1431 COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE OF THE WHOLE FY '06 OPERATING BUDGET - - - - Room 696, City Hall Philadelphia, Pennsylvania Wednesday, March 23, 2005 10:40 a.m. - - - - BILLS 040767, 040789, 050001, 050002, 050003, 050007, 050008. RESOLUTION 050022. PRESENT: COUNCIL PRESIDENT ANNA C. VERNA COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN DARRELL L. CLARKE COUNCILMAN DAVID COHEN COUNCILMAN FRANK J. DICICCO COUNCILMAN JACK KELLY COUNCILMAN JAMES F. KENNEY COUNCILWOMAN DONNA REED MILLER COUNCILMAN JUAN RAMOS COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN FRANK RIZZO COUNCILWOMAN MARIAN B. TASCO - - - - 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 1432 I N D E X WITNESS PAGE JOHN DOMZALSKI, Health Commissioner. 1433 CARMEN LEMMO, Health................ 1456 MORRIS FINE, Health................. 1515 JOSEPH CRONAUER, Health............. 1524 KATE MAUS, Health................... 1549 ARTHUR EVANS, Health................ 1587 ROBERT HESS, OESS................... 1602 LETISHA HINTON, OESS................ 1636 LEON KING, PRISONS.................. 1642 EDWARD SZYMANSKI, Prisons........... 1647 ALAN APEL, Prisons.................. 1662 ELLEN STEIKER, MDO.................. 1677 1433 03/23/05 - FY '06 OPERATING BUDGET
Good morning, everyone. Again, I apologize for the delay. This is a continued public hearing of the Committee of the Whole regarding Bill Nos. 050001, 050002, 050003, 040789, 040767, 050007, 050008, and Resolution No. 050022. The first department to testify will be the Health Department. I would ask that they please approach the witness table. Good morning and welcome. Please identify yourself for the record and proceed with your testimony. COMMISSIONER DOMZALSKI: Good morning, President Verna and Members of Council. I'm John Domzalski Health Commissioner. Thank you for the opportunity to present the Health Department's FY '06 Operating Budget request. With your permission, President Verna, I would like to summarize the testimony.
We would certainly appreciate that. I see you have a book here. 1434 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Thank you. 5 million. 5 million is in the Grants Fund. 4 million comes from city tax supported funds. The Department's budget will support 954 positions; 680 in the General Fund and 274 in the Grants Fund. This represents a reduction of 81 General Fund positions from the FY '05 adopted budget. Working within the confines of this budget, the department will maintain key performance and service levels in certain areas comparable to those of FY '05. However, with the reduction of 81 positions, the Department has reached a point where staff reductions can no longer be confined to administrative positions. These reductions will result in service delivery inefficiencies as well as the inability to meet key performance and service levels in other areas. Health center patients may experience service 1435 03/23/05 - FY '06 OPERATING BUDGET delays, and the interval between restaurant inspections will increase, as examples. To lessen the impact on direct services, we are implementing extraordinarily tight measures in managing and deploying existing staff to deliver critical primary care and core public health services. We have a number of accomplishments and progress to share with Council this morning. With regard to lead poisoning, the public health offensive against childhood lead poisoning, launched in April 2002, continues to reap benefits for Philadelphia's children. The Philadelphia innovation, the Lead Abatement Strike Team, LAST, has gained national recognition as the model for securing effective collaboration among health, housing, regulatory enforcement, and child welfare agencies to combat childhood lead poisoning, as has the Philadelphia Lead Court. The combined impact of the strategy is that houses in which lead poisoned children reside are no 25 longer added to a backlog. The backlog itself 1436 03/23/05 - FY '06 OPERATING BUDGET has been reduced by two-thirds, and the number of new cases of lead poisoning is decreasing every year. Primary prevention is where we're going next with public health intervention to prevent babies from becoming lead poisoned in the first place. So far this year, we've provided primary prevention services to 1700 new mothers and conducted lead hazard reduction in 115 of the houses in which these new mothers reside. Philadelphia's effectiveness is being recognized by nomination for an Innovations in Government award, but more importantly, by attracting federal and state funding to support this effort. With regard to childhood immunizations, one of the significant public health measures of the health of the community is the extent to which children, namely, children between the ages of 18 and 36 months, are age appropriately immunized. When we began looking at this in 2002, we found that not only were the City's immunization rates 1437 03/23/05 - FY '06 OPERATING BUDGET among children lower than needed, but they were declining at a very, very fast rate and we set about to turn this around. And with our excellent Division of Disease Control staff and our immunization staff, what we did was look at the immunization rates, not only in the City, but in the neighborhoods, and found that where we were at 75 percent at that point was really the good news because some of our neighborhoods had fallen to below 50 percent. And we strategically redeployed our resources to have those neighborhoods of greatest need. I'm happy to report that the impact of this is extraordinarily significant. Last summer the Centers For Disease Control immunization program told us that not only had we achieved our goal of stopping the decline in immunization rates among children, but we had actually turned it around. 5 percent.
We've continued our effort, and we expect this August to receive a report from the Centers 1438 03/23/05 - FY '06 OPERATING BUDGET for Disease Control telling us that our immunization rates have climbed again to approximately 84 percent. If that turns out to be true, not only will that be wonderful for our children, but it will be the first time in the history of the City of Philadelphia that immunization rates among children have ever been that high. Our goal is not 84 percent; our goal is 90 percent, and we are extraordinarily confident that we are going to achieve that. With regard to the health of our adolescent children, Philadelphia like, other major urban areas in the country, is experiencing an epidemic of sexually transmissible diseases, particularly among our adolescent children 15 to years of age. 19 Philadelphia was like every other City in the country in that regard. Philadelphia is no 21 longer like every other major city in that regard as a result of the collaboration that our STD Program has achieved with the School District and with Family Court and other agencies across the City to do aggressive 1439 03/23/05 - FY '06 OPERATING BUDGET screening and education in all settings and to argue for making the identification of the presence of sexually transmissible diseases in our adolescence a standard of care in this community. The result of this has been that for the first time in eight years, Philadelphia has experienced a decline in both chlamydia and gonorrhea among our to 10 19-year-olds. This sets us apart from other 11 large cities. And in fact, the model that 12 we've developed here with this close 13 collaboration with the School District, with 14 public health professionals, with the Family 15 Court, with the Youth Study Center across the board has been held up as a national model for other cities to emulate in terms of battling this increasing epidemic of sexually transmissible diseases. Regard to HIV/AIDS, not enough can be said about this epidemic. The reason not enough can be said about is because we are at tremendous risk of becoming complacent. We look, for example, in my testimony, it will tell you that we have an adjusted number of 1440 03/23/05 - FY '06 OPERATING BUDGET cases in FY '04, cases had fallen from an adjusted 970 cases to this year's estimate of 815 cases. That's a significant decline. Unfortunately, it's only the tip of the iceberg. We do not know enough about the number of persons who are infected with HIV in our City. Our Board of Health in March of 2004 approved a regulation making HIV reportable, not by name as the prior Administration in Harrisburg had wanted to us to do, but by a unique identifier, code-based identifier, and we're beginning to get data on that. Another significant piece of this is that this disease, continues to adversely impact communities of color to where 66 to 75 percent of all cases of HIV and AIDS are definitely in our communities of color. For this reason, we have to continue our efforts to get our services out into the communities and using community-based organizations across the City. We've been fortunate to be able to have a good cadre of community-based organizations that can deliver these services. 1441 03/23/05 - FY '06 OPERATING BUDGET And our recent contracting with regard to this in the neighborhoods with our $6 million of HIV prevention money, we've been able to get out there and get into minority organizations in our neighborhoods. So we need to keep plugging away at this. This virus is something that is extraordinarily daunting. We had a case in February in New York where an unusual virus was reported. It was a virus that was though to be a new strain. We don't know in that's so or not. We do know the fact that a man who was relatively recently infected had progressed to full-blown AIDS in a period of time unprecedented at anytime in the past.
