Committee Hearing, March 4, 2002

1248 COUNCIL OF THE CITY OF PHILADELPHIA PUBLIC HEARING BEFORE THE COMMITTEE OF THE WHOLE - - - Monday, March 4, 2002 9:44 a.m. Room 400, City Hall Philadelphia, PA - - - CONTINUED FY03 OPERATING BUDGET TESTIMONY/BILL 020001 PRESENT: COUNCIL PRESIDENT ANNA C. VERNA, Chair COUNCILWOMAN JANNIE L. BLACKWELL COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN DARRELL L. CLARKE COUNCILMAN FRANK J. DICICCO COUNCILMAN JAMES F. KENNEY COUNCILMAN W. THACHER LONGSTRETH COUNCILWOMAN DONNA REED MILLER COUNCILMAN MICHAEL A. NUTTER COUNCILMAN BRIAN J. O'NEILL COUNCILMAN ANGEL L. ORTIZ COUNCILMAN FRANK RIZZO COUNCILWOMAN MARIAN B. TASCO - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 1249 3/4/02 COMMITTEE OF THE WHOLE INDEX (CONT'D FY '03 OPERATING BUDGET TESTIMONY/BILL 020001) WITNESS HEALTH DEPARTMENT John Domzalski, Commissioner.............. ..... 1250 Michael Covone, Deputy Commissioner............. 1263 Ellen Steiker, Deputy Managing Director......... 1300 Estelle Richman, City Managing Director......... 1370 Richard Tobin, Lead Poisoning Prevention........ 1396 D. Roebuck, Maternal & Childhood Health Program 1399 M. Bencivengo, Behavioral Services.............. 1407 J. Cronauer, Philadelphia AIDS Office........... 1413 PHILADELPHIA SAFE AND SOUND Naomi Post, President/CEO....................... 1417 DHS Alba Martinez, Commissioner..................... 1512 David Fair...................................... 1534 Wanda Mial...................................... 1547 Rob Hess (OESS)................................. 1577 OESS Rob Hess....................................... 1590 PUBLIC PROPERTY Andres Perez, Commissioner..................... 1604 Estelle Richman................................ 1617 Rob Dubow....................................... 1618 Joseph James.................................... 1619 Chris Zearfoff (Transportation)................. 1620 Vincent Costello................................ 1621 FLEET MANAGEMENT Riley Harrison.................................. 1657 - - - 1250 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

This is the continued public hearing of the Committee of the Whole regarding Bill 020001. The first department to testify today is the Health Department. Would you please approach the table. (Witnesses come forward.)

Good morning. COMMISSIONER DOMZALSKI: Good morning, President Verna.

Please identify yourself for the record and proceed with your testimony. COMMISSIONER DOMZALSKI: Certainly. President Verna, I'm John Domzalski, and that's D-O-M-Z-A-L-S-K-I. I'm Commissioner of the Department of Public Health.

Please proceed. COMMISSIONER DOMZALSKI: Thank you. Good morning, President Verna, and thank you for the opportunity to be here and present the Department of Public Health's operating budget for FY '03. Accompanying me this morning is Deputy Commissioner Michael Covone, who will, after my 1251 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET testimony, talk about the Behavioral Health System. million in the Grants Fund, and $618 million in the HealthChoices Behavioral Health Revenue Fund. million in FY '02. Looking at an overview of the Department, Mayor Street has made quality, comprehensive, coordinated, employee-integrated social services for children, adults, and families a high priority in his administration, and the Health Department administers a wide range of programs that provide quality social services in meeting that goal for Philadelphians. These programs include primary care at eight neighborhood health centers, monitoring and control of communicable diseases such as tuberculosis, a specialty clinic for the treatment of sexually-transmissible diseases, and a coordination and funding and oversight of HIV/AIDS programs. 1252 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Investments over the recent years and an infrastructure to support program development and service delivery have borne measurable results. For example, there has been a continued decline in infant mortality and in the prevalence of elevated blood levels in young children. There's been an increase in the number of pregnant women receiving prenatal care. Our commitment to the health care safety net remains strong. I will focus today on some key areas of our accomplishments and challenges. With regard to public health emergency response, the events the September 11th and the following anthrax scare placed a sharper focus on the public-health aspects of emergency management. Emergency situations involving real or suspected agents of bioterrorism require that the Department of Health serve as the lead agency. In mid-October 2001, there was an unprecedented number of urgent requests from citizens for assistance with mail suspected of anthrax contamination. In response, the Health, Fire, and Police Departments formed a system of rapid-assessment teams. Since October 14, 2001, 1253 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET these teams have responded to 1,263 requests. Fortunately, no evidence of contamination was found. This national event demonstrated that local governments must prepared to mount the initial response to threatened or actual bioterrorism events, as well as the critical importance of partners such as hospitals, other health-care agencies, and traditional emergency- response agencies. Moreover, that event made clear that effective response to such occurrences requires a significant enhancement to the public health infrastructure, including surveillance systems, laboratory capacity, communications systems, and personnel. Just as clear is that such enhancements are beyond the financial capacity of local government. This fact is recognized in the current federal budget, which provides substantial increases for infrastructure investment. It is expected that Pennsylvania will receive $37 million of this funding. At this time, we do not know what the City share will be. However, we are working aggressively to ensure that we secure sufficient funding from that source to meet our emergency response needs. 1254 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET In considering services benefitting mothers and children, the issue of lead poisoning is prominent. Q. as well as brain and central nervous system damage and even death; however, lead poisoning is also completely preventable. The prevention and control of lead poisoning is a community-wide effort requiring the assistance of medical-care providers, community and advocacy groups.

The efforts of these groups combined with are own are responsible for our current and future progress in protecting our children. In FY '95, we had approximately 3,000 newly identified children in Philadelphia with confirmed elevated blood lead levels; as a result of a variety of prevention activities, we expect fewer than 800 in FY '03. This is 800 too many, but is still a significant improvement. Another key indicator of child health and disease prevention is childhood immunization rates. After showing a steady upward trend in immunization rates to a high of 82 percent of 2-year-olds, Philadelphia has experienced decrease of 1255 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET approximately percent. Factors that may be contributing are the increase in the number of vaccines given to infants and the fact that the vaccines are now all injectable, so parents and doctors may be reluctant children up to five injections per visit. Nationally this issue is being addressed through an enhanced effort to develop combination vaccines. Locally, we are working with the American Academy of Pediatrics and other groups who educate health-care providers about the safety of administering multiple vaccines simultaneously. in calendar year '99, the latest year for which official data are available. 8 percent during the same period. While public education and outreach have been successful in bringing about these improvements, we must continue to step up our efforts to reduce these statistics, which lag behind national levels. Two programs which have the highest likelihood of reducing these statistics are the Nurse Family Partnership Program, also known as the David Olds Model, and Healthy Start. The Nurse Family Partnership Program is a nationally-recognized intensive home-visiting program for first-time mothers in areas of the City with high incidence of infant mortality, child neglect, and abuse. This program was launched in FY '02 in conjunction with the Department of Human Services and is projected to serve 400 pregnant women. The program is designed to improve pregnancy outcomes, child health development, and family economic self-sufficiency. The Health Department is also working to combat the rise of sexually-transmissible disease in adolescents. From 1995 to 2000, reported cases of chlamydia increased 68 percent. Overall, young 1257 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET adults aged to years represent 71 percent of 3 total cases. We are collaborating with the Family 4 Planning Council, the Recreation Department, 5 Philadelphia Safe and Sound, and the School District 6 of Philadelphia to increase screening of youth for 7 chlamydia. 8 With regard to HIV/AIDS services, the 9 number of newly reported cases of AIDS in Philadelphia increased from 1,039 cases in FY '00 to 1,137 cases in FY '01. AIDS continues to disproportionately affect minority communities, with 78 percent of those living with AIDS in FY '01 being persons of color. 7 million in City tax-supported 18 funds. 2 million in Ryan White 22 dollars. 23 The Department continues to target its 24 efforts to reducing health disparities among minority populations. One important activity is the 1258 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Ryan White Congressional Black Caucus-funded storefront initiative. This initiative, which began two years ago, targets African-American and Latino communities that are most heavily impacted by the epidemic. There are three sites in Philadelphia; these are in Germantown, West Philadelphia, and in Kensington. The storefronts are street-level, open-access service sites geared to walk-in traffic. These storefronts provide a safe place located directly in the affected community with where people at risk of HIV infection and those who they're HIV status but are not engaged in medical care can receive primary care and other related support services in a non-threatening environment.

