COUNCIL OF THE CITY OF PHILADELPHIA PUBLIC HEARING BEFORE JOINT COUNCIL COMMITTEES ON PUBLIC SAFETY AND HEALTH & HUMAN SERVICES - - - Room 400, City Hall Philadelphia, Pennsylvania Thursday, 1/25/01 3:15 p.m. - - - RESOLUTION 000692 - Authorizing City Council's Committees on Public Health and Human Services and Public Safety to hold a joint committee hearing to investigate the quality level of medical and mental health care services that is provided or made accessible to prison inmates under the care of the Philadelphia prison systems. PRESENT: COUNCILMAN ANGEL L. ORTIZ, Chair COUNCILWOMAN MARIAN B. TASCO, Chair COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN DAVID COHEN COUNCILMAN JAMES L. KENNEY COUNCILWOMAN BLONDELL REYNOLDS-BROWN COUNCILMAN FRANK RIZZO COUNCIL PRESIDENT ANNA C. VERNA - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 2 1/25/01 PUBLIC SAFETY I N D E X Secretary Esteele Richman, Director . . . . . Department of Social Services 5 Kenneth Trujillo, City Solicitor. . . . . . . 21 6 Prison Health Services 7 M. Catalano, Chairman . . . . . . . . . . . . 62 Dr. Harold Orr, Regional Medical Director . . 65 8 Dr. Sandra Newkirk, Regional Mental Health. . 66 Director 9 Rodney Fry, Regional Manager. . . . . . . . . 118 10 Donnie Moore, President . . . . . . . . . . . 105 Department of Human Services 11 Aisha Russell, ACT UP Representative. . . . . 130 12 Tracy Ann Franks, Ex-Inmate . . . . . . . . . 131 James Graham, Former PPS Case Manager . . . . 135 Knesset David Klein, Prison Rights Activist 162 Carol Karash, ACLU Volunteer. . . . . . . . . 168 3 1/25/01 PUBLIC SAFETY - RES. 692 P R O C E E D I N G S
The public health and public safety committees been waiting for the members in chambers. It seems that we are dealing with the announcement of Jonathon Saidel. So a lot of the folks that are supposed to be at this table are down in the Mayor's reception room, so we will wait. - - -
The announcement is still going on downstairs, and many of the Councilmembers are in the Mayor's reception room, most of them, so we might have to wait until Mr. Saidel makes his speech, or whatever it is. - - -
The announcement is still going on downstairs, and I've just been informed that Chairman Brady is at the microphone, so we have to have to wait a little while longer, until the Chairman finishes, I guess, and I don't know who else is going to be -- but I apologize for making you sit here for this time. - - -
We will begin at 1/25/01 PUBLIC SAFETY - RES. 692 o'clock, and we will let the Councilpeople join us as we move on in the hearing. - - -
Good afternoon, good afternoon. I figure by the time I finish, Saidel should be finished speaking, so by the time I finish my statement, Saidel should be finishing his statement downstairs. This is a hearing of the Joint Committee on Health and Human Services and Public Safety Committees chaired by Marian Tasco and Councilman Ortiz. Would the clerk please read the title of the resolution.
Authorizing City Council's Committees on Public Health and Human Services and Public Safety to hold a joint committee hearing to investigate the quality level of medical and mental health care services that is provided or made accessible to prison inmates under the care of the Philadelphia prison systems.
I'm sorry for the delay. When we set the date, we didn't know that Mr. Saidel was going to schedule his announcement, 5 1/25/01 PUBLIC SAFETY - RES. 692 and they tell me that 13 members of City Council are down there. What I think I shall do is begin with reading a statement to give an overview of what we believe the problem to be. In Philadelphia, the burden to improve the Prison Health Services has not been voluntary. It was part of an overall obligation shaped by a long-standing class action suit against the City filed in 1971. In 1972, Jackson v Hendrick, a three-judge panel issued an opinion and a decree holding the City responsible for violating prisoners' constitutional rights. Among the many findings, the panel concluded that the Philadelphia prison was system overcrowded and it had committed acts of negligence, resulting in the gross mistreatment of the inmate population, in effect, violating many constitutional protections. This decision also cited the City for providing inadequate medical and psychiatric care. Since 1972, this 20-year-old case has been characterized by a series of consent decrees, charges of contempts and fines against the City. Although the City has made improvements, the nature and scope of the provisions of mental and 6 1/25/01 PUBLIC SAFETY - RES. 692 medical services has always been contentious. These issues were clearly a part of the challenges facing the City in 1991, when another court agreement required the City to implement a list of mental health care policies that would be monitored by a court-appointed special master. Seeking a solution to the prison health care fiasco in 1993, Mayor Rendell moved to contract out most of Philadelphia's Prison Health Services. But since then, there have been a series of reviews and reports by experts that have been critical of how we, as a city, have performed in terms of compliance with a laundry list of court-ordered policies and procedures requiring remedies. Even as recently as May 1999, Dr. Robert B. Greifinger, a nationally-recognized mental health expert was brought into to evaluate the City's compliance where the court mandates made the most critical observations and reviews of our prison system. He instructed us and advised that central to our problem was the lack of prudent oversight and monitoring of those responsible for providing physical and mental 7 1/25/01 PUBLIC SAFETY - RES. 692 health-care services. That would be Prison Health Services, Incorporated, the private company that the City contracts with to provide such services. But he went further. He called for a complete overhaul of the tuberculosis management system. He found women's health care to be deficient, in that: too few were screened for sexually-transmitted diseases at intake; the lag time for report was excessive, leading to missed opportunities for treatment; pregnant women were routinely not counseled or tested for HIV, thereby endangering their offspring; newborn babies were not allowed to bond effectively with their mothers, a setup for future dysfunctional family relationship. Further, Dr. Greifinger pointed to many other issues having both clinical and administrative concerns. For example, he ordered: The laboratory turnaround time for sexually-transmitted diseases testing was excessive; Mortality review was not documented; There was no contract monitoring and 8 1/25/01 PUBLIC SAFETY - RES. , higher than in other similar prison population; There was a lack of supervision of inmates demonstrating suicidal tendencies; Clinical guidelines for the management of HIV and chronic diseases needed to be updated; There were insufficient opportunities for inmates who want substance-abuse treatment. At the time, there was a waiting list of 500 inmates; There was no methadone detoxification program for appropriate candidates; Physician licensing status were not all verified. In fact, 43 percent of physician licenses at the time of Greifinger's report had not been verified.
