1305 COUNCIL OF THE CITY OF PHILADELPHIA CONTINUED PUBLIC HEARING COMMITTEE OF THE WHOLE FY '04 OPERATING BUDGET - - - Room 696, City Hall Philadelphia, Pennsylvania Tuesday, March 4, 2003 10:00 a.m. - - - BILL 030004 BILL 030008 BILL 030010 - - - PRESENT: COUNCIL PRESIDENT ANNA C. VERNA COUNCILWOMAN JANNIE BLACKWELL COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN DARRELL L. CLARKE COUNCILMAN DAVID COHEN COUNCILMAN FRANK J. DI CICCO COUNCILMAN W. WILSON GOODE, JR. COUNCILMAN JAMES F. KENNEY COUNCILWOMAN JOAN L. KRAJEWSKI COUNCILMAN RICHARD T. MARIANO COUNCILWOMAN DONNA REED MILLER COUNCILMAN MICHAEL A. NUTTER COUNCILMAN BRIAN J. O'NEILL COUNCILMAN ANGEL L. ORTIZ COUNCILMAN FRANK RIZZO COUNCILWOMAN MARIAN B. TASCO - - - V A R A L L O, INCORPORATED Litigation Support Services 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 (215) 561-2220 1306 I N D E X WITNESSES JOHN DOMZALSKI, Health Commissioner ......... 1307 MICHAEL COVONE, Dept. of Health .............. 1322 ALBA MARTINEZ, Commissioner of DHS ........... 1445 JOHN ZANIER, Fiscal Director ................. 1461 DAVID FAIR, DHS .............................. 1465 ANN MARIE AMBROSE, DHS ....................... 1550 ROBERT HESS, OESS ............................ 1486 CHERYL RANSOM, DHS ........................... 1495 WANDA MILE, DHS .............................. 1564 ROBERT HESS, OESS ............................ 1579 JOSEPH MITCHELL, OESS ........................ 1598 ANDRES PEREZ, Commissioner, Public Property .. 1609 JOSEPH JAMES, Public Property ................ 1616 JAMES MULLER, Fleet Management ............... 1667 RICHARD TYLER, Historical Commission ......... 1673 1307 3/4/03 - FY '04 OPERATING BUDGET
Good morning, everyone. This is the continued public hearing of the Committee of the Whole regarding Bill Nos. 030004, 030008, and 030010. The first department to testify is the Health Department. Good morning, Commissioner. Please identify yourself for the record and proceed with your testimony.
Good morning, President Verna and Members of Council. I'm John Domzalski, Health Commissioner. Joining me at the table to my left is Deputy Commissioner Michael Covone and to my right is Carmen Lemmo, our Director of Financial Administration. I very much appreciate the opportunity to present the Health Department's testimony in support of its FY '04 Operating Budget request. This morning our testimony will be divided into two parts. I will speak on public health services, and Michael Covone will address mental health services and the Behavioral Health Services. I'm pleased to report that the Department's recommended Fiscal '04 budget maintains 1308 3/4/03 - FY '04 OPERATING BUDGET key performance and service indicators comparable to those of FY '03. During FY '03, the Department undertook major initiatives aimed at improving and protecting the health of the community and incorporating a neighborhood perspective citywide on health status indicators. We will continue these initiatives in FY '04. 7 million in the Health Choices Behavorial Revenue Fund. 8 million is in the Health Choices Behavioral Health Revenue Fund. 2 percent is for behavioral health and mental retardation services. The Department's budget will support 1,350 positions, 835 of which are in the General 1309 3/4/03 - FY '04 OPERATING BUDGET Fund and 515 in the Grants Fund. This represents a reduction of 51 General Fund positions. The staff reductions will be taken in administrative areas that do not affect direct services. The Health Department administers a wide range of essential public health services for Philadelphians. These include primary health care at eight health centers; monitoring and control of communicable diseases, such as tuberculosis; a specialty clinic for the treatment of sexually transmissible diseases; and coordination, funding, and oversight of our HIV/AIDS programs. The Department coordinates, funds, and monitors child health services, including infant mortality reduction, prenatal and family planning services and childhood lead poisoning prevention. We are responsible for a range of environmental protection services, including monitoring of pollutants and enforcement of local, state, and federal environmental regulations, as well as regulations of the local retail food industry. In addition, the Department operates the Medical Examiner's Office, maintains oversight of 1310 3/4/03 - FY '04 OPERATING BUDGET the Philadelphia Nursing Home, and monitors health services at the Riverview Home. In an increasingly uncertain world, the Health Department is prepared to respond to threatened or actual bio-terrorism events. 4 million in emergency preparedness funding under the new Homeland Security Act. In this regard, we are working to significantly enhance the public health infrastructure, including surveillance and communication systems and personnel. In addition, we are working with the State of Pennsylvania on the issue of smallpox inoculation. In keeping with Mayor Street's focus on the transformation of our neighborhoods, we are organizing our data on health status indicators so that the overall health of the City can be understood from the perspective of the health of its neighborhoods. These neighborhood level data, aided by the mapping capacity made available through Philadelphia Safe & Sound, are now being used to strategically deploy services to areas of greatest need. These range from smoking behaviors and diabetes incidence, to the occurrence of 1311 3/4/03 - FY '04 OPERATING BUDGET communicable disease and the extent of immunization coverage of our children. The Mayor has emphasized that, while we turn our attention to neighborhoods, we will not turn our backs on the businesses that are so important to the economic health of the City. Accordingly, in our regulatory activity we are making our procedures and our processes more user friendly, while not compromising the public health objectives of our regulations.
