(Photo by C. Smyth for Visit Philadelphia)
The City of Philadelphia will most likely begin its first-ever overdose fatality review by March, and a small group of advocates are pushing the city to build community oversight into the process.
A fatality review analyzes deaths in a specific population and their causes and help the city improve their services to prevent future deaths. In 2017, 1,217 people died of unintentional drug overdoses in the city — a 34 percent increase from 2016. During the first half of 2018, 539 people died of the same cause.
Advocate Brooke Feldman petitioned for the city to establish a community advisory board to oversee its overdose fatality review in October and met with the Department of Public Health to discuss her campaign earlier this month.
“While nothing can replace those who are no longer with us, these deaths can tell us an important story about if and where our City’s safety net services failed,” read the petition, which Feldman shared with city officials, including representatives of the Department of Public Health and the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). “There are valuable lessons to be learned if City officials have the courage to look — lessons that can help prevent more unnecessary deaths.”
What advocates want
A community advisory board would inform the city on what parts of its systems should be examined by an overdose fatality review, said Feldman, the president of a consulting firm who is in long-term addiction recovery herself. The board might also be involved in post-review brainstorming about ways to improve the city’s treatment services.
The city has been planning an overdose fatality review for the past year, but it’s been delayed by legal challenges.
For a holistic approach, Feldman said, members of the board should be stakeholders with different backgrounds, including homeless services providers, street outreach workers, people involved with the criminal justice system, people who tried and failed to access city services, people who were able to access the same services, and family members of people affected by addiction.
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Kendra Viner, the public health department’s opioid surveillance program manager, said the city has been planning an overdose fatality review for the past year, but it’s been delayed by legal challenges.
There are state and federal restrictions against service providers — including hospitals, DBHIDS and the city-funded insurance entity Community Behavioral Health — sharing private data about patients and treatment. But participants are drawing up memorandums of understanding to hopefully begin the review by the end of 2019’s first quarter.
There’s been pressure from the community and within the government to advance the process, Viner said.
“What this fatality review process would allow is more of a deep dive into particular individuals’ sort of trajectory toward fatal overdose and may lead to questions that we didn’t even consider,” she said.
The group’s progress
By signing Feldman’s petition, over 600 people agreed more community input is required to combat this issue. Some even left personal notes, like signer Patti Kelly:
“I am tired of burying our children!” she wrote. “I am tired of watching adults be treated for medical conditions with opioids, become addicted, and then be cast off by the healthcare system with no resources or instructions to help them off of the medication their doctors put them on. Cut off and addicted. We need answers!!”
"I'm very passionate about everybody having the same opportunity for wellness and recovery, however they define it, and with equity."
Feldman, public health policy professional Jake Bowling and recovery scientist Robert Ashford met Viner to discuss her request in early January. The group is planning to submit a proposal to Viner explaining the logistics of the community advisory board this week.
Viner believes a community advisory board would provide insight that government staffers “would never be able to provide.”
It’s also a “mechanism to get that information back out in the community and ensure the community that we’re serious about making the changes that we propose and ensuring that we’re held accountable for those changes,” Viner said. “I think it’s critically important.”
The matter of finding a solution to the city’s drug and overdose crisis is a personal one. Many of Feldman’s loved ones died of overdoses, including her mother. And without continued access to services, Feldman believes she wouldn’t have been able to celebrate her own 14th recovery anniversary recently.
“I’m very passionate about everybody having the same opportunity for wellness and recovery, however they define it, and with equity,” Feldman said. “That’s a large part of what drives the work I do.”
How fatality reviews helped other city offices
Since 2009, the city has conducted three fatality reviews of deaths in the city’s homeless population. The most recently released report examined 269 deaths between 2011 and 2015. The city has also conducted fatality reviews for infant-related deaths and child deaths.
The city’s Medical Examiner’s Office is officially tasked with conducting all of the city’s fatality reviews, said Roberta Cancellier, the deputy director of the Office of Homeless Services (OHS). More than 20 agencies have also contributed to the reviews, making up the Philadelphia Homeless Death Review Team (HDRT).
“It deepens our understanding, I think, of the population and their specific vulnerabilities,” Cancellier said. “It underscores how critical it is for systems to coordinate and communicate for the betterment of people. Thirdly, it also underscores that we’ve got to create programs that are really well-trained for wherever people are.”
To honor those who died, every Homeless Death Review Team meeting begins with a moment of silence.
To start the process, the names of those who died are given to the HDRT, Cancellier said. The group will then meet and discuss each person’s life, and a representative of the Medical Examiner’s Office will explain their cause of death. Then, OHS will detail the person’s history of homelessness. Other organizations will also contribute the information they have about the individual.
It becomes so thorough that participants begin to feel like they “really know a person’s life,” Cancellier said. She added that it’s tough work: To honor those who died, every HDRT meeting begins with a moment of silence.
But it rewards the city with lessons on where services could be improved. Past homeless reviews have influenced several programs, including OHS’ case to continue funding its winter initiatives and the opening of the city’s first medical respite program in April 2018: Serenity Court on 19th Street and Ridge Avenue houses people experiencing homelessness who were just hospitalized and still need recovery time.
Cancellier said she expects an overdose fatality review will offer the city similar benefits — with the added value of hearing community members’ input, if the city goes through with this advocate group’s idea.
To Feldman, collaboration between the city and the community is the only way to solve the city’s drug crisis.
“I strongly believe that the solutions are not going to be found in City Hall or in buildings downtown, but that they’re going to be found by city officials working with community stakeholders and the people closest to the problem,” she said. “I’m really excited about this looking like there may be an opportunity to do that, in addition to being able to have accountability and transparency in the fatality review process.”-30-
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