COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE OF THE WHOLE - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, April 19, 2006 2:30 p.m. - - - PRESENT: COUNCIL PRESIDENT ANNA C. VERNA COUNCILMAN W. WILSON GOODE, JR. COUNCILWOMAN JOAN L. KRAJEWSKI COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILWOMAN MARIAN B. TASCO BILLS 060001, 060002, 060003, 060004, 060006, 060007, 060008, 060014, 060089, 060090 RESOLUTIONS 060019, 060099, 060100, 060119, 060172 - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good afternoon, everyone. Sorry for the delay. This is a continued public hearing of the Committee of the Whole, and I would ask Mr. McPherson to please read the number of the bills and/or resolutions before us today. MR. McPHERSON: Bill No. 10 060001, 060002, 060003, 060004, 060006, 060007, 060008, 060014, Resolution 12 060019, Bill 060089, 060090, Resolution 13 060099, Resolution 060100, 060119, 060172.
Does anyone have any questions of the Treasurer's office? (No response.)
I know that a Councilmember had requested that the Treasurer's office be here. However, I understand that the issue has been resolved. I kept your name on the list thinking that maybe there were other 3 4/19/06 - WHOLE - BILL 060001, ETC. Councilmembers that might have questions. Since there are none, you're certainly welcome to leave. MR. McPHERSON: Finance Department.
Good afternoon, Madam President. I'm Vince Jannetti, Acting Director of Finance for the City.
One of the informational items Council requested was a response to the PICA letter detailing their concerns of the Five-Year Plan, which we expected to receive, I think, weeks ago. Can you explain why we have not to date received your response and when we can expect to receive it? 4 4/19/06 - WHOLE - BILL 060001, ETC.
The response, Madam Chair, has not yet been completed. We are working on that.
When do you anticipate that it will be completed and we'll have a copy of it?
I'm not exactly sure when it will be completed, Madam Chair, but as soon as it is, we will forward it to you.
You know, I think that Councilmembers would like to know what we're doing as far as PICA is concerned before we pass the budget.
So can we anticipate receiving it in the next week or so so that Councilmembers could in good conscience --
I 5 4/19/06 - WHOLE - BILL 060001, ETC. would appreciate it. Thank you. During the Finance Department's hearing, it was put on the public record that the Housing Trust Fund was not included in the 2007 operating budget. Members of City Council expressed their concern as to why these funds were not included in the operating budget and we asked that you review this decision. Can you tell us the Administration opinion of how the Housing Trust will be handled and will we be amending the 2007 operating budget, and, if so, how will it be amended?
Madam President, we looked into that situation and we agree that it will be an appropriated fund. So we are preparing an amendment to the budget to include the Housing Trust Fund as an appropriated fund as any other operating fund.
Mr. Jannetti, during the testimony of the Department of Human Services, the issue 6 4/19/06 - WHOLE - BILL 060001, ETC. of the replacement -- and I'm going to ask this question because my colleague, Councilwoman Blackwell, is not here and I'm sure she would want this question to be asked. The issue of the replacement of the Youth Study Center came up, as I said, when we did have her testimony from the Department of Human Services. Can you explain how the Administration proposes to finance this project, where the payments are budgeted and what payments are included in the Five-Year Plan?
Madam President, the new Juvenile Justice Center would be funded with a Philadelphia municipal authority bond issue. We would lease that facility from the municipal authority when it's completed. The funding for that facility would be included -- the budget for that facility would be included in the DHS budget. Off the top of my head, I 7 4/19/06 - WHOLE - BILL 060001, ETC. believe it's around $5 million a year, and I'm not sure what year they have it starting in the Five-Year Plan. It is in the out years, since construction hasn't started yet. And DHS would be billing a portion of that debt service -- it's actually not debt service to them. It's a lease payment -- to the state for -- a portion of that would be reimbursed. And I will get you details on what years in the Plan it starts.
We would appreciate that. Thank you. Are there any questions from members of the Committee of the Finance Department? (No response.)
Seeing none, Mr. Jannetti, we'll be expecting to hear from you, A, regarding the letter to PICA and also you're going to get us information regarding the Youth Study Center and how that is being done.
Yes, ma'am. 8 4/19/06 - WHOLE - BILL 060001, ETC. Thank you very much.
Thank you. The next department? MR. McPHERSON: Fire Department.
Good afternoon, Commissioner. Welcome. COMMISSIONER AYERS: Good afternoon.
Gentlemen. Commissioner, I have a couple of questions I'd like to ask. At the time of your hearing, you could not identify which engine and ladder companies you would be taking out of service. Are you now able to share with us what your redirection of service plan is? COMMISSIONER AYERS: We actually are in the same position that we were in before. We have not been asked to do anything as related to the 9 4/19/06 - WHOLE - BILL 060001, ETC. reorganization plan.