I will briefly highlight some of our major accomplishments and challenges. With regard to lead poisoning in children, childhood lead poisoning prevention has been elevated to a major priority in the Department. The number of properties brought into compliance with lead paint removal requirements has nearly tripled from 115 during the period April 2001 through January 2002, to 335 from April 2002 to January 2003. As of February 2003, we have reduced the backlog of houses by one-third, from 1,400 homes to 950 homes, with 301 properties made lead safe, 136 vacant properties referred to the Department of 1312 3/4/03 - FY '04 OPERATING BUDGET Licenses and Inspections so that they cannot be occupied until they are lead safe, and were 4 demolished. As of February 2003, there were 28 more 5 properties where the owner is in the process of 6 doing the work, but has not yet completed it. This 7 progress results from the work of the Lead Abatement 8 Strike Team, LAST, and the newly established Lead 9 Court. 10 LAST brings together nine City 11 departments and related agencies to resolve the wide 12 range of issues and situations that can impede the 13 lead intervention process. These issues range from enforcement and family relocation to structural repair and abatement. The Lead Court results from the creativity of the City Solicitor who conceptualized a court that is knowledgeable and informed about childhood lead poisoning issues. The Solicitor secured approval from the First Judicial District, and cases began being heard on an expedited basis in November 2002. Last year at this time we were adding 350 houses a year to a backlog. We promised last year never to add another house to the backlog and 1313 3/4/03 - FY '04 OPERATING BUDGET to attempt to reduce the existing backlog. We have kept that promise. Not a single house has been added to the backlog and the backlog itself is being reduced. We will continue this effort. Moreover, we have set ourselves the additional challenge of substantially increasing the effort directed at primary prevention. Essentially, we want to get to the point where we know longer use a report of lead poisoning in a child as the entry point into the lead poisoning prevention program. With regard to the infant mortality, infant mortality is one of the most significant indicators of the health of a community. It is a measure of the babies who die per 1,000 live births. 3 in the year 2000, which is the latest year for which data are available. This is a decrease of 28 percent. However, as a result of our focus on neighborhood health data, we learned that reliance on the citywide rate alone is deceptive. In some of our neighborhoods, the rate is shown to be as high as 22, while in others, it is as low as three. The death of even one baby is unacceptable and the 1314 3/4/03 - FY '04 OPERATING BUDGET disparities we see across this City are outrageous. We will change this. In FY '03, the Department developed a new neighborhood strategy to attack infant mortality, beginning in the neighborhoods with the highest rates. This strategy will operate under the title FIMR, F-I-M-R, or Fetal and Infant Mortality Review. It is a process that involves medical practitioners, community-based organizations, advocacy groups, faith leaders, health care providers and government. We must improve infant mortality citywide and we will do this by attacking the problem in a coordinated fashion at the neighborhood level. Turning to childhood immunizations, Philadelphia and other large cities in the nation have experienced decreases in the rates of childhood immunizations, due in large part to the introduction of additional inoculation requirements. In response to our determining that the citywide immunization rate had fallen from a high of 83 percent in 1998 to 76 percent in 2002, the Department set a goal to raise the citywide rate to 90 percent by Fiscal Year 2006.
Here, again, our focus is on neighborhoods, 1315 3/4/03 - FY '04 OPERATING BUDGET and it has provided the critically important information that the rates in some neighborhoods were as low as 52 percent. Using data from our KIDS Immunization Registry, we identified those neighborhoods with the lowest rates and strategically re-deployed resources to those neighborhoods. Children in these neighborhoods receive intensive outreach services which have resulted in a significant increase in immunization levels. In Passyunk, for example, the percentage of the two-year-olds with up-to-date immunizations improved from 52 percent to 66 percent as a result of this intervention. In Fairhill, the immunization rate improved from 60 percent 74 percent. And in West Oak Lane, it improved from 62 percent to 74 percent. We will continue to implement this strategy in these neighborhoods and across the City to identify pockets of need and develop strategies to improve the overall immunization rate. Considering chlamydia and gonorrhea, we are in the midst of an epidemic of sexually transmissible diseases among our adolescent children 15 to 19 years of age. In 2002 we confirmed that 1316 3/4/03 - FY '04 OPERATING BUDGET 8,000 cases of gonorrhea and chlamydia are in this age group. While to 19-year-olds make up 7 4 percent of the Philadelphia total population, more 5 than 35 percent of STD cases diagnosed were in this 6 age group. This is especially troubling because the 7 complications of untreated sexually transmissible 8 disease include pelvic inflammatory disease, 9 infertility and tubal pregnancy, and an untreated 10 STD can make a person more easily infected with HIV. 11 Because people with these infections often have no 12 symptoms, we know that many young Philadelphians 13 have infections they are unaware of. 14 Beginning in FY '03, through 15 unprecedented collaboration with the School District, we launched an intensive initiative of education, testing and treatment in public high schools. As of January 2003, Health Department staff provided STD educational sessions in five high schools with a total of 4,062 students attending these sessions. An astonishing 70 percent of those participating agreed to be screened for STDs. 5 percent in some groups tested. Treatment is made available at the school. The goal 1317 3/4/03 - FY '04 OPERATING BUDGET is to provide this program to students in all public high schools by the end of this school year. Turning to HIV/AIDS services, AIDS continues to disproportionately affect minority communities in Philadelphia. While the number of newly reported cases of AIDS remained relatively stable over the last year, with an increase from 1,137 in FY '01 to 1,160 in FY '02, 80 percent of persons living with AIDS are people of color. To address these disparities, the Department funds 12 community-based providers through the Ryan White 13 Minority AIDS Initiative. 14 The centerpiece of this initiative is 15 the "Storefront Project," which is three sites 16 located in Germantown, West Philadelphia and 17 Kensington. The storefronts are street-level open 18 access service sites providing a "safe space" geared 19 to walking traffic. They link people living with 20 HIV to primary medical care, testing and counseling, case management, substance abuse, treatment, prevention programs and other needed services. During the past year, we served 1,417 high risk people and people living with HIV through this Storefront Initiative, about half of whom are 1318 3/4/03 - FY '04 OPERATING BUDGET women and children. This year, the National Black HIV Awareness Campaign with the theme, "Get Educated, Get Tested and Get Involved" is an example of the outreach and collaboration that must continue to occur in fighting the epidemic.
Looking at our animal control services, on September 1, 2002 we marked the end of a 20-year relationship between the Department of Public Health and the Pennsylvania SPCA for the provision of animal control services. To continue these critical services, the Department has formed a non-profit organization, the Philadelphia Animal Care and Control Association, PACCA. PACCA performs all municipal animal control functions, including maintaining an animal control shelter, picking up unwanted animals from both streets and homes, and providing adoption services, enforcing animal control regulations, and euthanizing animals. From September through December 2002, PACCA has received 10,409 animals. The adoption rate has gone from zero percent the first month of operation to 20 percent in December 2002. In order to maximize the number of adoptions, PACCA has 1319 3/4/03 - FY '04 OPERATING BUDGET established working arrangements with a variety of rescue and humane organizations and forged a brand-new relationship with a national pet store chain, Pet Smart, and is currently promoting adoptions at various Web sites. PACCA has established a relationship with the University of Pennsylvania School of Veterinary Medicine and is also actively soliciting support of several foundations to assist in the adoption and support of these services. The health insurance initiative. During a typical year, approximately 1,000 patients make a total of 340,000 visits to the Department's health centers. In FY '02, 64 percent of our patients' health care center visits were not covered by health insurance. We project by the end of FY '03 we will reduce uninsured visits to 59 percent. Our goal for FY '04 is to reduce our uninsured visits to 50 percent, and by FY '08, to 30 percent. A number of studies, including a recent study by the Institute of Medicine, has found that people without insurance have worse health status than people with insurance. Yet, many of the uninsured in our health centers are insurable, 1320 3/4/03 - FY '04 OPERATING BUDGET particularly the children. Our Insurance Initiative, which includes assignment of benefits counselors to health centers and the active follow-up of patients to complete the insurance application process, is directed to significantly increase the numbers of health center patients with insurance. The success of this effort will improve patients' access to care, allow patients to choose among providers, and allow the City to benefit from the state and federal funding streams that support health insurance coverage for low-income persons. In the absence of this, the City unnecessarily absorbs the cost of these services. 5 million over the next five years. One of the most highly used services in the health center is pharmacy. This Fiscal Year the health center pharmacies will fill over 560,000 prescriptions. This volume is very close to overwhelming the present system and it has affected the quality of this service. The ability to recruit pharmacists in the midst of a nationwide pharmacy shortage and the physical limitations of the existing pharmacy areas in the health centers 1321 3/4/03 - FY '04 OPERATING BUDGET results in long, daily waits for service which, despite the best efforts of on-site managers, can stretch to several days' wait for routine prescriptions. These factors persuade us that the way this service is provided must be re-conceptualized to take into account changes that have occurred in the pharmacy services delivery industry, including increased accessibility to neighborhood pharmacies, increased availability of mail order prescription services and the near universal institution of prescription co-pays. The Department has undertaken a major management initiative which will be instituted in early FY '04.
