I don't know if the City's ambulatory health network has. Part of the issue for that would be whether or not our clients have access to the equipment for telemedicine.
One of the notions that I'd like to put forth again for your consideration is that I believe that the future of publicly- owned facilities such as rec centers will be truly multipurpose centers, where a number of services are provided during different times of the day and 00069 adapting those physical structures to meet the needs of the citizens. And one such use might be the equipment necessary to do telemedicine, where, if we have a shortage of doctors, we can, through technology, plug people up and into machinery that can do certain types of examinations vis-a-vis telemedicine and something that is low-cost, high-yield by way of access to health care. It may even cut down on the time that it takes for a person to be seen at a public health center, and it might be a worthwhile investment. Also, I think there are federal grants that might be available to fit out a multipurpose center, and it's something that I think we need to not be (indiscernible) with our health care delivery and be willing to go in different directions on trying to solve, cost-effectively solve, some of the challenges before us. 00070 Finally, this whole debate about universal health care, every candidate is talking about it in some form or fashion. Has there been any thought to what that means for public health in the City of Philadelphia? And if you could give me your vision of that.
There most certainly has been more than discussions so that -- and you may know that this Council helped pass a Charter change that assures that we move toward universal access for people in Philadelphia. There's a task force that's been working with the Health Department on that, and we're serious about figuring out how to assure that all Philadelphians have access to care. I think in terms of vision, it's a partnership. So the public sector needs to do some things; I 00071 think the private sector as well needs to do things, and it sounds like you agree with that.
Identifying how to target those particular services so that our partners within the private sector meet the needs in the City with us so that it's seamless for real people; they can go where they need to go, and we can help facilitate that in an efficient way is a high priority. One of the things we need to do is make sure people have access; hence, we're investing in the health centers and will continue to invest in the health centers so that people who need have access will have a place to go. But once they come in, if people have a problem, the next step in this is assuring that they have access, for instance, to specialty care or to diagnostic care. And we're 00072 currently looking at that; we're looking at both the existing City contracts with universities and hospitals that pay for specialty care to see if we can do a better job in managing those dollars and improving access. We're also looking at pharmacy services that we provide and assuring that people can get prescriptions is in a timely fashion. And one of the big issues there, as I mentioned is hiring so that we have enough pharmacists.
Okay. Commissioner, I just want to encourage you to continue that work. Too often when, finally, the federal government decides to do something about a problem, the only thing that's developed is a cottage industry by the private sector then to take advantage of it, after ignoring it for decades. So what I would like you to do 00073 is make sure that the City of Philadelphia, the percent of the 4 folk that fall below that poverty 5 guideline, take advantage of any 6 health care at the federal level, that 7 it trickles down truly to them. 8 Finally, the most expensive 9 thing in the world is being poor; we 10 pay more for everything, you know, 11 whether it's insurance or other 12 commodities, by virtue of the fact 13 that we are poor. 14 I noted in your testimony that 15 you are looking at the fact that 16 because of high interest rates, 17 because of predatory lending and other 18 monthly obligations, that people are 19 choosing between having utilities on. 20 And I note that you note that, and I'm 21 particularly encouraged by that, 22 looking at that outside of the box as 23 a health hazard. 24 So I wanted to applaud you on that. I read that and underscored it 00074 and wanted to say it publicly for the record.
You're welcome. The Chair recognizes Councilman Green.
Thank you, Madam Chair. Good morning, Mr. Lemmo and Dr. Schwarz. I want to echo those of my colleagues that congratulated you on the appointment that you have and say that the professionalism and expertise that you're bringing to the position gives us hope for the Health Department. So thank you for your willingness to serve the citizens of Philadelphia. I'm going to follow up on two points raised by the questions on my colleagues that relate to some of 00075 questions I have and then get in my own questions. In your answer to Councilman Jones, you mentioned that the City's unique malpractice structure compared private industry. One of my questions was going to be: Do employees, doctors, health professionals, whether they are employed -- in the Health Department, whether they're employees or consultants, do they have sovereign immunity?
