00001 COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE OF THE WHOLE PUBLIC HEARING - - - Room 400 City Hall, Philadelphia, PA Monday, March 31, 2008, 10:15 a.m. - - - Bill 080154 - An ordinance to adopt a Capital Program for six Fiscal Years 1009-20014, inclusive. Bill 080155 - An ordinance to adopt a Fiscal 2009 Capital Budget. Bill 080156 - An ordinance adopting the Operating Budget for Fiscal Year 2009 Bill 080173 - A resoolution providing for the approval of a Revised Five-Year Financial Plan for the City of Philadelphia. Committee Members Present: Anna C. Verna, Chair Marian B. Tasco, Co-Chair Jannie L. Blackwell Blondell Reynolds Brown Darrell L. Clarke Bill Green William K. Greenlee Jack Kelly James F. Kenney - - - V A R A L L O Incorporated Litigation Support Specialists 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 00002 I N D E X WITNESS Dr. Donald Schwarz, Health Commissioner 4 Steve Agostini, Budget Director........ 98 Dr. Arthur C. Evans, Director.......... 145 Department of Behavioral Health and Mental Retardation Services Michael Covone, Deputy Director........ 182 Department of Behavioral Health Dr. Arthur C. Evans, Jr. .............. 201 Acting Commissioner, DHS Ellen Walker........................... 223 DHS Director of Prevention Dainette Mintz, Director............... 285 Office of Supportive Housing * * * 00003
Good morning, everyone. This is a continued public hearing of the Committee of the Whole regarding Bill No.'s 080154, 080155, 080156, and 080173. And the first department to testify this morning will be the Health Department. (Witnesses come forward.)
Would you please identify yourself for the record and proceed with your testimony.
Good morning, President Verna and members of Council. I'm Donald Schwarz, the Health Commissioner. With me today is Carmen Lemmo, Deputy Commissioner for Financial Administration. Thank you for the opportunity to present the Department of Health Operating Budget request for Fiscal Year 2009. 00004 The FY '09 budget supports significant efforts by the Department of Public Health to address two of the mayor's six result areas: Healthy and sustainable communities and better customer service and higher-performing government. The Fiscal Year '09 Department of Health Budget request totals $201,823,211. Of this total, about 122 million is in the General Fund and 80,129,327 is in the Grants Fund. 5 million, comes from City 16 tax-supported funds. The Fiscal Year 17 '09 General Fund budget represents an 18 increase of $3 million over the Fiscal 19 Year '08 estimated obligations. 20 The department's Fiscal Year 21 '09 budget will support 1,008 22 full-time positions: 757 in the 23 General Fund and 251 in the Grants 24 Fund. This represents an increase of 25 ten full-time positions over the 00005 number of positions in the Fiscal Year '08 adopted budget, an increase of 62 full-time General Fund positions over the Fiscal Year '08 target budget level. The additional positions will serve as an investment in the department that will allow us to enhance the public health services we provide in improved customer service in several areas of the department. I would like to highlight the program areas that will receive portions of the additional Fiscal Year '09 funding. The largest portion of the increase will be directed toward the provision of care in our health centers, allowing us to increase staffing in the health center system by 41 people. This additional staff will include a range of medical and technical professionals and support persons who will use this staff to help us move toward our 00006 customer-service goals of shortening the time it takes to schedule an initial clinic appoint and reducing the time it takes to obtain a prescription in the health center pharmacies. Reaching our ultimate goals of shortening the appointment scheduling time to 30 days and filling proscriptions in one day will require significant financial resources. To further improve delivery of the services at the health centers, we are also working toward instituting an electronic medical records system that will include a state-of-the-art interactive system for patient registration, appointment-scheduling, laboratory testing and reporting, and prescription services at our pharmacies. Improvements in our Food Safety Program will allow us to make the Philadelphia community safer while improving the service we provide to 00007 the business community we regulate. The additional support in the budget will allow us to hire two additional sanitarians. This will permit us to increase the frequency of food establishment inspections and shorten the time needed to respond to establishment operators requesting pre-opening, plan reviews, and facility inspections for approval of new licenses. Increasing the inspection frequency will help the department more toward full implementation of the risk-based inspection program for food establishments that we have been developing for nearly two years. The efficient operation of the Office of the Medical Examiner is critical to both the City departments and agencies that depend on timely reporting and to the families needing the service of that office. I am 00008 pleased to announce that we have recently hired a new chief medical examiner, who will assume a position vacated nearly two years ago. With the increased General Fund support, the Office of the Medical Examiner will hire an additional forensic pathologist, two forensic investigators, and a clerical support person. The additional staff will improve our response time to death-scene investigations and expedite the identification of decedents and notification of next of kin.