In response, the City responded with a status report prepared by Miss Estelle Richman, Secretary of Social Services, dated January 27, 2000. The report outlines the areas where the City has achieved most progress and provides 9 1/25/01 PUBLIC SAFETY - RES. 692 appropriate strategy intended to remedy the deficiencies included in Dr. Greifinger's report. The following reflects some of the more salient highlights of the Richman report: It was proposed that a holistic-integrated model of health care services delivery would be developed that incorporates the coordinated work among the various service professions; There would be an improved system of the distribution and monitoring of prescribed medications; Screening and referral services would be available on a 24-hour basis; There would be a restructuring of the short-term inpatient treatment unit to include therapeutic functions, crises, acute and sub acute; There would be greater continuity of mental health services to inmates and improved cases of management; The City would institute a model detoxification and methadone maintenance program; And the City committed to improve the 10 1/25/01 PUBLIC SAFETY - RES. 692 system monitoring of all medical and behavioral services within our City prisons. However, on September 16, 2000, it was reported by the Daily News that Jose Santiago, a prison inmate, someone who had not been convicted of any crime at that time, was found dead in his cell due to a lack of insulin shots for his diabetic condition. Upon inspection, we found there were other tragic incidents; in fact, three deaths in the last four years, along with many other complaints of inadequate care. I introduced this resolution, cosponsored by the vast majority of my colleagues, to call for a public hearing to investigate the quality level of medical and mental health-care services that are provided to prison inmates and to see whether the questions that were raised by Dr. Greifinger and then the report that Estelle Richman put forward have been implemented -- is being implemented and what are the timelines of that implementation to take place. Today is the first step in that process. We want to hear from all parties 11 1/25/01 PUBLIC SAFETY - RES. 692 responsible for and those affected by this important issue. Our purpose is to get all of the facts and to ensure that we as a city provide a health-care delivery system that meets all of the Constitutional and statutory rights afforded all prison inmates in our Commonwealth. After all, we don't want to be Texas. )
We must also make sure that as a legislature, we closely monitor the provider of medical services -- in this case PHS, Incorporated. We have responsibilities to hold them accountable for their contractual obligations to the City and to the prison population. As a legislature, we must also make certain that strict adherence to quality health care standards and financial audits are maintained in order to effectively maximize the use of taxpayers' dollars. Miss Estelle Richman? (Witnesses come forward.)
Please identify yourself for the record. SECRETARY RICHMAN: Okay. 12 1/25/01 PUBLIC SAFETY - RES. 692
And I see that you're accompanied by the City Solicitor, Mr. Kenneth Trujillo. Estelle, you know the drill. SECRETARY RICHMAN: Yes, I do.
My colleagues will be here shortly, we hope. SECRETARY RICHMAN: Good morning, Councilman Ortiz and the soon-to-arrive members of the joint committee on Human Services and Public Safety. I am Estelle Richman, Director of --
We are now joined by the President of Council and Mr. Michael Nutter, who have just arrived. SECRETARY RICHMAN: Thank you. Good afternoon.
I am Estelle Richman, Director of Social Services for the City of Philadelphia. I am joined today by the City Solicitor, Ken Trujillo. The Philadelphia prison system is one of ten entities for which I am responsible. I 13 1/25/01 PUBLIC SAFETY - RES. 692 would like to take a couple of minutes to review the history of the provision of health-care services in the Philadelphia prisons. There are three components of the health care in the prisons: physical health care, mental health care, and substance abuse health care. Until July 2000, these services were provided by three separate entities. An outside contractor for physical health, Correctional Health Care Solutions, from 1989 to July of 1993, and Prison Health Services from August of 1993. Prison Health Services is the current provider. There has also been an outside contractor for mental health services -- Allegheny Health Services, starting in 1996, assigned to Tenet Health Services in November of 1998 to July of -- to June 2000. Substance abuse services have been provided by City social workers through the prison's options program. As a result of this fragmentation of the system, the Harris court cited the City on a variety of issues related to physical and behavioral health care in the prison. In addition, the court hired a consultant, Dr. Robert 14 1/25/01 PUBLIC SAFETY - RES. 692 Greifinger, to review health policies. Dr. Greifinger identified areas of 4 noncompliance. The Greifinger report was issued 5 in September of 1999. 6 The City response, filed February the 7 3rd, year 2000, serves as a blueprint for enhanced 8 mental health services. It was accepted by the 9 federal court as an adequate and appropriate 10 response to the issues raised by Dr. Greifinger. 11 To accomplish and institutionalize this 12 change, I have convened a group consisting of 13 representatives from Prison Health Services -- 14
-- what is the total cost of contract yearly? Is it around 20-something? SECRETARY RICHMAN: It's about $25 million, of which probably, what, about 7 or 8 million came from the behavioral health contract 15 1/25/01 PUBLIC SAFETY - RES. 692 that was a special contract up until July. So we combined two contracts.
The Hahnemann contract -- Hahnemann was removed and the mental health services and the other health services were then given to PHS. SECRETARY RICHMAN: That's correct, through a competitive bid process.
But is it still $25 million? SECRETARY RICHMAN: Right. Before July of 2000, it was not $25 million.
Okay. So the combined contracts of Hahnemann and -- it brings it up to $25 million, okay. SECRETARY RICHMAN: That's correct.
Okay. SECRETARY RICHMAN: To accomplish and institutionalize this change, I convened a group consisting of representatives from Prison Health Services, Tenet, the Philadelphia Department of Public Health, the Philadelphia Behavioral Health System, DePaul Health Services, and prison social services staff. The group met one to two times a 16 1/25/01 PUBLIC SAFETY - RES. 692 week for about three months to create new policies and procedures to change the operational format for services.