I can't answer your question directly; I can find the answer for you. Mostly it's my own lack of knowledge about the specifics of the City's malpractice or liability coverage, and I don't want to misspeak.
Well, what I would like to suggest is if the City -- if an employee of the Health Department 00076 or a contractor of the Health Department has sovereign immunity for performing medical services -- in other words, the limit are 250 or 500 max on anything that they do, that we look at creating a serious joint-venture partnership with all of the emergency rooms and hospitals delivering children in the City of Philadelphia and perhaps look at opening up some of those that have closed and staffing them with, quote/unquote, City employees, where the doctors can make what they were making in the private sector. We are just the overall employer and, therefore, we severely limit the potential for malpractice. If we have to lease space in the hospitals or become the operator of the emergency rooms in the City or the operator of the obstetrics wards, or whatever the case is, that we look at taking our sovereign immunity and blanketing the, you know, people 00077 providing services in the City. And if you could get back to us about the possibility of that.
I can tell you I think I now better understand the term and the question. That is something that we are currently exploring around obstetric services, particularly prenatal-care services. The question of whether or not there is a protection of a site where we would contract to provide services is one that I think is still open. So, in general, in a malpractice case, all parties are subpoenaed and all parties are named. And if one party has limited liability, the other parties generally are pursued.
So perhaps we can look at some closed facilities where they used to provide these services or other things where -- maybe not a new hospital, but a hospital 00078 focusing on delivery or emergency services or other things, where we can own the facility; or perhaps we can own the facility and lease departments to lease the non-obstetrics and emergency services departments back to the nonprofits or the hospital on a sale lease-back type situation. There's ways to take everybody else out of the line of liability and to severely decrease the potential for awards that should make the malpractice insurers, you know, happy. It's a long-term plan, but it's something that I think we need to look at in the City of Philadelphia, given what's happening to our -- has happened, and is happening, to emergency rooms and obstetric-service provision. Is there a problem competing with these federally-funded places like Spectrum? I mean, in terms of people who have insurance or can be 00079 reimbursed with, you know, through these federally-funded operations like Spectrum and then leaving the City of Philadelphia Health Department with the people who are uninsured? Do you have -- is there a problem in the marketplace with respect to that, or is...
We collaborate with the other health centers through the Health Federation of Philadelphia. We meet with them frequently. I think we share problems and issues. There are uninsured people who go to those federally-qualified and federally-funded health centers. The City district health centers are federally-qualified, and so the reimbursement structure is, in many ways, similar. But I've not heard particular discussion about competition in that way. You're sort of asking about adverse selection. 00080
I am. In other words, they show up there and then they're found to be uninsured or not reimbursable, and they're told to go see the City Health Department.
Yeah. I can certainly look into those issues more specifically. It may be difficult to nail that down, but I hear your point.
We generally have questions that are asked routinely, as in any health facility, but I don't know that that question is a part of it. We could certainly ask that question.
The question, I guess, would be: Were you referred to this facility from another, you know, place?
In terms of 00081 your testimony, you referenced chronic obstacles to filling many vacancies in our civil service professional positions. I would ask you, what actions can City Council take to change the law with regard to salaries or with regard to more exempt positions, et cetera, that can help you alleviate that problem so that you're, for example, with dentists, maybe not having to negotiate with the Civil Service Commission, but you have the relief you need more quickly and directly from this body. And if you don't have an answer to that question today, if you could get back to the Chair with what we can do to make your job of getting, you know, health delivery to citizens more efficiently and quickly, I'm sure we would all be very pleased to assist you in that effort.
How many of 00082 the public Health Department's employees are appointed by the Mayor and/or Managing Directors versus employees appointed via Civil Service; do you have any sense?
Are you specifically asking about the ambulatory health centers or the whole Health Department?
The whole Health Departments. Just how many -- in other words, are you using the MDO's office or other places to get exempt employees down into the operations of the Health Department?
