Committee on Public Health and Human Services, March 12, 2024

COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES Room 400, City Hall Philadelphia, Pennsylvania Tuesday, March 12, 2024 1:08 p.m. PRESENT: COUNCILWOMAN NINA AHMAD, CHAIR COUNCILWOMAN QUETCY M. LOZADA, VICE-CHAIR COUNCILWOMAN CINDY BASS COUNCILMAN MICHAEL DRISCOLL COUNCILWOMAN RUE LANDAU

240015, 240017 - - -

Good afternoon. This hearing is called to order. This is the public hearing of the City Council Committee on Public Health and Human Services. The purpose of this public hearing is to hear testimony on Bill Nos. 240015 and 240017. We have in attendance Vice- Chair of this Committee Quetcy Lozada, Councilmember Quetcy Lozada, Councilmember Driscoll, Councilmember Bass, Councilmember Landau and myself. Okay. Councilmember Lozada, the way we're going to work on this is you're going to make your comments here and I just want to make sure I put a few comments about this testimony on this bill before we commence to really understand the rationale for this and to follow the evidence that leads us to this space right now. And I want to hand over to Vice-Chair Lozada for any opening comments. Thank you so much.

Thank you, Madam Chair. As we know, opioid use is persistent, is life-threatening. It's a life-threatening issue that continues affecting the quality of life of the residents of Philadelphia, and the concentration of overdoses must be monitored closely. There are individuals who repeatedly receive opioid antidotes from first responders. Other than the state requirement to report overdoses, there is no system in place to track repeat overdose reversals or the impact of policies intended to curb narcotics usage. This bill will call for a system of transparency by which first responders will provide consistent and up-to-date data on a quarterly basis on the total number of repeat overdose reversals. This will also help us to determine the geographic concentration where overdoses are happening, focusing resources on hotspots for overdoses as well as tracking the impact of policies made to address overdoses. And so, I'm really excited about hearing from those from the community that are on the ground and who often times have to administer Narcan and really looking forward to coming together and figuring out what we do and how as a government we legislate the policies that we have. Currently there's no system in place to monitor or track where and how it's happening. And I think as we move forward to address what is happening on the ground, this is information that I think will help us bring resources and necessary resources to those specific hotspots.

Thank you. I want to recognize that Councilmember O'Rourke just joined us. Thank you so much. He's a Committee member. And now, I'll have the Clerk please read the title of Bill 9 240015.

Bill No. 11 240015, an ordinance adding a new Chapter 6-1600 to The Philadelphia Code, entitled "City Reports on Opioid Antidote Use," to require certain reports from the Office of the Managing Director to Council concerning the City's use of opioid antidote, all under certain terms and conditions.

Clerk, will you please call the first witness to testify on Bill 240015.

Martin W. McCall, Deputy Commissioner for Emergency Medical Services in Philadelphia Fire Department. DEPUTY COMMISSIONER McCALL: Good afternoon, Chairperson Ahmad and other members of the Committee on Public Health and Human Services. My name is Martin McCall, the Deputy Commissioner of EMS for the Fire Department. I am here on behalf of the Acting Fire Commissioner Craig Murphy regarding Resolution No. 240015. Thank you for allowing me to speak about the role of EMS providers in the opioid epidemic. To begin, I'd like to give you a basic overview of our current system. Last year the Fire Department responded to about 740 EMS incidents every day, making it one of the busiest systems in the nation. These calls range from low acuity medical complaints to cardiac arrests and traumatic injuries. We have 63 ambulances in service. 54 of them operate hours a day and 9 are in service from 8:00 a.m. to 8:00 p.m. Although we respond to overdoses across the City, we created an alternative EMS response unit known as AR-2 to focus specifically on Kensington. AR-2 is a marked SUV staffed by a paramedic and a social service case manager whose ultimate goal is connecting people to lifesaving drug and alcohol treatment. AR-2 is a partnership with the Department of Behavioral Health & Intellectual Disability Services and the Philadelphia Department of Public Health. AR-2 has become a welcome fixture in the neighborhood due to its continuous outreach when not responding to calls. Staff members regularly distribute literature on treatment options, they attend weekly community events with partner agencies offering social services to those who have substance use disorder. And sometimes they self-dispatch when they are flagged down by passersby to respond to overdoses. But not every overdose survivor is ready to accept treatment and they often refuse to go to the hospital. For this reason, we never learn their names. And they would make it difficult to provide accurate data involving repeat naloxone administrations. In addition, sometimes we respond to an overdose only to find that naloxone has already been administered by a private individual. So the number of naloxone administrations by PFD members captures only a small percentage of its overall use. In an everyday case, patient confidentiality is paramount. We must protect their privacy according to the federal health law known as HIPAA. Thank you again for your attention and I'm happy to answer any of your questions.

Thank you so much for that testimony. Since we don't -- how many people do you have lined up today?

Do you want to take questions now?

Yeah, I was going to ask questions as we go along. So I'll take the privilege to ask the first question. You had said that AR-2 has become a welcome fixture in the community due to its continuous outreach even when not responding to calls and you distribute information in the community. Do you have any data to say since AR-2 has been in existence if for a prescribed area have you seen any change in either people going for treatment or the numbers of administration of naloxone that you might have done or any data around having been in the community for the time that you've been there? DEPUTY COMMISSIONER McCALL: The data that I have to date is I have the citywide naloxone administration data. I do know that in the Kensington area our 911 and AR units had in 2023 distributed or administered, excuse me, 784 doses of naloxone. Year-to-date they have in the Kensington area, that's the 19134 zip code, 128 year-to-date administration of naloxone. To answer the first part of the question, I would need to get back to the Committee with that data. I know that we have seen a good response to AR-2 and the number of people entering into treatment. That exact number I would need to get that information and get that back to the Committee.

That would be wonderful because that would tell us if this is the direction we need to go in, in terms of one of our options, right. You can go ahead, Councilmember Quetcy Lozada.

I just want to say thank you to our EMS team that are on the ground. AR-1 or AR-2 has really made to me a huge impact just by their presence. I talk to some of the EMS workers when I'm in the area. I've talked to EMS workers when I'm in the area and they shared some of their challenges as well. And so, the goal really is to figure out how can we create policy or how do we help you all do more. How do we help you collect data that will allow you to get more resources, which is what your team has always said when I'm on the ground, right? Councilwoman, we want to continue to be here, we believe this work is important. I believe the work is important, but we need more resources. And often times it gets challenging because sometimes we are reversing overdoses for the same person multiple times throughout the course of the day. And so, at what point do we as a government say we need to address this person or we need to connect this person to more resources than just here's an option, here's some information about recovery and prevention, right. How do we figure out the need to connect the individual to resources even beyond them not being ready at that moment? Reversing someone who has potentially lost their life three or four times over the course of the day is very serious, right. And so, we need to be able to collect information in order to be able to get you all the necessary resources that you need on the ground. DEPUTY COMMISSIONER McCALL: We appreciate that, Councilmember. We see that relationship, AR-2 being in the community establishing that relationship, that rapport with those in the community that live in the community as well as those that may be having some -- that are in the community for the other reason, right. So we want to have that relationship with them to feel comfortable to come to AR-2 and have that conversation about getting the help that they need. Gathering the information as far as how we administer Narcan, that's going to be a bit of a challenge because of those who receive the Narcan, they tend to get afraid and want to walk away. So getting that information and knowing their names -- but once we know the people, have that relationship, we'll be able to get that data a lot better.

Do you currently collect any data when you're doing a reversal, anything at all? DEPUTY COMMISSIONER McCALL: Yes, we do collect as much data that we can collect as far as the amount of administrations we give total. We know what we acquire, as far as how much Narcan we acquire in order to work the system, the entire system and how that usage is given, how that works throughout the given year or given quarter or month or even week. But it is more difficult when you get down to the individual because of that fear, that relationship, when you want to establish that relationship so that when we do use Narcan and people come out of their state, that they are comfortable to be able to give that information without any adverse actions.

Who holds that data? Does that stay with the Fire Department? Do you guys give that to the Opioid Response Team, MDO, the Health Department? Who has that information? DEPUTY COMMISSIONER McCALL: We have the information in the Fire Department. We keep that in our patient care data reporting and in our Mobile Integrated Health Unit. We have an epidemiologist that we share that helps us out in that space. We're looking to get full- time epidemiology and that team to help us on a regular basis to be more granular, to be more detailed in our data-collecting because the more help we need -- I mean, we respond to 911. That's what we do well, right. And we respond to crisis, but looking at that data and putting it all together, we really need some support in that space. An epidemiologist is the direction we'd like to go.

In the event that there is an individual or multiple individuals where you all find yourselves administering naloxone in one specific area, is there anyone you alert? What's protocol? DEPUTY COMMISSIONER McCALL: I'm sorry, Councilperson. Can you repeat that question?