This major management initiative which we will institute in FY '04 will involve one or more of the following alternatives: Use of a central fill system to reduce the number of refills handled in the health center pharmacies, use of mail order prescription services, conversion to complete outsourcing of the prescription services to a neighborhood pharmacy. In conclusion, the Department of Public Health is moving forward and meeting longstanding 1322 3/4/03 - FY '04 OPERATING BUDGET and developing public health challenges in new ways. We are meeting the budget challenges by bringing sound management principles together with creative program initiatives to preserve and improve the delivery of essential public health services to the people of Philadelphia. I very much appreciate the opportunity to present testimony today. Deputy Health Commissioner Michael Covone will now present testimony on the behavioral health part of the budget, and after his testimony we will be pleased to answer questions.
Good morning, President Verna and Members of City Council. My name is Michael Covone, Deputy Commissioner, and I am here to present testimony on the Behavioral Health System/Mental Retardation Services component of the Health Department budget. 7 million in the Health Choices Behavioral Health Fund. 1323 3/4/03 - FY '04 OPERATING BUDGET The Behavioral Health/MRS budget will support 295 positions, 64 in the General Fund and 231 in the Grants Revenue Fund. 1 billion, $285 million, or percent, is for mental 6 retardation services and $814 million, or 74 7 percent, is for behavioral health services. 8 The Behavioral Health System consists of 9 three major components that coordinate the City's 10 treatment services for approximately 100,000 adults 11 and children annually. These three components are 12 the Coordinating Office for Drug and Alcohol Abuse, 13 the Office of Mental Health and Community Behavioral 14 Health. 15 The system provides a full range of 16 mental health and drug and alcohol treatment for 17 both children and adults via a network of 18 community-based providers, which include an 19 extensive array of services to children with 20 behavioral health needs. 21 Mental Retardation Services is the 22 office responsible for the development, coordination 23 and monitoring of services for children and adults 24 with mental retardation. MRS provides services to 25 over 11,000 individuals per year, including case 1324 3/4/03 - FY '04 OPERATING BUDGET management, in-home and residential services, early intervention services for infants and children, family support services and day and employment services. These services are provided through contracts with over 70 provider agencies. Over the last year, Behavioral Health and Mental Retardation Services has operationalized a variety of collaborative initiatives with its sister social service agencies in order to improve the effectiveness and efficiency of services. Examples of these initiatives include, first, the increase in Student Assistance Program. Although Student Assistance Programs have been provided in middle and high schools since 1990, not all middle and high schools have had access to these services. With the infusion of an additional $500,000 from a Safe and Drug Free School Grant, the Behavioral Health System began, in January 2003, to expand student assistance services from the current 57 schools to all 90 middle and high schools. This increase will be accomplished by increasing the number of school-based liaisons from 13 to 20. The overall outcome of this expansion is to continue to foster a collaborative relationship 1325 3/4/03 - FY '04 OPERATING BUDGET with school personnel through the assessment of children with behavioral health needs, and consultations with School District and families in assuring appropriate follow-up. It is anticipated that this grant will increase the number of assessments and consultations from its current level of 3,500 annually to over 4,000 annually. In collaboration with the Office of Emergency Shelter and Services, the Behavioral Health System has seen consistent growth in supported housing resources. 4 million federal grant that targets chronically homeless individuals. This initiative will support units of supported housing and 17 services, as well as support services for 50 18 individuals through the development of an Assertive 19 Community Treatment Team. 20 The new resources will continue to build 21 on an existing network of specialized housing 22 resources for individuals with behavioral health 23 needs. Currently there are 1,920 beds in the 24 Community Mental Health Program, with an occupancy 25 exceeding 96 percent. 1326 3/4/03 - FY '04 OPERATING BUDGET In addition, supportive recovery housing for individuals and families maintaining clean and sober lifestyles are projected to increase from 332 currently to 350 in Fiscal Year '04.
With the inception of Operation Safe Streets in May 2002, the Behavioral Health System has been actively involved in providing support to individuals identified through this initiative. While the goal of Operation Safe Streets is to disrupt drug trafficking and return the streets of Philadelphia to the people who reside in the City, emphasis has been placed upon treatment and rehabilitation. Unable to purchase drugs, individuals have been entering treatment in numbers that far exceeded admissions during the month prior to the initiation of this program. On average, monthly admissions have increased by 190 persons when compared to the same time period one year ago. The Behavioral Health System has played a lead role in assuring treatment is available and that persons wishing to enter treatment are assisted in doing so. The accomplishments noted above represents the continuing effort to ensure a system that is both responsive to consumer and family needs 1327 3/4/03 - FY '04 OPERATING BUDGET and accountable to our various funding sources and the residents of Philadelphia. In order to further our mission, Behavioral Health and Mental Retardation Services will undertake the following additional initiatives during Fiscal Year '04, including the continued development and implementation of performance-based contracting for the delivery of mental health, substance abuse and mental retardation services. During the past year, baseline data in key program areas has been collected and reviewed with providers. These efforts have assisted the provision of technical assistance to providers and allowed for piloting of performance-based contracts with a number of agencies during the current year. Pilots with hospitals providing psychiatric in-patient services have included performance measures related to length of stay expectations, effective linkages to outpatient services within five days of discharge, and evidence of comprehensive evaluation within 48 hours of admission. During Fiscal Year '04 the Behavioral Health and Mental Retardation System will continue to refine the performance measures and expand 1328 3/4/03 - FY '04 OPERATING BUDGET implementation of performance-based contracts to other service areas. The Behavioral Health and Department of Human Services have begun to develop a blueprint for integration that began implementation on February 1, 2003, for delinquent and dependent children and youth. The co-location of behavioral health staff within the DHS infrastructure will assist in identifying those children and families who may have current services, a history of treatment, or have never had services, but are in need of specific evaluations. Behavioral health staff will be co-located within the screening unit at DHS to help divert unnecessary placement of children when safety is not an issue, but there are behavioral health needs that require immediate intervention. In closing, the Behavioral Health and Mental Retardation System will maintain its ongoing efforts to improve accountability and ensure the delivery of quality services to the citizens of Philadelphia. Thank you again for this opportunity to testify this morning.
Thank you very 1329 3/4/03 - FY '04 OPERATING BUDGET much. Each Council Member will get five minutes of questioning on the first go-around. Mr. McPherson, would you start with my timer? Commissioner, you state in your testimony that you will be reducing your General Fund position level by 51. However, if you look at the detail on -9, I would like you to explain why it reflects a 29 position increase in the General Fund?
