Thank you, 23 Dr. Schwarz. 24 Thank you, Madam Chair. 25
On that 206 4/7/10 - WHOLE - BILL 100115, etc. note, how is your department doing with increased number of W/DBE and minority and women providers? We've had this discussion many --
So when I was in Council a couple of weeks ago during the budget hearings, I was specifically asked what do we know about the non-profit provider community, and we had a conversation about how we would define for today a minority non-profit. The issue there, just to remind everyone, is ownership. So the reason everyone is concerned about for-profit in particular contracts is, that improves the equity position of minority, women and disabled business owners. Since there's no equity ownership for non-profits, it's harder to figure out what the goal means, other than employment, for instance, leadership 207 4/7/10 - WHOLE - BILL 100115, etc. in the community and building capacity ultimately for people to be equity owners in business. So we agreed here that what people wanted us to do was to look at Board composition, which we did for the Health Department. So in Fiscal Year '10 to date, we have -- I thought I had it in front of me. I don't. Wait a minute. We have in contracts about $96 million with 74 non-profits, and we reviewed their Boards. And if we look at non-profit Boards, we have 35 of those Boards with majority control by either minorities or women. That accounts for $58.9 million of contracts from the Health Department, and that means that somewhere around 61 percent of the non-profit contracts from the Health Department are with agencies that have majority, minority or women Boards. I hope that answered the question everyone wanted.
It answers 208 4/7/10 - WHOLE - BILL 100115, etc. part of the question, because the other -- and I think that's good. I mean, I'm glad you did that. Thank you. But in years past, a number of community-based organizations, non-profits, had difficulty acquiring access to the Health Department and some of the programmatic activities that the Department provided, and those -- some of them are small neighborhood organizations working in the neighborhood with women or with children or whatever, just providing the on-the-ground health services, whether it's health information -- basically health information, that kind of thing. Those are the non-profits that we are too interested in having access. We talked to Dr. Evans, and he talked about how they have increased their provider base. And that has been a concern raised to us by many community organizations. And so we know we deal with the big non-profits, but there are smaller non-profits that provide that 209 4/7/10 - WHOLE - BILL 100115, etc. kind of service to the community that we want to see increased also. So I hope that you will, since you oversee CBH, kind of follow that pattern or that model and informing people what programs are coming up, what they might bid for, and if there are programs that can be broken down, unbundled, and to allow more opportunity in the community, because people say, Well, I want to run this program, but I don't have funding. So where do we send them for funding or could they contract with the City? But they're not a large profit or large non-profit. So I appreciate looking at the Boards. I think that's very important, but I think we also should look at too how we increase the smaller non-profits.
We can certainly look at it, and it is a priority for the Department.
The Chair recognizes Councilman Greenlee. 210 4/7/10 - WHOLE - BILL 100115, etc.
Dr. Schwarz, on the question I asked, I guess, the other years I've been here too on the health centers and you talk about the increase in need, I've asked before about the waiting times. Have they changed at all? Have they gotten worse because of --
So overall they got better. The average number of days for all eight health centers, I could sit here and just tell you it looks better. However, that's not really the answer to the question, and the reason is that the busiest health center for us is Health Center 10, and Health Center 10's waiting times continue to go up. And we've tried a bunch of things. What we haven't done is expanded service at 10, and we need to do that, and part of the reason for that 211 4/7/10 - WHOLE - BILL 100115, etc. has been the general fiscal condition of the City and the Health Department's contribution to that. But going forward in the next fiscal year, you'll see in our budget that we are investing dollars and expanding services, and a substantial proportion of that will be to expand services at Health Center 10. How much difference that will make is an open question, because the demand is so great. So of parts of the City, Health Center 10 represents a part of the City where there are not very many opportunities for uninsured people to receive care. And I believe that we can even expand services, and I don't know if we'll make a dent on the number of days people wait for a new patient visit. What we're trying to do is help people go to other health centers where we have shorter waiting times.
No. I understand. And I know Health Center 10 is a particular challenge because of the 212 4/7/10 - WHOLE - BILL 100115, etc. geographic area and that kind of thing. I just want to bring up one other issue, and I see Councilman Kelly came in. I know he's been the leader on this issue of animal control. And I say this with all due respect, and I know how hard you've worked on many issues here and I'm not trying to rank issues. Some people might say, Well, there goes Greenlee and Kelly again talking about dogs and cats with all the other stuff going on, but it is an issue that's important to a lot of people. And would you agree that things as far as animal control in the City are not going in the right direction? Well, let me say why I ask that question. At the City shelter, you have a situation, and I think I'm pronouncing this right, Strep zoo disease, which I understand is extremely rare, and it's happened twice in the City shelters. And I understand the kill rate, which has not been good in Philadelphia to start with, 213 4/7/10 - WHOLE - BILL 100115, etc. is going in the wrong direction. So that's why I asked that question.
I'm going to answer both parts of your question. The kill rate is getting better. So our euthanasia rate is improving. We're at 75 percent live release as of now. The bigger issue is the Strep zoo. That is a germ that lives in inanimate objects, and there are a lot of inanimate objects at the shelter. The good news is that if we treat animals with antibiotics, because it's a bacterium, we can protect them. So we don't have large numbers of animals at this point who are being euthanized because of Strep zoo. We have controlled that. But the bigger issue is, we had an outbreak. We have another outbreak. Remember, we take animals from all over the City, and the shelter itself had an outbreak. So what is going on now -- and it was highlighted in the newspaper -- is 214 4/7/10 - WHOLE - BILL 100115, etc. the PSPCA has taken a very unusual step, which is to say we are emptying the shelter of animals and we're cleaning the shelter from top to bottom. Now, that is a calculated gamble, because I think there is many people who would say, who know veterinary medicine, that the germ could have been brought in from the animals that we take in or it could exist on some inanimate surface in the shelter. So we hope this will make animals safer and we will reduce and ultimately control the infection. I think it remains to be seen. If there is, for instance, a part of the City where that organism is embedded and animals go there, they will bring that germ to the shelter and we will likely have another epidemic. I am hopeful that the expense we're going through and the difficulty we're going through will ultimately finish this epidemic, but I can't promise you that. It's the nature of the --
It is a 215 4/7/10 - WHOLE - BILL 100115, etc. rare disease; is it not?