I said in the event that you all find yourselves reversing the same person or multiple people within a specific footprint, is there anyone that you notify, what's the process, who do you communicate that information to? DEPUTY COMMISSIONER McCALL: There isn't a person that we notify. We ask for additional resources from internally if we need those resources. We have -- you know, in my testimony we have during the daytime hours. We have 63 medic units in service. And at night we drop that down to 9 and 54 medic units, so we have those resources in place along with our firefighter first responder companies and they carry naloxone as well. We understand our PPD partners and brothers and sisters, they carry that naloxone that they have as well to help us in that space. But when there is a surge as you may want to call it, there is no report out at the current time.

Thank you.

I recognize Councilmember Rue Landau. Use this.

Thank you. It's been since yesterday. Deputy Commissioner McCall, thank you so much. Thank you for being here. Thank you for all that you do. Thank you for AR-2. Thank you for saving lives all the time. We know that the Fire Department in general when it needs to go out and the EMS units, whenever they have to go out are extremely important for our city, so you're lifesavers. Thank you. I have a lot of data questions, if it's okay. I just want to dig down. I'm trying to figure this all out. I want make to sure I heard you right and then also just figure out a couple of numbers. You said, am I right, we get 740 calls for EMS every day? DEPUTY COMMISSIONER McCALL: Approximately.

Approximately. And do you know where those calls come from? DEPUTY COMMISSIONER McCALL: They come from various areas across the City. I mean, it's citywide.

Do you know how many come from Kensington? DEPUTY COMMISSIONER McCALL: I can get that for you. I mean, per day? We can kind of get an average and look at a particular time frame and look at particular zip codes and determine what those call volumes are like and dispatches are like and I can get you that data.

Okay. So out of the 740 calls per day, we know approximately how many will come from the zip code of Kensington. And do you have a code when the call comes in where someone's calling because they think someone's overdosing? Can you also extract the information of how many overdose calls you get in Kensington? DEPUTY COMMISSIONER McCALL: Well, it can come out as several things, but it's bound to be when we arrive is different. So in our patient care reporting, we do ask both questions of our responders what you're dispatched as. So you can be dispatched as an overdose but it's found to be difficult breathing, for example, right. So you may not have to administer Narcan on that particular call because it's difficulty breathing, not an overdose, right. So we'd have to look at that and determine and pull that data out what calls are found to be and what they are actually dispatched as.

Okay. So the good news is we can find out approximately how many of those calls come from Kensington and how many of those calls were for overdoses you were on the ground and saw the person? DEPUTY COMMISSIONER McCALL: Yes.

We would love to have those numbers. DEPUTY COMMISSIONER McCALL: Not a problem.

The second thing is when you administer naloxone do you keep track of when you -- do you keep track of when you administer naloxone when you go out to -- DEPUTY COMMISSIONER McCALL: Yes. When we administer naloxone, we keep track of -- the administrations is documented in our patient care report, yes.

Great. We would love to have that number as well. DEPUTY COMMISSIONER McCALL: I can provide that for you.

You talked about when sometimes you don't know if you're administering naloxone twice. Am I correct that there's no adverse effect if you give naloxone multiple times to a person, there's no harm to them? DEPUTY COMMISSIONER McCALL: I can't say that for everyone because we all may be allergic or have some kind of response to a medication if you're giving it, but it is safe to say that most people are -- there's no allergic response to it. Our PA state protocols determine how much we are allowed to give before contacting our mental command physicians in order to give anymore. They've actually backed down from the maximum dose and they want it to be given more slowly because of people getting sick if it's given to them too quickly.

So there's a state protocol that after giving a certain amount you're supposed to report it? DEPUTY COMMISSIONER McCALL: If you give a certain amount, you contact your medical command physician and let them know that you've given that amount and if they're going to give an order to give more if you need more.

Do you keep that data? DEPUTY COMMISSIONER McCALL: If we need to contact medical command for that?

Yes. DEPUTY COMMISSIONER McCALL: Yes, we do.

Okay. What do you do with the data that you already collect, the amount of calls that come to Kensington, the amount of calls that you now know were for overdoses, the amount of times that you administered naloxone, the amount of times that you've had to go up in medical command to give even more naloxone? What does your department do with that data? DEPUTY COMMISSIONER McCALL: There's several things we do with that data. We determine how operationally where the needs are going to be. Like in the Kensington area, we've just recently added three additional ALS response units. One at Engine 2 on Second Street and the other one at Engine 25 on Boudinot and I think that's Erie, I believe so. We've added three additional ALS response units because we understand that because of the amount of naloxone we give in that area and the type of dispatches that we give, a basic unit often times would not be dispatched so those three units that are being utilized quite a bit. So to help them we needed to upgrade to an ALS response, and that data helped us make that determination. Also, it helped us determine that that's where AR-2 needed to be located and we're looking at boosting that in other ways, in certain ways in order to give additional support in that space.

When you do respond to somebody who's had an overdose, can you walk me through what happens then with your interaction with that person to see if they want to go and get treatment? DEPUTY COMMISSIONER McCALL: Well, that's -- however way I walk you through it, that's just one scenario. I mean, there's a lot of different scenarios that take place. It's very dynamic in the response for 911 for a case, right. It could be that the person received naloxone prior to arrival and has now gone, is not in that location and we're now available for the next run. It could be that we get to that response and we find that person unresponsive and CPR has begun and we contact our fire communication system to ask for additional resources, so the engine would come and assist us with that cardiac arrest. It could be that the person had a reaction to the medications or the drug that they were taking and they're conscious, alert and oriented and just want to go to the emergency room. There are multiple scenarios to the response. But we'll get it, we respond. Our goal is to be on scene within nine minutes of receiving the call and we will exceed that. We're well below nine minutes. That's just a national number, and we provide care and get people where they need to be. Often times AR-2 does self- dispatch and come to calls that are overdosed and if that person chooses not to go to the hospital, they're there to provide some additional support and offer alternatives.

Thank you. What -- I just have a few more. In your opinion, what's the goal for collecting repeat antidote administration within the 30 days? What does that tell you about the extent of the problem? DEPUTY COMMISSIONER McCALL: It tells me that we're looking to -- that we want to show that we got the right resources in the right places, that we have enough resources in the right places and we're looking to get that data, understand that problem and determine what the needs are. I understand that there's a lot of departments that are doing other things and we want to make sure that information is brought together and we're all working in the same direction.

My understanding is that your goal to get -- my understanding then is one of your goals is to get the identity of the person who has had the overdose. Do you ask any of that information now when you respond to a situation? DEPUTY COMMISSIONER McCALL: Yes, it's a question on our patient care report, the patient's name, their address. That information is pretty much asked if you've been in our system. If you provide your Social Security number, it automatically populates that information for us so we try to limit asking people repeatedly the same questions over again. We just try to ask one question and try to populate as many of the fields as we can.

Fields in a computer system? DEPUTY COMMISSIONER McCALL: (Nodding head).

So you have a tablet with you when you go out to these locations?. DEPUTY COMMISSIONER McCALL: Yes.

And so, you're already asking the name, address, getting a little bit of information about the people when you go out anyway? DEPUTY COMMISSIONER McCALL: Right, if we can, if we can get it from them.

I'm trying to understand what the difference would be in this bill if you already respond, administer Narcan, ask them information about themselves, will come out again. What is different here -- what is the difference -- how do you expect to collect additional identifying information about people? DEPUTY COMMISSIONER McCALL: Additional information about people, we're not looking to get additional information. It's a state requirement that we do, a patient care report for every transportation or every interaction that we have. And if we can obtain that information, we get it and put it in our system. It's a requirement by the state, Pennsylvania.

The last question for now and I'll pass it on to others for a minute but I might come back, so thank you. It's very, very helpful. If you are called out for someone, Jane Doe, and you put that information in your system and you're called out again later in the day for Jane Doe, is there a way to look up Jane Doe to see whether or not you administered naloxone to them previously? DEPUTY COMMISSIONER McCALL: No, unless you were their provider that responded initially. You cannot. Privacy won't allow anyone to kind of just research or look back into the history of a particular individual. Once it's in the system, once we report that one report, it's done and finished, it's now off and into our system and no one can access it unless they have specific permission or level of permission to able to do that.

And there are people in your department that have that level of permission? DEPUTY COMMISSIONER McCALL: Correct.

That's it for now. Thank you.

Are there any other members -- Councilmember Nic O'Rourke.

(Inaudible). I will use my outside voice until we get some hot mics. Hello -- we've got action. All right. We apologize for our technical difficulties. And I want to thank you, Deputy Commissioner McCall, for your coming before this Committee and to share your insights. And thank you for the work that you do in our community. I just had a couple of questions, appreciate your report out. In it you discussed a bit about challenges for first responders to discuss accurate data from overdose survivors. What kind of additional challenges or burdens would this reporting requirement put on first responders on the ground, if you can name a few of those? DEPUTY COMMISSIONER McCALL: Well, individuals are not comfortable once they are -- if they're an overdose survivor and we revive them from an overdose, they often times don't want to cooperate or they don't want to provide any information. We are not there to be confrontational. We're here to provide support and services. So if they allow us to transport them, we'll transport them. We'll put in whatever information we have. It may be male, female or whatever basic data we can or whether they provide us. And then we will transport them to the hospital. But if they don't decide to give us anything or they don't want to go to the hospital and they just choose to walk away, then we document that accordingly and we don't have the information.