I just want to let you know that we have achieved a quorum, with Jim Kenney, Michael Nutter, Dave Cohen, Ann Verna, and Frank Rizzo. SECRETARY RICHMAN: Good afternoon, Councilmen.
So now we have a achieved a quorum, Mr. City Solicitor.
Duly noted. SECRETARY RICHMAN: The new policies were put in place beginning in February 2000 and continuing through July 2000. The court and Dr. Greifinger reviewed the policies and the implementation process and approved the plan. Some of the new policies adopted at this time will be described in the testimony of Prison Health Services. During this same period of time, there was a change of administration and a change in position for me from Health Commissioner to Director of Social Services. One of my first assignments -- 17 1/25/01 PUBLIC SAFETY - RES. 692
And now the Co-chair of the committee, Marian Tasco, has joined us. I'm sorry for the interruption but as I said, we were just -- we were going to do this as soon as Marian Tasco came. Do you have anything to say, ma'am?
Okay, go ahead. SECRETARY RICHMAN: Does everybody have a copy of the testimony? Okay. One of my first assignments was to review the status of the requests for proposals for Prison Health Services and to determine the format for the proposal. That means, would the current separation of behavioral health and physical health remain, or would there be integration of the two services under a single provider? The decision was integration under one provider. The behavioral health system was fully involved in writing the requests for proposal and responsible of the full identification of best practice for mental health services in a prison. There was also recognition that many inmates have 18 1/25/01 PUBLIC SAFETY - RES. 692 co-occurring disorders of addictions and mental illness. Plans are currently underway to provide methadone services as well as detoxification at the prison. The RFP was released in February of 2000, responses were received in March of 2000. Prison Health Services was selected from four respondents. Operating under a contract that began in July of 2000, Prison Health Services consolidates the services for physical health and behavioral health under one provider. This facilitates seamless communication between physical and behavioral health services or 40 enhanced comprehensive care for inmates. The consolidation of behavioral health with physical health under one provider is logical and promises to ensure a higher level of care. The behavioral health components are being phased in with a purposeful planning methodology, in conjunction with support from outside agencies, including the behavioral health system. When the current prison contract was initiated, oversight was a shared responsibility between Social Services and the Philadelphia 19 1/25/01 PUBLIC SAFETY - RES. 692 prison system executive staff. Effective November 2000, Social Services hired a deputy of administration to serve as contract administrator and take the full-time lead in managing the four major professional services contracts in the Philadelphia prison system. These contracts include health, food, commissary and facilities maintenance, and operations. Combined with a cooperative prison medical staff that lends many years of correctional health experience, there are several notable initiatives underway that address the goals and objectives of top-quality Prison Health Services. In addition to ensuring high-quality medical services for the inmate population, programs are in development to extend services beyond the time spent in custody to address human needs that help individuals assimilate back into society and reduce recidivism. To provide this comprehensive level of health services which draws on resources from the local community, Prison Health Services works closely with Northeast Treatment Centers to develop and provide community linkage services and systems that provide 20 1/25/01 PUBLIC SAFETY - RES. 692 behavioral health services to those inmates released from the prison system upon return to the community. The health service contract is monitored with a four-layered safeguard approach. The first layer is a service provider's contractual requirement to conduct a continuous quality management program with measurable indicators. Indicators include physicals, chronic care, infection control, screenings, medications, and significant other items. A second safeguard layer of monitoring is through an agreement with an independent agency whose expertise is in analyzing institutional health services. This is DePaul Health Services. Their objective oversight is directed at the specific scope of services described in the health contract.
When did DePaul Health monitoring the services go into effect? SECRETARY RICHMAN: I believe they went into effect in 1994.
I imagine that they 21 1/25/01 PUBLIC SAFETY - RES. 692 submit periodic reports to the Department in terms of their findings and monitoring of the services. SECRETARY RICHMAN: Yes, they do.
Have they been submitting these reports from '95 until the present time? SECRETARY RICHMAN: Yes. My guess is, yes, they do.
Can we have copies of the reports that they submit to the Department of Health from that period of time?
For the record, my name is Kenneth Trujillo. I'm the City Solicitor.
By the way, he shaved the beard, so -- he is Ken Trujillo, I can vouch for that.
Councilman, as you and I discussed earlier this week, these reports are reports which, in my judgment, are reports cannot yet be made publicly available. There's a number of reasons for those. And in my judgment, the release of those reports implicates a couple of issues, one of which is the privacy rights of numerous inmates whose names and medical conditions and the like are revealed in those reports. And secondly, as the Council is aware, we are engaged in litigation in a number of facts -- there are a number of factors that prevent us from being able to release those reports at this time.
I understand the aspect of litigation of what we can and cannot do, and I am very mindful of not intruding in that. But from '95 to today, we have had -- and I what want to begin establishing through this committee and these hearings is a record of what our health services are and what the provision of those have been like during this period of time. DePaul works for an agency of the City on a contractual basis. I would imagine that 23 1/25/01 PUBLIC SAFETY - RES. 692 those reports, even -- even under the broadest of interpretation, if they are reports, then they are public information.
Except those that may be in litigation. Are you telling me that all of the reports from '95 to the year 2001 are all -- all protected under the -- that they're all subject to discovery in terms of litigation and so on? I think they're subject to discovery.
Well, right now, there is, in fact, ongoing litigation up to the Commonwealth court and is pending before the Commonwealth court on the discovery of these specific reports. And so one of the things, as you're aware -- in fact, Councilman Cohen I notice is here as well -- that to the extent that a document or anything is turned over to a third party which is under a claim of privilege, that turning over of that document may implicate that privilege. And so there is ongoing litigation in 24 1/25/01 PUBLIC SAFETY - RES. 692 which these reports have been sought and which the City has declined to produce and which is subject to litigation.