With regard to our health centers, they continue to provide a major contribution to the Department's capacity to deliver public-health services throughout the City. These centers are the logical nexus with their communities for attacking neighborhood public-health problems. The health centers provide a range of services such as primary care for children and adults, prenatal care, family planning, and dental services. 1259 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET In order to provide greater access to health care for families throughout the City, each health center is open in the evening one day a week, and one center holds half-day Saturday clinic. In addition to expanded hours, all centers offer supervised child-play areas. In FY '02, the health centers are projected to provide care to 91,500 individuals, who will make 328,000 to the centers, of which of 64 percent will be uninsured. We are projecting similar numbers for FY '03. 1 million in FY '03. 6 million in FY '03. 8 million in FY '03, a 31 percent increase over the five-year period. 5 million is in the General Fund and $5 million in Grants Revenue. Services range from overseeing manufacturing facilities to protect their quality, to conducting food service sanitation programs in relation to the over 14,000 retail food establishments that must be inspected by the Department. Our air-management services, in addition to its regulatory function, has adopted a plan to assist Philadelphia manufacturing businesses and others that must obtain operating permits under the Clean Air Act. This year, we provided workshops for environmental managers from 73 companies. The workshops provide information geared towards simplifying the permit process, resulting in lower cost to the industry, and increased and more timely compliance. In the past three years, West Nile Virus has appeared in the eastern United States, including Pennsylvania. In FY '01, 11 people in the Pennsylvania-New Jersey area were infected with the mosquito-borne virus, including two in Philadelphia. Our Environmental Health Services Program has acted to combat this disease by eliminating mosquito 1261 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET breeding. During the summer of 2001, we treated over 70,00 inlets with larvacide. We also treated other prime mosquito-breeding areas and have deployed light traps at sites throughout the City 6 in order to monitor mosquito activity. 7 In addition, this past October, the 8 Department was awarded a one-year $250,000 grant 9 from the Centers for Disease Control to develop an 10 innovative rodent-control model for implementation 11 in urban neighborhoods. 12 Turning to animal control, FY '03 will 13 mark the end of a two-decades-old relationship with 14 the Pennsylvania SPCA for the provision of animal 15 control services in the City. Like other SPCAs 16 around the country, our SPCA will no longer 17 euthenize animals. To continue this service, the 18 City is negotiating a lease for a facility at 111 19 West Hunting Park that, when renovated, will have 20 the capacity to handle over 40,000 animals each 21 year. 15 million. Looking at our nursing home, we continue to contract with Episcopal Long-Term Care to operate the Philadelphia Nursing Home, a skilled-nursing facility, for our most needy Philadelphians. 3 million to maintain the current census at approximately 95 percent of its available beds. The quality of care continues to be rated as high as evidenced by the latest annual survey, which occurred this fall 2001, which was deficiency-free. Concluding, the Health Department is continuing to move forward in integrating and coordinating services with our fellow agencies. For example, the Health Intervention Program for Families is a collaborative program with the Department of Human Services to provide home- visiting services to families whose psycho-social problems put their children at risk of poor health outcomes.

In this service-integrated structure, the Health Department makes a significant contribution toward the quality of life and well-being of Philadelphia's children, adults, and families. 1263 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET While we do face continued challenges, we're optimistic and we're enthusiastic about meeting the challenges and seizing the opportunities that lie ahead. Thank you for the opportunity to give testimony today. I will now turn to my colleague Deputy Commissioner Michael Covone

Thank you, Mr. Covone.

Good morning, President Verna and members of Council. My name is Michael Covone, Deputy Commissioner, and I'm here to present testimony on the Behavioral Health System/Mental Retardation Services component of the Health Department budget. I will present a brief overview of the fully testimony which you have in front of you. 8 million in Grants Revenue Fund; and $618 million in the HealthChoices Behavioral Health Revenue Fund. The BHSMRS FY '03 budget will support 297 1264 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET positions: 72 positions in the General Fund and 225 positions in the Grants Revenue Fund. The Behavioral Health System consists of three major components that coordinates the City's treatment services for approximately 100,000 adults and children annually. These three components are the Coordinating Office of Drug and Alcohol Abuse, the Office of Mental Health, and the Community Behavioral Health. Mental Retardation Services is the office responsible for the development and coordination and monitoring of services for children and adults with mental retardation. Over the last year, the Behavioral Health and Mental Retardation Services components, under the Director of Social Services, has operationalized a variety of collaborative initiatives with its sister social-services agencies in order to improve the effectiveness and efficiency of services. Examples of these initiatives include the continued expansion of its Criminal Justice Treatment Initiatives, available to offenders with substance abuse and mental illness. Principal among the goals of these initiatives is the focus on assisting the courts and prisons in reducing prison 1265 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET overcrowding through early parole and direct diversion to treatment in lieu of incarceration. In FY '03, approximately 2200 clients will be admitted to treatment through these initiatives. Over the last two years, the Department of Human Services and Behavioral Health System have focused on coordinating the management of cases involving intensive behavioral-health services for youth. As a result, the Behavioral Health System has seen increased and more timely access to inpatient care and more timely discharge to appropriate community-based care from residential treatment facilities. This has been demonstrated by a decrease in the average monthly census in residential treatment facilities from 800 beds in FY '01 to a current census of 650 as of January '02. The accomplishments noted above represent a first step in establishing a system that is both responsive to consumer and family needs and accountable to our various funding sources and the citizens of Philadelphia. In order to further our mission, Behavioral Health and Mental Retardation Services will undertake additional initiatives during Fiscal Year '03, including the continued 1266 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET development and implementation of performance-based contracting for the delivery of mental-health, substance-abuse, and mental retardation services. The development of a model of integrated case management services. The key objective of the case-management system is to assure that the delivery of these services is provided in a manner coordinated across the various social-service departments in a manner supportive to families and individuals. BHS and MRS will also continue its collaborative activities with DHS in order to assure that children with behavioral-health needs or mental retardation who are the responsibility of DHS receive timely, coordinated services in the most appropriate setting. In closing, Behavioral Health and Retardation Services will maintain its ongoing efforts to improve accountability and assure the delivery of quality services. Thank you for the opportunity to provide testimony this morning.

Thank you very much. Mr. Domzalski, can you explain what type 1267 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET of services and frequency are provided by the Nurse Family Partnership Program? COMMISSIONER DOMZALSKI: Yes, President Verna. The Nurse Family Partnership Program, the David Olds Model, is focused on aggressively and comprehensively dealing with the constellation of factors that impinge on a family, pregnant women, as well as young children and that result in outcomes ranging from infant mortality to other poor health outcomes. It's intensive nurse visiting, where the families are visited in their homes, and the focus is on, one, you know, the mother understanding the importance of early and timely prenatal care, that referrals can be made to other social-support agencies such as housing or heat, LIHEAP, other programs such as that that might help the mother cope better with those situations. There's an ability to bring in other referral sources such as substance-abuse counselors, as the case may be. And importantly, we're also keying on the Nurse Family Partnership to go into those homes and actually do some testing for lead early on so that we can understand whether or not the child, once the 1268 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET child's delivered, might be coming home to a leaded environment, and we can give the right kind of education to the mother in that context.

Thank you. What is the current average wait for an appointment at a health center? COMMISSIONER DOMZALSKI: President Verna, the current average is a moving one, and it ranges from as long as four or five weeks in our most heavily impacted center to as few as several days in one or more of our other centers. And this is one of the issues that we are going to be addressing this year in terms of dealing with the issue where if someone calls for a health center appointment and they call the center that's got a tremendous influx of patients and they're told, Well, gee, we can't see you for three or four weeks, there may be at that very time in the system another center that can see you maybe in a couple of days, and so we'd like to centralize that process and be able to at least make the overture to the patient that even though it might not be the center that you originally called about, we might still, if that's to your liking, be able to see you in another 1269 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET one of our facilities.

And that process will take effect almost immediately? COMMISSIONER DOMZALSKI: We're doing that now, looking at that from our appointment systems to our phone systems.

And what happens to their medical records; do they have to pick up their medical records when go to another district office? COMMISSIONER DOMZALSKI: Yeah, these, President Verna, would be new patients calling for a new appointment. We don't have that kind of a wait for a patient if the physician is seeing a patient now, and says, you know, I'd like to see you back in about three or four days. We can always accommodate that so there's no need to transfer records. And in the former case, she'd begin her care at the new center.

What districts are the busiest, where you would have to wait four or five weeks? COMMISSIONER DOMZALSKI: Well, the longest wait is for adult patients -- 1270 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Mr. Domzalski, excuse me. COMMISSIONER DOMZALSKI: And that's --

Excuse me, excuse me. We have some competition with the noise outside the building, so if you could pull the mic closer to you, it would be helpful. COMMISSIONER DOMZALSKI: Certainly, I'm sorry. Certainly. Yes, our center with the longest wait for appointments is for adult appointments, and that is our Health Center 6, which is presently 52 days. The shortest wait for adults is Health Center 2 at Broad and Morris, and that's two days for a new adult appoint. And so we have this disparity that we're hoping to iron out here so that we can make our services not only good but readily available.

You mentioned the escalating cost of pharmaceuticals and how you were trying to control these costs. What is the Medicaid Best Price Program? And what are the eligibility requirements and what are the assumptions in the out-years of the plan for 1271 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET pharmacy services? COMMISSIONER DOMZALSKI: The Medicaid Best Price Plan is a purchasing arrangement, President Verna, that permits us to purchase pharmaceuticals at the most competitive rate of any purchaser of drugs in the system; in even huge systems, we get at least that price and sometimes we do better. In terms of what we see in the outgoing years with the kind of increase that we've seen going from FY '95 from $4 million in expenditures in pharmacy services to our projected $8 million. That trend line continues upward.

Will the City be operating the Animal Control Program, or will that be done through a contract? COMMISSIONER DOMZALSKI: It will be done through a contract.

And when will that be done? COMMISSIONER DOMZALSKI: We will begin services on July of this year.

Do we have any indication as to who you will be contracting with? 1272 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: Yes.

And how much it will be costing? COMMISSIONER DOMZALSKI: Yes, we do. Our operating costs are going to be in the neighborhood of $2 million a year, and those costs will be defrayed by the efficiencies that we will experience by collocating our Vector Control Program, which is now in rental space, which is our Rat Control Program, essentially, and the economy that will result from our not having the SPCA contract. And so those two factors brought together will bring our total operating costs down to $1.15 million.

Can you tell us if CBH has renewed its contract with the State? COMMISSIONER DOMZALSKI: Yeah, I'll turn to Mr. Covone, President Verna.

CBH is currently operating under an amendment at this point in time for the January 1st period. The Law Department is in the process of finalizing the contractual negotiations. We were successful in negotiating a rate for fiscal year -- or calendar year 2002, which we believe is appropriate to continue the program. 1273 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Will CBH be coming to Council for a multi-year contract with the State, or are you entering into a series of one-year contracts?

CBH will be coming to Council whether the final results of the negotiation are either a single-year or a multi-year contract. So we are planning to bring either contract to Council.

And when do you anticipate that will happen?

We are hoping by the end of the month to have the ordinance information to Council.