Okay. And what kind of additional burdens would it create for FDP, OEM and collecting and for the MDO in reporting? DEPUTY COMMISSIONER McCALL: I'm sorry. Could you say that one more time?

Yeah. What kind of additional burdens would this create for OEM in collecting of the data and MDO in its reporting out of it? DEPUTY COMMISSIONER McCALL: Well, I think that the burden would be how accurate, the accuracy of it based upon, you know, how many administrations we had and do we have actually names for and what's Jane Doe or John Doe and we don't know that person's name.

Right. DEPUTY COMMISSIONER McCALL: So these are unidentified uses versus identified. And of those identified, these are the ones that are multiple doses, but then you still have that identified cohort, for lack of a better term, that you would not have data from. You wouldn't be able to get this information from.

Do you have enough skilled data collectors or do you train them? DEPUTY COMMISSIONER McCALL: Really I think that's probably again one of the biggest concerns we have, is the number of skilled data collectors we have to be able to put that piece together. We just don't have that resource available to us.

Thank you. We know that naloxone -- am I saying it right? I usually say Narcan. DEPUTY COMMISSIONER McCALL: Naloxone.

We know that it's considered an important harm reduction tool. We've also heard in this past week or two from the Administration, others that there will not be any City funds going to expand on that or to give that out. If the City stops funding harm reduction resources like Narcan specifically, what will the impact be on OEM's ability to deliver the services that you deliver? DEPUTY COMMISSIONER McCALL: I can't speak to that right now. I don't know what would be defined as harm reducing or not harm reducing. I could not speak to that right to this point.

Okay. If we move forward with these new reporting requirements, will the reports be distributed to all of the Councilmembers through the Chief Clerk's Office? DEPUTY COMMISSIONER McCALL: I can put the reports together and we'll get them to whoever the Chairperson decides to distribute them to.

But they would be made available or made public and accessible to Committee members and advocacy groups as well? DEPUTY COMMISSIONER McCALL: We will make it available.

Okay. DEPUTY COMMISSIONER McCALL: As long as it's de-identified information.

That's enough. Thank you.

I just want to respond to some of the questions or comments that my colleagues made. I think, one, Councilmember Landau, this bill 25 will also help us figure out where the supply is coming from, right. There's a $1 billion open air narcotics sale operation that is happening in the Kensington corridor, just along the corridor. I'm not going to talk about outside of the spaces, which we know is also an issue. But we know that there are certain operations that are in those particular areas that are much more dangerous than others. And so, what I have heard from the AR-2 folks is that it's difficult to kind of pinpoint sometimes where this is coming from. It's also challenging for them to receive funding if they don't really know who they're serving and how to get additional resources to be able to keep them in operation. And I just want to ask you a question. You said that of the 740 calls that you all respond to, does AR-1 respond to those alone or is that citywide? DEPUTY COMMISSIONER McCALL: AR-2?

AR-2. I'm sorry. DEPUTY COMMISSIONER McCALL: AR-2 will respond -- they self- dispatch. So of the 740, they respond with a dispatched ambulance. They may be dispatched themselves or they may self- dispatch and take that call, re-calling the 911 unit depending on --

I thought AR-2 was just for the Kensington corridor? DEPUTY COMMISSIONER McCALL: Correct, so there would be a slice of those 740 that we talked about. Roughly what part of those 740 comes from the Kensington area, well, I'd have to get that number for you. And that piece, that part, AR-2 assists the 911 responding units. They may re-call them. They may self-dispatch with them or they may go on their own or they may be dispatched.

Okay. And then I just want to comment, Councilmember O'Rourke, from my understanding what I had -- what I understand the Administration has done around harm reduction, the goal is not to get rid of harm reduction in the Kensington community or at all. I think that what you're referring to is a decision that the Administration made to remove needle exchange from being an allowable service through the opioid settlement dollars, right, from the opioid settlement money that has been earmarked for community grants. Is that -- Noelle, you're here. You can respond if that's not correct or not. And I'm saying that and I'm putting it on the record because I want to end the misinformation that is out there that my colleagues and I or this Administration want to end harm reduction in the Kensington community. That is not facts. And it's easy to get confused, right. I understand that. And I understand that there's a lot of emotions that are high, but we are not trying to end harm reduction services in the Kensington community. That is not the goal. We're trying to identify services. We're trying to ensure that harm reduction services that are provided out there are actually happening. Because there are people who are making money out of saying that they're doing harm reduction work and it is not happening. So for all of you who are here who are under the impression that we are ending harm reduction, those are not the facts.

Thank you, Councilmember Lozada. Deputy Commissioner, do you mind staying for a few minutes because we're going to take a break to fix our AV situation and there's a couple more questions for you before we let you go. Do you have the time to -- DEPUTY COMMISSIONER McCALL: (Nodding head).

Do you have the time to sit? DEPUTY COMMISSIONER McCALL: Yes.

Thank you so much. We'll take a five-minute recess so our AV equipment is fixed and then we'll be back. Thank you so much. (Brief recess.)

We're calling the hearing back to order and requesting Deputy Commissioner to spend a few more minutes with us. Councilmember Rue Landau and then I will have questions and whoever else is teed up.

Thanks again. I want to first make a statement and then get back to an original comment and then question. And the statement is I think all of City Council is deeply disturbed at the situation in Kensington. We want to all work together to help end the billion dollar drug market to get folks who are using into treatment with long-term wraparound services and long-term housing. And all of this is a part of harm reduction and I think we really are much more on the same page. We all want to solve the same problem, and the question is how are we going about doing it. My questions today are we have limited City resources. I am trying to figure out what information the City already has and what do we need to do to solve the problem. To me what I'm getting from the Deputy Commissioner is we have a lot of this information already. We need it. We would love you to crunch some numbers. We'd love you to crunch numbers with the Health Department and a variety of other entities. We want to see these numbers too. We all know there is a massive problem and we're all ready to roll our sleeves to help with it. I don't want to use limited City resources to do things like counting people and counting things. When what we really need to do is building significant treatment facilities that lead to long-term housing and care and job creation for folks who are going to get back into the market, family reunification, beautifying Kensington, supporting the residents who have lived there for so long with so much disinvestment and with everybody turning a blind eye. There is so much to do. I think we all just want to make sure our resources are put in the right way. So my first question, Deputy Commissioner, is when can we get this data from you? DEPUTY COMMISSIONER McCALL: Well, that's a good question. It all depends on what you're asking for. And most things are readily available to us, so we can probably have a turnaround in a week for the information. It just depends on again what it is you're asking for, how drilled down we need to get. We're keeping a lot of this data now. We recognize what Kensington is doing. We also see spikes in some other areas in the City too. Our AR-2 unit is doing a wonderful job with placement and we want more of that. And whatever we can do to help with that, we're willing to do.

Okay. And then just one point of clarity, and I'm not sure if I missed some questions and answers, so I just want to clarify one point. If you're already asking some information when you come out to somebody, what's your name, what's your address and basic identifying information, what different information would you ask or collect with this law and what kind of enforcement do you see if somebody doesn't give you that information? DEPUTY COMMISSIONER McCALL: I will answer the second question first. The Fire Department, we're really not enforcement when it comes to that space. We're there to provide a service to help people, to get them into the care that they need. And if we don't know, you know, there's no request for resource and you want to be seen by a doctor, we will take you to the emergency room. If you are refusing care, we will contact our medical command physician, we'll make a care refusal. And if that's granted, then you sign a refusal and we will allow you to refuse. We don't get into enforcing people to do anything like that. They give us the information that they want to give. We ask, we request, they provide. If they don't, we know what we have and we take what we got and we contact our medical doctors and we get the refusal, if possible. And we put the information in our reports as we always have. The first part of the question, what other information would we ask, really no other information. The other information, what we need is on the back end in order to see how many times Jane Doe has contacted 911, not for being sick, not for abdominal pain but for overdose, right, and then pull that information out. That's when we would need our special workers to be able to do that, our epidemiologist and data collectors to be able to do that. And that's where we would need the support. Because like I said, we respond to 911. That's what we do. We come out. We handle your emergencies. We put out the fires. We take people to the hospital. We treat for your illness.

Thank you so much. I can't wait to work with you in the future. DEPUTY COMMISSIONER McCALL: I appreciate you.

The Narcan -- are those individual doses? The reason I'm asking this is about tracking, right. So we know when you're given a batch, you know the Batch No. We know how many doses were in there and we know how many are left after use, correct. There's some reporting that goes along on those lines; am I correct? DEPUTY COMMISSIONER McCALL: We don't go that deep in tracking.