Lack of staff in this area frequently precludes timely preparation of autopsy reports for homicide cases, which adversely affects the justice system in their ability to bring charges against a criminal suspect. The increase in staffing will help us meet our goal of achieving a 90 percent completion rate 00009 of homicide autopsy reports within eight weeks. The department's chronic disease prevention efforts address emerging public health issues related to obesity, diabetes, asthma, and tobacco use. S. Grant, will end across the country in September of 2008. Of the $3 million increase in the department's Fiscal Year '09 General Fund, $300,000, or 10 percent, will be directed to chronic disease prevention efforts, including critical staff and the most effective outreach programs for small community-based organizations that focus on promoting healthy eating, physical activity, and improvements in the local built environment. These programs help 00010 prevent overweight and obesity, diabetes and asthma in high-risk populations. A dearth of comprehensive policy and planning strength within the department has increasing negative consequences over the years. To reverse this trend, we are concurrently evaluating the scope of responsibilities for a health planning unit and the credentials of persons who can fill this critical need within the department. A portion of the Fiscal Year '09 budget increase will allow us to hire two persons that will be dedicated to resource planning, policy development, and effective resource allocation at the executive level. The department's human resources section, critical to all aspects of filling positions, will also receive funding to support the hiring of two positions to assist the 00011 department in overcoming the chronic obstacles to filling many vacancies in our civil service professional positions. The new human resources position will allow us to target recruitment networks, particularly for qualified minority candidates. They will also be responsible for heightening our visibility as an employer of choice and promoting additional changes to classification and pay structures needed to reduce the number of vacancies in the department to track and measure the numbers of hires, promotions, and so forth, and shorten the time needed to process internal promotions. In most of the areas where the Fiscal Year '09 budget increases provide for additional hiring, savings to offset costs will be realized as we improve our capacity to reduce expenditures for overtime, which is used frequently to meet minimum 00012 staffing levels. In carrying out mission to protect and promote the health of all Philadelphians and provide a safety net for the most vulnerable, the Department of Public Health administers a wide range of essential services for our residents. I believe that the Fiscal Year '09 General Fund budget will allow the department to continue these programs and, with increases in these key operational areas, help us build a more healthy and sustainable Philadelphia community. Thank you for the opportunity to present testimony today. I will be happy to answer questions at this time.
Thank you very much, Doctor. I think on the outset, I ought to say that I am very pleased to hear this administration is going to move 00013 forward and finally, finally hire the additional personnel that City Council had approved to your budget for the School District -- or, rather, the district health centers that the prior administration absolutely refused to spend. With that being said, can you tell us what the waiting period is at this time for clinical appointments?
I can. For adult initial visits, it is 55 days; that's down by five days from March of last year at this time. For return visits, last year, the waiting time was 12 days; it's down now to two days.
From 12 to 2. And I'm happy to provide a table for you that has this information if that would be helpful to you. For pediatrics, it's down from 00014 days last March to 9 days this March; for initial visits and for returns, down from days last year to 5 three days this year. 6 For dental visits, we've had difficulty recruiting dentists, as you've heard, so that the initial time for a dental visit has required 10 days from call to visit a year ago and is now up to 34 days, which we're trying very hard to address. We just have been completing interviews for dentists to improve the staffing in our dental practices. Return visits have been about stable, at about days to get an 18 appointment, versus 20 days this year. 19 For prenatal care, last year, 20 the initial visit waiting time was 29; 21 it's 20 days this year. Return visits: 13 days last year and 10 days this year.
I know that in the past, we have heard 00015 consistently that not every district health center had the same waiting period. Some had to wait months for an appointment in some of the centers; and in others, you would wait maybe a month or a month-and-a-half. Now, you're telling us that the initial clinical appointment will go to 30 days? How's that going to work out if they've been waiting for months in some of the centers?
