Committee Hearing, February 16, 2001

Now, we can do that because it's money that flows through the City, and this is why we're very interested in how these dollars are going to flow. But almost regardless of how they flow, I'm sure if someone believes that the religious piece and the work statement piece have not been sufficiently separated, that we'll still get the phone calls. So we will work with those as they come.

Well, tell me, is there anything new in the ideas being promulgated or are they based on, say, the Philadelphia experiences or similar ones? COMMISSIONER RICHMAN: I think it crosses the gamut. Unfortunately, I was not able to be here during the testimony for the prisons, but one of the things I know they were going to 839 2/16/01 - FY '02 OPERATING BUDGET mention is the variety of faith-based initiatives that are happening right now with the Philadelphia prison system and the involvement of many of the City's ministers to can come and sort of adopt a prisoner, to be the support system when that person is released. One of those initiatives called "REST Philly" was funded by the Behavioral Health System and begins to work together with the prison system on how do we reduce the recidivism related to drug and alcohol as people get out of prison. That one's a little different than the kind that we have done before. So there are some differences coming up rather than the traditional work that I believe we need to watch very closely.

Well, I think both sides need to be protected, because religious groups have a right to be free of government interference, and the government has the right to be free on behalf of its people of religion coming to people at the same time that they're dealing with human services. So I think it's a difficult problem for 840 2/16/01 - FY '02 OPERATING BUDGET both. If it works out, the results can be fine, and that's what we want to see happen. But I just think that it requires vigilance on both sides, and each must know their own limitations. COMMISSIONER RICHMAN: Yes, and we will try to be very vigilant.

All right, good. Now while you're speaking, Secretary, how do we get hard figures on what's happening on welfare to work? Anecdotally, it seems to me that in a number of instance when fires have been reported, for example, the number of people in the household seems to have increased. There was a recent fire where there were 10 people in a small house that were threatened. I remember one not too long where there were 13. And I'm wondering whether when people talk about welfare rolls being reduced what the real impact is and whether there are any objective studies. I have a feeling that in my community, there's a great deal of double families coming together. I know of a young couple with four children living in a single-bedroom apartment, under absolutely deplorable conditions, where the 841 2/16/01 - FY '02 OPERATING BUDGET landlord doesn't take care of anything, people are worried and can't even report it to anybody 'cause they won't let us live, you know, in this kind of a situation, and we can't afford to pay a higher rent. And I'm just wondering, is there any governmental body or any private body that's making objective studies of what's really happening? Is it a fact that families are just, you know, grouping together in larger numbers? COMMISSIONER RICHMAN: The data coming across from welfare to work across the country continues to be coming in very slowly with analysis. I do believe that it's coming. We're completing about four years at a national level, and so they can do a look-back on the first couple of years, but I'm not sure that's always the kind of information you can make definitive statements on. There is data. I'm not sure you can analyze the data to make assumptions yet. I'd be very happy to try to get you as much of that information as we can. Much of it is coming from the State level and from the national level as opposed to the local level. What we have 842 2/16/01 - FY '02 OPERATING BUDGET now is basic information about who's going to be affected by some of the changes in deadlines that are coming up next March. And all of that information comes to us from the State. The impact of that -- I think the one piece that we are aware of is that no one has been sanctioned yet, but we are expecting sanctions to start happening possibly as early as next March, so that --

Well, I'm worried. For example, there seems to be some evidence that the longevity of a job, unrelated to economic conditions but related to the ability of people to do a basic job, you know, have enough work training, so that they come into work every day and come in on time, you know, and know that they're to perform work. That seems to be a skill that's kind of difficult yet to acquire. And I'm wondering if there are any studies on that. When we hear of people getting jobs, how do we know how long they last? Are there studies on that? And then what happens when the job doesn't last? Is there a return to welfare, or is 843 2/16/01 - FY '02 OPERATING BUDGET there this bundling up in just larger family groups? It's raised all kinds of problems for us with respect to quality of life, family safety, and so forth. COMMISSIONER RICHMAN: The initiative by Philadelphia Workforce Development, called Greater Philadelphia Works, actually has put out a couple of reports about what has happened within that framework around job retention and what happens to people if they don't hold a job. I'd be very glad to get you a copy of the report. Again, I would caution you, this is data as opposed to always analysis, but I think it can give you some feel around the challenges that folks are facing as they make that transaction from welfare to work and what happens next.

Could I ask you to give us your analysis. What are your conclusions as of now, knowing that the question's coming to you without you're knowing about it and you're not having all of the documentation available? What is the general feeling that you have as to what's happening with that program? COMMISSIONER RICHMAN: Depending on how 844 2/16/01 - FY '02 OPERATING BUDGET much support is given to a person making the transition determines to a large degree on how long they will hold that job. People are changing jobs, are moving between jobs fairly frequently with downtime in between. We know there are people who have been working, who, at the same time, are still approaching their 60-month point, which means they haven't worked for long enough to be able to stay off of that list for right now. It is an area that I am becoming much more knowledgeable of than I thought I would be at this point in time. Again, I would like to give you an analysis of how I view the data as opposed to talking too much off the top of my head.

Thank you very much. I'd appreciate very much receiving it. Thank you, Madam Chair.

You're welcome. Councilman Reynolds Brown, did you want to be recognized? (Councilwoman Reynolds Brown responds off-mic.) 845 2/16/01 - FY '02 OPERATING BUDGET

Thank you. I think there are a few more questions, but certainly, I think maybe we should move on today. Again, kudos for the great job you're doing. And certainly, Madam Secretary, we went to thank you for your leadership in many controversial areas in the City to help people in need and people with special problems. And, again, thank you all. Are there any other questions. (No further questions.)

Thank you very much. COMMISSIONER MARTINEZ: Thank you for your time and support.

Thank you. (Break taken.) - - - (Proceedings resume.)

Thank you very much. We're ready to resume our hearing. We'll now hear from the Health Department. Thank you very much for your patience as well. 846 2/16/01 - FY '02 OPERATING BUDGET (Witness comes forward.)

Please identify yourself for the record and begin, Commissioner Tsou.

Good morning, Councilwoman Blackwell and members of the Council. I'm Dr. Walter Tsou, Health Commissioner. Thank you for the opportunity to present the Health Department's budget request for Fiscal Year 2002. Joining me is Deputy Commissioner Michael Covone. 15 billion. 4 percent, comes from City tax-supported, up from 61 million in Fiscal Year '01. 7 million, or 86 percent, is for Behavioral Health and Mental Retardation Services. Today our testimony will be divided into these two areas. I will speak on new programs in Public Health, and Deputy Commissioner Mike Covone will speak on Behavioral Health and Mental Health and Retardation Services. " We are also working collaboratively with our fellow departments and Social Services to address the public health challenges presented by the Report Card 2000. In the area of children, Mayor Street has reaffirmed his commitment to the Year of the Child. Under the Director of Social Services, we are working with other agencies to promote a more integrated and coordinated delivery of children's services. For example, two of the Health Department goals, insuring a medical home and obtaining health insurance for every student, are also the two major health goals of the School District of Philadelphia. In working with the Department of Human Services, we plan to direct our Temporary Assistance for Needy Families (TANF funds) to implement a nationally-recognized, intensive, nurse home-visiting program for first-time mothers in areas of the City with high incidence of child abuse and neglect. Healthy Start, a public-private 848 2/16/01 - FY '02 OPERATING BUDGET partnership to reduce infant mortality, which began in West and Southwest Philadelphia, has now expanded to lower North Philadelphia, with an additional half million dollars in Fiscal Years '01 and '02. In the area of HIV and AIDS, the federal Ryan White Care Act is the major source of funds for AIDS treatment services in Philadelphia. million, an increase of million from last year's grant award. ) implemented the Philadelphia HIV Prevention Continuum, a redesigned continuum that offers a range of access points into the prevention system for every high-risk group across the City. 2 million community access program grant from the Health Resources Services Administration. This program, called "Health Right," will track uninsured residents in North Philadelphia to assure that they receive appropriate care. In the area of environmental health, the West Nile Virus, a recently-identified cause 849 2/16/01 - FY '02 OPERATING BUDGET of encephalitis in New York and New Jersey, was identified in mosquitos and birds in Philadelphia in late fall last year. We anticipate that this virus will survive this winter. 1 million statewide. A special challenge for our department will be the assumption of animal control services in Fiscal Year '03. And after many years, the SPCA has decided not to renew our animal control contract. In conclusion, we are very proud of the people who work in our Department of Public Health. Together, we are enthusiastic and optimistic about working to meet the public health needs of the City in the coming year. Thank you for the opportunity to give testimony today, and I will now turn to my colleague, Deputy Commissioner Mike Covone. And after his testimony, we would be both pleased to answer questions. DEPT. COMMISSIONER COVONE: Good morning. My name is Michael Covone, Deputy 850 2/16/01 - FY '02 OPERATING BUDGET Commissioner, and I'm here to present testimony on the Behavioral Health and Mental Retardation Services. I, too, will provide a brief overview of the full testimony, which has been provided to you. The Behavioral Health System consists of three major components that coordinate the City's treatment services for approximately 100,000 adults and children annually. The three components are: the Coordinating Office of Drug and Alcohol Abuse, the Office of Mental Health, and Community Behavioral Health.