We think there are about six or seven FTE's. Part of the issue is, it also works the other way so that Health Department personnel also work -- for instance, are deployed to health and opportunity to help share on particular issues, but the number is small.
Okay. If 00083 you could just get back to the Chair with that information.
I note in the administration's Five-Year Plan, it mention that DPH will study the implementation of an electronic medical records system to ensure the efficient delivery of high-quality health care and to enable all departments and agencies to enter pertinent information directly into an electronic system that can then shared by the appropriate providers. The Commissioner will create a task force to review operations and health plan for a new EMR.
I understand that, actually, the last administration did an assessment analysis of this and made recommendations in terms of the implementation of a system, and I'm just wondering if you can talk to us 00084 about where that stands.
I can. That implementation suggests that we need somewhere over $2 million in the next fiscal year and about $3 million in the fiscal year after that in order to implement what I would call "a comprehensive electronic medical record" across areas in the Health Department, so not just in the ambulatory health service, but also for prison health. And we're moving to the next step with that, which is, we're doing a survey of existing capacity, which is what's required ultimately for implementation. And we're stepping back a bit. Having looked through that plan and having worked in my previous employment a fair amount of electronic medical records, there are different ways to implement electronic records. There is one that's generally 00085 pushed by the industry that makes electronic records, and there's one that relates to the experience of many providers in the use of electronic records, so thinking about a staged approach, which would allow us to get most of the functionality of a record, an electronic record. It would allow us to share the kind of information we need to share, but it wouldn't provide either the complete expense, nor would it put the burden that is often associated with using electronic medical records on our providers, who are already pretty burdened, to keep up with numbers. So we're trying to look at a phased-in approach, which will, I think, be both less expensive and more effective in the long run for both prison health and ambulatory services.
When you say that electronic records burden providers, I don't understand that. 00086 Any implementation of an electronic medical record system should be purely electronic. Was the proposed system to keep paper records and electronic records?
No. The issue is the amount of effort required to do complete electronic documentation of what would be called "the physician or nurse practitioner notes." So there are a lot of pieces to an electronic record: There's a registration system, a scheduling system, a billing system, a pharmacy system, a laboratory system. There's the documentation of allergies and patient-safety information and the documentation of diagnoses and ordering of tests. And then on top of that, there's the written text that a physician or nurse practitioner completes on each patient.
The heavy lifting for the providers in an electronic records system is that which is now currently handwritten documentation, which is actually pretty quick and efficient for most providers on paper, and takes additional time that often is done off-hours, so weekends and evenings in using that kind of record. And also the change in the culture around use of electronic records. If we have scheduling, billing, laboratory, pharmacy, allergy, patient safety, and so forth information that's available to a provider on every patient, that goes a very long way in allowing that provider to manage that patient's care. Looking at the text of the last provider's record is very incremental in that. And yet it is the use -- it is the heavy step in provider time in adjusting to an 00088 electronic record.
I come -- I don't know if you know I come from the software industry; I was CEO of a software company. And I guess I don't agree because you could take an iPhone and you could literally write the record on it and it could be a part of the file. You could take a -- I can't remember what the new Microsoft computers are called that have -- allow you to write handwritten notes right in them. There are many PDA's and other devices -- HP makes them, et cetera -- that allow you to simply write on a screen and it's stored as a text, but also, in combination with OCR technology, allows actual searching of that data. It takes no more time to write on a -- one of those handheld devices than it does to write on a piece of 00089 paper. And then we're eliminating all of the back-office work that is associated with keeping track of that paper, filing that paper, pulling that paper out, et cetera.
We're in agreement on that. The issue is the state of affairs in terms of health technology for doing that and doing the rest of the record and what will happen in terms of the change in the health centers if we do it all at once. The history across the country, I think we might agree, is when that culture you is done in a one-step fashion, what happens is, there's both a certain degree of chaos but there's also a burden placed on providers who have to change every part of their process, not just the documentation part, per se. And all that I'm saying is that we do it in a two-stage process instead of a one-stage process. 00090
So we are going toward the same place, but we're doing it in a way that allows the whole system where we have facility issues, we have hardware issues, we have staffing issues, we have union-position issues, we have a bunch of things that will all -- and paper-management issues that will all be affected simply by creating electronic registration, scheduling, and so forth down the line all at once. And then we do a second-stage implementation of the transfer of medical documentation from the record. But we're going to the place that I think you're indicating we should go; it's just that instead of doing it in a one-step way, which is what the assessment was focused toward, we're doing it in a two-step process.