We do know that this virus replicates and it mutates and it changes; and for that reason, we've got to continue to press the issue of HIV awareness, to get people tested, to get involved, and to continue to get that message out. There's just no way that we can take this virus for granted. And I can say that our AIDS Activity Coordinating Office certainly does not do that and is at the 1442 03/23/05 - FY '06 OPERATING BUDGET forefront, working with our community-based organizations particularly with battling on this new issue that we're dealing with, and that's the impact of crystal meth in this community. I want to say a quick word about influenza immunizations. This year, as we recall -- seems just so recently, but in other ways so long ago -- we had one of the difficult influenza seasons that we've ever had, not so much because we've had more influenza disease in Philadelphia; we did not. But we had a huge disruption in the supply of influenza vaccine. When we thought we were going to have plenty of vaccine for everyone everywhere, a week later we were advised that one the major manufacturers had a problem with the manufacture of the vaccine, and the vaccine supply was precipitously cut in half, which meant that all of your vaccine supply that you counted on you couldn't count on anymore. What we did was decide that we were going to press on this. We opened clinics and then we would have to close them. We opened 1443 03/23/05 - FY '06 OPERATING BUDGET them, then we'd have to wait for another supply of vaccine. We took an aggressive approach with regard to this with both the state government, with federal government, all levels, at the Centers For Disease Control with secretary Tommy Thompson at the health and human services level, and we were very much helped by Senator Specter's office in pushing our case forward to get information and to get supplies of vaccine. Last year when there was no vaccine shortage, we were able to get through government auspices 30,000 doses of vaccine into the arms of Philadelphians. This year in the face of this shortage, we were able to change that performance, so at the close of business last Friday we were able to say that this year we got 59,000 doses of vaccine into the arms of Philadelphians. And for the first time ever we were able to get flu vaccine to our long-term care facilities. We were able to get 7,000 doses out into long-term care facilities when most long-term care facilities were continuing to have to wait for their flu 1444 03/23/05 - FY '06 OPERATING BUDGET vaccine supply. So I think we can be grateful for that and also to really take my hat off to our excellent immunization staff in the Division of Disease Control, Dr. Johnson, her staff, and Joe Cronauer. With regard to our health centers, our health centers continue to provide essential medical and public health services to a large number of city residents this year. The health centers serviced 107,000 individuals who made a little over 319,000 patient visits. In addition to delivering high-quality medical care to our patients, a major focus is to assist insurance eligible health center patients in becoming insured. Since FY '03, this initiative has increased the number of insured visits to the health centers from 36 percent to 47 percent, and continue emphasis on this will be place in the year ahead. Prescription drugs. Our health center pharmacy this year are on track to fill an astounding 600,000 prescriptions in our health centers. Among the services, that is 1445 03/23/05 - FY '06 OPERATING BUDGET the most severely pressed in these health centers, our prescription services and our pharmacies. And it has nothing to do with the supply of drugs, it has nothing to do with our ability to fund personnel to operate the centers; it has everything to do with the capacity of those pharmacies to deal with this huge increase in volume. And so while I've talked about this before, it turns out to be a daunting task.
And one of the things that we finally settled on is a model that looks like it's got some value in terms of improving the service in a cost-effective way. We're going to be rolling out a pilot on this with a pharmacy service that operates on a central fill basis supporting the health center so that individual prescriptions don't have to all be filled in the health centers. So we expect that within probably within a month to be rolling that out at one of our health centers, and we'll continue to give you an update with that. Infant mortality is a measure of the numbers of babies who die before the age of 1446 1 03/23/05 - FY '06 OPERATING BUDGET year of age per thousand life births. 6 in 2002, which is the latest year for data are available. Nonetheless, we continue to see disparities in infant mortality across neighborhoods. In some cases, some of our neighborhoods have infant mortality rates that rival third-world countries and are up around and deaths 12 per thousand live births, and we continue to 13 plug away at that to deal with this critically 14 important public health indicator. 15 The Department of Public Health also 16 has a challenge with regard to dealing with 17 the situation that occurred when the 18 Pennsylvania SPCA decided to exit the animal 19 control services industry two years ago. At 20 that point, we set up a non-profit 5013C 21 corporation to handle the more than 30,000 22 stray and unwanted animals in Philadelphia each year. Since it's inception, PACCA, Philadelphia Animal Care and Control Agency has faced many challenging issues, some of 1447 03/23/05 - FY '06 OPERATING BUDGET which, indeed many of which that were brought on by inexperience and others brought on by the shear numbers of animals. A number of these issues were raised and very well in Council here and convened by Councilman Jack Kelly late in 2004. I'm pleased to report that after a nationwide search, the appointment of a permanent director for PACCA has been finalized. And quite different from what the situation was in November 2004, the Board of Directors has been expanded to put control of the board entirely within the community. It is no longer a City-controlled board. And to PACCA and the Department of Public Health have become founding members for the Alliance for Philadelphia Animals, working toward a no-kill policy for the City. Important in this regard is our ability to retain a national expert on the operation, humane operation, of shelters; Nathan Winegrad, he's completed his study and we expect to have his report in probably another several weeks. Among our challenges for FY '06, I 1448 03/23/05 - FY '06 OPERATING BUDGET list the following: The top of list is our bioterrorism preparedness. One of the challenges facing Philadelphia is to be able to enhance our readiness to be able to respond to an attack with biologic agent. The fore most concern is the ability to respond in a timely manner to a bioterrorism event over a large geographic area with an agent such as Bacillus anthracis, the organism which causes anthrax. Should that eventuate in Philadelphia, antibiotics must reach the entire population quickly to have the greatest life-saving effect. Philadelphia is presently well on the way to developing a plan to distribute antibiotics to one and a half million residents within 48 hours of such an event. The logistics of designing and implementing this plan will require intensive cooperation between various city agencies, not only including health, but fire, police, Public Property and others. With regard to the Philadelphia Nursing Home, for the past 11 years a non-profit corporation under contract with the 1449 03/23/05 - FY '06 OPERATING BUDGET City has managed the Philadelphia Nursing Home. This corporation has decided to exit the long-term care business and does not intend to operation and manage the contract which expires on June 30, 2005.
The Department is seeking to identify a new organization to either manager the Philadelphia Nursing Home or to acquire the 500-bed license. The Department is collaborating closely with the Pennsylvania Department of Welfare in an initiative to develop additional community-based resources to ensure that wherever possible individuals are served in the community rather in the institutional environment. In selecting a new organization to manage or acquire the nursing home, the Department will prioritize the willingness of a new vendor to continue the commitment to the City's mission of ensuring that long-term care and services continue to exist for Philadelphia residents who have no 23 other options. In November 2003, we were given an assignment by the voters when they effected a 1450 03/23/05 - FY '06 OPERATING BUDGET Charter change mandating that the Health Commissioner develop a plan for the delivery of universal healthcare to all Philadelphians. Since that date, the Department has worked toward a goal of creating a realistic and practical plan to provide quality healthcare services for every citizen. We actually sought the participation of a variety of stakeholders, health systems, et cetera, in a series of community meetings and information gathering sessions in order to assess the full universe of issues and problems with the current system. A successful plan will require some degree of systems integration on local, state, and federal levels and a practical strategy for making universal healthcare available to all Philadelphians. We have been engaged in a number of management initiatives over this past year in particular to adjust a severe management downsizing by way of DROP and to accommodate budget reductions. I'll tick them off: The management of the health centers has been restructured, replacing higher level 1451 03/23/05 - FY '06 OPERATING BUDGET administrators with hands-on operating level managers. We are assessing the utilization of staff at the patient and client contact level. This may mean nurse supervisors will be working supervisors and medical assistants will conduct patient processing so that critical RN staff can handle triage. The management of our three laboratories operated by the Department has been consolidated under one laboratory operations director and planning is underway for the physical consolidation of these three laboratories. To help offset costs, such as our school STD program, we've identified a way in order to have managed care companies respond to insurance claims that are rightfully made on behalf of individuals receiving this service, and we've already begun to receive payments for the services that we have delivered. Importantly, in a collaboration with the Department of Public Property, two years 1452 03/23/05 - FY '06 OPERATING BUDGET ago I said we need to centralize the way we make appointments across our health centers. That's been done. The centralized call system is in full operation to handle calls for appointments at eight health centers from one location and with one half of the staff previously used to handle these calls in the health centers. During the last three months of 2004, this call center handled 41,000 health center appointment calls and 20,000 calls for animal control services. In addition, potential reductions in the preliminary FY '06 federal and state budgets could have an effect of reducing funding in several department program areas, including childhood immunization, STD prevention programs and the state funded tobacco control program. Proposed changes in the state Medicaid program could also increase the number of uninsured patients in our health centers. We intend to have further initiatives in FY '06. We're going to rearrange our maternal and child health 1453 03/23/05 - FY '06 OPERATING BUDGET service to establish a collaboration to ensure that each child born in high-risk areas will receive an early intervention visit.
We will establish a minority health focus in the Department to better coordinate interventions to address health disparities. And we will create a program structure to address chronic disease prevention as a public health program. This budget presents significant service delivery challenges. We will work to minimize the impact on services, but we know that the all of the impact cannot be avoided. We will continue to confront these budget challenges by bringing sound management principles together with creative program initiatives to deliver essential public health services to the people of Philadelphia. President Verna and Members of Council, I thank you very much for the opportunity to present this budget request.