Mental Retardation Services is the office responsible for the development, coordination, and monitoring of services for over 11,000 children and adults with mental retardation. Approximately 98 percent of the resources dedicated to these services are State and federal resources. Over the last year, the Behavioral Health and Mental Retardation System, under the Director of Social Services, has established collaborative relationships with its sister social service agencies. Much of this effort has focused 851 2/16/01 - FY '02 OPERATING BUDGET on improving the effectiveness and efficiency of services. 's Office, of a multi-systemic therapy program aimed at reducing the number of children requiring out-of-state residential care; The establishment of a process to assure that eligible inmates leave the Philadelphia prison system with medical assistance in order to ensure access to court-ordered behavioral health treatment; The establishment of a multi- disciplinary team jointly developed by Mental Retardation Services and DHS, which will provide home visiting services to parents who need assistance in raising their children and managing a household due to their mental retardation. While many of the initiatives noted above are still in their early stages of implementation, the cross-system collaboration associated with these efforts has established a strong foundation for success in current and future initiatives. 852 2/16/01 - FY '02 OPERATING BUDGET During Fiscal Year '02, the Behavioral Health System and Mental Retardation Services will undertake additional initiatives aimed at streamlining access to and availability of services, while at the same time, taking measures to assure that those service result in positive outcomes for consumers. The Behavioral Health System is working to enhance community safety by reducing criminal recidivism due to substance abuse and mental illness. This effort will include the continued and expanded provision of behavioral health treatment and related services under criminal justice supervision as an alternative to incarceration. The increase in the Fiscal Year '01 State appropriation for Mental Retardation Services was the first of a five-year plan to reduce the statewide waiting list. Based on the Governor's budget for Fiscal Year '02, which continues this commitment, the Mental Retardation Program anticipates significant growth both next year and over the course of the next four years. Finally, over the course of the next 853 2/16/01 - FY '02 OPERATING BUDGET few years, Behavioral Health and Mental Retardation will implement a performance-driven system for contracted services. Payment will be tied directly to provider performance in key areas of effectiveness such as the number of people with disabilities that get and keep jobs and the reduction and recidivism rates for individuals receiving inpatient services. These indicators of quality will be developed with the involvement of consumers, families, advocates, and providers. The first year of this implementation will involve training and technical assistance to agencies as well as feedback on areas where they're doing well and areas where they need to improve. I too want to thank you for the opportunity to testify this morning, and will welcome any questions for Dr. Tsou or myself.

Thank you very much, Mr. Covone. Because Councilman Rizzo has to leave the room to make a presentation, we will call on him for questions. Can we have his mike on, please. Councilman Rizzo. 854 2/16/01 - FY '02 OPERATING BUDGET

Thank you, Madam Chair. Thank you, Sergeant-at-Arms. Commissioner, welcome. I believe this is your first budget?

My first.

The first question that I have is that we've learned that -- and you can explain the relationship that you will have with the methadone program in our prison system. DEPT. COMMISSIONER COVONE: Joining us at the table is Assistant Commissioner Mark Bencivengo, from the Coordinating Office of Drug and Alcohol. (Witness comes forward.) ASST. COMM. BENCIVENGO: The Coordinating Office is assisting the prison in developing the methadone detoxification program in the prison and is assisting the prison in getting the necessary licenses and approval in order to dispense methadone behind the walls.

Is this a Health Department program or a prison program? ASST. COMM. BENCIVENGO: This is a Behavioral Health Program, but it is being run by 855 2/16/01 - FY '02 OPERATING BUDGET the prison.

Could you tell us how much the prison system or your department have budgeted for this methadone program behind the walls? ASST. COMM. BENCIVENGO: We have not budgeted any funds from CODAAP for this particular project. Prison Health Services would be responsible for funding it, and we can make available to your office a break-out of that cost center, if you would like that.

I'd appreciate that information going to the President of City Council so we can discuss that. So you're telling me that we're -- SECRETARY RICHMAN: Let me jump in real quick, Councilman. The money to fund this program was in the $26 million that went into Philadelphia Health Services, and that was a contract that was basically let by the Social Services, the contract was drawn up, and we've been guiding on that. And it is a joint initiative between Health and prisons, but we're the ones basically driving that 856 2/16/01 - FY '02 OPERATING BUDGET in the Office of Social Services. We are currently for you getting the precise amount of money that is within that $26 million, and it's a fraction of that money, obviously. But we originally included it, and the operation of it will be within the contract for prison health services.

I think because of the possible controversy associated with the program, it might be very helpful to have a dollar amount associated with the support, the budgeted money, the process, and licensing it. I'd like to really know what this program's going to cost. And, Commissioner, for the record, and again I want to state it, that State prisons do not have a methadone program at this time, and I also checked with the feds, and there is no 19 methadone program in the federal institutions as of today. COMMISSIONER RICHMAN: That is correct, Councilman. And one of the reasons for that is, those are considered, quote, long-term programs. A City prison system is typically a short-term program, and it's only targeted at people who are 857 2/16/01 - FY '02 OPERATING BUDGET currently on methadone when they come in. And many of those folks are released fairly quickly because it isn't considered long-term program. So that when you have someone who has been on methadone, say, for ten years, and you know they're going to be in our prison for approximately a year, and you don't want them craving heroin when they get out, you want to maintain that treatment. The total amount of people -- and this is not for new people; this is for people currently on the program. And the number of folks that will probably involved in it is somewhere in the order of 15 out of the 7,000.

But I think it's safe to say that you just described a scenario in our City prison system that I believe we also have that same circumstance in the State facilities also, and they do not have a methadone program. There are short-term people incarcerated in State facilities. COMMISSIONER RICHMAN: I know you're right, but most of the time, we transfer people to the State prison after they've been in the City 858 2/16/01 - FY '02 OPERATING BUDGET prison for a year or two.

Okay, we'll be watching. The next question is this -- I think it should disturb us that the Pennsylvania SPCA has indicated that they're not going to renew the animal control contract with the City of Philadelphia. And I know that a lot of this is based on a decision on theirs and pitbull and other aggressive animals that we haven't dealt with here. They don't particularly like the fact that they are just asked to be the killers of dogs. Commissioner, do you think -- 'cause I want to ask you to be a little specific on how we can do, and I hear we've been looking at other agencies to do this, but if we undertake the animal control project that the SPCA presently administers, and I'm not talking about just going out and collecting stray dogs or aggressive dogs; I'm talking about all of the work that the SPCA does for the City. How much money would the Health Department need to construct an organization that would perform the services of 859 2/16/01 - FY '02 OPERATING BUDGET the SPCA if we had to do it in-house?

We're right now trying to explore all of our options in terms of trying to find either an alternative vendor who can substitute for the SPCA and/or studying doing it in-house. We estimate -- our current contract with the SPCA, I have to say, is $790,000. It's a very good contract for the City in the sense that the SPCA supplements that money with some of their own funds to help the animal control program. If we were to replace all of the animal control efforts that the SPCA does, we believe that it could easily exceed $1 million for the City.

Would you say that again?

We believe that it could exceed $1 million.

What million dollars you're saying?

It could exceed. And we would obviously need to discuss all of this with the Budget Bureau. We believe, however, that this is an issue for Fiscal Year '03. 860 2/16/01 - FY '02 OPERATING BUDGET

Commissioner, but I think -- I think we'd better start discussing it now.

Mm-hmm.

I think that that figure that you just threw out there, $1 million, is far from what it would take to replace the SPCA. We don't have a facility, we don't have any of the facilities. How could you build a facility? Could you just revisit that number one more time on how much it would cost the City to duplicate the services of the SPCA? Because I think I didn't hear you correctly.

Well, I understand your point. What I'm saying to you is that there are many aspects of trying to do animal control itself. In fairness, we believe that it will be difficult for us to fully replicate everything that the SPCA has been able to do. At a very minimum, I believe that we would have to spend at least a million dollars to try to do animal control services in the City. But I believe that the number could be higher. And what I'm saying to you is that we 861 2/16/01 - FY '02 OPERATING BUDGET have to explore all of the other possible options, including other vendors out there who may want to provide this service.

Could you give me a feel for other than SPCA, who these other vendors may be?

Well, we've been actually looking around to find other vendors who could do animal control. We have not been successful at this point, but we believe that over the course of the next months -- in fact, by September this 13 year, we will have a definite plan in terms of 14 what our plans are for the animal control plan in 15 the City. 16

Commissioner, this leads me to the point that the SPCA is pulling out of this contract. The fact that I think it's more politics at this point than anything. Do you think, Commissioner, that we could sit back down -- and I'd be willing to sit at that table -- sit back down with the SPCA and address the concerns of -- and I know one of their requests to us is to ban the pitbull from the streets of the City of Philadelphia, and I think they approached it in a 862 2/16/01 - FY '02 OPERATING BUDGET way where they weren't just asking for every pitbull to be put in a cage, that they wanted to phase the pitbull out because of the problems associated with the breed. Do you think we could sit back down -- and I'd be willing any day of the week, hours a 8 day, to sit down at the table talk to Eric 9 Hendricks, to talk to the executives at the SPCA, 10 because when you're saying to me it's a million 11 dollars to replicate the services that the -- 12

No, I said "at least a 13 million dollars." I didn't say that that's the 14 full amount. 15

Well, with all due 16 respect to that, I think that that's not even a 17 realistic figure to suggest that we could do this 18 even for $3 million. 19

Mm-hmm. 20

But my point being 21 is, do you believe we can salvage the relationship 22 and renew the interest of the Pennsylvania SPCA to 23 continue as the company that -- as the 24 organization that manages the animal issue in the City of Philadelphia? Have you tried to do that, 863 2/16/01 - FY '02 OPERATING BUDGET Commissioner?