We know that -- the numbers I've given you are averages across the system, so there are health systems that have much longer waits, and there are health centers with shorter waits than that. We're targeting with the dollars those health centers that have particularly longer waits. For instance Health Center 10 in the Northeast has been known for a long time to have long waits, and we will target with these dollars particularly 00016 Health Center to improve staffing there in order to reduce the waiting time for an appointment. We've been particularly anxious to improve the facilities there, the staffing there for prenatal care, because, as you may have heard, access to prenatal care for those in the northeastern part of the City has been particularly problematic.
When do you anticipate that we would be able to work with all of the centers to have a 30-day waiting period?
When do you anticipate your goal will be accomplished?
I would like to tell you that we could do it by the end of the next fiscal year. I don't know -- the year 2010 fiscal year. What we have in the budget 00017 currently will not allow us to get to 30 days everywhere. We will approach it; it is the goal to do so. One of the things that we are working on is looking at both efficiency in the centers and ways to do a better job in terms of particularly no-show appointment schedules.
Can you tell us what is needed to get there this year?
Thank you. Commissioner, you state in your testimony that you will be able to fill prescriptions within one day. How are you able to do this and not increase your Class 200 Budget overall? Will you be cutting other services in order to fill prescriptions? 00018
Your concern has been my concern over the course of the last two months, since taking office. What is clear is that we have positions that have been approved in the budget for pharmacists, but we've not been able to fill those positions.
There are a number of reasons. It's -- there's a shortage of pharmacists in general in the Philadelphia area, in ambulatory care. We've made an appeal, for instance, to all of the hospitals in the region to see if we can share employees. And to date, none of the hospitals have been able to come forward with an employee that they can share because, in virtually all cases, everyone is stretched to provide ambulatory hospital services, even at hospitals. So we're working with the 00019 pharmacy schools, we're making a major effort to recruit, but the issue is that there are few pharmacists who are not -- who are available to come to work. We've looked at our salary structure, so we've gone back to increased salary for pharmacists to make us more competitive; we will continue to do that. But recruitment is a serious issue, and one of the things that the H.R. Department and the Health Department is working on now is a more comprehensive strategy for recruitment.
Have you spoken to anyone at the College of Pharmacy?
Well, the -- every college has a graduating class 00020 that ends its schooling in June, so we're hopeful.
What is the salary of a pharmacist that works for the Health Department?
Thank you. Commissioner, during the last few budget hearings, we have been told the lead in homes is continuing to be a problem. Can you tell us what, if anything, is being done to address this?
I can. There are several issues related to lead in homes. Again, one of them is hiring, so there are vacancies within our current Childhood Lead Prevention 00021 Poisoning Program. We've targeted those particular ones and are prioritizing the hiring of people in that program. I'm hopeful that this will help. But in addition, as you may know, federal funding through HUD grants expires this year. We are in the process of reapplying for those monies. I am concerned that should we not be successful, we will be able to serve less children, and I think that will be a crisis, but we are putting every effort forward to successfully apply for those monies. We've been successful in the past. And recent site visits have been very positive about our program and the quality of services that we provide, so I'm optimistic that we will able to fund ongoing abatement and cleanup work.
Can 00022 you share with us what the backlog is?
I can. There are approximately 260 properties that are waiting for risk assessment and about 70 properties that are waiting for further work after that assessment. There are about 300 homes that still need to be lead-safe. And we're working hard to reduce that backlog. Part of the issue is staffing. Our current staff does overtime work, but even with that, we need to hire in order to be able to make a dent in that number.
We have money in the current budget to hire and we're working to fill those positions. There's been --
There is an existing list, a civil service list, for those positions?
There is an 00023 existing list for some of the positions, and we're working on the list for the remainder.
I'll tell you, it seems like this one problem continues to exist no matter how hard we try to address it.
What is your appropriation for the lead abatement? What is the appropriation that you have in your budget presently, and how many properties would that amount of money be able to address?
Can you give us a rough estimate as to how much -- or how many homes that that 00024 would be able to address?
So that would just address all of those homes that you mentioned earlier.
Mm-hmm. All right, Doctor, I just have a couple more questions 'cause I know all of my colleagues are eager to be heard. Doctor, what initiatives will your department be taking to address our high rate of infant morality?