Isn't it a rare disease to have it twice in one place in that short a period of time? At least that's what I've been told.
It would indicate from a public health point of view is there's somewhere the germ exists on a surface or an area that animals are contacting. It may be in the shelter. It may be out of the shelter. We don't have a good way to know that other than to do what we're doing, and I'm hopeful that this will take care of it.
Just one last question just generally, and I hope I'm not stealing Councilman Kelly's question, because he asked it of the Managing Director. But do you think with all the other things going on in the Health Department -- and, again, I'm not trying to rank them, and I know the passion you have for some of these 216 4/7/10 - WHOLE - BILL 100115, etc. things -- is animal control -- should it be in the Health Department or maybe should we all work together to try to find another place to try to do that?
So I will say officially that from a public health point of view, I think the Health Department has tried to be a good home for animal control. It makes a difference on the human side. So if we took animal control out of the Health Department, we would still have human issues, I hope, and rabies is a substantial issue, and rabies control is animal control. So the two are linked in some way. In addition, the Health Department has spent a very large number of hours over the last two years, and particularly in the last year, trying to think carefully about how do we develop, in partnership with the many agencies that care about animals in Philadelphia, a comprehensive plan for animal welfare. 217 4/7/10 - WHOLE - BILL 100115, etc. We've had great participation. We've recently reconstituted that group under the Charter and Councilman Kelly is actually a participant in the group, which is about to have its first official-official meeting. But I'm hopeful that we will be able to create a comprehensive plan for animal control. The issue with animal control at the moment is in part a fiscal one, and having additional millions of dollars in the City budget for animal control would help us get quicker to what is needed, particularly around spay/neuter goals for the City. I'm hopeful that we can find partners, private partners, who will help us achieve that goal.
Okay. I won't belabor the point. Thank you. Thank you, Dr. Schwarz. Thank you, Madam Chair.
Thank you. The Chair recognizes 218 4/7/10 - WHOLE - BILL 100115, etc. Councilwoman Sanchez.
First I want to go on record and thank you so much for all the help that your office has provided as it relates to Aria Hospital and Frankford and your personal attention to the situation in light of all these closures and how important Frankford Hospital is. I know for many folks, when you came over from CHOP, they were probably a little concerned about whether you were going to take care of hospitals, but my hospitals are very happy, so I'm very happy. So I want to thank you, because I think they feel you get it, and that's important in light of what we're going through with healthcare. So I want to go on record and just say I appreciate that. I met with St. Chris the other day and Bernadette also had 219 4/7/10 - WHOLE - BILL 100115, etc. great things to say about you. I wanted to check on our relationship with our federally certified and funded health centers. I know we've talked about it. In some of your PhillyStat discussions, there was discussion about it, and how are we using them in areas, particularly underserved areas, to help us with our overflow at our health centers? Have we strengthened that and how -- can you give me an update?
That's a great, important issue. Everyone who provides safety-net services in Philadelphia has seen an increase in demand, and I would say that most of us, we're part of the official network of all of those health centers. We meet with them on a regular basis. I think we have good relationships with them. I think everyone is strained at the moment, and we have been fortunate we have great leadership in ambulatory 220 4/7/10 - WHOLE - BILL 100115, etc. health here. That leadership and the staff in our ambulatory health centers has bumped up efficiency fairly dramatically, because their budget hasn't gone up, and they've improved service delivery. Some of the other health center sites have had much more difficulty fiscally than we have in that way. So they've had a problem increasing service to the uninsured. And we're committed to being the safety net, so we work with them, we partner with them, we refer to them, they refer to us. We make sure that the hospitals in town who frequently see the uninsured in emergency rooms know not only of the City health centers, but all the other health centers as well. And I am supportive. I cannot even count how many letters and other things of support I've sent in for applications that they've put in to the federal government and to private sources, because if they go down or any of them goes down, just like hospitals in 221 4/7/10 - WHOLE - BILL 100115, etc. Philadelphia, we're in a bad way, and not only from a public health point of view, but from an employment point of view. So we've been very supportive. I hope they would say that.
I want to make sure that, again, for areas that are underfunded, I mean, my district could not get served without some of these providers and they're so important. And I'm aware that Esperanza Health just got a grant through the stimulus and will be setting up shop in Hunting Park, and I want to make sure that we provide them the supports, because, again, they're going to be picking up a lot of our backlog and it's so important.
I wanted to talk a little bit around what Councilwoman Tasco was talking about, our contracting as it relates to small organizations. There's been some cuts in your tobacco funding and I wanted you to 222 4/7/10 - WHOLE - BILL 100115, etc. kind of explain what have been those cuts. And I'm a little concerned about our move from doing some of the youth reduction work that we were doing, particularly the hard-to-serve and hard-to-reach communities, like the Latino community and the gay and lesbian, transgender and bisexual community.
