COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE OF THE WHOLE - BUDGET - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, April 11, 2007 10:35 a.m. - - - PRESENT: COUNCIL PRESIDENT ANNA C. VERNA COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN W. WILSON GOODE, JR. COUNCILMAN WILLIAM GREENLEE COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN FRANK RIZZO COUNCILWOMAN MARIAN B. TASCO BILLS 070114, 070115 and 070116 RESOLUTION 070128 - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good morning, everyone. Sorry for the delay. This is the continued public hearing of the Committee of the Whole. I would ask Mr. McPherson to please call the first group up to testify. MR. McPHERSON: Philadelphia Department of Public Health.
Good morning. Please identify yourself for the record and proceed with your testimony. COMMISSIONER PARIS: Good morning, President Verna and members of Council. I am Carmen I. Paris, Interim Health Commissioner, and with me today is Carmen Lemmo, Deputy Health Commissioner for Finance and Administration. Thank you for the opportunity to present the Department of Public Health Operating Budget request for Fiscal Year 2008. We provided copies of the testimony to Council, but today I would like to 3 4/11/07 - WHOLE - BILL 070114, ETC. summarize the testimony by highlighting parts of the original version.
That's wonderful, and we will give the stenographer your complete testimony and it will be transcribed in full. COMMISSIONER PARIS: Thank you, ma'am.
Thank you. COMMISSIONER PARIS: The Fiscal Year '08 Department of Public Health budget request totals $195,973,305. Of this total, $114,321,171 is in the General Fund and $81,652,134 is in the Grants Fund. 4 million is in the Grants Fund. In carrying out our mission to protect and promote the health of all Philadelphians, the Department of Public Health administers a wide range of 4 4/11/07 - WHOLE - BILL 070114, ETC. essential services. The Department coordinates, funds and monitors child health programs, prenatal care, family planning and gynecologic services, and provides childhood lead poisoning control and prevention. The Department maintains oversight of the Philadelphia Nursing Home and monitors the provision of health services at the Riverview Home. The Department has been a part of the City's overall emergency preparedness effort, assuming the role in biopreparedness planning and activities, including ensuring the City's ability to respond to natural public health disease emergencies and threatened or actual bioterrorism events. Along with the Police and Fire Departments and the Office of Emergency Management, the Department is an essential component of the overall emergency response structure. In anticipation of the implementation of the Clean Indoor Air Worker Protection law, on January 8, 5 4/11/07 - WHOLE - BILL 070114, ETC. 2007, the Department's Environmental Health Services Unit mailed notifications to 4,000 food establishments most affected by the ordinance. In the first week of implementation, Department staff visited 1,900 food establishments to conduct smoke-free compliance checks. The implementation of the ordinance has proven to be a significant public health success by providing a safer and healthier workplace environment. Public support of and compliance with the ordinance has been overwhelming. During Fiscal Year '07, the Department received a multi-year grant from the Healthy Tomorrows Partnership for Children to expand "215 Go," the Department's comprehensive pediatric obesity clinic. Previously available at Health Centers 5 and 9, the clinic is now provided at Health Center 6 as well. In 2006, the percentage of Philadelphia's children having age-appropriate immunization coverage 6 4/11/07 - WHOLE - BILL 070114, ETC. increased from 81 percent to 85 percent for key childhood immunizations. The 85 percent immunization rate is the highest ever achieved in Philadelphia and exceeds the national average of 83 percent. We continue to offer excellent medical care in our health centers. We strive to hire superbly trained physicians, and in a recent patient satisfaction survey, more than 90 percent of our patients expressed confidence and satisfaction with their physician. In that same survey, 84 percent indicated that they will recommend their health center to a family member or a friend. We have focused on insurance enrollment for our patients for several years, and I am proud to report that for the first time, 50 percent of visits to our health centers were insured visits. For a number of years, several issues have had a negative impact on recruitment to both professional and non-professional positions in the 7 4/11/07 - WHOLE - BILL 070114, ETC. Department, many of which are in the health centers. In FY07, we initiated a number of actions to address staffing challenges at the centers, including offering competitive starting salaries for dentists, nurses and pharmacists. Within the Medical Examiner's Office we have been successful in filling a long-term vacancy by hiring one forensic pathologist. We have also contracted with a professional search firm to conduct a nationwide search for the position of Chief Medical Examiner, which was vacated through retirement. In November 2006, I testified before the Committee on Public Health and Human Services on the status of the Department's Food Inspection Program.
At that time, I described some of the actions we have begun, as well as our long-term plans to transform the program into a more meaningful risk-based program. I am pleased to say that these new activities are currently in place and 8 4/11/07 - WHOLE - BILL 070114, ETC. we have begun the assessment process of the City's food establishments by which we will be determining risk-appropriate inspection frequencies for each type of food establishment based on the risk associated with the actual food handling operations and activities. The Department has identified implementation of an electronic medical record system as a key business need and a necessary technological improvement to ensure the efficient delivery of integrated high-quality healthcare to the citizens of Philadelphia. The City can achieve greater patient medical benefits, cost savings and operational efficiency by eliminating the use of paper charts as a means for recording patient data. All of the Department's programs currently in place will continue through Fiscal Year '08. Those improvements related to recruitment, hiring and retention of our own staff that were initiated in Fiscal Year '07 9 4/11/07 - WHOLE - BILL 070114, ETC. will continue to result in increased staffing levels and better retention of experienced staff at the health centers in Fiscal Year '08, allowing us to better meet our needs. Thank you for the opportunity to present testimony today. I will be happy to answer questions at this time.
Thank you very much. Commissioner, what is the number of full-time General Fund positions for the Health Department in FY08? COMMISSIONER PARIS: Our FY08 proposed budget total positions is 695.
Well, can someone explain why the Five-Year Plan and the Budget in Brief show that the Health Department with 663 full-time positions and the detail budget has 695 full-time positions? Which is the correct number and why should there be a difference between the Five-Year Plan and 10 4/11/07 - WHOLE - BILL 070114, ETC. the detail? COMMISSIONER PARIS: The proposed budget total number of positions is 695. I believe you are referring to an additional number of positions that were added after the target budget.
After what? DEPUTY COMMISSIONER LEMMO: Originally --
I'm sorry. You're going to have to identify yourself, please. DEPUTY COMMISSIONER LEMMO: Carmen Lemmo, Deputy Health Commissioner. We originally submitted as part of the Five-Year Plan, the original number was 663. After consultation with the Budget Director, we added an additional 32 positions in the General Fund and, true, because the Department has a high turnover rate, it was decided to increase the additional positions by 32. So the number now, the official 11 4/11/07 - WHOLE - BILL 070114, ETC. submitted number, is 695.
The Health Department personnel services budget was cut $1,040,102 for the 2.5 percent reduction and the City Council increase of $1,620,000 from the FY07, which was eliminated in FY08. This apparently represents a total payroll reduction of $2,660,000 before the four percent pay increase is factored in, correct? COMMISSIONER PARIS: That's correct.
Well, City Council did in fact last year give more money to the Health Department than the Administration was asking. I believe it was $1,600,000. Of that amount, how much were you able to spend? And if you say you have such a high turnover, how many people turned over and you were not able to hire, and why weren't you able to hire if you had more money in your budget? 12 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: The $1.6 million turned out to be approximately 38 positions. What we did was, we added those vacancies to the vacancies that we had in the Department as, what you said, turnover and retirements.
How many retirements did you have? COMMISSIONER PARIS: We have a very, very high turnover.
What was your turnover? COMMISSIONER PARIS: It's about ten percent. The Health Department's turnover is about ten percent. So it might be a little bit higher at the health centers, 18 percent at the health centers.
Eighteen percent? COMMISSIONER PARIS: Yes, ma'am.
