Dr. Mirchandani also testified at our hearings on January the 5th that his office had an advisory committee and that this committee had experts in the field of missing persons, but no one from our 125 3/8/06 - WHOLE - BILL 060001, ETC. communities of the City or family members of missing persons are on this committee, and, Dr. Mirchandani, as you remember, you indicated that you welcomed this idea. I just wanted to know if this issue has been addressed. Have you expanded the people, the number of people, to also include on that committee families of missing loved ones? COMMISSIONER PARIS: We --
Excuse me. I believe you're asking the doctor the question; are you not?
Yes. The doctor can answer. COMMISSIONER PARIS: I'm sorry.
Doctor, please identify yourself for the record.
My name is Haresh Mirchandani, Medical Examiner of the City of Philadelphia. Good morning.
Good morning. The stenographer cannot hear 126 3/8/06 - WHOLE - BILL 060001, ETC. you properly. Would you please spell your last name?
My first name is Haresh, H-A-R-E-S-H. Last name, Mirchandani, M-I-R-C-H-A-N-D-A-N-I.
Medical Examiner for the City of Philadelphia. We have met with the Medical Examiner Advisory Committee. We have a meeting every quarterly. Every three months we have meetings, and we have not -- we brought the problem to the Medical Examiner Advisory Committee, which consists of the Chairman of the Department of Pathology at the Drexel University.
Doctor, you're going to have to speak into the microphone, please.
And we did meet with them, and we are going to -- we are still looking for the candidates for 127 3/8/06 - WHOLE - BILL 060001, ETC. who have expertise in missing person. And I think the expert of the missing person are the people from Police Department, and we are meeting with them anyway on a regular basis.
What you committed to do was to add someone from the community that either had had an experience with a missing loved one or people in the community that were involved in this type of human anguish type of problem. Have you added that type of person to your Advisory Committee?
Okay. I believe I stated at that hearing that if you were to give me a call, I can probably recommend you 20, and if you call the President of City Council, she probably has another 20. If you reach out to us, we will be able to recommend you some people, especially that we have 128 3/8/06 - WHOLE - BILL 060001, ETC. families now that have had missing loved ones just recently. Latoya Byrd, who had been missing for almost a year, showed up in Newark. There was a big story about her. It was because of the type of attention that the public gave to their missing loved ones that this now has become an issue of a lot of interest and throughout the City. So I would suggest that you reach out to -- you're welcome to reach out to me, and I'm quite sure that the Chairwoman of this Committee as well, that there are people that are willing to be part of this Advisory Committee.
I will certainly do that, Councilman. I'll do that, absolutely. I think you'd be of help to us. As to suggesting names of these people, they would be included on the Advisory Committee meetings.
And the transcript will also tell me that two of the families that were here that 129 3/8/06 - WHOLE - BILL 060001, ETC. testified, families of missing loved ones, volunteered to join the Advisory Committee on that day. So time has gone by, and I think that if you had two people here that testified and two different families that testified on their experience of missing loved ones, one of them was this one particular case, I find it kind of -- I don't know why you didn't call them up or got them here and tell them, Why don't you join my Advisory Committee. Get someone on that Advisory Committee, please.
A Mr. Quain also testified at that hearing that he had been working for the Medical Examiner's Office for 17 years. Is he here?
Yes. There you go. And that his office had -- and 130 3/8/06 - WHOLE - BILL 060001, ETC. you stated that your office was understaffed, and that in your budget, there is -- I asked if there was any request for staffing in your budget, because you did state that you were understaffed. Have you included a request for additional staffing in your department?
David Quain. That's Q-U-A-I-N, and I am the Forensic Services Manager for the Medical Examiner's Office. Yes. We have asked for two additional investigators.
Are they in the budget? COMMISSIONER PARIS: Currently we have eight investigators and nine technicians, Councilman Ramos, and we understand that we need to have at least 131 3/8/06 - WHOLE - BILL 060001, ETC. investigators and 12 technicians to really be able to address the volume of work. And what we're doing is, we will be asking in target budget for five new additional positions to fulfill the vacancies, any addition to bring in support.
10 Excuse me, Councilman. I'm sorry. I 11 don't mean to interrupt. 12 But I don't understand what you mean by "target budget," and why wouldn't you be asking for it now? COMMISSIONER PARIS: The request for additional staffing came in late and we were not able to include it in this fiscal year budget on time. That's why we are going to wait until this is revisited again during target budget, which happens in the end of May, beginning of June. Then we will request the additional positions that we need for this office.
Was January 132 3/8/06 - WHOLE - BILL 060001, ETC. the 5th too late to make that request of this year? COMMISSIONER PARIS: Yes, it was.
What was the deadline to receive the request? COMMISSIONER PARIS: Our budget was due in December.
I know this was not on your clock, Ms. Paris, because your clock only started ticking the other day. I think yesterday, right? COMMISSIONER PARIS: Yes.
Mr. Quain, did you make this request to higher-ups or Dr. Mirchandani about the necessity of these two -- you referred to them as investigators?
Staffing has been an issue at the Medical Examiner's Office 133 3/8/06 - WHOLE - BILL 060001, ETC. for some time and it's hard for me to recall exactly when this request was made. Certainly after the hearing.
Was it made right after you testified here on January the 5th?
It was made after. I'm not sure exactly when after. I think Carmen Paris was away and so upon her return.
How important was this issue to the Medical Examiner's Office and to the Health Department? I have now my good friend Dr. Mirchandani saying that he couldn't find a volunteer or he still hasn't gotten a volunteer, he hasn't gotten a person for his Advisory Committee, and now a request that you've made a number of times to get two more investigators has not happened, after everything that has occurred in the area and all the publicity, all the facts that have come forward in this Chamber and in the media 134 3/8/06 - WHOLE - BILL 060001, ETC. about a problem over there in the Medical Examiner's Office when it comes to identifying missing persons that are in the morgue, one of them for two years.
I understand that, but if you tell me in a hearing that that's always been a problem, you emphasized that on January the 5th, the request to hire two people -- and the Commissioner just talked about hiring five people -- it gives the impression that although the public is saying that this is a very important issue, it doesn't seem like you're at the same level of the public's concern about this issue. This is a perception you're giving. COMMISSIONER PARIS: If I may, Councilman Ramos, since the hearings in January, we have as a result of the issues that were brought to our attention from this Council, we have done some 135 3/8/06 - WHOLE - BILL 060001, ETC. significant changes and improvements in the way we do business at the Medical Examiner's Office. One of the problems that we have is that we have vacancies, because one of the seasoned experienced Forensic Investigators has now been given the responsibility of solely working with missing persons for identified bodies in the morgue. So even though we still have had some vacancies, this issue is of such importance that we moved one of our most experienced workers to address this issue. And this is the person that is responsible to continue and carry on the formalized weekly meetings that we have with the Forensic Investigators and the representatives from the Police Department Missing Persons and also with the Special Victims Unit. We have formalized a procedure for submitting the reports, so that we now have demographic information 136 3/8/06 - WHOLE - BILL 060001, ETC. available. We have been in contact -- and, actually, I am very excited because we have successfully been able to submit three names to the University of North Texas DNA Collection Center project so that we can go at a national level to expose this information and hopefully be able to link these missing individuals with their loved ones. In addition to that, we have arranged for an agreement with the FBI for the acceptance of our specimens to be entered into the national database, and we have established a website link in the Medical Examiner's page to a current list of UHR missing to the -- and identify human remains. So that now the public can access information directly. When you open the Health Department website page, sir, you have a link that will connect you --
I'm familiar with it. COMMISSIONER PARIS: -- to the 137 3/8/06 - WHOLE - BILL 060001, ETC. MEO that will connect you immediately to the list of unidentified human remains.