I know what you mean. So we were very concerned when the State budget was finalized this year. You know there was a long period when agencies hung on without cash flow. And when the State budget came out, there was a substantial reduction toward tobacco control, and a large piece of that was taken out of Philadelphia, and it came late. What that meant was, we had been told by the State in the early part of the current fiscal year that we should continue delivering services. Then they didn't fund us. So we had paid agencies for a period of time to continue to deliver services, particularly around 223 4/7/10 - WHOLE - BILL 100115, etc. enforcement, and we didn't have enough money. So we had to suspend some of those services. They, as the agencies all know, will be re-implemented in the current month, actually. So we're going back to that. In addition, in this budget we've been able to identify supports. So we're going to continue doing it, and, in fact, one of the things that is wonderful about the CDC award for tobacco is, we'll actually be able to surround that with all kinds of educational supports that we didn't have before. So, one, for your providers, they should be reassured, and hopefully they are, and, two, I hope they'll feel supported, because in many cases -- and the bodegas and small businesses will feel supported, because one of the other things we're going to do is try to work with them on education in partnership, because a lot of the businesses don't know what a sustainable business model 224 4/7/10 - WHOLE - BILL 100115, etc. would be without selling to youth. We have to help them with that, and we will.
Okay. Just so we've restored -- so what's the difference now between our youth dollars and our adult dollars? Has there been a shift?
Most of the dollars toward youth for inspecting and then enforcement, and we will continue and we'll actually beef up the enforcement side. A number of the agencies from the Latino community in particular have been frustrated that we've not had a strong enforcement piece. We haven't had the money for it. And we've found some money to be able to do that enforcement piece. So I think they'll actually be happier and I believe public health will get better.
Okay. Well, I'm pleased to hear that. I know a lot of that had to do with the State fund, and I just wanted to make sure that 225 4/7/10 - WHOLE - BILL 100115, etc. we were still as committed, particularly around the prevention for young people --
-- since it's such a big issue. I wanted to ask you a little bit as it relates to your provider network in comparison going back to what Tasco was asking. So I just want to be clear on the philosophy, because it's an issue for me. We've moved away to less providers and bigger providers. And I share the concern around some of these harder-to-reach communities where these locally based providers really have their foot in the ground as opposed to the bigger ones, and there's always this debate around administrative costs and it costs us too many to manage. So are you saying that you've moved to more providers or less providers?
I'm embarrassed 226 4/7/10 - WHOLE - BILL 100115, etc. to say I don't know the number. I can tell you -- I'm trying to think where in your neighborhood we've cut back on a provider in the last year. I don't know if there's a particular provider --
No. 12 Obviously from DHS and Health, but a lot of it had to do with the State budget. I just want to make sure that as we move into the next year, we're going back to those funding levels and that folks are reassured.
DHS is different on this one. So I can speak to Health and I can put on a different hat and talk about DHS, but we can wait for the Commissioner.
We'll 227 4/7/10 - WHOLE - BILL 100115, etc. wait for them.
For Health I will say the State budget does not restore funds. So what we've had to do is to piece together, where we can, funds. Where that is a serious issue is around HIV and --
Well, I don't want to make a guarantee there, and the problem is the size of the cut. The size of the reduction in the State budget was huge. We were able to piece together dollars in partnership with the federal government for the end of this year. So we keep everything whole through July. And we're now working with the HIV provider community very actively to figure out how we can fill that in continuing forward, but it is particularly around testing and youth. And I think for the City it is very worrisome the loss of those dollars. We 228 4/7/10 - WHOLE - BILL 100115, etc. don't have good ways to make those up, and it's a substantial -- it's $2 million. It's a lot of money. So we're looking actively. We're happy that CDC dollars for the coming year are more than they were in the last year, so the federal government is helping us, but particularly around testing and minority youth, we have a problem and we need to figure out where to go to get dollars to help, because the State is not going to provide those, at least in full. We're still working, and I'm hopeful that they will come through in some way, but it will need to be a partnership with a lot of partners.
I just want to make sure that when we're making some of those cuts, that we take into consideration when we're making this decision -- and, again, you should never want to choose between young people and adults, but there has to be some sort of commitment that we're going to try to 229 4/7/10 - WHOLE - BILL 100115, etc. keep those youth-directed programs or hard-to-reach communities, because, again, as it relates to HIV, which was going to be my next question, women of color, who are one of the largest growing numbers, that when we're looking at where we take the funding, the big guys can afford a hit. These smaller guys that work at that level cannot.
We completely agree on this. I also think that the populations affected by HIV are often hard to find and it is the small agencies that may be trusted by them. So the sad part and the difficult part about this is, much of the funding around HIV is highly categorical, so it goes to treatment services for X population or testing for this population. We don't have a lot of flexibility to move dollars. The AACO, 230 4/7/10 - WHOLE - BILL 100115, etc. the AIDS Activities Coordinating Office, I think did a magnificent job talking to our funders, helping them be flexible with us so that we could fill in as best we can. We don't have that flexibility at the moment past July 1st. So you're concerned. I'm concerned. We will do our best. I can't guarantee that there won't be cuts, because at the moment based on the budget, there will need to be, but we're going to try our best to figure out a way to minimize those, particularly for communities that are otherwise ones where people are disproportionately affected by HIV and don't have great access to services necessarily.
Thank you, Madam Chair. 231 4/7/10 - WHOLE - BILL 100115, etc. Dr. Schwarz and I spoke beforehand and I spoke with President Verna about the Health Department budget. There are 83 unfilled or newly created positions in the Department of Health, and what I have been doing in each department is going through all of the vacant or unfilled positions. What I would propose to do for the Health Department is sit down with Dr. Schwarz and his team, go through each of those positions, and if I feel the need to put any of that on the record, we will call them back sometime before the end of the budget process. And Dr. Schwarz has graciously agreed to that, and I just wanted to put all of that on the record. Thank you, Madam Chair.
We thank you for your kind consideration. I'm sure Dr. Schwarz does, too. The Chair recognizes Councilwoman Blackwell. (No response.) 232 4/7/10 - WHOLE - BILL 100115, etc.