Okay. 00091 That's great. So you'll have time to re-engineer your work flow processes in connection with going totally paperless prior to the implementation.
And do you have any estimate of the efficiencies that will be gained in Step and Step in terms of savings?
The principal efficiency in Step 1 is going to be around billing, particularly pharmacy billing, which currently is a multi-step process because there's no 17 connection between the pharmacy system and the current billing for the health centers; everything is done manually. And I think we'll see improvements in patient flow with an integrated scheduling registration and so forth system. So those are the principal efficiency. The efficiency around record 00092 management is one that I've pushed back to have a reassessment, because part of the issue is that we receive a fair amount still of paper-related records. So subspecialty records, when we send out patients and get them back, are done on paper. And unless we can assure that our vendors, or our subspecialties who we work with, will be able to deliver us an electronic product paper, we're still going to have to maintain a record room and paper records. So the incremental savings that would ordinarily come from a paperless system we won't get for a period of time because so many of those who surround us still use paper.
Can we have an open system with an STK, which will allow offices that we communicate with to participate in our paperless system?
We most certainly 00093 can if they're prepared to prepare things electronically, or that we invest in scanning, for instance.
Right. And so I guess my question is, are we looking at whether or not paying for our providers to be paperless or providing them some extra money to -- incentive to do that in Year One will save the system overall, the health care system overall, a lot of money? I mean, every study I've seen on going truly paperless in the medical records business has tremendous efficiencies associated with that.
That was not a part of the initial assessment but needs to be.
And then if you could -- if you do get that 00094 information or if you could figure out that information, let us know. Also, one of the big problems in going truly paperless, I understand, can be insurance companies, who prefer a slow paper system because it allows them to hold their cash for a longer period of time; you know, 30 days versus instant reimbursement, that sort of thing. Are you -- have you -- does your system contemplate forcing our insurance providers that the City pays big money to go paperless with us?
Most of the insurance providers must have that capability based on now federal and insurance regs, so that's possible.
Thank you. I have just a few more quick questions. Is there a coordinated effort 00095 to seek research funding from NIH, CDC, and other sources within the Health Department?
That is the Planning Office that you see. So my intent is to begin, in the Commissioner's office, with an office that would look at just those issues, how can we better, identify, coordinate, and so forth, applications.
That's terrific. Is -- and that would also -- the Planning Office would also coordinate efforts to partner with local research hospitals, medical schools, et cetera, in terms of joint studies?
Finally, you're department has Budget Detail Section 39, , $54,760 for lobbying services, the same amount spent as in FY '08, with vendors to be determined. Is there any reason why this lobbying is not run through the Mayor's Office, which has requested 400,000 in lobbying services in FY '09?
This is a tithe to the Managing Director's Office that's paid for across departments, as I understand it, so that the lobbying is actually done centrally, but the cost is dispersed, each department is charged.
So this is lobbying in addition to the lobbying 00097 budget in the Mayor's Office, because it would not be in the budget twice; is that correct.
I don't know the answer to that, but we could certainly ask the Budget Bureau.
Okay. And it's your understanding that all of the departments include funding for lobbying in their budgets?
I don't know that across departments. I can tell that that's the explanation of that line item in the health budget.
I haven't seen it before, that's all. With respect to your capital budget, you mentioned the PICA report. Can you tell us --
We have an answer to your last question, I think. (Witness comes forward.)
Hey, Steve. Yeah, there's a -- I think the 00098 first two categories are work that need to be performed immediately and then work that should be performed within the first year. What is the dollar-amount required under the PICA report for Items 1 and 2, and what is the Capital Budget that you've been allocated?