If Mr. Quain and others have for the last years 6 stated that they're understaffed and then 7 we see all these things happen around the 8 Medical Examiner's Office, particularly 9 last year, then I would probably, if I 10 was in your shoes, if I was in the shoes 11 of the -- although I don't qualify to be 12 Health Commissioner by no stretch of the 13 imagination, but I would have included 14 already something in this budget by now, 15 because chances are that because of your 16 understaffing and these other things that 17 are very good things that you just mentioned and very important that we bring the Medical Examiner's Office up to speed on what's out there and be connected to it so we don't have a Niecey Jefferson case happen. Again, shortly after that case, a case of a gentleman who had been missing for a number of months, a gentleman from Juniata, Bobby 138 3/8/06 - WHOLE - BILL 060001, ETC. Borschell, his body also was found in the Medical Examiner's Office, that you would include and know that this is something that the public thinks is very, very important, and that you have people in City Council that are willing to fight for you and say if we need it, let's go see how much is it going to cost and let's get the money to address this problem. Can you give us a quick overview of some of the changes? You just mentioned some of them, Ms. Paris, but some of the changes, if not Dr. Mirchandani, some of the changes the Health Department and Medical Examiner's Office have done in regards to communications between city, state and federal agencies regarding missing persons. You mentioned Texas, because Texas seems to be one of the areas where they're leading in this area of missing persons identification. Are you doing anything with the 139 3/8/06 - WHOLE - BILL 060001, ETC. state? You mentioned what you're doing with the City. Are you doing anything with the State of Pennsylvania, Mr. Quain?
Yeah. In August of 2005, there was the President's DNA initiative, and basically it was -- this is a national problem and there are about 40,000 unidentifieds in the country. So my plan was to model our efforts the way that the FBI suggested in this initiative. So what we do is, and so far, for the three that are unidentified for 2005, is, we have sent specimens for DNA typing. Once that typing is done, we can forward that to State Police. We could have that for the City as well. But this is a service that University of North Texas is -- they're receiving grant money from the FBI from the Department of Justice. So it doesn't cost us anything. In addition to the specimen, they do DNA typing on anyone who has a 140 3/8/06 - WHOLE - BILL 060001, ETC. missing loved one. So they can -- they accept it from people who have someone who is missing. So the idea is, on a national level, you'd be able to make a connection. Just keeping in mind even if we sent it to the State Police, Philadelphia being so close in proximity to New Jersey or Delaware, it's not out of the realm of possibility that somebody is from any other state. So the plan was to make it on a national level so that we'd be able to be more successful.
Thank you, Mr. Quain. One of the problems, Mr. Mirchandani, one of the troubling things that I found came out of the hearings on January the 5th was that there's an individual that has been identified as Mr. Hall. This is a matter of public record. This is not for me to make any judgment on him, on his qualities, but his name came up a number of times during the hearings. It was 141 3/8/06 - WHOLE - BILL 060001, ETC. that Mr. Hall who works for the Medical Examiner's Office made some disparaging remarks to a Ms. Orlanda Smith who testified in those, and that testimony is available to you because it's public record. She was a person that found the children who found the body of Niecey Jefferson. She related the comments that were made by Mr. Hall that were very, very offensive, bad taste. I read it as very bad taste, and everyone in the hearings that day were very taken aback by the remarks that were made by a Mr. Hall in the Medical Examiner's Office. Have you talked to Mr. Hall about that, anyone talk to him since January the 5th about questions about his professionalism, his language, the content of his language in dealing with people? We always have to remember that regardless of the circumstances around a disappearance or in a lot of cases 142 3/8/06 - WHOLE - BILL 060001, ETC. ultimate death, this is still somebody that people in the family, they still love him and it means a lot, their baby and their loved one. It means a lot to them. And to call the Medical Examiner's Office and to have someone talk and say the things that were said here in public testimony to a person who is broken-hearted and not sleeping for two years trying to find their daughter was very, very appalling.
Yes, sir. As a matter of fact, the day of the hearing, when I returned back to the office, Mr. Hall was there. And I, too, was upset at the remarks that were made, and I spoke to him immediately about that and told him that it was totally inappropriate, and he was disciplined for that. The discipline consisted of a written reprimand, as well as he was due for a promotion and he was not promoted.
We also stated at that hearing -- I don't know if 143 3/8/06 - WHOLE - BILL 060001, ETC. it was Councilwoman Miller, but that if you have someone saying things they shouldn't be saying to a person who is searching for a missing loved one, that training -- I mean, you said you're going to do training. I know that was something else that the Medical Examiner said that he would do. Has he been sent to be retrained?
Yes, sir. We are -- and not just for him, for the entire staff, obviously, but we're looking into dignity training, sensitivity training, things of that nature. And also, I should say that monitoring all the employees. I am spending more time monitoring their behavior. We meet with families in person as well as over the phone. So that's the other side of it.
Okay. Tomorrow I'll be introducing a resolution 24 urging the Pennsylvania House of Representatives to pass Bill No. 1462 144 3/8/06 - WHOLE - BILL 060001, ETC. that basically would require local officials such as the Police Department, the Medical Examiner's Office to share DNA samples of missing persons with the State Police for the latest in DNA analysis, and I hope that -- I was just in touch with the sponsor of the bill, Representative Gabig from Cumberland County, and he's very much interested in getting this bill passed. So I will introduce that bill 13 that -- I'm sorry. I will introduce this resolution tomorrow, and I'll look forward to my colleagues supporting this resolution and see if we can get this passed. It is going to be upon you. I will follow it, but it's upon you to do some follow-up now. It's like follow-up to getting someone on that Advisory Committee, follow-up on this. I suspect that you will be in support of this, right?
Then you need to follow up on it, and you want to make sure that the Medical Examiner's Office is staffed to handle the workload, and if you don't tell us that you need it, then we can't help you.
And there are circumstances -- and I know you have an option to redress the issue by June, right? Was it June you mentioned? COMMISSIONER PARIS: The end of May, beginning of June.
You're welcome. Point of information. Councilman Rizzo.
I don't want to lose my turn. I know when I push this 146 3/8/06 - WHOLE - BILL 060001, ETC. button --
Thank you. It's really troubling to hear Councilman Ramos for all these months concerned about this particular issue. Could you explain to me, when you have a person -- when you have a body -- forgive me for not all the terminology here -- that's in your facility for months and months, what does the Police Department do about it? Obviously when a body turns up, it normally, you would think, be a Police issue. It sounds like the burden is on you to figure this out. Where does the Police Department fit into this thing?
The Police Department does the initial processing of the scene. If a death is determined to be a homicide, then it's a criminal matter and there's follow-up by the Police Department. Often times if a 147 3/8/06 - WHOLE - BILL 060001, ETC. situation is, whether it's a drug death or a natural death, the burden of identifying the person and locating the family is on the Medical Examiner's Office.
So have you ever had a situation where there has been a -- maybe not homicide, but let's say someone comes with physical injuries to your facility. What's the proper terminology for your facility? The morgue?
If a person comes there that doesn't have a gun shot, or just say that they've been beaten, is that your responsibility or is that a police case? Maybe that's part of our problem here, that the Police Department is getting out of the loop on some things that they should be more involved in. I mean, how often do you have a person that comes in that's clearly just 148 3/8/06 - WHOLE - BILL 060001, ETC. natural death, you don't know who they are and the Police aren't involved?
So far this year we've had almost 40 unidentifieds that have been identified. We don't have anyone currently who is unidentified for this calendar year. Some of those are homicides. Most of them are not homicides. We have the body and we have the information about the deceased. So the responsibility has been with the Medical Examiner's Office to use that information to identify the deceased and track down the family.
I remember an issue a few years ago where I received communications from some very poor people that claimed they couldn't afford to have that member of their family buried. What do we do now with the person that -- I hate to use the word they're unclaimed, or nobody steps forward. Maybe that's a better word. What do you do with the 149 3/8/06 - WHOLE - BILL 060001, ETC. corpse now?
On cases where the family is indigent and can't afford any type of cremation or burial, the City does do a cremation, and the family is entitled to the ashes. There is a time period of probably two months before it can happen, but it's what we have in place. And they are usually happy to get the ashes back, and, like I say, there's no expense to them for that.
At this present time, there isn't a situation where we have someone being kept at the morgue for months and months and months waiting for someone to pick them up? I mean, what's the longest you keep a body there? This is difficult to discuss, but I'm trying my best.
We have a period of time of 90 days. When we have a deceased and we don't have family, it gives us an opportunity to try everything we can to locate relatives and it also gives -- 150 3/8/06 - WHOLE - BILL 060001, ETC. there's a period of time for relatives to come forward. And then after three months, we would do a creation even if we didn't -- even if we weren't able to find family. There are a number of elderly people in this City who live alone who have, for all intents and purposes, outlived their family, and we will still try to find any distant relative, notify them of the death, but eventually after three months, we will do a cremation. If we have family right away or less than three months and the family is notified but they're either financially unable or unwilling to assume any responsibility, then at that time we would immediately arrange for a City cremation on their authority.
