Skip to main content

Legacy’s Gresham maternity unit closure endangered patients, federal regulators say

Blistering federal notice says Legacy’s Gresham-based hospital could lose Medicare payments unless it corrects findings of patient safety violations
A sign on top a fire engine reads "save our legacy mount hood family birth center.
Activists on Feb. 13, 2023, protested the proposed closure of Mount Hood Family Birth Center in Gresham. | JAKE THOMAS/THE LUND REPORT
May 11, 2023

This article has been updated with comment from Legacy Health and a state announcement issued late Friday.

As Legacy Health closed the maternity unit at Mount Hood Medical Center in Gresham, administrators assured a leery community that they would ensure the safety of pregnant patients. 

But a federal document The Lund Report obtained shows that a surprise inspection launched the day after the March 19 closure concluded hospital officials were ill-prepared for the change and “failed to ensure that hospital services and the physical environment were safe and appropriate” when the maternity unit closed. 

The Centers for Medicare & Medicaid Services detailed its findings in a blistering April 5 letter to administrators of the Legacy Mount Hood Medical Center. 

The letter appears to explain why, six days after the federal notice, news broke that Legacy had suddenly reversed course on the closure after previously appearing to dismiss public protests, a letter from lawmakers, and weeks of threats of “regulatory actions” from the Oregon Health Authority for moving ahead with the closure without state approval.

The federal letter states that hospital administrators failure to ensure the facility’s emergency department was prepared for pregnant patients in labor after the maternity unit’s closure “created a potential for patient harm.” 

Included with the letter is a 66-page inspection report that found the hospital was “not in substantial compliance” with federal regulations meant to safeguard patient rights, quality of care, a safe physical environment and emergency services. As a result, the hospital would no longer be eligible to receive Medicare payments as of July 5 unless it corrects the deficiencies. 

“While we might disagree with some of the language used in the report, we remain committed to working with them to resolve the identified issues,”  a spokesperson for Legacy said in an emailed statement to The Lund Report Friday morning. “We will submit our updated action plan today.”

The statement did not cite specific portions of the report that the health system disagreed with, and it did not otherwise respond to the federal criticisms. Legacy was granted an extension on correcting deficiencies and now has until August 3, according to the statement. The Oregon Health Authority conducted the inspection for the federal government, and makes recommendations on whether the health system corrections are approved.

The day after this article published, the state agency announced that Legacy on May 12 provided an "updated" plan of correction responding to the federal findings. The press release included a statement attributed to Cara Biddlecom, the state's deputy director of public health, saying, “We recognize the progress Legacy has made toward our shared goal to ensure that families in the Gresham area have access to safe, high-quality maternity and delivery care close to home. We will provide a thorough and timely review of Legacy’s corrective action plan to ensure that it meets federal standards and families can count on having access to comprehensive care at Legacy Mount Hood Medical Center in the future.”

Legacy Health, which operates six hospitals, announced in January that the financially strapped system would close the maternity unit at Mount Hood Medical Center in response to high costs, declining birth rates and a sudden exodus of staff triggered by a change in its care model. The announcement sparked outrage among community members, staff and elected leaders worried that the closure would endanger pregnant patients in the less affluent and more diverse part of the greater Portland region. 

Legacy has now set a mid-June target to reopen the birth center. The statement from Legacy said the plan is contingent on establishing “a care plan that will meet or exceed the minimum service levels outlined in state regulations” and securing physicians, nurses and anesthesiologists to staff the maternity unit.

“On behalf of the Legacy Health leadership team, we want to apologize for the stress, confusion, and disruption caused by the situation at our Mount Hood Family Birth Center,” Jonathan Avery, Legacy senior vice president and chief operating officer, said in an April 18 letter. “We understand the impact it has had on our employees, providers, and most importantly, our patients. Now, it is our goal to rebuild trust as we move forward together.”

But for at least one critic, revelations from the federal inspection of Legacy Mount Hood Medical Center confirmed their suspicion that Legacy closed the maternity unit haphazardly and at the expense of the community’s well-being.

“This shows the information my office was receiving from nurses and staff at Legacy was accurate,” state Rep. Zach Hudson, D-Troutdale, told The Lund Report in an email. “I am pleased to hear that state and federal agencies will continue to monitor the situation and that Legacy is on its way to reopening the birthing center that provides critical care to patients in my district.” 

Hudson also called on Legacy to make public the plan of correction it submitted to the health authority in response to the federal findings. 