I just want all of this for the record and that's why I am proceeding, so that we can have a very clear picture. They are a consultant to the City?
They produce paper, information, evaluation as such, they give an evaluation of another contract that we have with another private entity.
I'm not certain that that is the scope of the work. I'd be happy to provide --
But they monitor how this other private entity that we have contracted to provide services, and they're able, through that report, to tell us whether that entity is following all of the policies and procedures that the Health Department and Estelle Richman have established for PHS.
Again, I am not certain 25 1/25/01 PUBLIC SAFETY - RES. 692 that that is an accurate portrayal of what their duties are.
Well, tell me what it is, give me an accurate portrayal, then, of what DePaul is supposed to do.
And, again, this has to be broken down into a couple of different time frames. The current report, as I understand it -- and, again, I think we made available to your staff copies of the contracts themselves, so that language, rather than my work, can --
But for the record, I would like to establish what -- we have PHS, they're supposed to provide medical and mental health services to the inmate population, including the Youth Study Center, right, Miss Richman? SECRETARY RICHMAN: That's correct.
Okay. And they are supposed to provide these medical services following a whole series of procedures and guidelines. And DePaul is the entity that we have contracted with to monitor this. Now, give me, in your assessment, in 1/25/01 PUBLIC SAFETY - RES. 692 your opinion, what is it that DePaul -- if it is not an of the evaluation of program, what is that --
-- Miss Richman is supposed to follow? And I imagine that she's not going to be daily overseeing and monitoring the prison system. She has to have the information from somewhere. I imagine DePaul is it. What is it that they're supposed to give the City so that the City can be somewhat satisfied and confident that $25 million is being spent correctly?
Again, with the caveat that the language of the contracts speak for themselves, my understanding is that the --
I don't want to read the contract; I want you, as the legal entity of the City, to tell me what is it that DePaul is supposed to do for us.
Yes. Again, with that caveat, my understanding is that they are to prove an objective professional evaluation of services delivered to patients under the contract with a 27 1/25/01 PUBLIC SAFETY - RES. 692 health-care provider, to measure the quality of services which are provided, to define the cost-effectiveness of the programs that are developed, to identify potential problems, to monitor details of the contract.
And how we, as a committee of City Council that, one, oversees the Department, the different departments, and monitor the different departments, how are we supposed to begin making an evaluation whether those monies that we appropriate to be spent on these services are being spent correctly and efficiently unless we have the information that we require? How are we supposed to know that PHS is doing the job that it is contractually supposed to do unless we have reports that in essence document to us the work that they have done?
I think that you are absolutely entitled to ensure that the funds that are being expended by the City by PHS or any other contractor are being expended appropriately and that the service that are being contracted for are -- the service are being provided also appropriately, but I do -- that does not 28 1/25/01 PUBLIC SAFETY - RES. 692 necessarily equate to these reports being the ones that need to be turned -- are the appropriate ones that should be reviewed. I believe that certainly the Director of Social Services and prison service in our two camps, and there certainly is an ongoing review by the City, and you can certainly, I think, inquire properly about those, and we'll do everything we can to get you those documents. My concern is very specific and the one that I articulated to you earlier, and that is that my responsibility is to protect the City's interests in connection with a number of things, including ongoing litigation. It is my judgment that the public disclosure of these reports at this time is inappropriate and potentially puts the City at risk. And that is why, in my judgment, it is inappropriate for them to be disclosed at this time.
Okay, continue, Miss Richman. We'll come back to -- I just wanted to put those parameters on the record so that we begin to understand certain things. SECRETARY RICHMAN: Okay. These regular reports are submitted to the monitoring team, which is at the Philadelphia prison system, and their medical staff, and this is City staff. I have a prison health care coordinator who is assisted by two nurses who review and supervise the contracts health care staff. In other words, there are people on my staff that do direct supervision and monitoring of the Prison Health Services.
In terms of that, let us -- because I -- you submitted a response to Dr. Greifinger's report. SECRETARY RICHMAN: Yes.
And in that, he listed a series of deficiencies that he found with PHS. SECRETARY RICHMAN: Yes. 30 1/25/01 PUBLIC SAFETY - RES. 692
And the services that PHS was providing. And although I'm going to name a few, and you tell me in your opinion and -- not only your opinion but how these deficiencies have been cured, if they have been; or if not, what is the timeline that you have given PHS to get into line. For instance, one of them is that too few of the inmates were screened for sexually-transmitted diseases at intake. SECRETARY RICHMAN: That's being addressed. I would be able to get back to you. I didn't bring any of that information with me, but they all have protocols, and they are all being addressed, and that one should be addressed by now. Yeah, I didn't bring the detail of those kinds of things.
We can assume that at intake, the inmates being processed. SECRETARY RICHMAN: Yes.
And the lag time in terms of issuance of reports, what has happened 31 1/25/01 PUBLIC SAFETY - RES. 692 with that? SECRETARY RICHMAN: I'm sorry? The lag time --
The lag time for reports. SECRETARY RICHMAN: Yes, it's being done.
What's being done? SECRETARY RICHMAN: The lag time for reports to be submitted?
Yes. SECRETARY RICHMAN: It has been closed so that there is not a lag time.
The pregnant women were not counseled or tested for HIV. SECRETARY RICHMAN: That one I don't know off the top of my head. (Sec'y Richman confers with colleague off the record.) SECRETARY RICHMAN: That is happening. I am told that is happening. I will confirm all 32 1/25/01 PUBLIC SAFETY - RES. 692 of this and give you a written statement on it.
Newborn babies were not allowed to bond effectively with their mothers. SECRETARY RICHMAN: I know --
I'm just going down some of Dr. Greifinger's critiques, and I want to know what of those critiques have been addressed and what is the status that they find themselves in. SECRETARY RICHMAN: I know that as we build the new women's prison, we're putting in facilities so that women can continue to bond with their children. That was one of the specifics that we have done.
You're putting it in; it's not in yet. SECRETARY RICHMAN: Well, we -- in the new women's prison, we don't have the facilities at this point.