Of what? Now you're saying 18 percent of 13 4/11/07 - WHOLE - BILL 070114, ETC. the health centers. Is it 18 percent of the employees? COMMISSIONER PARIS: Eighteen percent of the staff at the health centers, ten percent total department turnover.
What is the operational impact of these reductions on the district health centers? COMMISSIONER PARIS: There will be a loss of positions at the district health centers, approximately -- we estimate somewhere in the neighborhood of 38 positions, ma'am.
What is the projected visits to the health centers for FY07 and FY08? COMMISSIONER PARIS: For FY07 our projected number of total visits will be about 600,000 -- I'm sorry; about 318,000.
For '08? 14 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: That will be for FY07. Probably about the same for FY08.
And that's 300 and -- COMMISSIONER PARIS: Three hundred eighteen thousand.
I just can't understand -- and you're going to have to try to explain it to me in a much clearer fashion -- with the vacancies that you have and, in my view, not enough employees, if you had the money that Council had appropriated, the additional monies that Council appropriated last year, why would you not have hired more people? COMMISSIONER PARIS: When we got the approval to hire the positions, we immediately started working on the process, the long-term process, on the hiring of the positions. As we were approving the positions and as we were hiring, there were still -- we were still 15 4/11/07 - WHOLE - BILL 070114, ETC. having to deal with the high turnover. So as we were hiring, people were leaving the Department. So that was a challenge that we had. So then what we did was, in order to secure that we were getting large amounts of people in, we then came up with some innovative initiatives with the Personnel Department in terms of hiring at a large number, mass interviewing and so on, and with that initiative, we have been able to secure a lot of positions for the health centers. I think that in the past couple of months, we've had about 45 people just hired for the health centers alone.
When were you given approval to hire? COMMISSIONER PARIS: We were given approval to hire at different times. We submitted our first approval -- I mean, our first request for hiring back in May, but when the new fiscal year started, we had to resubmit 16 4/11/07 - WHOLE - BILL 070114, ETC. those. For those, we got approval in August. Then we put together another list of vacancies. For those, we got approval in October. We got another list of vacancies in December. For those, we got approval in January. We just submitted a couple of weeks ago another list of vacancies for approval. We got approval immediately.
But were the hirings that you did, were they for vacant positions, people that were just retiring or leaving? Why do you have such a large rate of people leaving the Department? Is that because they're eligible for retirement, they're -- COMMISSIONER PARIS: It -- I'm sorry, ma'am. It is a combination of people that are in the DROP program, people that are looking at opportunities in other departments within the City, and it's also because we're faced with the fact that we have in the Health Department professionals that the 17 4/11/07 - WHOLE - BILL 070114, ETC. environment, the whole industry, is looking for; for example, nurses. I mean, there is a shortage of nurses. When we get them in the health center, they work with us. They require experience and then they're lured to other institutions at much higher salaries. We have the same situation with dentists. We face the same situation with pharmacists. What we have done in order to diminish that and to be more competitive is, we have asked for increase of salaries for all those classes, and we have been given approval to increase the salaries. So now we feel more capable of not only keeping them but also hiring them.
Can you tell us what the projected waiting lists for '07 and '08 will be? COMMISSIONER PARIS: Ma'am, projected waiting for an appointment? Is that -- okay. For appointments, well, we 18 4/11/07 - WHOLE - BILL 070114, ETC. had two different kinds of appointments. One is the initial visit appointment and another one is the return visit appointment. For an initial -- for both of them, it really depends on the health center that you're referring to, because they all have different average waiting times. Some of them could be as low as a week, five days, seven days. Some of them could very well be as high as 20, 13 days. It depends on the health center, 14 and that is for both. That is for 15 initial visits as well as for return 16 visits. 17
How 18 are you able to improve this when in the 19 paper and I think even last year we were 20 told that some people had to wait six 21 months for an appointment for an initial 22 visit? 23 COMMISSIONER PARIS: The way in 24 which we have done that is by identifying 25 which are the health centers with the 19 4/11/07 - WHOLE - BILL 070114, ETC. highest demand, and one of the key indicators of that is looking at the community and how many providers are in the community that could serve the patients that we serve at the health centers. We then went on to aggressively recruit physicians for those health centers. And because we made a very conscious effort of bringing in physicians and expanding the physician hours at those health centers, that's how we were able to decrease the waiting time for an appointment.
Is that in every center? COMMISSIONER PARIS: Yes, ma'am. We did it for those health centers with the highest demand. Like I said, the waiting time depends on the health center. For Health Center 5, for example, if you want an initial appointment, I can probably get you in within a week. For other health centers, like, for example, Health Center 6, it 20 4/11/07 - WHOLE - BILL 070114, ETC. could potentially be longer.
How much longer? COMMISSIONER PARIS: That's the one that could take up to anywhere between four, five weeks.
And, Commissioner, I'm going to repeat a question. Apparently you do not need an additional $1,600,000 that the City Council gave your department last year; is that correct? Because apparently you didn't spend it. COMMISSIONER PARIS: I'm sorry, ma'am. What is your question?
I'll repeat. Last year City Council unanimously felt that the Health Department and the health centers needed more money to be very prudent in the way we did business. We consequently added $1,600,000 to your budget. I don't think a dime of that was used, and I am saying to you, am I correct in my assumption 21 4/11/07 - WHOLE - BILL 070114, ETC. that you don't need that increase in money to be able to do a more efficient job? COMMISSIONER PARIS: We in the Department are working very hard every day to utilize whatever resources we have available to the best of our ability. When we are able to hire staff, we make sure that the staff is there to service the patients. When we have vacancies, we make sure that services are still provided, and we do that by utilizing overtime or by using contract agencies. My job is to make sure that services continue regardless of whether or not we have one vacancy or more than that.
So that I clearly understand you -- and I'm sorry to do this to my colleagues, because I want it to be eminently clear -- what you're doing is you're simply replacing employees who are leaving the Department; is that true? COMMISSIONER PARIS: Replacing? 22 4/11/07 - WHOLE - BILL 070114, ETC.
Well, if they're leaving -- COMMISSIONER PARIS: I'm sorry. In the hiring process, we are replacing those that are leaving, and included in that group were the new positions that were approved.
What new positions? COMMISSIONER PARIS: The ones that were approved because of the additional dollars identified by Council.
But they're being eliminated in '08, so how are you going to manage that? COMMISSIONER PARIS: Well, the thing is that our turnover is so high that we have continuously and aggressively continue to and will continue to hire through '07 until the total number of budgeted positions, which is still not -- do not pose a risk to our budget, because, again, by the time we hire 20 individuals, we already have two 23 4/11/07 - WHOLE - BILL 070114, ETC. or three that are already resigning. So it's a constant going through. It's a cycle. It never stops.
How many employees do you have? COMMISSIONER PARIS: Total employees, 695 budgeted for '08.
And what was it in '08 -- '07? I'm sorry. COMMISSIONER PARIS: 748.
So that's quite a reduction. Yes. Councilman Rizzo.
Madam President, I'd like it to be a little tighter response. You asked how many employees. The response from the Commissioner was budgeted. How many employees do they actually have?
Ms. Reed, please come up to the table, make yourself at home, because I want to 24 4/11/07 - WHOLE - BILL 070114, ETC. ask you a couple of questions.
Commissioner, when you're ready, could you tell us again the number of budgeted positions that you have and the actual number of positions? And that will include the money that we're discussing here for budgeted positions, correct? COMMISSIONER PARIS: Budgeted positions for what year, sir?
The last fiscal year. COMMISSIONER PARIS: Fiscal Year '07, the budgeted positions are 748 positions.
And how many employees did you have in Fiscal '07? COMMISSIONER PARIS: Filled positions -- and this information the Director just shared with me, because her information is more updated. Filled positions we had 641.
Six hundred forty-one and you're budgeted for 748. 25 4/11/07 - WHOLE - BILL 070114, ETC. That amazes me.