Thank you, Councilman. Councilwoman Reynolds Brown. 151 3/8/06 - WHOLE - BILL 060001, ETC.
Thank you, Madam Chair. I was mistaken. I've just learned that the questions I have for Ms. Danzy were actually in your testimony, so I'll propose them to you and then you decide as leadership. First, on the child immunization, 40 percent in two-year-olds in 1993 and now 81 percent in 2003, which for sure is a remarkable gain. What factors do you believe have contributed to the progress, number one, and do you have current figures for 2004 and 2005, and then what strategy do you have in place to ultimately break the 90 percent barrier? COMMISSIONER PARIS: The significant increase was based on collaborations between the Department of Health and community-based organizations that were actually in the community doing outreach work. What we have done was, we collaborated with them, trained their 152 3/8/06 - WHOLE - BILL 060001, ETC. staff so that in addition to what every kind of support they were providing already to the Department, they will now start looking for the children that have not been immunized as of yet. And we concentrated our resources in those specific areas where there was a significant low percentage of children immunized.
CBOs such as what, such as who? When you say you partnership with community-based organizations, cite a few examples. I'm curious to know, is the mission of those organizations health related, or what? COMMISSIONER PARIS: They have been giving me the names of two of the organizations. One of them is the Council of Spanish Speaking Organizations, Concilio, who is in North Philadelphia, and the other one is Scan, who does --
Scan? COMMISSIONER PARIS: Yes. Both 153 3/8/06 - WHOLE - BILL 060001, ETC. agencies, which already had contracts with the Health Department to provide services.
I see. So right now it's two? COMMISSIONER PARIS: Yes.
So what might be the strategic plan to ultimately move that to 90 percent child immunization? COMMISSIONER PARIS: Well, among the many things that we are looking for, the implementation of Done By One, which is the program that in January '06 was put together to ensure timeliness of immunizations. So we added a brand new program. We have also launched a website, immunization registry, in February of 2006 that will allow the providers to receive up-to-date immunization information on every child in Philadelphia. So if you're taking your child to the doctor, now the doctor 154 3/8/06 - WHOLE - BILL 060001, ETC. will have updated information that will be able to let them know whether or not this child is up to date with their immunizations.
One continuous challenge in government is getting professionals to talk across lines, but also getting folks external to government connected to, for example, the service of child immunizations. So with that in mind, is there any connect with the new childcare alliance association, ABC, Alliance for Better Childcare? COMMISSIONER PARIS: Yes, ma'am. And I'm smiling because it is one of the projects that I have been personally working in the Department for. We have now convened a task force that includes the childcare organizations in the City, and we meet with them monthly to look at not only immunization rates but also childhood lead poisoning. And with them, we're working on improving not only how we access those licensed 155 3/8/06 - WHOLE - BILL 060001, ETC. providers but also the non-licensed providers. And we continuously come up with strategies that we implement. Some of the players that come in, not only are they childcare organizations but also we have agencies like PCCY is a member of our task force, as well as the state.
Very good. Any role for the School District? COMMISSIONER PARIS: Yes, ma'am. We actually have -- the educations are, Ms. Burnett attended our last meeting.
So they're at the table? COMMISSIONER PARIS: Yes, they are.
Let's move to the newborn home visiting initiative, which appears to be a terrific goal. I'm curious to know how you're going to pay for it and what strategy are you going to use to ensure, as you state in your 156 3/8/06 - WHOLE - BILL 060001, ETC. testimony, every new mother in Philadelphia will ultimately be able to benefit from this early intervention piece? COMMISSIONER PARIS: We're extremely excited about this initiative. We are working toward a system that includes the managed care organizations. So that as it is, through the mandate that the managed care organizations have, they are supposed to provide for a visit for every newborn. What we are doing is collaborating with them so that since they have that mandate anyway, why not allow us, the Health Department, to take the partners that we have in the community and make sure that that visit takes place. It's a win-win situation. So they will, instead of paying their own staff or people that certainly know how to access this population, instead of doing that, they will do it through people that are already in the community. 157 3/8/06 - WHOLE - BILL 060001, ETC. So this is something that we're really, really excited, because not only will we be able to talk to the mothers about immunizations, but also we'll be able to talk to the mothers about childhood lead poisoning. We are going to take it a step beyond and we're going to partner with the Philadelphia Fire Department and they're going to even train us on how to go in a property and look for different hazards.
Is that to suggest that managed care companies or is there some evidence to suggest that managed care companies are currently not doing that since they are mandated to provide these home visits? COMMISSIONER PARIS: I would not say that we have evidence that they're not doing it. What I'm saying is that because of their low rate in terms of success, they have not been doing it correctly. 158 3/8/06 - WHOLE - BILL 060001, ETC.
When you say you just started, what does that mean? A month ago? Six months ago? When? COMMISSIONER PARIS: Well, we have been meeting with them for quite some time, and right now we are almost ready to launch this effort.
We'll look forward to that. COMMISSIONER PARIS: Thank you, ma'am.
My final question, I believe, is around, are you aware of the Benefits Bank and what that is and what enormous potential it has for moms who are low-income status and the like? I mentioned the Benefit Bank with all the leadership of this Department because it also has as a part of its portfolio, I guess, state children's health insurance plan and medical benefits. Are you aware of that? 159 3/8/06 - WHOLE - BILL 060001, ETC. COMMISSIONER PARIS: I am personally not aware of it. I'm pretty sure probably the staff will be aware of that.
It's not a problem. For the record, you should know that I'll be calling for a briefing so that my colleagues can also hear about it, and we will extend an invitation to all of those in the social service leadership positions so that you're aware of it and what it can mean in terms of delivering better services to low-income families so that they don't have to jump around various systems to get what they need. COMMISSIONER PARIS: We will be more than happy. It will be our pleasure to participate, ma'am.
On of your testimony you talk about 78 percent of those living with AIDS in the City, of course, are people of color, and we know more and more that -- I've 160 3/8/06 - WHOLE - BILL 060001, ETC. learned that more and more of them are women of color. I'm pleased to see that the Health Department is taking a targeted, active approach in dealing with this. Describe for us more the HIV/AIDS education and testing program that's briefly discussed in your testimony. COMMISSIONER PARIS: I am going to defer to Assistant Commissioner Joe Cronauer to answer that question for you, ma'am.
Sure. ASSISTANT COMMISSIONER CRONAUER: Hi. I'm Joe Cronauer, Assistant Health Commissioner in the Philadelphia Department of Public Health. Our efforts around HIV prevention are primarily guided by what the federal government, the CDCs, calls a Community Planning Group made up of Philadelphians, more than half of whom already have HIV and know what that 161 3/8/06 - WHOLE - BILL 060001, ETC. experience is like, and they provide us not only with guidance around what interventions we should follow the CDC has found to be scientifically valid, but also what communities we particularly need to target. And primarily we follow the epidemic; that is, if we know the epidemic is primarily affecting people of color, we want to get ahead of that. We want to provide more -- we want to focus on that to a greater extent, to a greater percentage than the epidemic represents, because it's a trend and we want to get ahead of it. Same thing with women and particularly women of color. Our efforts are primarily through community-based organizations. HIV testing, for example, we provide over 30,000 HIV tests that the City pays for every year. They're provided through 50 sites across the entire City. They're virtually all community based. There's a mix between anonymous, if people don't want to give their names, or 162 3/8/06 - WHOLE - BILL 060001, ETC. confidential. And we're initiating new programs primarily with the help of Senator Hughes, who last year secured an additional million dollars to target HIV prevention activities primarily to African-American youth, and we're hopeful that he'll be able to secure that money in the coming year as well. And we're doing that in partnership with the School District and we're doing it with community-based organizations, particularly within his district, but also across the entire City.
Can you provide to the Chair a listing of who those organizations are? I'm curious to know where they're located. ASSISTANT COMMISSIONER CRONAUER: The organizations doing HIV testing?
Both, the organizations providing the testing as well as those where you're providing education-related information. 163 3/8/06 - WHOLE - BILL 060001, ETC. ASSISTANT COMMISSIONER CRONAUER: Absolutely.