And currently you don't have it. SECRETARY RICHMAN: Right.
And so you can say 33 1/25/01 PUBLIC SAFETY - RES. 692 that this one is not happening as of yet. SECRETARY RICHMAN: That one is not happening.
Okay. SECRETARY RICHMAN: That one isn't done. As we plan the new women's prison, which is being built as opposed to existing, there are facilities being built in for women to be able to spend more time with their newborn infants.
The laboratory turnaround for sexually-transmitted disease testing, how has that -- that was excessive. SECRETARY RICHMAN: That's the lag report, I believe.
What? SECRETARY RICHMAN: That's the lag report. In other words, the time between the testing and when those results get to the prison and get reported was too long. The lag time in those --
So that's been taken care of? SECRETARY RICHMAN: Right.
Mortality review? 34 1/25/01 PUBLIC SAFETY - RES. 692 SECRETARY RICHMAN: Mortality review?
Review was not documented. This is according to Dr. Greifinger's report. SECRETARY RICHMAN: That is now being documented. That has been documented on an internal basis.
Tell me how that happens. SECRETARY RICHMAN: What the citing is that there was no notation in the chart of a review of any death. That now happens.
The use of psychotropic medication was high, higher than in other populations. SECRETARY RICHMAN: Right. There is now a psychiatrist onsite full-time who is a director of that unit, who reviews all psychotropic medication, and whose goal is to reduce it and to be able to use more housing options and more therapeutic models than medication.
There were very few opportunities for inmates who wanted substance 35 1/25/01 PUBLIC SAFETY - RES. 692 abuse treatment. Where is that at the current time? SECRETARY RICHMAN: It -- we are expanding that significantly both inside and outside of the walls through both the options programs and other opportunities for people to get not only drug and alcohol counseling but entire behavioral health counseling, particularly those folks who need co-occurring -- who have co-occurring disorders.
Is there any methadone detoxification program in place? SECRETARY RICHMAN: We are probably about three-quarters through the State licensing process. To get a methadone license, it takes review from the federal government as well the State, it takes about a year, and we're almost through that process.
And what is the licensing status of the physicians? And, according to Dr. Greifinger, over 43 percent of them were not verified. SECRETARY RICHMAN: Fully up to date.
And what about the 36 1/25/01 PUBLIC SAFETY - RES. 692 nurses? SECRETARY RICHMAN: Up to date, all licenses.
Do you have any report on the mortality reviews? SECRETARY RICHMAN: This is an internal mortality review as opposed to an external mortality review, so it's the documentation of that.
And they're available? SECRETARY RICHMAN: Those are individual client records as opposed to mortality reviews that are external that begin to collapse that data into trend data.
Okay, continue, Miss Richman. SECRETARY RICHMAN: Okay. The health care coordinators staff mandates follow-up review until issues are settled satisfactorily. My fourth safeguard of monitoring is the social services assignment of the Deputy Managing Director to serve as an impartial contract administrator within an emphasis on 37 1/25/01 PUBLIC SAFETY - RES. 692 contract supervision, uniformity, and strong leadership. Working from the social services unit gives a global perspective an advantage to coordinate outside departments to assist in managing delivery of health care for inmates. Recent planning and implementation initiatives include: Behavioral health transition units for men and women being consolidated; A behavioral health discharge planning pilot for inmates requiring extended behavioral health services after release; A methadone detoxification licensure to operate a program as part of the Behavioral Health Transition units; Insulation of an onsite dialysis unit to minimize cost and security risk for offsite dialysis treatments; And implementation of a management information system to organize, track, and record inmate medical information more efficiently and accurately. To coordinate these efforts and ensure multi-agency commitment to quality prison health 38 1/25/01 PUBLIC SAFETY - RES. 692 care, monthly prison health meetings are held to continue dialogue along all stakeholders. Representatives from social service staff, Prison Health Services, law, behavioral health system convene to discuss topical issues and usher progress on initiative and service modifications. We feel the current methodology for health service delivery and oversight is both cutting-edge and comprehensive. Multi-agency support, consolidation of services, multi-layered monitoring, safeguards, and ongoing stakeholder meetings all play a role in providing health care for inmates in the Philadelphia prison system. Incidently, these stakeholder meetings and the review with Prison Health Services are meetings that I hold so that I get to ask questions and to satisfy myself that there is quality service going on.
I was just going to question 'cause I've been very puzzled by the 39 1/25/01 PUBLIC SAFETY - RES. 692 dilemma the City Solicitor seems to put himself the City and us in. Is it your position that when the City gets sued, City Council loses its ability to have an oversight because documents which City Council needs for its oversight function may be subject to discovery or demand or be of some use or believed to be of some use to a person or organization suing the City? Do we -- does City Council lose its ability to function on those issues during the time of the court suit? Is that what you're saying to us, sir?
No, sir, not at all. I'm mindful that at times, the oversight functions of City Council coincide with ongoing litigation, and I'm mindful that this Council has not only a right but a duty to review what is going on, not only in the operating departments but certainly the Law Department or in ongoing litigation. I'm very mindful of that. I'm not suggest that this body does not have the ability to monitor those kinds of activities. What I am saying is that the documents that Councilman Ortiz specifically 40 1/25/01 PUBLIC SAFETY - RES. 692 referred to are specific documents -- are specific reports which are themselves the subject of ongoing litigation. And these reports themselves are the subject of litigation in which the City has -- has claimed a privilege, and that that issue has not yet been resolved by the Commonwealth court. It is my judgment that to -- at this stage, while that is on -- in litigation, to reveal those reports negatively impacts our -- the Law Department's and the City's interests with respect to those reports. I -- secondly, I am concerned specifically about these reports because one of the things -- one of the significant items that are contained in these reports is personal, confidential data about individual inmates. And --
Well, that can be solved by eliminating the name of the individual, crossing that name out or blocking it out.