Thank you. I have a number of other questions, but I see there are many other Councilmembers that want to ask questions. On the first go-around, each Councilmember will have ten minutes for questioning. The Chair recognizes Councilman Nutter.

Thank you, Madam President. Generous today. Thank you. Good morning, Commissioner Domzalski and congratulations to you. 1274 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: Good morning, Councilman. Thank you very much.

Let me ask about -- I heard you, I think, as a part of your testimony talk about immunizations and the rate of immunization, I guess, that we had experienced in the past in terms of the number of children immunized. Could you give me those numbers again, please. COMMISSIONER DOMZALSKI: Yes. For the past several years, we were experiencing an increase in the percent of children who were covered -- that is, immunized -- in Philadelphia, and that reached a high of 82 percent. Our current projection is is that number will drop by about 5 percent due to a number of factors that come out and come to play in relation to the visits that the caretaker apparent and the pediatrician have and the number, sheer numbers, of shots that a child might be eligible for and the fact that, in fact, they are now all shots.

As opposed to what? COMMISSIONER DOMZALSKI: For example, with polio, it used to be an oral administration, and now it's injectable. 1275 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Okay. So I understand that there may be more shots. Why is our immunization rate decreasing by percent? 5 COMMISSIONER DOMZALSKI: Again, we're looking at -- we don't know for sure, but the usual suspects are these, and they've been experienced in other cities, and that is, one, the parents' reluctance to subject a child to as many as five immunizations at a single visit, and also, oddly enough, the practitioner is reluctant to --

Well, is there a requirement that they have all five at one time? Can't you spread them out over some series of months? COMMISSIONER DOMZALSKI: Well, the immunization schedule works better if it's adhered to --

Right. COMMISSIONER DOMZALSKI: -- one month of age, two months of age.

Right. COMMISSIONER DOMZALSKI: The other piece of it is the difficulty for, you know, the family to get the child bank at frequent intervals. So it's 1276 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET best to be able to take advantage of that immunization opportunity when it presents itself.

Right. Well, let me ask this question then: What can we do, what do we need to do? Is there a public education campaign and a sharing of -- I mean, look -- COMMISSIONER DOMZALSKI: There is, Councilman.

It is no fun sitting there watching your child get stuck five times. I mean, my daughter has gone through, I think, the full immunization schedule, but I know she got something just a couple months ago and she just turned 7. It seems, though, at times, it's probably slightly more painful for the parents than it is for the kids. COMMISSIONER DOMZALSKI: I think at least as much. There are two things that can be done. Certainly, education of the practitioners, the pediatric practitioners, in the community that it is okay to do these five shots. The other piece is to make the whole process more user-friendly, and that 1277 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET effort involves the efforts of the CDC and the American Academy of Pediatrics and other health agencies to try to get manufacturers to develop more combination vaccines.

Right. Now, even at the 82 percent, I mean, is that from your perspective, and I understand you're -- you can't change the world in two months. Is 82 percent an acceptable level? COMMISSIONER DOMZALSKI: The goal is 100 percent.

I understand. COMMISSIONER DOMZALSKI: A hundred percent. And I look at that in the context of what it was in 1991, where in some neighborhoods of the City, we had immunization rates as low as percent. And so that's an improvement. 19

Absolutely. 20 COMMISSIONER DOMZALSKI: The 82 percent 21 is definitely an improvement. And it tracks other 22 cities, although some cities such as Boston did 23 achieve a rate of 90 percent at about the same time 24 we were hitting 82. 25 But the acceptable and the goal is really 1278 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET 100 percent.

Well, what happens to the other percent? 5 COMMISSIONER DOMZALSKI: There are 6 children out there that we know are not immunized, 7 that we have a system where we know that they're not 8 immunized because we have an immunization tracking 9 system, that the information in that database is 10 compiled. And so we know when a child has missed an 11 immunization requirement, and we'll work with the 12 private practitioner. The system is powerful enough 13 that we're able to generate call-back letters on the 14 physician's own stationary to alert the family to 15 come back. 16 When that doesn't work, we make home 17 visits and try to get the children in and try to 18 make our services available. I think one of the pieces also has to do with the fact that we've got to look at when we are providing the services and whether or not our services are being provided at the time when it's most convenient for us or whether we need to make our services available when it's convenient for the people who need them. 1279 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Okay, I'm going to want to talk about that more. In the same area with children -- and if I missed this in your testimony, I apologize. Talk to me about the efforts by the Health Department and other parts of government with regard to the issue of lead paint and lead paint abatement and the impact of lead paint on children. COMMISSIONER DOMZALSKI: Certainly. I'd just like to take at a step back and talk about that. The issue of lead paint has to do with that -- once a child ingests a lead-contaminated substance -- and in most cases these days, it is contaminated lead dust, household lead dust -- the child is at risk of not only brain damage, but permanent brain damage and impairment in the child's cognitive ability. And we focus on the child between the ages of 0 and 5. What happens is when a child gets screened by a health-care provider, a blood sample is taken and analyzed for the presence of lead. If it comes back as elevated lead, then we will go out and make a home visit and try to understand the source of that lead contamination. 1280 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET In the overwhelming majority of instances, that lead contamination is coming from the houses that the children live in; it is the houses that are making these children sick. And what needs to happen is that interventions need to occur in these houses, ranging from education to full-scale process, which we refer to as "abatement."

How many kids did the Department serve last year, or how many visits did you make? And how many children do you estimate have lead poisoning or have had lead-related contact? COMMISSIONER DOMZALSKI: Well, the -- the medical-care people never make it easy, and it varies. And going from the action level, which is micrograms per deciliter of blood once, or 2 19 readings over 15, we'd be talking probably about as 20 many as maybe 5,000 children in the City in that area. When you get down a little bit lower, that number would go up. The number we focus on are those children that we know are residing in houses that are awaiting lead paint abatement. 1281 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

How many houses do you think that represents in the City? COMMISSIONER DOMZALSKI: That figure is 1400.

So 1400 homes that you're aware of -- COMMISSIONER DOMZALSKI: That's correct.

-- have -- what do you call it? Lead... COMMISSIONER DOMZALSKI: Lead contamination.

Lead contamination. And how do you know about these 1400 homes? COMMISSIONER DOMZALSKI: We made home visits. First of all, we were alerted by an elevated blood level in the child, which a practitioner obtained. It was reported to us because lead poisoning is a reportable event in Philadelphia. And so we went out and made that home visit, looked at the house, determined that there was lead paint in that -- lead contamination in the house, and we became aware of it in that fashion.

So let's go back to the earlier conversation. We know that there 1282 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET apparently is some number of children who are not adhering to an immunization schedule because we've already determined that at least percent, if not 5 now 23 percent, of the population are not adhering 6 to an immunization schedule. 7 COMMISSIONER DOMZALSKI: Correct. 8

Is it correct to then 9 assume that some high proportion of those children 10 are also probably just not seeing a physician on a 11 regular basis and probably have not been tested for 12 lead and, therefore, there's a population of 13 children who have lead poisoning that we don't even 14 know about and concurrently homes that we have not 15 inspected? 16 COMMISSIONER DOMZALSKI: That's correct, 17 that's correct. 18

Do you have any way of estimating what that population is? COMMISSIONER DOMZALSKI: Yes. When you look at the distribution of lead-contaminated houses in which children are residing Philadelphia, and if you look at a map of the City of Philadelphia and you look straight up and begin at the northern edge of the City and then come down and make a brief stop 1283 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET at Center City and then make a hard right, if you're coming from north to south, you will then end up in West Philadelphia. So it's kind of like a J.

Right. COMMISSIONER DOMZALSKI: That is the lead J of Philadelphia, all right? And we know, for example, that -- we believe we're getting a good immunization screening done in that area because the practitioners are sensitized to it, the community groups are sensitized to it, the advocacy groups are sensitized to it, and we think we're getting good coverage there. So does that mean everyone is screened? Absolutely not. We know -- for example, we do about 40,000 lead screens a year, and in the age group we're talking about, that could be anywhere from between, I guess, maybe as many as 40,000 additional kids that we may need to be looking at, but they're in all parts of the City. We know in that lead J that there are approximately 10,500 children born every year, so that's where we concentrate our screening activity.

All right. 1284 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Commissioner, I believe my time is up, but I will return to these two topics as well as others. Thank you for the information. COMMISSIONER DOMZALSKI: You're welcome.

Thank you. The Chair recognizes Councilman Kenney.

Thank you, Madam President. Commissioner, I just want to move back to the Animal Control Program again. Are you accepting responses to an RFP at this point? COMMISSIONER DOMZALSKI: No, we are not, we're not. We're well, at this point, beyond that process. We would have welcomed enough interest in the community to have been able to done an RFP. This is, as you know, a very specialized service, and we went out and looked at people that we might encourage to come in and help us do this service. We were met with zero interest in some cases, and the level of interest in others was not such that we were comfortable in being able to proceed in that fashion. So we decided to pick it up as we are now doing it.

What are we doing? 1285 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: We are renovating a --

No, as far as who's going to operate it. Who's going to pick up the animals, do the service calls? COMMISSIONER DOMZALSKI: We've created a division, a nonprofit division, in our unit that will be called the "Philadelphia Animal Control Agency," and it will employ the people that will -- that are skilled, and in fact, a lot of them will be coming over from the current SPCA function, which will be done away with. And they'll be employed in the organization.

So will they be City employees that will be working for the nonprofit? COMMISSIONER DOMZALSKI: They'll be working for the nonprofit, they'll be contract employees.

Contract employees. COMMISSIONER DOMZALSKI: Yes, sir.

And most of the current SPCA employees will be coming over to do that? COMMISSIONER DOMZALSKI: Yeah, almost 1286 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET all, all that were associated with the Animal Control.

How many people are there? COMMISSIONER DOMZALSKI: 40.

