We are some of the mental health and addiction specialists of St Joseph’s Hospital in St. Paul.

Every day we help patients live, help them survive, recover and thrive. Our patients appreciate us because often there’s no one else there for them. They’ve burnt bridges, destroyed their lives, lost jobs, relationships, housing, their family, everything. Except us.

Think about Prince. One of Minnesota’s greatest claims to fame, one of the greatest musicians of all time. Prince died in his home from an overdose of fentanyl (a synthetic opioid). We scratch our heads and wonder how that is possible. Prince? He was wealthy, surrounded by staff, able to assess any kind of treatment. Where was the narcan? Why didn’t he get treatment?

Those of us in the business of mental health and addiction treatment understand how this can happen. Why? Denial, stigma, lack of access to confidential care, lack of informed prescribers.

Every day we prescribe narcan and educate our patients on why it’s essential part of their treatment plan. Every day we collaborate with other specialists — emergency physicians, hospitalists, infectious disease specialists, psychiatrists, psychologists, licensed alcohol and drug counselors, nurses, and medical assistants.

Why do we do this work?

We do this work because we are dedicated. We love our patients, we are gratified when they succeed in their path to stability and sobriety.

We provide critical life-saving care for patients in the hospital and in clinic. We need both levels of care to manage serious addiction. Sometimes a person must be stabilized in the hospital before they are safe to be treated as an outpatient.

It seems that just about all we hear in the news these days is about the increasing rates of suicide, people dying of overdoses and addiction.

Isn’t it odd that M Health Fairview threatens to close one of the state’s only addiction-medicine inpatient treatment programs licensed to care for pregnant women?

Isn’t it odd that M Health Fairview threatens to close a hospital that recently expanded to 100 much-needed inpatient mental health/chemical dependency beds to accommodate the increasing need for these services?

Consider this quote from the New England Journal of Medicine, Jan 16, 2020, “Treating Addiction as a Terminal Disease,” by Ame E. Caruso Brown, M.D.:

“Only 25 to 50% of patients receive any substance-use treatment in a given year, and even fewer receive medication for Opioid Use Disorder. More than 2 million people are candidates for such treatment — a number far outstripping the availability of physicians with a license to prescribe the medications, which requires a special waiver, and of counselors or other therapists.”

St Joe’s needs to stay open to continue to provide care and fulfill a huge gaping need.

But the fact that M Health Fairview wants to close St Joe’s is not unusual. In fact, historic hospitals founded in the mid-1800s are closing around the country. Just google Hahnemann Hospital, Philadelphia (closed 2019), and Providence Hospital, District of Columbia (closed 2017). These were the hospitals that served the inner-city population, often started by religious organizations as a call to heal the sick and serve the poor.

No more. Health care is a business. If maximizing profit is the name of the game, you have to get rid of the “liabilities” that are a drain on the profits. For example, patients on Medicare and medical assistance (including Medicaid) are liabilities. Why? Because the reimbursement rates are so low. The hospital-based addiction unit as we know it is on uncertain ground. Ongoing discussions indicate it is unlikely this unit will continue seeing the same types of patients it has since its inception many years ago. Potentially, patients on medical assistance (MA) and Medicare may be unable to get hospital-based addiction treatment.

That means people with serious medical conditions such as end-stage liver failure, heart failure, or on dialysis will have even fewer options for this level of treatment. There are only two hospital-based, medically managed addiction programs in the state (St. Joseph’s being one of them).

And across the state, we continue to see patients waiting for days in emergency rooms due to insufficient psychiatric beds.

It’s helpful to remember our history. Although there are newer evidence-based models of addiction treatment, it was here that the Minnesota Model of addiction treatment was created in the 1950s at a Minnesota state mental hospital. From there, the Minnesota Model spread first to the Hazelden Foundation and then throughout the country and world.

It was here in St. Paul that The Sisters of St. Joseph of Carondelet founded St. Joseph’s Hospital in 1853, Minnesota’s first hospital. And, according to the M Health Fairview website on St. Joseph’s Hospital:

“Although much has changed in health care since the hospital’s early days, the practice of providing high quality, compassionate care remains constant. As a Catholic hospital, the values of the CSJs are especially reflected in our welcoming all people as the dear neighbor, promoting human dignity, caring for the poor, embracing spiritual well-being, and supporting a relationship of mutual respect, trust, and honesty for our patients and providers.”

Let’s pray M Health Fairview’s corporate leadership remembers what’s printed on their website and support our mission. St. Paul and the Twin Cities need St Joe’s Hospital.

Dr. Kathleen Heaney, a distinguished fellow of the American Psychiatric Association, is an addiction psychiatrist. Dr. Emily Brunner is an addiction-medicine physician and president of the Minnesota Society of Addiction Medicine. This column also was signed by Dr. Sevdalina Missova, an addiction medicine specialist; Caroline Kuria, a psychiatric certified-nurse-practictioner; Speciose Sinyagaya, a psychotherapist who is a licensed drug and alcohol counselor and social worker; Dr. Salima Naqvi, an inpatient psychiatrist; and Dr. Eduardo Trinidad, a psychiatrist; Dr. Biljana Capra, a psychiatrist; and Dr. Pam Shultz, an addiction-medicine physician.