We've had extensive discussions with them, including the issues --

Have you? COMMISSIONER TSOU: Yes, I have personally had discussions with Eric Hendricks on this issue. And we have discussed this whole issue, including the issues of what would it mean if we were to even ban pitbulls and whether that would be an incentive. This is beyond even one breed as an issue. They are philosophically moving toward a policy where they will move toward rescue and adoption as their only business and away from euthanasia for animals who are stray animals. And because of that, they are not interested actually in the animal control contract for Philadelphia.

Well, I was told that they would be certainly interested in the animal control contract for the City of Philadelphia, if the City of Philadelphia would make some changes to the way we deal with these aggressive breeds. I'm sure the SPCA would not have a problem of taking a dog down if the dog was 864 2/16/01 - FY '02 OPERATING BUDGET injured or needed that remedy. So, again, I would hope -- because I know -- I have a -- COMMISSIONER TSOU: I welcome --

I have a feeling, Commissioner, that the taxpayers of the City of Philadelphia are going to be the ones that have to pay the freight for this relationship -- this breakdown in a relationship between the City of Philadelphia, if it's the Health Department specifically. And I have a feeling this is going to be very, very expensive, because I don't know too many organizations -- maybe this would encourage somebody to get in the business of animal control, but I don't know any -- I don't know any today that would be able to step in. And, again, I think it's going to be very, very expensive. So I'd appreciate this being revisited. I'm going to call Eric Hendricks myself to see if he would be interested in meeting with us to discuss this issue to see if it can be salvaged.

I would welcome your help 865 2/16/01 - FY '02 OPERATING BUDGET with this issue.

My next question is --

Excuse me, Councilman, may I piggyback on that?

Yes, ma'am.

I think the SPCA had a real high budget, not just for Philadelphia. It may be something like 44 million, some real high number. And as the Commissioner knows, we did pass legislation here that would do four things. The State doesn't allow us to regulate breed-specific legislation. That was the problem. Councilwoman Miller is working on a resolution asking the State to rescind that law that does not allow us to deal with breed-specific animals or dogs. What we did however, was pass legislation that dealt with vicious dogs that would permit -- provide for four things: One, it would up the fine; two, it would enact penalties for those training dogs to be attack dogs; three, it would certainly penalize the place being used, if a person would allow their home or a place to 866 2/16/01 - FY '02 OPERATING BUDGET be used to deal with vicious dogs; and, four, it allow for immediate temporary seizure of dogs that could be returned if, in fact, they were not being trained to be attack dogs. So this City Council has done some things, which we tried to tell the head of the SPCA, who decided that he wanted to run City Council and the whole universe when it came to dogs. We found him extremely offensive. I will say to you, Commissioner, that I have had some dealings with individual who have been working on putting together a company, some people who did, Councilman, work for the SPCA, who are now interested in trying to put together something. They are at the point -- we have not come to you because the package isn't all together, but they're at the tail-end of a place certainly large enough, and they've been dealing with some people that could have such a facility, and to decide what in fact what in fact the budget would be to do all of that. It's a massive undertaking. But I've said all of that to say that we do have some people who are interested. And, 867 2/16/01 - FY '02 OPERATING BUDGET you know, if you feel it would be helpful to involve you in these preliminary discussions, we'll be glad to do that because they've been talking about it since we had our last budget with the SPCA. Certainly, we find it offensive. You know, I don't think you have to fight people and pay them too. We found their attitude extremely offensive, as if we wanted to turn our heads and as if this Council certainly wanted to support attack dogs or pitbulls attacking people. And so we found them extremely offensive, because the SPCA director did not want to hear that we don't control by law breed-specific dogs. If we could say outlaw them all tomorrow, we would have been glad to do that, but we don't control that; that is a State mandate. Councilman, certainly we want to thank Councilman Rizzo for his interest then and now in seeing that we do something about this. But, Commissioner, we'll be to you in short order, as soon as the organization has finalized this package to see what the City and your department, what part you might be willing to 868 2/16/01 - FY '02 OPERATING BUDGET play and what they think able to do on their own.

Thank you very much, Madam Chair. That gives me some comfort to know that there's something being developed.

Thank you.

That could replace this organization.

Excuse me, one moment before you continue, and I know we said you could go first. Councilwoman Blondell Reynolds Brown wanted to introduce some of the students here. Before she does, I will take the initiative to introduce our leader Greg and some Friends of Malcolm X Park, who are here, and there he is in the back. Greg, raise your hand so people can see who works so hard in my district. (Applause.)

And that is Friends of Malcolm X Park. Many of you know it as the old (indiscernible), but it's Friends at Malcolm X Park, across the street from Huey School, at 52nd and Pine. Councilwoman Blondell Reynolds Brown, 869 2/16/01 - FY '02 OPERATING BUDGET you wanted to do introduction? There are other schools here.

Sure. Thank you very, very much. Because the time is sensitive for the young people who are here, and they're here to be strong advocates with regards to Friends of Philadelphia Parks we want to salute, welcome, and celebrate the presence students from the Huey School and the Elmwood Elementary School. (Applause.)

And let the record show that they are in your district, Councilwoman Blackwell, and we know that you know very much about the good work they are doing as public policy-makers for tomorrow. Thank you very much.

Thank you. We also understand that some students are here from Cassidy School. And let me say to all of you at Huey School. In fact, I have big posters, but now is not the time, I suppose. We are really trying to make Malcolm X Park a model for the City. We have prevailed upon Children's Hospital and they have committed $200,000. We've already -- the City has already invested another $245,000. So I 870 2/16/01 - FY '02 OPERATING BUDGET say to everybody and all of my colleagues around the City, this will be a model for the City. It's a special place, the Friends group works well, and we're looking forward to having puppet shows, we're going to have a gazebo in the center of the park. At night, we hope to have jazz shows there for the adults in the community. We're doing a public-private institutional partnership there, where a developer is going to -- a private developer going to invest private funds in 75 houses on the periphery. As I said, we have Children's Hospital who's invested $200,000 in addition to the City's $245,000 for Children's Hospital for playground equipment. And Huey School is across the street and the church, a faith-based organization across the street. So we will show you what public-private institutional faith-based school partnerships can be. Thank you. (Applause.) - - - 871 2/16/01 - FY '02 OPERATING BUDGET (Recorded by Lisa C. Bradley, RPR.)

Good afternoon. My name is Louis Rossman. I'm an Assistant City Solicitor in the Law Department. Councilman, I'm not going to prepare to give you a definitive statement on legal issues surrounding the needle exchange program, but if you you'd like, I am prepared to give you a brief outline of what I think are the legal issues surrounding the program. First of all, in addition to the executive order about which you're aware, I believe that the Health Department has authority to develope something like the needle exchange program under its general charter authority which is under section 17 5-300B of the charter to conduct public health programs. In addition, I note that under state law, 35PS Section 521.5 local boards of health and departments of health may, based upon a report of a disease that is subject to a particular type of control measure, the local body is authorized to carry out that measure in such manner as they may prescribe by rule or regulation. And I note that 872 2/16/01 - FY '02 OPERATING BUDGET prior to the executive order that was issued in June of 1992, the Board of Health adopted a resolution 4 endorsing a needle exchange program as an emergency public health measure to control the spread of HIV and AIDS in the City. The question about how the needle distribution program -- needle exchange program might be prohibited under law is a question of whether state criminal law regarding the distribution of drug paraphernalia would apply. I think there's two issues that are raised there. The first is whether under that criminal statute you would have, when public health officials are contracting for this service, you would have the requisite criminal intent that the legislature meant to instill in that criminal statute when they distribute needles in exchange program for public health measure. The other issue, I believe, is that given that there is a state authorization, a particular authorization for local boards of health and departments of health to adopt particular control measures to control the spread of disease in the local area that you have to consider how that specific authorization to the local Health 873 2/16/01 - FY '02 OPERATING BUDGET Department, how that would play into an interpretation of the criminal statute and whether that might in the case of a local a health department in some affect the drug paraphernalia statute. I also note, as you noted, that the program has been in effect for nine years. The law enforcement agencies that are responsible for enforcing the criminal statutes in Philadelphia, the DA's Office and the Attorney General's Office of the Commonwealth have not, as far as I'm aware, ever sought to challenge the program or prohibit the program. In fact, I think at the inception of the program there were discussions with the DA's Office about the program, and they were not opposed to the City's participation in the program. So the particular enforcement agencies involved have, I think, over the course of nine years demonstrated that they do not believe at the least even if there is -- they have not demonstrated that they believe that there is a violation of law or that they feel that there is an enforcement action they should take.