And we'll be hiring more people? COMMISSIONER DOMZALSKI: That will be the number. We will not be expending it beyond that.

So even though there's a contract, it's not a contract with an outside vendor; it's almost a hybrid kind of -- COMMISSIONER DOMZALSKI: No, it's not an outside vendor, no, sir.

Okay. Let's move a moment to your testimony on the nursing home. It says for FY '03, we are requesting an appropriation of $37.1 million with a City subsidy of 3.3. Could you explain what that means? COMMISSIONER DOMZALSKI: Certainly. When we outsourced the nursing home in 1994, and just prior to that time, the City -- it was costing the City just a little under $9 million to operate that facility at an occupancy of 255 residents. We 1287 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET wanted to improve the fiscal situation but also improve the care. And we also, though, wanted to keep the facility open to the most needy Philadelphians, which, in our parlance, translates into those individuals who require the most heavy amounts of care. And to do this, we knew there needed to be a subsidy. So we pay the $3.3 million subsidy to the operator of the nursing home, and essentially that's all of the City's costs. The rest of the cost is borne by third-party reimbursement.

So that's the $37.1 million appropriation. COMMISSIONER DOMZALSKI: Yes, sir.

It's advanced based on -- COMMISSIONER DOMZALSKI: Well, that's our spending authority.

And then we wait for -- how does it work? COMMISSIONER DOMZALSKI: The way it works is that when a resident is admitted to the home, we obtain third-party reimbursement for those days. 1288 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET It's overwhelmingly medical assistance. There is some Medicare. And then we bill the operator of the home bills for those days. And since the City is the license-holder, that money comes to the City and then we disburse it to the operator.

And the shortfall's 3.3. COMMISSIONER DOMZALSKI: Yes, sir.

Okay, thank you. Thank you, Madam President.

You're welcome. The Chair recognizes Councilwoman Tasco. I believe that Councilwoman Blackwell and Councilman Rizzo are yielding.

Yes, and I want to thank both of my colleagues for allowing me to ask these questions at this time. I may have to leave the Council chambers on some business. I want to go back to the lead program. What is the policy on abatement of houses pre-sale? I know there was some discussion of rules and regulations regarding the abatement of lead in houses prior to sale. 1289 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: Yeah. There's a disclosure requirement that if a house contains lead paint, it must be disclosed to the purchaser, and the obligation is to have that premise abated before the transaction takes place.

Is this being enforced? COMMISSIONER DOMZALSKI: Yes. And I think there are some instances when it isn't, but by and large, when people get that notice, they understand it these days, and are either going to ask the owner of the house to abate the premises, or they're going to say, Look, since I'm going to have to have this abated, I need a consideration in the purchase price so I can have it done. And then these houses are -- we become aware of them and then we go out and clear them to make sure that they have been abated properly.

What's the responsibility of a landlord to lead abatement in houses or apartments they may rent? COMMISSIONER DOMZALSKI: To abate that condition, to abate that condition. We issue orders to that effect. 1290 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Because you mentioned the high incidence in West Philadelphia in the J corridor. I heard West Philly and probably another area. And so some of these houses may have been inhabited for a long period of time by a family. So what happens to them? Is there an inspection process by the City to see that these homes are abated? COMMISSIONER DOMZALSKI: There is, there is. And when we find the order that has not been complied with, that property then finds its way onto our list; that's what -- part of those 1400 houses -- in fact, almost half of them are in tenant-occupied dwellings.

But in the meantime, they're on the list, so what happens? COMMISSIONER DOMZALSKI: To the child?

Yes. If they're on the list and -- if they're on the list of houses to be abated -- COMMISSIONER DOMZALSKI: Yes.

-- is there a time period for the landlord to abate the property? COMMISSIONER DOMZALSKI: It's 1291 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET immediately. The issue is at this point that it isn't being complied with with the speed that the condition requires. And we're ramping up that function to make sure that we get with those landlords and in a way that doesn't impair their interests to continue to rent to children, but to make sure that they understand that responsibility, and together with the Law Department to, you know, take the necessary legal action to make that happen.

What can you do to force them to -- or encourage or -- well, enforce really, because encouragement is not working. What about forcing them? COMMISSIONER DOMZALSKI: One of the things -- I mean, what you do is, you end up with, you know, an order from the court that's either complied with or isn't, and then there's that whole process. What needs to happen is that these properties need to be abated. And everything that -- and in order to do this, we need a whole new strategy for looking at this. The way we have looked at this in the past has been good, appropriate, but it's been slow 1292 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET and it has been ineffective as measured by what's been happening to the backlog.

Well, the City has to issue a license for these landlords to rent these properties. Why do we continue to issue them a license if they don't comply? COMMISSIONER DOMZALSKI: And that's where L&I comes in. It's going to be a joint effort to ramp this whole enforcement process up. And in the final analysis, when we look at this and we have a child who really is at risk in those houses that we're concerned about, even with our present situation, we can go in and abate that house and then lien the property.

And we end up with more blight. COMMISSIONER DOMZALSKI: (Nods head.) Yeah, it's not without its difficulties, Councilwoman.

Well, I think there are some people here, such as PCCY, and myself, as chair of the Committee on Health and Human Services, who would like to have a dialogue about how we can ramp this up. 1293 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: I think we absolutely have to do that, Councilwoman Tasco. I mean, it is something that is just crying for a whole new look. We can share with you some things we plan to do differently and are doing differently as of this very moment in relation to all of this, and that dialogue would be most welcome.

Thank you. Question: How would the seller know that lead is in the house? COMMISSIONER DOMZALSKI: There's a disclosure form.

So they get a disclosure form. So do they have to have someone come in and test to see if the lead is there? 'Cause if I want to sell my house, I don't know whether I have lead or not. I'd say, Well, no, but then if you find out later there's lead, what's the come-back on me? COMMISSIONER DOMZALSKI: There's a notice either on the agreement of sale or in connection with it that says, you know, there are these hazards you may be aware of and while -- if the owner doesn't know, then the owner can just say, "I don't 1294 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET know," and if that's truthful, then that's fine. If, on the other hand, the owner knows that there's lead paint in there and does not acknowledge that, then there's a whole other set of problems that accrue to the owner in that circumstance. But what we're finding is people are, particularly with HUD houses and the rest of it, going out and getting the lead condition of the property checked.

And you say that they have to abate it? COMMISSIONER DOMZALSKI: Yes.

Okay, there's a certificate that says that it has been abated? COMMISSIONER DOMZALSKI: Part of that certificate is -- we're part of that certification process. We will go out and make a measurement in the house after it's been worked on and determine whether or not it was abated, and if the abatement was done, whether or not it was effective.

Is there any way for the seller to leave an escrow of funds for the abatement? What if they check off "I don't know," 1295 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET what happens? COMMISSIONER DOMZALSKI: Well, I think, you know, for anybody in Philadelphia, just -- there shouldn't be anybody in Philadelphia that's buying a house that shouldn't be thinking about whether or not it's got lead in it, no matter what part of the City you live in, although the newer parts of the City don't have the problem; just as there shouldn't be any medical-care provider that's seeing a child under the age of 5 that isn't thinking lead. So people need to be aware of that, and what our finding is, is that they are aware of the issue of lead. And, you know, we do have an ordinance, a disclosure ordinance, that came through this Council very helpfully that makes that a reality in Philadelphia.

Let me ask my other question here. So we won't belabor this. I'm sure other people have other questions around it, but I do just want to confirm that we will follow through with you on getting together to have this discussion. COMMISSIONER DOMZALSKI: That's most welcome, Councilwoman. 1296 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Okay, another question. How can we help low-income property owners with the abatement? COMMISSIONER DOMZALSKI: You know --

Has that been thought in the NTI Program or somewhere through the CB community? COMMISSIONER DOMZALSKI: It's really the question of the day, and I want to first acknowledge that this is a critical public health issue, but it arises as a consequence of the condition of housing. And we need in our strategy to look at our housing and how we deal with housing in the government. I've recently been over, you know, to talk to Debra McCullough about it in the Office of Housing and Community Development. They have some programs that have to do with home stabilization. You know, what we're seeing in these houses and part of the reason we've got this backlog is it's just not just a simple matter, as it was 20 years ago, of going in and taking care of the lead paint. Oftentimes these houses need tremendous systems repair. What I mean are -- the roof, sometimes they don't have an adequate roof. 1297 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Sometimes the other systems, such as plumbing is just broken and they need that. Sometimes it's heating. So these houses need a good look at comprehensively not only by public-health people, which we are prepared to do, but by people who also know the whole housing environment, and does it make sense to invest anymore money in this particular piece of property or does it make more sense to get the child and the family relocated.

Well, thank you very much. You gave us a list of professional contract services. COMMISSIONER DOMZALSKI: Yes, ma'am.

We have a $32,409,075 contract with Episcopal Long-Term Care? COMMISSIONER DOMZALSKI: Yes, ma'am.

What percentage is that of the total operational cost? COMMISSIONER DOMZALSKI: That number is -- and I'd have to look at it. It either would have to be combined with the -- I believe that's the entire operating cost. That's our subsidy plus what 1298 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET the revenue produces to operate the home. It's just a little under 37 million

Does Episcopal Hospital provide any support revenue for the operation of the -- COMMISSIONER DOMZALSKI: Yes. They are the employer. They employ some 504 personnel, ranging from nurses to nursing assistants to food service workers to operate the home.

Do they pay for it out of this 32 million, or is that something they pay out of other revenue? COMMISSIONER DOMZALSKI: No, it's paid out of that money.

So we're paying them to manage the Philadelphia Nursing Home? COMMISSIONER DOMZALSKI: Yes, to operate and manage.

To operate and manage. So they do no contribute any money to the operation of that facility? COMMISSIONER DOMZALSKI: Well, it depends on what conversation we're in. You know, we think that there's an awful lot being contributed, but we 1299 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET think that number covers the cost of operating that home.

