The second attempt by a multi-national mental health corporation to build a large psychiatric hospital in Wilsonville has drawn a deluge of harsh criticism along with some effusive praise.
During a public hearing and in submitted documents, critics said for-profit Universal Health Services failed to make the case that the $47 million, 100-bed facility is needed.
Critics said that the Gov. Kate Brown’s Behavioral Health Advisory Council last fall issued a report calling for more small, peer-run respite centers, more community-based hubs for youth with behavioral health issues, more community-based supported housing for people with behavioral health issues, plus a 16-bed locked facility for people with mental illness who are alleged to have committed crimes and need to recover before they can help in their own legal defense.
The council did not recommend a large new acute-care in-patient psychiatric hospital, noted Lynnea Lindsey, director of behavioral health for Legacy Health, the hospital system that is also the managing partner of the Unity Center for Behavioral Health in Portland. Unity, with 107 beds plus extensive out-patient services, was co-established in 2017 by several metro area hospital systems.
“There is no indication there is any need for new acute-care beds nor any dedicated psychiatric hospital,” Lindsey said at a public hearing earlier this month. The hearing was held by state officials who are evaluating the company’s application under Oregon’s certificate of need process.
Executives at Universal Health Services disagree. They argue that existing behavioral health facilities – including the company’s Cedar Hills Hospital psychiatric facility in the Portland area, Unity, the Oregon State Hospital in Salem, and metro-area hospital emergency rooms – are swamped with behavioral health patients. Unity has been a flop at trying to address the crisis, the company argues.
While the proposed Wilsonville hospital won’t solve Oregon’s sprawling behavioral health crisis, it is needed and will help, said Universal Health Services, which owns 185 psychiatric hospitals nationwide.
The company has an ally in Portland Public Schools. The facility would be “a step towards increasing resources and services that could be another option for students and families that are in crisis and needing help,” wrote Brenda Martinek, chief of student support services for the school district.
Plan’s Critics Now Speaking Up
The long line of commenters have given state administrators who run the certificate of need procedure plenty to chew on.
In the many months that Universal Health Services and regulators went back and forth over the application – which had not yet been declared complete -- critics were largely silent. Now, with the application deemed complete, they’ve let loose.
Opponents include the Providence Health & Services hospital system; Legacy; Service Employees International Union Local 49, which represents thousands of Oregon hospital workers; Health Share of Oregon, the nonprofit coordinated care organization that oversees Medicaid insurance for more than 300,000 low-income people in Multnomah, Clackamas and Washington counties; Disability Rights Oregon; and some elected officials, including state Sen. Sarah Gelser, D-Corvallis, chair of the Senate Committee on Human Services, Mental Health and Recovery; and Dr. Sharon Meieran, an emergency room physician and a member of the Multnomah County Board of Commissioners. Plus, about a dozen people from around the country have sent in letters blaming the company for patient deaths and other woes at its psychiatric hospitals.
Backers of the plan are eclectic. Besides Portland Public Schools, the list includes the Southwest Hills Baptist Church in Beaverton. It also includes 96 individuals who signed letters, most of which contain largely identical language, and which were submitted in a single electronic file by Universal Health Services. The submissions include a 2019 supportive letter from Tim Knapp, who was the mayor of Wilsonville at the time, but no longer holds that post.
A final verdict may be months in coming.
The state plans to issue a draft recommendation by June 1, with a proposed decision by the Oregon Health Authority coming at an unspecified time after that. Universal Health Services can request hearings on both the draft recommendation and the proposed decision. After that, the health authority will issue a final decision, which Universal Health Services can legally challenge.
The company’s previous application ended with state denial in 2017. The state said Universal Health Services had failed to show a need for the facility.
The certificate process is meant to prevent construction of unnecessary major capital projects that could drive up health care expenditures in the state.
UHS Faces Tough Standards
State law and regulations specifically for psychiatric hospitals set a steep hill for the company to climb.
State regulations say that Oregon should maximize behavioral health services “in the community where the person lives, in order to achieve maximum coordination of services and minimum disruption in the life of the person,” and that the state should “encourage and assist community general hospitals to establish psychiatric services.”
The gist of most critics is that the project isn’t needed because the fix to the Portland area’s behavioral health crisis lies in community-based services, not a relatively remote, standalone psychiatric hospital in Wilsonville.