Counselor, I know 874 2/16/01 - FY '02 OPERATING BUDGET you're a busy attorney in the Law Department, but I would appreciate that opinion to the Chair. And again, I made my statement earlier that maybe the DA, maybe the State Attorney General at the time overlooked the law based on the need. But I've been asked by my constituents that live in the area of the distribution of the needles that they have obviously a probably with it and there's concern about the program. And the question is constantly asked of me, is it legal or is it not. And once you're able to tell me, sir, in that opinion that it is -- and I hear what you told me today, that it is a legal program and it is not just a program that is being -- an issue that is just avoided by law enforcement. I would have no problem telling my constituents that we are administering a program that conforms to the law. I thank you.

Thank you, Councilman. We'll work on that and we'll get that opinion to you.

Thank you. Thank you, Madam Chair.

Thank you, Councilman. Might I note that in my area, I 875 2/16/01 - FY '02 OPERATING BUDGET neglected to ask the DA earlier, but in the same area where we have the highest rate of infant mortality and we're focussing on the Mayor's blight program, we had the trucks out there to give out the needle exchange program and we think it's a great program and we're glad to have it and glad to have the opportunity to try to protect people and prevent more death than already exist. That's my personal opinion. Commissioner Tsou, let me thank you for helping us with helping us with an immunization program. Two years ago, maybe three now. Time, as Councilman Cohen knows, time moves very quickly. But we had a youngster die, a seven-year-old. His name was Kylon Tyler (ph) from McMichaels School due to bacterial meningitis and it just motivated us to get involved in immunization. We started that one school two years ago. Of course, this year, thanks to your help, just yesterday we had an immunization school. We try to do three clusters and increase it. And next year, we want to increase it more. I know there's some debate about where we immunize kids. And I know that the recreation commissioner is talking about doing. I think the more, the 876 2/16/01 - FY '02 OPERATING BUDGET better, especially since we have this HIV serum that has to be given to students by the time they're in the sixth grade. And I wondered if you have any particular strategy or if you see any particular need that we should be aware of in trying to help this program, the immunization program, be all that it can be. COMMISSIONER TSOU: Let me briefly say that we appreciate all the efforts of our fellow agencies who want to help promote immunizations. Clearly, childhood immunizations is one of the most cost-effective things we can do in public health. And by expanding our sort of domain of people who can speak on this issue, I think it helps us. And we're also proud of the fact that the State of Pennsylvania has taken some initiatives in making school-based vaccines. Barb, you want to say anything about our special immunization efforts we're doing in the Philadelphia that maybe the councilwoman might be interested in hearing about.

Thank you, Councilwoman Blackwell and Walter Tsou.

Please identify 877 2/16/01 - FY '02 OPERATING BUDGET yourself for the record.

Dr. Barbara Watson, advisor to the immunization program for the Philadelphia Department of Public Health. There are several aspects. We are trying along with maternal and child health and DHS of having every child have medical home, and we really see that as one the key points. So in working with the Academy of Family Practice and the Academy of Pediatrics is to facilitate each child getting into an office on time. The early childhood welcome home visit and the kids immunization registry has turned out to be the most important factor over the last seven years of increasing our immunization rates which have prevented the measles outbreaks that we had in early '90s and have prevented a number of other diseases. But we continue to need to do more work with that because a lot of children go from one provider to another provider up to five times in any year. And the constant question that comes back is, well, what did they have, what do they need? At this point, the registry is fully populated and providers are finding that it's very much more helpful than it was when we first developed it. So the work that Walter 878 2/16/01 - FY '02 OPERATING BUDGET Tsou has done for getting funding for that registry has been a great success. Obviously, once you get levels up into the 90 percents, there does tend to be complacency. Addressing the issue about meningitis, there is now a new vaccine to prevent pneumonococcal meningitis and hopefully in the children under 5 we will start to see impact of that as we've seen in impact on all the vaccine-preventable diseases. At this point in time, there's some issues with various insurances not covering it. Again, working with the pharmaceutical agencies as well as the Academy and Department of Health, all of those kinks hopefully will be decreased.

I think we're doing a lot better job. When this initially happen, everybody panicked. The School District panicked and the City panicked and we handled it badly. But now we have an organized, and the Deputy Commissioner was very, very helpful during that period. And we have a much more organized way we deal with diseases. And I think that sometimes we have to remember that none of us created it, but it is our job to try to help organize it and resolve it 879 2/16/01 - FY '02 OPERATING BUDGET and make life better for students and the citizens of our City. So we're committed to working with you toward that end.

And just to recognize the out reach as well. They do an enormous job of educating in the homes as well as the child care. So we're trying to be in all places.

Thank you very much. Commissioner, you mentioned elevated blood levels and lead levels. I see Bernard Johnson here. It's his issue since I've known him. In fact, you mentioned elevated blood levels will be fewer than 900. Could you explain the significance of elevated blood levels and what you found this year and how do you see us attacking this problem? COMMISSIONER TSOU: Well, we have to begin by saying that we have a naturally recognized success story in lead poisoning in Philadelphia. And over the course of the last six or seven years, the incidence and prevalence of lead poison children has dropped dramatically. To give you some sense about this, an action level of over 20 micrograms per deciliter would be -- in 1998 we had approximately 5.8 percent of the kids that were 880 2/16/01 - FY '02 OPERATING BUDGET screened who had levels over 20. Just two years later in 2000, that number is down to 2.1 percent. So we've actually cut it in half. And those who have very high lead levels despite the fact that we've greatly increased screenings for lead. I think it's a really a tribute to many of the people who work in our lead program that we've done so well. We, obviously, don't want to rest on our laurels and we want to continue our efforts to try to reduce the number of children who might be lead poisoning. The month most serious complication of lead poisoning, as you are probably aware, is the problem of learning disabilities and its effect on school readiness. So we do see this as an important issue for us and for our children.

You may not know, and maybe we'll have to ask the School District, but we still get complaints that in schools where clean drinking water is supposed to be brought up that it is not happening in all schools. Are you aware of any of that. COMMISSIONER TSOU: We're aware that, as you know, we've had about 20 percent of the drinking water supplies in the School District had detectable 881 2/16/01 - FY '02 OPERATING BUDGET levels greater than parts per billion of lead. And we have actually ordered those drinking fountains to be shut off and that bottled water be brought in in its place. We've now extensively been able to assure ourselves that school kids are not drinking water that has lead contamination in it and we're working on a biweekly basis with the School District and EPA and the Health Department and Water Department to assure that a remediation plan is in action.

I will ask Mr. Johnson if he would refer to me or the Commissioner because he has heard that there are some schools where it's not happening. We'll ask him if he'll get that information to us so that we can pass it on since you're dealing with it biweekly. COMMISSIONER TSOU: We can.

Thank you very much. In terms of infant mortality, as you know I have one of highest -- in my district we've had many problems. I see Virginia Brown and others who have worked with us in Mantua. Where do we stand in terms of our success rate? I know we've done a lot in the past and in terms of your testimony on 2/16/01 - FY '02 OPERATING BUDGET 5, in decreasing in this area, infant mortality? COMMISSIONER TSOU: Well, again, the good trend is that our infant mortality rate is in fact decreasing. Our rate of approximately five years ago was around infant deaths per thousand 7 life births. We're down to the most recent 8 statistics n 1998 of 12.3 infant deaths per thousand 9 live births. 10

Do you have any 11 more recent data than 1998? We'd certainly like to 12 have it for Mantua if we can get it and Kingsessing. 13 COMMISSIONER TSOU: We don't have more 14 recent data yet. We are dependent on the state to 15 give us the statistics, so we're waiting for the 16 state data sets to come in.

Do you have any idea when that would be, Commissioner. COMMISSIONER TSOU: When that would happen? We don't know when that would happen, but it should happen sometime this year. Beyond that, I can't say.

All right. Thank you. There have been some changes with our overall City organization of HIV programs. I don't 883 2/16/01 - FY '02 OPERATING BUDGET quite know why. I've always thought that we were a leader in this country with all the programs. I've never had a person referred to my office or who has called and we haven't been able to try to secure them help within the City system which is why I always support community base health in any other program where we can be tied -- where our constituents can be tied to government because it always gives us referral systems. Where are we with regard to AIDS programs. And I suppose that reorganization started before you came in. And why was there a need to reorganize? And do you fund some agencies, changed things around, and that's about all I know about it other than I realize there has been some changes. COMMISSIONER TSOU: Well, we also have a naturally recognized AIDS program in Philadelphia. And the good news, I think, is actually in terms of dollars because between last year's Brian White Care Act which came into this Philadelphia and this year we've had an increase of $4 million which is actually one of the highest of any City in the country. That's a recognition I think on the federal of success that we've had. 884 2/16/01 - FY '02 OPERATING BUDGET What is part of the success, I think, is the fact that is the fact that we actually have a very intensive community based program effort to try to make sure that our programs are focussed in terms of HIV prevention and minority communities and to those people at the highest risk for HIV and also to provide services and treatment services in those areas. Joining me up here right now is Pat Bass who could perhaps speak a little bit about our programs.

Good afternoon. My name is Pat Bass. Councilwoman, I think you might be talking about the fact that we have just procured a great deal of our dollars in case management and outreach. We have restructured outreach only in that we are now asking our outreach workers to really collaborate with both primary care and also with counseling and testing so that we have now gone through a training program. And so that while it might look like it's been a change, certainly it's been our effort to make sure that we are unifying folks who know thier diagnoses who are not in care, those who are newly diagnosed, and those who are 885 2/16/01 - FY '02 OPERATING BUDGET engaged or who live in risk-based communities. And so that the change, I think, really has been a change in just how we are providing the services. But, yes, we have actually just gone through a procurement. It has always been our intent that when new monies come into the City that we do this. We've always outreached minority providers in particular. And to be sure that when we do the out reach for procurement that we engage minorities providers, the small CVOs in the process. We give them the technical assistance so that they can effectively apply for the dollars. And once the awards are made, we give them the kind of technical assistance that they need to build their infrastructure so they can be successful in providing the services.

