Social Services Chief’s Appointment Advances

The city’s acting social services chief promised that the Health Department under his watch will follow the letter of the law regarding lead hazard inspections and abatement — and suggested that preventive inspections represent the best long-term strategy for combating child poisoning in this city.

Mehul Dalal offered those public health insights Monday night during his confirmation hearing before the Aldermanic Affairs Committee in the Aldermanic Chambers on the second floor of City Hall.

Mayor Justin Elicker has tapped Dalal to serve as the city’s next permanent community services administrator (CSA), a City Hall coordinator position that oversees the Health Department, the Youth Services Department, the Project Fresh Start Prison Reentry Department, the Office of Housing & Homelessness Services, the Food Policy Council, and the Elderly Services Division.

Dalal, who lives in East Rock, served from 2012 to 2019 as the state Department of Public Health’s chronic disease director. He previously worked as a primary care physician at New York City’s Bellevue Hospital and at New Haven’s Fair Haven Community Health Care, and as the medical director of quality improvement at the New York City Department of Health’s Cardiovascular Program.

The committee alders decided to take no action on Dalal’s appointment Monday — just as they did with the other two coordinator appointees interviewed, Michael Piscitelli and Scott Jackson. By this tehnical inaction, they expedited the process by which the full Board of Alders can vote on those items early next month.

Dalal touted his background in both clinical medicine and public health policy development and administration as key qualifications for the municipal social services coordinator job.

“I don’t think health in itself is the end,” he said. ​“The end is we want to be healthy to achieve our goals and live our lives.”

He said he ultimately made the professional transition from being a physician to working in public health administration and policy development because of his belief that good policies, and not just good healthcare, are critical for solving seemingly intractable social ills.

“Optimistic,” ​“Confident” On Lead

Downtown/Yale Alder Eli Sabin began his inquiry of Dalal by asking about where the city currently stands in reforming its lead hazard inspection and abatement enforcement policies and procedures.

He also asked about where the city needs to go next in order to ensure that children under 6, especially those from low-income communities of color, are adequately protected from lead paint hazards and the lifelong behavioral and developmental disabilities that come from lead poisoning.

“We’re actually making very good progress with respect to realigning and reestablishing and redesigning the protocols with respect to lead,” he said.

The Health Department under the former mayor was repeatedly sued by legal aid and chastised by multiple state judges for not adequately enforcing New Haven’s lead ordinance.

Alders unanimously voted to update the local lead law in December to clarify that an elevated blood lead level of 5 micograms per deciliter (μg/dL) in children 6 years old or younger qualifies as an ​“actionable blood lead level.” 

That law update requires what judges and legal aid attorneys had interpreted the previous law already made clear: that the local Health Department must conduct some kind of physical inspection and epidemiological investigation of a dwelling unit whenever it learns of a local child exceeding that threshold.

“We know that we have to handle any case of a child who has an elevated blood lead level of five or greater,” Dalal continued. He said that the city’s new health director, Maritza Bond, has ​“taken a very close look” at the city’s current inspection protocols and workforce capacity.

He said she has presented proposed updates internally as to how the department handles lead poisoning cases. He promised that those proposed protocol updates would be vetted by the Lead Paint Advisory Committee once that body is fully impaneled.

“We do know that we’ll be able to handle those cases once our lead program is staffed up,” he said, ​“particularly with the new grant from HUD that’s going to come online in March.

“I feel optimistic and confident that we’ll be able to implement the lead program as described in the ordinance that was passed in December.”

Last year the alders voted to transfer $365,000 from various department budgets to the Health Department to fund the creation of five new full-time lead inspector positions, bringing the total number of budgeted lead inspector positions to eight. As of the December 2019 monthly financial report, five of those inspector positions remain vacant.

As for what to do in the long term, Dalal said that that the city’s protocols around child lead poisoning should shift from being primarily reactive to preventative.

“Longer term, we have to look at ways we can do preventative inspections, not just react to cases when we get a child with an elevated blood lead level.”

If confirmed to the social services chief position, he promised to start thinking through ​“targeted strategies where we can do preventative inspections before a child moves into that [elevated blood lead] level.”

