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Multnomah County Suspends 2 Managers After Failing to Investigate Complaints About Unity

After reports surfaced about the lack of follow-up on reports of abuse at the Unity Center for Behavioral Health in Northeast Portland, a top-level county manager takes action.
August 20, 2018

Multnomah County suspended two managers after an internal investigation raised concerns about how it handled complaints about abuse and neglect at the Unity Center for Behavioral Health in Northeast Portland.

Mental Health and Addiction Services Division Director David Hidalgo and Joan Rice, the division’s quality manager, were placed on paid leave last week, according to letters obtained by The Lund Report on Monday through a records request. The Portland Tribune first reported the suspensions last Thursday. They will stay on leave until the investigation is finished, the letters said.

Ebony Clarke, the deputy director of the county’s mental health division, will serve as interim director of the unit while the investigation is underway, according to an email obtained by The Lund Report.

County spokeswoman Julie Sullivan-Springhetti declined to comment on the suspensions. Hidalgo has served as head of the division for six years and makes $155,803 annually. Rice has been in her role for two years and makes $119,654 per year, she said.

The county is looking into its handling of complaints by Greg Monaco, a former county mental health official, who reported death, violence and unhealthy conditions at Portland’s only psychiatric emergency room.

Monaco, a retired pre-commitment investigator for the county, told his managers about the problems at Unity as early as May of last year, just months after Unity opened. But it wasn’t until last week that the county announced it was investigating, following reports by Portland Tribune, The Lund Report and others.

Chief Operating Officer Marissa Madrigal first launched an internal investigation on Aug. 8. She told The Lund Report that she decided to expand the county’s internal inquiry after initial findings caused her to lose “confidence that we could say complaints had been routed and dealt with appropriately.”

For two years, Monaco reported concerns about staff and patient safety in emails to Unity Vice President Chris Farentinos, to his supervisors and to Rice, the quality manager of the Mental Health and Addiction Services division.

In an email obtained by The Lund Report, Monaco’s supervisors told him that Farentinos had complained about his emails and told him to stop contacting her.

His managers told him that the county was not liable for patient safety at Unity and therefore it was not their problem, Monaco told The Lund Report.

“Not only was very little investigated, but county staff received no training whatsoever on what should be reported, or to whom, or what would be done if it was reported,” Monaco said.

Monaco reported two patient deaths to Rice via email -- one in May and one in July. After he reported the May death, Rice told Monaco in emails obtained by The Lund Report that the county would wait to hear from Unity before investigating.

She said that Unity would only be required to report the death to the county’s adult protective services unit if the patient died in inpatient care and was also receiving state funding or Medicaid-funded care.

If the patient was covered by Medicare or commercial insurance, then Unity would not be required to report it, she said in the email.

“I feel vindicated that the county is finally taking a hopefully honest look at the situation,” Monaco told The Lund Report on Monday. “It is a shame, however, that it took this long, considering how critical it is to have safe and effective inpatient treatment where the civil rights of patients are also at stake.”

Monaco and other mental health specialists told The Lund Report that the violence at Unity likely stemmed from its open-room model for patients who arrive in crisis. They’re put in recliners in one big room -- without privacy curtains -- and then attended to by staff.

The county’s audit follows a state investigation that discovered the death of one patient, at least one instance of sexual assault, negligence and a long list of other ongoing safety hazards.

Unity, which has more than 100 beds, closed its doors to patients sent by ambulance and other emergency departments on July 28 while implementing new protocols. As of Monday, the center was still only taking walk-ins.

The center is at risk of losing its federal certification and reimbursements from the Centers for Medicare and Medicaid if it does not correct its problems by Sept. 11.

Madrigal did not say when the county investigation will be complete. In the email, she said  the county intends to ensure it has a clear process for handling patient safety complaints in the future.“Our job is to make sure that no matter what happens with that complaint that the person the complaint concerns is safe,” Madrigal said. “There’s legal responsibility and then there’s moral responsibility.”

The county said in a press release that it will report its findings to the Board of County Commissioners, the community and other partner agencies.