We currently are engaged as, you know, in a number of initiatives related to infant morality. The issue about infant morality, per se, is that there is no one activity that can be undertaken to make a 00025 difference. Infant morality as a measure was developed to measure what happens to women's health, family health, and community health more generally; and as a result, things like poverty, nutrition, and major issues affect the infant morality rate. Standard teaching is that prenatal care should make a difference to the infant morality rate, and it may to the first piece of infant morality, which is children who are born unhealthy. One of the things that we're undertaking during this year will be the -- work toward establishing a registry for prenatal care. As you know, we're down to only eight centers in Philadelphia that deliver babies, and prenatal care is available at just those eight centers and one independent practice in the City. One of the issues that's been identified by the obstetricians in a 00026 working group on obstetrics in the City is that sharing information about prenatal care is very difficult at the moment, so that women from various parts of the City can go anywhere to deliver, and that may mean that a woman arrives at a hospital and there's no information from her prenatal care, which makes a difference to a healthy delivery. The Health Department can provide, as we do now for immunization, prenatal care to providers by creating a Web-based registry, which is one thing that we're looking into now and hoping to establish over the course of this year. That would allow every delivery site to have accurate and up-to-date prenatal care and information on women, which will go some distance. In addition, part of infant morality is death in the first year of life, and there are numbers of 00027 different things that have been identified to make a difference to death in the first year of life. One of the problems that has been identified and, I believe, Council has had hearings about, is co-sleeping, for instance. We have a new medical examiner who is coming. He is expert in issues around infant death, and one of the things that we've talked about is how we can better target our efforts with DHS and the Health Department and others to the issues of co-sleeping. It's not a problem that's unique to Philadelphia, but I believe that we could come up with unique solutions. One of the issues with co-sleeping that you've heard about is that many people co-sleep, and co-sleeping deaths are few in number, so I believe that we can better target risk factors for co-sleeping and make them known to people to try to reduce 00028 the number of infants who die from co-sleeping. And the other is continuing campaigns that are ongoing throughout the City around sudden unexplained infant death, for instance, and sleeping position and so forth. So doing what public health does well in terms of getting messages out, identifying risk factors, and making sure that people are aware of them, I think, is the most that we will do and the most important work that we'll do in the next year around infant morality.
Thank you. I'll ask one more question and then recognize my colleagues. Commissioner, please tell us what you think the physical condition of the City's health centers are. I know one in my district that is absolutely horrible.
So the PICA Board 00029 undertook an evaluation of each of the City health-related properties so that I have estimates of the total required capital improvement, and we have estimates of what replacement would cost; it's much more cost-effective for the City to do capital improvement than to replace every one of the health centers. So we have -- I can tell you by health center what we anticipate the overall cost is and what the total for capital improvement is. And I also have data on the priority-one total costs, which I'm happy to share. They're in table forms; I can read them to you or I can share them with your office, whichever you would prefer.
If you would send me a copy of whatever you have there --
-- I would share it with my colleagues. For sometime, it's been rumored that the center at Broad and Lombard been may be up for sale. What is the status of that?
My understanding at the moment is that there were at the end of the last administration discussions with the -- with a nonprofit organization to purchase that property. I understand that the property was only purchased by the City on the 31st of December. Since that time --
Up until that point, it was owned by a trust, and the trust agreement with the City said that the City had the right of first refusal; the City exercised that right and purchased the property, I believe, on the 31st of December. 00031 We are currently, as you may know, constantly aware of capital needs in that facility, so we are interested and we're working with Public Property to see if we can identify another site for the current inhabitants of that, which make up many of the programs of the Health Department. And I'm happy to keep you updated on the progress of that work.
I would appreciate it. Thank you. And I see that we have some of our constituents here -- I'm surprised to see them -- with signs, "Night Hours For Health Clinics." What are the hours that the health clinics are open?
It varies by health center. So for Health Center No. 2, it also varies by day. That health center includes evening hours on Thursdays until 7:30, and it's open on Saturday from 8:00 a.m. until noon. 00032 At Healthy Center 3, on Mondays, the health center is open until p.m., and there are no weekend 5 hours at this time, but the waiting 6 time for an appointment at Health 7 Center is significantly less than it 8 is at a number of other centers. Health Center is open until 8 p.m. on Tuesday evenings. Health Center is open until p.m. on Tuesday evenings. Health Center 6 is open until 8 p.m. on Wednesday evenings. Health Center is open until 8 p.m. on Wednesday evenings. And Health Center 10 is open until 8 p.m. on Wednesday evenings. The Strawberry Mansion health center is open until 7:30 every other Thursday evening.