An Oregon Health Authority official told The Lund Report in an email that the agency can’t release the hospital’s correction plan until the Centers for Medicare & Medicaid Services approves it. 

A spokesperson for Legacy said the health system will post its action plan once the Centers for Medicare & Medicaid Services approves it.

‘Inadequate to manage patients in labor and newborns’

The federal notice’s findings are based on unannounced onsite inspections of Legacy Mount Hood Medical Center on March 20 and 21 in response to a complaint. The letter is also based on a review of state and internal hospital documents as well as Legacy’s public statements.

After announcing in January that they would close the maternity unit due to staffing and financial challenges, Legacy officials said their focus was on “safe care.” They indicated the hospital would direct pregnant patients to Randall Children’s Hospital in Portland. The Gresham hospital’s emergency room staff would receive additional training to serve pregnant patients already in labor and couldn’t be diverted to another hospital, according to previous statements from Legacy. 

The unit closed on March 19, two days after its planned date, with the last patient discharged that morning, according to the letter. Regulators noted that a poster board sign on an easel reading “Congratulations to Legacy Mount Hood Medical Center’s Family Birth Center” was on display in the waiting room. The sign noted the center’s closure. Regulators described seeing staff gathering pumping devices onto a large cart to be taken to another part of the hospital. 

The letter cites numerous deficiencies found on site after the maternity unit closed. Among them:

  • Hospital administrators had set up a space for patients to give birth in the emergency department that “was inadequate to manage patients in labor and newborns, particularly in the event of maternal or newborn complications, and in which the space, supplies and equipment were disorganized and incomplete.”
  • An emergency room set aside for deliveries was set up diagonally. The space between the bed and the wall was “crowded” with a computer, a red biohazard container on the floor, a wall-mounted sharps disposal container with a yellow sticky note that read “replace with smaller sharps.” 
  • The space between the bed and wall was “insufficient for multiple staff to readily access and care for a patient in labor.”
  • Regulators also described seeing a baby warmer that had supplies placed on top of its shelves. The position of the baby warmer didn’t give enough room for staff to reach the supplies in case of an emergency. 
  • Regulators said the room was disorganized with various equipment piled together; hospital staff said they were not sure where supplies were located. 

Their report said just 27 of 77 emergency department registered nurses had completed training before the closure of the maternity unit, meaning nurses were unprepared to care for pregnant patients.

In fact, after the closure, when a pregnant patient showed up to the emergency room complaining of abdominal pain and a lack of fetal movement, the registered nurse who began triaging the patient had not completed the training, according to the federal notice.

One worksheet provided to emergency department staff directed them to call for anesthesia if a patient was severely bleeding, according to the report. But during an interview with hospital staff “it was indicated anesthesia providers would not be available for maternity patients.”

‘Confusing, misleading, and was not adequate to ensure patients’ rights’

Regulators painted a picture of confusion at the health system — both internally and in the messages shared with the public about the closure. 

Among those findings in the notice:

  • The hospital failed to give “clear and adequate notification” to patients that the maternity unit would close. 
  • The hospital’s internal policies “did not clearly and consistently reflect how and where at the hospital maternity services would be provided.”
  • Administrators didn’t submit plans to state authorities for how it would transition maternity services to a dedicated space in its emergency department nor did they have a plan to monitor services patients received there. 
  • After reviewing training materials and other documents regulators concluded that the “hospital failed to ensure patients’ rights to be fully informed about the hospital’s services and to the provision of safe care.”
  • “Patients were not provided clear and accurate notification of changes to the hospital’s maternity services”. 
  • The hospital’s website, marketing materials and other documents as “confusing, misleading, and was not adequate to ensure patients’ rights to have accurate information about the nature of the change to the maternity services.” 

The letter cited public-facing documents telling patients the hospital would be closing the maternity unit but could get care at the facility’s Women’s Health Clinic. The letter also faulted the hospital for conflicting messages that the state “must” approve the closure or that it was “tentative,” “potential” or “pending.”

Not only that, but the letter from federal regulators suggests the hospital’s governing body lacked attention, saying the hospital’s board only discussed the maternity unit’s closure once in 2023 at its March 9 meeting.

Board members, the letter said, “had not been responsible for the operation of the hospital to ensure the provision of safe, organization and appropriate care services.” 

You can reach Jake at [email protected] or via Twitter @jakethomas2009.