In early December, Gateway Rehabilitation Center (Pittsburgh, Penn.) honored its founder and medical director emeritus, Abraham J. Twerski , MD, with a very special 80th birthday president, announcing that its 75,000 sq ft, 130-bed detox and inpatient addiction treatment facility, located northwest of Pittsburgh, would be named Abraham J. Twerski Hall, or “Abe’s Place.
In announcing the honor, and presenting Dr. Twerski with a photograph of the facility’s new “Abe’s Place” sign, Gateway Rehab president and CEO Ken Ramsey, MD reflected on Twerski’s forty year impact on the field of addiction treatment: “There are thousands of people who owe so much to his vision of a better way to help those struggling to overcome their addictions. “He conceived a place where men and women could learn how to confront the disease of addiction with dignity; a place where a caring staff could provide the tools necessary to bring about lasting change in a person; and a place where families could learn to rebuild trust and move toward peace. His vision was a place that would be dedicated to healing above hurt, love above loss, and faith above fear. Today, Gateway Rehab lives on in a hundred thousand hearts as the place they were able to find hope at last. For these reasons, we have named Gateway Rehab’s main inpatient facility, the first building on our campus, Dr. Abraham J. Twerski Hall – ‘Abe’s Place.’”
Reflections on a long career
In a subsequent interview with Behavioral Healthcare, Twerski reflected on the history of Gateway Rehabilitation Center. His work in the Pittsburgh area dates back to 1960, when, following graduation from Marquette University’s Medical School and a year of residency in Milwaukee, he entered a three-year psychiatric residency at the University of Pittsburgh Medical Center’s Western Psychiatric Institute and Clinic, followed by a brief stint at Mayview State Hospital.
In 1965, his career took an interesting turn when he interviewed at St. Francis General Hospital for a position as director of its Department of Psychiatry, a position that at first, he says he didn’t want. There, the young psychiatrist, who had preached as an ordained rabbi until 1959, was won over in an interview by Sister M. Adele, a Roman Catholic Sister of St. Francis who was the hospital’s administrator. At the time of his hire, he remembers that St. Francis had a 25-bed detox unit “with an admission policy so liberal that one alcoholic was admitted 31 times in a single month.”
He recalls the genesis of what became Gateway Rehab in a subsequent conversation with Sister Adele. Noting the detox unit’s high rate of patient turnover, he stated, “‘Sister, we are not doing these people a service. They stay for a few days to get dried out, but there’s nothing out there to help them stay sober. Very few make it to AA. We can get a few people to Chit Chat Farm (now part of the Caron Foundation) but there is no continuity of care. We need a residential rehabilitation facility in Pittsburgh.’ Sr. Adele readily agreed,” Twersky noted. “She was devoted to anything that could help people.” But he had no idea then, in the late 1960s, how such a facility could survive financially, since there was no insurance coverage for alcoholism or drug addiction.
“It is fortunate,” he quips, “that neither Sr. Adele nor I had any concept of reality.” Just as fortunately, however, a committee of interested Pittsburghers did and, under Twerski’s direction, this committee solicited seed money from local industries and foundations for a treatment facility that would be sustained by charitable donations.
“A nursing home for alcoholics”
As the committee raised funds, Twerski struggled with the question of how to establish and license such a facility. He noted a HUD provision that would underwrite a loan for a "nursing home for alcoholics." However, obtaining a nursing home license would require that such a home be built and staffed according to then-current nursing home regulations, which were appropriate for physically-ill patients, but totally inappropriate for physically healthy addicts. But, he found that Pennsylvania’s Department of Health wouldn’t license his nursing home for alcoholics concept. “They told me, ‘you need a mental health facility license from the Department of Public Welfare,’” says Twerski. “However, the HUD provision wouldn’t cover that.”
Just as the project appeared doomed, Twerski says that “providentially, the Pennsylvania legislature created an entity called an ‘Intermediate Nursing Home.’” He contacted the state’s Department of Health to inquire about the regulations for the new entity, but was told that they didn’t yet exist. He saw his opportunity: “I asked them to give me a license for an Intermediate Nursing Home, and I got it.” Not long thereafter, with license in hand, he secured a $2.5 million loan, underwritten by HUD, to which he added the proceeds of the committee’s fundraising and a $200,000 loan from the Sisters of St. Francis—a debt that was later forgiven.
In 1970, ground was broken for a 100-bed residential treatment facility and Gateway Rehabilitation Center’s first patient was admitted on Jan. 2, 1972. But immediately, Gateway faced serious funding problems. “We understood that Blue Cross/Blue Shield was going to begin covering alcohol and drug treatment within a matter of months,” says Twerski. But commercial insurance coverage didn’t begin until 1975. In the intervening three and a half years, Gateway survived thanks to three funding sources: remuneration from the Pennsylvania’s Bureau of Vocational Rehabilitation, which paid 70 percent of costs for approved clients, and charitable contributions from local foundations and industry.