Okay. Thank24 you, Madam Chair.25 133 4.20.11 COMM. OF THE WHOLE - BILL 1101371 (Councilwoman Tasco now2 chairing this hearing.)3
Thank you,6 Madam Chair.7 Good afternoon, Dr. Schwarz.8
I have said11 this to you in the past and I'm also --12 and I said it to Dr. Evans. I'm very13 impressed with your staff and your team14 in the various meetings and briefings15 we've had over the past year.16 I do have a few questions for17 you, most of which I'm going to have to18 submit in writing, and I apologize for19 that, because I'm late for a meeting I20 had at 12 o'clock.21 But just the general question I22 have for your department is: We just saw23 what I think is extraordinarily24 impressive testimony from DBH and the25 134 4.20.11 COMM. OF THE WHOLE - BILL 1101371 attendant PowerPoint, which has specific2 performance metrics basically related to3 everything they do.4 Do you think it is possible for5 you to present a budget like that to us6 next year?7
The answer is yes8 and no, and I apologize for equivocating.9 So we are fortunate that the10 Centers for Disease Control, using11 dollars from health reform, has funded in12 large health departments in the country13 performance-management specialists. So14 we have hired a performance-management15 specialist, and it is our intention for16 all of our infrastructure areas -- Human17 Resources, fiscal IT and so forth -- to18 do that.19 We believe it's going to take20 probably another year to get all of the21 rest of the areas of the Health22 Department onboard.23 But what we did for this year's24 budget -- because I read your article in25 135 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the Inquirer -- is that we have output2 measures and cost-per-output. And where3 we have benchmarks, we have benchmarks4 for every division. So we believe that's5 a first step.6
And we need to9 work from there.10 The difference between11 Behavioral Health and Health is the12 diversity of the departments. Remember13 that Behavioral Health principally a14 series of insurance companies, and things15 are paid either for a program or for a16 service that's defined by a federal code.17 So the numerator and denominator can be18 defined easily because it's not so easy19 in Public Health to define a unit of20 service, unfortunately. So we're working21 on it.22
One of the23 things I'd be really interested in, if24 you could take a look at it as a25 136 4.20.11 COMM. OF THE WHOLE - BILL 1101371 department, is -- and maybe you've done2 this -- how much would you estimate the3 existence of our eight health centers4 saves the hospitals and emergency room5 walk-ins and things like that?6 And -- well, do you know the7 answer to that question?8
I mean, you11 cited a statistic that basically said, We12 know that the people who come to see us13 don't go to emergency rooms --14
--22 economically and in neighborhoods.23 And I think it would be very24 useful for us to have a study of the25 137 4.20.11 COMM. OF THE WHOLE - BILL 1101371 value we are giving the hospitals and2 medical community themselves.3 As you say, you are having4 trouble getting physicians. That may be5 something to present people who pay no6 taxes for their real estate and other7 things to the City of Philadelphia to8 maybe cause them to want to provide the9 physicians that we need to reduce waiting10 times and other things that would have a11 further benefit on them.12 That's just one small idea I13 have out of your testimony. I have a lot14 of questions for you.15
And I'm20 assuming I'll be satisfied. If not, we21 can do a callback.22
Thank you24 very much.25 138 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Thank you,7 Madam President.8 Good morning, afternoon?9
And thank13 you for your testimony.14 Of course, I pay close15 attention also to the line of questioning16 of my colleague Councilman Goode, and I17 wanted to thank you for the detail on18 , which for sure is a great19 improvement from last year in terms of20 preparation, and we appreciate that.21 What I would ask to dig even22 deeper, looking at next year, for those23 large -- for those organizations or24 agencies, nonprofit or profit, will you25 139 4.20.11 COMM. OF THE WHOLE - BILL 1101371 stipulate the composition of staff,2 specifically minority and women.3
My ask is5 that you dig even deeper.6 And the next question will, be7 for example, with PHMC, 60 percent are8 minority, 75 percent are female. The9 next question, to dig deeper, a step10 lower is: Of that, what percent are in11 positions of leadership and12 responsibility, and what percent are line13 staff?14
Yes,17 uh-huh.18 And I appreciate the19 information regarding the board 'cause20 I've been trying to get that for years.21
But we now23 need to dig even deeper for that type of24 information for City agencies getting --25 140 4.20.11 COMM. OF THE WHOLE - BILL 1101371 receiving City support, period.2 Of all those that you've3 mentioned, there was no indication as to4 whether they are all local. Are they?5
