County managers on leave over failure to investigate Unity Center

Investigator was told to stop raising concerns over mistreated patients; top officials ask why.

Multnomah County has placed two managers on leave in the wake of a Portland Tribune article about how complaints of abuse and neglect at Legacy Health's Unity Center were muzzled and ignored.

On Thursday morning, the county issued a statement saying an internal review it launched days earlier had expanded, and two managers had been placed on leave.

The review was initiated after an Aug. 7 article in the Portland Tribune detailed the story of how longtime county mental health investigator Greg Monaco was told more than a year ago to stop raising concerns of patient mistreatment and neglect to the management of the Unity Center for Behavioral Health, the Legacy-run regional crisis center that began operations in January 2017.

Monaco's concerns were recently verified by a state investigation of complaints from Unity Center employees, one of whom had described the center as a "hell hole." The scathing investigative report was released in response to a records request by the Portland Tribune.

One of the managers placed on leave is David Hidalgo, director of the county's Mental Health and Addiction Services Division, the Tribune has learned. The other is believed to be division Quality Manager Joan Rice.

The county is the state's designated authority to oversee the local mental health system, of which Unity Center was intended to be the linchpin. In response to the Tribune's questions about why abuse and neglect concerns regarding Unity were not investigated, the county at first issued an Aug. 3 statement claiming it had extremely limited authority to investigate complaints, and could not investigate cases involving patients on the state-federal Medicaid program for low-income people.

On Aug. 13, a county spokesperson followed up with a subsequent statement saying its earlier account was inaccurate.

Oregon State Sen. Sara Gelser, D-Corvallis, who spearheaded SB 1540 earlier this year to clarify abuse investigation authority, earlier this week told the Tribune it's "absolutely" incorrect for the county to claim it had no authority to investigate cases involving Medicaid patients. The county was "required" to, she said.

Monaco called the latest news a "when hell freezes over" moment. He earlier told the Tribune that top county mental health officials tolerated a complete absence of protocol, guidelines and training to ensure abuse complaints are investigated.

"It just seemed like a cavalcade of turning a blind eye to this," Monaco said. "People didn't know to whom to report things, because nobody really has responsibility for doing anything. And they have abdicated oversight to the corporation."

Here is the county's full statement:

Multnomah County Expands Review of Mental Health Complaint Process

Last week, the Multnomah County Chief Operating Officer learned of potential issues with the Mental Health and Addiction Services Division's handling of complaints of people receiving mental health care at Unity Center for Behavioral Health. C.O.O. Marissa Madrigal immediately ordered an audit of the complaints reported to the Mental Health and Addiction Services Division.

After assessing initial information, and after consulting with Chair Deborah Kafoury, the County is launching an investigation to fully review the County's processes, procedures and compliance. Two senior managers have been put on paid administrative leave pending the investigation.

"I have directed senior County managers who oversee adult protective services in the community to conduct this investigation,'' Madrigal said. "Multnomah County is committed to responding to anyone in a mental health crisis and assuring their treatment promotes their health and safety."

The County will be reporting its findings to the Board of County Commissioners, the community and our partner agencies.

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Here is an internal county email that went out this morning, referencing Hidalgo being placed on leave.

Dear Colleagues,

I am writing to inform you that Chief Operating Officer Marissa Madrigal is broadening an audit of how our Mental Health and Addiction Services Division (MHASD) handled complaints of people receiving mental health care at the Unity Center for Behavioral Health. After an initial assessment and consulting with Chair Deborah Kafoury, she has asked for a full review of the County's procedures and its compliance with state law.

As part of this review, and to ensure an independent audit, Ebony Clarke will be assuming the role of interim director of MHASD.

I want to acknowledge this is a stressful time for many of you. While the County conducts this review, I have faith our staff will continue to deliver the same high quality services to our community.

We will be reporting findings to staff, the community, and our partner agencies as the review proceeds. I will keep you updated as more information becomes available.

Thank you for all you do. Your work in service to our diverse communities is deeply valued.

Sincerely,

Wendy Lear, Co-Interim Department Director

Multnomah County Health Department