Although even-numbered districts were not slated for an election until 2006, an off-year election was held for District 2 because she was an appointed supervisor. Alioto-Pier ran for the seat in the November 2004 election and won, and in 2006 she ran for reelection and easily won the seat. As a Supervisor, Alioto-Pier was committed to the preservation of St. Brigid's Church, which was once slated for demolition. Another top priority for Alioto-Pier was earthquake preparedness, especially important for her district which was hit hard by the 1989 Loma Prieta earthquake. Alioto-Pier explained: "As the district representative for a community that was really hit in Loma Prieta, it is my responsibility to make sure if something like that happens again that we know what we're doing." In May 2004, she introduced a payroll tax exemption for biotech companies in efforts to create a biotech cluster in San Francisco which was later passed by the full Board of Supervisors. San Francisco had over 250 biomedical companies. As a San Francisco moderate, Alioto-Pier was attacked by San Francisco progressives for having a poor attendance record and mediocre constituent relations. One significant source of the criticism was over Alioto-Pier's attendance record while she was giving birth to her third child, which was a first for an elected official in San Francisco. Alioto-Pier responded by passing a family leave policy for elected officials in San Francisco. In 2007 it was announced that St. Luke's, a hospital serving under-privileged communities would be closed to acute and sub-acute patients and serve as an outpatient facility only. In January 2008, it was announced that Alioto-Pier would lead a panel of stakeholders to save St. Luke's. "Maintaining and rebuilding St. Luke's and developing it into a first-class hospital for the Mission District and the Southeast section of San Francisco is my primary objective." In response to the recommendations of the panel, in September 2008 CPMC announced a reversal of their decision, stating that St. Luke's would be re-built to continue serving the communities that depend upon it. On July 20, 2009, San Francisco Chronicle political columnists Phillip Matier and Andrew Ross broke the story of Alioto-Pier's announcement for state insurance commissioner. Alioto-Pier subsequently left the race for Insurance Commissioner due to a leg injury. Re-election challenge in 2010 On June 3, 2010, Alioto-Pier submitted papers to register as a candidate for re-election to District Two of the San