So with that response, I assume that things will stay as exactly as they are? COMMISSIONER AYERS: I haven't heard anything, Council President.
Who are you to hear from? COMMISSIONER AYERS: I'm to hear from the Mayor and the Managing Director. I have not been directed to change anything.
I would hope that you're the professional in this field and you would certainly have something to say about it. COMMISSIONER AYERS: We --
Commissioner, what are the locations -- don't respond. It's okay. I understand your position. But can you tell us the locations of the EMS units that you have downgraded from advanced life support to 10 4/19/06 - WHOLE - BILL 060001, ETC. basic life support during the current fiscal year? COMMISSIONER AYERS: Yes. The units that we have changed the resources in, they changed from advanced life support units to basic life support units staffed by emergency medical technicians. They are Medic 4 --
That means nothing to me. COMMISSIONER AYERS: I beg your pardon?
I said that means nothing to me. Medic 4 means nothing to me. If you could give us locations. COMMISSIONER AYERS: Well, I hadn't finished.
Okay. COMMISSIONER AYERS: I'm sorry. Medic 4 located at 2207 Hunting Park, Medic 8 located 2900 Boudinot Street, Medic 9 located 47 South 56th Street, Medic 14 located 20th and Federal 11 4/19/06 - WHOLE - BILL 060001, ETC. Streets. And we have put two additional basic life support units in as well, increasing the fleet from 40 medic units running to 42 medic units running, and those additional medic units are located Medic 41 at 1913 North 63rd Street and Medic 42 located at 4800 Langdon Street.
Commissioner, so that the record is clear and we all fully understand, can you tell us the difference between an ALS and a BLS? COMMISSIONER AYERS: Yes. The advanced life support unit is staffed with two paramedics from the City of Philadelphia and the basic life support units are staffed with two emergency medical technicians from the City of Philadelphia.
So actually there are four locations that we're changing? COMMISSIONER AYERS: Four locations that were changed as far as 12 4/19/06 - WHOLE - BILL 060001, ETC. resources and two locations that had additional units added.
Are we changing them from ALS to BLS? COMMISSIONER AYERS: Four were changed from ALS to BLS. Two BLS were added to the fleet.
If a BLS unit responds to a call and it is determined that an ALS unit is required, what happens, and are we not endangering a person's life by the delay in providing services? Because I have always heard, and you will probably agree with me, that three minutes can mean life or death for, say, a heart attack victim. Would you agree? COMMISSIONER AYERS: I do understand what you're saying and I agree that it's imperative that people receive care immediately. When you state the times, I think I'm going to defer to the doctor, Dr. Mechem. He is the doctor that has medical command over all of our 13 4/19/06 - WHOLE - BILL 060001, ETC. paramedics, over all of our emergency medical technicians, and he's going to be able to explain it a little more. He's the person who comes and is a part of our team as we make operational decisions based on life safety, based on service to the citizens and what paramedic and basic life support protocols are. So this is Dr. Mechem.
We welcome you, Doctor. Please identify yourself for the record.
My name is Dr. Crawford Mechem. I'm the EMS Medical Director for the Philadelphia Fire Department. I'm also an Associate Professor of Emergency Medicine at the Hospital of the University of Pennsylvania.
Do you mind pulling the microphone closer to you. Thank you. DR. Mechem: Too tall.
I 14 4/19/06 - WHOLE - BILL 060001, ETC. think you heard the question.
To answer your question, no, I don't agree with that. We have to be very careful about --
Yes. Let me try to explain. When you use the term "heart attack," you have to be very careful about what you're talking about. Heart attack from a medical perspective, from my perspective, is someone who is having an acute myocardial infarction, meaning he or she is experiencing a blockage in the arteries of the heart. So this is a patient whose heart is still beating and still pumping. When we think about a person who is actually in cardiac arrest, meaning the heart has stopped beating, 15 4/19/06 - WHOLE - BILL 060001, ETC. that's a much more time dependent issue, and so in that case, in a patient who is in cardiac arrest, three minutes does make a difference. For a patient who is having a heart attack, meaning a myocardial infarction, three minutes is probably less important. Getting them care sooner is certainly good, but there's very little, if any, evidence to prove or to illustrate that three minutes makes a difference in a patient who is having a myocardial infarction, or a heart attack, versus a patient who is having a cardiac arrest.
So cardiac arrest, you're telling me that three minutes does make a difference?
