This article was updated with additional reporting on Aug. 14.
In August 2021, Oregon Health Authority hired Angela Carter, a naturopathic physician, to roll out the state’s voter-approved drug decriminalization law. When it did, the agency gave Carter the title of “Measure 110 Implementation and Program Manager” and the behemoth task of overseeing the program — but little else.
That’s according to Carter, who on July 17, submitted their official resignation.
In their resignation letter to the health authority’s interim director, David Baden, Carter, who uses they/them pronouns, accused the agency of “maliciously negligent” oversight of the Measure 110 program: “it appears that OHA leadership has made a concerted effort to undermine the program in any way it can,” they wrote. It’s a claim the former agency director fervently denies.
Carter’s accusations are significant because of their position within the agency and because while media reports and the auditor’s office have faulted the health authority for the troubled rollout of the program, Carter said that the problems stemmed from more than just passive incompetence.
Instead, they portrayed leadership as rejecting efforts to improve the program internally while working to hide important information from public view.
One claim: that health authority leaders “denigrated” members of the volunteer Measure 110 oversight council that makes decisions on how to spend the program’s funding and who are community members in recovery from addiction or who otherwise have experience in addiction treatment and related areas. Agency leaders tried to “manipulate the council to make decisions the OHA favored,” Carter wrote.
They also claimed that agency officials “willfully design(ed) the Measure 110 funding, data collection, and communications procedures for failure against the advice of all program staff and external advisory councils,” and also held “meetings to discuss how best to obscure important and time sensitive information from the council and the public against the advice of (the Oregon Department of Justice).”
Carter went out on medical leave in August 2022, although they continue to serve as chair of the state Psilocybin Advisory Board that advises the Oregon Health Authority on the implementation of Measure 109.
In response to Carter’s allegations, Oregon Health Authority sent The Lund Report a statement that did not address the allegations directly, but noted that the program is up and running, and that “OHA appreciates Dr. Carter’s hard work and dedication to the Measure 110 program and wishes Dr. Carter well going forward.”
Pat Allen, who directed the agency when Carter was working there and now oversees New Mexico’s health department, told The Lund Report that he does not believe Carter’s allegations to be true.
“I wanted Measure 110 to succeed — I still want it to succeed,” Allen said. He said while Carter’s letter does not make it clear who in “leadership” at the agency was trying to kill the measure, “nothing could be further from the truth.”
Carter told The Lund Report they and Allen never spoke, and Allen said he was tied up with the pandemic when Carter was active but kept an open door policy.
“I think we’ve been really candid about policy failings, and execution failings, but they were just that — they were failings,” Allen said. “I am really confident that that leadership as I think of it, down into the Health Systems Division and Behavioral Health program, were fully supportive of the implementation of (Measure ) 110. I think there were a lot of challenges, but it was absolutely not some kind of an effort to, you know, to sabotage it.”
Carter told The Lund Report that the situation was complex, with the health authority experiencing stress under the weight of the pandemic when voters approved Measure 110. They acknowledged “political and economic barriers” to the measure’s implementation.
But they indicated that the state’s crisis in addiction and overdoses did not appear to be a priority among agency leadership.
“The unacknowledged pandemic of substance use deserved more attention and support, but we were not offered the same resources as public health,” they said.
They said they needed 30 staff within their unit to function effectively and 15 more positions to support their work elsewhere in the agency.
“But despite my constant requests for more help,” Carter said, “we were not allowed to hire more than 7 within our unit. This made it impossible for us to meet our requirements and deadlines, and greatly delayed the funding process, which put many community substance use treatment and support agencies at risk because they were anticipating funding and had already lifted up programs (to) serve their communities.”
Carter said in their resignation letter that the program had funding for more staff, but they were not given the authority to hire additional positions.
Allen said in terms of understaffing, Carter’s unit was not alone. Furthermore, he said the agency was charged with hiring roughly 300 new staff positions during the 2021 session of the Legislature. He said that he was aware of Measure 110’s need for more staff but was not aware of a specific request from Carter, adding “I think one of the challenges was trying to hire anybody for anything.”
He did not dispute Carter’s claims of being overworked, but said that was just about everyone at the agency during the pandemic.
Carter also complained of discrimination and retaliation in the workplace in their resignation letter. “I personally experienced sexual and disability harassment, transphobia, intimidation, silencing, and retaliation from OHA leadership on numerous occasions,” Carter wrote.
Carter filed a complaint with Oregon's Bureau of Labor and Industries and their claims are under investigation.
Scant training, support
Carter was the first staff the agency put in place to oversee the implementation, but wasn’t hired until six months after the law took effect. Their base salary of about $92,000 per year was the most they said they had ever earned.
