HEALTH AND HOUSING HEALTH AND HOUSING Collaboration at Collaboration at LASTLAST::

The LEAD ABATEMENT STRIKE TEAM

Philadelphia Department of Public Health

Carla Campbell, MD, MS; Robert Himmelsbach, BA; Peter Palermo, MS; and

Richard Tobin, MS, MPA

Pre-Collaboration:Pre-Collaboration:Extent of the ProblemExtent of the Problem

Housing in Philadelphia:

590,071 occupied units^

92% built pre-1978; 72% pre-1960^

57% of pre-1978 units (310,000) occupied by low-income residents*

60% of pre-1960 units (250,000) occupied by low-income residents*

^ 2000 Census * 1990 Census

Philadelphia Children Tested with Confirmed Blood Lead Level 10

g/dLYear 1995 1997 1999 2001

Total Tested 30,183 33,587 31,498 46,367

Total > 10 g/dL 9,554 9,652 5,898 5,395

% > 10 g/dL 32 % 29 % 19 % 12 %

CLPPP Functions:CLPPP Functions:Pre - LASTPre - LAST

Medical Case ManagementInspectionIssuance of Orders to Remediate Lead

HazardsRe-InspectionNo Further Action if Property Owner

Un- Responsive

Problems With Enforcement Problems With Enforcement Pre - LASTPre - LAST

Court-ordered lead hazard control (LHC) to be done by City without prioritization or resources

No resources for BSR (basic system repair) and resident relocation, often prerequisite to LHC

Fear of creating more homelessness and property abandonment

Backlog accumulated of 1400 properties with lead hazards

New cases continued to add to backlog (about 768 from 4/1/2002-10/23/2003)

CLPPP Functions:CLPPP Functions:Post - LASTPost - LAST

Medical Case ManagementInspectionIssuance of Orders to Remediate

Lead HazardsRe-Inspection

CLPPP Functions:CLPPP Functions:Post - LASTPost - LAST

Property Owner Responsive:– Visual and DW Compliance and Clearance by

Owner or City-Directed LHC

Property Owner NOT Responsive:– LEAD COURT PROCESS– LHC BY OWNER OR CITY-INITIATED– VISUAL AND DW CLEARANCE

Lead Abatement Strike Team: Lead Abatement Strike Team: CreationCreation

Strong community advocacy for increased enforcement and funding for LHC

Concern about the large backlog of casesIncreased interest in problem from City

Council members and Health Commissioner

Commitment for increased funding ($ 1.5 million) and activity around this issue

Lead Abatement Strike Team: Lead Abatement Strike Team: OrganizationOrganization

Partner Agencies meet Bimonthly– Policy Meetings

Decisions made about New Policies, Programs, and Direction of Group

– Program Operations Meetings Review Process to Accomplish Goals, address

obstacles and GET WORK DONE

MDO Office Coordinates the Collaboration

Lead Abatement Strike Team: Lead Abatement Strike Team: CollaborationCollaboration

ALPHABET SOUP OF INVOLVED AGENCIES PDPH—HEALTH DEPT. OHCD—HOUSING & COMM. DEVELOP. PHDC– PHILA. HOUSING DEV. CORP. PHA– PHILA. HOUSING AUTHORITY OESS/OAS—EMERGENCY SERVICES AND

SHELTERS DHS—DEPT. OF HUMAN SERVICES L & I—LICENSES AND INSPECTIONS CITY LAW DEPARTMENT

LAST Policy GroupLAST Policy Group

Why Have Collaboration ?Why Have Collaboration ? Some goals can’t be accomplished without it

– EX: Basic System repair work (OHCD, PHDC) preceding lead remediation work (PDPH)

– Resident relocation (OESS)

Pooling of resources from different agencies Sharing of expertise, knowledge of staff from

different agencies Look at problem from different perspectives Landlords can’t play one agency against the other

Philadelphia Lead CourtPhiladelphia Lead Court

Philadelphia Lead CourtPhiladelphia Lead Court

Created in 11/02 for code enforcement of both backlog and new cases

Court scheduled for three sessions a week, typically 25 cases/session

Deputy City Solicitor (DCS) and the CLPPP Program Manager represent the City

Defendant interview before start of court, we try and set agreements of when they will get the work done

This special court is one of the most efficient/effective courts in the City

Lead Risk Assessment (RA)Lead Risk Assessment (RA)

Always triggered by presence of a child with an EBL

Performed by staff who are PA-Certified Lead Risk Assessors

Full set of surface-by-surface readingsNote condition of surfaces

– Paint intact or defective?– Surface easy-to-clean?

Violation NoticesViolation Notices

PDPH issues Orders to the property owner to Remediate the lead hazards within 10 days.

