Unity Center for Behavioral Health is now in “crisis,” according to the psychiatric facility’s top medical official, intensifying concerns about a troubled facility that claims it is hemorrhaging money.

The cry for help to the Oregon Health Authority comes just one month after hospital officials asked for more state financial support, reporting a $21 million operating loss in its most recent fiscal year.

Greg Miller, Unity’s chief medical officer, described a dire portrait of a facility that is overcrowded and leaving patients to languish for days in places unfit for their needs, according to emails sent to state and local officials this month. Unity includes a 24-hour emergency room for psychiatric patients and an on-site inpatient facility for people in need of short-term care.

“This situation is approaching a public health emergency,” Miller wrote in a Jan. 9 email. “What can we do to address this issue as fast as possible. This is a real state of crisis for emergent psychiatric cases in Portland."

“This is very serious,” the state’s behavioral health director, Steve Allen, wrote to Oregon Health Authority officials in response.

The contents of the emails, released to The Oregonian/OregonLive on Friday, were originally reported by the Portland Tribune.

Unity was created to be a more humane, accessible answer to people with severe mental health illness who would sit for hours or days in hospital emergency rooms waiting to be seen without receiving specialized care. It opened in Northeast Portland in January 2017 to fanfare from local officials who desperately wanted a place that could ease the tide of mentally ill people flooding ERs, jails and the street.

But it has been steeped in trouble ever since, with a state and federal investigation that found significant problems with patient safety, and a bevy of lawsuits from former staff who claim it is a chaotic and unsafe environment to work.

Unity officials until recently downplayed problems as growing pains for a first-of-its-kind operation in Portland. A collaboration between four hospital systems, Unity is the largest psychiatric facility in the region and recorded more than 10,800 total visits to its emergency room last year.

Since it opened, the local mental health system’s reliance on Unity has grown. It serves as the primary backstop for police, hospitals and other players who lack resources to serve an increasingly large mentally ill population on their own.

Hospital officials on Friday maintained their commitment to keeping Unity open. Legacy Health, which operates the facility, declined to make Miller or any other official available for an interview.

“Legacy Health and its partners have no intention of closing Unity Center despite the financial challenges we face,” spokesman Brian Terrett said in a statement. “We remain committed to the mission of delivering immediate psychiatric care and a path to recovery for people experiencing a mental health crisis.”

While concerned, state officials are not taking Unity’s description of financial hardship at face value, records and interviews show. The Oregon Health Authority is working to schedule a meeting with hospital leaders, but the agency does not want to be on the hook for solving Unity’s financial problems.

The Oregon Health Authority pays for patient care at Unity in the form of Medicaid reimbursements to the facility.

“We are committed to working with them and understanding what their problems are,” said Robb Cowie, a state spokesman.

State officials have tried to stabilize Unity before. Within months of opening, complaints about patient safety surfaced, eventually leading to a state and federal investigation that found patients were victims of sexual assault and neglect. At least two people died from preventable causes while in Unity’s care.

The investigation led to a similar backlog while Unity was forced to shut its doors to new admissions and left people who needed psychiatric care to seek help in hospital ERs.

In the wake of the investigation, Unity hired at least 72 more nurses and other staff and paid for physical changes to the building, costs that hospital officials now say contributed to the year-over-year financial losses.

Nearly a year after that investigation ended, Portland police in November convinced Unity staff to re-admit a man who had been discharged but was still in a state of crisis. Unity security had tried to force him to leave, eventually handcuffing him and calling police.

Emails released Friday now show that Unity acknowledges it has been unable to adequately accommodate patients seeking care in both its emergency room and inpatient facility.

The emergency room, where officials expect to see 45 to 55 patients a day, is often full and has to turn patients away, Miller wrote in his Jan. 9 email. At the time, 15 patients were in line to transfer from the ER into Unity’s inpatient facility.

One person had been left waiting in a reclining chair in the lobby for six days.

The vast majority of ER patients are supposed to be discharged within 24 hours.

"We are on almost constant divert, causing patients to be mounting in area medical beds," Miller said in his email.