Thank you. Might you know, Ms. Bass or any of you, I understand that on you mentioned prison health services offer three days of HIV medications to released inmates. Is this really enough time to even to get an appointment at a health center? Psychotropic drugs also for the mentally ill are available for three days. How can this be helpful given the 886 2/16/01 - FY '02 OPERATING BUDGET nature of these illnesses?

We have focussed on case management sort of discharge planning in the prisons. And the idea is that we would give folks -- we would begin to engage them before they're discharged and we would give them the medications and then they can get an appointment with the community health centers and so that there is no 10 wait for that. So that once the case manager knows the person is being released, we can outreach this person and we can get them an appointment so that we are able to put them into ambulatory care. The issue is if let them go longer than the three days without engaging them, then we worry about them being lost to care.

I see, so you try to control it. Incidentally, in fact, Councilman Rizzo mentioned it on his way out. But if my memory serves me right, just as an aside on the SPCA, I think our figure was something like $8 million. I think it was $8 million we give SPCA, if my memory serves me right because we spent a lot of time with the director telling us off and blaming us for pit bulls. That's just an aside. He's one of 887 2/16/01 - FY '02 OPERATING BUDGET my favorite people. I'll be waiting for him when he comes back. On and 9, you mentioned the rising costs of prescription costs. Have we been in touch with Harrisburg regarding the plight to maybe use some of the tobacco settlement money or other funding sources to help this cost? Are you involved in that aspect of care? COMMISSIONER TSOU: Councilwoman, you are correct that we are very hopeful that the tobacco settlement money can help offset some of our prescription costs. And there is discussion in the Pennsylvania House that some of the money will be used for this purpose. It will be primarily aimed at senior citizens to supplement the Pace Net program that is currently in place. Of course, we have a wider audience because we serve all individuals regardless of their age and we do have a large number of uninsured individuals who come to our health centers who do need support for their prescription drugs. But we do believe that tobacco settlement can be of some benefit to us.

Thank you. Are there questions? Councilman Cohen, you're next. 888 2/16/01 - FY '02 OPERATING BUDGET

Thank you, Madam Chair. A number of years ago the City Council passed an ordinance dealing with the waiting period that occurs at the City 's health centers. At that time, the goal was to have no more than a two-week waiting period. And we're getting many complaints that the waiting period runs from three to five weeks. I wondered, Dr. Tsou, if you could comment on that and tell us what our goal is because I know in the business world if somebody had to wait a day, it is a crisis. And we think human health is pretty important and the health centers ought to be much more available. Go ahead, sir. COMMISSIONER TSOU: Let me start by saying that there is some differences in terms of adult versus children. For adult visits, there are more difficulties in getting the first appointment. And part of the problem actually deals with having the full staffing that we would like in all the centers. But in the areas of pediatrics, most pediatricians can be seen within three weeks and frequently they can be seen even within a few days. So we believe that at least for our most vulnerable 889 2/16/01 - FY '02 OPERATING BUDGET citizens, our children, they are able to easily get access to pediatric care. All of our health centers have walk-in capabilities and those who really do need help always have the right to come in and walk into our health centers. But we are concerned also about trying to see our patients more expeditiously and we are working on management issues internally to try to improve so that people don't have such a long wait time.

Well, is there any way of developing a plan in the Health Department that would achieve that goal that appointments should always be within the two-week period, preferably much shorter, but no longer than the two-week period. What would it take to do that? Could I ask that the department come up with a proposal for that, because it just seem wrong that the population that needs most care and is least capable of getting it, we indicate to them, you know, it's really not an emergency, whatever your health problem is. COMMISSIONER TSOU: Well, we will work on this issue. I'm going to ask Assistant 890 2/16/01 - FY '02 OPERATING BUDGET Commissioner Mike Lucas if he could make a comment about that.

Hello. My name is Mike Lucas. I'm an Assistant Health Commissioner.

You're going to have to speak into the microphone. The acoustics here is awful. And I won't accept the fact of my age being difficulty in hearing because I hear as well as anybody else if the voice comes through, so please speak into the microphone.

My name is Mike Lucas, Assistant Health Commissioner in the Department of Public Health. As Dr. Tsou said, we measure appointment availability in the health care centers by looking at different populations. If we look family planning -- we look at family planning, prenatal, dental, adult care, and pediatric care. The good news is that for prenatal care and for pediatric care, there's almost a hundred percent, if not a hundred percent chance you're going to get an appointment within a couple of days, not just three weeks, within a couple of days. For dental care, for the most part, except for two of our health care 891 2/16/01 - FY '02 OPERATING BUDGET centers, you can get an appointment within a couple of days. Pediatric care, as I said, it's easy access, as Dr. Tsou said. Adult care is slightly different. In five of our eight health care centers, you can get an appointment within the three-week period of time. It's the other three health care centers that we operate in which it varies. It goes anywhere from three weeks to five weeks as you suggested. Part of the issue is one of the health centers, Health Center No. 4, is currently under renovations. With the renovations, we did have to curtail the number of new appointments to patients to accommodate the renovations. As a result of that, we believe many of the individuals in West Philly are overflowing to Health Center 3, which is the second health center which has been having a problem for adult care and that's why it ends up being over the three weeks. The last center is Health Center 10 which does have appointments that take longer than three weeks. What we can provide you, if you wish, is what it would take us, some kind of plan, including a budgetary plan of getting us to a level which is deemed satisfactory by everyone. 892 2/16/01 - FY '02 OPERATING BUDGET

We would like that because there's nothing City Council can do unless you present us with a plan. We appreciate the fiscal needs of the City, but we think we ought to have the right to make a policy decision as to whether a bundle of money goes in one direction or another and we really can't think of anything more human health, particularly to that portion of the population that's least capable providing it for itself. So we'd like you to have a plan then we'll have a decision to make and we'll do it hopefully in cooperation with the Mayor's office. But Council will have a chance to express its opinion on a policy. I think a policy of three to five weeks is not an acceptable policy for the provision of health care for the neediest of Philadelphians. So could we set a time period? We'd like to get it so that if there is agreement in City Council and there are discussions with the Mayor, we would have an opportunity possibly to make the revision in the budget or to provide additional funding. What would be the time period required to provide a plan? We know that you don't make the ultimate decisions. We know that commissioners have to report to a higher 893 2/16/01 - FY '02 OPERATING BUDGET authority, secretaries, managing directors, finance directors, ultimately the Mayor. But at least Council would have the information so we can have an intelligible conversation with the officials we would have to deal with to make changes in the budget. Could we have a preliminary program within a week? Because our budget moves on a pretty fast schedule. COMMISSIONER TSOU: How about within two weeks.

An outline indicating the budgetary needs. And including in that was another question I had, there seems to be a special prime in the pharmacy department. The pharmacy seem to be especially overburdened. It may have something to do with what's happening in the area where payments are made that may be driving a larger portion of the population into pharmacies. I don't know whether that's the case or not, but the reports we get is that it's often impossible for the pharmacists and the clerk that some pharmacies seem to have and some don't seem to have. I don't know what drives that, but we think that there's got to be a provision for increased assistance in the 894 2/16/01 - FY '02 OPERATING BUDGET pharmacies that are not able to handle the flow. The third question I'd like you to incorporate in all of that would be the question of filling of vacancies. It seems to take an uncommonly large amount of time for a vacancy to get filled. I know there's a general personnel policy that says don't bring anybody on board until you've completed the payments, including vacation time and sick leave time sometimes for people that have left. But we think in your department there ought to be very special consideration as there appears in the police and fire department, all have to do with saving lives and you had the same problem of saving lives as the police and the fire people do. You were in the non-uniform category, and I think the urgency is just as great. So if you could prepare such a plan, I'd be appreciative. COMMISSIONER TSOU: We feel we can do that.

Thank you. And one other question. I don't know where the questions, you know, what their based on or what the origin is that Councilman Rizzo raised with respect to methadone and point of prevention and other things, 895 2/16/01 - FY '02 OPERATING BUDGET but I think there is common agreement -- and please disagree with me if you think I'm wrong. As I understand it, there's common agreement by all professionals in the field overwhelmingly that the so-called war on drugs as being waged in the United States has pretty much been a failure. And if prison population has anything to do with it, that seems to be direct proof because the budget at the state level on cost of prisons have risen, I think, by 10 fold over the last 20 years. And it's also generally considered that the use of drugs and drug addiction is a very major cause of that cost inflation and the numbers of people who are in our prisons. We're the most uncivilized country in the world if we were to judge civilization by percentage of people in jail. And it seems to be as a result of the drugs. I think we have close to two million Americans in jail or on probation or parole at any given time. It's an unbelievable figure. And I think drugs plays a large role in it. And I would like to see, and help me if you can, is there a comparison of a cost? I think the cost to taxpayers throughout the whole country for the inflated number of prisoners coming into jails because of drug 896 2/16/01 - FY '02 OPERATING BUDGET addiction as against the cost of attempting to bring about some cures or relieve some people from the pressures of addiction which apparently tend to create much greater crime. Is there any kind of analysis like that? Because it seems to me totally lopsided. Seems to me we're hardly spending anything on drug rehabilitation, drug prevention, you know, addiction prevention, and we're paying hundreds of millions of dollars in taxpayer funds to support not only building of new jails, but the staffing of them and so forth. It seems to me we maybe going in the wrong direction. Did you have any thoughts, professionally? You're all professionally in this area.