The project’s supporters suggest that’s beside the point: Broadly curing Oregon’s deficient behavioral health care system isn’t the company’s responsibility.
But critics are coming at UHS from every angle.
Providence wrote that more beds could be freed up at Oregon State Hospital – the state’s centralized, secure psychiatric hospital – by moving more patients from there to community-based facilities. That would require more out-patient mental health treatment, and more permanent housing for people with behavioral health issues, wrote Robin Henderson, chief executive of behavioral health for Providence in Oregon. Nonprofit Providence offers in-patient psychiatric care at four of its eight Oregon hospitals.
In its 47-page critique, SEIU Local 47 hammered on the relative inaccessibility of the Wilsonville site to the bulk of the Portland metro area’s population. The site is on a bus line, Universal Health Services has said. But SEIU wrote that for someone who does not use a car, getting there may require multiple buses and last “well over an hour each way.”
Such poor access means “the project will have a hard time meeting the needs of Medicaid patients and low-wage populations,” wrote SEIU Local 49 President Meg Niemi and Executive Director Melissa Unger. “While Wilsonville is relatively close to the densely populated Portland area, the facility will be difficult for anyone to reach who does not own a car,” they wrote.
“The location is simply unlikely to meet the outpatient and inpatient needs of prioritized populations and will exacerbate health inequities in the state,” they wrote.
UHS has said it will not screen patients based on insurance, and will accept government-paid plans, such as Medicaid or Medicare.
But critics worry the location, and the limited range of psychiatric services the company would offer would skew the facility toward patients with commercial insurance. Such insurance typically pays providers at about twice the rate of Medicaid or Medicare, and critics fear the Wilsonville facility could draw that valuable commercial revenue away from nonprofit behavioral health providers, such as Unity.
“Without serving the bulk of the Medicaid population, and being functionally inaccessible to many walk-in, no-pay patients, the (UHS) facility could attract a disproportionate share of more lucrative patients with private insurance. This could alter the payer mix of current providers, especially those who serve a significant number of Medicaid patients and already operate at a financial loss,” Niemi and Unger wrote. Washington County Health and Human Services “is concerned that the new proposed hospital would not serve individuals with the most challenging presentations,” wrote Nicholas Ocon, the county’s behavioral health division manager.
UHS’s application has “no reference to serving individuals with acute psychosis, who are often the individuals in local psychiatric units waiting for state hospital beds. With the Oregon State Hospital operating at limited capacity to support civil admissions, the need is to increase supports for community members with severe mental illnesses who would otherwise qualify for state hospital care,” Ocon wrote.
Washington County HHS believes investments should be made in increasing intensive community based services and expanding the local workforce, not adding a new psychiatric hospital that would not effectively address the current system challenges,” he wrote.
Hospital Is Needed, Supporters Say
Supporters of the plan say the hospital would be a valuable assist for many patients.
Pastor Daniel Fender of the Southwest Hills church said he often encounters adults and youth in mental distress. “There are things that I can do, through God’s mercy and grace, as a pastor to help with this
increased mental health crisis, but there are times when the proposed (Wilsonville) facility also becomes essential. This is such a time,” he wrote.
Mary Krogh, a social worker in Portland Public Schools, said the psychiatric hospital would be a welcome alternative to hospital emergency rooms.
“Often school social workers and other school mental health staff are forced to send students to the emergency department, because there are no other options when our kids are experiencing a mental health crisis or a severe reaction from substance use. Sometimes, these young people even end up being held in emergency rooms for days while they wait for an acute care bed to open up,” she wrote.
For publicly traded UHS, a win or lose in Wilsonville is a relatively small deal. The company is a giant in the niche market of psychiatric services. In the United States, aside from its hospitals, it has 12 outpatient facilities; in the United Kingdom it has 146 inpatient hospitals and three outpatient facilities. Its 2020 revenues topped $11.6 billion, up from $11.4 billion the previous year. Profits in 2020 were $943 million, up from $814 million the previous year.
The state is accepting comments on the proposal through to the issuance of its draft report.
Comments can be submitted to Oregon Health Authority, 800 NE Oregon St., Suite 465, Portland, OR 97232, or emailed to [email protected].
You can reach Christian Wihtol at [email protected].