Madam President, Councilmember Green, the PICA items ones and twos for the Health Department break into the following category: I think it's approximately 1.6 million for Prior Items, 7.4 million for Priority Items. What we have currently, I think, is about 1.3 million for funding of Priority 1 items in the Capital Budget. The Capital Planning Office is in the process of assessing those, just as they have done with Police and Fire. We are hoping to sit down with PICA at one point -- at some point in the near future to go over that, but 00099 that's what we have allocated. And our hope is to get the Priority 1's done quickly. As I understand it right now, the CPO has a fairly high confidence level that the Priority 1's are, indeed, Priority 1 items in terms of life, health safety issues. For the Police and Fire, part of the process of review has been to assess whether those are, indeed, Priority 1, sort of life-safety issues, and that process is almost complete.
And Priority 2 also as the recommendation is the first year, so the capital budget for Year 1 for the Health Department, is that 1.3 million?
It's 1.3 to deal with the Priority 1's of the 1.6 million and about 7.4 million in Priority 2's, and the --
Is that what's in the -- what's in the Capital Budget for ---
For the -- (Indiscernible; parties talking over each other.)
-- and when PICA recommends 8.6 million for the first year?
Councilmember, we've had this sort of running discussion. And I would tell you, having spent a number of hours, probably a half a dozen hours, in the last week or so, in part, because you've prompted me with questions. I think we need to be very careful about the assessments on the Prior 2's. Not all of them fit into the same category, and I would love to sit with you or any other 00101 Councilmember to go through in detail with the Capital Planning Office to understand. In some cases, what you have are visual inspections of situations where someone says, Okay, that light is out. That might be a Priority 2 or a Priority 3; when, in reality, what is out is, you have an electrical system in a building that's over 40 years old that wiring cannot support existing electrical appliances, existing lighting, the kind of load-bearing that, I think, all of us take for granted because we live in fairly updated buildings or in residences. And when you look at those assessments, we have to sort of keep in mind that a lot of it was visual inspection, they didn't go and tear out walls to go in and see what was behind the wall, that the Priority 1's and 2's are ones that we are trying to 00102 get on because the sort of criticality of those, and we're trying to fund them. But, you know, as with everything else here, there are trade-offs and there are priorities. And, sure, if we had the dollars, we would set aside as much as we could for all of these things, but it's a question of balancing and making choices.
Sure, it is a question of priorities and, you know, we are making choices. Governing is choosing competing ideas for good, and what we're looking at here is the choice between, say, planting trees or the choice between having clean, presentable health, you know, department facilities or great working conditions for police officers. And my -- I guess what I have been suggesting throughout these hearings is that we may want to look 00103 at infrastructure, which was a major theme during the last year and has been a major theme in this country, is infrastructure investment. The City has been woefully underfunding infrastructure investment. And the more we continue to do so the more expensive the problem gets in the out-years. So I am suggesting we probably need to reprioritize to more capital spending funding up front to fix some of these critical issues.
We agree that the capital and the infrastructure both for the City, that the owns its own assets, as well as for the City in terms of, you know, streets and -- is something we need to get our hands around, and that's why you've seen a sizeable increase to about $120 million in the Capital Program, that's why you're seeing sizeable increase with respect to maintains. It's why you're 00104 seeing, I think, a real attempt on our part to try to get a handle on the assessments that were done by PICA. But it's going to create, you know, some balancing, and we're trying to do -- and I know you're not suggesting this, but we're trying to fund what we can fund within the budget that we have while, at the same time, taking on some other priorities like the trees, which we think are important, like a range of other things. It's one of the reasons we put 10 million in pay-as-you-go financing for streets, which is not a small number, and will accelerate our ability to get in front of a sizeable backlog. I appreciate, you know, your intent here and that we're trying to get it. And we'd just like to get across that, you know, we have not sort of left it aside and said, No, 00105 that's not a priority. It is, and we're trying to do it within the resources that we have.