Would that have been the same cost for us if we were operating it? COMMISSIONER DOMZALSKI: No, I don't think so, Councilwoman. When we were operating it, it was costing us almost $9 million more than we were bringing in, and the census at the nursing home, the number of residents in the nursing home at that time, was about half of what it is now, about 255 residents at that time.

So what's the population now? COMMISSIONER DOMZALSKI: This morning, it is 435.

Mm-hmm. COMMISSIONER DOMZALSKI: And that includes 18 residents who are in the hospital, 7 of whom are in the hospital longer than 15 days.

What is our contract with United Way of Pennsylvania? COMMISSIONER DOMZALSKI: I'm sorry?

What is the contract for with -- what do we contract with the United Way 1300 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET of Pennsylvania for, the $16 million? COMMISSIONER DOMZALSKI: United Way of Pennsylvania. Let's see if I can get assistance here. That is in the Health Department -- approaching is Deputy Managing Director Ellen Steiker, who has not only the numbers but the information. (Ms. Steiker comes forward.)

Good morning. This is Ellen Steiker. The contract with United Way is for the Children's Investment Strategy, the after-school and the Beacon programs. We had to choose one department to put that initiative in, and we chose the Health Department.

And so all of this money goes directly to United Way for those programs?

That's correct.

Okay. Can you identify in this list of 82 contractors -- and you want to give that information to the Chair -- the number of companies that are minority? COMMISSIONER DOMZALSKI: Certainly. 1301 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Thank you. Do I have more time? How much time do I have?

This will be your last question.

I want to ask you just a brief question about infant mortality. I have a lot of questions about CBH, but I'll have to try and come back to that later. Recently -- and I noticed you testified in your testimony that -- you talk about the increase and the problems in West and North Philadelphia. Recently, about six months ago, there was an article in the Inquirer that stated that the increase in the highest number of infant mortality deaths are now in West Oak Lane. I don't know if you saw that or if you all were working on that or paying attention to that. But what is being done to address that issue in that community? COMMISSIONER DOMZALSKI: That is a fact, and it's one of the reasons where -- you know, the infant mortality, like immunization rates and the rest of it, varies across the City. What that 1302 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET number is is an average for the City. And even though when we look at the unofficial figures for the year 2000, there's an even greater decline in infant mortality. We know that it's not even across the City. And, in fact, when you look at these infant mortality rates, you see the variation from the very high infant mortality rates in District 9, in the northern part of Council District and Council District 3, and in Council District among the highest. And where we looked at West Oak Lane, you know, that's an area where, you know, if we were immediately to get some money to expand the Olds project, that's where we would go because that would be the next on our list to be there.

So we're waiting to get the money to do it? COMMISSIONER DOMZALSKI: Well, we're waiting, but we also have some ability to do some infant mortality reduction-related services through our Healthy Start Initiative, which can bump up into that area as well.

What about the 1303 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET possibility of expanding the Momobile to that community? COMMISSIONER DOMZALSKI: Well, they're slightly different services. I spent some of last week riding around in the Latino Momobile, and that was after coming from a series of case conferences with the agency that's providing some of our Healthy Start and some of other Olds programming. And they're significantly different services, but they would help; they would help in getting the word out, getting the message out about the need for and the importance of early, early prenatal care. In fact, one of the conferences I was in the week before last, the mother's first prenatal care was minutes before she delivered. So we 17 need to keep hammering on this and on ourselves to 18 get the word out. 19

So have you begun to 20 develop or initiate or generate or think about the kind of services that might be provided to the West Oak Lane area? COMMISSIONER DOMZALSKI: Yeah, and I think the model would be very similar to what we're doing, you know, both in the Olds Program and the 1304 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Healthy Start in West Philadelphia where -- it's just not, as you know, dealing with constituents and the issues that come before -- that are brought to you by them, that it is a very mixed group of resources that are needed. There was a family that we looked at last week that the baby came to our attention because she was cocaine-positive, and the home visiting team involved with the child, who was now several months old. The parents, the birth parents, were in an unsettled housing situation, had needed substantial substance-abuse counseling, as well as some vocational counseling. You know, we haven't done our people any favors in the systems that we've created for them to jump over. For example, the father in this case needed to get a Social Security -- needed to apply for Social Security. Well, he couldn't apply for Social Security because he needed a picture I.D, and he couldn't get a picture I.D. until he presented to the picture I.D. issuers some evidence that he, in fact, had a perfect address, and what was acceptable was a utility bill. Well, he lives in a rooming house and he doesn't get utility bills. So our 1305 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET people had to figure a way around this so he could get the resources that he needs to be able to, you know, deal with a number of problems, including the substance abuse as well as the vocational issue so that he can eventually make a home for this child who's now living with the paternal aunt.

Thank you.

Councilwoman, your time is up.

Thank you. I want to congratulate you too. COMMISSIONER DOMZALSKI: Thank you, Councilwoman, I appreciate that. Thank you.

Commissioner, when one sells a house, isn't it required that there be an inspection for termites if they're getting a mortgage? COMMISSIONER DOMZALSKI: As I recall that process, President Verna, it is, it's something that everyone asks for as a certification. It does not come under the Health Department, we don't administer that, but it is just my general knowledge that it is something that's sought after by everybody who buys a house. 1306 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Well, then I don't know why we couldn't have an inspection for lead paint at the same time. That should be a requirement. At this time, the Chair recognizes Councilwoman Blackwell.

Thank you, Madam President. I think some of the issues I have concerns about were addressed. The others I can hold in the interest of time. I did want to say that I'm very, very glad that we have a new plan for SPCA; that's been kind of bone of contention with me for some years, ever since Council was insulted by the former head of the SPCA. Having said that, again, we certainly want to thank you, Commissioner. We're absolutely happy to have you at the helm of your department, and we thank you for going the extra mile and for always being on call and for doing great things. What we would like to do in my area is, Mr. Johnson just brought to me info that our infant mortality rate in West Philadelphia is as high as it 1307 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET was before the Health Start stuff started. So what we would like to do is work with you and do some added workshops in the area to help disseminate information, but we'll contact you about that. But, again, we wanted to say thank you for the great job that you've continued to do and that through the years you've always been on call, and you've just been a great person and an excellent commissioner. COMMISSIONER DOMZALSKI: Thank you very much, Councilwoman Blackwell.

Thank you.

The Chair at this time recognizes Councilman Rizzo.

Thank you, Madam Chair. Again, congratulations. You've worked hard and it must be personally gratifying to know you've come through the Health Department and now lead it. COMMISSIONER DOMZALSKI: Thank you.

Commissioner, recently, I've had some interaction with the Philadelphia Corporation for Aging. We're all 1308 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET naturally concerned about our young people, but I'm as equally concerned about our older folks. And I would like to know what the Health Department is presently doing for our senior citizens and the interaction that we have. After doing some initial research, I find that we have some contracts, there's money spent, there's money received with the Philadelphia Corporation of Aging specifically, and I find out it's pretty much a State-controlled agency, if I may call it "an agency," and it gets State and federal money. But I do have some concern, and I'm not going to get specific right now, about that organization, and I would like to know our relationship with the Philadelphia Corporation for Aging and what services they provide the Health Department. And I assume I'm eventually going to be talking to the next panel, the Department of Human Services, to see what they do for those folks. But could you be specific and tell me about your relationship with the Philadelphia Corporation for Aging? COMMISSIONER DOMZALSKI: Sure, Councilman 1309 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Rizzo. We work in a couple of ways with them, and all of them are relatively non-contractual. The biggest program that we have with them is around our heat, our heat program in the summer, where they operate a heat hotline for, us and we have a system of being able to respond to individuals who are elderly, who are isolated and are able to assess the environment and get them what is needed, either relocated during a particular hot spell or a fan or something of that nature. And that's where we work very closely with them. We also work with them when we get called out to investigate a condition in a neighborhood -- maybe it's a house that's creating some sort of a sanitation problem, and sometimes we'll find that the occupant of that house is an elderly, infirm person, and we will try -- we will work with the Philadelphia Corporation for Aging in trying to attach some services quickly to that resident of that facility, that home. But as far as a contractual relationship with PCA, we don't have one.

Well, I wasn't 1310 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET necessarily suggesting a contract with PCA, but I'm more concerned on being it called "Philadelphia" Corporation for Aging, and I'm starting to talk to various people within the Administration that we might be taking some lumps unfairly based on services, or expectations of services, from this organization. And I'm finding every day that I check that we have very little interaction with them because, again, the executives over there believe that they are funded by the State, they are funded by the federal government, and really they don't provide a lot of services from what I'm understanding, and there are some rumblings right within the Administration about what they do, the way they respond to requests. How dependent are you on them other than them answering the telephone, which I believe you could do -- you have hotlines. And we know people -- I don't understand necessarily why we even need them to do that for us, but what do we expect of them? And I want to be real candid with you. COMMISSIONER DOMZALSKI: Yeah.

Do they help you? Are 1311 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET they doing what you need to them to do? And this is a question where I'm trying to find out exactly what they do, and are they doing well what they do? COMMISSIONER DOMZALSKI: Well, they do help and there are a couple of ways. One is where they actually do perform some certification functions for the State of Pennsylvania for the residents in our nursing home that would require medical assistance, so they help facilitate that. The other thing that is being done, and it's kind of an innovative thing being done at the State level that I think we need to pay some attention to, and that is a Medicaid waiver program, which allows the Corporation for Aging to provide a constellation of services in the home of an elderly and infirm person, with the objective being to keep that person from needing institutional care. And so that's a very valuable function. Admittedly, admittedly, the demand far outpaces the number of slots that they have, and I think sometimes that what I have experienced are persons who would really love to have attendant care and personal care in the home of an elderly person, and PCA happens not to have a slot. 1312 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Beyond that, I would certainly offer to work with you with the leadership of PCA to get to the bottom of some of the issues and particularly the service questions.