No. She said '07. Let's get it straight. This is real serious stuff here. The last fiscal year, how many budgeted positions did you have? COMMISSIONER PARIS: You're asking for filled positions from last year or budgeted positions?
I want both. How many positions did you have budgeted and how many positions did you fill? There's a difference between having budgeted, as you know, and how many you really have. COMMISSIONER PARIS: Absolutely. For Fiscal Year '07 we had 748 positions filled, but as of June 30th, '06, which is the last day of the previous fiscal year, we had 622 positions filled. 4/11/07 - WHOLE - BILL 070114, ETC.
And how about at the end of that '07 year? COMMISSIONER PARIS: Right now as of today I have 641 positions filled. I have positions more than what I had 7 back in June 30th, '06. 8
So 9 would you say you have 107 vacancies? 10 COMMISSIONER PARIS: From the 11 budgeted number, yes. 12
What's the 13 reason? And I'll end my point of 14 information. I can't imagine what you're 15 describing here, even though you do a 16 great job in response to the needs in 17 other areas of the Department, but why 18 would you not fill those budgeted 19 positions? You don't need them? 20 COMMISSIONER PARIS: It's a 21 challenge. It's a recruitment challenge. It's an environment challenge. We are very much aggressively coming up with all kinds of strategies to make sure that we recruit qualified individuals, but we 27 4/11/07 - WHOLE - BILL 070114, ETC. face a challenge of shortages of pharmacists, shortages of nurses and a high turnover in the Department as well. I mean, other departments have turnover, but they're not as high as ours. And we have staff that are at the point where they're looking for different opportunities, and because of the nature of their skills and their educational backgrounds, there's a lot more options.
Madam President, since I'll wait my turn, but I just wanted to make sure we had the right numbers budgeted versus the actual number of employees, and then when it's my turn, I'll come back at it. Okay?
Thank you. Ms. Reed, can you tell us or get us some explanation as to why the Administration eliminated the health center funding that was added to the FY07 budget in FY08?
Dianne Reed, Budget 28 4/11/07 - WHOLE - BILL 070114, ETC. Director. We did not do this with any pleasure. We had to eliminate increases granted for '07 and '08 in five or six cases because we had to make the Five-Year Plan balance. We are aware of the fact that Health cannot fill all the positions and so that we, in discussion with Health, determined that this would not have an adverse impact on operations because of the safeguards that they have built into their structure through contracts. And we also would try to make sure that during the year so that they can maintain the average number of positions that they need to fully staff the health centers, when they need -- should they be fortunate in recruiting and at some point their number might go over their budgeted number, that's going to probably, as in the case of the Police Department right now with attrition and the other turnover they have, probably they'll end up, if lucky, at the average 29 4/11/07 - WHOLE - BILL 070114, ETC. full staffing level they need.
So can you tell me how you arrived at your decision to eliminate these funds? Just because you're trying to balance the budget, you decided that, Oh, we'll just take that --
Right. We had to prioritize uniformed positions, prisons and human services, and so all other Class 100 -- and FJD, and all other Class 100 operating departments did receive a two and a half percent cut, unless the amount was de minimus, in which case we did not. You know, if it's $3,000, we didn't do it.
Let me ask you, do you believe that healthcare is a valuable service?
I think it is interesting that the City of Philadelphia 30 4/11/07 - WHOLE - BILL 070114, ETC. does include healthcare in its services. Philadelphia has got a very high number of services compared to other cities. There are a few cities that do have health services. And it is an important safety-net feature. I do not think that the City of Philadelphia should replace the non-profit or public sector in this area, however.
Ms. Reed, I think that the Philadelphia Green program is really great. I really do. I simply cannot let myself sit here and be quiet about it. You're adding $4 million to Philadelphia Green and yet we're going to decrease the Health Department's budget, which makes absolutely no sense to me whatsoever. None. Now, can you give me an explanation for that?
I'm sorry? 31 4/11/07 - WHOLE - BILL 070114, ETC.
And, that is, that Health Department services will be continued at the current level, but there would be no greening services if you eliminate that money, which has been before in the NTI budget and we augmented it a bit.
There would be no 15 lot greening services throughout the neighborhoods of Philadelphia if you eliminate that. Nothing will occur. And with the cut that the Health Department has, there will still be Health Department services at the level provided now. (Question asked by Councilwoman Tasco without microphone on.)
Well, the NTI money has been spent. So that's why it's been 32 4/11/07 - WHOLE - BILL 070114, ETC. transferred to the General Fund at OHCD and two million were added to it for a total of four. That is something that cannot be funded out of Grants Revenue off General Fund budget.
I just don't know where our priorities are. I really don't.
This is what amazes me: We're talking about this billion-dollar budget and we need to fund greening and we take it from the Health Department? I could give you 50 places to get that money that currently doesn't spend their money. The millions of dollars that we wrote off for Police overtime, the money that we're not collecting for the State Police patrol, on and on and on and on, and then you take money out of the pocket of the Health Department? It amazes me. 33 4/11/07 - WHOLE - BILL 070114, ETC.
-- we had already taken the two and a half percent cut out of the budget at the budget call and those other expenditures were added later.
I can sit down with you in five minutes and come up with the money in five minutes and give the money back to the Health Department. So I suggest you figure out a way. And, again, I just love it how the President puts it. If you can live with this budget, then it's yours to manage. And, Commissioner, you're saying that you can live with what we're hearing today? COMMISSIONER PARIS: What I'm saying is, my job is to do the best I can with the resources that I have available, and that's exactly what I'm doing.
And you think you'll be able to provide the same 34 4/11/07 - WHOLE - BILL 070114, ETC. level of service to our constituents, your constituents as you did last fiscal year? COMMISSIONER PARIS: I have been able through this year, sir, yes.
The level of service is not adequate. Would you agree? COMMISSIONER PARIS: I'm sorry, ma'am. I didn't hear half of it.
The question I believe was that you could maintain the level of service that you've been providing, but that service is inadequate, right? You can maintain the level of services, but it's inadequate services that you're providing. COMMISSIONER PARIS: We are providing the services to the patients as 35 4/11/07 - WHOLE - BILL 070114, ETC. they come and we continue to provide --
But you would agree that the level of service is not adequate. Would you agree? COMMISSIONER PARIS: I wouldn't agree with the fact that it's inadequate. We provide quality healthcare --
If there are long waiting lines and people can't get an appointment, you don't have the staff, it would not be adequate, right? COMMISSIONER PARIS: We still are able to provide care --
You provide some services to some people, but you don't provide services to the level that we require of the people who need the services, right? Right? COMMISSIONER PARIS: We are providing services --
I know you can't answer the question, and I won't pressure you. I appreciate your loyalty. Okay? I appreciate your loyalty. 36 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: Thank you, ma'am.
If I might also add to that, as we reported in testimony earlier, the number of people who wait fewer than minutes to be seen has 8 increased this year. It's back up around 9 18 percent. And the number of those who 10 wait greater than an hour has decreased 11 to a third, 33 percent. So they have 12 been improving their response numbers. 13 And in addition, last year; 14 that is to say, in summer of 2006, in the 15 annual Citizen Satisfaction Survey we asked people if they were waiting about as long as they expected, and the vast majority said either that it was about as long as they expected or a shorter time than they expected, and there were only 40 percent who said it was more. So that in fact statistically the level of dissatisfaction is not very high. It is 13 percent of the people who use the centers are dissatisfied with the 37 4/11/07 - WHOLE - BILL 070114, ETC. services. That is not a large number.
Councilman Rizzo, you said you wanted to be recognized again.