Oh, okay,10 'cause that's helpful to us as well.11 We're interested in keeping12 Philadelphians working.13
With18 regards to the schools and the details19 you gave around schools that are20 participating in ensuring that our young21 people are having healthy lunches --22
That24 number seems to be growing. What are the25 141 4.20.11 COMM. OF THE WHOLE - BILL 1101371 continuing hurdles or impediments for2 schools to just sign on and just get it3 done?4
I don't think5 there's been an impediment in will; I6 think it's a question of size.7
One of the things12 that we've worked with the district on is13 ideas. So for schools that are in14 communities that might not be used to15 eating the average American diet, as we16 might call it --17
-- or the new19 American diet that we want them to20 have --21
-- what are23 culturally appropriate foods, and how can24 they be prepared or contracted, and what25 142 4.20.11 COMM. OF THE WHOLE - BILL 1101371 do kids wants to eat.2 For the program we've done in3 rec centers --4
We were fortunate6 to be able to ask to ask the kids for the7 Supper program what they'd like to eat.8
We gave them what11 they like, and they're eating it, which12 has actually, despite the fact that we're13 feeding more children, the amount of14 wastage has gone down.15
The amount of21 stuff that's thrown out, unopened has22 gone down dramatically. So we're feeding23 many more kids, we're feeding them more,24 and the amount they're leaving behind is25 143 4.20.11 COMM. OF THE WHOLE - BILL 1101371 down because they're getting what they2 want to eat.3 So it's been clear with the4 School District that that's an important5 piece of this, within their budget6 constraint.7
And that doesn't9 happen for the whole district overnight.10 So you can't just say everybody has to do11 it this way.12 The school Wellness Councils13 have helped us so.14
So there are16 parents and staff and others in the17 school, on the ground who are helping18 make those decisions, and we're excited19 to have them. There are 200 who have20 signed up. A hundred are in full-fledged21 action so far.22
So we're -- we24 think we're well on the way.25 144 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I agree2 2,000 percent. I'm very excited about3 all of you're doing in that way, and I'd4 be remiss not to say thank you for the5 huge partnership we've enjoyed --6
So that11 there was one task that your office12 delivered on in terms of mapping high13 blood pressure and diabetes, and now14 you're mapping food deserts.15
Have you17 broken that down by Councilmatic18 Districts because that becomes very19 informative for District20 Councilmembers --21
-- who23 then may look to look for economic24 development opportunities where there may25 145 4.20.11 COMM. OF THE WHOLE - BILL 1101371 be a growing -- you know, continuing2 needs for supermarkets.3
Okay.6 Could you forward that to the Chair,7 please.8
Thank15 you.16 The Chair recognizes17 Councilwoman Tasco.18
I'll be19 brief.20 Good morning -- well, good21 afternoon.22
Good day,24 Dr. Schwarz and staff. Good to have you25 146 4.20.11 COMM. OF THE WHOLE - BILL 1101371 here. And thank you so much for all f2 the work that you're doing, good work.3 According to recent studies and4 an April 15th story in the Philadelphia5 Tribune, most new HIV infections are6 clustered in areas of the City with7 limited access to HIV-prevention8 services, including Germantown, North9 Philadelphia, Southwest Philadelphia.10 President Obama national AIDES11 strategy calls for allocating resources12 to the area of the country and city most13 affected by HIV/AIDS.14 How does the City plan to15 address the geographic clustering of16 infections, and will new resources be17 dedicated to the most highly affected18 areas of Philadelphia?19
I appreciate the20 question. I'm actually going to call up21 the head of the AIDS Activity22 Coordinating Office from the Health23 Department to give you more detail on24 that.25 147 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I'm Jane Baker.10 I'm the Director of the AIDS Activity11 Coordinating Office.12 And in response to your13 question, we currently have a new ECHIP14 Grant that was put out through the City15 --16
An ECHIP Grant, for19 enhanced comprehensive HIV program20 planning. So we're looking at those21 things for areas that are underserved.22 And we're doing geo special23 mapping to look at these areas so that we24 can target, you know, those communities25 148 4.20.11 COMM. OF THE WHOLE - BILL 1101371 and put services there.2
Would you3 -- are you -- do you know if you have4 resources or programs or offices in those5 areas where they could -- where the HIV6 patients could go to provide those7 services? Do you have providers in those8 areas? I guess --9