Okay. Well, to me, as a layperson, that's still a heart attack, but you're the doctor, so you can label it any way you want. I'm labeling it as a heart attack. 16 4/19/06 - WHOLE - BILL 060001, ETC. I have asked and I still have not received and I am interested in the one location at 20th and Federal. I have asked repeatedly where is the closest ALS from 20th and Federal. I don't know the other locations. I think Councilpeople from those districts would certainly be more familiar with them, but I don't know them. Where would the closest be? Because I think our top priority has to be public safety. I am really very concerned about this, and I know, Commissioner, you did indicate at one point in time that there would be a rover, whatever a rover is. I don't know what happens if somebody, say, on my block has heart failure or heart arrest or a heart attack, or whatever label we want to give it. Where is the closest ALS? Because three minutes in some cases can mean a difference. COMMISSIONER AYERS: Council President, the closest locations to Medic 17 4/19/06 - WHOLE - BILL 060001, ETC. 14-B, which is the medic unit that was in question located at 20th and Federal Streets, the closest medic units are Medic located at 2110 Market Street, 6 Medic 11 -- 7
I'm sorry. Did you say Market? COMMISSIONER AYERS: That's correct. Medic 11 at --
It will certainly take more than three minutes for somebody at that unit to get from 21st and Market to 2000 South Broad, but that's okay. Continue, please. COMMISSIONER AYERS: 1300 West Shunk Street; that's Medic 11. 1341 South 12th Street; that's Medic 27. 711 South Broad Street; that's Medic 35. 2301 South 24th Street is Medic 37.
Is that in Grays Ferry? COMMISSIONER AYERS: Yes, it is. That's correct. 18 4/19/06 - WHOLE - BILL 060001, ETC. And 3031 Grays Ferry Avenue is Medic 40. So that is a total of six medic units that are perimetered medic units. They surround Medic 14-B.
And you feel very strongly that that is the way to go and people in my community should have no concern about a response that would be in ample time for their life to be saved? COMMISSIONER AYERS: I believe that our emergency medical technicians are well equipped to respond to that location; to initiate or to continue based on who is there, to continue CPR; to administer oxygen; to apply an automatic external defibrillator to try and save this person's life; and to get them to a hospital. I believe that they can do that.
What is the difference between a paramedic and an EMS technician?
Actually, there's 19 4/19/06 - WHOLE - BILL 060001, ETC. a paramedic and there's an emergency medical technician. An emergency medical technician has gone through a Department of Transportation curriculum of roughly 110 hours. He or she are able to provide some basic medical intervention, such as apply oxygen, open an airway, immobilize a cervical spine, apply and activate an automatic external defibrillator, stop bleeding or put pressure on bleeding and some other skills as well. A paramedic, on the other hand, is a higher level emergency medical technician who has gone through somewhere between 1,000 and 1,500 hours of training. In addition to building upon the curriculum of an EMT, he or she has in addition acquired the skills of inserting intravenous lines, placing and interpreting a cardiac monitor, administering a variety of essentially prescription medications.
I know that the Commissioner had indicated 20 4/19/06 - WHOLE - BILL 060001, ETC. at the last hearing that we were having difficulty trying to get paramedics. What are we doing to try to address that issue? COMMISSIONER AYERS: Well, we currently have an open exam for paramedics now. We have been recruiting in all of the hospitals in the area, and that will remain open until April 21st. It's been open for a few weeks now. So hopefully we're going to be able to get paramedics into the Fire Department and start to get a class and put them into service. I'm not sure what number we'll get, but we're going to continue.
And when do you anticipate or hope that will happen? COMMISSIONER AYERS: The application period closes on the 21st. Personnel will inform me of everyone who has applied. As soon as the application process that they have to do is 21 4/19/06 - WHOLE - BILL 060001, ETC. completed, they'll create a list, an eligibility list. And once that eligibility list is in place, I'm going to put a class in. That class is going to be approximately six to seven weeks they'll be in-serviced.
And how many paramedics are we short? COMMISSIONER AYERS: Currently, we have 240 paramedics that's required. We have five vacancies, and we have ten paramedics that are detailed for training and other reasons, which would mean 15 for the current level. However, with the 24-hour units and the added units, we have approximately 48 that we would be short right now. And if we wanted to upgrade to all paramedics, it's like 63.
So if you had your way, you would hire 63 paramedics from a list that may be created after the test is given? COMMISSIONER AYERS: If we have a list of 63, Council President, I'll be 22 4/19/06 - WHOLE - BILL 060001, ETC. a happy person and we would begin to hire.
Okay. And how much would that cost? Do you have any indication? COMMISSIONER AYERS: I can get back to you with the exact cost on those things.