Well, we could because we have the Batch No. and we have the Vial No. So the reason I'm asking this is we have all this information available. Is it that we're not collecting it because we're not tracking it or it's not easy to do, that's why we're not doing it? DEPUTY COMMISSIONER McCALL: Well, I don't know -- I know we have a Lot No. --

Right. DEPUTY COMMISSIONER McCALL: -- for the lot of, you know, that box of naloxone. It comes in a particular lot and that Lot No. can be the same and distributed all over the City. We don't have a particular Vial No. that I'm aware of.

So there's no identifier per dose? DEPUTY COMMISSIONER McCALL: Only the Lot No., and that Lot No. 13 could be a lot -- if it comes in a case and it's all the same lot, then you would probably -- you could have upward of 120 in that lot and that 120 would be distributed citywide.

Are you telling me for sure you don't know if there's a unit identifier on the units within a Lot No.? DEPUTY COMMISSIONER McCALL: I know we have never looked at that in our department.

Would you be able to do that and say that in a batch there are so many units available and are those units tagged with a specific number because that's how it's produced? I don't know what you get in your package because that would allow us to do tracking much more effectively, right, so we know what batch went where, we know how many doses were in there. Without identifying who used them, we would know the consumption side of these Narcan doses. That's the question I'm asking. And that would be correlated to your zip code where they were dispersed. And that cannot answer the question of second use, but at least it will give us the volume of what's going on. So that's one question I would like answered if you have that data. DEPUTY COMMISSIONER McCALL: We don't have that data. We only go by the order of naloxone. We note it as a Lot No. I know that each vial may have a bar code on it. We do not get down to scanning each particular bar code to identify each dose of naloxone. We only go by we set par levels for each unit. So, for instance, Medic 31 on Second Street may have a par level of 100 doses of naloxone. And when they get down to 50 doses, we know that they used 50. So we then replenish them with 50 more bringing them back up to their par level.

So we do have that number, what is being used. So I think one of the issues that you brought up about the usage of Narcan in certain areas, we extrapolate those numbers from the total number used even if you don't go down to the nitty-gritty of labeling. DEPUTY COMMISSIONER McCALL: Yes.

So that data is available to us to say if we look at the City map, we can see where the highest Narcan use was along some axis, correct? DEPUTY COMMISSIONER McCALL: Right. And I provided 19134 in 2023 used 784. 19133 used 250. 19124 used 237, so we keep those numbers.

Those numbers. And the second thing is about we are anonymizing people. We don't want their names and anything, but somebody has that data, correct? DEPUTY COMMISSIONER McCALL: Correct.

And HIPAA-protected data about who. And if we are trying to help people to recover from their addiction disorder, substance abuse disorder, who has that ability to target folks to offer help which they might not have taken at one point, but if there's an intense engagement with harm reduction specialists will that change and then how are we to target those people to say this is someone who has had -- if you're able to capture the number three Narcan survivals and we need to send our social worker or our public health folks, whoever it is, to engage with that person because they've already been revived so many times, are we able to pinpoint to give that help? DEPUTY COMMISSIONER McCALL: Chairperson, I think what we're talking about is the prehospital care is what I'd like to call it, right, and that is identifying people before they contact 911 and doing that outreach to get them into the right places, right. And we're trying to put work into that space now. We're just getting the resources together. And Fire Suppression, they call it community risk reduction and in EMS world, Emergency Medical Services, we call it mobile integrated health and we're looking to combine a lot of that work, community risk reduction, mobile integrated health doing a lot of pre-prehospital work, right, and get into the community by identifying those who may need or has been in the system in another way we've transported prior, identifying them and having that connection with them and ensuring that, if they choose, get the appropriate care and the directions because some people may not be aware of what resources are available to them. So we want to be able to connect with those people through our AR units. And this is what the AR response, the mobile integrated response, the community risk reduction response is so critical for us going forward is because we need to be able to get to that pre-prehospital care. It allows us to take a lot of the -- to reduce our response, 911 call response numbers, but also get people to the right places. And I think that's the primary goal is get people to the right places.

So this bill would help you in doing that? DEPUTY COMMISSIONER McCALL: Yes, because I think it would -- I made this mention earlier. There's a lot of departments doing different things. And I'm assuming that this bill is not just the Fire Department's work. It's other departments as well, and then we can use that data collectively to ensure that we're getting the right people, that is, the Department of Health, Behavioral Health and DBHIDS. DBHIDS, are they seeing the same people we're seeing, are they seeing something different than what we're seeing. And then we can use that work in a pre-prehospital environment.

And also, data collection allows us to ask for federal -- why we need numbers, right, is to be able to justify asking for funding from the sources in order to support the work because our resources are limited. And so, whether it's how we are disbursing the opioid settlement money, we need to have underlying data to support to say in these zip codes we got so many, these were second time or third time revivals, this is where the need is and articulating the need with the use of that data. That's how I see this, right. And you're telling me this is a helpful bill 3 to do the pre-prehospital support that could get long-term care in the horizon for the person with substance abuse disorder? DEPUTY COMMISSIONER McCALL: Yes.

Thank you. Are there any other questions? (No response.)

If not, thank you for your testimony and thank you for being so patient. We can call the next testifier. DEPUTY COMMISSIONER McCALL: Thank you.

Signed up to testify for Bill No. 240015, we also have Shoshana Aronowitz and Mar Schneider. If you are here, please come to the table. (Witnesses approached Witness table.)

Hello and good afternoon. My name is Shoshana Aronowitz. I'm a substance use disorder treatment provider, health services researcher and an assistant professor of nursing. I'm also a resident of Councilmember Squilla's District. I'm here today to register my concern with Bill No. 240015. This bill does not just require City employees to track the number of individuals who have been administered naloxone, but also requires them to keep records of repeat opioid antidote recipients. I'm not necessarily in opposition to data collection, but I believe that the people of Philadelphia deserve clarity about the purpose of this bill and the guarantee that this type of data collection is being used to inform investments and evidence-based public health policy. We are in a moment of increased hostility towards people who use drugs. In light of the current climate, my concern is the creation of a data pool that attempts to surveil marginalized people, split this population into compliant and noncompliant or mandate a single path to treatment, none of which are evidence-based approaches to substance use disorders. Coupled to Bill No. 16 240017's intent to document reasons for refusal of services, the language of these bills suggest an intent to hold individuals responsible for the City's failure to provide adequate services. Again, the people of Philadelphia deserve clarity on Council's intentions. As a researcher in this field, I understand and support the collection of data to improve quality of life outcomes. However, scrutiny of research questions, methodology and protective measures for the data collected are equally important. I'm deeply concerned that the data collected under this bill could later be used to exclude patients from needed services or even criminalize people whose lives are saved by naloxone more than once. Thank you.

Let's have the second person testify. Please state your name and go ahead with your testimony, and then we'll ask the questions collectively. Okay.

My name is Mar Schneider. I'm a resident of Councilmember Squilla's District. I live in the Kensington area as well as do outreach work in harm reduction in Kensington. I'm here to express my concerns also about Bill No. 240015, a bill that is about reporting in data collection of opioid antidote use. This bill is calling for City employees to record data on numbers of individuals that have been administered naloxone for overdose reversal. Particularly troubling to me are the reporting requirements asking employees to track individuals who qualify as repeat opioid antidote recipients. What good reason does City Council have to take data on repeat opioid antidote recipients? What are the intentions here given the statements of some members of Council to introduce involuntary treatment or jail those who refuse? If someone receives what the Council considers too many overdose reversals, will they become a candidate to be committed into treatment if they seek medical examiner after receiving naloxone? What are the implications for health privacy and HIPAA protections? We already have some examples of policy affecting this community that restricts access to basic needs such as shelter policies that prohibit the admission of individuals due to active drug use. Often these policies are framed as incentivizing sobriety, but we know that in practice these policies cause harm by cutting people off from basic needs for survival. I'm concerned about the intentions and the implications of this bill within the current political climate of City Council. The people of Philadelphia deserve clarity about Council's intentions for this bill as well as the assurance that any proposed data collection will not be used to further restrict access to resources or further criminalize its community. Naloxone is also merely one strategy to save lives, others being safe consumption sites, access to safer use supplies such as clean syringes, safe supply. All of which are necessary to work in tandem with pathways to recovery should people desire to pursue treatment. The full scope of this bill doesn't clearly see the full picture of the reality of needs to address the overdose crisis. At best, this bill is a potential drain on resources. And at worse, it has the potential to further harm the community and ostensibly aims to help. Thank you.

Thank you. Any questions for --

Yes.

-- these folks?

I just wanted to make a statement and I thank you for being here today.

(Inaudible).