Well, Commissioner, that's very important to me because, again, I'm very, very concerned about our young, but I'm equally as concerned about the way we treat our seniors. Let me give you an example. There was recently a senior citizen -- and you might have seen it in the newspaper and on the television -- where she was assaulted and almost beaten to death off of Girard Avenue. COMMISSIONER DOMZALSKI: That's right.

Well, a person called me and I won't, again, identify the person, but the person was involved in an investigation of what went on there, at least the -- it was an investigation not within your department. And this woman was almost beaten to death. She was close to 90, living by herself. I was so concerned, I went there, and when I got to the house, we would have thought maybe she was dead 1313 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET inside because there was no response to the door, but she finally came to the door. The oven -- she had no heat in the house, the oven was the only sole source of heat. And I'm wondering how we could let, after the police -- she went -- they took her to the hospital and they sewed her head up, she had a arm that was broken, that there was no automatic follow-up on that person. I mean, something's not right here when a person is almost beaten to death, 90 years old or close to it, released from the hospital, taken home, and no immediate case or communication from the Police Department or somebody reading in the newspaper that this occurred, but I wouldn't want to have to depend on reading in the newspaper to start a process. Well, we finally got the heater going, we told her how dangerous it is. The Fire Department came out the same day and put smoke detectors in the property. But my point being, here's a lady almost beaten to death, released from the hospital back to her home. We brought her a pie, Commissioner; after the next day, I had a person drop off a pie. She 1314 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET opened the box and actually started to eat the pie with her hands. COMMISSIONER DOMZALSKI: Oh, my God.

She hadn't had food. COMMISSIONER DOMZALSKI: See, this is a case where, you know, certainly, you know PCA should -- but also our protective services and --

Two days later, Commissioner, I got a call back from PCA and, again, I'm not trying to beat them to death here. Two days later, I get a call back from PCA asking me to do the intake process for PCA. I don't know the lady; all I know is that anyone should care about a person that I just described. So maybe I just went to the wrong organization for help. Maybe I should have come to you. But that's why -- and I am going to do whatever it takes, whether it's writing to the people that audit federal money, to the Governor, to find out why this system doesn't appear to me -- I'm not a professional and I'm going to turn to you for some guidance and assistance. But, again, I'm very, very concerned about our senior citizens, and I feel confident that 1315 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET if we hadn't gotten there when we did, people from the Fire Department and the utilities said that she might have died in that house, and it's unfortunate that conditions like this exist. So I'm willing to work with you, but I can tell you, if you call it "rocking the boat," I'm going to rock the boat on this one. COMMISSIONER DOMZALSKI: Oh, absolutely. And, you know, I think the frustration and, I think, anger that, you know, justifiably evidence in relation to that case are the kinds of things that are making us in the government look at just how we need to structure our assessment capacity. I was just talking with some people in my department as well as the DHS Commissioner, Commission Martinez, about putting together what we're calling a different social-services version of a rapid-assessment team, because oftentimes these problems don't fall within any one department or agency. And it shouldn't be on the shoulders of Council to try and figure that out; you should be able to come to us or someplace in the government where we can work through that to get the services 1316 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET to the people such as this poor soul who needs it.

And I'm convinced that there's more people like this lady out there that -- I don't want to suggest that our seniors are overlooked, but in the twilight of their life, dignity, some care. And I'm not sure what the Health Department does, what Human Services does for our senior citizens, but I'm going to learn more about it exactly what services are out there, you can bet, and hopefully get them that care that they need, especially during some tough times like this lady. COMMISSIONER DOMZALSKI: I'm sure. I mean, it's just --

And I know that when you say that, you say that with sincerity. COMMISSIONER DOMZALSKI: Oh, absolutely.

I know you -- COMMISSIONER DOMZALSKI: I take this, you know, as a personal responsibility to work with you on just these kind of issues.

Thank you, Commissioner. Thank you, Madam Chair. 1317 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

You're welcome. The Chair recognizes Councilwoman Brown.

Thank you, Madam President. (Inaudible) my colleague Councilman Ortiz was ahead. Good morning and congratulations to you both. Let me follow up on the lead discussion and add to the course of my colleagues about our strong interests in seeing a comprehensive strategy around lead. The biggest surprise to me, as I read in your testimony, is that it is completely preventable. So With that said, you spoke briefly to conversations that you've had with City Housing officials. Is that the beginning of a long-term discussion, or where did that end up? What are the next steps specifically as it relates to lead? COMMISSIONER DOMZALSKI: It's part of the beginning and, actually, the strategy of the Health Department, in conjunction with an overall strategy for the City -- I'm not sure if you can hear me Councilwoman. 1318 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Sure. COMMISSIONER DOMZALSKI: It began a couple weeks ago when about eight of my colleagues and I met on a Saturday morning in the Lead Program and brought together medical personnel, social- service personnel, public- health nursing personnel, environment experts, and fiscal people to look at a new way of looking at lead poisoning and how we need to organize our services and what kinds of resources are necessary. And we're calling that the "Lead Abatement Strike Team," and for those who are given to looking for acronyms and things, we want this to be indeed the last time we need to deal with issues like backlogs and have a strategy for dealing with this issue once and for all. And clearly, clearly, the Housing authorities need to be involved with this. Not only was I with Debra McCullough last week but also with Carl Greene and my colleague Rob Hess in terms of vouchers and things that we might need to do to temporarily or permanently relocate people out of these houses that just cannot be invested in further. 1319 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

It's a huge problem. So you mentioned a you few stakeholders. With regards to landlords, would not L&I be a stakeholder in that conversation and discussion as well? COMMISSIONER DOMZALSKI: Absolutely, Councilwoman, they've got to be there, and they will be.

Okay. Councilwoman Tasco spoke to the role and responsibility of landlords; I did not hear an answer to the question, what is the penalty for landlords who don't obey the law? COMMISSIONER DOMZALSKI: The penalty is, we can fine them, we can get a fine in Municipal Court or Court of Common Pleas, we can do the work and we can lien the house; all of those are very uncomfortable processes for the landlord that, one, the landlord would want to avoid, and we want to make the cost of maintaining that condition something that the landlord in fact would want to avoid while, at the same time, trying to work in a collaborative, productive way so we don't unnecessarily decrease the stock of housing in the 1320 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET City. But the bottom line has to be that if you're renting a premise and it's lead-contaminated, it's got to be abated.

This speaks to a follow-up to President Verna's question. If landlords are asked to honor building codes and the like and those are enforced, why can't this be put up and given as high a priority, enforcement of abatement of lead as well? COMMISSIONER DOMZALSKI: Exactly, exactly. And part of the reason is just what we did a couple of Saturdays ago, is saying that this is no 15 longer acceptable, all right? That that is at least as high a priority across the board that we've got to deal aggressively with this situation. And that's part of it, just saying that. And then the question of --

And then putting some muscle and real teeth behind the discussion. So we all will look forward to the reports, I guess status reports, of this new strike team. COMMISSIONER DOMZALSKI: I want to 1321 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET caution you, Councilwoman: None of this is going to be, you know, easy, right out of the box.

Absolutely. COMMISSIONER DOMZALSKI: It's going to take some finesse, some elegance, and some hard work and resources.

But finally, there's a group of professionals collectively working on this in a focused kind of way, which has not -- well, I haven't observed that since we've been discussing lead now for my third year. COMMISSIONER DOMZALSKI: Yes.

Okay. The more immediate problem is -- the 1400 is a huge backlog, but speaking to more immediate steps such as removing peeling and flaking paint, repainting the area, replacing windows, doors and the like, has that been a part of the discussion with the Housing Department? because those are the more immediate steps that homeowners may or may not be able to tackle. Where are you with that? COMMISSIONER DOMZALSKI: Yes, it's very definitely a part of it and a critical part of it 1322 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET because what we need is an assessment of, does it make sense for us to go in there and do that very labor-intensive work to stabilize those services and repaint them when we have a roof that isn't there or leaking badly or where we have plumbing systems that are leaking on the second floor and causing the work we're doing to be deteriorated on the first floor, so it's those systems that need to be looked at in terms of the whole abatement process. The technical piece of abatement is not all that difficult.

Okay. COMMISSIONER DOMZALSKI: What's made it difficult is the quality and the deteriorated nature of the houses that we end up dealing with and also some of the antiquated ways we've been going about things, like saying simple things, which, if I say it to you, you'll probably leap over here after me, which says that we can just say to a family, you know, "We want to come in and abate your house, how about everybody getting out of here."

It doesn't work that way. COMMISSIONER DOMZALSKI: Well, I mean, 1323 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET no. I mean, there's children and where we're going to put them, you know, and we get upset if we say we're going to be there at and then we can't start 5 till 10:30 because, you know, mother's got two or 6 three children to get moving, you know, and then 7 cleaning up at the end of the day so they can come 8 back in. 9

Sure. COMMISSIONER DOMZALSKI: And it's a colossal waste of resources in doing that, and it's not the family's fault.

And inconvenience to families. Councilwoman Tasco also spoke to the opportunity being ripe, R-I-P-E, with the blight program. Do you agree, as the City moves to do things differently around housing and decay of housing and the like? COMMISSIONER DOMZALSKI: Yes, yes, Councilwoman. And we've taken another first step in that regard where, as a result of meeting with Debra McCullough, we have exchanged lists, both she and her dealing with the blight program, her list of properties, and we've been running our database of 1324 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET houses on the backlog list against hers to see, you know, other overlapped similarities and how we address them again.

So there's some connect, if you will. COMMISSIONER DOMZALSKI: Yes.

