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."