No, I understand that there are mechanisms by which you can deal with confidential information. 41 1/25/01 PUBLIC SAFETY - RES. 692 But what I had earlier responded to Councilman Ortiz about was that these documents themselves are subject to litigation, and it is my judgment that for them to be turned over at this time would be detrimental to the City's interests in this litigation.
Well, but does that mean that Council, because you reached the conclusion that it would be harmful to the City's legal interests, does that mean that City Council is then blocked from getting necessary information? For example, in the fine report issued to us by Secretary Richman, she refers to a doctor that was appointed by the court, and that doctor found the services to satisfactory in one degree. She then concludes her report with the feeling that the system is in effect is cutting-edge and is comprehensive and is satisfactory. They're fine conclusions; we hope we can join with her in those conclusions, but we've got to get the material that enables us to engage in our oversight function to see on what the Commissioner bases her findings. 42 1/25/01 PUBLIC SAFETY - RES. 692 (Applause.)
And on what this doctor appointed on by the court bases his. Now, it may be disadvantageous to any party to litigation at sometime, but that's the way of life. I don't see how we can carry out our function if we're going to be denied access to the material. And I suggest to you, sir, that if there's any law that supports you, I would like to see it because I just cannot believe that private litigation can foreclose Council's right to investigate. (Applause.)
I understand, and I am happy to discuss that with you further or provide any further information which you wish.
Thank you, thank you, Mr. Chairman. Could you tell me for the record, and I assume that you know this number, what is the total population of our prison system? 43 1/25/01 PUBLIC SAFETY - RES. 692 SECRETARY RICHMAN: Yes. As of yesterday, it was 72,047.
We constantly hear that many of those people incarcerated are there because of drug activity. Do you know, do we have identified how many of those inmates that we house are there because of drug -- SECRETARY RICHMAN: Well, at any given point, you have probably have somewhere around 80 percent of the people are there secondary to drug and alcohol. In other words, it may not be on a drug offense, but drugs may have played a part in why they have committed the crime.
I've always wondered, knowing how difficult it is for a person to break a habit, whether it's smoking, whether it's alcoholism, whether it's drugs, would you describe to the best you can -- could you compare how when an inmate that is brought -- when a person's incarcerated and has a very severe drug problem, could you describe how a person is cared for in that environment versus one of the 28-day 44 1/25/01 PUBLIC SAFETY - RES. 692 programs that -- I mean, is it horrible, do we hear people screaming because they're going through withdrawal? What is it like in a jail to -- in an environment that there are 80 percent of the population that are -- I'm confident that they're not all -- SECRETARY RICHMAN: They all aren't addicted, but they're --
How many -- do you know how many are addicted that we house? SECRETARY RICHMAN: No, I don't know that off the top of my head.
That would be interesting to know. SECRETARY RICHMAN: One of the numbers -- and actually, it was smaller than I thought it would be. Of the people that are addicted to heroin, it was actually a fairly small number; it was probably a number under 100 that are addicted. But you have a lot of people who are abusers of alcohol, cocaine, drug dealers. When I say "drug," it's any kind of drug involvement; it's not necessarily people who are at that point 45 1/25/01 PUBLIC SAFETY - RES. 692 in time so addicted to drugs. But one of the reasons that I wanted a methadone program or a detoxification program in the prison because, one, we have people with methadone who are going into the prison, and I would like to see them continue on methadone. Incidently, having a methadone or a detoxification program in the prison is something we had to truly fight the State on. They don't condone it, they think I continue to be a weird person because I demand it.
We used to contract that out, Miss Richman? SECRETARY RICHMAN: What?
We used to contract detoxification out, didn't we, at one point? SECRETARY RICHMAN: Never in the prison, it's never been in the prison.
Well, we contracted a program of detoxification, 'cause I remember a program that used to be at the old Girard Hospital on York that had a prison detoxification program in the '80s. Okay.
Could you -- does a 46 1/25/01 PUBLIC SAFETY - RES. 692 person come in to a jail -- let's say a person's arrested and they are an addict. SECRETARY RICHMAN: Right.
They're addicted. Are they -- is it cold turkey? SECRETARY RICHMAN: Yeah.
There's no care at all for that person? SECRETARY RICHMAN: As I understand --
What is that like for a person to be brought in there -- two, three, four people brought in there just cold turkey? I mean, do they just have to do the best they can and -- SECRETARY RICHMAN: My impression -- and this is my impression -- is that what it really does is increases the probability that people will go back to drugs when they are released.
So have we had any inmates -- as a result of the addicted inmates, what is the ramification of us allowing a person that's brought there that's addicted to go cold turkey? Have we had any die that we know of? 47 1/25/01 PUBLIC SAFETY - RES. 692 SECRETARY RICHMAN: Not that I know of. Not from the point --
Would you know if they died? SECRETARY RICHMAN: Yeah, yeah. I review all dates.
Do we have many deaths in jail? SECRETARY RICHMAN: Well, I review all the deaths since I've been in this position.
How many deaths have you had in the prison since you've had this job? SECRETARY RICHMAN: I cannot give you the figure. I can give you the figure, but I can't give it to you off the top of my head.
Would you -- do you recollect that any of them have been as a result of addiction? SECRETARY RICHMAN: A result of not going through detox? No, no. 22
Are you telling me -- what -- do we have a detox program in the prison? SECRETARY RICHMAN: No, we don't. 48 1/25/01 PUBLIC SAFETY - RES. 692
We have nothing at all right now. SECRETARY RICHMAN: Nothing at all.
And that's why you're encouraging the methadone program. SECRETARY RICHMAN: Yes.
Which I have seen on national television. It's been -- and, again, all due respect to you and your support of it, but I've seen it be terribly criticized nationally on some of the areas of -- SECRETARY RICHMAN: Of having methadone programs?
Yes, uh-huh. SECRETARY RICHMAN: Yes. Most people do not think that methadone -- they don't condone methadone, but if somebody is on methadone, if they've been on methadone in the community, often for several years, and you take them off methadone cold turkey, the probability that they return to an addictive life style is very high.