So just about every center is open one night a week.
They are. One of 00033 the ways that we hope to reduce waiting times is to increase evening hours. As you may imagine, there is some discussion about that because there are many people who, while evening hours may make sense, in dangerous neighborhoods, people may not feel comfortable coming out at night. So this was a pilot program to make sure how things would go at those centers. In those centers where evening hours are filled, we will first target them for expansion.
Thank you. And to our constituents that are here, I would just like to make a statement: I just feel very, very encouraged from what the doctor has said today. I think that this is the first time that we're finding that at least we're going to see quite a bit of improvements in the Health Department. 00034 And, Doctor, I want to thank you. I think -- I don't know you, but I think you're going to do a fantastic job.
Thank you. The Chair recognizes Councilman Greenlee.
Thank you, Madam President. I want to echo what the Council President just said. You clearly see that the issue at health centers is one of our -- has been a priority at Council for a while, and we're glad to certainly see it's one of your priorities. As I'm losing my voice, I might need the health center myself. You mentioned specifically District 10, and I know it's an area we've heard a lot of complaints about. 00035 I don't know if you've gotten into it at this point yet, but what seems the reason why there seems to be more of a backlog there? Is that the worse backlog it seems to be? And is it just pure volume? is there a particular staffing problem there?
Health Center 10 is our busiest health center, and it serves the Greater Northeast, and that's an area with rapid population increase. It's an area where the population of those who are uninsured, including those who are undocumented, has increased fairly rapidly, so the need for services is high. Keeping up with that has been difficult when the budget for the Health Department has generally been reduced year after year and filling positions has been difficult. So with the increase in budget that we're requesting, Health Center 10 is a high priority for us to target 00036 to expand staffing there, to fill staff positions, to increase hours, to improve prenatal care, and to reduce the waiting time.
Okay, great. And you mentioned the problem with dentists. Is that a salary issue, or is that why you're having problems with getting dentists, you know?
Right. What is the -- do you know offhand what a dentist is paid by the --
I don't have that.my colleague may. (Dr. Schwarz consults off the record with some colleagues.)
So the range that we have is about $74,000 to about $95,000.
Mm-hmm. 00037 And I guess compared to what other places can pay, that's kind of low, right? Okay. If I could just jump to the Food Safety Program for a minute, you said that the two additional sanitarians will increase the frequency of food establishment inspections. What is the frequency now? And, again, ideally, what would you like to get?
Okay. The change, which I think has been reported to Council in the past, is that we'd like to have a risk-based system.
So that when we identify an establishment that has particularly difficult practices, we can increase the frequency of routine 00038 inspection, not just coming back to see that they've done what they're supposed to for a given citation.
But we actually can come back more frequently to inspect them on a regular basis. The general practice in restaurant inspection nationally is not risk-based. There's a movement to create a scoring system for risk-based inspection,which we are implementing and will be a leader in the field in doing so. But what we need to do then is have the staffing to go back and inspect some establishments much more. The official national plan has very frequent inspection, somewhat frequent inspection, and less frequent inspection. Less frequent inspection would be every two years. We currently, for all establishments, have a standard of one year. We don't feel comfortable 00039 reducing our standard to two years. At the same time, we feel that the highest-risk establishments should have frequent inspections. So the goal of this budget is to get us to a two-tiered system, where we will have very frequent repeat inspections for those establishments that have high risk, and others will have the standard of a year at minimum.
Is it also complaint-driven if people find problems at --
Mm-hmm, okay. Have you found the problems increasing over time, or are restaurants more careful, are they more observant of the law, less? Is there any kind of a pattern that you see? 00040
So it would make sense that more people are attentive to it.
Okay, great. All right, thank you. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Tasco.
We're very hopeful that we're going to see some changes in the Health Department. 00041 I just want to follow up on a couple of questions. Is it possible to contract with dentists who are practicing in the City as opposed to -- do you hire the dentists on staff; is that what you do?
We do. Anywhere we can find a dentist who is willing to work with us, we find a way to hire them.
What is the problem with -- in recruiting dentists to participate with the City?
Salaries are a huge piece of this. The residency requirement here used to be, but my understanding is that we've gotten a waiver of the residency requirements, which has helped. But simply finding people who 00042 will work for the amount that we can pay is an issue.