Thank you. Commissioner, I know that we have been asked on several occasions if any of the health centers are open -- if they have evening hours or weekend hours. Can you tell us if we do and how that works? COMMISSIONER PARIS: We have Saturday hours, weekend hours, in one of our health centers. That's Health Center No. 2. The other health centers, including one session at Health Center 2 as well, have evening sessions. They all have one evening session. Health Center 2 has an evening session and a Saturday morning session.
You 38 4/11/07 - WHOLE - BILL 070114, ETC. spoke about some employees being under contract. Would they be the doctors? Who do you have under contract, what type of employees? COMMISSIONER PARIS: Serving the health centers we had, until not too long ago, pharmacy techs, and we were able to hire those. Now we continue to use contracts for the pharmacists.
And they're the only ones that you have a contract with? COMMISSIONER PARIS: They're the only ones that we contract to come into the centers and provide the services, yes. We have doctors that are hired that are our employees, and we hire them in two different categories. We have doctors that are on Civil Service and we have doctors that are on contract, but they are our employees, unlike the pharmacists that we use. It's a service that we contract with.
And 39 4/11/07 - WHOLE - BILL 070114, ETC. for the record, can you tell us how much a doctor is paid? COMMISSIONER PARIS: How much doctors are paid an hour?
What is their salary? COMMISSIONER PARIS: I can tell you the hourly rate of our physicians, and, of course, they differ between pediatricians and adult medicine. $76 an hour, ma'am.
Now, are the nurses under contract also? COMMISSIONER PARIS: We only use nurses under contract for our Riverview Home. The nurses that we have at the health centers are our employees. They're Civil Service employees.
Do you find that you have a difficult time to employ doctors? COMMISSIONER PARIS: It is challenging, yes, to recruit. I think recruitment in general in healthcare is 40 4/11/07 - WHOLE - BILL 070114, ETC. very challenging, not only the physicians, the nurses, the medical assistants. It is all challenging, ma'am.
Thank you very much. Certainly, Ms. Paris, I know that you've worked very hard to try to do your job, and I want you to know that we appreciate it. We understand -- at least I understand -- the constraints that you work under, and at the end of the day, it's not your call, but one time we hope in the future that the Health Commissioner will be an advocate for the needs of the people who need the health services, but we also know that you could not be there also. Let me just ask a question, because we seem to be piecemealing the whole Health Department. There doesn't seem to be an overall strategy of what 41 4/11/07 - WHOLE - BILL 070114, ETC. the Health Department is supposed to do, what its mission is, how to fulfill that mission and what it will cost to fulfill that mission. Has there ever been a strategic plan done for the Health Department, sort of lay out all of those things and then attach a bottom-line dollar so that we would know what it would take to fully -- not only the health centers, there are other areas that go lacking because you don't have staff, can't hire people and there doesn't seem to be an ongoing program to keep in the hopper a list, an ongoing list, of people who you can just pick up. If a doctor leaves, you should be able to have somebody on the waiting list or that you can call, or if there's a Civil Service, there should be a list that you can pick up somebody off that list without having to go out and recruit again and all that kind of stuff. Is there a strategic plan for the Health Department? 42 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: Of course, as you know, there is the financial plan, but in terms of the Department as a whole, the answer is no. Now, there are units within the Department that right now we're conducting an assessment on. For example, we just hired a new Director for Human Resources. Our Director of Personnel is a new employee. And what we're doing with her is exactly that, we're doing an assessment of what are the process that we have in place that are not really up to speed to allow us to hire and retain staff the way we should. So that's something that we just started with hiring a new Director, and we are looking at completion by the end of this fiscal year. Another one that we're doing the same thing for is Environmental Health Services. We are doing an assessment of that whole unit, because we have so many people in key positions retiring. We realize that we just can't 43 4/11/07 - WHOLE - BILL 070114, ETC. replace positions, that we need to be strategic about where is this unit going. We have plans to adopt programs such as the risk-based assessment Food Protection Program and so on. So we realize that we needed to have a plan for this unit, and we're doing that right now. There are other units that are on the waiting list for that to be done. But we need that. We need to have a plan, and the way we're addressing it, I guess in terms of priorities.
So you kind of like do it department by department. There's no overall plan for the Health Department. If you look at the Health Department and say, This is the Health Department, this is our mission and these are the things that we're supposed to accomplish and all these units fall within that, this is the staffing needed for that unit, staffing needed for that unit and the cost attached to that, so that when you're 44 4/11/07 - WHOLE - BILL 070114, ETC. doing your budget, you can see if you're meeting the needs of the various departments. COMMISSIONER PARIS: We have identified over 135 objectives for the Department.
Totally? COMMISSIONER PARIS: Yes. And they are subdivided by unit. In other words, the Child Lead Poisoning have their objectives, and what we have done is, since I became Interim Health Commissioner, is, we put a timeline to those objectives. We have our first six months objective. We have our 12 months objectives and our months objectives. 18 And what we have done is, as we complete those objectives, we move on to the next projects. So we did that now. It's been 12 months now that we have done that. So it's not like we're just working in a vacuum. We established objectives for each of those units, and each of those 45 4/11/07 - WHOLE - BILL 070114, ETC. Directors understand that that is where they're headed and that's what they need to do and that's where their priorities are.
So has there been an evaluation of those efforts, and how will you evaluate whether you met your objectives or not? COMMISSIONER PARIS: The evaluations are being conducted as the objectives are met. So, yes. Yes. Just because a unit says to me, We completed these five objectives, that doesn't mean that that's the end of that. There needs to be a report, an evaluation component to it, that tells me how was it met and if it was by a contract agency, what contract agency. If it was our own staff, how many staff, how many visits before we move on to the next objective.
Are you familiar with the May 2005 study on the Philadelphia Department of Public Health entitled "Decent Healthcare for All in 46 4/11/07 - WHOLE - BILL 070114, ETC. Philadelphia"? It was prepared by healthcare professionals and others from the Woodrow Wilson School of Public Health and International Affairs at Princeton University. COMMISSIONER PARIS: Yes, ma'am.
So have you looked at this report to see what recommendations they made for the Health Department and what's happening? Are you using any of the recommendations? COMMISSIONER PARIS: Actually, ma'am, it was our report.
You commissioned that report? COMMISSIONER PARIS: Yes. That's correct.
Okay. COMMISSIONER PARIS: And that's the report -- and we released that report in the spring of 2005, and that was, as you know, as a result of the voters' mandate to put together a plan that will 47 4/11/07 - WHOLE - BILL 070114, ETC. result in universal healthcare for all Philadelphians. And what we did in the Department was, we took that mandate very seriously, and instead of just putting together a plan and saying, Okay, here, the mandate has been fulfilled, we took it to another step, and what we have done is, we are creating right now a body, a Board, and we are providing support to the individuals on that Board to actually get incorporated to look at ways in which the stakeholders of healthcare in the City of Philadelphia can come in and together come up with a plan that will hopefully meet the mandate of universal healthcare or at least access to healthcare for all Philadelphians.
Well, are you tying them in with the Governor's proposal to provide healthcare in this program? COMMISSIONER PARIS: Actually, that's one of the things that we're doing right now. We have been in constant 48 4/11/07 - WHOLE - BILL 070114, ETC. communication with the Governor's office, because we have a lot of questions about what that proposal entails. Prescriptions for Pennsylvanians has more than 47 pieces. I mean, it's a very, very complex regulation. One of the things that we are doing right now as we speak is looking at those 47 parts of that legislation, looking at which ones are the ones that will support the efforts that we already have here in Philadelphia so that then we can lobby for them, which ones are the ones that are not really in favor of the services and the needs of Philadelphia so that we can lobby for a change. And what we have found is, as we work with everybody in the Governor's office, is that there is still a lot of questions within the Governor's office that still need to be answered. But they know we are interested. They know that we are going to work with them, and they know that 49 4/11/07 - WHOLE - BILL 070114, ETC. we're really -- this is more than just a good program. This is something that can benefit the Department of Health and we're not going to sit back and wait for them to just cross all the T's and dot the I's without our involvement.