President Verna, the increase is from the increment run, which I believe is the November increment run. It's from the increment run, as opposed to the budgeted number of positions.
So we're really not eliminating the positions that were never filled. Where is the cut? There is no cut. We're not saving any money. 1330 3/4/03 - FY '04 OPERATING BUDGET
Well, President Verna, what we're doing is reducing General Fund positions in the administrative areas in the Department, and that runs across about six specific components within the Department.
Commissioner, what is the backlog for lead paint removal?
The backlog for lead paint removal is, at this time, approximately a little less than 950.
Can you explain why you're eliminating in FY '04 the $1,273,000 dollars that was used for the lead paint hazardous abatement of homes? That's on the detail on -51. Mr. DOMZALSKI: Yes, I can, President Verna. That is the amount of money that we put into lead paint abatement in this Fiscal Year, which we do not have an identified source for at this time in Fiscal Year '04. I do believe that we have resources from which we will obtain that money so that we're able to continue this effort. 1331 3/4/03 - FY '04 OPERATING BUDGET But what we did in Fiscal Year '03 was piece together money from a variety of sources within the General Fund in the Department to make funding available for lead paint abatement that never was made available before.
And when would you know that you're going to be able to accomplish this?
We're going to continue as we go forward. Even now we're continuing. What we have are two sources. We put in from the General Fund in the Department's resources in this Fiscal Year, $1.5 million. For FY '04 we have two sources that we are very confident are going to come through for us this year. One is a $500,000 grant from under TANF, Temporary Assistance to Needy Families. The other is a $1,500,000 HUD grant that's available for lead paint abatement from the federal government.
So when do you 1332 3/4/03 - FY '04 OPERATING BUDGET expect to eliminate the backlog?
If I could take a step back, President Verna. When I sat here last year, what was going on is, we were adding houses to the backlog at the rate of 350 houses a year. I promised then I would never add another house to the backlog. I've kept that promise. What I also said was, that we were going to try to reduce that backlog. And the way we were going to do that was by resources that would either become available to us through a grant that we anticipated, or through efficiencies that we're able to achieve through the Lead Abatement Strike Team process. We didn't get the federal funding that we anticipated. Nonetheless, because of the efficiencies we were able to generate in our abatement process, we were still able to reduce that backlog from 1,400 to 950. We expect that backlog to continue to be reduced by a similar number this year, and by the end of the following year for it to be gone completely. And it will never return.
Wonderful. Let me ask you a question. When a 1333 3/4/03 - FY '04 OPERATING BUDGET property is demolished, do they have to check if there's lead paint in the building that's being demolished? And if so, how is that addressed?
Any house, President Verna, in the City of Philadelphia that was built before 1978 has lead paint in it. And so the debris from that has to be handled in a way that respects the fact there's lead paint contamination there and disposed of according to federal and state rules.
The specialized landfills where they're allowed to be deposited.
Commissioner, the Administration has indicated that they will be eliminating 50 Senior Administrative positions, and that six of the 50 will come from your Department. The Budget Director, when asked about this, indicated it was a planning unit that never accomplished its goals. Could you explain this reduction? Is it the mission of the units and accomplishments? If no accomplishments, why did it take so long to terminate?
I can't, President 1334 3/4/03 - FY '04 OPERATING BUDGET Verna. The unit is called in our Department the Organizational Development Unit. And I want to at the outset say that the unit has been and continues to be staffed by very able and valuable public health and administrative professionals. The unit was developed in the mid '90s with the thought that certain activities having to do with management and leadership in various units of the Department could be centralized, and that is the planning function, the developmental function. And in the early years of that, the unit was very active in doing on-site assessments in different program areas about how services could be improved and how management systems could be streamlined. Over the years, and particularly from the year 2000 onward, those functions have been increasing seen by me to be a responsibility of the individual program managers throughout the Department. And so while the services certainly had a value, they are the kinds of services that are now incorporated into the individual management expectation that I have of all of my managers. And I don't expect that to change. 1335 3/4/03 - FY '04 OPERATING BUDGET
Commissioner, would Air Management be here and could they tell us if they have any information regarding the underground fire at Hog Island? It was in the paper today, and I think it was in the newspaper one day last week. Could we be enlightened as to what Air Management has found?
I can help with that, President Verna. We have had Air Management engineers at the site of the fire on Hog Island at different times since the fire's existence. And what we've been doing is taking air monitoring samples there and the situation -- and I think you're aware, President Verna -- ranges from sometimes a very pronounced odor to sometimes odors that are very hard to detect. At some cases that we have been there, we have taken measurements and we have not found toxic materials in the air. Other times we've been there, we haven't been able to detect the odor itself. And so it's a matter of our continuing to monitor that situation until it is resolved. I'm not sure of the mechanics or what's really going on with the fire itself. 1336 3/4/03 - FY '04 OPERATING BUDGET
Whose responsibility is it to determine exactly what is causing this?
Point of fact, I think it's probably a joint responsibility. Certainly the Fire Department has the expertise in much of that area. In terms of the geology and physics and what else is going on, there may be some other professionals that need to be involved as well. We have been called on at this point to look at what are the health impacts of that and have done that assessment.
I know that Councilman Rizzo has written a letter to Christine Whitman asking that she look into this. Reading the paper, this has been going on since 1990. I think we've got to come to the bottom of what is causing this. Is it really hazardous and how deep do they have to dig to determine that? But the Fire Commissioner was in here last week and he said they merely go out and there -- in fact, I think they have hoses that are there permanently to simply douse the fire, the flames. Something is causing it. The concern is how 1337 3/4/03 - FY '04 OPERATING BUDGET dangerous is it and what is actually the cause.
I think a unit, President Verna, that has been involved with this as well has been the State Department of Environmental Protection. They have engineers and environmental scientists that have also been on the site. And what we can do is provide your office with the information that they have at this point, and maybe just get a little more certainty as to precisely who has the ball and, one, determining why that's burning and what the plan is for extinguishing it.
I would appreciate your forwarding that to my attention today.
Thank you. My five minutes is up. Councilwoman Brown.
I'd like to give my preliminary questioning to the issue of young people and mental health and drug/alcohol services, and call your attention to a map that was produced by PCCY in August 2002, where they did a comprehensive report on drug and alcohol treatment programs for young people. If you look at that, you'll notice that, according to this map, there are no services available for young people that live in West, Southwest and South Philadelphia. So for me, it begs to question, how are we serving adolescents and children in that section of the City?
There are a variety of initiatives going on relative to drug and alcohol treatment for children. Assistant Commissioner Bencivengo can talk about some of the specifics. And I know there's some follow-up with PCCY on the report that they put together around this particular issue. But beyond just the traditional treatment services, we have been able to do some additional school-based services over the course of the last year. As I indicated in the testimony, 1339 3/4/03 - FY '04 OPERATING BUDGET we've increased the Student Assistance Programs to all middle and high schools throughout the City this year with an additional grant. We've also been able to continue programs that began a couple years ago utilizing Health Choices Reinvestment Funds with C&E Specialists, Consultation and Educational Specialists in the school. Those programs have been sustained and are currently funded through the Department of Human Services.
