Doctor at risk

In this era of managed health care, it is difficult to recall a time when you could call your doctor directly or have access to that same physician for phone consultations on weekends and holidays, let alone get a call back at 2 a.m.

But that is exactly what happens if you are a patient of Dr. Jerome Lackner, a physician specializing in the treatment of drug and alcohol addictions and medical director of the Silkworth Memorial Fund Clinic in Davis.

Silkworth is Lackner’s answer to managed care—a system he opted out of vocally back in September 1997. (SN&R’s cover story; October 2, 1997.)

In an open letter to his patients at the time, Lackner railed against a system he claims forces doctors to “meet and satisfy the needs of the money brokers,” overriding the needs of patients.

“It never made sense to me that when you were well enough to walk into the office, you got to see the physician who knew you best and who had a complete record of your medical history,” Lackner wrote, “but when you were much sicker, at 2 or 3 in the morning, you could only talk to a doctor who didn’t know you, had no access to your office chart and who sometimes couldn’t care less because he or she was answering your 2 a.m. phone call primarily because he or she was paying back an obligation to another physician.”

Silkworth, by contrast, is a full 180-degree turn from the managed-care philosophy.

One glaring difference: No patient, regardless of income size, pays one dime for the care he or she receives from Lackner. (He only recently acquiesced to his wife’s suggestion to include a donation form with a new patient’s paperwork. “I never wanted anyone to think they were being pressured, even indirectly,” Lackner said. “But I see now, with our financial situation, that giving them an option of making a donation is a wise thing to do.")

Additionally, when Lackner takes on a patient, he or she has access 24 hours a day, seven days a week, 365 days per year. The doctor’s 24-hour voice-mail system automatically pages Lackner when the hotline is called.

Lackner said he’s long since stopped “signing out” for weekends and vacations—something that got him in trouble under the managed-care system.

“I got tired of coming back from a weekend only to find some doctor who has no idea how to treat my patients and their unique needs has put one of them on an addictive substance and then I have to get them back down,” Lackner said. “That’s why I’m always reachable.”

One more thing: If Lackner takes on a patient, that person is his patient for life. “This disease is chronic, progressive, relapsing and often fatal,” Lackner said. “It’s not a matter of ‘let’s get you cured and send you on your way.’ Until one of us dies, I’m your doctor.”

Neither Lackner nor his wife, Becky, who is responsible for the day-to-day administrative operations of the clinic, takes a salary. Their bookkeeper, LaHoma Folster, volunteers her time, as does the four-person board of directors.

But after six years, and well more than 1,000 new patients, Silkworth may have to close its doors.

The reason is simple enough: Run entirely on donations, clinic expenses are roughly $4,000 per month; its current income: $2,000 per month.

A recent financial statement showed that from January 1 through October 31 this year, the clinic took in $18,176. Its expenses, however, exceeded $23,000. On October 31, Silkworth was $5,112 in the red.

A recent donation letter sent out to more than 700 community supporters throughout the region in November has generated enough money to fund services through March 2004, but, Becky said, if Silkworth doesn’t find $25,000 by March 31, the clinic will be forced to shut its doors.

“It’s not a matter of reducing services or putting a cap on the number of patients,” Becky said. “It’s really just open or shut. That’s the reality.”

They call when they’re at their wit’s end, they call when they feel like using, they call after they’ve relapsed, and they call to find out what over-the-counter cold remedies won’t interfere with their recovery. They call for letters testifying to their hard-won sobriety in order to convince family-court judges to grant them custody of their kids. At all hours of the day and night, they call.

A small sampling of calls to Lackner on December 10 bears this out. (Names have been omitted to protect anonymity.)

“Hey, Doc,” began a female patient. “I’m drinking again. I can’t even handle being sober; I’m a nervous wreck. I’m losing it, Doc. I hope you haven’t given up on me. … Please call me back.” (The patient, in her early 30s, struggles with both addiction and bipolar disorder—a common occurrence. According to Lackner, she has had periods of sobriety but always relapses when she goes off her psychiatric medication—also a common occurrence among people who are diagnosed with both a mental illness and substance-abuse disorder.)

“She needs medically supervised detox,” Lackner added later. “If she tries to stop on her own or go cold turkey, she’ll run the very real risk of grand mal seizures—just as any heavy user of alcohol would.”