Mm-hmm. And you are looking at maybe changing the salary structure?
We've worked with the Civil Service Commission on salary structures and will continue to do so, yes. It's for pharmacists as well and nurses positions.
Let me just ask you a question about the prescription program. Again, you hire pharmacists to work in the health centers?
And you contract. Is there a possibility, since I do believe City employees have to get their prescriptions filled at Rite Aid, right?
Since the City has these contractual relationships with these pharmacists, is there any way that we could explore working out a relationship with them to fill the prescriptions for our clients, our constituents?
I've thought about that. Part of the issue is, if we do that, the issue is that they need to be willing to provide us the same people on a regular basis because our pharmacy system, in terms of the computer and so forth, will be different than their pharmacy system. And having a rotation of people might sound good, but it won't provide good service within our pharmacies. So I made an attempt with 00044 hospitals, 'cause I had the opportunity to challenge them to provide us with help that we would pay for it; we have money to pay.
But they're quite short-staffed. I've heard rumors that the chain pharmacies as well have had difficulty with hiring, but I need to explore that.
Mm-hmm. Some time ago when it -- well, let me ask this question: You're not timing this, are you? How are -- what is the status of our building for individuals who come to the health center and who might have -- might be eligible for Medicaid? And are we doing an effective job of billing for those services that would help with our revenue?
So there are two questions. One is, how well are we 00045 identifying potential sources of health insurance for clients?
The second is, if we identified that source, how well do we bill; is that right?
Mm-hmm. Well, I guess the question is: Are we billing the State for the services that a client may be eligible for?
The bigger issue is identifying folks who are eligible for insurance, which, from a public health point of view, goes beyond just our need to bill. It's better for the individual, if they're eligible for insurance, to have insurance.
So we have had benefits counselors. We currently have three vacancies, which we've just 00046 cleared the obstacles and will be filling at three health centers.
Some of our colleagues said they cannot hear. Would you pull the microphone closer? Thank you.
I'm sorry. We have filled vacancies -- or are in the process of filling vacancies at three health centers, where we have had not had benefits counselors. I'm hopeful that by -- certainly by the end of this fiscal year, we will have those positions filled. But we track carefully the proportion of our clients who are insured and uninsured. We -- the policy in the Health Departments is for those who are uninsured to have a screen done by the provider roughly figuring out if this is someone who has income that wouldn't be eligible -- for instance, for medical 00047 assistance -- and anyone possibly eligible to be referred to benefits counselors. We are relooking at that process to make sure that we're being efficient and looking to track the portion of clients who actually get referred for benefits-counseling and then the yield on that benefits- counseling.
I can say that when we look at the pediatric population, where we believe most children should be eligible, we have a high proportion of children who are not currently insured. The issue there is the proportion of people in our health centers who are undocumented or the children of those who are undocumented. I believe we have a particularly high proportion, as we should, since otherwise, those 00048 children wouldn't be served, of children who are undocumented, and that means that we will have a higher proportion of children compared to other places who are not insured, but we are working very hard to make sure, in fact, that that is the case. But when people have insurance we are billing.
Thank you very much. Let me just ask you another question about the sanitarians. What other areas do they cover? They just don't cover -- inspect restaurants. What other areas do they inspect?
The class sanitarian could do a number of different jobs, but in this case, we would be hiring people to do restaurant inspection for the restaurant and food control program.
Okay. And you have other inspectors (inaudible; off-mic).
No, we have inspectors and sanitarians, but they work in other -- the classification is used within environmental health.
And there are a number of different things that we do under the auspice of environmental health, so there are sanitarians in a lot of -- in Vector Control, for instance. The rat control program has people who are inspectors and sanitarians. But the people who we have targeted to hire are for the restaurants control, the food service program, in the Health Department, so that is the work they will do.
When we 00050 had the hearings some years -- a couple of years back about the -- some of the restaurants in the communities, the Zoning Board was granting a license on variance to restaurants where the ventilation they were installing and proper ventilation; is that something that comes under the Health Department in terms of (in inaudible) but working with the zoning Board so they understand that there could be a health problem in the way they dispose of some of the materials they use in the restaurant, and also how the ventilation has an impact on the community, lack of proper ventilation.
Well, listen, you don't have to answer that now, but maybe it's something that you might want to follow through on with so that the Zoning Board may understand that granting those variances without 00051 proper construction of the cooking process is a health hazard.