Thank you, Madam Chair. That means I get Councilman Green's extra minutes. He's yielded them to me.
Thank you. I want to be brief. I will not raise the point that the 4th District does not have a public -- I will not do that this year.
And I will not. But I will cite the fact that last year we talked about the fact that the federal government has clinics in my district and to inform you that one of them has moved from my district to Councilwoman Blackwell's district. So we have now one. And I'm concerned, I'm growing concerned, that the 4th District only has one emergency room in it, and 233 4/7/10 - WHOLE - BILL 100115, etc. that's in Roxborough section of town, and that those kinds of concerns more and more lead me to a solution that I asked you about last year, which is telemedicine. Now, through the insistence of improvements in technology that have proven and borne fruit in other departments, such as the Prisons have utilized technology, teleconferencing and cameras to reduce some of their administrative burden, that it seems to me that technology is a theme that might be applied to your department. Telemedicine and that kind of concept has been used successfully in the private sector. Visiting nurses who moved their headquarters into my district use that on a regular basis to see more senior citizens through teleconferencing than they can ever do with actual visits. So it is something that is not just cute, it is effective. It's proven to reduce costs in other departments. 234 4/7/10 - WHOLE - BILL 100115, etc. I'm asking you again on the Mayor's theme of using technology but also multi-modal buildings. So not just recreation centers, not just libraries, but schools as interchangeable buildings, using them at different times of day for different functions. A mobile teleconferencing unit can come into, let's say, public housing at Abbotsford where there's an open room all the time that could be set up within a matter of hours and more people get access to services. I want to know if we've made any improvement from last year on that concept.
So the district health centers have invested over the last four or five years in a number of telemedicine applications. Probably the largest has to do with radiology. So you may know that we've made a substantial investment and partnership with Council around, for instance, mammography, and our health centers offer mammograms to 235 4/7/10 - WHOLE - BILL 100115, etc. folks. If they can't afford it, they're free. And we would not be able to do that without telemedicine, because we don't hire radiologists, and we beam our mammography images and we beam our x-ray images to a radiology provider who reads them distantly.
Is there a sense of cost reduction if we had to hire that person versus --
It is less expensive for us to do it this way than it would be if we had to hire radiologists at each of our centers. Absolutely.
So following that logic, that there are people who are travel challenged, I'll say, don't like leaving their homes, don't like leaving their immediate communities, that we can get to, deal with some of the problems that Councilwoman Blondell Reynolds Brown has brought up over and over again by getting to them the kind of healthcare, 236 4/7/10 - WHOLE - BILL 100115, etc. and if we just looked at the application of the technology and replicating it in the example that you had, that we could realize those savings over a period of time.
So we look I think with longing at what's possible. There are two issues for us. One is reimbursement. So there's often an initial investment and some recouping. It's unclear based on the current regulations for billing that we could recoup very much around telemedicine. In other parts of the country; for instance, rural areas, there's often a better break-even for telemedicine, because people live sort of clustered in an area, they all use the same provider because there's only one provider for --
It is my understanding, and correct me if I'm wrong -- and I'm sorry for interrupting, but that clock is ticking.
I'm not on the Bill Green time zone. But my understanding is that the federal government has made allowances for telemedicine and those types of visits that allow them to be reimbursable.
It depends on where you are and what kind of visit, unfortunately. So urban telemedicine isn't -- so I'm going to answer the question and maybe I can finish it for you. Urban telemedicine is not quite so lucky as, for instance, rural telemedicine in that way. One of the things that does happen, which you correctly point out, is visiting nurses do a fair amount for heart failure patients, who are often homebound, using telemedicine, and the reason that works is, there are clear measures that have been worked out and there are clear protocols. What we don't want to do is 238 4/7/10 - WHOLE - BILL 100115, etc. what I would call lower-quality care through telemedicine. So what we do with radiology is every bit as good as if we had a radiologist on site.
Dr. Schwarz, my time is up, but I will say this: I agree with you, but some attention is better than no attention.
So as we start to explore this, I want to challenge you with this, that we've gotten significant support for an aging in the new age conference dealing with the issue of aging, dealing with the use of technology to improve that quality of life. Therefore, I want you to be a part of that, along with the visiting nurses, along with some experts nationally that are looking at this issue.
So that next year -- you've made progress, and I'm appreciative of that, but we can make 239 4/7/10 - WHOLE - BILL 100115, etc. substantial leaps of progress if we can codify where we can get those federal reimbursements, and then find a way to minimize your capital outlay to do it. And I'll work with you on that.
Thank you. Dr. Schwarz, according to a recent briefing by Bebashi, Philadelphia's HIV infection is at epidemic proportions. What are the steps being taken to address this issue?
Well, I'd like to say that -- and I think it's true -- that we have one of the finest partnerships between the Health Department and a very rich network of community agencies that address HIV. I don't know that there are any innovations that we're not putting in place. We are a poor city. We have a lot of very poor neighborhoods. That 240 4/7/10 - WHOLE - BILL 100115, etc. means, unfortunately for the HIV epidemic, that we have a lot of people who are at risk for HIV, and in particular, our rates of unidentified infection are very high. As a result, we have invested substantially. We have gone after lots of funds. We have taken State dollars that have come to Philadelphia through the wonderful advocacy of State Senator Vincent Hughes to focus on testing people, going out, identifying and educating and then testing people. And we have made some progress. The problem is, it's those funds which were cut by the State. So I think to date we have done good work. I am very worried about what the work will be like in the future if we are compromised by that funding. So I think we have an epidemic like many urban communities. We have really good partners. We have really good technology. We are using everything from alternative media texting and 241 4/7/10 - WHOLE - BILL 100115, etc. messaging and you name it, things that in my generation I'm afraid were new and different, in order to reach young people and get them to regularly be tested. Once tested, if we can identify them, we have services. That is not the issue. We don't have every service any human being could imagine, but I'm not as worried about the service network as I am about the outreach and testing piece. And particularly for Philadelphia and people's issues around access to care, we need to do better. We're doing testing in the prisons. We're doing testing in emergency rooms. We're doing it in homeless centers. We're doing it on street corners. We're doing it everywhere we can. We need to do more. And I'm afraid in the next year we'll only be able to do less because we won't have the resources. So I'm worried about it. Something that I already mentioned and will mention. I think Bebashi is right 242 4/7/10 - WHOLE - BILL 100115, etc. to raise the issue. I think it is a big concern, what's going to happen if we don't have adequate numbers of dollars for testing.
