CPMC wants to build a 550-bed hospital on Cathedral Hill, a project with big impacts.

CPMC Director of Communications Kathryn Graham, responding by email to questions and issues raised by the Guardian, wrote generally and positively about CPMC and the project without addressing the specific concerns about whether housing, transportation, and other mitigation payments are too low.

On the jobs issue, she wrote, "Our project will create 1,500 union construction jobs immediately—and preserves and protects the 6,200 health care professional jobs that exist today at the hospitals. Currently, nearly 50 percent of our current employees live in San Francisco. During the construction phase of this project, we are committed to hire at least 30 percent of workers from San Francisco. We will create 500 permanent new jobs in just the next five years—200 are guaranteed to be local hires from underserved San Francisco neighborhoods. We don't know where you got the ridiculous idea that our employees must reapply for jobs at our new hospitals. That is incorrect."

Yet CPMC has resisted requests by the California Nurses Association and other unions to be recognized at the new facility or to agree to card-check neutrality that would make it easier to unionize. And union representatives say CPMC has offered few assurances about staffing, pay, seniority, and other labor issues.

As one CNA official told us, "If they aren't going to guarantee jobs to the existing employees, those are jobs lost to the city."

"We're giving Sutter a franchise over San Francisco's health care system for 30 to 40 years, so we should ensure there are basic worker and community protections," Kumar said.

Welch and other activists say they believe CPMC is prepared to offer much more than it has agreed to so far, and they're calling on the supervisors to be tougher negotiators than the Mayor's Office was, including being willing to vote down the project and start over if it comes down to that.

"They make too much money in this city to just leave town," Welch said of CPMC's implied threat to pull out of San Francisco and shutter St. Luke's. "It's bullshit."