And not that we just don't want the take-out in the neighborhood, but the way they construct the ventilation system causes a lot of problems in the community. And also the disposal of some of the oils. So it's all tied in with the health of the -- of our community. The other question I want to ask you is: Research shows exercise and sports are helpful in preventing and curing the systems of chronic diseases such as high blood pressure, obesity, and perhaps diabetes. I am glad to see that $300,000 of the '09 General Fund increase will be directed towards these issues. Are there any plans to partner with the Recreation Department and Fairmount Park to encourage walking, exercises, and sports for 00052 Philadelphians with these diseases?
We currently are part of a coalition that is looking at two things. One is increasing exercise in communities through readily available means, and the other is increasing the availability of fresh fruits and vegetables in community grocery stores.
But the first part of it will completely be, and is, a partnership among City agencies but also among non-City agencies, so private and community-based groups.
Now, are you working with the School District to promote healthy life styles for our students?
We'll soon be getting a new superintendent, so it might be a collaborative there. Let's see. Some of my questions -- oh, let me just go back to the closing of the hospitals for OB-GYN services. You weren't here and I wasn't around, but back in the '70s, when Philadelphia General Hospital was closed, there was -- of course, we had far more hospitals than we have today, but do you know, or does anyone in the Health Department know, whether or not there was an agreement with the local hospitals to provide the services that would have been provided had PGW [sic] not closed? Is there a formal agreement? And if so, would that agreement cover and require these hospitals to provide those services?
I don't know the answer to that. I am happy to look and 00054 see what we can find.
Part of the answer to your question will be in the wording of that agreement. My guess would be that it didn't specifically address obstetric services because there wasn't a specific problem with obstetric services at that time, but it's worth looking to see.
My guess is that such an agreement -- because I've heard speak of it, but I have not seen it, so I don't want to say there is such an agreement -- may relate to accepting patients who would have gone to PGH, particularly for specialty service. And if it's written in general terms, we can certainly work with the Law Department, should such an agreement exist, to see what we can do with it.
Why are 00055 these hospitals discontinuing the service?
We've spoken with those institutions that continue to provide service. As folks here know, there was a question about one of them in particular, one of the eight remaining hospitals, within the last year-and-a-half. And the Health Department and private partners pulled together a group to work with the obstetric providers to ensure that we stabilize the existing net of eight hospitals. The general feeling from those providers -- I've met with providers of obstetric services and I've talked to those hospitals. The general feeling is that the cost of malpractice is prohibitive and that reimbursement, particularly from insurance companies, including the State, doesn't cover the cost of malpractice. 00056
Oh, the malpractice is specialty-based, and within the area of obstetrics and gynecology, it's different for those who are obstetricians versus those who are simply gynecologists. So yes, the insurance is, in a sense, risk-based. And the insurance premiums for obstetricians have risen precipitously, particularly in the Philadelphia market, because of the high cost of settlements in the Philadelphia area. And the hospitals say that it means that the -- their ability to break even on obstetric services is limited, and that's a problem.
Is there a higher incidence of claims in that particular area than in other areas?
I don't know the specific numbers, but the issue is the 00057 magnitude of the settlements, and the size of the settlements is particularly large in this region.
(Inaudible.) I'll retract that statement. I won't say it, I won't say it.
Thank you, Madam Chair. Commissioner, first, thank you for attending the briefing held by Councilwoman Blondell Reynolds-Brown this morning talking about the CHIP Program and some of the issues related to recruitment of underemployed people 00058 who do not take advantage of CHIP for their children, and your comments were well taken in bringing that issue to light. So thank you for attending that. Could you give me a brief description of the type of profile of the patient that comes to a public Health Center?
I can. So about 59 percent of the patients who come to the health centers are women.
About 59 percent are women and 41 percent are men. About percent of the patients are 19 children or adolescents and 76 percent 20 are adults. 21 Broken down by race and 22 ethnicity, about 65 percent are 23 African-American or black, about 12 24 percent are white, 11 percent are Latino or Hispanic, 6 percent are 00059 Asian, and 6 percent other. And I can tell you insurance information.
I don't know that we know that, but I can certainly find out and get back to you on that.