Thank you, Commissioner. I first want to applaud you and 1454 03/23/05 - FY '06 OPERATING BUDGET members of your staff for doing an absolutely magnificent job. With that being said, I do have some questions. You mentioned on of your testimony that your department has been reduced by 81 positions. Can you tell us what positions have been eliminated and their impact on services? COMMISSIONER DOMZALSKI: I can. First of all, just in terms of the overall makeup of the 81, we've addressed that, there are 58 positions that are in the category of cuts. There are 13 positions that have been transferred to grants. There are 7 positions that are associated with the centralization of certain core services such as custodial and facilities management services, and we have had to layoff three individuals. The program areas in which these reductions take place are in our health centers, in maternal, child and family health, in our lead program, in air management services, in environmental health services, in AIDS Activity Coordinating Office, in the 1455 03/23/05 - FY '06 OPERATING BUDGET Division of Disease Control, and in administrative support.
Commissioner, I did hear you say there were 58 positions that were cut and three layoffs. COMMISSIONER DOMZALSKI: Yes.
Can you explain to us about the cuts? COMMISSIONER DOMZALSKI: Yes, of 11 them occurred in ambulatory health services, 12 which are units where our health centers are 13 managed from. Three positions were in the 14 Division of Maternal, Child and Family Health. 15 Five positions were in our lead program. 16 Seven positions were in environmental health. 17 Seven positions were in air management 18 services. Three positions were in the 19 Division of Disease Control. Two positions were in the AIDS Activities Coordinating Office. And 12 positions were in administrative support.
So I can safely assume that those 58 positions were budgeted but not filled? 1456 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Yes.
Carmen Lemmo, Director of Finance and Administration Right now we have 680 filled as of December 1st. Right now, we are about 680 filled positions, which is exactly about the same number which we are budgeted for FY '06. COMMISSIONER DOMZALSKI: So they're budgeted positions, Councilwoman.
Also on of your testimony, Commissioner, you state that health centers may experience service delays and the interval between restaurant inspections will increase. Will you please explain what service delays we might expect in the health centers? COMMISSIONER DOMZALSKI: Sure. In the health centers, the areas that are of most concern in our health centers are nursing positions and some of our clerical positions. All the positions are important, but these are the ones that impact on our ability to move 1457 03/23/05 - FY '06 OPERATING BUDGET patient through the health center efficiently. With reduction of those five positions, what we're doing is looking -- just to give you a concrete example of this, part of the operation that goes on in the health center, you come in, you get an appointment, you see the doctor. After you see the doctor, the doctor might say, "I think you want you to see a dermatologist," some other kind of specialist. In our managed care program, we will make that appointment in the health center using one of our managed care nurses. It is highly probable that in that circumstance we may be pulling that managed care nurse away from making that the appointment with the specialist to deliver care immediately to a patient that's in the center. So the delay would be that the patient might not get his or her specialty appointment that moment that they're on the site but would have to get it mailed to them or call them a day or two later about it or something like that. Again, I don't want to underestimate 1458 03/23/05 - FY '06 OPERATING BUDGET the significance of these reductions. But on the other hand, we need to work very, very hard to make sure that we minimize those. That's the kind of thing that require hands-on management every second of every day in those health centers just to make sure that we don't incur delays or inefficiencies that are not necessary. And I think we're not going -- the good news, I think, is we're not going to have to cut the number of patients we're able to see.
What is the current waiting period for a health center visit? COMMISSIONER DOMZALSKI: It can range from a low yesterday in some of our centers of one day. And I think we have to distinguish between adults -- I'm going to talk about right now adult appointments. It can be a low of one day. There's another center that has a four-day wait. And there's another center that has 180-day wait.
What center is that? 1459 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: I think that's Health Center 10. That's where we have a huge demand for adult services. And, of course, what's driving this demand is the increasing numbers of people who don't have health insurance and particularly adults who have no other place to go but the City's health services system. Now, the reason I spent a little bit of time talking about our centralized appointment system, what we want to do is look at the health centers as a whole, as an entire system. So if that patient who's calling up there at Health Center 10 and saying, "You know, I want to come in" -- this is nor new patients. And we say, "It's going to 187 days or whatever or we can give it to you in November." The patient says, "Gee, don't you have anything else? I can't wait that long." Our central appointment system can look at the screen and say, "You know, I can get you in in a month at Health Center 3 in West Philadelphia or I can get you the next day at Health Center 2 in South Philadelphia." So 1460 03/23/05 - FY '06 OPERATING BUDGET we're able to use the entire capacity. I think our ability to do this is going to become more efficient as we get more experienced with the power of that central appointment system.
Well, if I live in Center District and I have to wait 9 180 days for a visit and I feel that I 10 definitely have to see a doctor immediately, if not sooner, and I am told that if I go to District 2 I would be get an appointment the very next day, if I have to continue seeing the doctor, would I have to continue going to District 2? COMMISSIONER DOMZALSKI: I'm sorry.
Would I continue going to District 2 for every visit. COMMISSIONER DOMZALSKI: What we're able to do is move patients around. We like to stay where they are, but sometimes what would happen is as the capacity of the system changes -- you know, one of the things that we do here in an area we really need to give some thought to, we do things nobody else does. If 1461 03/23/05 - FY '06 OPERATING BUDGET people decide that they really need -- first all in, that context there where someone comes in and say "I really need to see the doctor," we'd hook you up with our nurse at the time. We say, "Now, wait a minute." After a discussion, the nurse may say, "You really need to see a doctor and it's not this kind of doctor. You really need for that condition go to straight ahead to the emergency department." Or we might be able to schedule as an urgent walk-in. What we're talking about here are people who don't have an urgent condition, people who just want to come to connect with a source of care, get a routine physical exam.
I notice there are a number of Councilmembers that would like to be recognized; however, there's one area I would like to cover while the microphone. Commissioner, who currently has the contract to manage the Philadelphia Nursing Home? COMMISSIONER DOMZALSKI: It's a 1462 03/23/05 - FY '06 OPERATING BUDGET non-profit corporation called Episcopal Long-term Care.
And they've had that for years, have they not? 6 COMMISSIONER DOMZALSKI: Yes. 7
When did 8 they give you notice that they do not intend 9 to renew management contract, which you 10 indicate expires end June 30, 2005? 11 COMMISSIONER DOMZALSKI: Probably about a year and a half ago.
I personally was rather shocked to hear that. Has the District Councilperson been notified of this? COMMISSIONER DOMZALSKI: I don't think so.
I believe that would be Councilman Clarke. COMMISSIONER DOMZALSKI: I don't think so.
I was just shocked to hear it. You mention that you seek a new 1463 03/23/05 - FY '06 OPERATING BUDGET organization to either manage the Philadelphia Nursing Home or to acquire the 500-bed license. Who are you in discussion with? Are you at liberty to tell us? COMMISSIONER DOMZALSKI: I'd rather not talk about the specific organizations. I can tell you some detail.
That's fine. That's fine. How can you sell the 500-bed license and what are the procedures for its sale? Wouldn't you need federal, state, and city approval to sell the license? COMMISSIONER DOMZALSKI: It's a state license. And there is a question with regard to what, if anything, can be, quote/unquote, sold. The City does not own the physical structure of the nursing home. We occupy it as a result of 50-year lease from the state. That had been the old Henry R. Landis tuberculosis hospital.
Do you know how long it would take for the approval of a state license? We're talking about three 1464 03/23/05 - FY '06 OPERATING BUDGET months. COMMISSIONER DOMZALSKI: I think the details that they need to consider on that, they already have, the state does. We've had meetings with the Secretary of Welfare, Estelle Richman, in regard to this. We've had a number of meetings with her staff. Everybody pretty much knows what the information is that everybody needs to have in order to think about this. Of course, one of the things we want to come out of this is while it certainly wouldn't have been our preference to end this contract at this point, now we are going to make a change, we want to make that we try to make some lemonade out of this lemon in the sense that we're able to take full advantage. You know, when Episcopal Long-term came in 11 years ago, we didn't have much, if any, ability for people to receive care in their homes. The only answer was you had to go to an institution. Thank heavens, so much of that has changed. The State now is making many more resources available to allow people to receive long-term care in their 1465 03/23/05 - FY '06 OPERATING BUDGET homes as opposed to only going to an institution. So we want to take full advantage of that opportunity as it comes along.
Commissioner, what if any City Council approvals are required for either a management contract or the sale of the license? COMMISSIONER DOMZALSKI: I don't know about the sale of the license. In fact, one of the things that comes up with the sale of a license is whether or not anybody owns the license and whether or not it's something that the State retains ownership of. That's just a new wrinkle that's come up in this, and it's more like a privilege kind of thing where they would approve the transfer of the license. With regard to a contract, we're still bound by City Charter regulations where we would be limited to a one-year contract with the potential for some extensions.
Point of information. 1466 03/23/05 - FY '06 OPERATING BUDGET
Yes. The Chair recognizes Councilman Rizzo for a point of information.
I'd be interested, Madam Chair, to know when did we first know about this change. It certainly is a surprise to me.
I think the Commissioner said it was a year and ago.