Carter came to the job as a person in recovery from substance use disorder who had a passion for equity and social justice. As a self-identified “genderqueer, disabled, neurodiverse naturopathic physician, community organizer and health care advocate,” they brought a wealth of personal knowledge of the health care system and as a person who has experienced addiction and marginalization in Oregon. They had co-founded the Equi Institute, Oregon’s first trans and queer integrative primary care program, where they worked as a lead physician, and they had earned a reputation as a champion for LGBTQ+ focused health care.
In March, The Board of Naturopathic Medicine placed Carter’s physician’s license on probation for prescribing to one patient high doses of opioids and benzodiazepines without required oversight measures while at the Equi Institute between 2017 and 2019. The board also cited Carter for a pattern of incomplete medical charting during the same time period.
Carter defended their actions to The Lund Report, noting the complexity of their patients’ needs and heavy workload. They also said they were unaware of the complaint against them that led to the recent action when they were hired as the Measure 110 program manager.
The recent board action aside, Carter came to the Measure 110 program with a resume that included experience in health care instruction and research, nonprofit and physician leadership, and a list of volunteer medic work.
But the choice of someone with no government experience to lead the new program raised questions at the time.
It was their job to coordinate with the volunteer Measure 110 Oversight and Accountability Council and see through the implementation of a new grant program that would dole out $300 million to treatment and recovery providers every two years.
Part of that job was to create new networks of treatment services in each region of the state that all offered a full menu of Measure 110-funded services.
Carter facilitated meetings of the 22-member council — public meetings that saw frequent conflict as diverse perspectives grappled with putting together a new government program. In those meetings, Carter’s on-camera demeanor and cadence were consistently diplomatic and calm as they tried to answer council members’ questions and guide the group.
Carter also served as the primary liaison between the health authority and the volunteer council. They admittedly knew nothing about how the agency worked or how Measure 110 would fit within its bureaucracy — and they said the health authority did little to train or enlighten them on those matters.
“Upon my arrival at OHA,” Carter wrote in a Sept. 12, 2022 letter addressed to the agency at large, “I received an hour and a half review of the agency’s org charts, as well as the standard workday training that all staff receive. I was then sent to design, implement, and manage a novel statewide health program with no further training or education on the systems in place at OHA or how to navigate them.”
Lacking guidance, Carter said they relied on reading the text of the measure and the implementation bill that followed, Senate Bill 755, to create the program. “Because I lacked training in the structure and function of the Health Systems Division and the political milieu of Oregon, I was unable to anticipate the pressures and dynamics the program would face,” they wrote.
Secrecy and obstruction claimed
Some of those dynamics involved how much the agency would inform the public about the program.
In the same letter, Carter said managers at the Oregon Health Authority worked to thwart data collection and transparency with the council and the public. For instance, it scrapped a data collection program that the agency’s own office of Health Policy and Analytics spent 8 months constructing to fulfill the law requiring it, Carter wrote.
“Leadership has unilaterally decided that we will not follow the requirements outlined in SB755 on data collection, and gave the council almost no opportunity to weigh in on the plan. The current plan for data collection determined by OHA leadership will provide almost no information on the outcomes of the program or its efficacy for specific communities.”
Failure to inform the public, they added, put the program “at higher risk for deconstruction,” meaning elimination.
At a December meeting of the council, health authority staff explained to members the phased approach they’d be taking to collecting data considering barriers some of the newer and less sophisticated service providers faced, with more data collected as providers got acclimated.
A Lund Report analysis of the agency’s Measure 110 data dashboard released earlier this year concluded that the data lacked key measures that would help the public determine the program’s effectiveness — among them, how people were moving through the services and whether or not they were completing treatment or remaining housed.
Carter also blamed the agency for poor communication with providers seeking grants — a problem grantees often lamented as the funding stalled.
“When I reached out to our community partners to inform them that we would not be able to meet deadlines due to our understaffing and under-resourcing, OHA leaders retaliated, restricting me from any further communications with any external stakeholders or community partners, and refusing to allow any transparent or consistent communication with those we were trying to serve,” they wrote.
Carter oversaw the program until August of last year, when they went on an extended medical leave.
Since then, after Gov. Tina Kotek’s election, many people in Oregon Health Authority leadership who oversaw Carter’s work have left.
Upon resigning, Carter wrote that “I have persisted because this program, the services it funds, and the mental health paradigm changes it facilitates are deeply important to Oregonians and our entire country. … Imagine what our community partners and grantees could accomplish across the state if the Measure 110 Unit were fully staffed and had the full and appropriate support from OHA leadership,” Carter wrote. “Our hard working community partners deserve so much more than they are receiving from OHA. Our community seeking healing and recovery from trauma and harmful substance use deserves better.”
But they added they did not want to continue with an agency whose actions were so “persistently unaligned” with their values.
Emily Green can be reached at [email protected]. Follow her on Twitter @GreenWrites.