There is some information we can provide you on some of the initiatives that are currently going on relative to prison and drug and alcohol treatment. Forensic Intensive Recovery Program is one area that we can provide you some information on the success rate of that particular initiative which is really linking individuals to leave the prison system to services in the community by tying in the criminal justice system with them and actually having folks ordered to those services. 897 2/16/01 - FY '02 OPERATING BUDGET

It seems to me the explosion in cost at the state level of the prisons and the staffing of them is what causes the Governor to kind of mete out in very few numbers the dollars for the school system because of the demands of the cost of the prisons. And that seems to me just the wrong direction we ought to go. We ought to spending much more money on our kids and much less in prison confinement, certainly, if there's any other way of dealing with a population which causes crime largely because of drug addiction. So we're so happy when we get a few extra million dollars from the state for schools and the need is so much greater. Yet hundreds -- I think the state budget used to cost around a hundred million. I think it's into a billion, maybe two billion on maintaining prisons. I would appreciate if you could furnish the Councilmembers with whatever exists in the field of professional opinions about how you deal with drugs and the results of building more prisons as against drug prevention. Maybe in the prisons system it seems to me that maybe that is a good place to begin with because most prisoners ultimately come out, and it would be great if they 898 2/16/01 - FY '02 OPERATING BUDGET come out free of drug addiction. Otherwise, we're going to have that revolving door. So whatever you can furnish us I think would be very helpful to us in developing our policy in the City of Philadelphia. Thank you very much.

Could I ask for an a yield for a moment?

Yes.

Councilman Rizzo.

Thank you, Madam Chair for this opportunity. Based on data, I talked some folks also that have indicated that the rehabilitation program is, A, very costly and it has not been as effective as it could be or where we would want it to be. Is there a report or data that could indicate the performance of the programs that we spend a tremendous amount of money on so we can see how successful we are? Is there anything at all that we can read to help us better understand where the taxpayers' money is going and how well it's being handled? I'd appreciate a report like that be sent to the Chair because I'm not sure whether we do a 899 2/16/01 - FY '02 OPERATING BUDGET good job, whether we're doing poorly. Could you just comment briefly on the performance of these various programs and what we can read to substantiate your comments?

Mark Bencivengo. We have an initiative that Michael Covone referenced called the Forensic Intensive Recovery Program where we arrange in conjunctions with the District Attorney's Office and the Public Defender where we arrange for early release for people from the county jails. We've now completed a 48-month study of people post Forensic Intensive Recovery Program. That is, people who came out and were placed into substance abuse treatment programs and then we followed them for a total of 48 months. The first time we did the study, we followed them for about 18 months. And we did it a second time and followed them for 48 months. And the measure that we looked at specifically was reconviction, people who had gone through or program and whether or not they were reconvicted of a subsequent crime versus people who had not gone through the program and whether or not they were reconvicted. We can make those reports available. They are very positive in terms of the 900 2/16/01 - FY '02 OPERATING BUDGET affect of the Forensic Intensive Recovery Program, and you'd really need to look over the long term. I mean, what is the cost of crime in a variety of ways and in terms of its impact on the quality of life. We will be glad to make those available Council President.

Correct me if I'm wrong. You're pointing out one specific program. I'd like to see the results of the entire universe of money spent on all of the programs and understand how successful all of this money that is being sent -- I mean, if we have to look at each program, that's fine. But I'd like to better understand of all the monies spent how effectively is it being spent? Is that possible?

That would be a much taller order. I'd also mention it's quite important that the amount of general fund City dollars that are spent on this program is actually quite small. There's a much larger amount of Medicaid dollars spent on this program because the services that the programs provide are Medicaid-eligible services and they're able to seek reimbursement for providing those services. So one would have to look at. 901 2/16/01 - FY '02 OPERATING BUDGET

It skews the --

There's multiple sources of money coming in, and as I said, the City dollars are very, very modest in terms of supporting substance abuse programs.

Would the feds have -- would they have looked at the performance of the programs? I can't imagine them not.

The federal government, and particularly the Center for Substance Abuse Treatment has funded a number of much more limited evaluation similar to what we funded around the Forensic Intensive Recovery program. So there are slices of the substance abuse rehabilitation program that have been looked at in various research projects. We are constantly reviewing the literature that comes out in an effort to let our decisions be guided by data and best practices in establishing programs in Philadelphia. So while we have a number of studies, they may not be specific to Philadelphia; they are specific to substance abuse rehabilitation efforts in general.

Thank you. Thank you Madam Chair for allowing me to 902 2/16/01 - FY '02 OPERATING BUDGET have Councilman Cohen yield to me. Thank you.

You're welcome. Councilman Nutter.

Thank you, Madam Chair. There's been a lot of discussion about this and I know this is an issue that Councilman Rizzo cares very deeply about. He's asked a lot of questions about, he has a right to ask questions about and try to get answers to his questions. I wanted to try to get a sense of where we are with all of this and where we're trying to go, but the first think I'd like to understand, I think it's sometime important that we know, quite honestly, who we're talking to. Now, Mr. Bencivengo, how long have you been with the City.

Twenty-eight years.

And always in the CODAAP area?

Always in the substance abuse CODAAP area.

What's your back ground and training in this area? 903 2/16/01 - FY '02 OPERATING BUDGET

My academic background is graduate degree in sociology, particularly criminology and deviant behavior.

And you've worked for the City for 28 years and you've been in the drug abuse substance abuse area all of that time?

All of that time. I'd also mentioned that I'm on a number of national groups that look at the substance abuse problem from a national perspective.

So you've been working in an area for a while and I think under any set of criteria you would be a considered a practicing professional in this area?

I would say so, yes.

At least from your perspective, you know what you're talking about. Mr. Covone, what particular area for you.

I've been in the mental health and mental retardation area for 17 years.

What's your background and training.

Actually, a degree in 904 2/16/01 - FY '02 OPERATING BUDGET accounting and I've worked in various aspects in both program areas, mental health and mental retardation and administrative areas.

Dr. Tsou, MPH, what is that, a master's in publish health. COMMISSIONER TSOU: That's correct.

Let me try to understand this. Is the current research and literature in drug abuse/subtance abuse area now determined that drug abuse and substance, is that something that people engage in just because they want to or because they like it, or is it now considered in the medical profession to be virtually a disease?

Increasingly there's recognition that substance abuse is a disease, and in fact, Dr. Alan Leshner (ph) of the National Institute on Drug Abuse in his presentations, and he is an M.D., presents scientific evidence pointing to the disease concept of substance abuse.

If we stay along that particular path, do we provide any other medicines to treat disease of people who are either in prisons, on probation, not in prison but have 905 2/16/01 - FY '02 OPERATING BUDGET other medical needs? Do we help people who people who have diabetes? Do we help people who have heart disease, liver problems? Do you deliver any other medicines to people who have disease? COMMISSIONER TSOU: We do provide medications for other people with other physical illnesses.

Do we have contracts with providers? The other issue that was raised was with regard to the methadone. What would happen if the person came into the criminal justice system and they had been however they were doing it, but had been in a methadone treatment program prior to there incarceration? And I think the Prisons Commissioner testified the other day that our average length of stay, I believe, for an adult male is 54 days or maybe 74 days. I don't have those notes in front of me at the moment. What would happen if the person came in and we stopped providing methadone, although they had been in a program prior to their incarceration? What do you think would happen with that individual?

They would experience the discomfort of withdrawal from the methadone. 906 2/16/01 - FY '02 OPERATING BUDGET

And does that have any behavioral ramifications? Will it affect how they act while they're in our care? And what happens when they leave?

I would posit that it would very definitely impact on their behavior in the prison. Obviously, they're uncomfortable, they're feeling sick and they may find it difficult to adhere to prison rules feeling that way, yes.

Do we have any contracts with providers involving the provision of methadone for people in a non-incarcerated situation?

Yes, we have approximately 10 methadone programs in the City of Philadelphia. The first one, I believe, was licensed in the late 1960s.

And why do we do this?

I happen to believe, and other people in substance abuse also believe that in areas where there are high levels of open addiction, that you'd want to have full array of treatment responses. And methadone is very 907 2/16/01 - FY '02 OPERATING BUDGET definitely a legitimate treatment response. I'd also mention that in 1998, I believe it is, 43 states, including the District of Columbia, had methadone programs, including 58 in the State of Texas. Pennsylvania has 28 methadone programs; and I believe that approximately of them are here in 8 Philadelphia. 9

And methadone is 10 recognized as one of the leading treatments to deal with heroine addition?

It's one of the leading treatments in dealing with opiate addiction, in this case it happens to be heroin addition.

Is Philadelphia considered one of top centers on the East Coast for both heroine use, heroin transportation and heroin purity?