Commissioner, in the FY2007, you will be adding eight ALS units. Will the units you downgraded in 2006 be restored to ALS in the 2007? If not, can you tell me why not? COMMISSIONER AYERS: Well, if they weren't, it would be because of the same position that we're in now, that the paramedics would not be available. The units that we plan on upgrading, we do plan to upgrade to ALS based on the arbitration and everything that we went through, and we would configure them as an ALS with a different staffing. We would have a limited, what is called, a 23 4/19/06 - WHOLE - BILL 060001, ETC. dual-staffed unit, a dual-staffed unit, where you have a paramedic and an emergency medical technician. So that is my intention on the eight units. And when we have enough paramedics and we've hired enough, we will upgrade.
Well, I get extremely concerned, because, as I said, I consider public safety to be our top priority, and I have to -- the doctor may disagree with me. I may disagree with him. But there are cases and, as I said, whether it be heart arrest or whatever, three minutes I am told by some very good people could mean a matter of life and death. And I am telling you, I don't think that we should ever, ever be in a position where we cannot respond to an emergency call like that. Councilwoman Krajewski.
Thank you. Good afternoon, Commissioner. 24 4/19/06 - WHOLE - BILL 060001, ETC. COMMISSIONER AYERS: Good afternoon.
If the Department intends to close less than eight of the companies, what is the new number and how many do you wish to spare -- wish to close anyway? COMMISSIONER AYERS: The company closing -- the budget that came in, the proposed budget, was for three engines and two ladders.
Which are the targeted companies that will be spared? COMMISSIONER AYERS: With that configuration, we don't know. The only thing I can say is that we would look at that, we would examine it, and it would be of the eight that was designated originally.
By your response, you're telling me that you really haven't done the review yet about what companies will be spared or closed? 25 4/19/06 - WHOLE - BILL 060001, ETC. COMMISSIONER AYERS: We've looked at a myriad of scenarios, a myriad of scenarios. We don't know exactly which companies at this point.
So our constituents really don't know what companies they're going to lose; is that right? Don't you think that they have a right to know? COMMISSIONER AYERS: Well, what we do know is that it was -- of the eight companies that were put out there, it will be of those eight companies. It was four engines and four ladders in the initial presentation. It would be from that grouping.
But you can't tell me which ones will be spared; is that right? COMMISSIONER AYERS: No, I can't say that right now.
So you haven't really completed the review; is that what we're saying here? 4/19/06 - WHOLE - BILL 060001, ETC. COMMISSIONER AYERS: No. What I'm saying is that those combinations are numerous, and for us to actually look at that and say what happens after we're told to implement this budget, then that's when we'll actually go in and we'll look at the data again. We'll look at what we have in front of us and we'll make those decisions.
You're not alone. I mean, we are in the process of a budget hearing.
But we still don't know which ones are going to close.
The Commissioner can't answer your question. The Finance Director can't tell us when we're going to receive a letter regarding the PICA issue. I don't know what we're doing sitting here. But we're supposed to pass a budget. 27 4/19/06 - WHOLE - BILL 060001, ETC.
Well, that's one of the reasons I've been absent for a while, because you don't get any answers. You're only told what they have to.
What they think they want you to know. That's what it is.
I agree. It's a waste. Only what we're being told.
Commissioner, when do you think you will have the information that Councilwoman Krajewski is asking for? Will it be before we consider this budget? And we would have to vote on this by the end of May. COMMISSIONER AYERS: Well, I believe that once we find out exactly what the budget is going to be and we get information to take those companies and close those companies, realign that, I'll be able to give it to you. 28 4/19/06 - WHOLE - BILL 060001, ETC.
Commissioner, we're talking about the budget that's in front of us. I don't mean to be short. I really don't. But I find this extremely frustrating. We have a budget in front of us. You have your budget.
Also, public safety are the effects of closing, what effect will they have on it.
So as I said, it's your budget that we're considering and you can't answer the Councilwoman's question. I don't know how we are supposed to in good conscience vote on a budget that we can't get answers to. So will you in fact have the information that Councilwoman Krajewski is asking for by the end of May? COMMISSIONER AYERS: I will work on the --
Or before the end of May, because we vote on 29 4/19/06 - WHOLE - BILL 060001, ETC. it at the end of May. COMMISSIONER AYERS: I will work on the different configurations so that you can look at that, Councilwoman.
I'm not blaming you. COMMISSIONER AYERS: No. I understand.
Nobody is blaming anybody, but here we're going to be blamed in the end.
Our constituents want to know. They want to know.
They don't want to wake up one morning and see the firehouse isn't there.
Any 30 4/19/06 - WHOLE - BILL 060001, ETC. other questions or comments from members of the Committee? (No response.)