Is this some something you didn't think was important, Commissioner, for us to know about? COMMISSIONER DOMZALSKI: Of course it's important to know about. Could our communications be a little bit better, a little more timely? I will tell you certainly. But I'll tell you that once you -- the big change in the Philadelphia Nursing Home is when we went from 100 percent City-operated facility to an outsourced 1467 03/23/05 - FY '06 OPERATING BUDGET management contract, which means that people are not in it forever. This comes up as part of a change. Quite frankly, we're surprised that we've had a 11-year relationship with a company and pretty much a very good one.
Part of the problem in the budget process is that the Administration drops these things at the budget hearings and then you get the reaction like you get. So you're a victim of your style of not communicating. COMMISSIONER DOMZALSKI: I think I take ownership of that, Councilman. In retrospect, it wouldn't have taken a whole lot for me to pick up a phone and make some calls. I don't want to duck that one. I own that one.
Thank you. I'll just take the opportunity of asking one last question on this issue. If June 30th comes and goes and you have not been able to find an entity to run the PNH, what 1468 03/23/05 - FY '06 OPERATING BUDGET happens? COMMISSIONER DOMZALSKI: We'll be able to continue the operation. One of the things I said, we were given notice a year and a half ago. That's really emblematic of just how responsible our current provider is. There's no question they corporately want to get out of long-term care business, they told us, "Look, if you're making progress in finding a new operator, you need a little bit of an extension, we're going to be able to work with you on that." What they don't want is just some vague piece and saying, "Well, we'll get out of some day." They say, "No, show us evidence that you're making progress and we'll hang in there with you."
In the event of a sale, what happens to the current residents? COMMISSIONER DOMZALSKI: There's a process for transfer. In fact, with change of ownership, it would be transparent to the residents. It would be a coordinated transfer just as it was when we went from a 1469 03/23/05 - FY '06 OPERATING BUDGET City-operated facility. There's notice that we have to give to the State. We would meet with the families, make sure that they know about when it's happening and what it means to them. Essentially, there would be no impact on the day-to-day care of the residents.
How many residents do we presently have? COMMISSIONER DOMZALSKI: About 433.
Thank you, Commissioner. I see that a number of my colleagues have their lights on. I do have several other questions, but I'll wait. The Chair recognizes Councilwoman Tasco.
Thank you. I want to go to the nursing home. What are the requirements for operation of the nursing home. COMMISSIONER DOMZALSKI: The requirements are that the entity, whether it has experience in operating a large long-term care facility, and successful experience 1470 03/23/05 - FY '06 OPERATING BUDGET meaning, the important thing for me is successful in terms of the quality of care that they've been able to deliver in any other operations that that they've had, whether they've had any issues with quality of care to the patients. We'll look at that very closely. Of course, we'll be very interested and demanding that they have a stable financial structure to allow them to take this on.
Now, who will make the determination on who finally gets the contract? COMMISSIONER DOMZALSKI: What we'll do is put together a group of people to look at -- that know the long-term care business, some people from government who know the long-term care business. The selection committee hasn't been finalized at this point. But what we did in the past is we brought people who understand the operation of county homes, people from the advocacy community, people from government to assess and people, quite frankly, who understand the very 1471 03/23/05 - FY '06 OPERATING BUDGET difficult aspect of the long-term care business. This is a changing environment where you can see the ripples at the federal level of them wanting to cut back on Medicaid, and most of the nursing home care is financed by Medicaid. We want to make sure that we have all factors represented so we can make an informed judgment.
Do you have a RFP out now? COMMISSIONER DOMZALSKI: It's called REI. It's something new to me. It's Request For Expression of Interest, people who would be interested in engaging in serious conversations. We ask for those Expressions of Interest to come in on March 11th. We did get them. We insisted that as part of the due diligence that those interested actually come to the facility --
How many do you have? COMMISSIONER DOMZALSKI: We have three.
I'm sorry, 1472 03/23/05 - FY '06 OPERATING BUDGET how many, Commissioner? COMMISSIONER DOMZALSKI: Three.
Three responses? COMMISSIONER DOMZALSKI: We asked them to come to the facility individually as a company and walk the facility. We prepared a lot of due diligence material for them about the different care patterns and what's going on, because we want the people who are serious to be serious and that know that operation.
Thank you. Let me go to the health centers. We talked about the wait for pregnant women is from four to five weeks, and for a well child, two to six weeks. And you talked about your open scheduling process, the ability for someone to go out of their community to get service. How many people are doing that? Do you track how many clients go to another health center? COMMISSIONER DOMZALSKI: In all candor, not many do. We've had some people, I would say you know maybe or percent of 1473 03/23/05 - FY '06 OPERATING BUDGET people that say, "Yeah, I can do that." Others would say, "You know, I don't mind waiting."
What is the impact of the budget cuts on services from the health centers? COMMISSIONER DOMZALSKI: I think the impact in the health centers are going to be the increase in -- some of the delays in the non-direct patient care aspects of the service, such as people having to wait maybe a little longer to get that referral to go to the specialist. We're not going to change the availability of the specialty appointment, but if the appointment that we make for the specialist is two weeks from now. The patient instead of picking up that specialist appointment right now might get it three days from now or two days from now.
What's the cause of the delay? Is it because you don't have the staff? COMMISSIONER DOMZALSKI: It would be that we would pull the nurse that does that 1474 03/23/05 - FY '06 OPERATING BUDGET managed care, that does that specialist appointment scheduling.
So the nurses are being cut. COMMISSIONER DOMZALSKI: To do that direct patient care.
That is what's occurring today. However, if in fact the '06 budget were adopted, what would be the waiting period? COMMISSIONER DOMZALSKI: I'm actually projecting --
You'll have 81 less people. I would think that that's certainly going to affect the impact. COMMISSIONER DOMZALSKI: President Verna, my comments are having to do with when these cuts go into effect.
So you're talking about '06? 1475 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Yes, ma'am.
So the nurses are being cut in the health centers? COMMISSIONER DOMZALSKI: Yes, ma'am.
All of the nurses? COMMISSIONER DOMZALSKI: Not all of them, no. We've come with a budget challenge of 81 positions. We needed to look very carefully as where we're going to take some of those. We've got, essentially, two sides of the Health Department. We've got the side of the Health Department that's primary care, that's doctor's office kind of care that goes on in our health center. The other side of the Department is the services that only a government health agency can supply, and that is those services for knowing what diseases are occurring in the community and mounting interventions, doing environmental regulations, et cetera. So it's a balance between where you can most withstand the 1476 03/23/05 - FY '06 OPERATING BUDGET reduction.
What's being done to identify other dollars for some of these other environmental issues? Could there been state dollars or federal dollars which you can fill in so the staff could be provided to the health centers? What's being done about that? COMMISSIONER DOMZALSKI: Yes, ma'am. We've done some of that with some of our programs. Instead of actually laying people off, we're able to transfer people into grants. The reality on the health center side is that the only, quote/unquote, funding there is for that operation, non-City funding, is from the reimbursement you get from the federal and state government for medical assistance.
How is the billing for services? COMMISSIONER DOMZALSKI: It's much, much improved. Two years ago, only 37 percent of our visits were insured. Now we have 47 1477 03/23/05 - FY '06 OPERATING BUDGET percent of our visits are insured. That's percent change. Now, the good news is we're talking about people who have insurance. Increasingly the problem in Philadelphia and across this country is that there are increasing numbers of people who just don't have insurance.
What about 10 Medicaid? 11 COMMISSIONER DOMZALSKI: But there are so many people who don't qualify for Medicaid. If you're between the ages 18 and 64 years of age in this country and you don't have some tremendous underlying medical condition, you get all the medical care you can afford, and there are very few places who will see the uninsured.
Has your department ever done a strategic plan to establish what priority services you would provide in the Health Department based on what's needed in the community and what you will provide? Or it's just we go along and do what we're supposed to do because this is what 1478 03/23/05 - FY '06 OPERATING BUDGET we're supposed to do? Has there ever been a strategic plan? COMMISSIONER DOMZALSKI: That's an excellent, excellent question. In the healthcare system in the City --
Yes or no? COMMISSIONER DOMZALSKI: Well, yes there are. But any planning other than to do what we're doing is getting more and more out of the business and leaving more and more people without any source of care.
I'm asking you have you studied the health conditions in the City, what are the needs, what will be the Health Department priorities? Have you just sat down with people in your department, maybe other external sources, to talk about how do we provide health services in this City to the clients that need it -- COMMISSIONER DOMZALSKI: Absolutely.
-- and how do you do that and what are the priorities of the department and what is your advocacy for those priorities in the department? 1479 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Strong.
Have you done the strategic plan? Yes or no? COMMISSIONER DOMZALSKI: Yes.
You have a strategic plan? COMMISSIONER DOMZALSKI: Yes, absolutely.