Okay. Let me just go to some other questions. One of the issues you raised was the difficulty in hiring and recruiting staff. What effect has the $35 fee for Civil Service exams had on the number of applications for the Health Department positions? COMMISSIONER PARIS: Ma'am, that is a very good question, and I don't have an answer for that. I think that I will need to probably talk to Tanya Smith in Central Personnel, because it is them that that responsibility falls in. We usually get the candidates from them and the list from them. But I'll be more than happy to have a conversation with Tanya and get back to you. 50 4/11/07 - WHOLE - BILL 070114, ETC.
We'll ask that question of her. COMMISSIONER PARIS: Okay.
Have you devised a plan to open all the health centers with full service to 9:00 p.m. at night with Saturday hours? COMMISSIONER PARIS: You mean in addition to the 8:00 to 5:00 hours?
Yes; the evening hours. One of the concerns people have is that we need evening hours for people who work and Saturday hours for people who can't get there. It's a convenience effort. Have you had any discussion about expanding the hours of the health centers? COMMISSIONER PARIS: Well, what we have had is numerous conversations about how we make sure that appointments are kept during the evening hours that we already have and how appointments are kept during the Saturday hours that we 51 4/11/07 - WHOLE - BILL 070114, ETC. have. One of the challenges with evening hours -- I can mention two off the top of my head immediately -- one is the weather, ma'am. Depending on how the weather is, we will have a good turnout on an evening session or we will not have a good turnout on an evening session. Another thing that is very challenging for evening sessions is safety. Many of our seniors have told us that they will not come out to an evening session. Another challenge that we have is SEPTA hours, what is considered the off-peak hours, where SEPTA riders, seniors that are utilizing SEPTA, they get a discount on the fare, and that is why they prefer the 9:00 to 3:00 hours of the day. I mean, so we've looked at how utilization is right now.
What are the hours now for the evening hours at the health centers now? COMMISSIONER PARIS: 5:00 to 52 4/11/07 - WHOLE - BILL 070114, ETC. 8:00.
So what is the level of service and the request for service from 5:00 to 8:00? Do you have a number of people coming in between 5:00 and 8:00? COMMISSIONER PARIS: Yes, ma'am.
And if you expanded that to 9 o'clock, could you provide more services? Is there a problem with that? That's the question I'm trying to get to. COMMISSIONER PARIS: Yes, and what we found is that the patients prefer, if it's going to be in the evening, they prefer the early evening hours, because they don't feel safe coming into late in the night hours. And they prefer that if it's a child appointment, if it's a pediatric appointment, they specifically ask for the earlier hours, 5:00 to 7:00.
What are 53 4/11/07 - WHOLE - BILL 070114, ETC. the hours on Saturday? COMMISSIONER PARIS: 8:00 to 12:00.
And could you use more hours if you had the money? COMMISSIONER PARIS: Could I use more hours if I had the money? One of the challenges with that question is --
No, not the challenge. Just answer the question. COMMISSIONER PARIS: I'm sorry, ma'am.
If we had more money to expand the hours on Saturdays, would that be helpful? COMMISSIONER PARIS: I don't have the answer to that. I don't know if patients will come on a Saturday afternoon to a doctor's appointment.
Well, how many people do you service between 8:00 and 12:00 and do you cut people off because you have to close down at 12 54 4/11/07 - WHOLE - BILL 070114, ETC. o'clock, so you have a waiting list for people to come back to the next Saturday and if you expanded it to o'clock, maybe you could have more appointments on that Saturday, or o'clock or whatever? COMMISSIONER PARIS: We give appointments for the Saturday hours. So we give enough appointments, according to the physicians, that we are going to have on that specific session. It could very well be that we have adult medicine, that we have pediatrics. We could very well have GYN services for that time. And one thing that we added this year that was key -- and I don't know if, Councilwoman Tasco, if you remember. I used to be a health center Director. So one of the challenges that we had on those evening sessions was that once we were -- I mean, we were seeing them at night, but we didn't have the lab working or the pharmacy open. So then they had to come back for services. What we did this year is, in 55 4/11/07 - WHOLE - BILL 070114, ETC. working together with the Director of Ambulatory Health Services, is, now when they come in in the evening and they come in on Saturdays, we make sure that we have full services, that we have -- if we need to have radiology, we have radiology. And I know for a fact that we have lapse services now in each one of those sessions in the evenings and on Saturday.
Now, you know the Jeanes Hospital has closed their OB/GYN clinic. I think Drexel has closed. And there's a discussion with Chestnut Hill Hospital that they may close, which is going to create a -- cause you, the Health Department, to service women who need these services. What plan have you developed to accept these additional cases? COMMISSIONER PARIS: I have been told over and over again by the Director of Maternal and Child Health that prenatal is just not one service, 56 4/11/07 - WHOLE - BILL 070114, ETC. that prenatal is a package, that prenatal is not a service that you just provide on those first nine months and then forget about the patient. That is something that doesn't end until the delivery. Our end is the prenatal, and what we're doing is, we're being very, very aggressive in making sure that we continue to have a relationship with hospitals so that we can continue to provide the prenatal care in the health centers. The component that you're talking about is the delivery, the delivery of the babies. I mean, once we have provided those prenatal services, what we do. And there is very little control, legal control, that the City of Philadelphia has over those hospitals, because, as you know, they're regulated and they're licensed by the state, not by us. But understanding that, I had a number of conversations with the Director of Social Services and the Managing 57 4/11/07 - WHOLE - BILL 070114, ETC. Director and I've asked them to allow me to really take a leadership role in the City in convening a meeting not only with the delivery hospitals but also to the major players. What I did was, I reached out to people such as Joe Frick from Independence Blue Cross, and I have his commitment to come to the table to discuss this problem. And the same thing I've done with some of the major hospitals. One of the things that I found in talking to the people from the University of Pennsylvania is that right now they have more babies that they're licensed to care for, and they are willing to come to the table and talk about these issues. It's something that, again, we can play a leadership role and we're ready to do that, but on the other hand, we have the limitations that we don't really control. Once the hospital makes the decision, whether it's a business 58 4/11/07 - WHOLE - BILL 070114, ETC. decision or -- I don't know how they define that decision -- of moving out of the business of delivering babies, there is not much that the Health Department can do.
Thank you very much, Councilwoman. Then we'll come back to you. Councilman Greenlee.
Thank you, Madam Chair. Good morning, Commissioner. COMMISSIONER PARIS: Good morning, Councilman.
And I'm sorry I had to step out for a short time, so I may be repeating a question, so I apologize. But I know in your testimony 59 4/11/07 - WHOLE - BILL 070114, ETC. and you mentioned about that 84 percent of people indicated they would recommend health centers to a family member, and I don't mean this sarcastic, but we must be hearing from some of those percent 7 that feel differently, because we heard 8 about the wait time, the three to six 9 months, all that. Was that, in your 10 estimation or your records, an accurate 11 statement or was that an exaggerated 12 statement? Because now you're saying 13 you're down to maybe a couple weeks 14 depending on the health center. I mean, 15 was there a time that it -- was that 16 accurate, that there was one time a six-month delay in appointments? COMMISSIONER PARIS: In some health centers, yes.
In some health centers, okay. COMMISSIONER PARIS: And that happened, I believe, a couple of years ago when there was a challenging time when we were not able to hire some 60 4/11/07 - WHOLE - BILL 070114, ETC. physicians.
So you've been able to work that down, you're saying? COMMISSIONER PARIS: We have been able to address and make that a priority, sir.