Thank you, Madam Chair. I just wanted to thank you for coming down today and for your concerns. I just wanted to say that I think sometimes people have the assumption that government knows everything and government has all of the answers and that government, you know, that we just have a sense of everything that's happening in the universe when it comes to this particular subject. And I just want it to be clear that the purpose of data collection is to help us to be able to better address the problem that's really been alluding us for a very long time now. We really have not been able to get to where I think we should be by now. And maybe if we had the data some time ago, we would be able to have an idea of the scope of the problem. If you ask us now how many beds are available right now in the City of Philadelphia for treatment, how many treatment facilities are available with open slots, how many folks are lined up, is there a waiting list, is there not a waiting list, these are the kinds of questions that you really just have to answer in realtime to be able to fix this problem. And I think that that is what the sponsor's aim is, is to be able to fix the problem. But you can't fix it without data. Data is absolutely necessary to be able to figure out what can we do, how can we do it and how can we provide care to the people who need it the most. I'll be voting in support of both of these bills because I think that we need the data to be able to make educated and crucial decisions around this very important topic. Thank you.

Any other Members have questions for these two witnesses? (No response.)

Hearing none, thank you so much for your testimony. You're excused. Clerk, if you would announce any further witnesses who are here to testify.

There are no 18 further witnesses for 240015.

Any other comments from any members before we move on?

Yes. I just want to say thank you to everybody that came to testify today and to those who also submitted written testimony whether in opposition or in support of. To follow up on what Councilmember Bass said, it is difficult to be able to sometimes make decisions blindly, especially if you work for government who often times has the tendency to work in silos and we don't share information. And so, I think that the EMS folks coming out and sharing the information that they have and even saying that they have it, right, is appreciated. We've asked for information in the past and we've not been able to get it, not just from them but from other City departments as well. And so, unfortunately having to put bills or ordinances or resolutions on the floor is the only way we're going to be able to capture some of this data in order to be able to address the concerns that are on the ground or be able to tap into resources at the federal, city and state level to help us resolve and restore quality of life. So I just want to say thank you to everyone who came out today.

Councilmember Rue Landau has another comment real quick.

Yes. Just a quick comment. I'm an internal optimist who believes that this Administration is working towards breaking down the silos as much as we want to see them broken down and information shared. It seems to me if we're not questioning the Fire Department, they have a lot of information that we need -- and I hear you, Councilmember Lozada, that you've asked in the past. But I don't know that we've asked since this Administration has been in power in the City. And I would hope as somebody who has been on the other side and worked for the City and also somebody who likes clear laws that are enforceable and not unnecessary laws and I want to make sure that we've done everything we need to do before we pass a law to make it happen. I believe the Fire Department from what we heard today, I didn't know, they have a lot of the information we need. Let's get it from them. We've now asked them on the record and they said they'd supply it in a week. Let's get it. Let's look at that information. Let's see what else we need. Let's see if this is necessary as a next step. But I strongly believe that we can work in partnership together with the data to find out everything from how many beds do we have, how many are available, how many slots do we have in outpatient, what are the barriers for people to get into the beds and housing, how many treatment facilities do we have that are funded, what's working, what's not. It's all there. We just have to ask for it again and that might be frustrating, but I think we ask for it again, let's get that information. Let's see what we have, what we need and let's work on what we need. Thank you.

Thank you. If there are no other comments from anybody else on this panel, this concludes the public hearing. We will now go into a public meeting to --

(Inaudible).

Oh, we have to do -- we do it together. Okay. Now, we will consider Bill 1 No. 240017. The Chair recognizes Councilmember Lozada to speak on this.

Thank 6 you, Madam Chair. 7 Bill No. 240017 will help 8 us to understand the repeat 9 obstruction of walkways in the City 10 of Philadelphia which causes severe 11 economic health and public safety 12 issues. Children are exposed to 13 dangerous individuals in difficult 14 conditions that remain persistent 15 throughout some parts of the City 16 but more prominent in the 17 Kensington community or in the 7th 18 Council District. 19 Individuals repeatedly 20 occupy sidewalk spaces and outdoor 21 spaces unlawfully posing a risk to 22 the public and themselves and who 23 are often under the influence of 24 narcotics. And so, the goal really 25 is to -- the goal of this bill is really to try to figure out how do we offer supportive services to these individuals and how do we clear up our public spaces, how do we restore a quality of life for some of the businesses that are impacted by this and how do we bring people we talk to in, out of the elements. We talk a lot about making sure that people are connected with services. We talk a lot about people who are suffering from extreme health conditions aside from their addiction and we talk a lot about the resources that we should be connecting people to, but we can't do that if they're out in the elements, you know. I always find it extremely frustrating when I get phone calls from some of the very same people who are calling about issues as we try to address what is happening on the ground in Kensington that are calling and concerned about dogs or pets that are left outside but who will not allow us to address the needs of individual humans who are sitting on our sidewalks. And so, this bill to me will really allow us to figure out how do we bring people in and out of the elements, how do we bring people in and really monitor them, their physical condition. I don't believe and the folks that I talked to on the ground do not believe that we're going to be able to address and connect people to services unless we address what they're experiencing physically. How do we stabilize them physically, how do we take away some of the pain that they're experiencing from some of the wounds that they have before we're able to present them with an opportunity of real recovery. And so, living on the streets in certain conditions, especially in severe snow, rain, cold, to me is not acceptable. And we've not been able to do anything as a City to be able to bring people in and prevent them from camping on our City streets. So I'm looking forward to the conversation and hearing the testimony today.

Thank you, Councilmember Lozada. The Clerk will please call the first witness to testify on Bill No. 240017.

I'll also read the title of the bill. Bill 17 240017, an ordinance adding a new Chapter 10-2700 to The Philadelphia Code, entitled "City Reports on Impermissible Camping," to require certain reports from the Office of the Managing Director to Council concerning camping activities carried out in violation of the Code and the City's efforts to address such activities, all under certain terms and conditions. And our first witness is David Holloman, Interim Director Philadelphia Office of Homeless Services. (Witness approached Witness table.)

Good afternoon, everyone. Good afternoon, Chair Ahmad and members of this Committee. I am David Holloman, Interim Executive Director for the Office of Homeless Services here to testify on Bill 16 240017. This bill was introduced by Councilmember Lozada. This bill 18 adds a new Philadelphia Code Chapter, entitled "City Reports requiring Certain Activities on Impermissible Camping." It requires certain activities to be reported in -- sorry about that. It requires certain reports on camping activities concerning violation -- hold on. I'm sorry, guys. It requires certain reporting activities in violation of this Code in the City's efforts to address certain activities. As we discuss this legislation here, it's important to highlight the efforts of the Office of Homeless Services Realtime Encampment resolution. In 2023 the Office of Homeless Services conducted two encampment resolutions. 1,272 service day connection clean-ups. Out of this, 982 of those service day clean-ups was in the Kensington areas. Despite all of these efforts here, to percent of 19 the encampments represent 20 individuals who are unhoused in 21 Philadelphia. Still 25 to 30 22 percent we see pop-up encampments 23 every day and constantly 24 relocating. I'm extremely in 25 gratitude for the partnership and collaboration of this City Council in efforts to reduce homelessness and for the well-being of citizens in Philadelphia and in our community. At this time I will take any questions you may have.

The Chair recognizes Councilmember Lozada.

Dave, I want to say thank you for being a consistent partner, right, and for always being transparent and always being honest and for correcting me and my colleagues when we don't have the correct information, for sharing your expertise with us honestly regardless of where you are and regardless in front of who we are in front of. And I want to say that publicly because not many people can do that consistently. Can you tell me how many people are actually living on our sidewalks?

I can only reference in 2023 point-in-time count, and that is a count that is conducted every year by Philadelphia that is required by the federal government. In 2023 we encountered individuals sheltered and unsheltered, so this a total number of 4,725 individuals. 706 of them were reported living unsheltered on the street. I want to caveat this. Because it's a point-in-time count, we understand there may be people who are doubled up, living in cars that we have not been able to encounter. And so, that number again represents a snapshot in the moment. We're currently working on 2024 point-in-time count.

We often hear that the number of -- the count number is not the same or that it is different depending on who counts. Who else does this count and how often does it happen?

Yes. So the City of Philadelphia is mandated to report to the federal government once a year. This count usually takes place January, the third Wednesday of the month. However, Philadelphia conducts also four quarterly counts that is ran by the Department of Behavioral Health in partnership with Project HOME. This allows us to look at trends in certain communities to allow us to see where there's homeless individuals living, and these counts are conducted four times a year.

And the police department does a count as well, right?

So the police department -- there's been a lot of conversation around the police count. So the police department does do a count. I would consider that count to be a census count because it doesn't reflect any methodology. It really just gets into who is out there during certain times period at night. The difference between the police count and what we consider to be a count is conducted by homeless outreach workers and other social service providers is that it is done with a methodology. It's usually defined by certain zones where homeless individuals have been appearing in certain areas. What we have seen, and I want to put this on record here, is that the numbers that we have seen by law enforcement, especially in the Kensington area, have been sort of consistent over the last couple of years as we have seen higher numbers in the Kensington area of people who are experiencing unhoused and homelessness at that time.

When we do the encampment resolutions, how successful are they? How many people actually do come in out of the elements? How many people take their belongings and just walk away and move to another location? What are the real numbers?