We can't use any of the Recovery money or any of the money we got from the CDC to --
As you are well aware, the lack of maternity care has been a growing problem in Philadelphia with more and more facilities reducing or closing down maternity operations. What can we do, the City and the Health Department, to address this problem?
We are trying to be innovative. So telemedicine actually comes up in this. We have looked to put together what would be what's called a prenatal care registry. So it's an electronic solution whereby prenatal care providers put information into a 243 4/7/10 - WHOLE - BILL 100115, etc. web-based database, and it allows information about prenatal care to be available wherever a woman goes thereafter for her care, either other prenatal care if she can't get to the same place or, better yet, delivery. Because at the moment, for many women, they go for prenatal care in the community and at the time of delivery, when you most want prenatal information, it's not available because it's a paper record. We have the technology to create this tool. We have the six delivery providers in Philadelphia and several of the delivery providers outside the City willing to participate. We have a lot of the prenatal care providers willing to participate. So I think within the next year, we'll make substantial strides in creating this prenatal care registry. That will help. Two, we have contracts with the large providers, the six hospitals, to 244 4/7/10 - WHOLE - BILL 100115, etc. provide prenatal care services in our health centers. So women can come to our health centers, get prenatal care. And we put out on the street, through many of the partners who are here, information about the availability of that prenatal care. But for some areas of the City, and most notably the Northeast, there's no delivery service in the Northeast and there is no large primary care provider beside our own Health Center 10 that provides prenatal care. So I've been talking to a lot of providers, big providers in the City and some of the small ones, about what are some models we could use to try to create another center or more. And we don't have answers yet, but we're making some progress on that. When we have healthcare reform, this may get a bit easier, but the real issue is capital and liability. Philadelphia has the highest liability costs in the State of Pennsylvania and 245 4/7/10 - WHOLE - BILL 100115, etc. actually some of the highest in the country for malpractice, and that puts a major limit on the viability of new sites, particularly for delivery. So a birthing center, for instance, is something that you and I have talked about in the past. There are huge fiscal constraints because of liability coverage for birthing centers. We're trying to figure out if there's any way to leverage federal protections for that. The City can do something to try to reduce the cost for liability so that it becomes a feasible model for development of a new birthing center.
I think this will be my final question and I'll do it so we can move on. In addition, the lack of maternity care has led to a deficit in care in communities of color. 246 4/7/10 - WHOLE - BILL 100115, etc. Particularly, there are increased rates of infant mortality in minority communities. Again, what are you doing to confront this issue? Are there federal or State or private grant funds that are available to address this issue? If so, how are these funds being used and are these funds being used to track performance and measure outcomes related to the Department's ability to address this issue?
Okay. That's a long question. So let me start with infant mortality rates in Philadelphia, I think I can say, have gone up for some groups and not others. So among the Latino population, for instance, a greater proportion of births in Philadelphia are to Latinos, and infant mortality rates among Latinos have been low. Asians have low infant mortality rates. There has been an increase -- there had been an increase in infant mortality rates in both African Americans 247 4/7/10 - WHOLE - BILL 100115, etc. and Caucasians in Philadelphia. The most recent complete data we have had is for 2007, and we're just about to put out the 2007 vital statistics reports, which summarizes that. It's a new format this year and it will highlight infant mortality changes. Preliminary data for 2008 look like it may be getting a little better, but you still have too high an infant mortality rate in Philadelphia, particularly among African Americans and among Caucasians. And we will be having a conference convened on infant mortality in June, but we get dollars, substantial dollars, from the federal government around infant mortality prevention focused on care, the prenatal care piece, and we do well with that. I think the issues nationally people would say relate to women's health, because the nine months of pregnancy are very important, but it's very difficult to change pregnancy outcomes in those nine months if a woman comes into pregnancy 248 4/7/10 - WHOLE - BILL 100115, etc. unhealthy. It may also be that one of the great risk factors for increased prenatal care -- increased infant mortality in Philadelphia is morbid obesity in women. Yesterday I met with one of the directors of one of the large obstetric units in Philadelphia, who told me that they are replacing all of their gynecology operating room beds because the capacity on those beds is 350 pounds and a substantial proportion of the women who they deliver are over that weight and they are needing to change all of the beds because of that weight. In addition, obese is marked by a body mass index greater than 30, which is a ratio of height and weight. He says that now more than a quarter of his deliveries, pregnant women, have a body mass index greater than 50, twice the body mass index for obese. That is a risk for infant mortality. That is a risk for maternal mortality. What you 249 4/7/10 - WHOLE - BILL 100115, etc. didn't ask me about but particularly worries me is that with the obesity epidemic, obese women are having C sections at incredibly high rates, and maternal mortality is also affected by that. So we need to address obesity. I've said it a lot of times. I'll say it again. This one in particular floored me just to hear his experience. We need to do something about obesity in this city. I actually believe that will have an impact on infant mortality and maternal mortality. And we will be talking as a community in June about what we can do particularly around lifecycle issues for women, so what are ways that we can have healthier women, who then have healthier pregnancies and have healthier children. We're doing a lot around care. We need to do something around life-style and other things I think at this point.