Another female caller began by saying she was referred by a current patient of Lackner’s. “I’m sitting in a parking lot. … I need help, Doc,” said the woman, crying openly. “I’ve been taking about 25 Norco a day. … I need help, but if I tell my therapist, he’ll kick me out, and I’m in danger of losing my kids. Please, if you could just call me … thank you.” (The drug Norco is the highest level—at 10 milligrams—available in hydrocodone, the main ingredient in Vicodin.)

Before leaving his internal-medicine practice to run Silkworth, Lackner served as a physician at Solano State Prison. He received his medical degree from the University of Southern California School of Medicine. Though he spent much of his career as a primary-care internist, his subspecialty of treating addiction disorders was always his driving force, Lackner said.

“I promised God that if I ever got into medical school—which was very unlikely—I would treat the underserved,” Lackner remembered. “And people with addictions are grossly underserved; and those that are served aren’t served very well.”

He recalled taking patients to 12-step Alcoholics Anonymous meetings more than three decades ago—before he ever acknowledged his own addiction to alcohol and drugs.

Clean and sober now for at least 30 years ("I stopped counting the months a long time ago,” he said), Lackner is a hard-line 12-stepper who tempers his demands that patients “work the steps, get a sponsor and surround themselves with winners,” with the knowledge that relapsing is part of the disease.

“I always tell my patients to call me before they purchase, before they use,” Lackner said. “But if they don’t, they know they can still call me after they relapse, and I’m not going to push them away or yell at them. You don’t have to relapse if you do what you’re supposed to do, but it happens. The important thing my patients know is that there is always a choice to get recovery again.”

Trino Savala said his life is proof that recovery is possible. He credits Lackner for showing him the way.

At 43, with three-and-a-half years of sobriety, Savala’s world is radically different from the one he inhabited most of his adult life. That life included heavy gang affiliation, prison and, of course, drugs and alcohol. He now works with other addicts in the Effort detox program.

His seven children, ages 9-21, are again part of his life. At his recent marriage, Lackner and his wife stood in for Savala’s parents, who were unable to make it to the ceremony.

Savala met Lackner, as many of his patients do, at the popular Friday-night Alcoholics Anonymous meeting at the Sutter Cancer Center—the meeting Lackner requires all new patients to attend if they want his help.

“I’m an ex-prison[er], Hispanic, ex-gang member, you know?” Savala said, explaining his praise for the doctor. “And my life changed because one day, one Friday night, a little old white man stood in the corner and took the time to talk to me. He told me I could break the cycle.”

The closure of Silkworth, Savala said, would be “devastating” for many. “You can’t even begin to know how many people he’s helped.”

Bobby Joe Miller, 44, met Lackner when Miller was an inmate at California State Prison, Solano. He was sent to the infirmary for severe and chronic back pain—pain that had been “handled” for years in prison through self-medication with heroin. At the time Miller saw Lackner, in early 1999, he had a $1,200-per-week habit. But when his cell mate got busted for selling the substance, Miller lost his ability to trade his skill as a tattoo artist for drugs. As a result, he was faced with two options, he said: trade sexual favors for drugs or stop using.

Unwilling to take the first option, Miller took Lackner’s offer of help.

Out of prison since November 1999, Miller has maintained his sobriety and now manages the House of Miracles, a clean and sober transitional-living home in Sacramento.

Closing Silkworth, Miller maintained, would be a “tremendous loss"—for both Sacramento and California.

“If it wasn’t for the foundation that Silkworth has given me,” Miller said, “I wouldn’t be where I am today. I would charge hell for a bucket of ice water for that man or his wife. It’s that simple.”

Lackner, whose pager never seemed to stop going off during a recent interview, is kind but somewhat dismissive of the praise he receives from his patients.

In keeping with the 12-step philosophy, Lackner readily said, “You’ve got to give away what you’ve got in order to keep it.

“Ambroise Paré, a [16th-century] surgeon who invented the tourniquet, said, ‘I treat, and God heals.’ That was his motto, and I accept it as mine.”

Anyone wishing to donate to the clinic or receive care from Lackner may call (916) 446-4325, 24 hours a day.