It's not limited by anything. Okay. Thank you. Any other questions?
In Mr. Gill's testimony, in terms of the bidding process for the contract, he stated that PHS was not a bidder and that the City has the reservation of right to negotiate with vendors who may not have bid on the contract. Is that standard practice?
Standard practice to include that type of language or standard practice to pursue that course?
Standard practice to include that language? Is this the only contract we had this language in with the City that you know about, and is it standard practice to include this language when you're putting an RFP out to include 53 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 this language?
From my perspective in solicitations that I've worked on for the City, this is the standard reservation of rights that we include. I can't say categorically that it's included in all our RFPs because the Law Department isn't involved in all our RFPs by the City.
Did you say the Law Department is not involved in all of the RFPs sent out? They do not review them?
So an RFP can go out without your knowledge or approval?
That's changing with the advent of the CRC, and we're working on that piece of it. I'm just saying that in terms of standard reservation of rights language that many of us in the commercial law practice offer to our clients, that's included.
You stated that PHS meets the numbers in terms of MBEC, the minority 54 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 subcontractors. Could you detail to me what minorities contractors are within the new contract and could you identify who they are and what they provide? Are they women? Are they Latino, black, African American?
I don't have that breakdown in front of me, but I believe we submitted that as an attachment to the recent documents that we had sent to your office the other day. And it does list the names of the companies and the categories for which they fulfill the MBEC participation.
They should be listed right on the chart. It's pretty easy to follow.
YS Contract Pharmacy, Bumbe and Simmons, there's no detail what --
I thought that chart did reflect what MBEC requirement they were fulfilling, but I can get a clarification for that.
There is no 23 clarification, no. It doesn't say whether it's African American owned or you know.
We do have that information. 55 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 If it's not on that chart, I will get that to you, if the Councilman wishes that.
I also just wanted to add, Councilman, you had asked earlier about damages that the City was authorized to pursue. They're on of that thick packet.
Yes. There's a section in the RFP that describes damages that the City is authorized to pursue upon the occurrence of various things, and one of those is expressly the imposition of damages. But the RFP becomes part of the contract.
All right. Thank you very much. Any further questions? Any other questions? Councilman Goode.
Mr. Gill, at the end of your testimony you stated you're exploring other models for providing correctional health services, 56 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 and among them are non-profit models but you said you didn't feel at liberty to discuss those models. Why is that?
Only to the extent that without having done enough in-depth analysis as to what the options are available to us, what the structure of those organizations may look like or how the formation of them would affect the care and delivery of services, we're not really at a point where we can sit down and kind of hash out what the details may be, what it might look like, and have a more meaningful conversation about it. We're hoping to be in that arena sometime soon and that would be a better time for us to be able to sit down and discuss with the Council as to what the implications are and what our options are.
Well, without even comparing those models with existing models here, have you found any advantages to non-profit models in other cities?
Well, I think that one of the biggest advantages is that if you're able to establish a non-profit agency that employs and maintains the employment of all the line staff, all 57 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 the worker bees associated with the work that's being done, they have more consistency and more continuity of their work rather than being concerned with whole new contracts coming in, you know, either on specific periods of time. There's different ways that some non-profits organized with just changing the management team or keeping the same management teams in place, you know, different economies of purchasing power, ability for grants or fund-raising or funding revenues but, you know, one of the most important aspects that other jurisdictions or other models have shown is the consistency of the employees being able to stay on a year-to-year-to-year basis and they look at more long-term commitments with their job rather than seeing turnover on an annual or a biannual or some other yearly basis that they would otherwise see.
Thank you. Thank you very much, Tim. Thank you. Commissioner Costello.
Good morning, Mr. Chairman. 58 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598
Thomas J. Costello, C-o-s-t-e-l-l-o, Commissioner of Prisons.
Thank you for that protocol that you gave us on this part of the committee hearing.
Commissioner, there have been reports that the number of women being arrested has jumped significantly and that we're now looking at 200 women being arrested per week in the City of Philadelphia. How many of those end up in your system?
Basically, we've seen over the last few weeks -- or the last month about a 10 percent increase in the overall population. It's hard to say exactly how many of those arrested come to the facilities. I don't know what the numbers are. But we have seen a significant rise over the last month or so, but over the last week the population has decreased significantly.
