Oregon Health Authority Director Sejal Hathi defends outside job at legislative hearing

This article has been updated to include additional reporting.

A routine budget hearing in Salem Thursday turned personal and contentious as lawmakers questioned Oregon Health Authority Director Sejal Hathi about her decision to accept a post seeing patients at the Stanford University teaching hospital one weekend a month.

Stanford University School of Medicine’s announcement of hiring her as faculty had sparked debate and criticism of Hathi's new job in recent days — though Hathi has said she does not intend to collect any pay for the  position, and plans to only fly to California once a month. 

Hathi’s Oregon position pays $265,488 annually, oversees a $17 billion-a-year budget and is considered one of the toughest jobs in state government — overseeing care for 1.4 million low-income Oregonians as well as several other programs.

At the heart of her decision to take a part-time job to see patients in California is not just her desire to see patients, she told members of a joint Ways and Means subcommittee after saying she wanted to address a “rumor” about her new job. It’s that her parents live near Stanford, her alma mater, and she’d been flying down there already.

Not only that, but working at an Oregon hospital would pose a conflict of interest and working at a clinic is out of her league because she lacks that expertise, Hathi said.

 “You would not want me as your outpatient provider,” she said, adding that it would amount to medical malpractice. Her goal is to stay “connected to the real, hard, messy work of care, to the sickness, suffering, living and dying that make policies and programs and budgets like ours worthwhile. That is a privilege and a burden that I wish every leader could assume, because it makes us better by compelling us to grapple through lived experience with the very systems that we seek to steward and to repair.”

While other physicians in non-medical government jobs have kept seeing patients, they've generally not had the same level of managerial responsibility as Hathi, earned as large a government salary or had their second job become a matter of discussion on social media. Meanwhile, the news has come in the context of past questions that have arisen repeatedly around Oregon public officials' outside work.

Still, the level of interest seems to have caught Hathi by surprise, as did Stanford's announcement of her hire on LinkedIn — which did not stress the part-time aspect of the job until people started asking questions, and university staff edited it.

“I was not aware that they were going to post on LinkedIn,” Hathi said. “It was not intended to be a formal announcement, or really any big announcement. It was not intended to be news, and it certainly was not a post that I was aware of until after the fact. Otherwise, you know, I would have loved to have known that.”

Goal is to see patients while visiting parents, Hathi says

As reported in an earlier article about the job in The Lund Report, it's not uncommon for physicians who hold government elected or administrative jobs to keep their skills up and maintain their medical licensure. One former top health authority physician reportedly took a pay cut to let her see kids regularly at a pediatric practice.

Hathi's additional work has struck some longtime agency observers as odd, however.

 Dr. Ken Rosenberg, who worked as a top Oregon Health Authority public health official and an Oregon Health & Science University assistant professor, wrote in comments on The Lund Report article that “her job as head of OHA is a 24/7 job. If something comes up outside of working hours she must be available to respond to it.”

In the hearing, Hathi largely echoed what she’d told The Lund Report for an article published Feb. 19, but she also provided additional detail. Whereas she had told The Lund Report through a spokesperson that she had only checked “verbally” with the Oregon Government Ethics Commission when she was coming to Oregon, she told lawmakers she had received written advice that she promised to send them.

Hathi also addressed speculation sparked by the Stanford announcement that she was preparing to transition away from her Oregon job. “No, that doesn't mean — with condolences, perhaps to some of your colleagues—  that I am readying a move or that you're reading getting rid of me,” she said.

Rep. Travis Nelson, a nurse, told Hathi, “I've worked part-time in the hospital setting at various points of sessions in the past, I get it. I get wanting to stay in touch with what's happening at the bedside, but would just love to know how often you plan on actually going there?”

Hathi, who grew up near Stanford, responded that “my parents live in the area, so for me, I was already traveling to see them roughly once a month on weekends, so this just really doesn't add to that. Instead, during the daytime, I'm seeing patients in the hospital, and in the evening, I'm able to eat dinner with my parents, so I would say roughly once a month.”

