Portland's Unity Center wins reprieve to fix problems in care for mentally distressed

Feds give Legacy Health seven more weeks to avoid funding cut-off; investigation finds new problems.

This article has been updated from its original version. It has been updated to reflect comment by Legacy Health and clarified with further reporting on the federal review of Unity.

The federal government has extended its deadline for Legacy Health to fix what a complaint claimed was a "hell hole" created for some of the region's most vulnerable people at the Unity Center for Behavioral Health in Portland, the region's psychiatric emergency facility that opened last year.

The federal government had previously given Legacy until Sept. 11 to address what a recent state report depicted as a woeful and unsafe situation for patients at Unity. Investigators found that, time after time, reported instances of patient abuse and neglect were ignored or downplayed by staff or management at Unity — contrary to the safety-first picture that Legacy officials had long publicly portrayed to local officials. In some cases, unsafe conditions created an "immediate jeopardy" for patients, investigators found.

Now, the decision by the federal Centers for Medicare & Medicaid Services, or CMS, means that the Legacy hospital chain will have another seven weeks to address the management deficiencies that have been identified.

The federal decision to allow more time is significant because it shows that, as advocates had predicted, regulators are bending over backwards to keep Unity in business and avoid "termination." Such a decision would block the center from collecting federal funds.

But the reprieve also comes as newly discovered hazards and issues continue to surface, including troubling circumstances alleged concerning two additional patient deaths.

"The decision by CMS to extend its 'termination track' for Unity from Sept. 11 to Oct. 31 was made after Unity implemented a plan to end an 'immediate jeopardy' situation that had been placed on it in July," said spokesman Jonathan Modie of the Oregon Health Authority, which works closely with CMS and is spearheading the investigation of Unity. "CMS came to the conclusion that it would be very difficult for the hospital to complete the correction tasks by Sept. 11, but recognized the efforts the hospital made to remedy the immediate jeopardy."

Meanwhile, the U.S. Department of Justice is believed to be conducting its own, separate review of things at Unity — one that could reflect poorly on on the implementation of the vision local and state officials so vigorously sought.

High hopes initially

Unity Center opened in Northeast Portland in January 2017 as a 24-hour emergency room providing mental health crisis services for adults and adolescents, with about 450 employees.

Overseen by Legacy Health, it was set up in partnership with Adventist Health, Kaiser Permanente and Oregon Health & Science University. The goal: to ease federal Justice Department concerns over the treatment of the mentally ill in Oregon, cut costs for area hospitals, and create a place to take people in severe mental distress including homeless people picked up by police.

Though Legacy says it is committed to making improvements to ensure patient safety, whether Unity has improved the situation for the mentally ill in Portland is being questioned.

Greg Monaco, the former county mental health investigator who went public with his concerns about Unity a month ago, says he has heard that two other deaths of Unity patients came amid troubling circumstances, in addition to a third that the state attributed to neglect in its report a month ago.

That would be one more Unity death than Legacy has publicly acknowledged to the Tribune.

Legacy declined to comment when contacted last week, including on a new state investigation launched of Unity since the earlier one made headlines a month ago. But after this article was posted Legacy submitted comment reiterating that there have been only two deaths at Unity. It stressed its commitment to safety and transparency, noting it had set up a website, unityfacts.org, documenting its efforts.

One of the two Unity patient deaths that Legacy has acknowledged was a patient's suicide by hanging on July 11 — despite Legacy having just installed new doors to address state concerns that the older doors created a risk of hanging.

Now there is an allegation of a third troubling death as well. Monaco says that he heard of another incident a few months ago in which a patient was supposed to be monitored via one-to-one staffing but was not due to short staffing. She slipped and fell in her own urine, and could not be revived — perhaps because there was no emergency cart with debrillation equipment nearby, Monaco suspects.

Legacy, after this article was posted online, vigorously denied that there have been more than two deaths of Unity patients.

"To say that there have been additional deaths is false and inaccurate," said Brian Terrett, Legacy's public relations director, in an email.

Monaco's public complaints five week ago fueled a decision by Multnomah County officials to launch an internal investigation of how complaints about Unity were handled. Two top mental health managers have been placed on leave pending the review.

Investigator skeptical of OHA

Monaco has been trying to get the state to investigate for weeks, but said the investigator he's communicated with has not seemed very interested — leading him to question oversight by the Oregon Health Authority.

"I feel like they're trying to make themselves look good, like they are holding Legacy's feet to the fire, and then they're going to clear them," he said of the state health agency

However, OHA spokeswoman Delia Hernandez said that, despite the state's past support for creating Unity, officials would remain impartial. "OHA and CMS work in tandem to provide consistent, thorough and impartial regulation of hospitals and behavioral health facilities and pursue corrective action," she wrote in an email.

In any event, further OHA investigation led to another report listing concerns, called a "statement of deficiencies," to Legacy on Aug. 10, the Portland Tribune has learned. Legacy has submitted a plan to fix the listed problems, but at press time it had not been approved by regulators.

New federal review

Whatever OHA and CMS conclude about Unity's fitness to be a health care provider, a new review of the facility by the U.S. Department of Justice could shed a different light on what's happening.

For months, word has circulated in health circles that Justice Department lawyers want to know if agencies are abiding by the agreement they entered into with the federal government to improve care for the mentally ill, including with the creation of Unity.

DOJ lawyers are reaching out to patients, it was announced at a Multnomah County mental health advisory council meeting in July.

"They are looking for information about individuals who have been patients of Unity and have had a bad experience," according to the meeting minutes.

Jason Renaud of the Mental Health Association of Portland says DOJ has already interviewed about dozen former Unity patients that he knows of, in preparation for a status report to be delivered to a federal judge next month. The hearing is part of the city's 2012 settlement with the federal government signed following an investigation into the treatment of the mentally ill.

Renaud suspects the federal lawyers may realize what he already has concluded: that it isn't smart for Unity to mix two populations of the mentally ill — the severely distressed picked up by police and the "walk-ins" who self-reported and may be suffering anxiety or suicidal thoughts.

If he is right, the region may need to further beef up its services to avoid sanction by DOJ.

"There really are two distinctly different populations: Different needs, different security issues, different clinical needs and different legal statuses," Renaud said. "And they don't mix too well."

CLARIFICATION: The federal DOJ's investigative efforts regarding Unity, while concerning patient care and safety, do not constitute a formal patient-care investigation. The earlier version of this article did not make this clear.