There's a program called the Domestic Monitor Program which is run by the drug enforcement administration. The Domestic Monitor Program makes street-level purchases of heroine in approximately 22 cities across the United States. In the most recent Domestic Monitor Bulletin that I saw, Philadelphia ranked No. 2 in 908 2/16/01 - FY '02 OPERATING BUDGET terms of the quality of the heroine available at a street level and the price per milligram pure. So the answer to your question is yes. There is a fair amount heroin, a large amount of heroine in Philadelphia. It's very high quality heroine, and the price is very reasonable.

You said we were No. 9 2 out of 22 cities?

I believe it was 22 cities, yes.

Do you know what the No. 1 City was?

I think it was either Baltimore or Newark.

Also on the eastern seaboard corridor. Okay, thank you for that information in that area. I want to go back to two areas where my colleagues have been. First, the comments that the Chair made with regard to the SPCA. I have not been that actively involved in the on whole SPCA issue. I can say, though, as a person who has attempted on a couple of occasions to access their services based on complaints by my constituents -- and I don't know 909 2/16/01 - FY '02 OPERATING BUDGET this individual, Dr. Tsou, that you've been dealing with. I have not high level discussions with anyone from SPCA, but I can say that on most occasions, they have been non-responsive to anything that I've asked them to do or that my office has asked them to do. We didn't get into who's who or who's calling or anything. It was a problem. There was an issue. It's my understanding we had a contract with them, and I have this quirky little thing about me that if I have a contract or the City has a contract with someone, I actually expect them to perform according to the contract terms and conditions. And I have had tremendous negative response from the SPCA. I do not know all the particulars. I don't know whether it's substantive issues, personality issues, or what the problem is, and quite frankly, I don't care at this point. If it gets worked out, that's wonderful. If not, we'll find somebody else to do the work. But on a personal level, representing a specific area, they have been nowhere in terms of responding to the constituents that I call on behalf of. With regard to lead abatement, I think it's on or 4. of the testimony. The 910 2/16/01 - FY '02 OPERATING BUDGET one thing I never really understood about what we do in the lead abatement area, and you're certainly to be commended for the statistical information that you laid out. Who gets tested or who gets screened? What's the population of children who get the screening? You know, it's kind of like one of those situations where, you know, who do pollsters talk to? I've never met anyone who was ever polled by a pollster. I don't know anybody whose child has ever be screened. And I'm not saying you're not doing the work. I don't understand how it happens. COMMISSIONER TSOU: Dick Tobin will speak on this issue.

My name is richard Tobin. I'm director of the Childhood Lead Poisoning Prevention Program. Last year there over 40,000 children screened in Philadelphia. They screen primarily in hospitals, doctor's offices, clinics across the City. We do some limited screening with our community outreach workers. When we find an area where we feel it's being underserved or we feel there's particular problem. The greatest concentration of children is in North and Central and West Philadelphia in the highest risk areas, but 911 2/16/01 - FY '02 OPERATING BUDGET screening is now spreading out throughout the City in a number of areas and particularly in terms of children who are on MA. That's a requirement under the EPSTT Program that the doctors do the screening. We get recording on the screenings through the City's public health lab and also through laboratory reporting from private labs across the state.

Forty thousand kids out of an estimated population of how many?

It's probably somewhere around a little over a hundred thousand in that age range.

What's the age ranger that you're primarily concerned about?

One through six.

One through six?

One through six years of age.

And you're saying that the City does 40,000 on our own?

No, there's 40,000 screened in the City. We do only a very limited amount of screening ourselves.

Well, what happens 912 2/16/01 - FY '02 OPERATING BUDGET with the other 60,000 kids?

I wish they would get screened.

What are we doing to help them get screened?

We are educating doctors and parents to ask for screening. And many of those children do get screened within that age range. In other words, if I were to look at a five-year spread in that age range, there's substantially more tan the 40,000 that we just screen last year. Some kids get screened each and every year for the first six years of their life. Some kids get screened each as the department recommends at least each year for the first three years of age of life which is the highest risk time. Some kids get screen once in that whole period.

Tell me a little bit about any affirmative steps that we take to encourage screening. And for instance -- and maybe you already do this. What particular steps have we taken, for instance, to encourage all public employees to make sure that their kids, their grandchildren, their nieces, nephews, or anybody 913 2/16/01 - FY '02 OPERATING BUDGET else get screened? Do we send material out to all the public employees? Do we stuff anything in the pay envelopes? Do we have anything on the web site? Does stuff go around?

We do have information on the web site. We have sent mailers out with Water Department bills. We've also had some public service announcements on. We concentrate a great deal on the medical community. We hold provider meetings and conferences periodically and try and push it because even if parents don't remember to ask to have their child screened, the doctor should know that this is something that they need to do.

Do we need to do more outreach?

We always need to do more outreach. We have concentrated outreach programs. We have community health workers who do presentations on a City-wide basis to parents groups, to day care groups and to basically anyone who will sit down and listen. Be more than glad to give one here.

Maybe we should. Councilman DiCicco has, quite frankly, lead the 914 2/16/01 - FY '02 OPERATING BUDGET effort here in City Council, for instance, on giving blood. I mean, it's one of a number of things that we could probably shine some additional light on. As a result of his efforts, I have, for instance, become much more sensitive and will now on a regular basis give blood to the American Red Cross. I think to the extent that either public employees are being asked and encouraged to look after little ones in that situation and then the general employer population, working through whether it's Greater Philadelphia First and partnering with those organizations to provide some emphasis to their workers. I mean, that's the kind of thing that really should be promoted and encouraged throughout our entire community to the extent that people are thinking about this. I understand your emphasis on the doctor because at least at that point they kind of have the kids. But apparently -- would you agree that a fair number of young people do not get this kind of screening which then has tremendous implications later on in their lives?

There are a fair number of young people who aren't screened. However, they tend also to be concentrated in the lower risk areas 915 2/16/01 - FY '02 OPERATING BUDGET of the City. As we've increased screening, for instance, going out to the newer housing in the Northeast, we found very low incidences in those areas. There's very little incidence for the number of kids who were getting screened. In the highest risk areas with the oldest most deteriorated housing in City, we find a very great penetration in those areas because historically that's where we've concentrated our efforts.

Well, what I would ask you to do, if you forward to the Chair, one, I would like -- and it's been dangerous around here the past couple days to ask for any maps, but I will ask you if you could get us some maps that show the gradations of these concentration levels as well as where you think the population is throughout the City of Philadelphia. If you could forward that to the Chair and then in some reasonable period of time maybe share with us what you think an ungraded outreach program might look like and what City Council can do both directly and potentially from a funding standpoint to help support that.

Absolutely.

Thank you. 916 2/16/01 - FY '02 OPERATING BUDGET

Councilman, I'm Susan Lieberman and I'm Director of Division of Early childhood, Youth, and Women's health. I'd just to add a little bit to Mr. Tobin's testimony. In all of the outreach programs that we do, which include Welcome New Families which is a program for all new parents with information packets, for our Home Visiting which is nurse home visiting and lay home visiting, and outreach programs for a Healthy Start. We include information about the importance of lead screening so that we're trying very hard. We work with community organizations who actually do an excellent job of getting the word out about lead screening, nutrition, all kinds of activities which improve mothers and babies' health.

Thank you, Madam Chair.

Councilwoman Miller, you're next.

Thank you. Just as a follow-up.

I'm sorry, Councilwoman. You'll have your follow-up. 917 2/16/01 - FY '02 OPERATING BUDGET Councilwoman Brown was next. Sorry.

I just wanted to do a point of order.

Certainly.

In regards to lead base paint, I just wanted to ask a question regarded removal. How many do you remove -- lead base paint removal from homes, particularly in the areas you just identified, how many homes did you do last year? How many do you expect to do this year? If there's a backlog, what are the plans to address the backlog because that's important, too. The education and whatnot is really good, and the testing. But also removal is key to us addressing the problem of lead base paint.

Lead paint removal, at one time we did lead paint removal with blow torches and scraped it off and it was a fairly quick job to do. And unfortunately, that was wasn't right way to do it. Doing it properly is a very expensive and tedious process. We don't always get houses into compliance. Now, we get -- I don't remember the number right off the top of my head. But there are about a thousand houses that have come into 918 2/16/01 - FY '02 OPERATING BUDGET compliance within our open case load right now. That doesn't mean nothing's been done in them. We outreach workers speak to the parents and the parents very often will do what they can in those situations. Many of those houses, more than half are owner-occupied or low-income owner occupants. In many cases, they don't have the resources to safely do that removal. We try and qualify them for HUD grants. We try and get these jobs done, but there are probably a thousand houses out there where we have found lead base paint and hasn't been completely removed.

Well, if they qualify for a HUD grant, then they can get it removed?

If they qualify for a HUD grant, we work for the Office of Housing for the HUD grants. If they meet all the qualifications in there, they can get a contractor which is a certified contractor under the Commonwealth certification laws, come in and do the paint removal work and do the necessary work that need to be done to make the house safe. Very often, people can't qualify because of problems with title and things of 919 2/16/01 - FY '02 OPERATING BUDGET this nature. And what we try to do in those cases is help them to get it in the safest condition possible. The one thing I will say is during the last quarter, none of the children who received follow-up testing for lead had an increase in their blood lead level. I think we've been very successful in terms of teaching parents what to do, even in an environment that does contain lead.