You know, I can get back to you on those numbers. What we have seen, so there's the concept -- there's an encampment resolution that has a 30-day concept. And that 30 days allow us to provide a binding list where we gather information from individuals who are out there and determine whether they need treatment, whether they want shelter or whether they want to be relocated with family members. What we have seen in the past is that about 20 to percent 25 of those individuals depend on how large that encampment takes us up on services at that point in time, and it's really what's available at that moment.

Have you all -- when you're doing your count, have you all engaged some of the businesses that are impacted as a result of some of the tents and some of the belongings that some of the people -- have you guys engaged them? And if so, can you share some of their concerns, some of their experiences or some of their challenges with us?

Absolutely. So we are in direct conversation with many of the businesses that reach out to us requesting a service day clean-up. In some cases we're able to assist, but there are cases where there is private dwelling where we're unable to participate in a service day clean-up. And the reason for that is that we collaborate with partners such as the Philadelphia Police Department, the Department of Behavioral Health, CLIP and other City entities. And so, I would say the rules of engagement going on the private dwellings limit our ability to respond as appropriately as we would want to.

There's a perception that when we do encampment resolutions that we throw people's belongings away. What do we do with folks' belongings when we are moving folks along who agree or accept services and what do we do with the belongings of the individuals who don't want services but don't choose to take their belongings with them?

So let me first address that issue there. So everyone when we conduct an encampment resolution, we give more than adequate notices. They're presented with hand bills. Outreach teams are out there day-in and day-out. We also provide storage for anyone who is willing to go in. Even in cases when people are unwilling to go in, we provide up to 30 days of storage for facilities. We partner with L&I to where we are documented that process so that no one can come back and see that we were throwing things away, but we do have storage available for any encampment resolution that we conduct.

And my last question, what was that number you said of homeless folks, 4,000?

725.

In 2023, point-in-time count, there was 4,725 individuals sheltered and unsheltered. Of that, 706 were unsheltered at that time.

How has that number changed over the course of the last five years?

During the pandemic, we have seen numbers fluctuate. There was a lot of federal monies on the street. And so, some of the individuals who were traditionally residing on the street end up benefiting from a lot of the stimulus money that was available in many of the communities. As we have seen in many other communities where many of that monies have dried up, we're starting to see a steady rise of homelessness, not only just in Philadelphia. There's a 12 percent rise and continuing rise as many of those dollars are beginning to dry up.

And do you think that that rise has to do with -- what do you think is driving that rise?

I think that's a combination of factors there. I think rising rents. I think people have complicated lives. You know, when self- reported in our shelter system, there's about 45 percent of the people who come in self-report either struggling with serious mental illness, substance abuse or physical disability. The average amount of income in our people who utilize shelters are 861. One, that tells me that they're on a type of entitlement benefits. When you look at rents in Philadelphia, with one bedroom rent being at fair market rent is about $1400, even with someone who's on an entitlement still can't afford that. The other threats that we're starting to see that is continuing to be on the rise are people who are young, college-educated that are living in cars because they can't afford rising rents. And so, when we talk about what do we see, the factors there, there's a number of different factors that contribute to why people are experiencing homelessness out there, not along the opioid crisis where we've seen the heightened of this in 2018 in your particular District, Councilwoman.

And so, do you guys collect data and can you share the data of folks who are actually living in addiction, folks who are homeless because they can't afford to live anywhere, homeless because they are in some type of domestic situation, homeless because they choose to be not because they don't have anywhere to go, is there a way for us to be able to take this number of unsheltered population and really break it down to figure out who is truly living in addiction, what's that real number and what are those other buckets that the other folks fall in? Is there a way for us to do that?

So we collect data on service day connection and that's basically self-report, people who are willing to give us information. So we can have some of that data already available. However, we also collect data at our front door of our intake sites, and that is through our homeless management information system. And again, that depends on what information is available based on self-report. And usually those assessments range anywhere from where were you staying, are you fleeing domestic violence, a wide range of life- safety questions that are available there. We also ask the questions are you struggling with any form of addiction. We don't get into the diagnosis or anything like that because we are not a HIPAA-protected agency. And so, we really get the baseline of information.

We heard earlier, someone referenced, I think it was Councilmember Landau and even Councilmember O'Rourke may have mentioned this, and you and I have talked about my frustration over beds. I find it really difficult to understand how as a City we're able to book a flight. We're able to book a vehicle. We're able to book a hotel. We're able to keep track of a bunch of different things, right, just by going online and clicking a button. But we're not able to track beds. There's not one central location where if an individual says to you, I'm ready right now, for us to say there's a bed right there and that's where we're going to put them. Why is it so challenging to do that? Why is it so challenging to say I don't care what kind of bed this is, this person is ready to come in out of the elements right now. We need to get them in that bed, stabilize them to a point where we can then figure out what their situation is and then move them into a more appropriate bed. Why can't we do that as a city of the first class whereas I mentioned to you, right, central intake to me is supposed to be that space? Why is that so difficult? And is that difficult? And is it as difficult as we think it is or is it that we choose not to find those beds quickly as we can, right, because we talk to providers and they're like we have beds and then you talk to other people and they're like, there are no beds available?

So let me lay this out. I would love to have realtime data. The system is a little bit complicated. From 7:00 a.m. to 5:00 p.m. we have centralized intake. We have the ability to look up beds within our system because we operate and run those systems. In the after-hour where subtracting -- we're relying on a number of our providers entering data into the system. Here is where the challenge comes into play. Because it's on a first-come, first-served basis, those beds can change by the minute. And so, if you have 24 people in the lobby and just say 25 you have 10 beds there, you really don't have 10 beds. You really have no beds because it's first-come first-served, and this is happening throughout the entire system. We need to get to an area where we are looking at realtime, but I think that requires some systematic changes. One of the things that we're looking to do is have OHS City-level staff be in our after-hour intake site hours 13 because we know homelessness is 24 14 hours a day. This would allow us 15 better accountability, more 16 accuracy and making sure that data 17 is entered into the system 18 appropriately. 19 We also serve as the feeder 20 for multiple systems that allow 21 many of the challenges of why it is 22 hard to get realtime data. We have 23 talked to other communities and 24 looked at their systems. Philadelphia, because it has a first-come, first-served basis, it's very hard and challenging to do that unless you are prioritizing beds and holding beds where you start to hold and keep an accurate count.

How do we work with our partners across the Commonwealth to identify some of these beds and some of the resources that we can connect people to when they're ready to come in out of the elements?

So the City of Philadelphia for emergency housing beds are what the City finds. I want to be very clear with this because if you look at some of our website, we have what we consider the housing inventory chart. It is required by the federal government to capture every bed that's within your continuum even though you may not fund them, even though you may not control those front doors. In City-funded shelters, we have 3,111 beds. We expand capacity during the winter initiative months. It is difficult to manage beds that are outside of our systems. We really rely on those partners that are willing to work with us to make their beds available. Some of them have different guidelines and regulations on how they accept beds. I know we have talked a lot about low barrier over the last several years, housing first. Not every provider is there yet. We are working with them to get them trained around that. Some people are honestly afraid to deal with some of the folks that are dealing with some of the opioid challenges as it relates to open wounds and different things of that nature and not always make those beds available for us.

How do we as legislators help facilitate those conversations? What are the fears, right? How do we fix that, right? Because if folks are coming to our City, if folks are coming to Kensington from across the Commonwealth, from across the U.S. and they're living in encampments, how do we help the Office of Homeless Services or how do we help our departments work across the Commonwealth and across -- I don't know. Just how do we help be that voice and bridge those resources for you? Because having this many people living in a concentrated area and if we're, you know --

We need to have --

-- to teach the resources, right? I'm just trying to figure out how do we help you get them to the table and really start sharing information that is going to connect people and bring people in out of the elements? Because again, I find it really stressful that we are providing wraparound services to people living on a sidewalk. I can't wrap my head around that, and it's frustrating to me.

What I'm going to say here is probably controversial and not always agreed upon with everybody. I think we take a philosophy that there's no 16 wrongdoers. For too many years we have talked about housing first and low barrier, and we haven't done a really good job of educating the public and providers around that. Low barrier doesn't mean low expectation or no expectation. If you're a provider that has five beds, we need to be working with you to figure out how do get those five beds. The one thing that we have as it relates to homelessness, we have people that are dealing with all walks of life, and there may be some people who are at the beginning of their recovery, but there may be some people who are really deep in their recovery and want a recovery-based setting. We need to welcome them into the tent, and that's one of the things that we're talking about, is that we want to, one, provide adequate training, technical assistance. One of the things that we're immediately doing as our team is going out doing quality assurance, making sure that we are out there seeing the providers, seeing where there's limitation at and providing adequate training. But not only that, I think with the resources that City Council, the Administration provides, general funds allow us to have a lot of discretion in terms of how we're able to serve. When it comes to federal resources, there are a lot of requirements that come with those dollars. And sometimes they're extremely helpful. I'm not going to say they're not helpful, but it also puts tighter restrictions on how we're able to identify help for individuals there. So the one thing that I want to do is again talk about this in a way that is not frightening and to provide educational opportunities to our providers because I do believe there's enough providers who want to help, but they just have not been given that proper level of technical assistance on how they can help. And again, this has to start with no wrongdoers.

