Unity Center Delays Reporting Abuse, Stirs Concern About Patient Treatment, Documents Show

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UPDATED: Monday, Jan. 23 at 6:40 p.m.

More than a year ago, the state’s only emergency psychiatric hospital risked closing. It was under state investigation of reports of abuse, neglect and death. The federal Centers for Medicare & Medicaid threatened to pull certification, which would have meant losing essential reimbursement for poor and elderly patients.

Unity Center for Behavioral Health in Northeast Portland survived that ordeal as the state pronounced that it had met all requirements. It hired new staff, conducted training and got a new director.

But the problems continue to fester, according to just-released documents from Multnomah County obtained and reported on by the Portland Tribune and reviewed by The Lund Report. 

The documents detail concern among county staff and commissioners about timely reporting of problems at Unity and its treatment of patients.

Last October, a Multnomah County assistant attorney, Jonathan Strauhull, wrote to Legacy Health, which manages Unity, pointing out that by statute it is supposed to “immediately” report suspected abuse or neglect that likely occurred to Adult Protective Services or law enforcement, including any deaths that were not an accident or caused by natural means.

And yet, Unity did not do that in several instances, Strauhull said. 

The letter cited a delay of two weeks or more last April, June and September in the filing of abuse reports; a delay in filing a report about a patient death in July 2019; and said Unity had yet to file a report about a patient who escaped the facility in October 2019.

A Legacy attorney, Anne Greer, responded, essentially denying the allegations. Strauhull answered her, rejecting her response. 

The documents also include a note from Josh Thomas, a program coordinator with Washington County’s mental health services, who said he was concerned about a call he received from a nurse floor manager at Unity about a substantiated case of abuse.

“I don’t know what their standards are for investigating things such as this, and I am concerned they only called after it was decided the abuse was substantiated,” Thomas wrote. He said the nurse reported the incident in mid-March, 2019, almost two month after it occurred.

“The time lag is of great concern,” Thomas wrote.

Brian Terrett, a Legacy spokesman, said in a statement Wednesday that the problems reported by Strauhull stemmed from internal misunderstandings: “When questions about reporting requirements first came up, it was unclear what was required by various agencies,” Terrett said. “At that time, Unity Center for Behavioral Health staff had been advised and believed that they were meeting all required reporting standards. Since then, there has been a clarification of what is required, and now Unity Center for Behavioral Health is following all statutorily required reporting.”

The release of these documents follows a report last week that showed that Unity Center has a treatment crisis, with patients stuck for days in recliners because all beds are full while patients waiting to get into Unity are stuck in local emergency rooms. 

Then earlier this month, documents showed that Unity had reached out to the Oregon Health Authority last year for higher reimbursement rates, saying it’s providing the same care at the Oregon State Hospital to patients yet is paid less for Medicaid patients.

Critics say Unity, which opened in 2017, has lacked leadership on the part of Oregon Health & Science University psychiatrists who designed the treatment model and Legacy Health officials who administer the facility.

Unity is a joint project of Legacy, OHSU, Adventist Health and Kaiser Permanente. The facility, the first of its kind in Oregon, was modeled after a hospital in California. It was supposed to solve the problem of mental health patients in crisis "boarding" in area emergency rooms

Unity’s founders have been largely silent about the facility’s problems, with Legacy fielding questions about the latest problems with prepared statements.

But behind the scenes, there’s been a flurry of activity, the documents show, with a slew of planning for meetings involving the Oregon Health Authority, Unity, Legacy and Multnomah County. The state has the authority to pull Unity's license. The county can investigate reports of abuse and neglect. 

According to these latest documents, Unity filed 44 such reports  with Adult Protective Services last year. The longest delay in filing a report was 56 days in a case involving patient to patient assault. The average delay was nine days, the documents show.

In December, Adult Protective Services trained Legacy staff on reporting, according to the county's communications director Julie Sullivan-Springhetti. "The county has seen a marked improvement in Unity’s reporting time," she said in a statement.

She said the beds at Unity is part of a statewide problem. 

"Historically, Oregon has not built any capacity at any level of community mental health care, inpatient or outpatient," she said in a statement. "Now issues at the state hospital and the uptick in meth use and homelessness has exacerbated that lack of beds."

She said the county is working to find more beds and get more housing for people with severe and persistent mental health issues.

Emergency rooms are not designed to address mental health issues -- Unity is. But there appear to be some problems with its staff, according to the documents. They include a November email from Dr. Sharon Meieran, Multnomah County commissioner, to the president of Unity, Melissa Eckstein, about an anonymous complaint. 

The patient reported that staff were disrespectful, used the wrong gender, made him sit four hours in the waiting room, then had him urinate in a cup in the bathroom. The patient said it was filthy: “I cleaned the restroom: put paper towels and toilet paper in the trash can, wiped down the sink, cleaned a stain surrounding the toilet with paper towels and soap,” the complaint said.

The patient saw a social worker but was sent home, the complaint said: “I do remember essentially being told that I should come back when I was actively suicidal, as in ‘come back when you are worse.’ I did not feel stable or safe enough to be home, but after everything that had happened up to this point, I was concerned that I would hurt more by staying. So I left, even though I now reflect on what was going on in my mind at that moment and I know that I really gambled with my chances on my own.”
Meieran, a physician and lawyer, asked Eckstein to look into the allegations and use it as an example of how staff should not act.

“This complaint raises serious concerns for me about the care provided to this person, as well as broader concerns about the adequacy of protocols and training at Unity. expressed concern about suspected mistreatment,” Meieran said.

You can reach Lynne Terry at [email protected].

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