Do we -- do you believe that the people that you -- it's hard for me to believe of that population that there's only 49 1/25/01 PUBLIC SAFETY - RES. 692 a hundred people addicted, and I'm talking -- SECRETARY RICHMAN: On heroin.
I'm talking about people that necessarily aren't there for ten months, fifteen months; I'm talking about people that are arrested and brought there to the Detention Center, and forgive me for dating myself by calling it the "Detention Center." Are you including those folks? SECRETARY RICHMAN: No. I'm talking about only heroin addicts.
Well, I'm talking about heroin addicts that are arrested today and housed until their trial comes up. Are you including those folks? SECRETARY RICHMAN: Yes, yes, anybody who's admitted to the prison system. The number of people we have in the community who are heroin addicts within a treatment program is not a huge number.
Without just the 50 1/25/01 PUBLIC SAFETY - RES. 692 normal medical care, a person that abuses alcohol, they're arrested and they're put in the jail, do you give them any kind of medical care at all? SECRETARY RICHMAN: For the addition?
An alcoholic goes there and he or she's cold turkey. SECRETARY RICHMAN: Cold turkey.
What's it like for a person? SECRETARY RICHMAN: I don't know.
I guess the people in the prison, it would be interesting to hear what it must be like to experience a person that has to experience that cold turkey situation, both on drugs and alcohol. So you would like to see -- and I think I could be supportive -- I don't know about methadone, but I could be supportive of a program, and we have none? Short of methadone, there's no 25 other program that could be implemented to deal 51 1/25/01 PUBLIC SAFETY - RES. 692 with those hundred folks? SECRETARY RICHMAN: There's no 4 detoxification program. The only place that there is detoxification or there is a methadone that's done is for pregnant women, and it's done on an outpatient basis with one of the hospitals.
What do the State jails do? SECRETARY RICHMAN: The State's our problem. Same thing, there is no detoxification, there is no methadone.
There's no detox program in the federal system? SECRETARY RICHMAN: There's no detox and no methadone, no. And, remember, our jail is a short term, so even if we did a methadone program here and the person continues their sentence at a State or at a federal prison, after they're sentenced, they would not be able to continue the methadone program. Now, at that point in time, the detox obviously has already happened. 52 1/25/01 PUBLIC SAFETY - RES. 692
That's a -- could you tell me that so I learn something? How -- if a person's incarcerated and they go cold turkey, how long does it take for them to be detoxed? SECRETARY RICHMAN: Oh, that is the detoxification. If you go through a detox program in the community, it's three days.
No, I'm talking about a person who's arrested today and they're an addict, how many days -- SECRETARY RICHMAN: Three days.
Three days? AUDIENCE MEMBER: Two months. SECRETARY RICHMAN: Two months to recover.
Miss Richman, the contract with PHS -- SECRETARY RICHMAN: Yes.
-- states that we're 53 1/25/01 PUBLIC SAFETY - RES. 692 supposed to be responsible for a population of, I think, 6600 to 6900. SECRETARY RICHMAN: That's correct.
And anything above 6900, the City -- again, we're all responsible, but the City -- SECRETARY RICHMAN: Right.
-- is -- you said that the current population is, what, 7200? SECRETARY RICHMAN: Yes, that's the current population. All of those people don't reside on State Road, however.
Does that include -- that 7200, does that include the Youth Study Center? SECRETARY RICHMAN: Right, that does.
And how many are today residing at the Youth Study Center? SECRETARY RICHMAN: I haven't checked the population today. I believe it's about 120.
120. SECRETARY RICHMAN: Incidentally, the 7,000 number includes approximately 3 to 400 prisoners that are not housed in Philadelphia. 54 1/25/01 PUBLIC SAFETY - RES. 692 They're housed in Delaware and they're housed in other places in the State that we don't have responsibility for their medical care.
What is the current in our prisons? SECRETARY RICHMAN: Within our site? Anybody have the number for today? (Sec'y Richman confers with colleagues off the record.) SECRETARY RICHMAN: My guess is -- it's probably about 68, 67, 68.
Okay, go ahead. SECRETARY RICHMAN: I'm done, I'm finished.
Okay. Estelle, if a family member calls up the prison and says, Look, Johnny Doe is -- has these needs, these medical needs, could you tell me what happens to that phone call? 55 1/25/01 PUBLIC SAFETY - RES. 692 SECRETARY RICHMAN: No, I can't. I can tell you if the phone call comes to me, which they often do, then I then inform the prison to follow up and get back to me about what is happening, and they always have and telling me what service the clients have received, what is the status of the report --
That goes to you. SECRETARY RICHMAN: Yeah, that is if the parent has called me.
-- and Mildred, his mother, has the medicines at home, for instance. SECRETARY RICHMAN: Right.
And she calls up Curran Fromhold and says, Johnny So-and-So suffers from diabetes or suffers from epilepsy or suffers from this or that or HIV, there is -- there's not a system in place for him to begin -- SECRETARY RICHMAN: I don't know the system, I can't tell you the system. My guess is that there is a system in place. If you would 56 1/25/01 PUBLIC SAFETY - RES. 692 like me to tell you what that system is, I'll be glad to get the information for you.
Oh, please do. Because I would like to see what happens if -- I think we've had problems with some of that happening and. . . Are you informed about the red flag system? SECRETARY RICHMAN: Yes.
What is that? 'Cause I don't know. SECRETARY RICHMAN: The red flag system is that whenever people are required to take medication, if they do not show up for the medication at the appointed time, then the system has determined that there would be a red flag on their files so that someone can follow up and make sure that a nurse, a doctor, a staff member goes to that individual to talk to them, to explain to them why their medication is important, to get them to come get their medication. If that doesn't work, then going with a next-higher level staff to try to do whatever they can to convince the individual why it's important 57 1/25/01 PUBLIC SAFETY - RES. 692 for them to take medication.
I saw this and I -- my staff couldn't explain it to me, but I have a sheet that says "Referral to Obtain Behavioral Health Services." SECRETARY RICHMAN: Right.