It's really important because I know in my district there are lots of old homes. Lots of us aren't fortunate enough to live in areas where they have a lot of new homes. I just think that -- I just wondered if there's anything that we can do at the City level to help people get this hazardous material out of their homes. And maybe we can talk about that at some other time. Thank you. Thank you, Madam Chair.

You're welcome, Councilwoman. It appears to me that I've learned from this hearing that we don't have a handle on this problem. Maybe if there could be some added focus on assessing where the problems are and what the needs are and then you can make budget requests, 920 2/16/01 - FY '02 OPERATING BUDGET then we can be of more assistance to you. But we need you to direct us. And certainly, when you have people -- I already mentioned Mr. Johnson. He is in here screaming all the time. And, in fact, we're getting a new school because of the screaming that we started on lead paint. And anybody who knows him, knows that's his issue. But I understand his concerns because we really, really don't have a handle around the extent of this obviously enormous problem. So if you help us to make those assessments, then we can try to help you to petition the Administration for the money, okay?

Thank you.

We will wait for a new minutes so the stenographer can reset her machine. Thank you. Just momentarily. (Brief recess.)

Thank you for your patience. I have Councilwoman Reynolds-Brown, you're next.

Thank you very much. I want to follow-up concerns raised by colleagues around the lead issue and underscore Councilwoman Blackwell's remarks that it really is 921 2/16/01 - FY '02 OPERATING BUDGET indeed an enormous problem. So let me attempt to get some additional facts. You mentioned that currently 40,000 young people have been screened; is that correct, lead poisoning expert?

During the last year there were 40,000 children screened, yes.

And approximately 60,000 remain to receive that service.

A number of those 60,000 kids may have been screened in the year prior to that also. In other words, you have a five-year period when the child can be screened or should be screened for lead.

Would it be fair to draw the conclusion then that if there are approximately 60,000 young people left to be screened or either re-screened, that equals the 1100 homes on the waiting list? Is it a conclusion arrive? I mean, you mentioned that there are 1100 homes on a waiting list.

The 1100 homes are related to children that were found with confirmed elevations. Not necessarily -- they're all children who were screened, but there were a lot of 922 2/16/01 - FY '02 OPERATING BUDGET kids who were screened who don't have the confirmed elevations.

What happens in cases where lead has been determined to be in a child, they receive the treatment, and they go back home where lead may still be present? What happens in an instance like that? What do you do? Is that not a potential reality?

That is a potential reality. Lead exists in probably about 95 percent of the houses in Philadelphia -- well, about 80 percent total Philadelphia; 95 percent of the older housing in Philadelphia. Children do go back and in some cases we do have teams we can send out to do housing reduction work. In other cases, that work is done by the owner or by the occupants. But we also have outreach workers and the inspectors are also trained to work with the parents to show them where the greatest hazard is in trying to eliminate that hazard. In some cases, you may still have a lead hazard present in the house. If you teach the mother to wash the child's hands repeatedly and continuously and keep them away from that area, he won't have as much exposure as he had when he was 923 2/16/01 - FY '02 OPERATING BUDGET going there. The children can come back and come back with high elevations after a treatment if they are continuing to be exposed.

How many homes do you clean up each year, approximately?

With all of our inspections, there are a couple hundred homes that do come into compliance. Our own crew only did 30 years homes in the past year because of limited resources and the fact that we didn't have full staffing during that time.

So if you did 30 this past year and there are conceivably 1100 on the waiting list, that simply underscores Councilwoman Blackwell's remarks that it's enormous and we'll never get ahead of the curve because we're always catching up. So I, too, will look forward to the data that Councilman Nutter has requested which can give City Councilmembers of Council an idea on where the bad marks are so that data and best practices can then drive a strategy that moves towards eliminating that 1100 homes that are still waiting to be addressed. What's the relationship with the School 924 2/16/01 - FY '02 OPERATING BUDGET District? You mentioned a number of partners. I did not hear the School District. You do mention on of your testimony, and I quote, "We also work closely with the School District to support our current lead prevention efforts." Please elaborate on that.

Right now the School District is a process of testing the drinking water in all the schools. They're almost completed the testing. They've run over 18,000 tests on over 16,000 water outlets. They've turned off all of the outlets, to the best of our knowledge, that were found to be elevated or that hadn't been tested yet. We have a couple of people on staff who full time are monitoring the School District's efforts in this regard and will continue to work with them through the process of remediation. We don't work very really strongly with School District in terms of screening primarily because of the age of greatest interest for lead screening is actually --

One through six?

The age we cover is one 925 2/16/01 - FY '02 OPERATING BUDGET through six, and the greatest interest is actually one through three, and they just don't have those kids for most part at that point. Also, the head start programs and things of that nature are also doing -- they do do some screening in conjunction with some other agencies and we don't really do that.

I hear what you're saying and recognize that the School District for the most part begins to touch children lives around three or four years old. But implicit in that may be an opportunity since the School District begins to touch young people between the ages of three and six and because your data say that you deal with young people one to six, that an opportunity might to exist to do some kind of linkages prevention types of things to get to parents who have children between the ages of three and six. I would suggest that you look at that and consider that is an opportunity.

And as a part of our outreach efforts, we do do those sort of things. We do have our community health workers making presentations at schools, at head start centers, at 926 2/16/01 - FY '02 OPERATING BUDGET day care center and things in association with the School District. There just isn't a big formal plan that sets it out as a part of the School District activity.

Very well. Your answers are well taken, but again I underscore Councilwoman Blackwell's remarks; it is an enormous issue. And to the extent that you all enlighten us and raise our antenna, it gives us the ammunition we need to put this as priority funding matter on the front burner when it comes to this time of year, budget time. So we'll look forward to the date that Councilman Nutter has requested so we can work with you in making this a front burner funding priority. Thank you very much. I have question now that I need see the leader of CODAAP. If I could ask him to please come forward. I simply want to follow-up on what Councilman Cohen eloquently touched on. I noticed in the testimony and I looked at the charts and, there are charts that speak to what's happening around disease control, AIDS prevention and early childhood. Currently $45.5 million are spent by CODAAP for a range of services. A lot of discussion 927 2/16/01 - FY '02 OPERATING BUDGET on this floor was given TO one side of the equation, which is what we do with young people, what we do with City residents after they've been touched by that disease. Let's look to the flip side of that equation, the prevention side. I need to hear what's happening, I need to hear what amount of dollars are being devoted to prevention, and I need to hear what's happening in the School District as relates to prevention so young people are at least enlightened because we know that when we look at the explosion of what's happening in prisons, if you track it, most of that is related to drug abuse. So what are we doing in the area of prevention and what percentage of this 45 million is devoted to prevention?

That's a very good question, but I would also like to say that when one does treatment and one treats, let's say, moms who have children or the dads, when you have a recovering person going back to a household, very often those households are reunited and those folks act as very positive role models for their children. Every spring I go to a number of graduations of treatment programs and I'm always very pleased to 928 2/16/01 - FY '02 OPERATING BUDGET see the numbers of children at those programs that are being reunited with their mothers and fathers who are now in recover. So while one can focus on prevention, you can also look at the impact of treatment with the adults in bringing those families together and, in fact, conveying a prevention message. But with regard to the specifically to your question, there are three programs which CODAAP funds that work within the public and parochial schools and they work in a variety of schools, a number of schools. Also, there are, I believe, 12 community-based organizations that do preliminarily after-school prevention programs in the neighborhoods. We call it our Youth Risk Reduction Project. There are three programs that work with -- specifically new programs that we just started that work with adolescence. One does outreach in case management with adolescence who are not yet really involved with substance abuse but are at high risk for substance abuse. In terms of what percentage of the 45 million that goes into prevention activities, I would say probably in the neighborhood about 20 929 2/16/01 - FY '02 OPERATING BUDGET percent of the monies that come into us from the state goes into prevention programs.

The programs you mentioned, you said that there three programs in the schools, or did I mis-hear you, including the Youth Reduction Project?

There are three projects that work in the school. The Corporate Alliance for Drug Education works in a number of schools. Shalom works in a number of schools. And Jewish Family and Children Services Project Pride works in a number of schools. And then there are the Youth Risk Reduction Programs which are community-based organization that do primarily after-school and weekend activities.

And they're funded by the percent you get from the 19 State? 20

They are funded within that 20 percent, yes.

Councilwoman, I just wanted to add one point to that also. There's also 60 consultation and education specialists that are funded in a variety schools throughout the City in 930 2/16/01 - FY '02 OPERATING BUDGET each of the clusters, clusters throughout the City. They're basically a frontline resource to the school administration and to children who may be experiencing some type of behavorial health, not only drug and alcohol, but potentially behavorial health services and then link back to a variety of resources. So that's in addition to what Mark testified on the drug and alcohol front.

I think it's very 11 important to note that while within the pages that 12 you have, there's a budget for CODAAP and a budget 13 for OMH and so forth, that these offices within the 14 behavorial health system work very closely together 15 so youngsters who are at risk of, say, substance 16 abuse which are very many young people, are touched 17 by the entire constellation of monies that are 18 within the behavorial health system. CODAAP has an allocation, and we're accountable to the State Department of Health for that allocation. But there's more money in the behavioral health system that touch kids.