No, I understand what you're saying, although, you know, to be fair, the increase to $120 million as a one-year investment, it takes, you know, $40 million roughly of the PICA funds that are available for such investments and spends them, and then we drop back down to levels of -- I can't remember exactly -- less than a hundred medicine a year, when the City's own Planning Commission says we need to spend $185 million a year on infrastructure investment every year.
So, I mean, we could continue this debate forever. I just make the point that I think we've got to make some harder choices and start investing in our infrastructure. That's all. 00106 No more questions, Madam President. Thank you.
Okay. The Chair is going to recognize Councilmembers who have not been heard as yet, namely: Councilwoman Brown, Councilman Kelly, Councilman Kenney, in that order. Councilwoman Brown.
Let me begin first by echoing Councilman Curtis Jones: Thank you for taking the time to stop by this morning and listen and hear from one of our area providers on how we can continue to fill the gaps of children around children's health insurance. And so let's start there. Just for the record, tell us what you believe the status is and what some of 00107 the short-term goals are to tighten those gaps, recognizing that there's a ceiling when we know it's not an entitlement.
We have, as mentioned, benefits counselors at our health centers. We currently have three positions, which we are filling.
And those benefits counselors have, as a priority, finding health insurance for anyone who comes into the health centers, but particularly we know that children in general should be eligible for health insurance, unless they are undocumented and not born in this country. So in those cases, we do everything we can to find ways to make folks eligible if there's a way to do 00108 so. We provide applications, help people fill out applications, submit them. We do education and outreach with partner agencies within the City, and certainly we advocate for children to receive appropriate health insurance cards and then to know how to access care. As mentioned earlier, we would be happy to work with your office and others in educating employers about benefits that would be available for dependents, even in places where parents themselves may not receive benefits.
CHIP is something that every child who is eligible should receive.
Okay. And do that in a way, again, where we don't get ourselves in a fix, knowing that the dollars are not limitless, as you 00109 stated this morning, correct?
We know that there are caps on the number of dollars that are available --
-- per fiscal year for CHIP, but we believe that there are dollars in Philadelphia that we need to capture.
And we shouldn't go into this, believing that children aren't eligible for health insurance when they are.
Okay. Now, in an earlier hearing -- and I don't remember what department it was -- there was a revelation that the dots are not being connected between the Health Department's CHIP and children whose parents are incarcerated. 00110 So has any further discussion or thinking been given to making sure we capture those young people as well?
I've begun -- it was in, I think, the Capital Budget process where we had the conversation.
And I've begun the approach to prison health services about this because it's an easy communication that the department has already.
I think the other area where communication is needed is likely through the court, and I've not yet made that approach, but it's one that is on the list.
On the list, okay. Is there -- okay, we've taken care of that question. You give some decision on of your testimony to preventive 00111 services and the like. Talk to us briefly about preventive services, specifically for children with special needs.
There's a children-with-special-needs working group that is convened by the Health Department --
-- that I think, over time, has been particularly effective in bringing to the table partners who are also concerned about children with special needs. And we will continue to do that going forward. It's an important part of the function of the Health Department.
Okay. And included in prevention are immunization programs. Any status report, any new goals around that function of the Health Department? Is it working, to your satisfaction? Does it need further attention like you've given 00112 some discussion to the lead program and the like?
We have. I think it's the nation's premier immunization registry.
We recently briefed the State on the specifics of our registry. As you may know, the State is looking at creating a statewide immunization registry, and we're pushing for them hard to use our registry rather than other software that they have looked at.
We are absolutely willing to share information with the State so that we could have a statewide registry for all children so that a child who comes to Philadelphia, who's been somewhere else and immunized in Philadelphia, we could retrieve their immunization data. Or a family that moves from Philadelphia to the suburbs, 00113 people in the suburbs would know the child's immunization data. It's incredibly important from a public health point of view --
-- that we not create barriers to people effectively immunizing children. I think the newest immunization in the armamentarium is the HPV vaccine.
And we are both providing it and the vaccine-for- children programs provides access to that for children.