You still say there's differences in the health centers as far as the time and all in the delay. Are personnel switched around in some fashion to adjust for that? I mean, if one center is waiting six, seven weeks and another two weeks, it would seem that some change or adjustment in personnel is necessary. Is that accurate or do you do that? COMMISSIONER PARIS: Actually, I am very pleased to say that I have personally worked with the Director of Ambulatory Health Services in addressing that specific need. At one point we sat down and looked at how many -- I mean, I personally went through position by 61 4/11/07 - WHOLE - BILL 070114, ETC. position how many clerks did we have in this health center versus this one versus the other one versus the other one. And what we did was, we agreed that in working in coordination with the unions, that we were going to transfer some staff so that there will be more of a balance between health centers, and we were very successful in doing that, and the union was very, very helpful.
Okay. So you have been able to work on that. Do you have any documentation that kind of shows how the times have gone down in waiting over the last year or two to kind of show the progression? Could you provide that to the Chair? COMMISSIONER PARIS: Absolutely. Not a problem. We'll do that. We'll provide you with a table that will show 2005, 6 and the current year.
Great. And you do that by district? 62 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: Absolutely. Not a problem.
Great. I appreciate that. This is a general question. Ms. Reed, if I could, I know you said my figure right here, 1.6 million less for health centers. Is that the figure? Did I hear that right?
And maybe this is a longer discussion than today, but obviously the healthcare needs -- how generally do you prioritize this? I mean, it sounds like 1.6 million -- I know in a big budget maybe it's not a lot, but it still sounds like a lot of money to me. And 1.6 million cut from health centers, even given the improvement that has happened, sounds like a heck of a lot to me, particularly if I had family that are going to use this. And I know this isn't easy and it's easier for me to sit here and 63 4/11/07 - WHOLE - BILL 070114, ETC. criticize than for you to do it, but 1.6 million sounds like a lot of money that could be used in health centers and it would seem to me there should be other places that that money should be cut.
Based on our discussions with the Health Department, the funding that is being provided in '08 fully staffs the health centers, fully staffs the health centers, and there's also Class 200 contracts to fill in any gaps. So there are not going to be discontinuities for the health centers. There are other things in the budget that have been added because if they weren't added, they wouldn't occur at all, such as a million and a half dollars for surveillance cameras, which is something that City Council wants.
And also the public, by the way. Also the public. Okay? Not just us. But just let me get back to it and then I won't dominate the time here. 64 4/11/07 - WHOLE - BILL 070114, ETC. You said that the health centers are fully staffed, but I hear about the vacancies. So that's not -- maybe, Commissioner, you can answer this. Those vacancies are not at health centers? You said about vacancies. COMMISSIONER PARIS: There are vacancies in the health centers.
But they're not real people in the place; is that it? COMMISSIONER PARIS: I don't understand the question, sir. I mean, we have vacancies in each health center, but we also have vacancies in our other programs.
I understand that, but Ms. Reed said that the health centers are fully staffed. You said budgeted fully staffed, but are the people there, the workers there? 65 4/11/07 - WHOLE - BILL 070114, ETC.
During the year, there may in fact be more filled positions than there are budgeted positions, but on average, the Health Department will hit the 345 number, and this is true also of the Police Department and any other department really.
Okay. I'll admit I'm not sure I totally understand that, but thank you, Madam Chair.
We appreciate the efforts of our Health Commissioner, but, Ms. Reed, Council put in the money -- I just checked with Charlie -- the additional 1.8. So we don't trade lives for cameras, and I resent you saying that. We don't do that. When a person comes to me and says 66 4/11/07 - WHOLE - BILL 070114, ETC. they've been waiting four months and they have a dental problem or when people come here and raise signs, we're committed to people. We know that people and cameras are two different things. So the fact that Council supports cameras does not compare to what we feel about human life. You can't compare the two. You can't get angry with us. We support truant officers, too. That was the Mayor's idea, wasn't it, $3 million there? I don't hear you criticizing that. So we can go there, but don't play lives against cameras. That's an unfair debate, but we can have it if you want to have it, because we care about people across this city and we haven't made that comparison. Councilwoman Brown.
Thank you, Madam Chair. Good morning. COMMISSIONER PARIS: Good 67 4/11/07 - WHOLE - BILL 070114, ETC. morning.
I believe adequate concern has been expressed about the lack of use of the 1.6 million that was added to the budget. Has the question been asked on what that 1.6 million was slated for? COMMISSIONER PARIS: It was slated for positions at the health centers.
And this is redundant and I apologize for that. If they were for positions in the health centers and the dollars were not used, then one should surmise what? COMMISSIONER PARIS: If dollars were not used --
The 1.6 million, according to testimony, was not spent. So if those dollars were not spent and they were intended for new hires or staff needs, then what should one surmise from that? COMMISSIONER PARIS: It means 68 4/11/07 - WHOLE - BILL 070114, ETC. that there will be a surplus in Class 100.
Okay. COMMISSIONER PARIS: At the end of the fiscal year.
And what would or could have been the impact in terms of services? If those staff persons were not in place, does that not also mean that there was a shortage of services provided or the quality of services impacted? COMMISSIONER PARIS: We have been able to serve every person that has come in through the health centers. We have been able to give an appointment to every patient that has called for an appointment. We have been able to see every person that had walked into the health centers that have been sick.
Okay. And so can we then have comfort in knowing that based on testimony last year, some of those very persons you're speaking 69 4/11/07 - WHOLE - BILL 070114, ETC. about had to wait -- it goes again back to Councilwoman Blackwell's question. Concern raised last year was how long persons have to wait for service. Seeing them is important. It's good that they ultimately get -- that that gets done, but our question has been the wait for service. Our concern has been expressed around the wait, the length of the wait of service. So when we hear that the dollars have not been spent, those staff positions were not filled, then what are some of the yield of that? So we won't beat that dead horse. Let's move now, if we could, to this issue of mercury. The good news is that what we know is that mercury fillings -- that there are other alternatives for mercury fillings, and according to three different major reports by several of the nation's leading environmental organizations, dental offices are the number one source of mercury in the wastewater. 70 4/11/07 - WHOLE - BILL 070114, ETC. Can you speak to us about the practices of the Philadelphia Health Department dental division? COMMISSIONER PARIS: One of the concerns that we have right now is that we have looked at the risk that you just mentioned and we have asked for experts' opinion on this, such as the Food and Drug Administration, and, of course, we, as always, welcome your concerns on the public health impact on this, as well as your leadership, but we don't have at this point, Councilwoman Reynolds Brown, enough scientific evidence that will tell us that this is something that needs to be remediated immediately. Again, one of the things that we did was, we reached out to the FDA, to the Food and Drug Administration, to see if they have come up with any set of regulations or recommendations that change the recommendations that are in existence right now, and what they're doing is, they're looking at the data, 71 4/11/07 - WHOLE - BILL 070114, ETC. they're looking at the scientific research that they have done, but they have not made any changes and they are not recommending any changes as of yet.
So given that statement, what can we presume for the Philadelphia Health Department? That dentists use mercury fillings? COMMISSIONER PARIS: We still use -- yes.
And has an inquiry or request been made to the Food and Drug Administration for them to come in and speak with you and your professionals to address the issue of mercury? COMMISSIONER PARIS: Absolutely. What we ask is, we ask them for their expertise, for their expert advice, and what they have said is that they don't have enough scientific evidence to prove that this needs to be changed.
And so 72 4/11/07 - WHOLE - BILL 070114, ETC. you're, therefore, relying on the documents only from the Food and Drug Administration and not from other leading environmental organizations? COMMISSIONER PARIS: Well, what we have seen is not enough to make us -- to prove to us that there is enough scientific evidence that this is a public health threat. We are also very concerned, ma'am, in terms of our public health mandate, that if we were going out there and we will put forward a message of a potential threat to getting fillings and to getting dental care, that families -- that people will not seek dental care. The other piece that we are very concerned about is that the options that you just mentioned are all not covered by the existing insurance companies. So then what we are establishing is certain disparities in who gets what. And, as you know, oral care has so many implications in terms 73 4/11/07 - WHOLE - BILL 070114, ETC. not only of the physical development but the mental development of the children.