I guess I was going to ask you if there are any 250 4/7/10 - WHOLE - BILL 100115, etc. federal or State funds to help us.
So we already get federal funds for care. There are not large amounts of federal dollars for prevention at this point. I'm hoping there will be, and one of the things that I hope will happen with the June meeting is, we'll begin to get ready for those, so we'll have a plan. We will think about partnerships, so we have lots of other agencies who are ready in partnership, so if they want to apply. There are a bunch of things that government can't apply for, but small agencies can. I want to support them in those applications, particularly for outreach for women's health and so forth. So, yeah. I think there are opportunities. I don't know of six if you asked me right now, but I'm hoping in the future there will be more.
Thank you very much. The Chair recognizes Councilman 251 4/7/10 - WHOLE - BILL 100115, etc. Kelly.
Thank you, Madam Chair. Good afternoon, Doctor, Commissioner Lemmo.
As Councilman Greenlee mentioned, I do have a concern about animal care. Now, I know that there's probably a lot of people in this Chamber, there's probably -- in fact, even a few members of this Council may not think that this is an important issue, that why get involved with animals when you have a lot of other things on your plate. I understand that. I understand the priority that you have. The highest priority you have, of course, is to deliver health service and to make this a healthier city than what it is. That I understand, and I agree with you, as it should be. But on the other hand, I do think there should be somewhere around 252 4/7/10 - WHOLE - BILL 100115, etc. that range some concern about animal care, because if we take care of our animals, we'll take care of our people. And I believe in that intensely. And there's -- I think this is -- I'm passionate about this because I think it's a quality of life issue, and a large segment of our city agrees with me. I know they do. I hear from them all the time. Now, what I would like to do is ask you certain questions that are going to come up, and I'm sure -- I'm hoping that you have the right answers for it. For instance, do you -- well, first of all, going back a couple years ago, I disagreed with you in your selection of a contractor to provide animal care service for Philadelphia. That's water over the dam. I'm not interested in that. Now we're in a different year. But what I would like to know, did you receive any commitment to renew the contract under the current provider, which would be the 253 4/7/10 - WHOLE - BILL 100115, etc. SPCA?
The current -- the RFP that went out and we bid and you've discussed includes renewal, which is what we're negotiating at the moment.
Well, did they send you a letter stating that they are requesting $900,000 additional to continue the service?
We've worked with them both to reduce that number substantially and we're looking for outside supports that can help them with their particular deficit so that we can make it work for them. 254 4/7/10 - WHOLE - BILL 100115, etc.
You gave them a number? Was it more than what's budgeted now?
No. We're working within our budget. As you know, I don't have additional dollars.
Exactly. As what you were mentioning to Councilwoman Tasco, that you can't provide a lot of the services you would like to provide.
I understand that. And I'm looking at that budget and it's the same amount as it was last year.
And it's my understanding that they're not too happy continuing this service with that same level of support. And what happens -- I would like to know if you have a Plan B. 255 4/7/10 - WHOLE - BILL 100115, etc. In other words, if you remember, a few years ago the SPCA did have this contract and they walked out at the last minute, which left us high and dry as far as providing the service and created PACA at the time. In fact, the Board consisted of, I believe, about seven members of the Health Department.
That is correct, and I hope we don't have to go there again, but we're prepared if we need to.
And I agree with you. But I just want to know if there is a Plan B, because that's a very, very good possibility at this point.
Plan B is to do what happened in the past. I don't have another way given the budgetary constraints that the City is under to do anything else.
Well, Plan B is for the City to take over and to run the 256 4/7/10 - WHOLE - BILL 100115, etc. shelter.
The Health Department would take it over again, going back into what it was probably eight, nine years ago?
In other words, it would be another -- you create another organization to take it over or it would be under the City now? It wouldn't be contracted out. It would be under the City. They would be City employees?
I don't know that they would be City employees, but the City would be in charge of the management.
But there isn't any organization ready to take it, as far as I know. You created PACA going 257 4/7/10 - WHOLE - BILL 100115, etc. back nine years ago.
Would you do the same thing again? That's what I'm asking. Could you?
So we -- the City provides a large number of services without creating a non-profit organization. So we don't need to initially -- wouldn't need to initially create a new non-profit. We could provide those services in place fairly quickly if we had to.
What level would you provide these services? In other words, I have a problem with your save rate. You mention somewhere that you have a save rate of 75 percent. How do you come to that save rate?
Is this because an animal is moved out of the Huntingdon Park facility going into SPCA?
We actually 258 4/7/10 - WHOLE - BILL 100115, etc. published on our website and have worked with other members of the animal care community about what the standard should be for a save number, and on the website we show what the save numbers are by month, and as you know, we had a bad summer. So in the summer the save rate went down. That was largely because when PACA left, the facility for spay/neuter at the Hunting Park site went away, and the SPCA installed a new spay/neuter facility there, which is open seven days a week, and since that facility opened, the save rate has gone up consistently. So we were at, for instance, 55 percent in November. We were at 75 percent in February.
Well, let me ask you something. With the animals that were killed in 2009 and 2008, why would there be 3,400 more animals killed in 2009 than 2008 if there was a save rate?
So I absolutely admit that in the first part of 2009, 259 4/7/10 - WHOLE - BILL 100115, etc. one, we had what I would call an epidemic of cats. So the number of cats that were taken into the shelter was at an all-time high, and I can't tell you based on biology why there were so many cats brought in, but I can say there were a very high number of cats brought in. With that, the save rate went down because we didn't have an active spay/neuter facility. We do now, and with that, the save rate has gone up consistently every month since then. And it was a priority for us to get a spray/neuter facility, and the SPCA I think was a good partner in making sure that facility opened and was staffed, and it's now open seven days a week.