Unity’s 107-bed inpatient facility was also full. Only 25% of Unity patients are supposed to be admitted to inpatient care and are expected to stay a week to 10 days. But people in the inpatient facility are staying far longer, forcing the ER to provide ad hoc inpatient care,

As of last Thursday, 25 patients were waiting to be transferred to the Oregon State Hospital for longer-term care, Miller wrote. The state hospital had announced three weeks earlier it would temporarily accept only patients accused of a crime but unfit to stand trial -- apparently helping contribute to Unity’s logjam.

In response to Miller’s email, the state hospital agreed to take one patient.

“I really appreciate the effort,” Miller wrote Jan. 9. “The crisis, however, is far from abated, and we need to come up with a solution, even if a temporary one, quickly.”

The situation at Unity didn’t improve in the following days. On Monday, Miller wrote to state officials under the subject line “Update on crisis at Unity.”

Miller said all of the emergency room recliners were full, with 42 patients seeking help. Meanwhile, the number of patients waiting to be transferred to the state hospital remained constant at 25.

“There are 12 patients waiting to be admitted, some close to five days,” he wrote of the emergency room situation.

The emails documenting severe wait times came just a month after Unity began pressing the Oregon Health Authority for more money.

Hospital officials met Dec. 12 with Kyleen Zimber, the interim deputy behavioral health director, and Elaine Sweet, the behavioral health manager. During the meeting, Unity presented a three-page document outlining huge operating losses.

Unity officials had projected losses of $6 million a year but immediately exceeded that. Unity lost just over $2 million in the first two months of 2017. Losses accelerated steeply each year since. In 2019, the losses hit $21 million.

Officials placed some blame on the state, saying Unity had become an extension of state hospital, leaving it to care for challenging patients.

“The current situation is simply not financially sustainable for Unity Center with the burden of caring for these patients being shifted from the state to Unity Center,” Unity officials wrote.

Unity asked the state to increase Medicaid reimbursements from $834 to $1,450, equal to what the state hospital receives.

But state officials are closely examining Unity’s claims. Among other things, the health authority wants to understand: whether the facility’s emergency room or its inpatient facility are driving losses; what role overcrowding at the state hospital is playing; and how much the state has made in reimbursement payments to the facility.

State officials also want to track how much money hospitals have saved in their own emergency rooms by consolidating psychiatric care at Unity. Legacy Health, OHSU Hospital, Kaiser Permanente and Adventist Hospital pay for Unity and access its beds.

In an email, Allen told staff that “our position would not be to ‘solve’ Unity’s financial problems.”

“We are willing to take a look at rates,” he added, “but solutions need to be spread across multiple stakeholders.”

Those stakeholders could include Portland and Multnomah County, both of which contributed to the construction costs for opening Unity.

A Unity spokesman said that Legacy has already started to talk to Portland and Multnomah County leaders about making the facility financially sustainable.

But a spokesman for Mayor Ted Wheeler said Friday the mayor had not been approached to contribute funds to Unity and hasn’t been involved in discussions about the facility’s viability.

Multnomah County Commissioner Sharon Meieran, who works as an ER doctor, said that it could be reasonable for the state to increase reimbursements to Unity, but that it doesn’t solve the problem that Unity shouldn’t be providing long-term care that it isn’t set up to give.

“This raises significant concerns for me about people who are seeking care, especially those who may not receive appropriate services quickly due to lack of capacity,” Meieran said.

Sen. Arnie Roblan, a Coos Bay Democrat who chairs the Oregon Senate’s interim committee on mental health, said the possibility Unity could shut down is “a big concern to me.”

Roblan said Thursday it was too early to say if the Legislature might need to become involved to provide additional funding. Roblan said he expects the state to vet Unity’s claims of financial trouble.

“We have to look at this,” he said.

Jason Renaud, an advocate for people with mental illness, said that Unity’s funding request seems like blackmail. Unity is the largest, and one of the only, psychiatric facilities that can deal with an increasing number of mentally ill people who need a high level of care.

“They have all the business they can handle,” Renaud said. “If their financial model doesn’t work for that, they’ve made a terrible error. And we’re going to pay for that because they’re going to close.”

Chris Bouneff, head of Oregon’s biggest consumer advocate organization National Alliance on Mental Illness, doesn’t see closing Unity as an option.

“We put a lot of eggs in one basket,” he said. “Unity has to work because there's no alternative.”

-- Molly Harbarger and Brad Schmidt

mharbarger@oregonian.com

bschmidt@oregonian.com

503-294-5923