Commissioner, I would really appreciate it if we could get any and all information that we have asked for in the last hearing which we are asking for today. We have to put this budget to bed. We will be voting on it, and we want to know that whatever we're voting on is something that we could live with. So please get back to us. COMMISSIONER AYERS: Okay. Thank you.
Thank you. MR. McPHERSON: The Department of Public Health.
Commissioner. COMMISSIONER AYERS: There is a handout for you that you had asked for that explained a lot better the chain of 31 4/19/06 - WHOLE - BILL 060001, ETC. life we talked about. You said you'd like to have it. I have one for each and every Councilperson.
Thank you. Commissioner, good afternoon and welcome. COMMISSIONER PARIS: Good afternoon, President Verna. Thank you.
Commissioner, during the public testimony, we heard a very different story than you presented with regards to waiting times for appointments at the various district health centers, as well as the shortages for drugs in filling prescriptions. Again, I'm going to ask you to please tell us what the waiting period is for appointments at the various health centers. COMMISSIONER PARIS: The waiting time for an appointment in the health centers depends upon what kind of 32 4/19/06 - WHOLE - BILL 060001, ETC. appointment it is that the patient needs and which of the health centers that person is interested in getting an appointment from. The average wait for the health centers right now for an initial appointment, which is the first appointment that the person receives when they first call in for medical attention, is anywhere between four weeks to about 12 weeks or more. That's the average. What happened is, in many instances when the -- the reason why it varies is because when the person first calls in, they ask for a particular health center, which is the health center in many instances the one in their neighborhood, and they are told what the waiting period is, but they are also offered the option of going to another health center where there might be an initial visit that it's much sooner. But the fact is that people want to be seen in the health centers that is within 33 4/19/06 - WHOLE - BILL 060001, ETC. their proximity, in their communities.
Commissioner, I don't think I was the only one that heard your testimony and I believe that there were people in other sections of the City that in fact were here, may have seen you on TV, may have heard you on radio talking about the period of time that one had to wait, and I think at that hearing you indicated that, for instance, if someone lived in South Philadelphia and had to wait 12 weeks for an initial visit, they could certainly go to a clinic in the Northeast which was not as busy and they could probably just walk in. Somebody from the Northeast clinic or who lives in that community said that that was so far from the truth. Their waiting period was as long as, if not longer, than people in South Philadelphia, for instance. So I would like you to clarify the record, please. COMMISSIONER PARIS: 34 4/19/06 - WHOLE - BILL 060001, ETC. Absolutely. What I referred to was not exactly -- it was not talking about a person wanting an appointment and being able to get it in another health center. What I was talking about was the fact that even a person that wants and calls for an initial appointment has access to seeing a physician through the walk-in clinic and they don't need an appointment. When a person calls and says, I need to see a doctor, we will give them, according to whichever health center they want to visit, we will let them know when the next available initial visit is.
Which would be 12 weeks hence. COMMISSIONER PARIS: It depends on the health center, ma'am, and it depends on the time of the day that they call. And I'm not being facetious at all. What happens is, it depends. If you call in after somebody has just cancelled an appointment, then that 35 4/19/06 - WHOLE - BILL 060001, ETC. appointment becomes available. But that is why when I talk about the waiting time for an appointment, I talk in terms of average, average time. Regardless of the waiting time for an appointment, anyone that needs care can go into the health center the day after they call and they will be seen by either a physician if it's available or definitely by a nurse.
I guess I'm not really seeing this picture as it's being painted. Do any of my colleagues understand it? Councilwoman Tasco.
Thank you, Madam President. I think a number of us were concerned, Commissioner, when you testified before that we were left with the impression that it took less time to get an appointment, say, in the Northeast than it would be in South Philadelphia. We had a number of members of the Health 36 4/19/06 - WHOLE - BILL 060001, ETC. Advisory Board to come in and they were very concerned about the information that we were given, because they shared with us information about the length of time it takes to get an appointment at practically all of the health centers. COMMISSIONER PARIS: Councilwoman Tasco, if I mentioned that Health Center 10 was easier to get in, I was probably talking in general terms, because actually Health Center 10 is the one health center that has the longest period of time to wait for an initial visit. Not to be seen by a physician, which is a different thing, but for an initial visit, because recently we had two physicians that resigned from that health center. We are in the process of identifying two physicians right now that will be hired to replace those two physicians that left, but because of that, it is hard right this moment to get an appointment at Health Center 10. But overall what I was talking 37 4/19/06 - WHOLE - BILL 060001, ETC. about was a person calling in, how long do they have to wait if they say, I am sick. If they say, I am sick, we will tell them to come in the next day early in the morning, because we have a walk-in clinic where they will be seen by a nurse, and if the nurse determines that the person is very sick and needs to be seen by a physician, the patient will be seen by a physician.