Well, I'm glad to see that, and there has been steps taken in that area, which I'm very appreciative over. Councilman Greenlee mentioned something about that Strep zoo outbreak.
Now, who recommended taking that action of closing up the facility, removing all the animals?
Who did they consult? Did they consult anyone other than themselves?
I actually don't know the answer to that. I can ask the person who runs that particular contract, if that would help you. If that's an important piece, I can get you that information.
Yeah. Okay. That's what I would appreciate. I just have questions about the whole attitude of -- and I think Councilman Greenlee brought this up too -- about having the Health Department -- and this is what scares me, that you're going to have the Health Department take over this facility if the SPCA walks away, and I remember years ago 261 4/7/10 - WHOLE - BILL 100115, etc. that's when we had all the problems, and I just don't feel comfortable going through that again. I think we're going to end up with a 90 percent kill rate in the City, and there's no doubt about it if we go into that direction. And I can see in your testimony today you didn't add one line about animal care in this testimony, not one. So I don't think -- I know it's not a high priority, but at least I thought it would be a little priority somewhere along the line. I don't think there's the concern about -- and maybe there shouldn't be in your department, but I think that there has to be some other way that we can do this, and as a member of the advisory board -- which I told you before I'm delighted to be working with you on and I'm looking forward to working with you to get things in the right direction, and I don't think having the Health Department take over the responsibility of this is in the right 262 4/7/10 - WHOLE - BILL 100115, etc. direction. I want to put that on the record right now. So I think what we should be doing is looking at other areas or other organizations, other institutions or whatever that can take over this concern. I really do. And I'm, again, willing to work with you and your department.
You're welcome. The Chair recognizes Councilman Greenlee.
Thank you, Madam President. I just said I would ask these questions when Councilwoman Blackwell had to step out, and there were a couple follow-ups to what I had asked about the health centers. I don't think you specifically answered this. If you did, 263 4/7/10 - WHOLE - BILL 100115, etc. I apologize. How much -- I know you said it has gone up, the wait time has gone up?
So the overall wait time -- as I said to you, it's the waiting time for a new visit or another visit. So the average appointment availability in days in March 2009 was 63 days on average wait for a new patient appointment for an adult and six days for pediatrics. In March of 2010, it was 56 days for an adult and three days for a child, and for a return visit was 13 days in March of 2009 and six days for an adult in 2010 and was two days for a child in 2009 and two days in '10. But as I said, I could give you that, but I don't think it tells the whole picture, 264 4/7/10 - WHOLE - BILL 100115, etc. particularly for Health Center 10, and you and I have talked in these hearings about it, so I want to give you full data. So for 2010, now, as of -- we picked sort of an average month. It's about 266 days. So three-quarters of a year.
And I don't think that's acceptable and you don't think that's acceptable for a new patient visit at Health Center 10. The other health centers are okay. Health Center 10 is the issue.
It is terrible, I agree with you. So what that represents is an increase in the number of patient visits particularly there. So the demand has gone up. No matter how much more 265 4/7/10 - WHOLE - BILL 100115, etc. efficient we are at 10, the demand is huge at Health Center 10, because as Councilwoman Sanchez mentioned, in neighborhoods where there are alternatives, we can work with partners. The Northeast doesn't have alternatives. And so we will be targeting with dollars that are in the budget for '11 Health Center 10 to do our best to improve availability. My fear -- and I will be honest about it -- is that we may never keep up with the demand. The demand in the Northeast because of new people moving in in particular who are uninsured makes it very difficult to keep up with demand.
I mean, that sounds -- I mean, we all agree, 266 days is ridiculous.
That doesn't mean that an acute visit doesn't come in. It doesn't mean that people can't get follow-up care, but what it does do is, it discourages people who are new 266 4/7/10 - WHOLE - BILL 100115, etc. patients from coming to 10, and because of the difficulty right now with space and staffing and everything else, discouraging people from going to and 6 trying to encourage them to go to either 7 other City health centers or other health 8 centers is the best strategy we have. 9
Okay. 10 And the other question she had again as a follow-up was emergency care, if somebody has a real emergency and they go to a health center, can they be seen or is it basically -- are they directed to an emergency room?
It depends on the issue. We have what's called walk-in. So anyone can show up on a given -- people can show up on a given day if they're somebody who is known at least to the health center and receive care. That isn't really emergency care. That's urgent care.
How about a dental issue? 267 4/7/10 - WHOLE - BILL 100115, etc.
So if somebody has been to the health center and they have a dental issue, they can come, yeah. We handle them. We make appointments for them. We get them in if it's something that can be handled there. In many cases they need to go somewhere that has surgical capacity or other things.
You're welcome. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. Good afternoon, gentlemen.
Councilman Goode has already spoken to our continued interest in OEO goals, so I won't use time devoted to that topic, but know that a number of us continue to pay close 268 4/7/10 - WHOLE - BILL 100115, etc. attention to that important issue.
Secondly, let me say what a pleasure it has been to work with your department and you and Kevin and others on the menu labeling. It was heavy lifting for two years, but persistence does have its rewards. So the next heavy lifting issue will be lead poisoning, and you do give some discussion of that in your testimony, but the dollars that you received were principally for childcare centers and foster homes.
So what are the Department's plans to -- are there any plans or opportunities to sustain that particular program after the Recovery Act dollars have been exhausted?
As you know, that is a general problem with Recovery dollars. So they last two years or three years in this case and they go away. 269 4/7/10 - WHOLE - BILL 100115, etc. Dollars for lead work are very hard to come by.