Owner required– remediate deteriorated lead paint– make all surfaces smooth, tight, and easy-to-clean

Ownership determined by:– resident interview– electronic record search of Phila. Water Dept. and

L & I databases

RA Follow-UpRA Follow-UpNon ComplianceNon Compliance

Inspected 10 days after OL; if non-compliant: No-compliance letter, which includes notification

of additional legal action:– PDPH may remediate hazard and bill owner– Lead Court

L & I notified of Violation – owner rental license revoked:

– Tenant can stop rent payment– Landlord cannot evict tenant

Copy pertinent case information sent to the Law Department

Law ComplaintLaw Complaint

Due ProcessDue Process  

Complaint filed with the Court Administration; a hearing date is set

Complaint (hand) delivered to owner Owner ordered to appear in court or face

significant fines Complaint contains copies of the CLPPP’s

original order letter, no compliance letter, and other official letters, eliminating the “I never got it” argument

Lead Court (old)Lead Court (old)

Defendant InterviewDefendant Interview

Lead CourtLead Court

Court Order Form (McJustice) – all usual court decisions pre-printed

Solicitor requests by numberJudge checks appropriate box, enters

next court date specified and signs order.Clerk date stamps document, copy is

made in court and given to the defendant with explanation

Lead CourtLead Court

Solicitor asks the court for certain set judgments and usually 30, 45, 60 or 90 days to complete the work.

Provided work is continuing, each new court appearance may generate another order to “keep up the good work” and another 1, 2 or 3 month extension.

Length of time given dependent on rate of work, BLLs of and presence of children, etc.

Status of Lead Court CasesFor the period 11/5/2002 thru 11/5/2003

1,821 Cases logged by Law Dept. to be processed for court filing.

1,460 Cases filed with the court (includes cases heard & re-listed)

1,406 Cases scheduled for hearings

1,274 Cases heard in court (includes cases heard & re-listed)

752 cases ended through court action

489 have been brought into compliance

93 have been found vacant and referred to Licenses and Inspections

165 have been given to the Health Department for LHC

5 ended for other reasons

Therefore 522 cases are still in the legal process (“returning for status”)

Continuing Evaluation of Lead Continuing Evaluation of Lead Court Dust/Blood ResultsCourt Dust/Blood Results

Ongoing analyses of BLL and dust lead levels post LHC Properties repaired by the Health Department experienced

30% fewer failures in post-repair lead dust loading tests than properties repaired by their owners.

Among failed areas, the mean dust sample test results in owner-repaired homes exceed the EPA standard by significantly more than in city-repaired homes.

Preliminary BLL analyses show that in children aged 25-36 months living in properties that have come into compliance through Lead Court, post-hazard-control blood lead levels decrease less in residents of owner-repaired properties than in residents of CLPPP-repaired properties.

LAST InitiativeLAST InitiativeLead Hazard ControlLead Hazard Control

LHC Barriers (Pre-LAST)LHC Barriers (Pre-LAST)

$$$BSRRelocationCertified Lead Abatement ContractorsProtocols and InfrastructureDangerous Properties

LAST LHC Infrastructure LAST LHC Infrastructure

$ 1.5 million for LHC– Six PA-certified lead abatement contractors

under contract with CLPPP for LHC– Two CLPPP LHC crews– BSR through PHA & PHDC

Relocation (by OESS) – 11 “Safe” housesL & I Inspection of Dangerous Properties

ClientsClients

Court-ordered (166 since 11/02) Pre-Court Owner-occupied CLPPP EBL

cases at time of non-compliance re-inspection (300 / year)

Grant Applicants (100+)

Protocol – ContractorProtocol – Contractor

PA-CertifiedHave multiple PA-certified crewsAgreed to a set price listHave adequate insurancePaid after CLPPP RA OK and Dust

Wipe TestNot paid for additional cleaning if dust

wipes fail clearance

Protocol – Work EvaluationProtocol – Work Evaluation Property evaluated by CLPPP:

– Surfaces / areas / fixtures measured– Treatment determined for each surface / area /

fixture Written Work Specification Report:

– List of specific treatment for each surface / area / fixture– Cost for each treatment

Basic System Repairs completed prior to work Relocation Coordinator notified if relocation

needed Case assigned to next available Contractor, or

CLPPP Crew

Lead Hazard Control WorkLead Hazard Control Work

Typical work:– Surface Paint Stabilization– Replace Windows and Doors– Luan / vinyl tile floors

Complete in 2 weeksMust pass Dust Clearance (by CLPPP)Typical costs for LHC: $ 6,000 - $ 16,000

LAST AccomplishmentsLAST Accomplishments 2001 – 159 Properties received LHC work

– 131 by Owner– 28 by City crew

----------------- (LAST Initiative started 4/1/2002) ----------------- 2002 – 332 Properties received LHC work

– 232 by Owner– 38 by City crews– 62 by CLPPP Contractor

2003 – 510 Properties received LHC work– 395 by Owner– 19 by City crews– 96 by CLPPP Contractor

Total LAST Tally : 819 properties serving 1118 children in 18 month period (340% increase)

Why Did This Collaboration Why Did This Collaboration Work ?Work ?

Strong support from Mayor and Health Commissioner

Managing Director’s Office mandate Different agencies within city government

urged to use 3 Cs:– Communication– Collaboration– Cooperation

Staff Dedication

Benefits of LAST ProcessBenefits of LAST Process

Much improved enforcementDramatic increase in properties receiving

lead hazard controlFor every City dollar spent $2.50 worth

of LHC achieved by private home ownersInfrastructure ready for Successful

Grant Applications and Primary Prevention

For More Information:For More Information:Philadelphia Department of Public HealthChildhood Lead Poisoning Prevention Program2100 W. Girard AvenuePNH - Bldg #3Philadelphia, PA 19130-1400Phone: 215-685-2788 Fax: 215-685-2978

Carla.Campbell @ Phila.govRobert.Himmelsbach @ Phila.govPeter.Palermo @ Phila.gov