The LUND Report has a repuation for doing excellent journalism
Therefore it is a great disappointment to read an article that reads like a press release for the aggrieved party. We are informed that Dr. Carter denounces the OHA after being on some form, of "leave" for almost a year. It's a "puff" and impossible to tell what if any the substantive complaint is!
Measure 110 can take credit for possible the worst overdose situation of all 50 states with Multnomah County report a 550% increase in synthetic opiate (fentanyl) deaths between 2018 and 2023.
The only hope is to re-refer Measure 110 and repeal it!
Josh -- take a deep breath.
The last national statistics on fentanyl overdoses (from CDC) was 2021, when Oregon was in 34th place at 26.8/100,000 -- just ahead of Washingon 28.1/100,000 and just behind CA 26.6/100,000. The top producer of fentanyl deaths was West Virginia at 90.9. https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm
Statistics later than 2021 are very hard to come by, probably unreliable, and don't directly compare states -- but the overall trend is a plateau in deaths. CDC does have a May 2023 map of the US with predicted change in overdose deaths for year 2022: https://blogs.cdc.gov/nchs/wp-content/uploads/sites/36/2023/05/dec2022Drugs.png
which shows a slight increase in Washington over Oregon and California deaths.
I find it very hard to blame any significant increase in deaths directly on Measure 110. It must be said that any overdose is too many, and also I note that a law enforcement tool is blunted. Sheriff Matt Phillips is not a fan of the measure, and for sure he has not been given any resources to compensate for loss of ability to aprehend drug users.
On the other hand, incarcerating people for simple possession leads to the revolving door of the County Jail -- and when the offender is released back to the streets in a few days will simply pick up where he or she left off. Not a wise use of resources in my opinion.
I would agree that forcible detention would make sense if the goal were forcible treatment -- but as the rollout of Measure 110 demonstrates, that is much more easily imagined than accomplished. Successful treatment requires years for many users -- and I don't see anyone stepping up to provide that level of care (except maybe Helping Hands.)
I do not believe the current "catch and release" policy works very well if the intention is to curtail drug use -- and I also don't believe that Measure 110 has been around long enough to tell if it is helpful or harmful.
M110 is not the reason for the high overdose rates; other cities and states have comparable numbers. We don't need to go back to what we know doesn't work (criminalizing possession); M110 needs time to roll out what is a huge, complicated project that will pay off in the end, if it can be coordinated with housing.
Articles like this are why I subscribe. This is one of the first honest, accurate assessments of the Oregon Health Authority's mishandling of M110 implementation to make it to print so far.
Measure 110, the Drug Addiction Treatment and Recovery Act, was a direct repudiation of the failed policies of the last several decades. It's no surprise that some of the same people who opposed M110 before the vote are still against it. Passage of M110 truly meant no more business as usual when it comes to addressing substance use.
Deaths in Oregon due to overdose and toxic fentanyl contamination of an unregulated drug supply started to rise in 2020 - before the vote on Measure 110. Prior to that, Oregon had been an outlier with relatively few fentanyl-related overdose deaths compared to the rest of the US. Toward the end of 2019 and into 2020, Portland saw a rise in gang-related shootings and murders. Any cop or prosecutor worth their salt could put two and two together, recognize a gang war, and realize that the influx of fentanyl was a consequence of that. Of course, admitting this would mean admitting that the war on drugs is an abject failure *that led to fentanyl coming into the state*. Their wounded pride has cost us the lives of friends, loved ones, our siblings, your children. Enough is enough.
Significant mismanagement is evident in the implementation of Measure 110 and the broader Behavioral Health unit within the OHA. Accountability should extend not only to politicians but also to the community, considering the pressure exerted on OHA to rapidly allocate resources. Individuals like Steve Allen and Pat Allen within the OHA should refrain from deflecting responsibility with claims of having done their best.
The reality is that the implementation was marred by a lack of preplanning and strategic foresight. There were pressures from the addiction/recovery community on OHA staff, but without a comprehensive approach. Acknowledging our collective failure is crucial; only then can we analyze the multitude of factors contributing to this misstep. The complexity of the issue was exacerbated by political motivations.
Regrettably, some within our systems prioritize power and profit. Their inability to navigate the intricacies of this initiative led to greed and a lack of holistic understanding. Recognizing this failure is the first step toward addressing the underlying complexities and motivations that contributed to this unfortunate outcome.
People like Angela, myself, and many other OHA employees were used as performative pawns in this situation we were manipulated or maneuvered into positions that served a certain narrative or agenda. Our experiences and efforts were exploited for the sake of appearances, rather than for genuine progress or change. It's a disheartening realization, as it signifies that our contributions were potentially devalued and instrumentalized to give the illusion of addressing problems.
Understanding this dynamic sheds light on the need for sincerity and meaningful engagement when addressing complex issues. It's important to move beyond performative actions and focus on authentic efforts that lead to substantial improvements and positive change.