And they're in all the schools, including those in West, Southwest --
They're in the majority of the schools throughout the City as well, and we could get you a list of which schools that they are in.
As well as a variety of other initiatives that are going on relative to supports around children's services. Specifically with the issue of additional services in that particular area, I think the follow-up discussions, and we will look at some 1340 3/4/03 - FY '04 OPERATING BUDGET additional data around that. What we have seen is actually an increase in the number of adolescents accessing drug and alcohol treatment.
Not broken down by areas, but as a City as a whole, we've seen an increase in that area, which has been historically a concern, are adolescents accessing either outpatient services or some other type of drug and alcohol services.
Another reason why I'm struck by that is in listening to Commissioner Vic Richards' testimony on why they have teen centers in certain parts of the City. And one issue or factor that drove them to the where, were the crime stats and geo-mapping provided to us by Safe & Sound. If you have teen centers in a certain section of the City, yet no support, MHMR services, then where is that comprehensive support?
And, again, I don't disagree. I think some of the follow-up discussions will determine, number one, should the services be traditional outpatient facility-based services, or is it a better approach to try to continue to enhance the services provided in the school and 1341 3/4/03 - FY '04 OPERATING BUDGET through after school programs as well, with that area. The services that are identified here are the traditional licensed behavioral health services, and what we've tried to do is come up with a series of alternatives as well, over the years.
Okay. I have questions later on licensed versus recovery houses. I'll get to that. Let's now move to seniors and mental health. Maybe I overlooked it in the pie charts that you provided, which are helpful. There's no 13 breakdown of services provided to -- you say you're providing services to 100,000 children and adults, but nothing in here reflects the actual number. How many of that 100,000 are services for kids and how many are services to adults? Further, what and where are we providing services for seniors specifically?
The actual breakdown of services between children and adults is of the --
Actually, I'm going into some of the Medicaid data right now for that. What this will represent is about 75 percent of that 1342 3/4/03 - FY '04 OPERATING BUDGET 100,000 universe on the Medicaid. And of that universe, approximately 37 percent, or 30,000, of the folks served are children under the age of 21. And 47,000 are over the age of 21. The population of individuals who are served who are 65-plus is about 1,500 individuals a year. And part of the reason for that, I want to just add one point to that, is because many of those individuals have Medicare coverage, which fall outside of the purview of the Medicaid program. And we've been working and struggling to try and ensure that some of the providers who are on the behavioral health panel of the City also get on the HMO panels for Medicaid as well. That's been a struggle we've worked with and in conjunction with Mental Health Association with some of their aging advocacy programs on this behalf as well.
Do we have any relationship or get any dollars from the Philadelphia Corporation of Aging specifically for this population?
We have a couple small joint funded initiatives with the Philadelphia Corporation for the Aging to provide some domicile 1343 3/4/03 - FY '04 OPERATING BUDGET care programs. We also have a program that we established a couple years ago for the elderly population, a mobile therapy program where we can actually have folks go out into the community in a couple areas. That is not citywide. And one of the struggles has been securing resources both from the State Department of Aging, as well as trying to get additional resources through DPW on that.
Well, I should share with you that I have been in discussions with a number of groups that care in a passionate kind of way about this population, and I will be introducing a resolution calling for hearings on how and what we can do better and differently to serve this population. So I give you a heads up on that. Is my five minutes up?
Thank you, Madam President. 1344 3/4/03 - FY '04 OPERATING BUDGET Good morning, Commissioner.
First, the issue of lead paint. What is the average cost per unit of lead abatement?
$5,800. That holds pretty true? There's not much variance one way or the other?
The reason I ask is, in testimony last week, Kevin Hanna (ph), the new Secretary of Housing and Neighborhood Preservation, talked about the discontinuation of their Settlement Grant Program because of the cost of lead abatement and placed that cost at -- he said it was guesstimate -- but at $10 to $15,000. Is that possible on average?
It is possible. Some of our abatement services have been $7,800 $8,000, $8,500.
But on average, it's 1345 3/4/03 - FY '04 OPERATING BUDGET not possible that it would cost $10 to $15,000?
It could. Let me tell you, Councilman, why this is a little beyond. There are some additional factors. For example, one of the things that -- it's one thing to abate the property for the lead hazard. Some of the properties that we get into, we cannot do the abatement until certain basic system repairs are accomplished. For example, sometimes a property will need a new roof. As long as the roof leaking, it will disrupt any abatement process that we have done. Sometimes an electrical system needs to be repaired and sometimes there are serious internal plumbing problems. All of those have to be addressed, either while we're abating or immediately before, preferably. So the total abatement could run -- if you add my lead paint abatement figure, just the average of $5,800 to what some of these basic system repair jobs cost, you could easily be $15,000 to 16.
He wasn't referring to basic systems repairs or related costs of lead abatement. He was actually just referring to lead abatement. That sort of begs the question, do you 1346 3/4/03 - FY '04 OPERATING BUDGET work in the same areas as OHCD?
We work in conjunction with them, Councilman. In fact, OHCD is a member of our Lead Abatement Strike Team.
So what level of coordination is there if one figure is $5,800 and another figure, $10 to $15,000?
I think we would need to look at what Secretary Hanna was addressing. My focus is on the universe of children who have diagnosed with lead poisoning. These may be two different issues. Under HUD, it's a requirement that you -- whether or not children are in the home or not -- that you do extensive lead abatement and that may be what he's talking about.
Let me ask the question, how are your programs coordinated under the Neighborhood Transformation Initiative?
Well, in neighborhood transformation, what we do is, when we're in an area, we are looking at the maps. Rob Hess has been very close to that process over in OESS. We have a coordination now. We're going to make that stronger as we go forward. 1347 3/4/03 - FY '04 OPERATING BUDGET
I'm assuming there's more than data sharing. Is there actual program coordination? I would assume that a natural link would be between the construction of affordable housing and lead paint abatement. Does that link exist or does it not exist?
The link that exists at this point -- and it will get more comprehensive and stronger -- is that when we're looking at houses that we're planning to abate, we look at what the situation is, whether or not that's scheduled for any neighborhood transformation activity. So far, we not seen a conflict.
Essentially we are subsidizing affordable housing to the tune of $150,000 per unit. In testimony last week we essentially said to the new secretary that you could find $10 to 15,000 within that $150,000 per unit, but you definitely could find $5,800 within that subsidy of $150,000 per unit. Shouldn't there been a direct coordination between the Health Department and what we're doing in terms of neighborhood transformation, in terms of producing housing?
There is. And Secretary 1348 3/4/03 - FY '04 OPERATING BUDGET Hanna and I have talked. We're working at the staff level. For example, I was at a community meeting last night that was focused entirely on neighborhood transformation. I'm very focused on this and looking for areas where we're going to coordinate more closely, and certainly where we're not going to duplicate any effort. There's not enough resources to do that.