Speak to activities that really are designed to target African-American women. ASSISTANT COMMISSIONER CRONAUER: The activities designed to target African-American women are -- there are two different venues. One is a community-based venue where organizations that are primarily organizations of color in communities like Germantown and in North Philadelphia and West Philadelphia, engages pretty much a peer-driven activity, but it's peers that are trained. So it would be women of color who are trained in the interventions. For example, curriculum that have been proven to be effective -- because we want to know what you're doing actually works. Conversations are great, but it has to be a conversation where we can really impart information and skill so that people can make more informed decisions. So we do 164 3/8/06 - WHOLE - BILL 060001, ETC. that training. We have training for all of the outreach workers that are community based. So they're trained and certified in the interventions that we know are effective, and they engage in those interventions in either a group setting or one-on-one called individual level intervention where they engage individuals on a one-on-one level and provide information and, where appropriate, help people develop plans for making safer decisions in the future. The second venue is around perinatal HIV transmission.
Around what? ASSISTANT COMMISSIONER CRONAUER: Perinatal HIV transmission.
Perinatal? ASSISTANT COMMISSIONER CRONAUER: Perinatal, which is the prevention of HIV from mother to newborn child. In that effort, we're now working with all of the delivery hospitals in the 165 3/8/06 - WHOLE - BILL 060001, ETC. City to make sure that rapid testing, which is a new technology introduced last year, is available to all women who present in a delivery room who have not been tested for HIV during their pregnancy during prenatal care. And, of course, it's optional, but our hope is that women who have been chosen to be tested will choose to be tested with a rapid test when they present for delivery, because if it turns out that they have HIV, we can provide interventions then during delivery to help reduce the rate of transmission from mother to child. So we're doing that, not only them but also targeting prenatal programs, because we'd rather catch women earlier as opposed to when they're presenting for delivery.
So then for sure you're tied into the newborn home visiting initiative? ASSISTANT COMMISSIONER CRONAUER: Absolutely. 166 3/8/06 - WHOLE - BILL 060001, ETC.
That was a test. Years ago there was a lot of criticism, some might say legitimate, that agencies providing services to HIV/AIDS patients were not talking to each other. What is the status of that today? ASSISTANT COMMISSIONER CRONAUER: The AIDS Activity Coordinating Office actually has monthly meetings with all of our providers, so that we're all in one room and we all have an opportunity to talk about what the issues are, how we can better work together. Then they have community-based meetings that happen on a regular basis. For example, around HIV testing, when we have to implement the new HIV rapid testing, which is our goal because people would rather know now as opposed to a week from now what the results are, the way we implement that is by having all of our HIV testing providers come in and meet 167 3/8/06 - WHOLE - BILL 060001, ETC. with us on a regular basis, work with us and work with each other to develop a plan on how to implement that which will meet their needs and will obviously meet the needs of Philadelphians. And we do that for all the variety of activities we have. For example, we do the same thing around HIV case management, where we have centralized coordination and regular meetings with all of our providers to make sure that they're overcoming that sort of silo mentality that can sometimes be there.
Very good. There aren't enough dollars for us to be silo anymore. ASSISTANT COMMISSIONER CRONAUER: Absolutely.
Finally, any linkage with recovery programs, and particularly recovery programs providing services to women and then women of color, since that's where the incident is going through the roof? 168 3/8/06 - WHOLE - BILL 060001, ETC. ASSISTANT COMMISSIONER CRONAUER: Absolutely. We have not only a lot of our HIV prevention interventions that are happening within drug and alcohol recovery programs such as One Day At a Time and Recovery King and a couple of other rather large programs where we do not only education but testing, CODAAP, and they'll be coming out next, has HIV testing and education that they provide in a range of recovery houses as well that they work with. And what we do in the Health Department is provide the training of certification and provide the resources for testing for all of those activities that happen as well. So we're connected with CODAAP to make sure that we have one system where everybody is educated to the same standard.
Okay. Well, thank you very much for your testimony. Thank you, Madam Chair. 169 3/8/06 - WHOLE - BILL 060001, ETC.
Thank you. Councilman Kelly, would you wait for Councilman Rizzo? His point of order took him out of his natural order. He's next and then you and then Councilwoman Tasco.
That's correct. Always, since I'm going to compliment him.
Congratulations. My question is about PACCA. I really appreciate all the improvements, but I really believe that if it weren't for my colleague, Councilman Kelly, that the progress would have been a long time coming on making significant improvements. I'm trying to remember, and 170 3/8/06 - WHOLE - BILL 060001, ETC. maybe you can help me, I'm sure that you recollect this news story. I believe it was in a suburban community where a person's cat was at a facility and they left a message on the machine, they even left a note that they saw the cat through the window, and the cat was put down. That was really sad, I mean, to see that occur. And I'm positive as a result of that whoever manages that facility, before they would do something like that, in the morning they check -- I'm being very basic here, but if something like that could happen there, I would hope we learn by that experience that we do everything, look in a mailbox or check the voice mail or do whatever we have to do. Because to see that young girl cry the way she did at the loss of her pet, it was really sad. And I got some e-mails. My own mother was so upset by the fact that that little cat was killed, and just the reaction that happened. It made it look like this could only happen 171 3/8/06 - WHOLE - BILL 060001, ETC. on something that the government oversees. It would never happen in the private sector. But it just makes us look, government in itself, look bad. Did we learn anything from that or did we do anything to make sure that something like that couldn't happen? I know it's only a cat, but to somebody, that cat is maybe the only person they have in their life that they love, you know. COMMISSIONER PARIS: Yes. Actually, I can relate to that story because I have adopted two cats from the shelter. So I couldn't imagine what it would feel like to lose one of them. But one of the things that we have done so that corrections are in place and PACCA can move forward is the hiring of an Executive Director. We have hired a person that is very much qualified to run this facility. And what we have done is, in addition to continue to provide the support, all the income 172 3/8/06 - WHOLE - BILL 060001, ETC. support, we have made sure that we continue to meet with her so that whatever assistance she might need, whether it's in information systems, the phone systems, whatever it is that she might need to get from us, she will get it. I understand that she's done significant improvement, and not only in terms of the facility itself but also in the training of the staff, and I know that the staff now is much better prepared to deal with that kind of situation.
CBS 3, I think it's on Sunday morning or Saturday morning -- my days get mixed up -- I heard something that was so impressive. Carol Erickson loves animals, and the success rate that they have, I don't think they've ever had one animal that they have shown on television go unadopted. That's really impressive. We have a great -- I'm amazed 173 3/8/06 - WHOLE - BILL 060001, ETC. how many people watch our City TV channel, and I mentioned it many years ago, that it would be great if the Commissioner could have her own little TV show on our City channel to show the public the pets that we have there. We have this system. It's there. And I'm impressed. I thought I was the only one in the world that watched it, because I want to sometimes see what we do here. A lot of people do see that, and I would just recommend again -- I did suggest it in the past, and I don't know how far we've gone, but even if we did pictures of an animal and say, Adopt this animal. Because I know after hours they just run stuff about the Water Department, about the Streets Department, about the Health Department. That might be another opportunity to get the word out so we don't have to -- I know Councilman Kelly wants it to be a zero -- what's the proper language? COMMISSIONER PARIS: No kill. 174 3/8/06 - WHOLE - BILL 060001, ETC.
No kill. And I'm for that. So what more can we do than use that TV station to do that? COMMISSIONER PARIS: Absolutely, and we totally agree with it. To the fact that not too long ago we had a company here in the City that wanted to do some taping of public service announcements and so on, and we thought that this might be an excellent opportunity for PACCA to take advantage of it and get some of those PSAs recorded. And that information has been made available to the Executive Director, who is in the process of contacting the company so that they can produce this show that then can be shown in the cities.
That's good to hear, too, that that's going to be on the general media. COMMISSIONER PARIS: But also on our channel. 175 3/8/06 - WHOLE - BILL 060001, ETC.
I'm talking about our Department of Public Property's and the School District, we have three or four stations where I think in this area the more, the better. COMMISSIONER PARIS: Absolutely. And these different videos, productions, are going to be done in a way that they can be used in any televised program or channel.
My colleague said I'll do the commercials. No. 14 That's okay. I think it's a great improvement, and I thank you, because it was really troubling to see what we were struggling through there, and thanks for all the effort, and also to my colleague, Councilman Kelly, who really pushed hard from the bottom of his heart, by the way, to make this happen. COMMISSIONER PARIS: Yes. Thank you.