Could we see it? COMMISSIONER DOMZALSKI: Yes, absolutely. And I'll tell you the strategic plan for the children of this city has to do with no longer letting lead poison --
I'm not talking about that. I'm talking about the overall Health Department, what is the overall mission of the Health Department and how do you plan to fulfill that mission? And what has been the discussion around developing that total plan for fulfilling the mission of the Health Department to provide health services to the citizens of Philadelphia? COMMISSIONER DOMZALSKI: The overall 1480 03/23/05 - FY '06 OPERATING BUDGET mission of the Health Department is to protect and improve the health status of the citizens of Philadelphia.
Do you have a strategic plan to do that? COMMISSIONER DOMZALSKI: Yes.
When was that plan done? COMMISSIONER DOMZALSKI: Well, the strategic plan has been one that's been developing since the changes of this community occurred. One of the big changes was when we closed Philadelphia General Hospital, and the strategic plan there was to take care of the people who used to be served at PGH by converting the City's public health centers to primary care centers. That's still a very important part of the plan.
But that was in that was 1970 when you closed PGH. COMMISSIONER DOMZALSKI: 1976.
So we're still working off of that plan? COMMISSIONER DOMZALSKI: Well, no. 1481 03/23/05 - FY '06 OPERATING BUDGET Actually, it's been changed, because that plan called for the conversion of three health centers to primary care.
Commissioner, you're missing my point. What is the overall strategic plan of the Health Department to deliver services in the City? Plans are done often because climates do change, the health climate does change. What is your department and what is the buy-in of the staffing in your department to help develop an overall comprehensive plan to deliver health services in the City of Philadelphia? COMMISSIONER DOMZALSKI: Could I talk about two parts of the plan?
No, no. I want to know, do you have an overall plan to provide health services for the citizens of Philadelphia? Answer me this. Evidently you don't. The other one is, where is the universal health plan program? 1482 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: We are almost finished with the plan.
So who were the participants in that? COMMISSIONER DOMZALSKI: Participants were people in the health systems in the City, people in labor unions in the City, people in advocacy community in the City, people in the neighborhoods in the City who every day struggle with the inability to get healthcare because they don't have insurance.
So when will it be done? COMMISSIONER DOMZALSKI: We expect to have that within a month.
Will you share it with City Council? COMMISSIONER DOMZALSKI: Oh, absolutely. In fact, this summer we did a briefing for Council on where we are with the plan.
Madam President, my time its up. I do have 1483 03/23/05 - FY '06 OPERATING BUDGET question.
Do you mind doing that on the second go around, please.
Thank you. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. I'd like to continue the line of questioning regarding the health centers. How old is the central communications operating technology piece that is designed to have the health centers talk to each another? COMMISSIONER DOMZALSKI: It's up and running fully for about a year.
And based on the response to Councilwoman Tasco's question, you do not as of yet have a procedure locked in where you can follow how frequently the health centers talk to each other? COMMISSIONER DOMZALSKI: Yes, we know. We get data that's broken down on a 1484 03/23/05 - FY '06 OPERATING BUDGET monthly quarterly basis as to what kinds of calls come in and what elections have been made by patients as to whether they want to go to the health center where they live or whether they accept an earlier appointment at another health centers.
Based on some information I have, I'm particularly concerned about pregnant women who, according to this information, have to wait up to 10 weeks, they're actually on a wait list for 10 weeks prior to being seen. In instances like that, I would think it becomes not optional for a pregnant woman to wait 10 weeks but require them to visit another center, given their circumstance. COMMISSIONER DOMZALSKI: There's no 19 question about that. Councilwoman Tasco asked if I thought about a plan which --
Can you talk more into the mike so I can hear you? COMMISSIONER DOMZALSKI: I think what's happening in the City is 10 years ago we had 19 hospitals, 19 hospitals who were 1485 03/23/05 - FY '06 OPERATING BUDGET delivering obstetrical care. Today, that's 10. Probably in about 90 days, that's going to be because Frankford Hospital is going 5 out of the business. So we have a huge, huge 6 demand for services. Of the 20,000 deliveries 7 that occur in the City every year, the City 8 health centers take care of about 3,000 of 9 those.
So given those realities, in the closing of your testimony you mention the top challenges. And you said that they were bioterrorism and the Philadelphia Nursing Home, in that order. Given what you just mentioned about the reality we're facing with regard to the enormous wait list for pregnant women and the fact that we have fewer hospitals, help me understand why that would not put in the list of challenges and priorities? COMMISSIONER DOMZALSKI: Well, it is. There's no question. The list of challenges could be much, much longer than it was. But we have dealt with this in this fashion. For example, it was not more than 1486 03/23/05 - FY '06 OPERATING BUDGET about seven weeks ago, six weeks ago, we brought in the heads of all the OB departments in the City into the Commissioner's office for a 7:30 in the morning meeting, saying, "Look, how are we going to deal with this?" And the big problem is, it isn't the well-insured woman who's got a problem getting healthcare. It isn't at that. It's the increasing numbers of women don't have insurance.
And their response to that reality? COMMISSIONER DOMZALSKI: Their deliver can be covered, not their prenatal care can't.
What is their initial response to that reality? What was one of the two yields out of that meeting? COMMISSIONER DOMZALSKI: Well, one, certainly, we were concerned about how newborns are discharged from the hospital. We wanted to make sure that those hospital discharge planners let somebody know when they have a high-risk infant going home. On the supply side, on a demand side, what we decided 1487 03/23/05 - FY '06 OPERATING BUDGET to do, we have a pilot going on up at Health Center where we can do more of the care, 4 more of the educational, anticipatory guidance 5 for pregnant women in somewhat of a group 6 setting so we can see more women in the 7 process that way. We're still hampered by a 8 couple of things. One is the supply of OB 9 docs in the city and the people who are electing to come to the city and practice, and the physical capacity of the health centers.
That's a segue into a different question. In the second paragraph of your testimony, you talk about the level of funding from various places. I see no mention, unless I missed it, dollars for CDC. Let me ask a different question. The 70.3 million is in the Grants Fund, correct? COMMISSIONER DOMZALSKI: Yes.
Is that where you would find CDC dollars? COMMISSIONER DOMZALSKI: Yes.
Is it any 1488 03/23/05 - FY '06 OPERATING BUDGET possibility that CDC might cover the type of need that currently exist around pregnant women? I'm simply asking. COMMISSIONER DOMZALSKI: It's possible. But, you know, we've been informed that the CDC is in line for, in addition to the Medicaid cuts proposed at the national level, in line for a 9 percent cut. We just don't know where that 9 percent is going to fall.
I also could not find in your testimony -- I'm going to get back to the centers, but I know my time is running out so I want to touch on a few things. I don't see any mention of a program I heard whispered about a couple years ago, and I'm anxious to know the status of it at this juncture, and that is the Steps Program. Where is that in the testimony? I don't see any discussion of that, unless I missed it. COMMISSIONER DOMZALSKI: It isn't in the testimony.
How many 1489 03/23/05 - FY '06 OPERATING BUDGET dollars -- first of all, who funds that? COMMISSIONER DOMZALSKI: It's CDC funded.
And of the 77 million, what portion of that is for the Steps Program? COMMISSIONER DOMZALSKI: It's about $2 million.
For one year? Is that a multi-year program? COMMISSIONER DOMZALSKI: I think we had less than that for the first year which was a start-up year. I think it's now 2.1.
How many years is that program? COMMISSIONER DOMZALSKI: I think it's a four-year grant.
The reason why I raise it is I was excited about hearing it in a very irregular basis a couple years ago because it was designed to be a trench, 1490 03/23/05 - FY '06 OPERATING BUDGET in-your-face, direct service type of initiative. So bring us up to speed on where that is now. Is it fully operating? COMMISSIONER DOMZALSKI: The first year was a planning year. We've got, I think, providers that are out working now on this. 8 It's not City-wide. Just as with a lot of 9 things, we target our services and try to go 10 where the greatest need is. You know, Steps 11 is focused on asthma, focused diabetes, 12 focused on obesity. What we look at is the 13 part of the City the greatest incidence of 14 those conditions and our funding community 15 based intervention raging from exercise to 16 nutrition to better disease management program 17 for asthma.
The clock went, but I have some additional questions specifically around Steps and additional questions on the health centers. Thank you, Madam President.
You're welcome. The Chair recognizes Councilman 1491 03/23/05 - FY '06 OPERATING BUDGET Kelly.
Thank you, Madam President. Good morning, Commissioner. COMMISSIONER DOMZALSKI: Good morning, Councilman.
I just want to follow up on the Council President's question relating to health centers. Where is District 10? COMMISSIONER DOMZALSKI: Cottman and Oakland.
That's the Northeast office? COMMISSIONER DOMZALSKI: Yes, sir.
Would you say that is probably the most widely used? COMMISSIONER DOMZALSKI: Health Center 10, Health Center 9, Health Center 2 are among the very, very busiest.