So when we have a further discussion with him about the Settlement Grant Program, which we will, you will be available to provide a hard number in terms of the average cost for abatement?
On the properties that we've been doing, Councilman, yes, I can, sir.
Or properties that may need to be done under neighborhood transformation?
I'm not aware that we've done any that may need to be done under a neighborhood transformation. I don't know whether there are issues that are different from what we're dealing with in lead --
But my assumption is 1349 3/4/03 - FY '04 OPERATING BUDGET from what you said is there's only one Lead Abatement Strike Team. So if there is going to be lead abatement done related to neighborhood transformation and related to a Settlement Grant Program, that it will be done from your strike team?
With the caveat, Councilman, that the Lead Abatement Strike Team is focused on children who are diagnosed with lead poisoning. They may be slightly different populations, so I don't want to go beyond what I know on that.
Maybe slightly different populations, but there may be also funding opportunities under neighborhood transformation?
Commissioner, I don't mean to beat a dead horse, but in the budget detail for last year under the Philadelphia Health Management Corporation, we had $1,273,000. It was to be used for lead paint hazardous abatement. That has been eliminated for FY '04. That was definitely 1350 3/4/03 - FY '04 OPERATING BUDGET from the General Fund.
This is the same $1.2 that we talked about earlier that we had found in the General Fund for this year. Philadelphia Health Management Corporation is -- if I may, President, I need --
We found it last year in the General Fund in the Health Department from two major sources. Both were reimbursements for services previously rendered. One was reimbursement for planning that had been previously done and was reimbursable under the new money that came in for neighborhood health centers under the tobacco grant. And the other one was about a $300,000 reimbursement that we got for expenditures from the General Fund that we made to support all the overtime and other activities that we accrued over around 9/11. It was bio-terrorism reimbursement. So 1351 3/4/03 - FY '04 OPERATING BUDGET from those are the two major sources that we ended up able to find the $1.5 to put into this.
Do you feel comfortable that you will find that money during FY '04?
We will find that money. I am not comfortable, but I am committed that we are going to get those resources. And the reason I can say that is because I was just this side of furious when this City failed to get the HUD funding that somehow, that somehow, was made available to 16 other cities in this nation. And We went and got a 17 personal debriefing, line by line, as to why 18 Philadelphia's children weren't eligible for that 19 level of funding. 20 I will tell you, President Verna, after that session I'm comfortable and confident that we are going find this money for Philadelphia's kids.
Why didn't we get the money from HUD, may I ask?
I believe one of the 1352 3/4/03 - FY '04 OPERATING BUDGET absolutely astounding, astounding assertions that was made, was that they didn't understand our link, that our link they didn't feel was strong enough with the housing agency when, in fact, we had links with all of the housing agencies. I didn't find that to be a very believable reason. And I will tell you, President Verna, it's one of the ones that's most remediable for the next grant application process.
How are you doing? I just need an explanation of -9. I'd like to know how you get to 51 positions if there's an increase in 29 positions? Could you explain -A under Summary C? You had 830 actual positions in June of '02, but you were budgeted for 886.
Councilwoman Tasco, there are two points in the budget that we look at. One is whether the budgeted positions, that is what 1353 3/4/03 - FY '04 OPERATING BUDGET we plan to do at the beginning of that Fiscal Year. The other is our increment run. It's kind of a snap shot of where we are at any particular date. That's what the snap shot looked like on November 2nd when we did the increment run. So our 51 positions, in fact, out of the General Fund will be reduced across about eight agencies within the Department.
And I was just looking at the paper where the entire training unit was cut?
Because I was going to ask you how many slots were in the training department. So you cut all the training?
Councilwoman Tasco, we won't be cutting all the training. We will continue to do training. What we're going to be doing is putting the focus and the responsibility on the individual managers in the Department to identify what organizational development they need to do in their units and what kind of training they need to 1354 3/4/03 - FY '04 OPERATING BUDGET do specific to their program management goals. And we've provided some additional Class 200 money to be able to support that training. So the training function will accomplish it. It just won't be done at a centralized level.
So will you have the level of experience and expertise to insure the Health Department is adequately trained?
Absolutely. And the expertise, for example, in our Maternal and Child Health Program, the experts there are the people who run the program. They understand the training needs of their individual persons. In addition, our Environmental Health Unit and Air Management, as well as our Disease Control Unit, will need to do some training clearly, as we look at our expanding disease control role. And we'll be able to access funds that remain for training within the Department and also take some additional money and resources made available.
It's possible. It's possible. In fact, it's possible that we'll be able 1355 3/4/03 - FY '04 OPERATING BUDGET to get that training from experts either at Centers for Disease Control or through the State Health Department or in our own shop where we have our epidemiologists who are on board to do the training as well.
Can you describe how the pharmacy management initiative will affect the waiting period for patients and senior citizens? Part of your testimony you talk about possibly several methods of clients being able to refill or fill prescriptions.
Could you talk a little more about that? I mean, how would you envision a mail order prescription service being done? And also, how would you envision outsourcing prescription services to neighborhood pharmacists, and what would be the cost associated with that?
Those are all options that we're looking at that are on the table. My objective is that however we reorganize this service, that the impact will be direct and it will be permanent. Presently, there was a time with the 1356 3/4/03 - FY '04 OPERATING BUDGET influx of demand for prescriptions in the centers that, in the fall of this past year, the fall of 2002, we unfortunately had waits of as long as eight days for regularly scheduled medication in those centers. We cannot have that. We have addressed that. We have gotten that wait down to an unacceptable -- but improved -- but unacceptable wait in some centers of two days, and some centers we're down to same day service. We want to get everybody down to same day service. The way to do that, the way we organize our pharmacy services, Councilwoman Tasco, is probably exactly the way you would organize a pharmacy service if you were going to do it in 1972. We haven't taken advantage of all of the things that have happened to change pharmacy delivery systems in the 30 years that have passed. Mail order delivery, I don't know whether any of our patients are going to be able to use mail order delivery. But we know, we know that people can access mail order delivery in the United States and in Philadelphia right now and don't have to wait eight days. They don't have to wait four days. Some patients may be able to benefit from that. 1357 3/4/03 - FY '04 OPERATING BUDGET With regard to the central fill, the idea there is to try to take some volume out of the center pharmacy itself. These center pharmacies weren't designed to be large volume community pharmacies. They just weren't. And as a result, their design is very inefficient and they work a burden on the people who work there. And so what we want to do is try, under the central fill option, try to get about 60 percent of the volume out of there, so that all that has to happen in the pharmacy is that the centrally filled medications can then be dispensed, given to the patient at another site in the center on that day. And so it's a combination of these that we're looking at. We haven't decided on any one yet, but our commitment is to improve that service.
Councilwoman Tasco, would you complete this, please, because your time has been up.
In looking at outsourcing, since we have a large contract with Rite Aid to fill our prescriptions, maybe they ought to tack on this service for people who use, as a service to the City because we have such a large 1358 3/4/03 - FY '04 OPERATING BUDGET contract with them. Maybe they could provide that service for the Department.