Will you provide us with a breakdown of race and age in the individuals 59 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 that are being arrested coming in? And you said the increase is percent? 4
Recently there has been 5 an increase of 10 percent over the last fiscal year. 6 And again, the female population has fluctuated up 7 and down between 850 and 925 is the record number, 8 over the past, we'll say, the last six to eight 9 weeks. And again, ironically over the last week, 10 the population is below 900 now, but it was 925 a couple weeks ago. The breakdown as far as this last fiscal year as far as the population is 71.8 percent African American, 16.7 percent white, 10.6 percent Hispanic, 0.5 percent Asian, and 0.4 percent unknown.
I have the exact figures for you, Councilman. I'll give you the numbers as of last night.
How many is the 60 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 facility supposed to hold?
The rate of capacity right now is about, probably for the female population, a little over 900.
We have a projection for the new women's facility. Do you have a date of when that will be available?
Yes. The projected opening date we'll actually admit female inmates to the new facility is March 30th of next year.
March 30th of next year. PHS also provides the medical services to those individuals, right?
Is there any coordinated effort between PHS and your administration to provide for a disaster plan specific to each institution which includes response, triage, and treatment of mass casualties. 61 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598
We do have a master plan. It is headed by Deputy Commissioner Grooms who meets with them on a regular basis and schedules drills with them whenever necessary. They are part of the overall team.
What's the current population of inmate population system right now in the system?
The overall population for inmates under the responsibility of the Commission of Prisons is 7966 as of midnight last night.
Basically, the percentages that we are running on legal status is 60.5 percent pretrial or detentioner; 4.3 percent sentence deferred, those have been found guilty but are awaiting sentencing; and 33.2 percent sentenced, serving a sentence within the county.
Do you have a breakdown by race of those 60.5 percent that are 62 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 waiting for trial?
I do not, Councilman, but I can get that information to you.
The average stay over all -- we actually include -- because of the number of admissions that we get over the year, we do not break it down specifically to detentioner. We break it down according to male, female, and all inmates. The average stay for males right now 79.3 days; female is 57.1; and if you take both male and female populations together, it would be 76.1.
Thank you, Commissioner. There's an estimate that a local director for prison services of the Defenders Association has given us an estimated count of inmates with Hepatitis C in the Philadelphia Prison System. It's 4 to 600. Is this a conservative 63 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 estimate or is it more in line of the reality of the existence? Maybe you can answer that, sir.
We got information that the current population of inmates with Hepatitis C ranges from 4 to 600; is that true?
I'm Richard Helender, the Regional Medical Director. The number of 4 to 600 is probably the number given of people that we know to have tested positive for Hepatitis C, and that's probably high. It's probably less than 400 known to have tested positive for Hepatitis C.
I would say that the number of people tested positive now for Hepatitis C is less than 400, yes.
We currently have somewhere in the neighborhood of 200, perhaps a little bit more in our HIV clinics.
And of those that are tested, how many are in the treatment for the disease for Hepatitis C? 64 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598
In terms of treatment, they're all being evaluated at this point in a development treatment protocol. They're all being evaluated.
Thanks for giving me this opportunity. I'm a criminal justice professor with a master's in forensic psychology at Temple University.
Nina Gorman. I'm a professor of criminal justice at Temple University with a Master's degree in psychology with a criminology specialization. And I'm also wearing another hat here as a co-coordinator of the Prison Health Advocacy Project, a small group of advocates and current prisoners. The members we have now, though, are Howstale State Prison who have been at Philadelphia State Prison and they've given us some feedback and their recommendations for the contract and Civilian Review Board proposal. So I would like to give a synopsis of what we recommended back in August for adherence to the contract for 65 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 Pennsylvania state law that applies to Philadelphia County facilities and all county and local facilities in the State of Pennsylvania. Specifically, Title 37-Law III, Subpart B, Chapter 95 of the Pennsylvania Code for recommending enforcement and stipulations in the contract that specify -- that back up this code by having written specifications that all inmates receive a healthcare screening. 232, Section 1, that they receive a healthcare screening by a person with healthcare training within hours 13 of admission and that within 24 hours of admission 14 all inmates determined to be not in good health are 15 supposed to receive an assessment by a healthcare 16 professional. So we know this would be cost saving 17 because folks who are identified at intake with 18 having chronic disorders or being in crisis, the 19 sooner the better that they can get the treatment 20 that they need so it doesn't deteriorate into 21 needing hospitalization. 