Thank you.

Any other -- yes. Councilmember Rue Landau.

Thank you so much, Acting Director Holloman. I appreciate your time. I want to start by saying how much I appreciate this conversation and giving us the space to have it. Certainly easier than doing it during budget season and we get a little more one-on-one time with you, so that's good. I also want to thank Councilmember Lozada for being a champion of your neighborhood, being a champion of Kensington, doing all of the hard work until now and knowing that there are so many us who want to help for the next steps. I look forward to my walkthrough with you. And there are problems to solve that have been so frustrating for so long because we would assume -- we're the sixth largest city in the country. Why can't we just share this information, create this infrastructure and make this happen. As the Chair of the Information and Technology Committee and the Vice-Chair of the Housing Committee, you better believe I am very interested in creating something for the City. Even if it's a Craigslist of beds, we have to get together what exists, what's open, what's free, what are the barriers to entry to those beds, let's reduce as many of those barriers to entry as possible, but we have to be able to keep an on-time inventory for folks who are in crisis or need things immediately. And this is not for you to solve directly, Mr. Holloman. This is for us to collectively come together as a City to know we have what we need. That's what I've been saying this whole time. What exactly do we have, what do we all need to know and then how can we all solve the problem. It feels like it's right there and I think our eyes will open a lot when we get all of that information. But just to be clear to make sure I didn't miss anything here, do you currently count folks who are at least in this proposed bill impermissibly camping? Do you count those people when you go -- your point-in-time count that you do, do you count who's in a tent or who's just on the street?

If they're in tents, we count them also.

And are they counted as sheltered or unsheltered?

They're considered unsheltered.

Okay. Do you distinguish in the data that you collect unsheltered in a tent or unsheltered and sleeping on the ground?

We don't when we report to HUD. Their methodology is restricted on that. You have to count them as unsheltered or if they're in a shelter, one of the shelters that we operated. But they're counted as unsheltered.

What would you need in your department in order to comply with this law?

I think we would need to look at what are you requesting from a reporting standpoint. If there's something that -- I would love to have a conversation or sit with many of you to figure out what makes sense. There's a lot of data that all of our departments collect already but doesn't make sense for what you want to consume. So I don't know exactly what you're asking in terms of what you want to report on. If it's just around encampments and cleanup, we can capture that data. If it's information that who's coming in at the front door and what are those symptoms that have led people to experience our services, we have a way to capture that too. I would just need to know exactly what is that cohort of data that you're looking for that makes sense.

Okay. I think that's it for a minute. Thank you.

Councilmember Nic O'Rourke.

(Inaudible). There we go. We figured it out. First of all, thank you for the work that you provide and what you do in the City. Just a few questions. And I apologize. I had to step out so if this was already asked, I do apologize for muddying up the waters, but just let me get it for my own team's purposes. Based on your experience, will the reporting requirements that are set forth in this proposed legislation give you any new information beyond what you already collect?

I think any time that you're looking to improve the quality of service that you're doing, data plays a very important critical element on that. That's why I would love to work with you closely to figure out what are those reporting structures that you will love to have because there may be something that we have not seen. What I would like to say is that we have to think about this in a newer era. You know, we had what homelessness looked like before the pandemic. Then we had homelessness during the pandemic. Coming out of the pandemic, there's a new phase of homelessness so there's a lot of information that we need to learn and how we need to adapt our system. And so, I'm always intrigued about what are those possibilities of what we're seeing so that we can get ahead of that curve.

So it's possibly the case given the new context within we live post- pandemic --

Absolutely.

Thank you. Are there any current barriers to OHS's collecting data around encampments that you can name or list?

Can you repeat that? I'm sorry.

Are there any current barriers to OHS's data collection around encampments?

Yeah. I think when you get into the client- level data. Again, a lot of this is self-reported, whether people are willing to give you information. One thing I want to be clear on is that we do not go inside of someone's encampment because that creates safety issues. So you're really relying on information, if the person is willing to engage with you and how much information they're willing to give you.

Got it. So the barriers are the actual tenants of the encampments themselves being willing to divulge information to you?

Absolutely.

Copy. And this is kind of a general question. This body is obviously extremely concerned with addressing the crisis of homelessness in Philadelphia writ large, obviously particularly in Kensington. What can this Council do to better empower OHS to address encampment issues beyond supporting data collection efforts?

One, I appreciate the opportunity right now to talk to you because there's a serious interest, homelessness, and I love the idea that you guys have shown the passion around that. I think funding is always critical.

Funding is always critical.

Always critical. The other thing that I think will be helpful too, and I've been doing this for a while, we always have the idea not in my backyard. And so, when we start to think about opening up new facilities and being creative in terms of housing, it would be extremely helpful that this body, this City Council body here, help us to open up facilities that may be in your backyard. We also have to understand that Philadelphia is the city of neighborhoods. Many of the people, especially when we talk about the Northeast, South Philly, many of those individuals are from those neighborhoods. But because of the trauma that they are experiencing they do not want to leave, so why create more traumatic events in their lives versus where we can help open a facility in those neighborhoods. I understand quite frankly all of the stereotypes that go with opening up a shelter and all the different things that come with that. We can partner on educating the public on things they just don't know. Shelter works for a number of people. There's a lot of people that -- last year alone 14,000 people utilized emergency housing. Keep in mind, we only have 3100 beds. Those beds turn over an average of four times with an average length of stay between 130 and 140 days. They work for someone. The idea when -- and I'll be honest, I cringe when I hear shelters don't work for anybody. Well, let's figure out why it didn't work for you and let's get it right. I'm not going to say everybody does everything right all the time because we don't always get it right, but we're willing to work to figure out how do we help people transform their lives. There's no thorough ways. So the one thing that this body of Council can do is help us to break in those relationships and those communities where Philadelphia still have pockets of affordable housing. There's still inventory stocks that we haven't been able to capitalize because of the fear and the stereotype that goes along with treating people who are homeless.

Thank you for your answers and thank you for raising that point 1001 percent as we say. There are no 11 throwaways. Human beings are just that. They're endowed with the dignity that God created them with. And so, I appreciate the work that you all do to see to it that folks have shelter over their heads certainly as we're trying to address some of these issues. Thank you so much.

Thank you. I have a quick question just going back to the ability to assess the number of beds. Our technology has outpaced so much and if we create room for you, would you be able to come back to us to tell us how do we have a realtime count and find the resources we need to do that? We have technology giants that could come in and support you in that work without costing us a dime. Just sort of address that. What is the barrier in this 21st century for us to do an accurate count of available beds in realtime, even when it's a first-time, first-come basis?

Yeah, we would love to work with fellows. We have the best universities around in this town here. There's no reason why we can't partner with some students that are looking into the data. I don't think that we shouldn't be exploring those opportunities. I was extremely excited that the Mayor held a health convening last week. I think that is the right approach to do this. The same way when we talk about data, how do we work with these institutions here in the City of Philadelphia to figure out how do we have realtime data.

So a follow-up question: The communication and cooperation with the Department of Behavioral Health and Intellectual Disabilities and the Public Health Department in addressing this because I believe the beds are the purview of the Department of Behavioral Health; am I correct in that?

The treatment aspect, yes, ma'am.

Treatment beds, right. So the realtime data to know which ones are treatment beds, which ones are just for housing folks who are down on their luck, whatever the case may be, we at the moment have -- there is no effort in our City to do that; am I correct?

I can't speak to that. I know one of the issues that we've run into in the past, we need a bilateral agreement. And that's usually a business agreement between HIPAA-protected agency and nonHIPAA-protected agency. That's always been sort of a challenge there. I think if we have such an agreement that could be in place, I think then we can begin to put those tools to where police, EMS, Fire all can see the data, can report into that data. Unfortunately, we haven't gotten there yet.