Wow. Okay. Let me thank the administration for assuring what department has the interest in knowing how departments are 00114 doing with regards contracting with disadvantaged firms, and when I look across departments, including Health, Behavioral Health, and OESS, the Department of Public Health, it's my personal opinion -- I'm pleased with the numbers for minority business entities. I'm struck by the numbers for women business entities both in public health, behavioral health, and OESS. So the question for me comes, is it lack of access or lack of awareness or lack of women entities out there that have the services that you're looking for? I don't know the answer to that, so what I'm going to be asking all three departments is to provide to the Chair the types of contracting opportunities that are left, period, so that I can try to figure out why we only see single digits, and I think in one place -- single digits for women 00115 participating.
The one piece that I would point out is that it was done as single counting.
-- companies that are women-owned or women-controlled businesses.
So we could break that out and try to give you those 00116 numbers. I would point out that the Health Department made a special effort to include both for-profits and nonprofit entities here.
So this includes contracts with not-for-profits, which, in the ASIS system for the City, that information isn't recorded directly; it's only recorded for for-profit entities.
So we polled our providers and looked at a careful definition of what "minority business enterprise" meant and what "women-owned business enterprise" meant, and so we're particularly happy with the data that we have to share with you, and we'd be happy to present it in another format, if that would help.
That would be helpful, that would be helpful. 00117 Talk to me about the relationship between your office and PHMC, Philadelphia Health Management Corporation.
Philadelphia Health Management Corporation was founded thirty or more years ago in partnership with the City. The City has had, during that time, significant presence on the board of PHMC.
It was formed in order to meet needs that the City, particularly in public health, had but could not be met by the City, either because of particular request-for- proposal issues or hiring delays movement of cash quickly to small enterprises.
So for community-level agencies, there are often cash-flow issues with dealing with the City. 00118
In some instances, they service a fiduciary for smaller health-related nonprofits.
Absolutely. Over time, PHMC's capacities have grown, and we continue to partner with them to, in a sense, take major maximal advantage of their capabilities.
So that we bring those capabilities to government and can share it with them around those issues. Um...
Madam President, point of information: Does PHMC come before us at any point for hearings?
They do 00119 not, okay. If I could then burden you, Commissioner, with getting a listing of their board members.
I'm not concerned; I'm curious to know if their board looks like Philadelphia. And if we, as a government, are doing business with them, then what is the level of commitment at their level when it comes to people of color, women, and disabled businesses?
Okay. There's one other question. Give us an update, if you would, on the after-school programming; what's happening with the stakeholder meetings and the like?
Okay. 00120 Then we can wait for DHS, that can wait for DHS. Not a problem. I think that's it, Madam President. Thank you. Thank you very much, Commissioner.
Thank you, Madam President. Good morning, Commissioner.
As I've been listening to, anyway, and I'm sure that by now that you know how important your office is by the questions of the Council President and many of my colleagues here concerning the health and welfare that many of our citizens who reside in Philadelphia. And I'm quite impressed with the way you responded, incidentally. 00121
I think you're doing a very, very good job. Sometimes we are not that -- we're shocked when we get direct answers anymore, but you're doing a very effective job.
I just want to say that that's -- your department, of course, has a huge responsibility in doing so, and that's a high priority. But now I would like to switch the subject a little bit and go into a less prioritized responsibility in your office, and that is animal care. Now, I know that many cities, of course -- some cities have animal care under their health departments, others don't. And I would just like to know if you have an opinion of whether this responsibility should be kept under the Health Department's jurisdiction. 00122 Or do you think it would be better if it was just placed somewhere else and it would free up resources and personnel to deal with the more important problems that you have in dealing with improving the health of many of the people in Philadelphia?
I appreciate the question. I don't know entirely the history of how animal care came to be within the Department of Public Health, but certainly the mission for animal control seems to be within the area of public health.
