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Unity Center for Behavioral Health Keeps Federal Certification

Federal officials told The Lund Report they will continue to fund Portland’s psychiatric crisis center after patient deaths and safety hazards sparked a months-long investigation and whistleblower complaint.
November 1, 2018

The Unity Center for Behavioral Health will not lose its federal certification and funding, federal officials said Thursday, one day after the center’s deadline to meet safety standards.

The Centers for Medicare & Medicaid Services took the Unity Center for Behavioral Health off a termination track that could have resulted in the behavioral health center losing its federal funding, federal officials told The Lund Report. 

Portland’s only medical center for people experiencing a mental health crisis was at risk of losing its federal reimbursements Wednesday, months after the state health authority discovered the death of two patients, at least one instance of sexual assault, negligence and a long list of other ongoing safety hazards.

The center had until Oct. 31 to correct its problems or lose its federal certification after the Centers for Medicare & Medicaid Services extended a Sept. 11 deadline.

The decision comes after a former Unity Center nurse filed a complaint with the Oregon Bureau of Labor and Industries accusing the center of retaliating against him for reporting unsafe working conditions. The Unity Center placed Christopher Lambert on administrative leave at least twice — in October 2017 and in May 2018--after he complained to Unity officials about unsafe conditions for Unity patients and employees and notified the Occupational Safety and Health Administration. He said Unity’s parent company, Legacy Health, also fired his wife after she raised concerns about Unity in 2016.

The federal decision followed a recommendation from the Oregon Health Authority, which told Medicare & Medicaid that Unity Center’s correction plan was sufficient to meet federal licensing requirements, according to a press release.

Additional corrective actions will help “ensure that patients will receive a level of care that meets state and federal standards,” said Dana Selover, the manager of the health authority’s regulatory branch, in a statement.

As the state agency responsible for enforcing federal Medicare and Medicaid regulations, the health authority’s recommendation carried a lot of weight with federal regulators, health authority spokesman Jonathan Modie said in an email.

Brian Terrett, a spokesman for Unity Center’s parent company, Legacy Health, declined to comment.

An online update from the Unity Center says it has achieved full compliance in several areas of the correction plan as of Monday.

The center was working to hire 54 open positions and 11 new registered nurses as of Monday.

Unity staff have checked in hourly on patients, audited their medication administration each day, documented suicide risks and cases in which the facility used restraint or seclusion to deal with a patient. The Oregon Health Authority report in May found that staff previously gave patients the wrong medication, failed to monitor them and failed to train for and document instances in which they had to restrain or isolate a patient.

The update noted Unity’s successful monitoring of patients in its Psychiatric Emergency Services unit by checking in on them every 15 minutes – something Unity employees failed to do before.

The center has drawn criticism for its unique emergency unit, which places patients experiencing a mental health crisis in one large “living room” style room with about 50 recliner chairs and no privacy. Based on a model developed in Alameda, California, the format aims to treat mental health patients more humanely than just locking them in a room.

But a lack of staff adequately trained to deal with an open room situation led to multiple problems.

Lambert, the former Unity Center nurse who accused the facility of retaliation, said in a state complaint that he had expressed concerns that the model was a “safety hazard” when he worked at Legacy.

“I saw great risk in consolidating so many volatile patients in one place, and I was concerned that the protocols and structures planned would be inadequate to control the environment and provide appropriate safe care,” Lambert said. “I feared the lack of controls and safeguards would lead to patient violence directed both at staff and other patients and would lead to patient self-harm.”

Once he got to Unity, Lambert said he saw repeated incidents of patient on staff violence, patient sexual assault, improvised weapons and other patient control issues. He said he had to stop a sexual assault at least once.

He said he saw Unity “outright terminate” other staff when they complained.

He said Unity put him on leave in anticipation of an October 2017 Occupational Safety and Health Investigation, for which he said officials wanted to interview him.

On May 7, seven months later, a patient died at Unity, Lambert said in his complaint. He said Unity put him on leave that month and told him to stay away from the facility. The same month the Oregon Health Authority started investigating.

Another woman hung herself on July 11.

In an update Wednesday, the Unity Center said it “will not rest” in its goal to serve those who need emergency psychiatric care.

“The safety and well-being of patients and staff at Unity Center is our number one priority and we remain 100 (percent) committed to the work underway to improve Unity’s procedures, policies and practices,” it said.