I just want to follow up on, of course, the same subject that we were just addressing. First of all, let me congratulate you on your appointment. I think it's very well earned, and I think that you and I are going to be working very closely on this subject, and that's PACCA. As you well know, about a year or so ago, there was some negative publicity throughout our local papers here, and from that, we were fortunate enough to have Councilwoman Tasco, who chaired the Health and Human Services Committee, to hold hearings immediately to resolve or at least to improve the 177 3/8/06 - WHOLE - BILL 060001, ETC. problems that PACCA was having. And I agree with you that we have now a Director who has really taken immediate action. I think that we have a turn-around. We're going in a new direction, and I want to see that continued. I think there's a lot of improvement that could be made, and I'll go into that in a minute. Presently their budget, their contract, for PACCA was 2.6 million, I believe. COMMISSIONER PARIS: 2.35 and we added another $304,000.
I believe you said 2.7 million. Is that for '07? COMMISSIONER PARIS: That will be -- actually, it will be 2.69 for '06 and we are asking that that becomes a permanent item in our budget. So that in years to come --
So it's almost 100,000 more than what it was? COMMISSIONER PARIS: 304,000. 178 3/8/06 - WHOLE - BILL 060001, ETC.
Now, the salaries, I believe, and the personnel expenses come to about 2.3 million. Would that be correct? COMMISSIONER PARIS: The personnel expenses, they come up to 1.2, $1,271,000.
And that leaves over a million or so for operational costs; is that true? COMMISSIONER PARIS: That's correct, sir.
See, what I want to get down to is that I think we should have improvements and probably additional funding for PACCA. I really do. Because presently there's probably, from what I gather, there's been reported 1,700 cases of dog bites, for instance. 179 3/8/06 - WHOLE - BILL 060001, ETC. And presently you have six trucks to handle animal control in the City. How many of them are actually being used? COMMISSIONER PARIS: To my understanding, all the vehicles have been used. They are contracted to be used for animal care, and that is the number -- what we have done is, we developed a scope of services for PACCA.
Is there anyone from PACCA here? COMMISSIONER PARIS: We usually don't --
I know it's a contract. COMMISSIONER PARIS: I don't think we have --
I know they're not part of it, but I just have a lot of questions on this. And maybe you can answer this one. The City Charter allows for an Animal Controls Fund? COMMISSIONER PARIS: Yes, sir.
And all 180 3/8/06 - WHOLE - BILL 060001, ETC. license fees collected by the City should be going to this fund. Do you know if that's being done or is this just going into the general revenue of the City? COMMISSIONER PARIS: That fund has been created. There is a fund, and we have right now -- we're starting to collect the monies from the licenses, and our plan is that we will -- anything in excess of the $60,000 that the City committed to put in place the licensing operation, that will go into the fund.
If there was an increase in licensing fees, that would go into this Animal Control Fund? COMMISSIONER PARIS: Yes, sir.
I don't know if people are familiar or people know about this, but about a year ago, there was about 25,000 animals euthanized every year in Philadelphia. We have made 181 3/8/06 - WHOLE - BILL 060001, ETC. improvements there. We've reduced the animals being killed, but we still have a long way to go, and as Councilman Rizzo has stated, my goal is, of course, to have a "no kill" policy in Philadelphia. It's going to take a lot of funding. It's going to take a lot of effort on a lot of people's parts to do this, and I'm sure that you're going to be part of it, because what we want to do is work with you and we're familiar with you and we want to ask you for any help you can give us in this endeavor. Right now what happens when an animal is euthanized? What happens to the body? COMMISSIONER PARIS: Well, the Streets Department takes care of that. Well, if it's an animal that is euthanized, we have an agreement where the Streets Department takes care of it and is in compliance with all the EPA regulations. EPA and Streets have communicated to confirm that, yes, we are 182 3/8/06 - WHOLE - BILL 060001, ETC. in compliance.
You're in compliance, but as far as you know, it's the Streets Department just picking up the animals? Do you have any idea what they do with it? COMMISSIONER PARIS: The Streets Department has a process by which they --
Well, what I would like to do is, shouldn't those animals be cremated? Wouldn't that be the proper way of -- COMMISSIONER PARIS: I apologize, sir. I don't know what the Streets Department does.
That's something I would like to know and how much would the cost -- I mean, would it be an additional cost for that? Does it pose a health risk when you're just taking those animals and throwing them in a landfill or whatever the Streets Department does with them? 183 3/8/06 - WHOLE - BILL 060001, ETC. COMMISSIONER PARIS: No. The Streets Department has a process in place that meets all the requirements and regulations of the EPA, of the Environmental Protection Agency. So they're regulated. So that they dispose of the animals that are euthanized in a way in which they are not a hazard to the environment or to anyone in the community.
Well, I'll follow up on that later, but it seems to me that the funding is -- this is a very low priority in the Health Department. I can understand why, with all the problems that we have today with AIDS and a lot of other things, but this is a problem that's been, I think, neglected and underfunded for many, many years, and to me, it's a quality of life issue. Some of the seniors that we have or people who just have a pet and that's it and it's part of their family, and I think this is very, very important to have the proper 184 3/8/06 - WHOLE - BILL 060001, ETC. animal care in this City. One of the things I would like to ask you if you would be recipient to is, if we received additional funding, for instance, for PACCA that would enable us to ask for grants from private sources, such as Maddie's Fund -- I'm sure you're familiar with it. New York City recently just received $10 million. This would be a great boom to us to get to be the first major city in this country to have a "no kill" policy for their animals in the City. If we were to be able to get sufficient funds from private sources, such as Maddie's Fund, I'm sure within five or six years we could be that city. This is one of the things that I'm going to be asking you to look into. I'm asking a lot of people if we were. And another thing it would do, I understand there's problems with people getting through to PACCA. Do you have any idea how many phone calls a month are 185 3/8/06 - WHOLE - BILL 060001, ETC. made to PACCA? COMMISSIONER PARIS: PACCA's phone calls are answered through the center call operation that we have here in City Hall. I don't have with me the numbers, sir, but I will certainly be more than happy through the President's office to get you that information on how many calls we receive monthly.
I may be wrong on this, but it's something like 10,000 a month. Now, I know they only have one or so operators in PACCA to handle those calls and I know no person could handle that many. And you're right, I think most of those calls are put through the City Hall switchboard, but that to me is not the way to go about it. If a person is calling and it's sort of an emergency or want to get some help immediately, going through the City Hall switchboard just doesn't do it. I think we would rather have operators from PACCA to give them the information that they 186 3/8/06 - WHOLE - BILL 060001, ETC. need immediately. COMMISSIONER PARIS: Sir, we have our own operators in this building. They don't go through the City Hall switchboard.
But how many do you have? COMMISSIONER PARIS: We have six of them that are just answering the calls for PACCA and the health centers.
Oh, okay. COMMISSIONER PARIS: They manage all the calls.
That's for how many health centers? COMMISSIONER PARIS: Eight health centers.
So you have six and they handle eight health centers in addition to PACCA? COMMISSIONER PARIS: That's correct.
Does PACCA have any operators themselves? 187 3/8/06 - WHOLE - BILL 060001, ETC. COMMISSIONER PARIS: Yes. They have one person there. Yes.
That's the problem. COMMISSIONER PARIS: What we have done is, we have provided, through the Department of Health, staff support to that one operator. It's another way for the Health Department to support PACCA's lack of support in that end.
I'm sorry. What was that again? COMMISSIONER PARIS: What I'm saying is that the reason why PACCA is where it is is because it allows the other Health Department staff to support that one person. When that person is busy, the other Health Department staff is able to assist with the PACCA calls.
That's provided that they're not busy with their calls. Because I'm sure the health centers get quite a load of calls, too, quite a number of calls. But, there 188 3/8/06 - WHOLE - BILL 060001, ETC. again, it could be a problem, an overall problem. But I just want to say at this point, I think there's a lot of things that we can do. One of the things that bothers me is that the facility itself, where it's located. I would think we would do a better service for the citizens of Philadelphia if that were moved to another area which would, I think, be better situated for people who want to adopt animals. That's very difficult to find. You can go by there 50 times and not even know where it is. I mean, it's just not prominent. It's just not in the right setting, in my opinion. But that's something that we can look at and we can work towards. I think that we can improve immensely on the adoption rate if that were placed in another section of the City. COMMISSIONER PARIS: I agree, sir. And if I may go back, I just found 189 3/8/06 - WHOLE - BILL 060001, ETC. my report on the average answer delay for PACCA is, the average answer delay is one minute.
Well, that's great. Okay. That's all I have at this time, Commissioner. And, again, I want to congratulate you on your appointment. COMMISSIONER PARIS: Thank you.