Do you think we'll ever see a day when children will no longer be poisoned by lead, or is that a panacea, is that too idealistic? COMMISSIONER DOMZALSKI: No. I think we will see a day, and when that day comes, it will be as a result of -- just as we make all of these things that are so important for us to do now very, very obvious that in cities like Philadelphia, the end of every commercial or something ought to be, "Have your child screened for lead paint," you know. You know that if you live in a house that was built before 1978, the odds are nearly 100 percent that you've got lead contamination in that house. Learn what you can do about that. And even in the most seriously contaminated house, with proper education and awareness on the part of the caretaker, that child 1325 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET can be prevented from getting lead poisoning or prevented from getting worse. But the absolute end of it is to get the lead out.

Okay. My only comment to that would be, so often, parents are concerned about getting food on the table and making sure they have a warm place and simply don't read the literature that comes through to them in the mail. So there's a need to sort of layer the message so that it hits them several different ways in order for the connect to happen and then for them to do the follow-through to make sure that their houses are tested for lead. And that's it on lead. Let's turn to AIDS. COMMISSIONER DOMZALSKI: Okay.

In your testimony on , you mentioned -- and I would add disappointingly -- that there's been an increase, a slight increase in AIDS. And, of course, it continues to disproportionately affect minority communities. Could you or your designee please speak to prevention and what's happening with that, given 1326 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET that we are continuing to see an increase. And additionally, I would say, on , in the paragraph preceding your discussion of AIDS, you mention partnerships with Safe and Sound, the School District, DHS, and the Family Planning Council. And for reasons that I would like for you to share with me, that's not evident in the AIDS attack. So speak to what you're doing by way of prevention, period. COMMISSIONER DOMZALSKI: Okay. And it is prevention, it is prevention. There was, I think, an adjective in the testimony that probably I do disagree with, and that is that, you know, when we had an increase from 1,039 diagnosed AIDS cases to 1,137, that that was somehow slight. That Isn't slight, and that is a matter of very, very serious concern. But what I also understand is that the difference between the diagnosis of AIDS -- of HIV and the diagnosis of AIDS, with most of the diseases that we deal with, once you come in contact with the organism, you have the disease. With AIDS, it's a much more protracted process. 1327 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET AIDS or HIV is an infection, and AIDS is a diagnosis, and what happens to a person after the diagnosis of AIDS is made is critically important as to whether AIDS will develop, if at all, and over what course of time. And a lot of that has to do with how early we get people into care, how early we get people to, one get tested and counseled for HIV. And then once the disease has been identified, to get the person into services. That's why these storefronts are so important. I was in one in Germantown, and I can tell you that it's street level, it's a welcoming environment, it's something that people feel comfortable with. And just as we talked about all the needs people have, often the needs people that come to us about are not so much their health necessarily, but their hunger, and they've got no 19 food and they've got no connection with a house. And so this is the beginning of getting those wraparound services for people so that they can begin to look at their health. And so I can really be comfortable when people tell me, Well, you know, when you look at it over the years, this is such a variation in the 1328 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET number of AIDS cases that it really depends on how successful we are with the drug cocktails and how good. There's something called "HAART," which is highly active anti-retro viral therapy, and if you want or need more about that, I sure will reach out to one of my doctors here to come up and educate us about it. But there are some issues about that and how effective that is and how effective it's becoming. And so all of these things impinge on whether or not and how fast someone progresses from a diagnosis -- from having -- being determined being HIV-infected to actually having AIDS.

Is there any benefit to having a relationship, if one does not already, with the School District? COMMISSIONER DOMZALSKI: Well, yeah. B

At all? COMMISSIONER DOMZALSKI: Yes, there is, Councilwoman. And, you know, we're in two of the schools right now.

Okay. Are these anonymous? 1329 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: At University City High and at Edison.

Okay. COMMISSIONER DOMZALSKI: And we're doing the prevention counseling and actually doing some chlamydia and gonorrhoea testing through the health resources center in those two schools, and we hope to expand that. We also are in, in terms of youth, about ten recreation centers.

Is this the first year for the schools? COMMISSIONER DOMZALSKI: Yes.

Is there any way to measure impact of prevention? I don't know. I mean, you spend the dollars for preventive measures, and at what juncture do we measure the success or the impact? COMMISSIONER DOMZALSKI: The success of the impact is going to be measured in whether or not we're having any impact on the explosive increase in chlamydia.

Okay. COMMISSIONER DOMZALSKI: A big problem of 1330 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET chlamydia are males, and males tend to be almost 100 percent asymptomatic, so they don't know they've got chlamydia, yet they're very important in the continued transmission of that disease. So, one, we have to get everybody to accept the adolescents to get tested; and, two, to understand, you know, healthy behaviors.

Councilwoman, your time is up as soon as the Commissioner finishes his answer.

All right. Let me close, then, where I started, and that is to say that I join the Chair of Health and Human Services, Councilwoman Tasco, and PCCY, Councilman Nutter and others who look forward to an update on this lead strike force or strike team in the months to come. Thank you. COMMISSIONER DOMZALSKI: Thank you.

Thank you, Madam President.

Thank you, The Chair recognizes Councilman Ortiz.

Thank you, Madam 1331 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Chair. Commissioner, how you going? COMMISSIONER DOMZALSKI: Good morning, Councilman.

Nice to see you. COMMISSIONER DOMZALSKI: Thank you.

You know, every time we get the Health Commissioner here every year, it sort of begins to seem like that Bill Murray movie about when he goes to go see that little runt that comes out of the cave.

"Groundhog Day."

"Groundhog Day," right, because we keep talking -- COMMISSIONER DOMZALSKI: Punxsutawney Phil.

We keep brining up the same problems because it seems like we've talking about lead poisoning since I got here. And we have Shelly (referring to Shelly Yanoff, PCCY) every year coming in and saying, you know, When are we going to take care of this? because it is government's function, this is government's function. And continuously, the 1332 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET promises are made that it's going to be taken care of, but it never is. And maybe one of the by-products of the blight program is that a lot of these houses will be knocked down that have lead paint in them and so on. And that way, we will reduce our rolls of houses in the City. But, you know, I just hope that your commitment -- because I do know you have that -- to begin establishing a task force and getting the people, because it's getting the inspectors out there and then forcing these landlords to abate this sort of thing, but it is something that we just can't afford. And, again, you know, we talked -- and I think Marion asked the last question that she asked before she left was about infant mortality. Again, I can remember the first time we had hearings on infant mortality here in 1986, and what is our infant mortality rate today vis-a-vis what it was ten years ago in areas such as North Philadelphia? because they differ from across the City, and in order to really grasp what the real situation in infant mortality really is, you have to take it in 1333 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET places. What is it in Mantua and what is it in Central North Philly, and what is the infant mortality in areas such as Kensington, which it has improved, I would imagine, because of the Momobile, the Latino Momobiles and other programs that have been instituted. But in '86, we didn't have any programs, and now we have Health Start and so on. But what are the differences? You know, what are the measurable differences between ten years ago and today in these areas? Do we have numbers for that? COMMISSIONER DOMZALSKI: We do have numbers. And you're right, Councilman, that infant mortality, as we talk about being a citywide average, and that's just an average and doesn't tell you much, but I can tell you, for example, that the highest infant mortality rate continues to be in Council District 3, with 14.5 against, you know, the City overall average of --

But wasn't it around there ten years ago? It was around 14, something like that, 10 years ago and -- COMMISSIONER DOMZALSKI: And I think that's -- to me, that's the fallacy of looking at 1334 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET citywide averages.

Right. COMMISSIONER DOMZALSKI: And part of what I think we need to do, in addition to looking at a whole different strategy, is we need to begin to look at our health centers as what they are: They are the principal focus for public health in a health district. And we need to be focusing on that / And when we go into a district, when I come to your office and talk to you, I don't need to talk to you about, you know, where we go from the City, you know, where your area of concern is. I need to be talking to you about things that you can only get from the Health Department such as infant mortality rate in your particular neighborhood your concerned with. What's immunization coverage, how many kids are lead-poisoned in that neighborhood, and so --

Well, those are the statistics that I want because the only way we can look at this is historically, and we got to see if it is 14 today in West Philadelphia, it was 14 today -- it was 14 ten years ago, and that's 1335 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET intolerable. I mean, that means that either the health centers are not functioning appropriately, and we got to see how they're reaching out and what policy they have. It means that we don't have Momobiles such as we may have, and I'd like to see what the number is in the Latino area in terms of Kensington and so on, and whether those numbers have appreciably changed during that same period of time. Because we do have -- and I fought for programs here: The Latino Momobile, the Health Start. Why isn't it changing? Why is it 14? Why is still in these areas of poor people. Why is it still at that level? And what is it about the health centers that we're implementing that is not reaching out to all of these families that surround those health centers? And are they appropriately staffed, do we have enough individuals to really reach out? Because if mortality is high, I would bet you that AIDS, HIV, chlamydia, the sexually- transmitted diseases also has not gone down in any of these areas. So we got to begin forming a strategy -- 1336 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET and hopefully, because you're there, I have some confidence that we might be able to do this -- that can begin attacking these areas through the health centers, through building of the health centers and the staffing around them and putting... So I'd like to find out, what is it that you need to put more resources out there, because we have a health crisis that is affecting poor people, especially black and brown, in a much greater measure than in any other parts of City, and we may need to put more resources in there. And I'd like to find out, what is it that you need in order for us to be able to change in this budget? COMMISSIONER DOMZALSKI: I think what we need most of all, Councilman, is --

You know, we get a lot of public relations about a lot of stuff, but kids are still dying. COMMISSIONER DOMZALSKI: They are, they are. And while overall rates have been improved, that isn't the case in every neighborhoods, and what we need to recognize, though, is the fact that, yes, we need those health centers functioning, and they 1337 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET are doing a good job, but we also need the other partners that are out there, you know, the other federally-qualified health centers that are in the neighborhood, the hospital outpatient departments. I was in -- and it's awareness and knowledge. I was in an event the week before last where we were doing something with books for babies, and I turned to one of the practitioners who was there, and we finished giving this lovely three-day-old baby a set of books that her mother was going to read her. And I said to the practitioner, How do we know the baby's not going to a home leaded environment? And he said to me, "Lead? I thought that problem was solved." So we haven't done enough, we haven't done enough. We can do more. And I think there's two reasons: Because of the sentiment that's on this Council and the sentiment that, you know, is happening in Social Services with a more integrated system and the emphasis placed on this by the Mayor. So I think there's tremendous reason for optimism.