I want to get back to that in a minute. Going back a few months ago, we heed hearings with the Public Health and Human 1492 03/23/05 - FY '06 OPERATING BUDGET Services Committee, which was chaired by Councilwoman Tasco. During that hearing, I know I wasn't very courteous to you. In fact, I was probably very demanding, and I know I gave your staff and yourself probably a hard time during those hearings. Frankly I was really upset about the newspaper stories about how PACCA was being operated, about the conditions of the facility itself, about how the people were being treated and how the animals were being treated. But during those hearings, I know at the end of the hearing you said you would make immediate changes. I want to take this time and I want to commend you because you're a man of your word. You have made changes there. I know that you've turned that operation around, and I think we're now going in the right direction. I want to thank you and your deputy commissioners, especially Carmen Paris who is here and Joe Ferrero and Joe Cronauer. I think we are going in the right direction. COMMISSIONER DOMZALSKI: Thank you, Councilman. They've all been right in the 1493 03/23/05 - FY '06 OPERATING BUDGET forefront in making these changes happen.
Since I'm on PACCA, how much was budgeted for Year '05? COMMISSIONER DOMZALSKI: Three million.
Now, it's my understanding that you increased that budget amount? COMMISSIONER DOMZALSKI: Yes.
How much? COMMISSIONER DOMZALSKI: We've got about another 300,000 in there.
We added about $360,000 to it. The total City contribution right now is about $2.7 million.
The total budget right now is 3 million. City contribution is 2.7 million.
Right now, we're hoping that some of the revenue will come in in which hopefully that we would like to reduce the 1494 03/23/05 - FY '06 OPERATING BUDGET contribute because it's supposed to be one time only. But if it doesn't happen, we'll try to keep it at the same level.
Now, during your testimony, you mentioned there's a reduction of 81 positions. How will that effect your inspections for restaurants and other areas? COMMISSIONER DOMZALSKI: Well, we're going to be down five sanitarians. These are the people who do those inspections. Two of them are at the staff sanitarian level and two are at the actual work level. Right now, our interval is about 14.3, one inspection every 14.3 or 4 months. And we're projecting if nothing changes between now and this time next year, we would see that interval increase to about 15.7 months. So it's a concern. When we got into this about 10 years ago, the interval between restaurant inspections then was once every 37 months. So while we've made somewhat a dramatic change in that, the uptick is still a concern. 1495 03/23/05 - FY '06 OPERATING BUDGET
I'm a little concerned again in those health centers especially in District 10. Can you tell me why it takes -- if a person walked in there today, they wouldn't get an appointment until 180 days, is that right? COMMISSIONER DOMZALSKI: Actually, Councilman, if a person walked in today, odds are the person would be seen today.
A follow-up appointment would be 180 days? COMMISSIONER DOMZALSKI: Yes. Coming in for a routine appointment, nothing acute, it would be that long.
Do you have a breakdown of how many people use that facility? I'm talking about the one on Cottman Avenue. COMMISSIONER DOMZALSKI: Yes. The number of visits that we have, we can calculate that.
You mentioned 1496 03/23/05 - FY '06 OPERATING BUDGET that in South Philadelphia, for instance they could probably get an appointment a heck of a lot quicker. I just want to know what the reason is for that? In other words, it's just the amount of people that are using that facility or is it that you more people at that facility to take care of people? COMMISSIONER DOMZALSKI: Our staffing is probably just a little better. Most of the health centers with the exception of Strawberry Mansion are staffed comparably. We staff on basis of the number of visits. T Health Center 10, we would see a little over 48,000 visits. So that would be probably somewhere in the neighborhood of about 14,000 individuals that we take care of for primary care.
That would be District 10? COMMISSIONER DOMZALSKI: Yes.
And the staffing levels would be almost the same in all of your districts? COMMISSIONER DOMZALSKI: Strawberry 1497 03/23/05 - FY '06 OPERATING BUDGET Mansion would be lower. It's a smaller health center. Probably about 26,000 visits at Strawberry Mansion -- I'm sorry, I was wrong, it's 25,999.
You have in your testimony that your insured visits to the health centers are increased from 36 percent to 47 percent. Is that where the City would get refunded by those insurance companies? COMMISSIONER DOMZALSKI: Yes, sir. For insured patients, we would get a per capitation rate, which is fairly small but we value it, a certain number of dollars a month. But then we would also be able to for those visits at the end of the year bill for what's called wrap-around per visit for the insured persons, and that's to make up the difference between what it cost us to deliver the service and what we actually get reimbursed. Our huge challenge is the increasing numbers of people who are uninsured. Most of the people -- 80 percent of the people who don't have insurance are working people, they're are employed. But what we have is an 1498 03/23/05 - FY '06 OPERATING BUDGET increasing number of situations where health insurance is either less part of the compensation package of the job or not part of it at all.
I just want to just thank you and all your staff in the Health Department. You're doing a remarkable job for the amount of people that you have. And I'm a little concern about the reduction of 81 people. I think that's really going to be very, very difficult to maintain that same level of service. This is something that I guess we'll have to work out. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Miller.
Thank you, Madam President. I just want to pick up on the 81 staff reductions. And I know that Council President Verna asked about it and Councilman Kelly. I'm not sure or clear if I know the 1499 03/23/05 - FY '06 OPERATING BUDGET answer. In the first page of your testimony you say these reductions will result in some service delivery efficiencies as well as the inability to meet key performance of service levels. Are you specifically talking about the patient service delays and the length of time that restaurants will now have to wait for inspections? COMMISSIONER DOMZALSKI: Yes, as examples.
Are there any other examples pretty much around patient delivery? Or was anyone laid off that served in the capacity of medical personnel or direct service staff? COMMISSIONER DOMZALSKI: The one direct service staff that we laid off was a physician assistant at our employee health services unit at 19th and Fairmount. The other two were not direct patient care.
So pretty much you still have the same level of medical staff that was providing services to patients? COMMISSIONER DOMZALSKI: Yes. We do 1500 03/23/05 - FY '06 OPERATING BUDGET have vacancies. And we have a reduction of 81 positions.
But they were administrative positions? COMMISSIONER DOMZALSKI: Not all of them. There were some nursing positions in the 81, not a huge number, but enough. We had 5 nursing positions in the health centers that are part of that. I have one nursing position in our STD clinic Broad and Lombard. That doesn't mean that patients are not going to get medical care or they're not going to get STD services, it just means that we've got to move that workload around and make sure we manage those resources so we don't miss taking care of people that need our care.
But out in the district health centers, the five nurses came from where? COMMISSIONER DOMZALSKI: The health centers.
The various health centers? COMMISSIONER DOMZALSKI: Yes. 1501 03/23/05 - FY '06 OPERATING BUDGET
So that just means that patient services will be slowed down? COMMISSIONER DOMZALSKI: Obviously, you don't have a reduction like that and have no outcome. So what we wanted to do is to give as honest an assessment as we can right now as to what the impact of that would be. We believe that that is what the impact is going to be. If someone were to say, "Commissioner, are you telling me that's the best you can do? You can't do any better than that?" I would say we're going to try very, very hard on that. We're not going to just accept that, but right now I cannot tell you honestly that there won't be that delay.
And you lost the staff when the City did the layoffs? What period of time? COMMISSIONER DOMZALSKI: What period of time what?
When did the 81 people leave? Or did they leave cycles? They didn't leave all at once, did they? 1502 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: No. We do probably or so percent staff that turns 4 over. So you're right. That's not all of it. 5 Even within the 680 in the General Fund 6 position that we will have budgeted for this year, we will have times when we will be below that because of turnover. There's no question about that and it's one of the things we take into consideration.
If it gets to a point where a particular health center -- I'll erase that question. I don't want to ask that question. I want to ask you a little bit about the infant mortality. In your testimony, you state that there are significant disparities among various Philadelphia neighborhoods. Is it possible for us to get a list, by neighborhood, that can tell us about what's happening with lead poisoning in those particular neighborhoods? COMMISSIONER DOMZALSKI: Absolutely, Councilwoman. We can give you data and also some maps. 1503 03/23/05 - FY '06 OPERATING BUDGET
That's good. Also, Health Center 9, one of their big concerns over the years has been the lack of women being able to get a mammogram. I think you used some type of mobile unit or you sent people to Medical College for mammograms out of Health Center 9. Is that till happening? If so, I want to know what's happening now since Medical College is closing. COMMISSIONER DOMZALSKI: Yes, we do have mammography services. There was a point a couple years ago when we couldn't get our mammography unit there because of some electrical issues and some access issues, but those have been solved. There are times when we will refer a patient out to get a quick mammogram at one of our backup facilities, one of the hospitals. I do not know specifically the status of that service at MCP, although I did talk to Dr. Pickering about a week and a half ago who told me that she believed that most, if not all, of the outpatient services would be continuing at that facility, although she couldn't say for how long. 1504 03/23/05 - FY '06 OPERATING BUDGET
You're welcome. The Chair recognizes Councilman Rizzo.
I think my button was pushed accidently, Madam President.