I think that you and I are going to see a lot of each other in the next two years. So I look forward to it. Thank you. Thank you, Madam Chair.
You're welcome. The Chair recognizes Councilwoman Tasco.
Thank you. Good afternoon and, again, congratulations to you on your 190 3/8/06 - WHOLE - BILL 060001, ETC. appointment. I hope you are planning to stay. I want to go back to the Health Department's services. What services are provided by the health centers? I'm sorry; health centers. If I'm a client who goes to a health center, what services can I get? COMMISSIONER PARIS: You get primary care services by an adult medicine physician or a pediatrician. We also have a pharmacy on site. We have a number of ancillary services like lab, laboratories, radiology. We also have family planning services, prenatal, GYN. We have dieticians on board. We also have social workers that provide any kind of social support to the patients that we serve.
President Verna asked about the waiting time at the health centers. Do you deploy staff to these health centers based on need or is there a one set plan that you have one of 191 3/8/06 - WHOLE - BILL 060001, ETC. everything at every center every day? Maybe the Northeast might not require the -- they don't have the same level of service need as, say, Broad and Lombard or Broad and Tasker. How do you determine how you deploy staff to these health centers? COMMISSIONER PARIS: We have a formula that I don't have with me that we use just to give us an idea based on the size of the center. And based on the size of the facility, based on how many exam rooms we have available and so on, we determine how many staff we deploy on each health center. No, we don't have them moving from one center to the other. We pretty much have them all stable where they are, and I think that is very critical, Councilwoman Tasco, because it is part of our mission to provide that continuity of care, and it is very important, because the patients do develop relationships with their nurses and their physicians 192 3/8/06 - WHOLE - BILL 060001, ETC. and so on. So we have a set number of clerks, nurses, physicians that staff each of the health centers.
So suppose you had a center that didn't have the volume of patients that you would have at Broad and Tasker. Would there be -- you don't like that question, do you? Could you probably deploy -- could you provide more staff at the center where you have the greater number of need and maybe cut down on -- no? The moment I started asking that question, I saw Yvonne in back of me. But I'm just trying to figure out how can we get the best service, not cutting out employees, but instead of having a dentist five days a week in an area where you don't need them five days a week, you take that dentist and use them in South Philadelphia with the other dentist or in North Philadelphia with the other dentist. You're not really cutting staff, but you're enhancing the services 193 3/8/06 - WHOLE - BILL 060001, ETC. where the greatest need might be. You don't have to answer that, because it might get you in trouble, but I just put that out there as a way to talk about how we cut down on the waiting time. If we're not going to have additional money to hire additional employees, which is probably what we should be doing, to have better service, because we have a large City -- (Applause.)
-- we have a large City with people who don't have health insurance, and our Charter gives us the mandate that we're to provide for the health and welfare of our citizens and we're not funding the health centers to the level that they need to be, we may have to look at another way or maybe we need to start looking at how we shift some priorities in some of the other areas of the budget and provide it to the Health Department to provide health coverage services to those families who 194 3/8/06 - WHOLE - BILL 060001, ETC. are working poor who don't have health insurance, who can't get examinations at a doctor's office or whatever, but need the health centers. So as you move towards being the new Health Commissioner, maybe you ought to think about asking for more money, looking at your departments. Because no one has come in here ever and advocated for additional staffing for the Health Department. We know you get the line that this is what you have to ask for, but part of the role of the Commissioner is to be the advocate for the people that you serve. So what we want is to hear what's really needed. Yeah, you get whatever the amount you want and that may cover what you're doing, but what is it that we need? Are people being served? I spoke this morning to a group about the disparity in healthcare. You talk about it in your testimony. Well, what is the City doing? You talk about 195 3/8/06 - WHOLE - BILL 060001, ETC. the -- I think David Cohen passed the initiative on universal healthcare so that we can come up with a plan for providing healthcare for those people who need it. So, Commissioner, you have a charge from me, and I'm sure maybe some other people on Council, to tell us what's really needed in the Health Department. I chair that committee. I don't hear from anybody that said we need anything. It's fine, business as usual. But I think we need to begin to think about what our needs are. So that's my speech for the day. But I won't have you answer that question. You can think about it with Ms. Sutton back there. The question I want to ask, Councilwoman Blondell Reynolds Brown asked about the newborn home visiting initiative. I need to have some clarity on how the Health Department is working with the -- you're working with the -- COMMISSIONER PARIS: Managed 196 3/8/06 - WHOLE - BILL 060001, ETC. care organizations.
Managed cares. Tell me how that's going to work. COMMISSIONER PARIS: Well, currently the state funds the managed care organizations to provide this visit to --
To every newborn? COMMISSIONER PARIS: That's correct, ma'am.
And the Health Department's role is to do what? COMMISSIONER PARIS: Well, the Health Department really does not play a role in that, because it is a business agreement between the state and the managed care organizations. So what we have done is, since we have realized that the managed care organizations have not been successful in doing that and we meet with them on a quarterly basis, in one of those meetings we discussed with them the possibility of the Department assuming a 197 3/8/06 - WHOLE - BILL 060001, ETC. more active role in that kind of a service, because we know that we can reach those women out in the community.
Who will you use to reach those women? I mean, how do you do that and they can't? If they're not doing it, how is the Health Department going to do it? COMMISSIONER PARIS: Well, we are going -- we already have a system relationship with many -- we contract with, I believe, almost every single home visiting nursing group in the City of Philadelphia for many other of our programs. We have contracts with them for the childhood lead poisoning program and other programs. So what we're going to do is, we're going to enhance what they're already doing successfully to add to that the information necessary for mothers to make sure that they are doing everything they can to raise their children correctly and in a healthy manner. 198 3/8/06 - WHOLE - BILL 060001, ETC.
But if the state has contracted with the HMOs to provide the service, they get paid for that? COMMISSIONER PARIS: Yes, ma'am.
Who is monitoring that from the state side? If they're not successful, why -- and I don't have any problems with trying to help, but what prevents them from fulfilling their obligation, since they're getting dollars for it? COMMISSIONER PARIS: We have set a number of -- and we have been meeting with the state to that effect also, because we understand that in order for this initiative to be successful, it's going to take more than just the managed care organizations and the state and the city. So we are talking about how best we can utilize and rechannel those resources to really make it a successful initiative. 199 3/8/06 - WHOLE - BILL 060001, ETC.
So how will you evaluate the success of this venture? COMMISSIONER PARIS: Well, now we have been able to receive information. We have established a system by which we receive information on every child that is born in the City of Philadelphia, and I think that with that information, we will make sure to track that every child has received that first home visit.
Okay. Thank you. Let me just talk a little bit about infant mortality. You said the Department of Public Health has a number of infant death review processes in place that furnish data related to the circumstances of death that we're using to improve Department maternal infant health policy. How are you gathering this data? During the hearings we had on infant mortality, we had the hospitals 200 3/8/06 - WHOLE - BILL 060001, ETC. come in and talk about the issue of the number of increases in the high rate of infant mortality in the African-American community. One, how are you collecting that data, and, two, what is the follow-up to the Council's hearing on the issue? I know you're just the Commissioner, but you were part of that administration. COMMISSIONER PARIS: I am asking the Director of Maternal, Child and Family Health to come and assist with me that question, ma'am.
I'm Kate Moss. I'm the Director for Maternal, Child and Family Health for the City Health Department. As to your question about the death review processes, my division now manages, I think we're up to, four death review processes, the newest of which is a real-time review of every infant death that occurs within the City of Philadelphia. We bring a 201 3/8/06 - WHOLE - BILL 060001, ETC. multi-disciplinary group together to take a look in enormous detail at every single death that comes through the Medical Examiner's Office. So any death related to asphyxia, any sudden unexplained infant death or any infant death that would be called SIDS, Sudden Infant Death Syndrome, we take a look at in great detail and then review it again to see what kinds of policy implications there might be. In fact, one of the reasons that we're moving ahead with this newborn home visiting program is that we've discovered that an awful lot of these deaths are related to parents who just didn't know how to provide appropriate care for their babies. Their babies died because they were face down on an inappropriate sleep surface. They were in a crib but with adult bedding, two or three mattresses, a couple of other kids. Just unsafe sleep arrangements in general, perhaps relating to a caregiver's incapacity, substance abuse, 202 3/8/06 - WHOLE - BILL 060001, ETC. exhaustion. So this is part of what led us in the direction of pushing for safe sleep education throughout our programs. So that's, I guess, one of the examples I can give you of how we're using the death review processes to change what we do.