Yes, mm-hmm. But13 for some services, we will redirect14 providers to those areas that are15 underserved.16
Okay.17 Would the providers be from that area, or18 would they be in other areas but to19 provide services in those areas?20
Okay, all23 right. Don't go away.24 The Tribune story also25 149 4.20.11 COMM. OF THE WHOLE - BILL 1101371 highlighted the issue of wait lists for2 houses where people are living with3 HIV/AIDS. How does the City plan to deal4 with this housing crisis, given that we5 know that housing is a part of HIV6 prevention and treatment?7 And how does Philadelphia's8 HIV/AIDS housing program and wait list9 compare to cities of comparable size?10
I guess I would11 start by saying there's always more12 demand than there is resources available13 to serve that, but we do actively look at14 that, and we do keep a waiting list at15 ACO for our services.16
So I will help17 only because Ms. Baker needs reading18 glasses, and I don't have them for her,19 and she got up quickly. So I apologize20 let me fill in, and she'll add as we go,21 but I'd like to answer your question22 today, okay?23 Okay. So we currently have --24 as of March 2011, there were 165 people25 150 4.20.11 COMM. OF THE WHOLE - BILL 1101371 on the waiting list for what's called2 "HOPWA," which is Housing Opportunities3 for People with HIV/AIDS.4
And that's down6 from 197 the year, before so we're making7 progress on that list.8 Of those people, none of the9 people, the 165 people, on the current10 list consider themselves, or considered11 themselves homeless. So they're living12 somewhere, they need different housing.13 We try to work down the waiting list with14 housing opportunities.15 We receive money from the16 federal government to provide that, and a17 little bit money from the State.18 Concerning to us is that19 federal dollars for this support and20 State dollars for this support look like21 they're being reduced.22 (Timer bell rings.)23
So we're worried25 151 4.20.11 COMM. OF THE WHOLE - BILL 1101371 about being able to keep up even as we2 are at the moment.3 We agree that housing4 opportunities would be important. We5 also know, with my other hat on, that6 there are very long waiting lists for7 housing in general in Philadelphia,8 including for people with disabilities9 and people with serious illness.10
So we prioritize12 those folks who are in shelter and13 homeless or those folks who have a14 medical need that can't be met otherwise15 urgently and/or homeless and in shelter.16
We get17 your message. Thank you very much.18 We'll come back.19
The22 Chair recognizes Councilwoman Blackwell.23
Thank24 you, Madam President.25 152 4.20.11 COMM. OF THE WHOLE - BILL 1101371 I am glad that Councilwoman2 Tasco brought up those issues. We had3 been asked about AIDS and obviously asked4 about people, homeless people during this5 budget crisis and what happens.6 I want to likewise say, Madam7 President, this is the day we have all8 good departments who work hard and do a9 good job for us, and we likewise want to10 say that to Dr. Schwarz and his11 department and certainly say that albeit12 we ask a lot of questions, and I continue13 to contact him, even before this meeting,14 on various issues, so we look forward to15 continuing to work with him, and we thank16 him for the work that he and his17 department does.18
A point of22 information.23 We don't wait until budget time24 to ask questions of these departments; we25 153 4.20.11 COMM. OF THE WHOLE - BILL 1101371 stay in contact with these departments2 all the time. So, you know, the3 questions are just a matter of formality4 for the record, but they provide us with5 information.6
Responsive9 and through hearings we've had an various10 issues. So it's not that we lack11 interest; it's just that they've been so12 helpful.13
I18 don't believe Councilman Rizzo is here19 but his light had been on.20 Do you have any further21 questions, Councilwoman?22
Yeah, I23 just had a couple.24 Based on the current State25 154 4.20.11 COMM. OF THE WHOLE - BILL 1101371 cuts, 72,000 will be cut from consumer2 education for ACO for AIDS education3 programs. How will this cut the City's4 ability to implement a local initiative5 that is consistent with President Obama's6 national AIDS strategy?7
I appreciate you8 asking that question. We obviously are9 worried as well about State cuts.10
The 72,000, I12 will say -- and let me be transparent.13 That's a small cut compared to the larger14 cut that was included in the Human15 Services Development Fund.16
So there's about18 a million dollars in cuts to ACO that19 happened through the State cut of the20 Human Services Development Fund.21