22 And we know from my interviews of 23 prisoners as a case manager for an AIDS agency and 24 also in our interviews of folks up at Howstale that the nurses don't always have the proper emergency 66 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 room training at intake. Nurses specialize in ER care, and we question the extent of this training. They should be able to recognize all the chronic disorders and all the symptoms of emergency, such as fever, chills, and be able to connect them with diagnosing the major chronic disorders and should be versed in how to treat emergencies as well. 232(4), that written local policy shall specify routine screening procedures utilized for infectious disease, acute illness and suicidal risk. So we're not just talking about guidelines here. The guidelines for -- whatever guidelines that PHS has have of its own or back in the APA or other accrediting organizations. But we're talking about specific symptoms that need to be addressed for screening chronic care and also intake. Some jails in other states, for instance, have a form that's used by both corrections officers and another form by healthcare workers and some used by both where they can be trained effectively to screen for suicide. Currently in the Philadelphia system, 67 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 from our understanding, they're just using a referral form that COs can access and other staff of the prison to refer someone if they're having a suicidal risk, but there's no requirement to document if an inmate complains to a guard or other staff member of wanting to commit suicide. There's nothing that needs to be done, to our knowledge, to hold that CO or staff member accountable that this is the information they've been given and what they did with that information. So an ounce of prevention can be worth a pound of cure with such documentation. We're also advocating that the contract include stipulations where access to emergency care hours a day is included. Now, we're recommending 17 that this be included with specifics, including a 18 triage nurse. Now, as a social worker over at the 19 detention center for this AIDS agency I was working 20 with, I often went over there, there was no nurse 21 triaging.
So the chronic care nurse was -- the 22 person in chronic care who was assigned to do 23 emergency, she would have to stop what she's doing 24 to go out into the waiting room to try to find who's there then. And more than once I had to escort 68 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 someone back to her because the only person that was out there with us was a corrections officer. I had to escort an asthmatic back there having a severe asthma attack. Because she can't be in two places at one time. So this is what we're recommending for emergency care. And also that healthcare coordinate security, that that be a requirement internally, because if guards are understaffed, they don't always have the time to escort up to medical. That should not be a responsibility of security to have medical staff to escort inmates up to medical. This has been a chronic problem for many years. Also, you mentioned access in the hole. The prisoners we've spoken with are recommending visiting status for the Civilian Review Board, that we have unlimited access to all medical units. And this in some states has been helpful, at least with monitoring for healthcare. For instance, we could go in as visitors and check that log book for folks that are checked in the hall and check the log book for those that are referred up to medical. 242, the extraordinary occurrences stipulation of the 69 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 Pennsylvania Code be adhered to. That an extraordinary occurrences report is supposed to be completed with the occurrence of death, including suicide and homicide, serious injuries and any use of physical force, according to the state stipulation. And in addition to that, or in order to support that, we're recommending the enforcement of the disposition of a Lester v. Schuler case on inmate assaults or reports of guard assaults on inmates and also of inmates assaults on inmates as well, which is more common actually. I know from being a volunteer for the Prison Society that those injury investigation referrals are not being completed. So if an inmate complains that they've been beaten, for instance, by another inmate or by a guard, they're supposed to go to medical and tell medical that, and medical is supposed to fill out an injury investigation referral which gets forwarded to, I believe, the Prison Society and some administrator in the prisons and elsewhere. And if they don't want to fill that out because they don't believe that the inmate's been beaten, they're supposed to fill out a 70 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 defamation of injury investigation referral. So the Prison Society can give you more information on that and how there's been very poor compliance. And the compliance goes up and down depending on the pressure they get. And we also recommend an inclusion of a stipulation on treatment services with staffing, especially mental health staffing. The Pennsylvania Code asserts that the jails with an average daily inmate population of 175 or more shall have, in addition to the treatment supervisor, one qualified counselor for every 75 inmates over the first 75. Now, we know that the model proposed by PHS -- I'm not sure what's going to be in this contract, but the model proposed is the crisis case management model and a residential treatment model for mental health. So this is very worrisome to us because it appears to eliminate outpatient counseling. And we know from testimony from Anthony Hightower from our group previously and from other documentation that we've gotten that mental healthcare is being triaged by a clerk with no 24 mental health training for parts of the procedure of assessment. And often folks are not getting the 71 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 counseling that they need. So we're recommending that those staffing provisions be in place. And also, focussing on residential treatment model is very controversial because for one thing, it's very expensive.