Asthma, Opioids, Homelessness

Monday night’s aldermanic interview was not only about lead. Sabin next moved to another chronic, environmental ill that disproportionately affects New Haven youth: asthma. He said that a 2015 survey by the Yale Community Alliance for Research and Engagement found that asthma rates in low-income neighborhoods of New Haven increased from 20 to 23 percent from 2009 to 2015. That rate is significantly higher than the 14 percent asthma rate of the state as a whole, he said, as well as the 13 percent asthma rate for the country.

What’s causing these disparities? he asked Dalal. And what can New Haven do about it?

“Much of this has to do with housing quality and housing stock,” Dalal replied. ​“You have triggers that are present in some of the old housing stock that are not present in some of the new.” Those triggers for asthma include rodents and other pests, as well as mold.

Poor outdoor air quality also contributes to higher asthma rates, he said.

Ideally, he continued, the city would be able to identify houses where residents have issues with asthma. The city would then inspect the house and enforce the remediation of whatever is causing the asthma to flare up.

As for outdoor air quality, he said, the culprit is particulate air matter. ​“Transitioning to cleaner fuels, electric vehicles, and developing policies that promote active transportation, biking, walking, to reduce the miles traveled” will all lead to cleaner air, he said.

Hill Alder Ron Hurt asked Dalal what he would do to combat the crisis in opioid addiction in New Haven.

“My approach is grounded initially in a strengths-based approach,” Dalal said. ​“To me, that means not trying to reinvent the wheel and institute a new program that might not be a good fit.” Instead, he promised to look at all of the community organizations, reentry services, homelessness services, and other public and private actors that currently touch in some way on the opioid crisis.

“We look at those brights spots, see where we have the opportunity to grow, and build on those and cultivate those” existing partnerships.

He also said New Haven should look to other cities that have been successful in reducing opioid addiction and use ​“the evidence and the data as a guide to inform our strategies.”

And he cautioned against stigmatizing opioid addiction as a moral failing. ​“We really have to look at this harm reduction approach,” he said. That is, by focusing on how to reduce the likelihood that someone with a high risk of becoming addicted or having a dangerous or potentially fatal incident gets into that spot in the first place.

“That’s the way we’re going to reduce the overdose deaths here,” he said.

The only alder who expressed skepticism of Dalal’s appointment was Edgewood Alder and Committee Vice-Chair Evette Hamilton.

She referred to a letter written by Newhallville Alder Delphine Clyburn, who was not present at Monday nigh’s meeting.

In that letter, Clyburn wrote, ​“Several residents in my community, including the Newhallville Management Team have expressed their deep concerns that just recently and under Dr. Dalal’s directives, the needs of homeless females have gone ignored, despite pleas from myself as Alder and members of my community. After meetings with Dr. Dalal and members of my community with no resolve, it is clear and apparent to me that he is not the right fit.”

“I am asking you to work with our alders, to work with our different groups,” Hamilton urged Dalal.

“I do appreciate you being straightforward,” Dalal replied. ​“I am more than willing to keep working on this issue.”

Committed To ​“An Equitable City”

Three personal and professional supporters testified on behalf of Dalal’s appointment during the public testimony section of the hearing.

Donaghue Foundation Vice President Nancy Yedlin (pictured above) praised Dalal as a ​“good listener,” a ​“thoughtful speaker,” and as possessing an impressive capacity for working with a variety of different stakeholders. She said he played a key role in helping lead the State Health Improvement Plan, as well as in helping develop and champion the ultimately successful Tobacco 21 legislation.

“I cannot think of a better person to assume this position,” said Fair Haven Community Health Care CEO Suzanne Lagarde.

And Yale Law School Professor James Forman, Jr. (pictured) singled out Dalal for praise not just for being a caring physician and dedicated public servant, but for being an engaged, respectful, and present father. Forman said he has coached Dalal’s kids in flag football.

“He’s somebody who’s constantly encouraging fair play and fair treatment of other young people,” Forman said.

“We need someone who has strong character. We need someone who has a real commitment to equity and justice and to the fight for fairness.” He said he has gotten to know Dalal through dinnertime conversations and flag football parenting.

“He is someone who is committed and determined to an equitable city, to a fair city.”