Pubdate: Wed, 30 Jan 2002
Source: San Francisco Chronicle (CA)
Copyright: 2002 Hearst Communications Inc.
Contact:  http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Patrick Hoge

CLINIC NURSES ADDICTS' WOUNDS

S.F. General takes burden off emergency room with program to treat 
drug-related skin infections

San Francisco -- Claudette Blueford, a battle-scarred 39-year-old addict, 
came limping into San Francisco General Hospital grimacing with pain from a 
tangerine-size abscess on her left shin caused by shooting 
bacteria-contaminated heroin into her muscles.

Once, Blueford would probably have spent eight to 12 hours in the emergency 
room, followed by several days in the hospital and a big bill for 
taxpayers. In fact, from 1994 to 2000, wounds like Blueford's were costing 
San Francisco General at least $22 million annually, and were the most 
common problem in the hospital's emergency room and inpatient wards.

Today, people like Blueford get treated at the hospital's Integrated Soft 
Tissue Infection Services clinic, an innovative surgical center designed 
for drug addicts that in its first year appears to have saved San Francisco 
General and the taxpayers about $8.8 million.

One of the clinic's major accomplishments, doctors and addicts say, has 
been to persuade drug users to seek treatment earlier for their potentially 
deforming wounds. Open seven days a week, the clinic gives addicts with 
infections priority, respectful treatment and even a sandwich and some juice.

"We have definitely saved people's limbs and lives," said Dr. David Young, 
one of the clinic's first doctors.

Hospital officials acknowledge that addicts with abscesses usually end up 
at the back of a long line of trauma victims and others with urgent 
problems in the emergency room. At the clinic, more than 90 percent of the 
patients see a surgeon within an hour.

"I've been to the emergency room, and I'll pass on that every time," 
Blueford said. "Downstairs, they look at us as just dope fiends, like we're 
below the scum of the earth."

A GRISLY WOUND

Blueford still procrastinated for a week before getting medical attention, 
and her abscess had grown to four inches across, with a large white center 
of pus and dead tissue that had ruptured. In the past, Blueford said, she 
might have tried to lance her wound herself, or pay someone in her 
Bayview-Hunters Point neighborhood "who knows how."

Instead, Blueford was treated by Dr. Stanley Rogers, a teaching surgeon at 
the University of California at San Francisco, who quickly cut, drained and 
cleaned out the wound. All seven doctors at the clinic are certified 
general or plastic surgeons, not the residents who frequently staff the 
emergency room,

Rogers said.

Rogers gave Blueford local anesthetic, but the procedure was still 
excruciating, and she screamed in pain, tears streaming down her face.

"I'm sorry, doctor," Blueford said when it was over, her lips quivering and 
her body hunched on the edge of the operating table.

"It's OK. It's not easy," Rogers replied gently. "That is very tender. I'm 
sorry that hurt so much."

Part of the clinic's credo is to treat people like Blueford with compassion 
and deference.

"When you begin to see these people like yourself, it becomes much easier 
and more fulfilling to help them," said Dr. Hobart Harris.

Head nurse Jacqueline Caesar said addicts appreciate that attitude and are 
far less confrontational as a result.

"I see patients coming in earlier. I see patients referring each other," 
she said.

DRUG ABUSE AS A HEALTH PROBLEM

Advocates say the clinic's success dramatically illustrates the savings and 
social benefits that can come from treating drug abuse as a public health 
problem.

The number of walk-in clients -- those who come without a referral from the 
emergency room or a city-run clinic -- steadily increased throughout the 
clinic's first year, according to clinic data.

Today, the clinic treats 275 to 300 people a month, with about two- thirds 
of its patients being acknowledged intravenous drug users. It performed 
more than 2,100 surgical procedures in fiscal 2000-01.

In its first year, preliminary figures show, the clinic saved the hospital 
nearly $800,000 in emergency department costs; $6.45 million for inpatient 
costs; and $2 million in operating room costs. Figure in what it costs to 
run the clinic -- just $500,000 a year, Young said -- and the savings add 
up to $8. 8 million.

The number of emergency room visits for soft-tissue infections at San 
Francisco General decreased nearly 34 percent during the clinic's first 
year, to 1,819 from 2,751 visits the year before. Use of acute- care beds 
for surgeries on infected patients also dropped sharply.

ADDICTS GIVE CLINIC A THUMBS UP

Dr. Dan Ciccarone, an assistant professor at UC San Francisco who works 
with young addicts and helped get the clinic started, said the "word on the 
street is that the clinic is doing a good job, that you get courteous, 
professional care, and you don't have to wait."

The food and drink is also a definite plus for many patients. About 
one-third of the 2,861 patients the clinic saw in its first year were 
homeless, according to hospital data.

Nearly all the addicts treated at the clinic in its first year requested 
substance abuse treatment.

Several part-time drug-treatment counselors try to help patients get into 
programs, including those that provide addicts with methadone, an addictive 
drug used in treating heroin dependency. Long-term methadone maintenance is 
considered preferable, but most patients are eligible only for 21-day 
detoxification, which experts say is largely ineffective.

Diana Glassman, a part-time social worker assigned to the clinic, tries to 
locate emergency shelter beds or temporary hotel rooms for homeless 
patients, but she says it is "often a scramble" and frequently people will 
refuse to go to a shelter.

"The hotel rooms can last up to a week, and if the person's condition is 
really, really bad, we can extend them," Glassman said. "It really depends 
on availability, which is not great. We have very few resources to serve a 
major homeless population."
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