Oregon Health Authority Director Sejal Hathi has taken a side job in California

This article has been updated to incorporate additional reporting including further comment from the Oregon Health Authority.

Stanford University’s School of Medicine recently named Oregon Health Authority Director Sejal Hathi to a part-time position on its faculty, meaning she’ll see patients in California one weekend a month while, during the week, overseeing the 5,000-employee Oregon agency’s operations at a challenging time.

Announced by Stanford on LinkedIn, the news has been circulating rapidly among agency insiders and observers in recent days, raising questions.

The Oregon Health Authority director’s job is full-time, pays $265,488 annually, oversees a $17 billion-a-year budget and is considered one of the toughest in state government. The initial Stanford announcement did not make clear her new position will be part-time.

“Congratulations!,” wrote Multnomah’s Department of County Human Services Director Mohammed Bader in response to Hathi’s repost of the news. “But I’m confused. Did you leave Oregon!?”

“Haven’t left Oregon…!,” Hathi replied. “One can both be a public servant and continue to see patients, which I am grateful Stanford has enabled me to do.”

Hathi maintains the job won't hurt her work for the state, and she's trying to figure out how to avoid being paid for it. 

But the situation shows, at the least, the sort of expectations and scrutiny that come with Hathi's job. It also shows how challenging it can be to take on an additional job, even if it's part-time.

Seeing patients keeps her ‘grounded,’ Hathi said

It's not unusual for physicians working in non-medical government jobs to quietly continue seeing patients, as not only does it keep their skills sharp, it lets them maintain their medical licensure. Several Oregon Health Authority managers have done it in the past. A spokesperson also pointed to the many physicians who have continued to care for patients while serving in the legislature, which in Oregon is technically considered a part-time job.

It is, however, unusual for the physician working another job to be the director of a large state agency — let alone have their role be broadcast on social media and on the internet by their new employer while mentioning their government post.

The health authority oversees numerous programs including the care of 1.4 million low-income Oregonians in the state's Medicaid program. 

“I love medicine, I love seeing patients. I think it's really important. It keeps me grounded and anchored in the real lived experiences and challenges of people navigating our healthcare system,” Hathi told The Lund Report. 

Normally,  public agency directors try to tell employees what's happening before things hit the news. One week after the Stanford announcement, employees had not received an all-staff email filling them in, perhaps reflecting the uncertainties around the details of the job.

Adding to the confusion, Hathi's LinkedIn page states that she's had the job for 14 months. She was appointed on an interim basis in November, did her first shift in December and her role does not become official until March, Hathi said.

Hathi told The Lund Report that, when updating her work history on LinkedIn, her practice is to only state the calendar years an engagement started and ended, without inputting the months.

Ethics law, agency policy put a spotlight on side jobs

Hathi did ask the Oregon Department of Justice about seeing patients in Oregon, but was told that working in-state would raise questions. She said she looked to Stanford to avoid that.

But the mechanics around working at Stanford are the sticky part.

The position Hathi accepted is technically a paid one — which would trigger Oregon ethics law considerations and the requirement for a formal process of approval. She said she’s working with Stanford about how to structure the job so no compensation goes to her, though she accepted the job without working out those details. She may give her pay to charity.

For a doctor to work at a hospital on a volunteer basis can be complicated, because they are often not covered by the hospital’s liability insurance. Some states, like Oregon, provide a liability exemption for such doctors, but California’s situation is less clear.

Making things more complicated, the university has cited Hathi's Oregon job on its Linkedin announcement and on its website. Her faculty page goes into more detail: “She serves as the 4th permanent Director of the Oregon Health Authority, appointed by Governor Tina Kotek and unanimously confirmed by the Oregon Senate to oversee health care and public health services, policies, and programs for the State of Oregon.”

Oregon law flatly prohibits officials from receiving a personal financial benefit due to their job. Oregon Health Authority policy also requires that when presented with any potential conflict of interest such an outside paid position, an employee must inform their supervisor and the Oregon Health Authority's personnel unit, and the supervisor “shall review and make a determination.” Employees are prohibited from taking a paid job that “interferes with performance of their agency job duties.”

Asked whether Stanford's reputation was benefiting from having hired a top Oregon state official, Hathi dismissed the idea that her Oregon job had anything to do with her hire. If anything it's a negative, she said, adding that Stanford is her alma mater and hired her based on her medical credentials. 

“Maybe this will sound a little arrogant, but I'll just do this anyway: I went to Stanford for an MD/MBA. I graduated and was accepted into the number one internal medicine program in the country at [Massachusets General Hospital], and then I practiced at Johns Hopkins,” she said. “It doesn't matter to Stanford that I have a government role in Oregon. They're looking at my clinical background.”

Hathi complied with rules, spokesperson says

Hathi said she had told Kotek upon taking the state job 14 months ago that it was conditional upon her ability to see patients outside of work hours. She more recently let the governor's office know that she was taking the position, but did not share the details around payment or discuss how to deal with it. 

“We continue to have no concerns,” Elisabeth Shepard, a spokesperson for Kotek, said.

The Oregon Government Ethics Commission’s web page posts requests for advice from public officials seeking guidance on a variety of situations, from when it' s OK to accept a registration fee discount to when an official can have an outside source of income. It displays records of when Hathi sought advice from commission staff over a friendship with a health care executive. 

In this case Hathi did not obtain formal advice. Health authority spokesperson Larry Bingham said in an email commission staff "verbally" advised her that an outside paid position “wouldn't trigger Oregon's ethics laws.”

 Bingham said the agency's personnel unit thinks the director is “fully compliant with OHA policies” and has “confirmed that even if the position were paid, it would not in fact require a formal approval process, as it presents no conflict of interest.”

New job won't detract from Oregon work, Hathi says

Asked initially whether Hathi saw any conflict with managing both roles, she wrote in an email that “Any assertion that I or other practitioners in leadership roles cannot manage their schedules, travel, and the responsibilities of their position is categorically false ... I chose to take a part-time faculty role out of state to avoid perceived conflicts of interest that were likely with my spending time at any hospital OHA also regulated.”

Hathi told The Lund Report that she’ll work one weekend a month in California. She has worked three shifts as an interim since December, she said. The job comes with an hourly wage, but she hasn’t put in for pay, she said.

“I'm doing this because I really was missing medicine, and I think it's really important and makes me a better OHA director,” she said.

The news comes in the middle of the legislative session, generally a time when agency leadership is focused on laws that agency leadership is either hoping for or dreading. 

This year, agency leadership, including Hathi, have been closely watching as the Trump administration and Congressional Republicans consider, among other major things, severe cuts and restrictions for the Medicaid-funded Oregon Health Plan — they've even made plans for an incident command center structure to track those changes, Hathi has said.

Hathi said she's confident her additional work won't distract from her paid Oregon job. She said a four-hour round-trip commute by plane one weekend a month is doable, and she won't be doing her state job remotely.

Correction: An earlier version of this article erroneously stated that Hathi had reshared Stanford’s LinkedIn post about her hiring. The Lund Report regrets the error.