Well, I guess you can understand our concern when, our reaction, I imagine, when the district representatives came in to say that they heard your comments and they did not agree. Let me ask you a question. How many doctors do you have at each health center assigned? COMMISSIONER PARIS: It depends on the health centers and it depends, of course, if we're talking about adult medicine or pediatrics. We have an average of five 38 4/19/06 - WHOLE - BILL 060001, ETC. physicians per health center. Our physicians, most of them, work an average of hours a week. So if you think of 5 them as part-times, then we will have 6 about ten physicians. If you think of 7 them in terms of the equivalent of a 8 full-time physician, then that will be 9 about an average of five. 10 In terms of pediatricians, we 11 have in each health center again about 12 four part-time physicians. If you think 13 of them in terms of full time, there will 14 be an average of two physicians. 15
So you 16 have five part time working 20 hours a 17 week? 18 COMMISSIONER PARIS: Each one 19 of them, yes. 20
Each one of them. So there are five physicians at Health Center 10? COMMISSIONER PARIS: Well, right now Health Center 10 is a different story because, like I said, there were 39 4/19/06 - WHOLE - BILL 060001, ETC. two physicians there that just resigned.
If they were all on board, how many would you have? COMMISSIONER PARIS: Yes, ma'am. That will be the average, yes.
But each of them work hours a week? 10 COMMISSIONER PARIS: Yes. 11
So it's 14 about 100 hours? 15 COMMISSIONER PARIS: That will 16 be about 100 hours a week? 17
So, 20 Councilwoman, as I understand it, we only have three physicians presently at District 10?
Three working 20 hours each per week. COMMISSIONER PARIS: Yes. That 40 4/19/06 - WHOLE - BILL 060001, ETC. is correct. I just double-checked, and, yes, we have -- it's an average of anywhere between five FTEs and four.
The doctors that are hired by the health centers, are they hired through the City Civil Service Department or do they contract directly with the Health Department? COMMISSIONER PARIS: Most of them are hired through a contract agreement with the hospitals that provide back-up services to the health centers.
So you don't hire them directly? COMMISSIONER PARIS: We hire them directly. We hire them directly, but they're not Civil Service employees. Some of them are, but very few. And some of them are, again, through a contract with the different hospitals.
That doesn't make sense to me. Do you contract with the hospitals? 41 4/19/06 - WHOLE - BILL 060001, ETC. COMMISSIONER PARIS: Yes. We contract with the hospital for specialty services. We don't provide specialty services in any of the health centers.
So the five physicians at Health Center 10, they have a direct contract with the Health Department or -- COMMISSIONER PARIS: Yes.
So you contract with them directly for services? COMMISSIONER PARIS: We hire the physicians, yes.
How does the hospital come in? COMMISSIONER PARIS: Well, some physicians are hired directly through the Health Department and some physicians are paid through contracts from the different hospitals that we contract with.
And they 42 4/19/06 - WHOLE - BILL 060001, ETC. provide the doctors to the health centers? COMMISSIONER PARIS: And they provide the services to us.
Do you have people on your staff here with you today who could answer these questions a little better than you? COMMISSIONER PARIS: Sure.
Tom Storey, Medical Services Director, Ambulatory Health Services, Health Department.
The way that we hire physicians is, as Carmen said, it's a combination. We have some that are on contract that we pay through direct hospital contracts that we have, and then we have some that are Civil Service. And 43 4/19/06 - WHOLE - BILL 060001, ETC. what we like to do is start folks on contract, and if we're happy with their medical performance and they're happy working with us, as Civil Service positions become available, we will move them to Civil Service.
Now, during the course of the discussion, I'm not sure, maybe it was the Civil Service Department, are these doctors residents of the City of Philadelphia?
Right. No. I understand. There is in fact a residency waiver for the medical job classes. So if we looked at the folks that work with us, I honestly don't know what the split is. Some do live in the City; some do not. COMMISSIONER PARIS: Actually, we have about 23 physicians on board 44 4/19/06 - WHOLE - BILL 060001, ETC. right now that do not live in the City of Philadelphia, which we have approved City waivers, City residency waivers.
Forever? The waivers are forever? COMMISSIONER PARIS: The waivers are based on the job classification.
So you can be a doctor working at a health center, be Civil Service and not have to live in the City? COMMISSIONER PARIS: That's correct.
What effort is made to recruit doctors who do live in the City? COMMISSIONER PARIS: I'm sorry?
What effort is made to recruit doctors who do live in the City? COMMISSIONER PARIS: Well, we 45 4/19/06 - WHOLE - BILL 060001, ETC. announce -- we advertise in all media. We use all written media, such as the Inquirer, the Daily News. We also use the medical journals, because that's really where physicians look for employment. We also use the Internet, and we do a lot of recruitment in the different schools of medicine.