Absolutely. COMMISSIONER PARIS: That I in this position don't feel comfortable yet that there is a balance in it and I still -- I am more concerned with people not seeking out oral care because of the issue.
Okay. Well, I should seize the moment and use this as an FYI. My office has been looking at this issue for at least 16 months now, and we're not done with it, 17 and at some juncture we are going to 18 introduce a resolution calling for hearings on the matter, because we believe that there is enough evidence that suggests that we as a city need to look at it differently, particularly as it impacts children. So I share that with you as an alert that the hearings are coming. 74 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: Yes, and I appreciate that. And by the same token, please know that we are going to stay on top of the FDA or any other -- whatever else we can get our hands on that will scientifically help us.
So you've made a written formal request to the FDA; is that what I'm hearing? COMMISSIONER PARIS: I know we did an official request. I don't know if that was written or not. I can certainly get back to you. But we reached out to the FDA, and I can get back to you on the method by which we did that.
I would ask that you please submit that to the Chair. COMMISSIONER PARIS: Not a problem, ma'am. My pleasure.
One other question, Madam President. A number of the hospitals that provide -- I'm not a physician. Deliver 75 4/11/07 - WHOLE - BILL 070114, ETC. babies, help me out. COMMISSIONER PARIS: OB, obstetrics.
-- (continued) OB/GYN services have closed and ultimately often times that means that the Health Department becomes additionally -- I won't say burdened but given the challenge to handle maternity services and OB/GYN services. Have you discussed strategies to accommodate patients who will be impacted by the closing of another hospital, for starters? COMMISSIONER PARIS: Absolutely. This is something that we're very, very concerned about. It's a problem that the Health Department really doesn't have much control over because --
You're talking about the actual closings of the hospitals? COMMISSIONER PARIS: Exactly.
That's for 76 4/11/07 - WHOLE - BILL 070114, ETC. sure, but one of the outcomes is someone then has to pick up the responsibility of many of those patients for OB/GYN services. COMMISSIONER PARIS: Well, we provide prenatal care services in all our health centers. That is really not directly connected with what is happening in terms of the last hospital that closed, for example. But in the big picture, there is a relation, because we need to make sure that there is still enough licensing beds for those women to go in and deliver the babies.
Repeat what you just said. There's what? COMMISSIONER PARIS: That there are enough beds for those babies to be delivered at those hospitals. And what is happening today is that as hospitals close, then there's more demand on the hospitals that remain open, to the point that some of them are not in compliance with their licensed number of beds, 77 4/11/07 - WHOLE - BILL 070114, ETC. because now they're caring for more babies than what they're licensed to do. And what we're doing is, in the Health Department, with the support of the Division of Social Services as well as the Managing Director, is, we are convening a meeting of stakeholders and the different players of healthcare in the City to address that need.
Okay. COMMISSIONER PARIS: We can't control who closes.
I'm not suggesting that. COMMISSIONER PARIS: I understand, but what we're doing is, we're going to bring them together, because when one closes, it affects others. It affects all. So what do we do to ensure that, whether it is together go to the state and ask for more resources or -- I mean, what is it that we need to do, develop a plan that not only serves the public health but also 78 4/11/07 - WHOLE - BILL 070114, ETC. serves the insurance companies, the hospitals and all the providers, the maternity care coalitions of the world and everybody that is involved in this issue.
Okay. What type of programs does the Health Department offer to teen mothers after or before they leave a hospital? Does the Health Department offer any kind of parenting education of any type to teen mothers before they leave hospitals? COMMISSIONER PARIS: We have the prenatal -- if they come to the health centers for services, yes. We also fund a number of agencies that provide outreach and education efforts to teen mothers.
Any connection with the School District specifically as it relates to teen mothers? COMMISSIONER PARIS: No, ma'am.
Do you 79 4/11/07 - WHOLE - BILL 070114, ETC. think that there may be an opportunity there for the Health Department to have conversations, discussions, look for systems talking across each other, talking with each other around the issue of teen mothers? COMMISSIONER PARIS: Absolutely. We will welcome the School District's invitation to come and discuss that.
So the School District should make the reach? That's what I'm hearing. COMMISSIONER PARIS: Well, we participate -- we collaborate with the School District in many levels. We have collaborations between the health centers and the schools in the area. If we want to expand to make sure that one of the issues that we address is teen mothers, we will do that, ma'am.
Okay. My final question is around the City food establishments, the inspections of City 80 4/11/07 - WHOLE - BILL 070114, ETC. food establishments and another hearing that was chaired by Councilwoman Tasco where there were not enough sanitarians -- is that what you called them -- sanitarians to handle the demand for food establishments. Can you speak to what the plan is post that hearing, what you're doing differently going forward to address that increasing need? COMMISSIONER PARIS: One of the things that we talked about at that meeting was the establishment of a risk-based inspection program, and that risk-based inspection program will allow the Department to prioritize the establishments that will get more than one inspection a year. At the point -- at that time when I came to Council and talked about it, it has not in any shape or form been implemented as of that point. And actually at that point, we didn't even have the software that will help us and that would allow us to do that. 81 4/11/07 - WHOLE - BILL 070114, ETC. What we did was, we went to the state and secured a grant to put the software for the risk-based program in place, and right now as we speak, that component is almost completed. So we're very happy. Once it's completed, which will not be -- should be by the end of this fiscal year, then we should be able to do a test and start working on risk based. The other thing that we have done is, we are training. We are allowing the staff to participate in trainings that will allow them to change how they do inspections today to how inspections are going to be done. So we're doing that as well. And what's going to happen is, we are going to end up with a number of -- we're going to end up with all our food establishments being prioritized. We will have those that need more than one food inspection a year and those that only one food inspection is required a year. And then with the 82 4/11/07 - WHOLE - BILL 070114, ETC. data with the software that we will have implemented, we will be able to --
Keep track of in a uniform way? COMMISSIONER PARIS: That's correct, ma'am.
Well, that's progress post that hearing, and we thank you for that. Thank you for your testimony. Thank you, Madam President. COMMISSIONER PARIS: Thank you.
You're welcome. The Chair recognizes Councilman Rizzo.
Thank you, Madam President. Commissioner, earlier you reminded me of an issue that Council had an interest in when you started to talk about doctors that work part time for the 83 4/11/07 - WHOLE - BILL 070114, ETC. City that get benefits and all the things that a full-time employee receives, and one of the concerns that we had was the residency waivers, the residency waivers for those physicians. We've asked this question many times, why we can't find young, middle-aged, older doctors right here in the City of Philadelphia. What I'd appreciate you doing is commenting on the number of residency waivers that the Health Department presently has across the board, specifically the physicians, and present that to the Chair. And could you comment, though, on how many doctors and other employees have residency waivers that have gone on for, in some cases, a decade or more? COMMISSIONER PARIS: If I may, I want to step back for one moment and clarify that. Part-time doctors do not have full benefits. They also have partial benefits. So the full benefits are just for our full-time -- 84 4/11/07 - WHOLE - BILL 070114, ETC.
What are partial benefits? COMMISSIONER PARIS: -- employees only.
What are partial benefits? COMMISSIONER PARIS: Well, those that are working -- the hourly doctors do not get any benefits. It is just those that are working with us that are Civil Service doctors. They're the ones that get full benefits. The other doctors don't get the benefits of -- we don't pay their malpractice. We don't pay them for sick time. We don't pay them for vacation. It's only those that are with us full time that get those kind of benefits.
And you do -- COMMISSIONER PARIS: Hourly doctors do not get benefits.