Okay. So what I'm hearing is breaking silos, bringing more organizations together and involving other resources who have the ability to do this. They don't have to permanently become government agencies, but they can give us the support and this will allow the federal government who has the bigger dollars to really have more flexibility around those dollars. Something I heard you saying and I've heard before, there's inflexible federal dollars that really silo us further. And so, that's a conversation we can advocate for because we're seeing on the ground level the money they're sending is not working because it's siloed so much. Well, thank you for that and thank you for this incredible amount of work all of you do. You are our unrecognized heroes because you're there on the front line talking to people nobody else does. We walk by folks, don't even acknowledge that they're living human beings sitting by the side. And so, all of you and your staff and your department and the Fire Department has let all of you to do an immense amount of work that nobody else wants to do and we want this problem gone away, right. These are our brothers and sisters and we have to find fair, equitable ways, empathetic ways to do it. And I think all of this panel are in one mind about doing that, what is the best use. When we talk about Kensington and we talk about the children who live there who are not substance abuse disorder folks, we have to remember them in that equation as well. We have to be equally empathetic for those who are stuck in this quagmire of ill health. And for us to be a health city, we have to look at both sides of -- what makes up this equation, and we cannot forget them at all. And I applaud my Councilmember Quetcy Lozada who has stuck out her neck and advocated for this and got a lot of heat for that. So I commend your courage to stay the course and to speak equally, forcefully for those who have disorders and need help and those who are there because they're not able to leave the area. So we have to think about both those situations. You talked about NIMBYism, Not In My Backyard. Philadelphia is full of that. And we have to challenge Philadelphia, all Philadelphians who don't live in Kensington to be part of that solution, to be understanding how they can contribute, not just point our fingers, oh, there's Kensington, that's an eyesore, we're not going to worry about it, we're just going to clean it up. We can't clean it up. We have to be empathetic, evidence-based how we do this, which is why we're having this hearing. And I want to really thank you and continue this work because we need a continuing dialogue. As Quetcy said, we don't know everything. We don't have all the information and there's a vast arena of folks. We have harm reduction folks who have been here. I thank them for their testimony to talk about the perspective they bring. That's important. All of this together should result in a solution which has been spearheaded for Kensington. So we look forward to doing that. I just want to thank you and excuse you. We are now going to -- oh, there's one other person ready to testify?

Yes --

And the Clerk will call their name.

-- Madam Chair.

I'm so sorry. I didn't realize there was -- I gave the speech before the last testifier.

Also signed up to testify on 240017 is Sterling Johnson. (Witness approached Witness table.)

Hello. Hello, Council Chair Dr. Ahmad, it's good to be back in person to see everybody here. I'm just going to go into this testimony. But I mean, I've sent it, forwarded to -- maybe I'll just say a few things and highlight a few points. So my name is Sterling Johnson. I'm part of a coalition for dignity and treatment. We're focused on making sure that there is dignity and other services of the City around people that are experiencing homelessness and other marginalized identities. A member of Philadelphia Housing Action. I've led several defenses, campaigns for housing in our city, specifically the 2020 Parkway encampments where we were able to get a lot of people into housing and those people are still there. But I will say -- actually a lot of people are not due to the fact that there isn't long-term housing solutions. Currently a member of the Office of Homeless Services Racial Equity Committee, so that's an issue I care deeply about. The fact that whatever we do it has to be implemented in a racially just way. For here I have concerns about Bill 240017, and I especially care about the information concerning (inaudible) reasons for refusing services that were offered. The City has a process for getting that data through the Managing Director's Office already. The evaluation for encampment resolution process already exists. 2018 you should look at some of those recommendations. And I guess to be clear, I'm not pro-encampment. I'm pro-having housing options for people. We need more investment in permanent and long-term housing, housing subsidies, housing vouchers. There needs to be an expansion of safe havens that are (inaudible) based. I know people that have been in safe havens. They're not the usual shelter, but there's not enough beds. I come up here to say then doing homeless work in Kensington and Center City and in North Philly and in Southwest for some time, you know people that have substance abuse disorders. You know people that have wounds on their bodies that have healed. You've seen change. You need to invest in it. I'm worried that we're putting resources in these spaces and taking I guess or building some case for the fact that people are refusing services. But I do know if the services were available and sometimes they are, sometimes they're not, when they're available, they work. And why do I know that? Because I've helped many people get into those services, and they still do. And I think one of the issues that we've always cared about is this idea that the people that are kicked out of the shelter, kicked out of hospitals for any number of reasons, exited from treatment for any reasons, those people go to the street. And if we had any just world and I guess the money to actually help people, nobody would be on the street from those places, nobody. There's no way that I should hear from people saying that, oh, I went to Einstein and now I had surgery and now I'm on the street in this bag in Center City. No, that sort of stuff should not happen. And I know that you've met with those hospitals. And I guess -- I know they kind of control a lot of the City, but we have to hold them accountable. We have to hold the treatment centers accountable. I cannot say where, but I can tell you that there are places in the City that are basically (inaudible) houses for people and they're like, no, I refuse to go to that treatment place because that place that you want me to go that is funded by the City is going to make me sick and I might die in there. That's not about them refusing the service. That is because they've experienced that service. So I just want -- I mean, you know. Each situation is very different, right. So of course they're going to be different situations, especially at K&A where we know there are encampments and there needs to be -- people need to be looked at as full human beings there in a case-by-case basis -- on a case-by-case basis.

And when we're talking about people that are from here and people that are not, the data that I've seen is that at least two-thirds, maybe 70 percent, 80 percent, there's another report coming out from the Homeless Advocacy Project that will give more information on this too, that it's always around those levels. And the report from 2019, it's two-thirds, right. I mean, at least from my end let's actually talk about the numbers. Let's talk about specifics. There are places that are making money off of the backs of people that are experiencing homelessness and have disabilities, they should be held accountable. I'm a person that has been to treatment. I'm a person that has a disability. I'm a person that -- like, I can't be (inaudible). I'm an advocate. And when we talk about our harm reduction people, we've all seen people die. And in fact, I'm sure everybody that is in Philadelphia has a family member that has died from or a friend or a family member that has died from an overdose. So when we talk about this, why we are here, we are here to actually make it better. You know, I just want to speak from that because sometimes people think that we haven't or that, like, and I just like -- I'm a Black person. My family's from here. We know about disinvested neighborhoods. We're not trying to say that, like, everything that is going on is okay. But we have to work together to do this because the other option, I mean we've kind of already seen what the other option is. It's abandonment. So making those services available and making sure that people can actually use them is part of this. So I've put some recommendations or things that need to be done around connecting people. Everybody with a disability income really needs to be connected to housing subsidy. And I don't know, just to end this I'm not going to say that I'm friends with Office of Homeless Services or Mr. Holloman, I don't know where he went, but the way that we work together it has been to keep people in housing. And sometimes the barriers of that is either the privacy issue, the priorities of another agency. And I don't understand why I will have available resources and the people on the street cannot be matched to those. I don't understand that now. So if that's the case, that this is what will really do it, then let's do it. Let's do it. That's what I say. Thank you.

Thank you so much. I really like that you have listed your five recommendations very clearly, some of which fall within this purview but some of them are bigger, but we have to think holistically and I remember you from before. So thank you for advocating for as long as you have, so you're excused.

Have a good day.

Are there any more witnesses who are here to testify on these two bills? (No response.)

So hearing none, this concludes the public hearing. We will now go into the public meeting to consider action to be taken on the bills heard today. And I wanted to recognize Councilmember Lozada to speak to the bills.

I just want to say thank you to everyone who came to testify today on both of these bills. I think the last thing I want folks to think is that I'm not willing to listen, I'm not willing to compromise or I'm not willing to allow for data to drive the decisions that would make -- this is important and I think that the situation in Kensington has been taking -- has progressively gotten worse, even though we had previous Councilmembers like Councilmember Sanchez and Councilmember Squilla who have consistently fought to address what is happening in Kensington. I want to publicly say thank you to the Kensington Caucus, Councilmember Squilla, Councilmember Harrity and Councilmember Driscoll, who have a position -- I know that you all have recognized me for being vocal, but I would not be able to take the position as strongly as I've taken had I not been confident of the fact that I stand with three other Councilmembers who consistently are fighting to change what is happening in our communities. This is about the people that we represent. This is about the people who are in our communities regardless of whether they are truly homeless or living in addiction or regardless of what their situation is. It is about all of us. It is about making sure that all of us have quality of life. It is about all of us making sure that we are connected to the resources that will better improve our lives or give us opportunities to live a healthy life. And so, I want to say thank you to them because I've gotten the recognition, but I really have not been working alone. My three colleagues have been there and have been a part of the decision-making along the way and have been consistently supportive of me since I arrived in November of 2022, so I just want to say that. It is because the people that came here today said that they would share additional information with us, right, that there is information --

Excuse me. He has to call --

-- that they are willing to share --

-- you have to call the roll first or let her finish?

(Inaudible).

Okay.

It is because of them saying that they're willing to share information that I will move that Bill No. 240015 and 240017 be held until this Committee is provided with the required information or the information that both of our panels have agreed to share with us before we move forward. (Duly seconded.)

I'll quickly call the roll just to see who's here. Councilmember O'Rourke.

Here.

Councilmember Landau.

Present.

Councilmember Bass.

Present.

Councilmember Driscoll.

Present.

Vice-Chair Lozada.

Present.

Chair Ahmad.

Present.

May I proceed?

Mm-hmm.

It has been moved and properly seconded that Bills 240015 and 240017 be held until this Committee is provided with the requested and required information. All those in favor will signify by saying aye and all opposed say nay. (Aye.)

And the motion carries. Bills 240015 and 240017 will be held until the Committee is provided with the requested and required information. This concludes the business of the Committee on Public Health and Human Services. Thank you all very much for being here. (Committee on Public Health and Human Services concluded at 3:16 p.m.) C E R T I F I C A T I O N I, hereby certify that the proceedings and evidence noted are contained fully and accurately in the stenographic notes taken by me in the foregoing matter, and that this is a correct transcript of the same. __________________________________ TANEHA CARROLL