We are looking23 now to see what we can do with federal24 dollars. And if -- while the federal25 155 4.20.11 COMM. OF THE WHOLE - BILL 1101371 government is changing some of its policy2 on housing, they seem to be, through the3 President's initiative, increasing4 funding opportunities particularly for5 prevention.6 So we're hopeful that we will7 actually be able to move some of our work8 among programs. And as you heard from9 Ms. Baker, we're also reassessing in10 terms of our service network where we're11 providing service.12
All right.16 So I'm sure we'll be working together and17 you'll be talking about what you plan to18 do.19
Let me21 just ask this final question about the22 Governor's budget and the cuts that have23 been proposed for education. If they24 shift it from education to health, how do25 156 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you think it's going to impact on you?2
Well, one, we're3 hopeful that it won't shift to health. I4 think the biggest concern for us is5 around Medicaid.6
And where that is8 particularly pertinent is that we have9 been protected to date in the State10 budget process because when health care11 reform was passed, it included a12 provision which said that states had to13 maintain their effort for Medicaid, which14 meant that they could not cut the15 eligibility of people on Medicaid.16 We are very worried that,17 through compromises that will happen18 because of the debt ceiling discussion,19 there will be a relaxation on that issue.20 If that happens and states are21 permitted to cut eligibility, then our22 Medicaid reimbursement will likely go23 down. That is a big issue for the health24 centers.25 157 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And it is -- I can answer a2 little bit about Behavioral Health, if3 that would help as well, but I can tell4 with this, my Health Department had to5 say that whatever the impact is on the6 health centers, Medicaid cuts would be7 very bad for the health of people in8 Philadelphia, not just the health of our9 health centers.10
Demand for our12 services, I think, would go up, and our13 resources would be less. But the bigger14 issue is, there are probably a lot of15 people who will be cut off Medicaid if16 eligibility can be cut have, who will17 have nowhere to go, or will go nowhere.18 We know that the largest line19 items in the State budget relate to20 education, but the second largest relate21 to Medicaid. It's almost one in five22 State dollars go to pay for Medicaid.23
So if the federal25 158 4.20.11 COMM. OF THE WHOLE - BILL 1101371 government allows the State to cut2 Medicaid, I'm very worried about what3 will happen in Philadelphia.4
I have one5 other question to ask you. You talked6 about the increase in the serviced of the7 health centers for I guess maternal care?8
Is that10 because we've lost so many -- so many11 hospitals have closed, providing those --12
Well, we've also13 provided prenatal care and postpartum14 care, and we have maintained that. We15 actually do that in partnership with the16 hospitals, the existing hospitals, so17 that we can facilitate entry to those18 hospitals for delivery and people have19 prenatal records that are available at20 the time of delivery.21
No, no.25 159 4.20.11 COMM. OF THE WHOLE - BILL 1101371 I'm saying, have you -- you've increased2 it --3
Increased6 it because some of the hospitals have7 closed?8
A little bit, a9 little bit.10 What has happened is, much of11 the change has been absorbed by other12 hospitals. And what we're seeing13 actually is, women are going outside the14 county.15 So the total number of births16 within the county appear, from17 preliminary information from a number of18 the hospitals, to be going down compared19 to what they were immediately on the20 closure of Northeastern and Chestnut Hill21 for delivery.22
And it looks like24 women are shifting to choose where they25 160 4.20.11 COMM. OF THE WHOLE - BILL 1101371 can to go outside the county in larger2 numbers for care.3 So it means that there are a4 larger network of hospitals that we have5 to worry about in terms of Philadelphia6 births, but at least it means that women7 are getting good delivery care.8 (Timer bell rings.)9
Thank you10 very much.11 Thank you, Madam President.12 COUNCIL PRESIDENT VERNA:13 You're welcome.14 The Chair recognizes15 Councilwoman Brown.16
Thank you,17 Madam President.18 Okay, I asked Dr -- help me19 out. I'm having a memory lapse.20
Dr. Evans22 about lead-related matters. We do know23 that there are new federal regulations.24 How will that impact what the department25 161 4.20.11 COMM. OF THE WHOLE - BILL 1101371 is already doing with its lead-related2 work?3
We're really4 worried about lead. We're really worried5 about lead because we have cuts in the6 State budget, which likely will impact7 the amount of money we have for lead8 abatement. And at the same time, it9 looks as though there will be cuts at the10 federal level.11
And you12 know that already, that there will be13 cuts in the State budget around that?14