So if we did not provide the waiver, would you believe we would not get doctors who do live in the City to work for the Health Department? COMMISSIONER PARIS: I agree with that, yes. I think that we will not have enough physicians to cover for the vacancies. And I can just give an example. Just recently, the Medical Evaluation Unit had vacancies, had a vacancy for a physician, and we advertised, and we did not get not one resume from a City resident, from a physician that lives in Philadelphia, not one. 46 4/19/06 - WHOLE - BILL 060001, ETC.
Okay. How many slots do you have for physicians and how many are vacant? COMMISSIONER PARIS: We have about 100 physicians on board.
How many slots are you budgeted for? COMMISSIONER PARIS: The problem, Councilwoman Tasco, is that we hire the physicians on a part-time basis. In other words, they work hours. So 13 we are trying to -- we have 100 14 physicians on an average on board. If 15 we're looking at -- if you're asking us 16 in terms of in full-time equivalencies, 17 then we'll talk probably about three 18 physicians. 19
Let's go 20 to your part time. COMMISSIONER PARIS: Then we will have five.
If you have part time and you have a budgeted amount of dollars for so many part time, 47 4/19/06 - WHOLE - BILL 060001, ETC. are all those part-time slots filled? COMMISSIONER PARIS: No, ma'am. We will say we have about five of those 20-hour slots that are vacant.
Five that are vacant? COMMISSIONER PARIS: Yes, ma'am.
Are they all over or in one health center? COMMISSIONER PARIS: They are in different health centers.
Now, one of the other issues that was raised with us was the number of staff positions in the Health Department and that there has been a decline in a number of positions not filled. Could you give us how that impacts on your ability to deliver service? First, is that statement true, that there are vacancies that have not been filled, and do you intend to fill them or have you been requested to fill 48 4/19/06 - WHOLE - BILL 060001, ETC. them, or what? COMMISSIONER PARIS: We have a number of vacancies, and if we're talking about specifically about ambulatory health services, the health centers --
Now we can go across the board now. COMMISSIONER PARIS: Across the board. Yes, we have a number of vacancies in the Health Department right now. And what we have done is, we have requested authorization to fill those positions.
How many do you have vacant that are critical to providing services across the board? COMMISSIONER PARIS: We have close to 40 positions that are vacant right now.
How long have they been vacant? COMMISSIONER PARIS: They are in different stages. Some of them have been vacant for months; some of them have 49 4/19/06 - WHOLE - BILL 060001, ETC. been vacant for a couple of weeks. And it depends on the vacancies. For example, we have some vacancies for nurses that have been vacant for a very long time, and the reason is not lack of authorization for us to fill those positions. It's just the national shortage of nurses that we are suffering from here in Philadelphia as well. So there are other positions; for example, engineers for the air management program, another very, very skilled position, that there is a shortage on that particular profession. So those positions are hard to fill. The clerk typist is a position where it's a lot easier to fill, but the problem is that it is hard to keep an ongoing active list. By the time a list is created and you go back to the list to draw, many of the people that are left on the list already have another job or do not want to come to the Health Department because they know that the demand in 50 4/19/06 - WHOLE - BILL 060001, ETC. terms of how busy and hectic it is in the Health Department is much greater than in other departments.
So of those 40, you have a number that you can't fill for various reasons or another, and the other percentage, are they not going to be filled at all? COMMISSIONER PARIS: I have put in a request to the Administration, ma'am, to have all those positions filled, and I am waiting for the Administration to authorize for me to follow up and contact Central Personnel to do the hiring -- I mean the interviewing and the hiring.
Okay. How about your prescriptions in terms of the time it takes for a patient to have a prescription filled? Is there a delay time there? COMMISSIONER PARIS: Yes, there is a delay. We are very proud that the waiting time has certainly improved in 51 4/19/06 - WHOLE - BILL 060001, ETC. the past years, where a couple of years ago it was weeks, two weeks an average for a health center. Today the average per health center is two days. And we actually have two health centers, Health Center 5 and Strawberry Mansion Health Center, where the person can come in today and tomorrow they can pick up their prescription. But an average is two days.