The issue of disease management, for instance, is one; we could look at rabies control as a very tangible example. And I believe that control of rabies is something that falls in general within the general auspice of departments of public health, so I can understand why 00123 the marriage, if you will, between animal control and the department. One of the issues, particularly in Philadelphia, that I've been made aware of is that we have a lot of animals. Compared to other cities per capita, we have many more animals than those cities do. And I think that the department is now focusing a bit on what we can do to think about comprehensively having an animal control program, not just a program to house animals that are captured, but a more comprehensive and, I think, public-health approach to the issue of animal control.
Well, I'm still waiting for your opinion. Would you think it would be better served if this responsibility was placed somewhere else other than your department, or would you prefer that this remain in your department? 00124
Okay, but it's something maybe -- (Indiscernible; parties talking over each other.)
And I guess it would be unfair of me to ask that question because it's something that you would have to look into. But I just want to touch upon another subject, and that is, it's my impression that you're going to be sending out contracts on animal care at the end of this year.
Now, the current contract, I believe, is going to be extended for six months, but I would like to know who in your department, or if it's you who's going to be responsible for awarding that 00125 contract. For instance, what criteria do you use? Is it just monetary? Is it just dollars and cents if we save a half a million dollars that's going to be awarded to a contract? What I would like to emphasize is that you look at the service end of it. Right now, with PACCA, we've been -- probably we have -- we have actually decreased the killing rate in the City by over 60 percent, and I think our whole goal here is to save animals, not to exterminate them. You have to look at other -- and it's easy to get to do it cheaply. That's all you have to do, is euthanize every damn animal that comes in your grasp. This is one of the things that I'm looking at. It's just -- it's one thing to take the contract and save money, but does it -- do the people -- are they going to be providing the 00126 same service? Are they going to be saving as many animals as the current -- the current PACCA people do?
I share your concerns and would anticipate that any contract that is let from the department will have a rigorous review of the issues, both around ability to meet the contractual requirements, history in terms of the quality of service, and cost. We'll have to balance those. And this is, I think, going to be as a transparent a process as we can make it so that people are aware of how the decisions are made.
Well, I just want to emphasize, and I'm telling you right now, just don't do it with dollars and cents, because right now, if you go back three or four years ago, we were euthanizing, we were killing over 25,000 animals a year. Now, we've reduced that by 60 percent. 00127 And we've done it through a lot of different ways. We've done it because we have a new board of directors at PACCA, a very dedicated group. We have a new director who's doing a terrific job. We have formed an alliance with probably the best veterinary hospital in the country, and that's the University of Pennsylvania. We have set up an adoption center with PAWS, and we want to have a few more of them. And with all of this, with the neutering and spaying program that we have in place, and we will have it in place, I think that we're going to increase the amount of animals, the lives of many animals that are destined to be euthanized now. And I think we're on the right track. We're on the right track to make this the first city in the East Coast to have a no-kill policy. And we can do that despite the fact that 00128 we are underfunded, that they're put probably in a dilapidated building -- I don't know if you've had the opportunity to see it yet --
Yeah. And it wasn't made for that purpose. And to me, I think it's one of the things that we have to look at, and I hope that I can work with you and the administration and try to work out, I think, a good contract and keep the people that are doing a great job to continue that great job.
You're welcome. The Chair recognizes 00129 Councilman Kenney.
Thank you, Madam President. Good afternoon. Can we talk a little bit about pharmacy? Can you explain to me how your pharmacy is managed and what some of the issues are that you're faced with other than just costs, which, I know, is a major issue now. Could you talk just a little bit about how your pharmacy system works?
Yes. For those who are patients of the ambulatory health centers, they may receive prescribed medications. And we've worked hard, as I understand it, to drive down costs. We have a contract, a sort of a collaborative agreement, with one particular drug manufacturer, where we receive pharmaceuticals of high quality at minimal cost. 00130 People come with prescriptions, prescriptions are dropped off. We make every attempt to fill them as quickly as possible. Emergency prescriptions or more urgent prescriptions are more filled within a reasonably amount of time. And prescriptions that are not urgent may be filled over a two- to three-day period.
Are we reimbursed for the prescriptions that we dispense?