It's the most expensive model. And also, it's debated whether or not folks with severe mental health problems like psychosis should be treated in a jail or not. If they're that bad off, shouldn't they be treated possibly in a mental health facility? And just a couple more of these things and then I'll get on to a brief review of the civilian review. 243(10), if an inmate is found to be psychotic or otherwise mentally disturbed, he or she shall not be treated in a jail but shall be transferred to a mental health facility in accordance with the provisions of the Mental Health Act. Now, in some states they're dealing with this prospect of transfer by having workers from the Defenders Office and a worker from the City's public mental health system, not to mention sometimes 72 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 workers from the City's health system right on staff at intake so the folks having severe health problems or mental health problems or minor charges, minor misdemeanors and a combination of health or mental health problems can immediately be transferred to either a mental health facility or some negotiation can be made with the Defenders Office and the lawyers there to get them out so they don't even have to come into the system so that they won't be the responsibility of the system to treat. So this could be a win-win situation for everyone concerned. And then lastly, we also recommend for the Pennsylvania Code enforcement of the housing stipulations that recommend each inmate have access to toilet facilities and ventilation. We know sometimes there's painting done or construction and the ventilation, poor as it is, is not accommodated under these circumstances. And people have been triple bunked and four to a cell, making a dangerous situation especially for violent offenders. And we know also that this lack of coordination with security between mental health and security poses for dangerous situations. I had one client that in order to get into protective custody 73 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 because he was being assaulted by an inmate, he had to go into a cell, he had to be double celled in protective custody in isolation with a rapist. And it wasn't until I intervened that we were able to stop that situation. And also let me just backtrack a minute. In reference to access to emergency care hours a 9 day, we wanted to recommend that that include, not 10 only a triage nurse in DC, but also training of 11 corrections officers in emergency care, and 12 especially mental health emergencies. We know they 13 do get some training as far as dealing with assault 14 of inmates, but how much of that training is with or 15 by mental health professionals that are really the 16 experts in the area of dealing with mental health 17 emergencies, assault of inmates. And that kind of 18 training literature support is most effective if 19 it's done with security, not in addition to 20 security. It's done with and by the security 21 personnel of the prison, preferably with mental 22 health specialists of security -- having mental 23 health specialists in security also, security 24 personnel. And I'm wrapping it up here. In 74 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 addition to housing, food is a health requirement. Even though PHS may not have influence over that, they do have influence over adherence to diet, the diet orders get fulfilled. We saw this as being a problem repeatedly in the Philadelphia Health System when I worked there where my dialysis patients weren't getting their proper food, some of the HIV patients weren't getting their proper food. And we know that more than once riots in the food cafeteria over increasingly small portions and also of spoiled food being served, which is a health risk especially to folks with poor immune systems. So that's basically it as far as the contract that we wanted to emphasize the recommendations that we had submitted back in August for that.
Now I wanted to shift on -- unless some questions, I wanted to shift on just a very brief review of my findings on civilian review boards at least that has to do with police. But I understand we're going to have a whole separate hearing dealing with so I wasn't going to spend too much time on that today.
Thank you. You've 75 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 heard the testimony on the contract as detailed by Mr. Gill and the City Solicitor's Office. What's your impression of the contract? And have any of the reforms that we were advocating been included in that?
I don't know. My understanding is that the behavioral measures that were proposed with a new contract by City Council weren't included in this new contract. So I would think any kind of measurable objectives would be helpful. And especially it seems dangerous at intake to have folks coming in. It's both a cost skyrocketer to have folks not diagnosed. Remember my previous testimony as a social worker, I had five clients who had PCP pneumonia, and I think about three of them didn't get diagnosed at intake. One of them ended up costing the City over a hundred thousand dollars, he was told, because he had to keep going in and out of the hospital. And also not having screening recommended by the doctors funded and delays in processing of them where it has to go to Harrisburg, it may take a week, two weeks, three weeks to come back to get approval. I had one client that was in there for a misdemeanor of 76 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 marijuana possession -- that's the one I was talking about that cost so -- and he ended up, not only getting PCP pneumonia that wasn't diagnosed until late, but also having a heart infection that almost killed him because Dr. Peppi's (ph) recommendation for a heart culture or some kind of culture having to do with diagnosing that infection were declined. And I've had others that were at risk, too, for not getting the funding and the approval quickly enough. I had one that went to an ENT doctor and obstructions from old scar tissue in his throat that the ENT doctor said almost killed him also, you know, from delays in getting that diagnosed and treated with a biopsy. So anything having to do with -- we would support the increase in funding because it's well known from the staff there that they are underfunded where they may have to -- one nurse, for instance, may be over at the detention center working with maybe a case load of 12, 15 clients on a night. And so when I would call her as a social worker to advocate for someone, she would barely have time to -- she would try to, but she'd barely have time to try to address someone that had a 77 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 problem.