What outreach do you have to expectant mothers to provide them with education prior to the child being born that would help you with that? Are there any programs in-house now?
Yes, ma'am, there are. We have a Healthy Start program. We had had two essentially separate Healthy Start programs which in the last year we've combined into a single program that we now call Healthy Start Philadelphia, and it covers all the high-risk areas of the City, all those areas where the infant mortality rate is such that we're eligible to receive Healthy Start funds from the federal government, and at this point, we extend 203 3/8/06 - WHOLE - BILL 060001, ETC. from the northern boundary of the City -- we became aware that there were demographic changes which were leading to increased infant mortality in some areas of the City where we've just never seen it before. So we now have these services from the north border of the City, Cheltenham, Cedarbrook, that whole area, down through the north central section of the City, out into the West Philadelphia area, Southwest Philadelphia and South Philadelphia. Any area of the City where we have an infant mortality rate that will allow us to qualify for Healthy Start funding we now have Healthy Start services. The bulk of that activity is around identifying pregnant women early in their pregnancy, getting them into care. We're currently using those Healthy Start monies to do some very interesting things, like providing pregnancy education classes at our district health centers and child birth 204 3/8/06 - WHOLE - BILL 060001, ETC. education in the district health centers, breastfeeding support classes in the district health centers. One of the really important protective factors against Sudden Infant Death Syndrome is breastfeeding. We know we haven't done as nearly as good a job as we'd like in promoting breastfeeding, particularly within the African-American community, which is at highest risk for SIDS. And so through our Healthy Start program, we have some breastfeeding education support groups. We train lactation consultants, who are now in almost every one of our birth hospitals. We've been able to show that particularly high-risk populations, when exposed to a lactation consultant in the hospital, are much more likely to leave the hospital breastfeeding. Again, a very important protective factor in Sudden Infant Death.
We never have enough 205 3/8/06 - WHOLE - BILL 060001, ETC. staff. Do we have enough staff? Yes. I would say that for the programs, where we are, we contract with a number of community-based agencies, so that we have less need for staff centrally because we're working with some excellent community-based agencies who provide services throughout the City. We're never able to pay them as much as we would like, but, yes, I think we're doing a pretty good job at this point.
Okay. Thank you. One more question about the health centers. Is there a big waiting list for dental care for children and are there plans to expand dental personnel and support? COMMISSIONER PARIS: Again, ma'am, the wait varies from one center to another, with the average wait being approximately about a month for an appointment for dental, with the understanding that if there's a medical 206 3/8/06 - WHOLE - BILL 060001, ETC. emergency, they will walk in and they will be evaluated and referred to one of our partner hospitals for follow-up.
You have not answered my question and you didn't answer the President's question. Maybe we're not clear. COMMISSIONER PARIS: I apologize.
We know that there will be a longer waiting list in some areas than in other areas. COMMISSIONER PARIS: Yes.
But what are the waiting lists like in each of the districts? COMMISSIONER PARIS: If you call in for an appointment today, we will give you an appointment within 28 days for dental.
For dental? COMMISSIONER PARIS: Yes, ma'am. 207 3/8/06 - WHOLE - BILL 060001, ETC.
But if they have a toothache today, they can walk in and get it taken care of? COMMISSIONER PARIS: We will examine you, and if you have a severe problem, you will be referred to one of the hospitals that we have agreements with. Because we have limited service, limited dental services, in the health centers. We don't do complicated oral surgery. I mean, there's some things that we don't do at the health centers.
So what kind of services do they get at the health center, dental service? COMMISSIONER PARIS: Just routine dental care.
So if they go to a hospital for more extensive care, who pays for that? COMMISSIONER PARIS: The City does not pay for that care, ma'am.
Now, how are you on your billing for services for 208 3/8/06 - WHOLE - BILL 060001, ETC. people who don't have Medicare, and are you all billing for Medicare -- or Medicaid? I'm sorry. COMMISSIONER PARIS: Yes, we are. We are billing for both Medicare and Medicaid.
How is your rate of billing? One time it was kind of low and you weren't collecting the money. Are you up to date on your billing? COMMISSIONER PARIS: We have implemented a number of procedures so that we can increase the turn-around productivity of our staff, as well as the methods that we now use. We hired a woman that has extensive financial experience to spearhead that particular effort. Our staff had undergone training once again, and they're much, much accurate and expeditious in terms of how they are submitting the bills.
Councilwoman Brown talked about the 209 3/8/06 - WHOLE - BILL 060001, ETC. Benefits Bank, and I know we had an interview. I know the Benefits Bank was presented to the last Commissioner. Were you a part of that presentation? Are you familiar with the Benefits Bank? COMMISSIONER PARIS: No, ma'am, I'm not familiar, but it will be on my to-do list for tomorrow morning.
What happens, if I walk into a health center and you can access all of the services that I should get through this Benefits Bank. It's a wonderful program, but we couldn't seem to get the City interested. It has to be a coordinated effort with you and it should go through the Social Services Director so that you can have up-to-date information on what benefits a person qualifies for when they walk into your office, and it can be accessed through the computer. We did not get a positive reception when we presented that to the Health Department about two or three 210 3/8/06 - WHOLE - BILL 060001, ETC. years ago. But there is a cost to it also, but in the end, it may benefit you, as we talked to Ms. Danzy, that there may be a benefit to that. I have a couple more questions. I mean, some of them were asked, but I'm coming back in a different way. Last March when we had the budget hearings -- and, again, I know you were not here -- we talked about the million dollars that Senator Hughes -- and the gentleman who is from HIV might want to come forward. Thank you, Kate -- had given a million dollars to the Department of Health to provide HIV/AIDS prevention services for minority youth. Now, are you all still working on that $1 million?
Yeah. I have the record. Good afternoon. My name is John Cella. I'm the Director of the AIDS Activity Coordinating Office for the Philadelphia Health Department. 211 3/8/06 - WHOLE - BILL 060001, ETC.
My question, in 2005, of these funds, over 924,000, or 92 percent, went to non-minority, non-community-based providers. In addition, 500,000 of these funds went to one agency to provide six testing events at a cost of $83,000 per event.
Those figures are not accurate. Let me say, first of all, that they're not figures that make any sense to me at all. When we first received, Councilwoman, these dollars from Senator Hughes, it was back in January of last year. We got them for six months. Now we have to stretch the million dollars for one year. It goes from July obviously on the state contract period. We implemented a series of historic very innovative relationships 212 3/8/06 - WHOLE - BILL 060001, ETC. with the Department of Human Services where we directed these funds to youth in foster homes, aging out of foster homes. We had a very innovative program with the School District for gay, lesbian, transgender youth. So we reached out and we did an RFP, a request for proposal. So we went through a codified process where anybody could apply. We ended up funding six agencies. I have a list here. I don't know them all right off the top of my head, but one of them is Bebashi, for instance, which is a minority organization. I can have the list for you right here. But we basically reached out and we reached out with our prevention activities, as Mr. Cronauer talked about before. These are scientifically based CDC activities. It's not whatever they wanted to do. But they were CDC-approved interventions directed at minority youth. So we have a number of programs out there through Senator Hughes' dollars 213 3/8/06 - WHOLE - BILL 060001, ETC. directed at minority youth being operated, for the most part, through minority agencies. I mean, it's Action AIDS. It's Bebashi. I have the list here. I have to like refer to it.
I'll refer to it. We also gave dollars for minority youth roundtable to the Office of HIV Planning. Let me get the list here. But, no, 500,000 was not given to one agency. I think you're referring to the Family Planning Council that got a sum of money through Senator Hughes' efforts for rapid testing and a series of youth-initiated events in the community. But it wasn't $500,000. Let me get the list, the state list here, for you.
Why don't you provide that information, because I think Councilwoman Brown asked for that information. So you can provide it to the Chair. 214 3/8/06 - WHOLE - BILL 060001, ETC.
Well, when we spoke to the office last year regarding the issue, they responded that they received -- was that they were using existing providers in order to deliver the services quickly.
We went through an RFP process, an extensive RFP process, which not everyone necessarily wanted, but we had a process, we issued an RFP. It was disseminated widely throughout the City to many, many agencies beyond the traditional agencies, and we have a Resource Allocation Advisory Committee which is an independent non-conflicted review committee, not associated with AACO, that made the decisions. The Health Department, AACO, doesn't make the decisions. The recommendations are made to the Health Commissioner. But there was an RFP process. 215 3/8/06 - WHOLE - BILL 060001, ETC.