Thank you. The Chair recognizes Councilwoman Blackwell.
Thank you, Madam President. I am encouraged by the creative programs that Commissioner Domzalski and the Department certainly has undertaken. I will say that I see the Commissioner all over the City, and we appreciate his firsthand approach to being involved in all of the issues that affect our communities, from our seniors to our teens, et cetera. I see Ms. Ransom and many others who do a fine job. In fact, we were with the Commissioner last night at an NTI meeting in my district. And, again, we say, thank you. I am glad to see that we have formed this new organization, too, called Philadelphia Animal Care and Control Association. You know, I have a lot debates about people who insult us over 1359 3/4/03 - FY '04 OPERATING BUDGET the years in the past. I'm glad to see that we are doing that ourselves, as well as across the board from Safe Streets to homeless funding. And I know that there was some questions about CODAAP's role in that because certainly in that arena we're doing things just not narrowly City funding, but we have to reach out, as we do, across the board now for funding from the state and the Feds in order to do the program to service our people. So I, again wanted, to thank you for your leadership and for always being available to do a great job for our citizens.
Good morning. Did I hear you say that the money for the lead abatement is not included in the budget as such?
That's correct. In FY 1360 3/4/03 - FY '04 OPERATING BUDGET '04.
We spent an incredible amount of years getting to the point in which, one, we had a focus on lead abatement. Two, in which we actually had a line in the budget committed to lead abatement. And I can tell you that I know your commitment and I know your passion and I know you from years on in, but I also know the bureaucracy and I know how things function in government of so many years. And it really preoccupies me that, as we're making this advancement in terms of finally getting a hold in making a dent in the lead abatement problem that we've had for the last 30, 40, 50 years in the City, that the money is not included in the budget. It really is worrisome. And I know that you will bend and cajole and try to do everything possible, but sometimes -- and if the things emanating from the central office as such, as David Letterman says, are not as bright as we'd like. I don't know if it is not there, I don't know whether you're going to be able to find it, because then it comes to be the area that becomes a subject of preponderance of need. So it 1361 3/4/03 - FY '04 OPERATING BUDGET really concerns me. I really would like a much more detailed answer as to how we're prepared to continue with this because it is such a huge problem, and it is a problem that, like you said, we have not added to the backlog. That, to me, is an incredible accomplishment, incredible accomplishment. So tell me, talk to me, convince me that this worry that I have, it should not be there.
I think it's well for all of us to worry about kids. I think it's very important to worry about kids that are poisoned with lead. I mean, just an editorial. These kids would not be poisoned with lead if somebody didn't put the lead there in the first place. And I think we need to look at that from a general policy standpoint. What is not in budget. We have a small amount in the budget that's always been in the budget for lead abatement.
We always have. It has never been the money that we needed, and we've never been able structure with that amount of money the programs that we need to do.
What is not there is the 1362 3/4/03 - FY '04 OPERATING BUDGET one-and-a-half million. And things are happening. Things are happening that give me a great deal of optimism and confidence that we are going to get the money. People will tell you when we have had our meetings internally, when we talk about this, one thing I always end the conversation with is, and we're not going back. Now, how to make that happen. Little things have happened. For example, in the advocacy community -- and, again, these are small things, small things. My eye is on the one-and-a-half million that we've got to extract from HUD. There's no question about that. We're going to do everything necessary -- not everything that we can do -- everything that's necessary to get that money. But little victories here and there, I think, help us in terms of displaying the commitment of this community. For example, as a result of the work of PCCY and their involvement with this issue over the years, this year, this year for the first time, we have had two hospitals who deal with children, come forward and say, as an expression of our bona fides on this, as an expression of our concern for 1363 3/4/03 - FY '04 OPERATING BUDGET children, we want to do an abatement in our hospital. We want to fund an abatement. Saint Christopher's Hospital for Children made that commitment and we've just completed that abatement and they've given us the check for that. Temple Hospital for Children is another one that has come forward and said, we want to do this. I've been talking with the managed care companies about their -- you know, at some point we're going to start talking about the fact that we in the government need to do as much steering as rowing. And so we need to invite our partners on the table on this. So we've got those two pieces that I feel comfortable with. I feel comfortable that we're going to make our convincing case with HUD and get that money. We're never going back. We're never going to add a house to the backlog.
Commissioner, children and youth and us, we've been in this struggle for a long time, and we would hate to be back here talking about the same things that we always talk about. We can't.
What's more is I know how much you don't want to be talking about that and 1364 3/4/03 - FY '04 OPERATING BUDGET that is even more of an enticement for me to be successful.
Commissioner, I'd like more detail in the reduction of 51 staff positions.
You've spoken about that, but I'd like more detail about it. And when you say it will not affect direct services, what do you mean by that? And if they were not providing anything that provided or assisted in the delivery of services, then we have to question why they were included in the first place. If we have 51 positions that can be eliminated, and that can be eliminated without affecting the delivery of services, then we have to question why those 51 positions were there in the first place.
Sure. I can tell you in some detail, and I'd be happy to supply this under separate cover. For example, 43 of the 51 positions will come out of Public Health Services, and eight positions will come out of Behavioral Health/MRS. The 43 that come out of the Public Health Services, there will be four coming out of 1365 3/4/03 - FY '04 OPERATING BUDGET Ambulatory Health. These don't affect direct services for the reason that this represents a reduction of four custodial positions that are related to the overall citywide centralization of that service.
Well, you're telling me that you're eliminating four janitors, right?
This whole service is going to be centralized in the government and provided across departments through a centralized service.
That's four. I'd like to find out how that centralized janitorial service or maintenance service is going to work. Because the community health centers usually get somehow neglected every once in a while and we need to be able to have them in a shape in which the individuals that come there understand that they're going into a clinic and not just a little dump.
Councilman, Mr. Dubow 1366 3/4/03 - FY '04 OPERATING BUDGET tells me that Public Property is going to discuss this very issue on how it's going to be organized and how the various needs are going to be met when they testify sometime either later today or whenever.
Well, give me more detail as to -- we got four positions eliminated in custodial services. That would leaves us -- I'm very bad at math.
In our Division of Early Childhood, we're going to reduce one clerk in the General Fund. And what we will be doing is just using the existing staff to absorb those responsibilities. In the Environmental Protection component of the Department -- now, the Environmental Protection component, Councilman, includes both environmental health services and also the air management services. We'll be reducing six General Fund positions from that component. They will consist of one administrative assistant, one vector control worker, one field investigator --
A vector control worker. 1367 3/4/03 - FY '04 OPERATING BUDGET
That person that helps us respond to complaints of various animal control, might inspect or respond to a complaint of rodent infestation.
Commissioner, my office does call your office regarding that issue. How many inspectors will remain?
Well, how many inspectors will we have? MR. DOMZALSKI I have that detail right here.