Very well. Thank you. The Chair recognizes Councilwoman Blackwell.
Thank you, Madam President. Certainly, we thank this Commissioner for the work that they do and for their always willing to respond quickly to the issues, whether it be the animal issues or any community issues we have. We say thank you. And we thank you, too, for working with us on this other immunization supplement for children of the seniors. That's very 1505 03/23/05 - FY '06 OPERATING BUDGET important. And we thank you for always working with us in that regard. That's one of the issues that we work on. The STD control program, I know it's been an epidemic. I've been around you many times since you mentioned it. Is this one where students can just deal with the Health Department with their parents being included or informed, or can they do it separate from that? COMMISSIONER DOMZALSKI: They can do it separate from that.
That's good. I'm always for that because we have to try to help people no matter what the issues are. Let me ask you. It was just mentioned to me about the old days when we had the Healthy Start Program and that they had a five-year grant or so for that program. For this Steps program, do we have the ability to do more marketing, in other words, to get the information out and to recruit people to out to try to help them? And do we take the 1506 03/23/05 - FY '06 OPERATING BUDGET information that we learn from the Healthy Start Program, Healthy Family Healthy Start Program, to apply it to other programs that we have? COMMISSIONER DOMZALSKI: That's an excellent, excellent question. That should be what the outcome of this, that it shouldn't be just once and done. That's a big part of the Steps program. In fact, we were talking about an asthma intervention program that's been very successful where we involve the children around one of the managed care companies in fact who's a partner with this and they involve the children around sporting activities. These are all asthmatic children. And they've been able to demonstrate by showing the children how to maintain when to take their medicine, other activities that they need to be careful of, that they're able to reduce dramatically the number of instances in when the children miss school and/or have to go to the emergency department. That's the kind of thing, what we want to do is get out and make sure we incorporate that in the 1507 03/23/05 - FY '06 OPERATING BUDGET teaching of that in our health centers and other venues where we're serving patients.
That's right. So the whole issues marketing for it being able to do that, certainly in addition to neighborhood newspapers and that sort of thing. I'm sure you already reach out to the community groups and that sort of thing, but we want to make ourselves available to help in that regard. Those are really important issues for us. Again, thank you. Thank you, Madam President.
You're welcome. Commissioner, I believe that you or a member of your staff would have a copy of the Operating Budget, the supporting schedules for revenues. COMMISSIONER DOMZALSKI: Yes.
Could you please turn to , because I'm somewhat confused. Perhaps you could clarify something for me. It's the budget in brief, . 1508 03/23/05 - FY '06 OPERATING BUDGET
Well, Finance probably has it. , and it would be Line Item 18, medical assistance for the Philadelphia Nursing Home. Now, if we don't know what's happening after June 30th, how can we show an increase yet in reimbursements, an increase of 16.1 percent. COMMISSIONER DOMZALSKI: This is appropriation. And we build in additional appropriation into the nursing home to take advantage of --
Commissioner, this is revenue. These are reimbursements. Are they not reimbursements?
Yes. We have to increase both the revenue side of it and the obligation side of it in order to be able to -- the total cost for running the operation of the nursing home, except for subsidy, is totally offset by revenue. So in order to be able to increase the cost based on increased 1509 03/23/05 - FY '06 OPERATING BUDGET rates, we also have to increase the revenue side of it.
But I don't understand between the federal and state, you're increasing it by $5 million.
I still don't understand. COMMISSIONER DOMZALSKI: There are times when our revenue -- we can't predict precisely how much the revenue will go up by because there will be changes in the reimbursement rate at the federal level.
I don't know how we come to that conclusion if come June 30th we don't know what's going to happen, whether it's going to be sold, whether we're going to have another entity that would be taking it. Councilwoman Tasco, did you want be recognized?
I want to piggyback on your question. If you put the increases in, what 1510 03/23/05 - FY '06 OPERATING BUDGET information do you have about the increase in reimbursements that we don't know right now? COMMISSIONER DOMZALSKI: A lot of what we know is that we don't know, and that is because a county rate -- we're a county home, and that county rate changes based on the case mix of the residents at the nursing home. And so depending on how our case mix fluctuates, and we always believe it goes up, we never know by how much or what the state's going to attach to that case mix revenue, we just know it's going to be more and we need to be able to have the authority to put it in there.
So are you accepting new residents between now and November 30th? COMMISSIONER DOMZALSKI: Yes. Yes. See, we know what's going to happen to the --
You apparently know more than you would like to tell us, and I don't mind that because if there are people interested, I don't think you should tell us. But apparently, you know more 1511 03/23/05 - FY '06 OPERATING BUDGET than you're willing to reveal and I think that's what's making it somewhat confusing for us to understand how you're actually increasing reimbursements by over $5 million. COMMISSIONER DOMZALSKI: I really didn't think the appropriation aspect of this, from an accounting standpoint, was unusual, but I'm not an accountant. What we could do perhaps at the end is get my budget people and get this information to Council so we could lay this out in some understandable way. The other piece, President Verna, I need to reassure you, June 30th, there will be a management structure at the nursing home taking care of patients, and they will receive good quality care.
Whether it be there or elsewhere? COMMISSIONER DOMZALSKI: For the most part, it's going to be there except for those individuals who elect another type of placement or who go home on their own.
Thank you. Commissioner, specifically, do you 1512 03/23/05 - FY '06 OPERATING BUDGET want to talk a little about your air management service? Have the regulations changed since the release of the Johns Hopkins study in 1997 to reflect the cumulative impact on environmentally regulated facilities on the surrounding communities? COMMISSIONER DOMZALSKI: Yes.
It has changed? COMMISSIONER DOMZALSKI: It has changed but not in relation to the Johns Hopkins report.
How has it changed? COMMISSIONER DOMZALSKI: The changes have ranged from -- some of stuff that didn't come from Philadelphia as such, for example, Stage 2 recovery at gas stations which require the certain types of nozzles be at gas stations, particularly over certain parts of the year to recover the vapors. Other things have been local regulations such as the regulations that we do with auto body shops requiring the licensing of their spray 1513 03/23/05 - FY '06 OPERATING BUDGET booths --
Commissioner, don't go any further. You're talking about one facility. I'm talking about the cumulative effect of the environmentally regulated facilities in the surrounding community. COMMISSIONER DOMZALSKI: Johns Hopkins didn't point out to any cumulative effect. Johns Hopkins was the first to say that there was no connection between their findings and the health status of the community that they were looking at.
What community were they looking at? I would like to know what your feeling is. Forget about Johns Hopkins. What is your feeling on that? COMMISSIONER DOMZALSKI: Well, I think that there are a couple of things. One is we look at the overall air quality of the City, and that has to do with what we do in terms of prevention of significant deterioration of the air quality that's picked up by our air monitoring stations city-wide. 1514 03/23/05 - FY '06 OPERATING BUDGET In addition to that, there may be some local issues that come up that concern a community, in which case we will put some specific monitors in the community for a period of time, whether it's a year or two years or a little longer, just to make sure we're not missing something in terms of air quality.
I don't know if you could tell me how many environmentally regulated facilities there are in the City that air management service is responsible for. Do you have somebody from air management that may be able to tell us? COMMISSIONER DOMZALSKI: Do we have that number? While we're getting the specific number, that includes everything from the large facility such as the refineries down to the corner dry cleaning plant.
Whatever air management services would be responsible for. It just bothers me that we look at facility and we get another huge facility and 1515 03/23/05 - FY '06 OPERATING BUDGET they have to be approved, but we never look at the cumulative effect it has on the entire community. COMMISSIONER DOMZALSKI: I think one area, the cumulative effect is in the significant -- what we know about the air quality from any point in time to another point in time. This is Morris Fine, Director of Air Management
Good morning. I'm Morris Fine, Director for Air Management. There were several questions that you asked, and let me start off with the number of regulated facilities in the City of Philadelphia. We have probably on the order of about 500 or so regulated facilities, and these range from large major sources like the refinery or some chemical plants all the way to the dry cleaners, gasoline stations, and such. So major sources, we have approximately 1516 03/23/05 - FY '06 OPERATING BUDGET 45 major sources. Then we have sources that we consider to be larger sources that we get to and inspection every year or so. That ranges around 180. Your question about cumulative effect, the issue is such that from a permitting standpoint --
Mr. Fine, we don't have to dance around the issue. You and I attended a community meeting where there were over 300 people several weeks ago. I think that's what their concern was, about the cumulative effect it will have on the community. Talk about the cumulative effect, please. We don't check into that at all. How do we check the air management?
Well, we monitor the air throughout the City and we monitor for what they call -- I don't want to get too technical 1517 03/23/05 - FY '06 OPERATING BUDGET -- criteria pollutants which are particulate sulfur dioxide, nitrogen oxides --
I think we're doing that in the Southwest Philadelphia because of the newly constructed post office, correct?