I think I have one last issue for you, Commissioner, and that is regarding the Mayor's Executive Order of 2005. Are you familiar with the Executive Order that the Mayor signed? There was an extensive Executive Order that the Mayor signed, because one of the concerns we've often had about the City is the involvement and participation of minorities in doing business with the City. And part of that RFP required that the departments deliver a compliance plan to MBEC that includes participation benchmarks for the coming fiscal year and proposed participation ranges for each contract to be awarded which ought to be approved by MBEC. To your knowledge, did your department comply with these requirements for this fiscal year, 2006, and will it do so for Fiscal Year '07? 216 3/8/06 - WHOLE - BILL 060001, ETC. COMMISSIONER PARIS: We have submitted the plan.
Can you tell us the results, and did you meet your benchmark goals? Did you first set benchmarks that you know of? Did you set goals? COMMISSIONER PARIS: Yes, we did, and we met those benchmarks. I don't have the specifics here, but I can tell you that in Fiscal Year '05, we have a participation of 28.93 percent of all the contracts were minority business contracts.
And what was your goal? Had you set a goal? COMMISSIONER PARIS: I will have to get that specific number to you through the President's office, but I know that our goal was not -- I remember being involved with it and receiving from MBEC a lot of support and positive feedback, because one of the things that the Health Department has is, we contract 217 3/8/06 - WHOLE - BILL 060001, ETC. with about 207 providers, and the majority of them are community-based organizations already. So the number of for-profit contracts that we have is a very, very small number. And I know that within that small number, we have a 28.93 percent of minority participation. We are very, very committed to increase that number, and what we have done is, we have taken it upon ourselves to put together training sessions for the vendors that we know are certifiable and for different reasons have not gone through the process. At this point, we even went on to identify a person in the Commissioner's office that works directly with the vendors and help them facilitate them to go through the whole MBEC process, because we are really committed to increase the numbers.
Okay. So could you after reading -- I know you're new -- reading the 2005 Executive Order 218 3/8/06 - WHOLE - BILL 060001, ETC. explain to us and submit that to the Chair how your department complied with the section that was required? COMMISSIONER PARIS: Yes, ma'am. We will do that.
You're welcome. Councilman, at the request of the stenographer, we're going to take a five-minute break. (Short recess.)
The Committee is now back in session, and the Chair recognizes Councilman Rizzo.
Thank you, Madam President. Yesterday we heard some cases that were a bit troubling in reference to infrastructure and the health centers. There are eight, correct? Could you tell me how we keep an eye on the physical plant? I mean, we talked earlier about 219 3/8/06 - WHOLE - BILL 060001, ETC. the services, et cetera. I have visited many, if not all eight, of the centers, and you can obviously see that they're used, they're well used. Do we have any concerns? Because we heard other operating departments, the Police Department, we got reports from Capital Programs. What's the condition of the physical properties and what is your concern about that, and how do you inspect or who do you have in your organization other than Public Property, I would assume, that takes care of them to keep an eye on the fact that they look like health centers? COMMISSIONER PARIS: We have made through the past eight years a considerable investment in each one of our health centers through capital projects. We have renovated the facilities. We have improved lighting. We now make use, much better use, of the limited space that we have there. Each one of the health centers had undergone a 220 3/8/06 - WHOLE - BILL 060001, ETC. makeover, a physical makeover, where it's more attractive and it's more pleasant for our patients. In addition to that, the renovations have included extensive improvement renovations for our heating and air conditioner systems. We've done the same thing for the electrical system and the plumbing system. We have new roofs almost in every health center. There was a time when we did not know if it was better to be inside or outside on a rainy day, and I'm happy to say that those days are behind us. So the facilities have improved. We've even included in some of the centers like Health Center 6 on 3rd and Girard where we have done all the sidewalks outside as well.
Commissioner, the only other concern, there was a media story recently about the disposal of materials from physicians offices, and I imagine you use a 221 3/8/06 - WHOLE - BILL 060001, ETC. tremendous amount of devices that you put in people's mouth, gauze, cotton. How do you handle the disposal of the materials that you use in the eight centers? I would think that's not handled through the Streets Department, normal pick-up, or is it isolated or is it handled by specialty companies? How do you deal with the materials that are used in the health process? COMMISSIONER PARIS: We have a contract with a company that specializes in waste management, and we bag all of this disposable material into a red bag that is then later on picked up at each of the health centers every afternoon by people that know how to handle this kind of trash or waste.
My last question for many years, and I think I've mellowed a bit, is the needle exchange program. Where are we? Does it still have the same presence it once had? Have we gotten to the point where we've moved 222 3/8/06 - WHOLE - BILL 060001, ETC. it away from schools and any controversial area? Could you give us the status of the needle exchange program? COMMISSIONER PARIS: It is my understanding that we continue to fund that program and that I know that there's been a lot of work between the communities where they are located and the providers to make sure that it includes a very, very clear agenda of staying away from any, not only schools but also playgrounds.
Commissioner, one of the concerns and just recently I've received again a communication from outside the City where syringes aren't readily available. Have we gotten to the point where we say no to people that we know, if we do know, that come from other areas? I have a mother that wrote to me that the source of her daughter's needles was our needle exchange program 223 3/8/06 - WHOLE - BILL 060001, ETC. from Camden County. Not a good situation if that is occurring. I understand the bigger picture, that we're helping a human being, but I would hope that we have a way of managing who and whether it becomes a business for someone to provide the needles. I mean, I assume a person could walk up that isn't involved in that kind of activity, exchange needles and go sell them on the -- how do we manage a program that's so -- I don't want to use the word "controversial," but could be so controversial? COMMISSIONER PARIS: Well, the program itself, I mean, it is an exchange. A person can just not walk out from the street and say, I want to pick up needles today. It's an exchange 20 program. We are in collaboration with the different providers to make sure that there is that kind of continuity where the same individuals are the ones that are benefiting from the --
So a person 224 3/8/06 - WHOLE - BILL 060001, ETC. could come from anywhere? If they had six needles in their hand, they can get six new ones? So if we have a visitor that's on vacation -- COMMISSIONER PARIS: The answer is yes, sir.
Policy-wise, do you agree with that? COMMISSIONER PARIS: In the picture of public health and how we serve the public and what our goal is, yes, because it will ensure that less people share a virus that could lead them to severe illness or death. So in the spectrum of public health, yes, sir.
Okay. I told you I've mellowed a lot on this. Thank you. Thank you, Madam Chair.
You're welcome. The Chair recognizes Councilman Nutter.
Thank you, 225 3/8/06 - WHOLE - BILL 060001, ETC. Madam Chair. Good afternoon, Commissioner Paris. I just have two issues that I'd like to raise with you. On of your testimony, you make reference to, under Chronic Disease Prevention Program, you make reference to Steps to a Healthier Philadelphia. That's a program, Steps to a Healthier Philadelphia? COMMISSIONER PARIS: Yes.
Is that a program within the Health Department? COMMISSIONER PARIS: Yes, sir, it is a program.
You make reference on the second paragraph to, This program targets asthma, diabetes and obesity. Could you provide us with a little more information about specifically the area of obesity in general and childhood obesity in particular? What kind of steps are we 226 3/8/06 - WHOLE - BILL 060001, ETC. taking in that area? COMMISSIONER PARIS: Through the Steps program, we fund a number of initiatives. We have done health planning where we had come up with strong recommendations on the interventions that we believe are going to be successful. We have currently, in terms of the management of the disease, which is part of the goal of the program, we have diabetes self-management education and we have contracts with a number of providers to do that, such as Thomas Jefferson, the Health Promotion Council and Congreso. We also have asthma self-management education programs that we fund through Steps, and we do that through Healthy Hoops, which is a very successful program that has been put together by Keystone Mercy. We have nutrition and physical activity programs that we do in several community sites, including churches and in schools as well. 227 3/8/06 - WHOLE - BILL 060001, ETC.
Okay. Could you provide us through the Chair any detailed information about where these programs function and operate, number of people served, and I'm particularly again interested in what steps we're taking to try to reduce childhood obesity, how extensive these programs are and what areas of the City in which they operate. COMMISSIONER PARIS: We certainly will do that, sir.