Her explanation to lawmakers was similar to what she’d told The Lund Report, that she expected to spend 12-20 days a year working shifts at Stanford.

Hathi claims a double standard

Hathi also divulged that she is eight months pregnant, and has no plans to work during her maternity leave.

“To be entirely candid, if I were a mom, which I will one day be, and I chose to coach my kids' Little League team on the weekend, no one would bat an eye. If I simply traveled to visit my parents once a month in California on the weekend, no one would bat an eye,” she said. 

“But when I, as a trained clinician, seek to leverage that skill set to give back to see sick patients during a national workforce shortage in a way that I hoped would preempt the very types of conflict-of -interest-related questions that seem to be rearing their head now — on my own free time ... it's interesting that folks are batting an eye. So I ask you to think about perhaps why.”

Sen. Cedric Hayden, a Republican, cited reporting by The Lund Report to suggest she’d not gone through the appropriate steps to vet the potential for a conflict of interest and had violated her agreement to serve Oregonians in a manner that seemed “arrogant.”

Hathi defends handling of outside job's ethics-law aspects

Hathi defended her handling of the outside job and said it had been confirmed to not violate state ethics law.  

When Hayden pressed her on whether she'd obtained advice from the Oregon Government Ethics Commission before taking the job, she replied that she had gone to them for “verbal advice,” an apparent reference to when she was coming to Oregon 14 months ago, “and then I thereafter accepting the job, sought written advice, and that written advice I can circulate to you.”

At press time the ethics commission had not posted any advice issued to Hathi about Stanford, though it has about a different matter she asked about.

State ethics law sets a clear expectation that a public official should submit the details of any potential conflict of interest for appropriate review as soon as it arises. Officials are also prohibited from deriving a personal benefit from their public job. Similarly, Oregon Health Authority policy requires employees to share the details of outside employment and any potential conflict with their supervisor — in this case Gov. Tina Kotek — as well as the agency’s personnel unit to get a “determination.” They must also avoid any job that would interfere with their state duties.

Hathi told The Lund Report that Kotek had approved her continuing to see patients when hiring her, and around that time she'd also consulted with staff at the ethics commission about whether being Oregon health Authority director would let her continue to see patients. She accepted the Stanford job without working out how to avoid accepting the hourly wage that comes with it — likely a higher rate than she makes for the state — and did not inform Kotek of the details until The Lund Report asked questions. 

She also said she consulted with the Oregon Department of Justice, which serves as the agency's lawyer. She also said the agency's personnel unit has cleared the job, though it's unclear when.

New post sparks debate

Regardless, Hathi’s job has sparked debate, with Republican House leader Christine Drazan telling Willamette Week that “The work of running the state’s largest agency demands—and deserves—the full attention of its leader, not someone who is auditioning for their next job on weekends in California.”

Other debate occurred in comments on the article about the job in The Lund Report.

“We are in the midst of several public health crises - which require leaders who are astute, involved, committed. And that's why we did a national search and paid top dollar for Dr. Hathi,” wrote Jason Renaud of the Mental Health Association of Portland. “OHA is a deeply troubled agency, out of compliance with a major lawsuit, at odds with many of its contractors, and too often failing to affect positive health change to Oregon's poor and disabled. The agency needs more, not less, effort from its leadership to execute its mission.”

Josh Marquis, a former Clatsop County District Attorney, wrote that “If you are paid a quarter million dollars a year by Oregonians, you owe them 100% of your attention.”

Others defended her. Alexis Webb wrote, “So basically, a brilliantly trained doctor is using her skills, on her own dime, to see patients in need — and she went out of her way to do it in another state to avoid accusations of favoritism and conflicts of interest ..... And we’re still pointing fingers?? Is this sexist or what?”

A commenter under the name Ashley Bartris wrote, “What’s the big deal?? Is it better for her to work for the state and report to a hospital that she ultimately manages as head of healthcare for the state? I’m sure people would be complaining about that, too,” and added, “I don’t see anything wrong with what she has done. She informed all parties and she’s even trying to figure out how not to get paid.”