That's one of the issues that happens. 1368 3/4/03 - FY '04 OPERATING BUDGET
While we're pulling that out, can I give you the others? There will be one administrative manager that's reduced. One Air Management Services license specialist. That will be the six positions. In Administration there will be positions that we're 8 reducing. Those 24 positions consist of two people 9 in personnel. It will consist of one equipment 10 operator in facilities management. We will have one 11 service representative in our medical eval unit. We 12 will have four positions in our Fiscal Office; an 13 account clerk, a financial technician, a clerk steno 14 and an administrative support specialist. There 15 will be three positions in the Health Commissioner's 16 office that will be reduced. 17
One will be an executive 19 assistant, one will be a secretary and one will be a 20 clerk typist. 21
Are any of 22 these employees that you have just mentioned under 23 the DROP Program? How many of them are under the 24 DROP Program?
President Verna, we have presently 125 people across the Department that are in the DROP Program. And in Fiscal Year '04, 49 of those 125 will drop. 38 of them are in Public Health and are in Behavioral Health. 9 And in the following year, FY '05, we 10 have 29 that are in DROP, of which 27 are in Public 11 Health and two are in Behavioral Health. And in '06, 37 people will drop, 30 of which are in Public Health and seven in Behavioral Health. And when we get out to Fiscal Year '07, we have 10 total in the DROP, and all of those are in Public Health.
In answer to your question, we will have seven remaining vector control workers after we drop that one.
That's for the whole 1370 3/4/03 - FY '04 OPERATING BUDGET City?
Yes, sir. But they're not the only one's who respond to those services. On the remainder, we have five positions in the Medical Examiner's Office, two of which are the custodial positions, which Public Property will talk about in terms of the custodial work. We have one investigator that we will not be filling. And we have two clerical positions that we will not fill.
Commissioner, what I would like is for you to give us a rationale behind this. Because when you eliminate 51 positions and you go through departments and you never perceived -- they're almost inter-dependent many times. And when you say it will not effect services -- and specifically because I'm very concerned. Health and DHS, Recreation, are probably departments that I don't like to see cut in terms of situations. So it concerns to me as to what services, delivery systems 1371 3/4/03 - FY '04 OPERATING BUDGET may be impacted and I would like to look at it. But I'd like to see it in print so I can read it. I can digest it and look at it.
Yes, they have been. And I just wanted you to finish your line of questioning.
First, I want to thank you for your aggressive action on the infant mortality issue. I know that you really are concerned about that as we've met and talked about taking some action. So I just like for the record to know how far you are along on your Fetal Infant Mortality Review. Just give us a little more 1372 3/4/03 - FY '04 OPERATING BUDGET information about what you're doing.
Sure, Councilwoman. First of all, I think the City should thank you, Councilwoman, for having the hearings that you had in September in these chambers for infant mortality. The chambers were packed and it really galvanized the interest around some things that we had been wanting to do. You may recall that at the end of that Session I turned to my staff and said, we now have an hour and a half less to do something than we had when we began this discussion this afternoon. What we have done is, first of all, I asked the Medical Director for the Department of Public Health, Dr. Joann Godley, to head up the infant mortality review focus for the Department. And toward that end we recognize that there are three major components in addressing infant mortality across the City. The first is the provider community; the hospitals, the obstetricians, the neonatologists, et cetera. We have worked in conjunction with the Delaware Valley Hospital Council and we've convened a meeting of the heads of those departments and all 1373 3/4/03 - FY '04 OPERATING BUDGET the hospitals across the City to talk about having them partner with us to begin to look at this from a scientific structural approach and to address the issue of infant mortality from a medical, scientific perspective. The other area that's important is the community-based organizations. Because as in all things having to do with health or public health, it's a community affair, and what we do together as a community to ensure conditions in which people can be healthy. And so we called together a meeting between of our provider organizations and community-based organizations, and we had that over at the School of Public Health just about three weeks ago on a Monday evening. I think we're going to have to redo that because it also happened to be Monday evening when it was very, very inclement. There was some snow. But despite that, we did have representation at that meeting. Third of all, we have the government. And when we look at our maternal and infant care programs, our maternal and child health programs, our Division of Early Childhood, Women's and Youth Health Services, a huge part of this is directed 1374 3/4/03 - FY '04 OPERATING BUDGET toward infant mortality and having -- and the two components as you pointed out in your hearing, Councilwoman, are the fact that most infant mortality comes about as a result of babies either being born too soon or being born too little. And so the more we can focus on women's health, that is a principal ingredient as to where we are. So the idea here is we will pull our community partners together on this and, yes, my partners in the managed care industry are going to be right there at the table with us when I meet quarterly with them and we do put these issues on the table. And so what we're pulling together is this focus so that when -- first of all, the death of infant, a child less than 365 years of age should not be a statistic. It's an event. It's a tragic event. And we need to understand each and every one of those from the tragic event that it really is. And understand that, albeit not in emotional terms, but what is it that we can do as a community to prevent that next infant death. That has a component that's medical. It has a component that's nursing. It has a social work component. It has an outreach and it has a neighborhood component. And 1375 3/4/03 - FY '04 OPERATING BUDGET so these things will be brought together under the Fetal and Infant Mortality Review so that this group meets and reviews infants' deaths on a regular basis and brings -- not two years from now, not two years from now, not a year from now -- but brings data that we can understand and we say, yes, this looks like it's an appropriate intervention to bear on the communities as we find the data. I've asked our staff to begin in the communities of highest need in this City. There's two communities right now that are very high need.
One is in your district, Councilwoman Tasco. The other one is in Councilwoman Blackwell's district. And so where we are is going to be focusing there and bringing our community and Fetal and Infant Mortality Review and resources in that. We're very glad to have you, your staff, as partners, and to keep you posted as to how we're progressing. I don't like the word "progressing" because it sounds like it's not a very active word, but we want to be active in this and to be sharing and to be effective ultimately.
Thank you. I have more questions, but my time is up. 1376 3/4/03 - FY '04 OPERATING BUDGET
Thank you. The Chair recognizes Councilwoman Miller.
Thank you, Madam President. Just to do a follow-up. Good morning, Health Department.
Follow-up on the infant mortality question. Can we, as Councilmembers, get a quarterly update from the Health Department that gives us information about what's going on in our district? For example, I believe Zip code 19144, which is Germantown, is an area that has a high infant mortality rate. When Councilwoman Tasco had public hearings last year there was a lot of information. I just wonder what's the information today. So if we have a quarterly update then we could keep a little bit current about what's going on. And then when we're going out to community meetings we can address certain issues during those meetings.
Absolutely, Councilwoman. And I can tell you that what I will provide you and to all Councilmembers is the infant 1377 3/4/03 - FY '04 OPERATING BUDGET mortality, the rates that exist in the various districts, including 19144. In addition to that, we have just completed something that I have talked about in this past year, and that is understanding the health of the City of Philadelphia from the perspective of the health of its neighborhoods. For the first time ever, we have got some 40 neighborhoods in the City all outlined with specific health status indicators, and I'll be happy to provide that to you, and can do that quickly. In fact, provide it to the Council President for consideration to distribute to all Councilmembers I'd be pleased to do that immediately.
That will be great. We need to know what health of our City is too.
Absolutely. We'll make sure that you keep informed, Councilwoman.