Babies born to drug-addicted women in Maryland can cost taxpayers more than $20,000 each before they even leave the hospital, state health officials say.
That is because 40 percent of these infants spend their first three weeks of life, on average, in a neonatal intensive care unit, a consequence of being born prematurely, underweight, drug-addicted or all three.
And that's just a down payment. The ultimate costs to individuals and to society in shattered families, child abuse and neglect, educational failure and ruined lives are incalculable.
In a bid to head off such costly tragedies, the Francis Scott Key Medical Center has joined forces with state and city health authorities to create a Center for Addiction and Pregnancy, scheduled to open at Key early in 1991.
Besides drug and alcohol detoxification, the center will offer pregnant women a comprehensive package of prenatal, obstetric, pediatric, psychiatric, educational, vocational and family planning services.
Adele Wilzack, secretary of the state Department of Health and Mental Hygiene, unveiled the program yesterday and called it "unmatched by any other in the country, and perhaps the world."
Drug treatment alone doesn't go far enough for addicted mothers, she said. "It's not just a medical problem . . . and they need a lot more experts than just people who know a lot about addiction."
The program will serve an estimated 150 women each year, in a 16-bed residential unit at Key, and through outpatient services.
The center's operating costs, estimated at $2.5 million a year, will be covered by an $800,000 grant from the state Alcohol and Drug Abuse Administration, and by payments from third-party insurers and Medicaid.
The program won't reach all who need it.
State health officials estimate that there are 1,590 pregnant women in state certified drug treatment programs across Maryland. Ten percent of all births in Maryland are complicated by the mother's use of cocaine. Four babies exposed to cocaine or narcotics in the womb are born daily in Baltimore alone.
Getting addicted women to seek medical care during pregnancy has long been a problem, said Robert K. Brooner, director of Key's drug abuse services.
He said pregnant addicts in drug treatment at Key typically kept only 30 percent of their appointments for prenatal care.
But when they were offered prenatal and obstetrical care as TC part of their drug treatment, they kept 88 percent of their appointments -- a rate comparable to non-addicted women seen by private doctors.
Thanks to the prenatal care, their newborns wind up in neonatal intensive care at near-normal rates, Brooner said. And their average length of stay is only one day, as compared with 21 days for babies born to cocaine-abusing women.
Despite appearances, Brooner said, "the drug-dependent woman is interested, not only in her own health, but in the health of her unborn child."
She neglects those things, however, because drugs "impair her ability to think clearly about life events and make good decisions."
Only 10 percent to 20 percent of female addicts use contraception, generally tubal ligation after past pregnancies.
Dr. Vanessa E. Cullins, who will direct family planning for the center, said these women also perceive the services now available to them as "inaccessible," and believe that the care givers "do not respect them."
Dr. George R. Huggins, who will direct the center, said the addict's pregnancy can actually work to help her change her life.
"We are dealing with the suppressed, covered-up sense of commitment that the female has for her child. And, if we can get their heads clear enough so that instinct can wake up again, we can have something going for us that you don't have in other drug treatment programs," he said. "We've seen it work in methadone maintenance programs."
The costs of providing such comprehensive care at the center will be considerable, Wilzack said, but "probably not as much as the average length of stay in a neonatal intensive care unit."
At $2.5 million a year for 150 patients, the average per-patient cost would be $16,666. The average three-week admission to neonatal intensive care costs $20,000.
Dr. Preston M. Gazaway 3rd, who will direct obstetrical services at the center, said most pregnant addicts will be referred to the program after a "moment of crisis" -- a suicide threat or attempt, a medical emergency such as pre-term labor or bleeding -- or by the courts or social workers.
Operating 24 hours and day, seven days a week, the center will provide intensive evaluations of the woman's addiction and pregnancy, and prescribe residential or out-patient treatment.
That treatment may include drug detoxification, medical and psychiatric care, pre-natal and obstetrical care, counseling for parenting and nutritional problems. There is no pre-set limit on the length of residential stays in the unit.
After the patient's baby is born, the center will offer her intensive post-partum services, including counseling, family planning, educational, vocational and housing assistance.
"The first week postpartum for drug-dependent or drug-prone women . . . seems to be a major triggering event [leading to abandonment, child abuse or renewed drug use], and we want to keep the woman out of the home environment during that period until she stabilizes and gets comfortable and confident in dealing with the baby," said Huggins.
The center will also provide her child with pediatric care from the delivery room on.
"We have plans to follow these babies for at least three to five years" to gauge the long-term impact of the program, said Dr. Archie Golden, director of pediatrics for the center.
After the postpartum period, he said, the center will work to help the new mothers establish ties to neighborhood support services "so that they can remain drug-free."