Well, yeah, but tell 1338 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET me how we're going to do it. COMMISSIONER DOMZALSKI: Well, I'll tell you how we'll do it.

Okay. COMMISSIONER DOMZALSKI: I think first of all what we need to do is to look at this person that was case-conferenced the other day and at the barriers that we put up in front of that mother so that her first prenatal care was minutes before 11 she delivered. Something's wrong with that, and 12 it's not that she had, you know, nothing else to do 13 but to do that -- 14

But, excuse me, but 15 that's exactly the problem. You see, we've been 16 talking about that here now every year at this time 17 and through the hearings. Just last year, I held 18 hearings on HIV and the increasing amount of HIV 19 that is being reported in Philadelphia. 20 COMMISSIONER DOMZALSKI: Mm-hmm.

And people are very surprised that we have once again an increase in HIV and specifically in the minority communities. We know that people in Kensington, many of them have never got a prenatal examination. We have a 1339 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Momobile that consistently -- every year, the Momobile has problems getting funded, consistently. And we have -- and they come in and we get some money from somewhere and we try to expand it, but we don't expand it because some other priorities take place. We know that it's happening, Commissioner, and you know that. I mean, why should we be surprised at this? This is 2002 and we're still surprised, and the fifth largest city in the country, we're still surprised that somebody comes in and it's the first time that they ever had prenatal care. And then we don't know how to go about and how -- let's structure a plan and let's put the money where it should be. And I constantly am talking about how much money we give to developers and other individuals and so on, but we're not spending the money where it has to be spent, and it's constantly surprising that we have and are always asking the same questions year after year. I just want to at one point come into this Council and not have to ask any questions about lead. That is all. Thank you. 1340 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Thank you. The Chair at this time recognizes Councilman Nutter.

Thank you, Madam Chair. Madam Chair, this is actually my second turn, and Councilwoman Miller has not had the opportunity, so I'd like to yield to her and I'll come back.

Thank you. The Chair recognizes Councilwoman Miller.

Thank you, Madam President. Thank you, Councilman Nutter. Good morning and congratulations. COMMISSIONER DOMZALSKI: Good morning.

I, too, would just like to echo the concern that my colleagues have expressed this morning about lead abatement, and the topic of lead and its abatement has been a topic and a issue at every budget hearing too that I've attended, so it sounds like putting together a task force is really a good direction to go and will finally help begin to deal with the issue of the problem of lead here in Philadelphia. 1341 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET I have a couple questions regarding substance-abuse treatment. And, you know, this is a quality-of-life issue in neighborhoods, particularly when you constantly see the same people on and off drugs. You see 'em, they're out, they look good, they look healthy, and then before you know it, they're right back on drugs again, particularly crack. And there seems to always be a debate around long-term versus short-term care, and I was wondering if there's a recommendation that CODAAP or your office has regarding the length of stay for an effective drug-treatment program. Private industry doesn't seem to want to pay for inpatient long-term care, and most people kind of think that they need long-term care, and someone told me that there's been a study that says the lengthy inpatient treatment programs aren't producing any better results than the short-term inpatient programs. And I was wondering if you had any information that would either support that or disprove it.

A couple comments on that, Councilwoman. 1342 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Part of the reason the City entered into the HealthChoices Initiative five years ago was the very issue of treatment of the drug and alcohol community, and Assistant Commissioner Bencivengo can speak to some of the studies that have done on this. But what we've tried to develop over the course of the last five years is an array of support ranging from intensive outpatient services, which means individuals can go multiple days, a week to outpatient, to the residential rehabilitation services as well. And both of those are covered services under the HealthChoices Initiative. There have been a couple studies done as a result of folks that have been involved in treatment who have left the criminal justice system. Those studies do indicate that the longer somebody is involved in service, the less chance of them coming back through the criminal justice system as a recidivist.

Mm-hmm, okay. So you're saying, then, that long-term inpatient care is better than the short-term inpatient versus sometimes people just can't even seem to get inpatient and just basically go to the outpatient. 1343 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET

Well, it's generally not inpatient from a hospital-based inpatient; it's residential rehabilitation services that are provided, and they can range anywhere from 30 to 45 days as the initial. And then as a follow-up to that, there are also intensive outpatient services and routine outpatient services, which may be less frequently as well.

Okay. Because out in neighborhoods, I mean, people go in and they come out and they go in and they come out and they're back on it, particularly crack, and it just seems to be a real nuisance, it's really a public nuisance in many, many parts of my district and, I know, in other parts of Philadelphia. And I know it's hard for you or anybody to put their finger on the cure, but in reading your testimony, you did mention that you're going to do performance-based contracting and set up benchmarks for select performance standards. So what would that be?

One of things we're looking at with the performance-based contracting is just the issue that you're raising, the number of times 1344 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET an individual may revolve through a service, and then looking at what are the characteristics of why someone is not successful or coming back multiple times for the same service. So what we're doing in the course of the first is year is attempting to develop some baseline information across providers and across the Behavioral Health System, which will give us information on where we're at today and be able to benchmark that going forward, both at a provider- agency level but also at an individual consumer level.

Okay, well, I'd be interested in knowing the data.

And we'll be happy to keep you updated as we move forward on that initiative.

Okay, great, 'cause it seems like you're spending a lot of money, and it's almost like a revolving door, in and out. The other area I would like to ask you questions is regarding your rodent control. I think in your testimony, you talk about a new, innovative approach that you were funded for last year, and tie it into NTI. 1345 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET I know that I've called Vector Control, and I think that you really don't do anything until after a demo or after a lot is cleaned. Can you explain just the steps to actually doing the rodent control? 'cause I would imagine that with the increased NTI demolitions and lot cleanups, that that is an issue. I know for anywhere that we've had a large demolition, most people -- residents in the neighborhoods are concerned because everybody just believes -- and even if you don't see it, they just believe that the buildings are full of rodents and other types of pests. COMMISSIONER DOMZALSKI: Yes, Councilwoman, that's a very real issue, one that as we went around on June 16th, when we began the lot cleanup, we were able to see firsthand of people not only saying "I think," but we were able to say, "Yes, you're right," because those houses -- one in particular was definitely infested with rats. We're going to be coordinating very closely with that process. We are now, with the lot cleanup and will continue with the demolition, so that we can do the right kind of baiting in that 1346 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET neighborhood to keep the rodent population down and also from spreading.

Mm-hmm, okay. So you're going to do certain a geographic area surrounding the lot or the building that's going to be demoed. COMMISSIONER DOMZALSKI: Yes, particularly sewer inlets. And when we do a survey, you can see rat burroughs are pretty evident sometimes, and we do abating for those as well.

Well, how large is your team? 'cause you're going to be doing this now almost citywide, in all the areas where NTI activities are going on. COMMISSIONER DOMZALSKI: Well, I mean, with the grant that we have, that's not going to increase our staff a tremendous amount. We've got roughly right now about 28 people that are associated with Vector Control. We do, you know, do some complaint response. We also try to get out there and do some proactive education in the neighborhoods to be able to begin, once again, charting environmentally improved blocks, where look at refuse, storage, and 1347 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET collection, where we look at whether or not the houses that are remaining are rodent-proof, and do people understand, you know, what the issues are and what can be done about rodent-proofing, and just an overall environmental sanitation program for the neighborhood, which can go a very long way in improving the situation with rats.

Okay, all right. Thank you. Thank you, Madam President. That's all I have.

You're welcome. The Chair recognizes Councilman Nutter

Thank you, Madam Chair. Good morning again, Commissioner. Commissioner, I want to go back to one of the topics that is --

Excuse me, Madam President. Councilman Nutter, would you yield for a moment?

Absolutely.

Thank you. 1348 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET Madam President, I absolutely -- as you know, I've already spoken for the Health Commissioner and for Naomi Post-Street and for our DHS commissioner and OESS, but I have to step out. I don't know how far you'll get and maybe by the time I come back, you'll still be with Commissioner Domzalski. However, I certainly wanted to express my support for them. We've certainly reviewed their budgets and, as you know, we do a lot with OESS, and we certainly support their budget request, and I wanted that to get on the record just in case for some reason you breeze through before I step out, but I have to step out for an hour for a funeral, as you know, and certainly wanted to lend my support to those departments in my actions.

Thank you, Councilwoman

Thank you, Councilwoman. Thank you, Councilman Nutter.

Sure, no problem, Councilwoman. I will do my best to hold Commissioner Domzalski until you return 1349 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET (Laughter.)

All right, I might have to go to the warehouse and pull out a few additional questions, but I keep a good number of them right here in the drawer. COMMISSIONER DOMZALSKI: We've seen.

Commissioner, let me go back to a few items that I started with, and there's been continued discussion about these two issues, assuming by now that I know that you know that these are very important issues and also that they're very important to Councilmembers. Let me go through a couple of the factual pieces, and then I'd like to talk about some money. Your testimony is that, on , in FY '95, there were approximately 3,000 newly- identified children in Philadelphia with confirmed elevated blood lead levels, and that in FY '03, you expect to have slightly fewer than 800, which, obviously, is an improvement but, by your own testimony, it's not at a place where you would like it to be. The 3,000 identified cases in FY '95, how many homes did that represent? 1350 3/4/02 WHOLE - CONTINUED FY '03 OPERATING BUDGET COMMISSIONER DOMZALSKI: I don't know. I can find that for you. I can tell you, thought, that for 1400 homes, it represents 2100 children.