We've added one monitor to look at fine particulate in an area in Eastwick close to the post office. We also monitor for toxic air contaminants. These are not federally regulated air contaminants which have an effect, long-term effect on the citizens of Philadelphia. In our monitoring, we have long-term monitoring at Eastwick and our laboratory in Northeast Philadelphia. The long-term monitoring does not show a significant difference in toxic constituents between those two locations. So in terms of cumulative effect, those two sites do not show up any differently. What we've done is increase the number of air toxics monitors more recently, and we are now collecting data which we hope will show whether or not there's a disparity 1518 03/23/05 - FY '06 OPERATING BUDGET in toxic air contaminants in different neighborhoods around the City. So we are looking at that issue, and we are concerned about determining where there are disparities and where these disparities --
Mr. Fine, can you tell me how many of the environmentally regulated facilities are in South and Southwest Philadelphia?
I would appreciate your forwarding that to me. Commissioner, I would ask you, how will enforcement efforts be impacted by the reduction of seven employees in the air management unit of the Health Department? COMMISSIONER DOMZALSKI: I think there will be some impact, particularly in those positions having to do with the air pollution control inspectors. That's an area that we're focused on right now to make sure that we are able to maintain an appropriate response time for urgent issues that come in. 1519 03/23/05 - FY '06 OPERATING BUDGET With the reduction of those positions, it's possible that for the none urgent matters, the response time maybe impacted negatively; it may be a little longer. We want to make sure -- and Mr. Fine and I were talking earlier this week just what arrangements we can make to make sure that when someone calls in and says, "Look, we've got an odor issue here at 17th and Morris, it's bad," that we don't have any decrease in our ability to get out there and assess that.
So actually the seven employees are inspectors? COMMISSIONER DOMZALSKI: There's one that's in there that's an analytic chemist. That person works in our laboratory and does the air chemistry on air toxics. That work is going to have to be distributed over the remaining several individuals who are also chemists. And one of the things that we will not do in that area since it is important that that work gets done on a timely basis is just not have it get done. We'll either get it done with working staff a little longer or 1520 03/23/05 - FY '06 OPERATING BUDGET whatever.
We have three inspectors on the air program, and we have four in the asbestos program.
Commissioner, I'm sure that you're going to be requesting that more inspectors be hired. I don't know how three inspectors deal with the entire City. COMMISSIONER DOMZALSKI: Well, I think we've got three, four so seven, and what we will do is make sure that they are cross-trained.
We have three, four, seven? COMMISSIONER DOMZALSKI: Well, we have three plus the four asbestos. So we have seven inspectors that we're going to make sure that they are cross-trained so they're able to also respond to air complaints.
I don't think that's enough. I don't think that's 1521 03/23/05 - FY '06 OPERATING BUDGET enough. Mr. Fine, thank you. And you are a very, very patient man. Thank you.
I want to go to Councilwoman Blackwell's question just briefly. What agencies -- you mention in your testimony you provide STD education in the schools. How is that done? Do you have outside agencies doing it? Does school staff do it? And also, what is your community outreach and what agency provide education in the community and what communities? COMMISSIONER DOMZALSKI: In the schools it's a combination of our staff plus community staff such as stuff YOACAP (ph), it's a youth organization that are a little bit closer to the age of the students and a number of our staff so that's a principal component of the educational program there. We do the educational programs in other settings such as the Youth Study Center, 1522 03/23/05 - FY '06 OPERATING BUDGET Family Court. We have a Web site specifically dedicated to this that's titled Think Think Think. I can get you an address for that. We work with youth groups to increase awareness around the significance of STD's. I will tell you, Senator Hughes was very helpful in getting us one-time money, it turns out to be a million dollars, but some of the programs that he put on, for example, at Freedom Theater talking to youth groups specifically about sexual behavior and the consequences of that have been extraordinarily effective.
Speaking of Senator Hughes and $1 million that he got from the Department of Health to provide HIV and AIDS prevention services for minority youth, 92 percent of this money went to non-minority, non-community-based providers. In addition, $500,000 of these funds went into one agency to provide six testing events at a cost of 83,000 per event. Could you tell me how you selected these providers? And also considering the Mayor's new Executive Order 1523 03/23/05 - FY '06 OPERATING BUDGET regarding minority Procurement, what steps are being done to address this problem to be more inclusive and what type of technical assistance do you provide to minority non-profit vendors? COMMISSIONER DOMZALSKI: Let me take the last part of that. The issue around the 1 million and where that went the percentages, I'm going to ask Joe Cronauer if he'd come up. If you look across the department, we break down our minority contracting in two areas. One is under the General Fund and the other one is under the Grants Fund. We do most of our contracting under the Grants Fund. In the General Fund, we have an abysmal record with minority contracting. It's 2 percent. In the Grants Fund, our contracting is approximately 30 percent that is in minority contractors. In '05, in the Grants Fund, 34 percent of our contracts are with minority organizations. As far as the technical assistance, we used to think that it was after somebody got a contract it was sufficient to provide 1524 03/23/05 - FY '06 OPERATING BUDGET technical assistance to help the program stay in business, to provide whether it's accounting assistance or whatever. We found, though, more recently that what we really do need to do if we're serious about this, we've got to get out there on the front end of this and actually give technical assistance to community-based organizations to assist them in grant writing in the first instance so that they can compete in a way in which their lack of experience isn't taken advantage of by people who've been in the business much longer. So we do both of those things.
How much of it do you do? How often do you have technical workshops or whatever you do to help people understand grant writing? COMMISSIONER DOMZALSKI: Joe, could you put a number on that?
I'm Joe Cronauer, Assistant Health Commissioner. Each division has a different number. We can get them to you, but it is a few a year, depending on the needs of the providers and what they need. 1525 03/23/05 - FY '06 OPERATING BUDGET Either they need to be trained in a particular activity that they're doing, they need to be trained in grant writing. And every RFP that we do, we make sure that there are grant writers available. AACO, for example, the Aids Activities Coordinating Office, so that any minority provider, or any provider actually, who would want assistance from a professional grant writer can contact us, tell us that, and we'll make the connection for them and pay for it.
How do they know that? How do they know they can get assistance from you?
Because we have for every competitive process a community meeting where we invite everybody who might be interested to talk to us. We announce at that time not only the fact that it exists, but we also inform them of who the grant writers are that are available, give them a phone number to call if they're interested.
Do you hold grant writing seminars aside from the time 1526 03/23/05 - FY '06 OPERATING BUDGET when you are issuing a program? Just on a routine basis, do you provide that service to people who might be interested in doing business with the Health Department?
We have a variety of courses that we pay one of the local universities -- I think it's Drexel -- around non-profit management and we pay them to hold classes with our minority providers around a variety of issues like fiscal management, grant writing, et cetera. It's a whole series. We can give you the schedule.
Could you finish the other part. So how are you going to meet -- have you determined how you're going to meet the new Executive Order issued by the Mayor around minority procurement? COMMISSIONER DOMZALSKI: Yes, Councilwoman. One of the things that we like to put into the mix is how we consider non-profits. If we at -- if non-profits could be subjected to the same minority business certification as other organizations, we'd be able to post a minority participation rate of 1527 03/23/05 - FY '06 OPERATING BUDGET about 51 percent in our contract. That's not in the cards. On the other hand, what we are able to do is look at those areas where we have very much, very large segments of business that we do on a contractual basis and open that up from the standpoint and say the people have some seminars, some meetings, some general meetings with people and say "Look, Health Department specific, these are the services that we buy."
Would you go back and repeat about the issue about the non-profits? COMMISSIONER DOMZALSKI: Right now under our MBEC rule, non-profits are neither considered majority or minority. They just don't count in terms of that calculation. Since we do so much business with non-profits -- a lot, about half our non-profits are not only minority owned, but the boards are minority. So in every stretch of the way you can look at this, they are minority, the principals are minority people. We'd be at 51 percent. I figure our average 1528 03/23/05 - FY '06 OPERATING BUDGET is 51 percent of all of our contracts if we were to have that calculation would be considered minority. I have to hasten to say that they are not now under their current rule. We're going to work -- we're not going to ask people to change their rules for us. We're not going to whine. We're going to figure out how to do this and how to increase our minority participation as the rules are now written.
So if you put a RFP out for service and you ask the providers to respond to your RFP -- do you know how many non-profits are minority providers in the City? COMMISSIONER DOMZALSKI: I think we might have a guess as to health services and the kinds of services that we buy.
For example, in the Aids Activity Coordinating Office, we currently have 41 community-based providers working with us. They're all, with one exception, they're all non-profits. So we can't count any of them right now under the 1529 03/23/05 - FY '06 OPERATING BUDGET MBEC rules. If we counted them between minority and women-controlled organization, they would be 100 percent MBEC providers.
Let's go back to the money that was given to the department by Senator Hughes. Tell me what happened with that process? I understand only one provider -- that you went with existing providers. Who were those providers and were any of them minority?