Remember that there are only a selected number of places in the country where lead continues to be a major problem. So that it's not easy to get dollars for lead prevention, and I fear that as state budgets are cut back and ultimately after Recovery goes away and the federal government has to deal with its deficit, we're going to be in a situation where dollars are even going to be harder to come by. At the moment, if a child is lead poisoned, their home is taken care of.
And that is a very important standard for us to maintain, and it is a high priority for this department. I hope never to have the situation where we don't have from some source enough dollars to deal with 270 4/7/10 - WHOLE - BILL 100115, etc. the lead issues in those cases, but that is the floor for lead care. We want to be able to do a broader base of inspection and care, so daycare centers, foster homes and so forth. That's true prevention. And those are the dollars that are hard to come by. So we can address and we will find ways to continue to address children who are poisoned. That's not prevention. That's the issue.
It is the primary prevention which I think should be the state of the art that we can't afford at the moment. And we need to make the case in Harrisburg and we need to make the case in Washington that waiting until a child is poisoned and then doing something about the environment is not the world's greatest investment, but it is far less expensive than trying to impact all of the homes with all children whether the children are poisoned or not. 271 4/7/10 - WHOLE - BILL 100115, etc. So from a limited-dollar perspective, we at least want to make sure that children who have high levels of lead have those levels come down promptly, and the good news is that that number of children continues to decline in Philadelphia.
We'll be working with your department on really continuing the work that Councilwoman Tasco started on this issue years ago, but what I've learned in the short term is that on April 22nd, I believe the federal government -- a new lead bill or new lead law goes into effect April 22nd at the federal level, and the question is, have you thought about professionals in your office looking at the federal law to see how and which there is an overlay for existing efforts within the Department?
We have. I can have our Director of lead come up, if you want or we can -- 272 4/7/10 - WHOLE - BILL 100115, etc.
No. We can wait until the hearing. That will be important, and it will really be a guidepost on how and if we proceed with the bill we've introduced.
Let's move now to a total separate issue, not covered in your testimony, but I'm curious to know. Being a physician, would you -- I want to ask an open-ended question. What would be your perspective on bullying as a public health issue?
So I believe bullying impacts children, and it affects self-esteem. It affects stress levels. It can in some cases for older kids, adolescents, impact the risk of suicide, for instance. So from that point of view, from the outcomes related, it's a public health issue. I believe that the interventions around bullying generally occur in schools, and as such, I think of 273 4/7/10 - WHOLE - BILL 100115, etc. it as an issue that has public health impact, but it's not an issue that's under the portfolio in the Public Health Department. It's under the portfolio in the schools.
That's very helpful in terms of what we're thinking about in my office. To follow up on Councilwoman Tasco's questions around Bebashi and other organizations in the business of attacking that issue, you did mention partnerships. Are there any partnerships with academia; for example, the University of Pennsylvania with John and Dr. Loretta Sweet Jemmott, who have distinguished themselves around prevention and actually outreach in some ways, have they not? Let me say this: They've distinguished themselves in that community. I don't know if it's intervention --
-- or 274 4/7/10 - WHOLE - BILL 100115, etc. outreach or testing. So when you look at the prognosis for next year when it comes to funding for HIV-related programs, are there opportunities there, using the University of Pennsylvania with Dr. Loretta Sweet Jemmott as examples?
So the Jemmotts have developed interventions that can be done to impact on reproductive health by changing behavior. They are interventions that the Centers for Disease Control and a lot of other agencies are looking at as best practices, and I'm hopeful that they will in fact come through and fund us to do some replication with those.
There's a recent publication particularly around abstinence education and there's a long history of work that they've done around general reproductive health education, 275 4/7/10 - WHOLE - BILL 100115, etc. also around violence prevent education, that has been shown to work. And at times, the Centers for Disease Control have highlighted their program and others and given communities an opportunity to choose and put in an application to get funded to do something with those. So I wait to see what that can look like. They're not inexpensive, and for us --
The interventions. So for us to do them and to gear up to do them would take substantial resources. In Philadelphia, we do a fair amount of prevention and information dissemination. One of the biggest pieces of prevention is testing.
And that is the area where, as I highlighted with Councilwoman Tasco, I'm worried.
There's a 276 4/7/10 - WHOLE - BILL 100115, etc. gap.
Excuse me a moment, please. We're going to request a five-minute break for the stenographer.
We're now back in session. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. So on the lead piece, we'll wait to see what the federal government ruling is on April 22nd and then let that be a guidepost going forward with the hearings.
Can you simply give us an update on the dollars recently received from the obesity, tobacco -- help me out.
Yes. Thank you 277 4/7/10 - WHOLE - BILL 100115, etc. for asking. So these are, as I hope everyone realizes, exciting dollars.
This is a national initiative. This is a signature initiative of the President and the First Lady, and this is money that was put aside from the Recovery Act for cities and counties to begin to change the way they're structured and do business to prevent because of infrastructure change tobacco use and obesity by both promoting good foods, discouraging unhealthy food consumption and improving physical activity. So in order to apply for this, they gave us a list of acceptable interventions that were evidence based. We were allowed to pick and choose from that list based on competency and ability we had here in Philadelphia. The good news was of the various interventions on the list, almost a third came from Philadelphia. We are beautifully positioned to do this. 278 4/7/10 - WHOLE - BILL 100115, etc. When we put in our application, we had a strong sense that it was a good application. So we began planning to be in the field immediately when we were awarded, because the CDC specified since it's Recovery dollars, that you have 30 days from the day of funding to be ready to go, and for the City of Philadelphia to be ready to go in 30 days was not realistic. So we started the day the application went in, and we're up and running.