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.