And this is supposed to be filled out by, I imagine, this form, by the prison guards. SECRETARY RICHMAN: By someone who has been on the unit with the inmate. It could be a correctional office, it could be a social worker, it could be anyone who would come in contact with that individual who believes that individual's behavior needs to be assessed quickly.
Is the prison guards given any sort of training -- SECRETARY RICHMAN: Yes.
-- to be able to detect -- or what type of training does the prison guards go through? SECRETARY RICHMAN: One of the things that we did as part of the initiative to try to get to make sure that we understood that anybody 58 1/25/01 PUBLIC SAFETY - RES. 692 who at any point needed behavioral health service was to make sure the correctional officers knew how to fill out the form, knew that anytime they think it, whether they're accurate, whether they just have a feeling, no matter what it is, that they would make the referral, and it's up to the folks who do the professional assessment to determine whether the need is valid. So you may just be scratching your head and somebody thinks that's not the way it should be done, and they can make the referral.
In the contract, does the Health Department specify to PHS the level of expertise training that they have to give and for their staffing? SECRETARY RICHMAN: Not the Health Department. Social Services is really handling this contract now, and we did the RFP. And, yes, we did.
And do they work with the prison guard population, PHS, in order to coordinate services and training with the prison guards? SECRETARY RICHMAN: The coordination of 59 1/25/01 PUBLIC SAFETY - RES. 692 services in terms of making sure people get transferred or moved to the right place at the right time, yes. In terms of alerting us if they believe something is suspicious, yes. In terms of making a determination about whether someone needs service, no. 9 This is -- we don't train them to recognize. All we are doing is saying, If you see something that you think is unusual or something where you would be suspect, then send them for an assessment or a referral.
A prison guard's job is stressful enough as it is. SECRETARY RICHMAN: My interest was to have them over-identify, not under-identify. In other words, if they decide one day looking at you that anybody who wears a tie has a mental health problem, then I want them to refer you. It's our job to figure out whether it's a good referral, not their job.
But how is a prison guard -- what type of training is a prison guard receiving that would give him the skills to say 60 1/25/01 PUBLIC SAFETY - RES. 692 that guy's paranoid, disoriented, you know, he's entertaining homicidal thoughts, and so on. SECRETARY RICHMAN: I don't want to train them to make those kinds of decisions.
Okay. SECRETARY RICHMAN: Anything that makes them feel that this person has any problem whatsoever, no mater how minor, I want them to give out a referral. We want to train them that everything should be under suspect.
So they're not supposed to make any sort -- SECRETARY RICHMAN: No, that's a professional decision. All they should do is send them for a referral. I want them to send more people than necessary, not less. I want them to send as many people as they think could use it and then let us do the assessment of whether it's something that's needed. They should make no 21 decisions on whether or not they think there's a need.
Thank you, Estelle. Thank you, Ken. Estelle, if there anything else you 61 1/25/01 PUBLIC SAFETY - RES. 692 want, you can write to me on. SECRETARY RICHMAN: Okay.
And I'll write to you. SECRETARY RICHMAN: Thank you very much.
Not here, okay. PHS: Mr. Catalano, Harold Orr, Cassandra Newkirk. (Witnesses come forward.)
My name is Michael Catalano. To my left is Dr. Cassandra Newkirk. To my right is Dr. Harold Orr. Thank you for the invitation to address the --
Thank you for the 62 1/25/01 PUBLIC SAFETY - RES. 692 invitation to address the joint committee. My name is Michael Catalano, and I am Chairman of Prison Health Services and its parent company, America Service Group.
America Service Group is the parent company of Prison Health Services. I'm Chairman of --
Tennessee. And I'm here today to demonstrate to provide the level of our company's commitment to provide the best quality health care for inmates in the Philadelphia prison system and to offer our full cooperation to the joint committees' effort. We have submitted written comments to the joint committee. With your permission, we will not read those comments at this time.
Instead, please allow me then to make some brief introductory remarks and 63 1/25/01 PUBLIC SAFETY - RES. 692 then to introduce the outstanding doctors who are actually responsible for clinical care at the Philadelphia prisons. Our company has provided medical care to Philadelphia inmates since 1993. During that time, we have worked alongside the dedicated personnel in the Philadelphia prison system. In July of last year, we entered into a new contract with the City, which, for the first time, allowed us to assume responsibility for behavioral health as well as medical care. We are very proud of our clinical leadership in Philadelphia. The heart and soul of our company are the thousands of doctors and nurses who provide compassionate care at correctional facilities across the United States. This is a vital community service and a high calling for our clinicians. Those in Philadelphia are among the those experienced and the most conscientious in the nation. So now please allow me to introduce Dr. Harold Orr, our Regional Medical Director; and Dr. Sandra Newkirk, our Regional Mental Health Director. 64 1/25/01 PUBLIC SAFETY - RES. 692 Dr. Orr is a graduate of the University of California who did his residency at Columbia University. He is board certified by the American College of Managed Care Medicine and has over 6 years of clinical experience. 7 Dr. Newkirk is a graduate of the 8 University of North Carolina at Chapel Hill, who 9 did a residency at Emory University. She is a 10 board certified forensic psychiatrist with over 18 11 years of experience. 12 Also joining me today is Mike Murphy, 13 our regional vice president, who is also an RN; 14 and Mary Silva, our regional director of Nursing; 15 Rodney Fry, our regional manager, also an RN; and 16 Jean (indiscernible), our general counsel. 17 Thank you for your patience, and we're 18 prepared to address your questions. 19
Mr. Catalano, how 20 many -- tell me your structure right now in terms of -- how are you organized to provide services to the prison population of Philadelphia?
We are organized as a self-contained regional administration group right here in Philadelphia. Local management here and 65 1/25/01 PUBLIC SAFETY - RES. 692 local clinicians are empowered to provide care directly and to communicate directly with the City.
What is the staffing level that you have currently? How many doctors, how many psychiatrists? What is the nurses?
In terms of the physician staff, we have full-time physicians, with a 10 total -- 11