Is there a notice or warning or some reminder sent to patients that their prescription might be due in a week and they might want to put their prescription in now? COMMISSIONER PARIS: Yes, and that is part of the physician education component. Each physician, they always are very good at reminding their patients not to wait until they run out of 52 4/19/06 - WHOLE - BILL 060001, ETC. medicine to bring in their prescriptions. It's what we call the five-day grace period. They can bring their prescriptions in five days before the date for the new prescription arrives and we will fill the prescription. So if the patients are doing that, if they bring in the prescription within five days, then the waiting period of two days or even three days, let's say in case of there's a weekend in between, will not affect them in any way. Now, that is with the understanding that we have the medication in stock. Our pharmacies, just like any other pharmacy in the industry, sometimes we have problems because there are no -- different medications are not in stock, whether it's because the pharmaceuticals are not producing them fast enough or because the demand in the health center is greater for whatever reason. That's also something that we are always aware of. And in a case, for example, where 53 4/19/06 - WHOLE - BILL 060001, ETC. somebody comes to us and gives us a prescription and we don't have that medicine available, they can take the medication to any facility, to any other pharmacy, because our prescription entitles them to get the medication. Many of the patients do have insurance, and we understand that some of them don't. In many occasions we have that they will go back to their physicians and explain the situation. Many times the physicians, if they have any kind of samples, they will share them with the patients. But that is the reality of the industry today. Sometimes we just don't have them.
Thank you, Councilwoman. I just have a question. I was just looking, Councilwoman, at -- Councilwoman Tasco, I wanted to thank you, but I was just 54 4/19/06 - WHOLE - BILL 060001, ETC. looking at the information that was provided to us by the Fire Department, and, again, it's contradictory. So I'll tell you, this could be a never-ending process. Commissioner, as I said, I was sidetracked. I was looking at what was provided to us by the Fire Department, and I don't know if Councilwoman Tasco did in fact question you about how long it takes for a prescription to be filled. She did? COMMISSIONER PARIS: Yes, ma'am.
Do you mind repeating that, please? COMMISSIONER PARIS: Not a problem. It takes anywhere between two to three days. The majority of the health centers, of course, are on a two-day turnaround. In addition to that, we have two health centers in which the prescriptions are ready the very next day. 55 4/19/06 - WHOLE - BILL 060001, ETC.
During the public testimony, we were informed that there is a great need for additional dental services. Can you explain what dental services are provided and what is the waiting period for an appointment?
We provide what we call general dental care or routine dental care. I think the best way to think about it is to realize it was originally set up as a children's program, although we provide care to both children and adults. So we do basic dental work. We do routine cavity repair, but we don't do extractions and the like.
There are dental clinics at seven of the eight sites. There is no dental clinic at Strawberry Mansion. And there are dentists assigned to each site, yes. 56 4/19/06 - WHOLE - BILL 060001, ETC.
Please, please tell me that the dentist is not included in the five doctors.
The dentist is not included in the five. COMMISSIONER PARIS: No, ma'am, it's not.
Thanks. In your opinion, Commissioner, what additional funding is required in order for the health centers to be able to provide services at an acceptable level, and what do you consider acceptable? COMMISSIONER PARIS: That is a very hard question to answer, because if we talk about what are the demands right now in the health centers, it's a demand that goes beyond not only staffing capacity but also infrastructure, building capacity. So it's not only the fact that, yes, ideally we would like to have more physicians and more nurses and 57 4/19/06 - WHOLE - BILL 060001, ETC. more clerks, but in the City of Philadelphia where we have such a big demand for services from the uninsured, it's not only that, it's also the fact that we have overgrown all the buildings and there's not enough space. For example, we don't have enough exam rooms.
So in the center where you presently have only three doctors, when do you anticipate the other two vacancies will be filled? COMMISSIONER PARIS: Actually, we hired the clinical director already for that facility. That was a promotion. She was a physician. Now she's transitioning out of her practice in the health center where she was working and she is transitioning into the new health center. The other position that we have vacant, we are, as we speak, advertising for that particular position.
Are you advertising for one or two positions? COMMISSIONER PARIS: We 58 4/19/06 - WHOLE - BILL 060001, ETC. actually have five 20-hour slots available right now for physicians, and we are advertising for all of them, ma'am.
How are you advertising? COMMISSIONER PARIS: Well, we use media. We use the written media. We use the Inquirer. We use the Daily News. But, most importantly, we use the medical journals, because that is really how physicians look for positions for jobs. We also have developed relationships with the different medical schools in the area and we are always constantly in communication with them when we have any kind of vacancies.
Okay. Thank you. Are there any other questions? (No response.)
Seeing none, I thank you, and I offer you my congratulations again. I know it's 59 4/19/06 - WHOLE - BILL 060001, ETC. quite a challenge that you're facing, and I do wish you luck. COMMISSIONER PARIS: Thank you very much, ma'am.
Thank you. The Committee will stand in recess until Thursday, April 27th at 9:30. Thank you very much. (Committee of the Whole adjourned at 3:35 p.m.) - - - 60 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on April 19, 2006, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)