Thus far. It15 depends on what happens with the final16 State budget, obviously.17
And those cuts19 are not huge compared to what we20 anticipate from the federal government.21
We already have,23 as you know, a waiting list for24 abatement. It's not as bad as it's been25 162 4.20.11 COMM. OF THE WHOLE - BILL 1101371 in past years, but there is a waiting2 list. And we're very worried about the3 proportionate cut that we could receive4 for abatement services.5 So I would like to have better6 news on that. We're thinking very hard7 about what super-cleaning. Do you know8 about super-cleaning and how super-9 cleaning has been used in many homes,10 where there are paint chips and things11 like that, to clean up or to seal --12
-- without14 removing lead, which is the most15 expensive thing.16
We've done that18 in the past; we're looking to see if we19 can do more of that. But I am very20 worried about what's going to happen in21 terms of lead-abatement availability.22
Do you23 have any idea how long that wait list is24 for families?25 163 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I know the2 numbers on it. And waiting depends a3 little bit on where you live and who you4 are and how your lead level is and so5 forth.6
I can give you11 the numbers of cases that we're waiting12 on if you'd like.13
Okay.14 Well, that's well taken.15 As I shared with Dr. Evans16 offline, we're going to go to look at17 that very closely --18
-- and see20 what alternative actions or strategies we21 need to look at, given the new budget22 constraints we're confronted with.23
It would be24 exciting to do this in concert with other25 164 4.20.11 COMM. OF THE WHOLE - BILL 1101371 northeastern and midwestern cities that2 are going to have the same issues with3 lead, because the federal cuts will not4 just affect us; it will affect us5 disproportionately because of the number6 of homes that we have with lead, but7 there will be other cities impacted as8 well.9
Oh, okay.10 All right, then. so we'll have subsequent11 discussions around that.12
In your14 testimony, you talked about how an15 appointment for an adult patient16 increased from five, six days to 6-617 days. What are the wait times at your18 busiest health centers?19
Okay. So the20 busiest health center is Health Center 1021 in the lower Northeast, and the waiting22 time at Health Center 10 is 238 days.23 And that's for adult care only. And in24 fact, the particularly long waiting times25 165 4.20.11 COMM. OF THE WHOLE - BILL 1101371 are in general for adult care.2 The next longest is at Health3 Center 6, which is at Third and Girard.4 And the waiting time there is 70 days for5 adult care, for an initial visit, not for6 a return visit.7
And given8 the earlier discussion around vacancies,9 do those vacancies in any way impact10 these realities you've just stated?11
Vacancies will12 always impact it a bit. We have -- and I13 have Carla Hill here because of the14 exemplary work she's done this year with15 the department, trying to come up with16 both a plan and move on how do we fill17 vacancies more quickly.18 We have meeting weekly with19 Ambulatory Health Services to go through20 every vacancy that they have and have a21 plan on every vacancy so we can fill it22 for Ambulatory Health.23 We have made remarkable24 progress on nurses. So a year ago, we25 166 4.20.11 COMM. OF THE WHOLE - BILL 1101371 had a shortage of nurses. I've been to2 each of the health centers throughout the3 year, and the cries I heard last year4 were, "We don't have enough nurses." This5 year, it's much better on nurses.6 The challenge for us is, we7 have a lot of job class, and filling them8 all is a big deal. But it's clear that9 the nurse and the nursing hierarchy --10 supervisors, health care coordinators --11 are very high priority.12 We also have a very high13 turnover rate.14
Nurses who come16 to work us see, in more cases than we'd17 like, come, see how hard they have to18 work, and decide they could earn the same19 money elsewhere.20
We have a very25 167 4.20.11 COMM. OF THE WHOLE - BILL 1101371 dedicated staff. They delivery really2 wonderful care, but they work very hard.3 And as a result, it's hard to retain4 nurses.5
Sure.6 That raises a real interesting7 opportunity if anyone had, you know,8 another staff person to oversee it.9 We have Teach for America,10 where teachers have to sign up for11 X-period of time. And so, linkages with12 Temple School of Nursing or Penn School13 of Nursing for young men and women who14 are coming out, any relationship at all15 with those schools?16
We've had17 relationships to help with recruitment in18 the past. It's difficult in the City19 system, in part, because we have a lot of20 hurdles, and it's a long process.21
And generally, if23 you're a new grad, you want to get24 licensed and go to work.25 168 4.20.11 COMM. OF THE WHOLE - BILL 1101371