Pubdate: Mon, 02 Sep 2002
Source: Tribune Review (PA)
Copyright: 2002 Tribune-Review Publishing Co.
Contact:  http://triblive.com/
Details: http://www.mapinc.org/media/460
Author: Mark Houser

WHERE TO GO WHEN THE SAFETY NET FOLDS

The region's hospitals need to change how they deal with drug addicts and 
alcoholics now that the longtime haven for such cases is closing, according 
to the man who used to oversee the hospital's addiction programs.

"St. Francis was a safety net for the community both in psychiatry and 
addictions. - The real question is, where does that safety net go?" said 
Michael Flaherty, who left the St. Francis Institute for Psychiatric and 
Addiction Services in 2000 after six years as its director.

With the closing of the St. Francis emergency room, he said, other 
hospitals will no longer be able to do what they have long done - redirect 
substance abuse cases to the Lawrenceville hospital. UPMC Health System and 
Highmark Blue Cross Blue Shield announced a $520 million deal last month to 
close the city's last independent hospital and turn it into a new 
Children's Hospital.

UPMC officials say beds at other hospitals will replace those lost at St. 
Francis, and outpatient programs will continue. But having enough spaces in 
wards or slots in support groups is not the only issue, Flaherty said.

Social stigma about addiction causes insurers to limit payment for its 
treatment. That affects hospitals' willingness to admit borderline patients 
or to prescribe long-term therapy, said Flaherty, who is now executive 
director of the Institute for Research Education and Training in 
Addictions, a Downtown health policy group he founded.

"There is no other chronic disease with these barriers, but the hospitals 
have to play by those rules in order to survive. St. Francis was one 
hospital that was willing to fudge," he said.

Most of St. Francis' outpatient services for addiction will continue, many 
with the same staff and in the same locations, but now they will be run by 
UPMC's Western Psychiatric Institute and Clinic. Services include a 
Homewood methadone clinic; various programs based in East Liberty for 
drunken drivers, pregnant women and substance abuse cases referred through 
the county court system; and several counseling and 12-step programs based 
at or near the St. Francis campus in Lawrenceville.

But with the shutdown of St. Francis comes the closing of its emergency 
room and the hospital's 120-bed psychiatric and addictions ward, which 
typically treated about half of its patients for chemical dependence. Those 
services will be replaced, officials say, some by Western Psych and some by 
an expanded detoxification and rehabilitation section at UPMC Braddock.

Anthony King, 42, was one of the last people to turn to St. Francis for help.

King checked in on Mother's Day, unable to keep a job because of his 
addiction to alcohol and crack cocaine, he said.

"I'd had enough. I surrendered. I couldn't take it no more," King said. 
"Mainly, I was just stressed out, stressed and just didn't know which way 
to go in life. I really didn't think I had a way out, but I did."

After a three-week stay in St. Francis' addiction rehab unit, King checked 
out and began attending the hospital's outpatient sessions and organized 
meetings. Now he lives in transitional housing in East Liberty, and he 
credits St. Francis for helping him start to get his life back on track.

"The staff treats you with respect, they act like they care, and they do 
the right thing to help you," King said.

King said he and most of his tightly knit peer group will continue going to 
programs now administered by Western Psych. But he said some others are 
worried they won't have anywhere to turn.

Western Psych admits patients with alcohol or drug-addiction problems, but 
only when they also are diagnosed with psychiatric problems, said President 
Diane Holder. Otherwise they will be sent to UPMC Braddock, she said, or to 
an outpatient program if the problem is judged to be less severe.

Braddock's expanded capacity of 20 beds for inpatient detoxification can 
make up for the closing of St. Francis' program, said Trish Rosenstein, 
director of psychiatric and addiction services at St. Francis.

The Braddock hospital also opened a 22-bed residential rehabilitation ward 
for recovering alcoholics and drug addicts this summer, according to Dennis 
Daley, chief of addiction medicine services for UPMC.

UPMC has offered jobs to most of the 350 physicians and other staff that 
worked at St. Francis' mental health services, Holder said.

"The majority of staff that have been offered positions, have been offered 
positions for services that will be licensed and operated in a way very 
similar to the way St. Francis has been offering them. - Hopefully the 
patients will feel some continuity of care, having many of the same 
clinicians and doctors that were part of their treatment before," Holder said.

Western Psych also will open a walk-in crisis center in Oakland for 
patients who need medical help in the evening or on weekends, but aren't in 
such severe distress that they need to go to an emergency room.

Chronic drug abusers or alcoholics who want treatment sometimes claim to be 
suicidal as a ploy to guarantee a hospital admission, Flaherty said.

"It's a common custom, made necessary by the way our society handles 
addictions," he said.
- ---
MAP posted-by: Beth