING CITY COUNCIL ADOPTION OF A PLANNED DEVELOPMENT REZONE AND STAGE 1 AND 2 DEVELOPMENT PLAN FOR THE DUBLIN GA TEW A Y MEDICAL CENTER BUILDING 3 HOSPITAL AND GARAGE PROJECT LOCATED AT 4084 AND 4100 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 cpfanni.ng Commission CJ<?gufar !Meetill{i 54 !May 8,2007 I Zl ~ )2.2- DRAFT DRAFT RESOLUTION NO. 07 - 25 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF DUBLIN REFERRING DECISION MAKING AUTHORITY AND RECOMMENDING CITY COUNCIL APPROVAL OF A CONDITIONAL USE PERMIT AND SITE DEVELOPMENT REVIEW FOR THE DUBLIN GATEWAY MEDICAL CENTER BUILDING 3 HOSPTIAL AND GARAGE PROJECT LOCATED AT 4084 AND 4100 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 RESOLUTION NO. 07 - 26 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF DUBLIN RECOMMENDING CITY COUNCIL APPROVAL OF A DEVELOPMENT AGREEMENT FOR THE DUBLIN GATEWAY MEDICAL CENTER BUILDING 3 HOSPITAL AND GARAGE PROJECT LOCATED AT 4084 AND 4100 DUBLIN BOULEVARD APN 986-0016-021 & 986-0016-022 P A 06-026 NEW OR UNFINISHED BUSINESS - NONE OTHER BUSINESS Cm. Tomlinson informed the Planning Commission and Staff that he would be on vacation during the August 14,2007 Planning Commission meeting. Cm. King stated that if the Planning Commission is going to discuss projects that impact Dublin Boulevard, he would like to know the City's position with regard to regional transportation planning. Ms. Wilson stated that she would research the issue. 10.1 Brief INFORMATION ONLY reports from the Planning Commission and/or Staff, including Committee Reports and Reports by the Planning Commission related to meetings attended at City Expense (AB 1234). The Planning Commission did not have any items to report. iPi4nning CommisJ'wn CJ?sgufar'Meetin{j 55 'M~ 8, 2007 J 2- Z-t'9-f r 2- ~ DRAFT DRAFT ADJOURNMENT - The meeting was adjourned at 9:00 p.m. Respectfully submitted, Planning Commission Chair AITEST: Planning Manager iPfanning Cormnis.l'wn iR.!guwr'Meeti11.fj 56 'May 8, 2007