So employees that have residency waivers, the 85 4/11/07 - WHOLE - BILL 070114, ETC. full-time doctors, the City pays their malpractice, which is a big perk today based on the amount that I understand doctors have to pay for malpractice, but let's just talk about how many employees in the Health Department have residency waivers, and many of them have had them for a long, long time. COMMISSIONER PARIS: Currently, it is the physicians. It is the physicians that have been granted residency waivers. We don't have any other position that has been granted residency waivers on a permanent basis. On occasion we might have to ask for a residency waiver for -- I believe at some point we did have two nurses on residency waiver. One of them moved into the City, was able to relocate into the City. The other one was not able to, and she was let go. She was fired because of that. The other position that I believe that we looked at potentially asking for a residency waiver were 86 4/11/07 - WHOLE - BILL 070114, ETC. engineers for the Air Management, as well as pharmacists. But currently, I couldn't tell you off the top of my head how many we have, how many doctors we have that live in Philadelphia and which ones don't, but I will be glad to get you those specific numbers and the classes.
That would be terrific. COMMISSIONER PARIS: I will do that, sir.
Because seeing the amount of young people graduating medical school, staying in the City, I just can't imagine that we can't recruit -- one of our colleague's daughters is a doctor. It just amazes me that we will really have to go to -- that we can't do a better job in recruiting here young physicians that want to work in the Health Department. I'm not suggesting that that's an easy job, but you talked about earlier how tough it is in the area of recruiting. You need some 87 4/11/07 - WHOLE - BILL 070114, ETC. help with that. You're not in the job of recruiting, and maybe Central Personnel or some of the other agencies that have expertise have to get more involved in getting the nurses, getting the doctors that you need. Go to the medical schools. We have a new medical school, Hahnemann, and see if we can start to recruit people. Because if we do have a policy that has an exception to it with residency, that's fine, but we need to really try hard to get people that do live in the City if in fact that's the rules of the game. COMMISSIONER PARIS: Absolutely. And to that extent, sir, we have developed agreements and partnerships with Drexel and with other academic institutions for that purpose. But, again, we are competing with the suburbs and many times it is more attractive, the school systems and so on, in those other places for some of these young professionals. Some of them are 88 4/11/07 - WHOLE - BILL 070114, ETC. very fortunate that look at all the good that the City has to offer and decide to stay here. So we have been able to recruit some very good people.
Good. COMMISSIONER PARIS: But it's still very challenging. But if you don't mind, you can give your colleague --
I wasn't suggesting she's looking for a job. My point is that we have young doctors that live and were educated here in the City of Philadelphia that I'm sure if we asked them or explained to them the opportunities that exist, many of these young people don't even know that there are opportunities to be a physician that works for the Health Department, that gets benefits, that gets their malpractice paid for them. So I think that maybe we need to do a campaign. And I'm not suggesting that we knock off a doctor that lives in Bala Cynwyd for the last 20 years that works for the City, 89 4/11/07 - WHOLE - BILL 070114, ETC. but maybe there ought to be a point where that list starts to shrink where then we have young physicians, again middle-aged physicians, older physicians that work for you. I'm not locked in to residency. There's some areas that I believe that we should be able to go outside the City, but as long as that isn't the policy currently, I think we should try to do a better job in adhering to the policy than just saying, Oh, well, we can't find anyone, so we'll go to Gladwyne and hire a doctor and that's the end of the effort. Thank you, Madam Chair.
You're welcome. The Chair recognizes Councilwoman Brown.
Quick follow-up on the services you provide to teenage parents. Just talk about that real briefly to give me a sense of the 90 4/11/07 - WHOLE - BILL 070114, ETC. extent of the service rendered by the Health Department for teenage mothers, you or a designee. Good afternoon. This is my last question. I promise.
My name is Kate Moss. I'm the Director of Maternal, Child and Family Health for the Health Department. We provide prenatal care, as we've said, in all eight of our City district health centers, and some portion of the pregnant women, young women, who come to us are teens. I'm not sure what that proportion is. But in addition, we serve about 3,000 families a year with home visiting programs. And I actually had our data people take a look at how many of those caregivers -- what was the age of those caregivers. More than half of the caregivers in families we serve are under 22. And I understand that the 91 4/11/07 - WHOLE - BILL 070114, ETC. School District has responsibility on some alternative programming available for pregnant and parenting young people, teens, girls and boys, up to the age of 22. And we're actually currently involved in discussions through the Project U-Turn initiative to try to figure out how we could make better connections between our home visiting programs. I'm willing to write in to every one of our home visiting contracts that any time they encounter a pregnant or parenting teen, their first call needs to be Project ELECT or whoever at the School District.
Okay. Well, for the record, that's an opportunity for several different systems to do what we can to save teenagers so that they don't become dropouts, who become the working poor taking care of children. And you should know that my office will be looking at this closely and be working with a number of 92 4/11/07 - WHOLE - BILL 070114, ETC. interested parties and calling for hearings on it. So when you get the notice, you'll know why.
You're welcome. Councilwoman Tasco, did you want to be recognized?
Just one question on a whole different subject. PACA I know comes under the Health Department. Is it still the plan to keep them as the animal control agency? Because there were some stories about a possible change there. COMMISSIONER PARIS: We are not foreseeing any changes on that contract, sir. 93 4/11/07 - WHOLE - BILL 070114, ETC.
I have a couple of questions about the -- these are questions about the lead program. We understand that there has been great progress made in the City to prevent children from being poisoned by lead, but we have learned that Philadelphia is beginning to again have a waiting list of homes where children have been poisoned by lead, but the homes have not been cleaned. Why is the waiting list growing and what does the Health Department need to do to clean these homes? COMMISSIONER PARIS: There are two different components to the lead program, ma'am. One is the component of testing the children. Once the children are tested positive, then they go on a 94 4/11/07 - WHOLE - BILL 070114, ETC. list for their homes to be either cleaned or abated. That's one component, and that is funded by HUD primarily and also we have some General Funds in that program. The other component is the primary prevention component, where we are actually identifying women that are pregnant close to delivery or women that have just had a child. We're going into the homes. This is something that we're very proud of. We actually can go into the homes before the child is exposed to lead and we do an assessment of the home, and based on the assessment, we are able to, for the most, do a cleaning. We can do a super clean. But we don't have any dollars. Our grants are very strict, and unless there's a child with a positive test, we don't have resources right now to abate a home where there is no child living with lead.
Well, 95 4/11/07 - WHOLE - BILL 070114, ETC. isn't this a federally mandated requirement? COMMISSIONER PARIS: If the child is positive, yes, and that's what we use the monies that we have secured to do. The homes that I'm referring to are homes where the young woman just had a baby. The baby is not yet --
Wait a minute. There are two issues. The one is, the home is being inspected by HUD, by the federal government or by your program. COMMISSIONER PARIS: By our program.
That's one program, right? COMMISSIONER PARIS: Yes, ma'am.
Where is that? Is there a waiting list for that? COMMISSIONER PARIS: We are inspecting and we continue to -- most of those homes -- the problem answering 96 4/11/07 - WHOLE - BILL 070114, ETC. that -- that's the program that used to have a backlog. That's the program where we used to have 1,400 homes in the backlog. Right now we have approximately about 230 homes on that backlog, and there is no children living in any of those properties, and we go back to those properties to make sure that there are no 10 children living in those properties. The others -- the difference between the 1,400 and the 200, we had either abated, we have cleaned those homes or they have been demolished or there's nobody in the home right now.
So you're saying that there are no children in homes that might have had lead and that have not been cleaned? COMMISSIONER PARIS: No. What I'm saying is the backlog that was originated by those, by having children living in homes that --
Had lead. COMMISSIONER PARIS: -- had 97 4/11/07 - WHOLE - BILL 070114, ETC. lead, that is the one that we have completely dealt with.
So there is no backlog? COMMISSIONER PARIS: There is no backlog of the homes of children with positive levels.