But I wanted to give a review on the civilian review boards. The inmates that we interviewed, about 40, are most concerned that they won't be paid attention to or the civilian review board will be, you know, just a show to look good or a way to pass the buck. They're also emphasizing for the contract reduction in sick call and medication line waits, which I think were supported by Griefinger as well as immediate healthcare for intake. We're recommending 12 hours. And mainly my findings for the civilian review boards, because these are based on police, were that if you don't include something in the contract about the oversight mechanisms that you're going to use, included the CRB, that the risk of non-compliance or weak effectiveness is a lot stronger. Also, we're recommending that there be a feedback loop, and this is pretty standard for the CRB to give recommendations to the monitored agency like the police, but we're recommending according to the findings of Landau and Lewis that, not only the 78 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 monitored agency get the recommendations, but also the executive branch of the City and also the legislature.
Any review board that is established, and given the Charter that we have, really depends on the executive and how much authority the executive, the Mayor, would give to that review board. We've seen that with the Police Review Board that we have at the present time. And really, the ability of it to really monitor the cases that come up in terms of the police has been very limited. Unless we get a Charter change in order to be able to do something along those lines, it really depends on how much authority the Mayor and how much concern the Mayor has on the issue and how much authority he would give it.
Both Colleen Lewis and also Goldsmith and Stenning, other researchers of civilian review boards internationally and nationally recommend not deriving power from the executive or from a particular legislature.
But the thing is that according to Charter, that's the only way we have in the City of Philadelphia. 79 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598
Well, the other alternative is to amend the City Charter, which is what some do recommend, to amend the City Charter. And this way, the civilian review board is not at the whim of, like, the Mayor. As you remember back in -- I think it was like '82 the Police Advisory Board got dissolved by the Mayor, because it depended on his power, as a Christmas present to our Police Department. It's been associated with executive power derivation with demise of civilian review boards such as in Washington, D.C. So I would recommend a revision of the City Charter. Otherwise, if the legislature comes in and is not friendly to it, they can also dump it as well. So we would recommend some teeth, some monitoring system where the civilian review board would not have legal powers, because it's very costly, it causes a lot of tension, a lot of fractiousness and very lengthy, it's responsible for backlogs such as what happened in Washington, D.C. But rather be a body to hear complaints from the public and the staff, possibly anonymously if they prefer, if they would opt to do so, and to forward those recommendations to the contract monitor and 80 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 the legislature and the executive who would then have the responsibility, especially the legislature and the contract monitor, to enforce them. And if there's patterns of serious medical neglect, those would be the situations where penalties would be recommended and enforced.
Thank you. Mr. Gill, one thing before we leave and recess. I would like from PHS a listing of the staffing levels that they have and will have available.
And the ratios in terms of population and so on, how many nurses per so many inmates and so on, mental health and so on down the line. And if you can, I would like to see a breakdown of the staff by race and gender. Councilwoman.
Thank you. I would like to add on to that request, if I could, a question first. Is there any type of staff audit that's performed either internally or externally 81 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 with regards to the system to measure what we hear actually reflects what's written on paper?
What do you mean a staff audit? Do you mean the composition of the staff?
No. For example, we heard today that the nurse works four hours a week, eight hours a day. Is there a practice, for lack of a better word, where just as we have financial audits there's a staff audit to see if the information we see on paper parallels the reality?
Well, internally I can double-check with their managing team to see if that's something that they do on a regular basis. I do know that they do their own reviews for quality assurance as to what staff utilization is, but I can verify that.
Thank you very much. So if you can do that and send it to the Chair, please. Thank you very much. This committee stands recessed until the call of the Chair. 82 10/08/02 - HEALTH, PUBLIC SAFETY - RES. 010598 (Council adjourned at 12:07 p.m.) - - - 83 C E R T I F I C A T I O N I HEREBY CERTIFY that the foregoing proceedings of the Council of the City of Philadelphia of Tuesday, October 8, 2002, were reported fully and accurately by me, and that this is a correct transcript of the same. RE: COMMITTEES ON HEALTH AND HUMAN SERVICES and PUBLIC SAFTEY ___________________________ Lisa C. Bradley, RPR and Notary Public