I think in light of the fact that the City has 12 percent people who live under the 13 poverty guidelines that there would 14 probably be a high percentage of those 15 people that participate in public 16 health centers as poor people. 17 And I say that to say that I 18 will not burden you with the 19 information again that the 4th 20 Councilmatic District does not have a 21 public health center, but I will ask 22 you today that there are some 19 23 non-city primary-care centers in 24 operation in the City of Philadelphia's neighborhoods. Where 00060 are those centers located?
Councilman, I appreciate your attention to this, and I want you to know that I've been attentive to this question, and so I have for you a map of your Councilmatic District with the health centers that are not funded by the City but are available through federal funding to those without insurance. You have two within your district.
One is the Spectrum Health Services Center and the other is the Family Practice and Counseling Network. You also have the distinction of being the only Councilperson who has two medical schools in his district. Neither of those medical schools provide service within your district, though.
We have also looked by census block at those folks who come to health centers, and we've tracked, based on census data, the portion of people who, we would anticipate, would be uninsured, so for every census block in the city. And I can show you one that there is one area within your district that has a high rate of poverty and has folks who are uninsured and not coming for health care.
I've got it, and I have a map for you to show you precisely.
Those folks live within twelve blocks of the Spectrum Health Services Center, which has capacity. And I think the issue isn't so much that they don't have access but they may not know about the center. So we would be happy to help you to work with Spectrum Health to publicize the services that are available to those people with those blocks, and I want to make it available to your office, and I'm happy to do it for every City Councilperson.
I hope that every commissioner in this administration does the good work that you do. When a question is asked, eventually, eventually, there will be an answer. So I appreciate and look 00063 forward to working with you. A couple of other questions. You mentioned the problem with prenatal care, high infant-morality rate, some of the issues related to reimbursement, and some of the issues related to the inability to get doctors insured. Is it time for the City of Philadelphia to revisit a publicly owned hospital? PGW [sic] was in existence; in fact, many Philadelphians were born there, including myself. And I wondered if we are at a economic point where we need to have a publicly-owned hospital here in Philadelphia?
The -- I came from the private sector, the nonprofit private sector, and worked in a hospital for 22 years in Philadelphia and know the state of affairs, I think, a bit both in the City and nationally 00064 around hospitals. The cost of investment in a hospital is extraordinary and the ongoing expense for that is equally extraordinary. The issue of access to prenatal care is a complex one. There's both the cost side and the revenue side. The revenue issues are ones which principally the State needs to undertake, and we've been in conversation with the State about those. There are a number of things that the State can, do likely in partnership with the City actually, to improve the amount of dollars available to hospitals in the City, particularly those who deliver babies. But on the expense side, there are a number of expenses that the OB Task -- the Obstetrics Task Force that the Health Department has worked to convene have identified, and we're going through them issue by issue to see if we can help reduce some of the 00065 costs. The chief cost that we're not going to be able work on in the City is malpractice insurance. However, we do have the ability to, if you will, spread out some of the costs for that under the auspice of the City, which, as you know, has a different liability arrangement than most other providers. So one of the things we are looking at is whether the City can, under its umbrella in some way help with some of the liability issues and, therefore, assure that those people who need prenatal care can get it by using providers who are a part of the City network. So there are a number of pieces to that. I'm happy to brief you or anyone else in your staff about those issues, but the Health Department, before I got here, had done excellent work, I think, in trying to form a partnership and identify those issues, 00066 and we'll go forward with that.
Well, I'll accept that answer except for one notion: That the cost of a hospital is probably high; the cost to the citizens of not having a publicly-owned hospital is higher. When we start talking about issues such as organ failure, kidney failure, it exceeds the death toll of gun violence in the City of Philadelphia, and these are silent killers that are affecting our communities. And we need as our public health drum major maybe a feasibility study to kind of take that into account and start looking at what's really happening to the public out there that doesn't wind up on the front page of the Daily News because it's just someone's kidney that failed and they died of that mysterious cause. 00067 So I would only caution that we probably don't truly know the cost of not having this facility and might want to engage some people that are a lot smarter than I to look at that. But that's something I'd like you to note.
The other issue I have is, in your budget, you have 51 million for ambulatory service. When you say -- could you define that for me?
That involves the amount that we spend on the City's district health centers.
It's outpatient. We don't have a hospital, so the general word that people use is "ambulatory" --
So you don't have a hospital? We don't have a 00068 hospital?
That would be inpatient as opposed to ambulatory services, sir.