After five years of trying, the company seeking to build and run a large psychiatric hospital in Wilsonville has won tentative state approval, but for a much smaller facility and with limiting conditions.
An Oregon Health Authority official on Aug. 26 issued a draft recommendation to let Pennsylvania-based Universal Health Services build a 60-bed facility, with the key condition that 45% of the beds serve mentally ill people who have been held at hospital emergency rooms or otherwise been confined, such as in jails, because they are a danger to themselves or others.
Universal Health had proposed a 100-bed facility, with no requirement that beds be dedicated as the state now proposes.
The company or opponents can contest the recommendation, after which the agency will make a final decision that can be fought in court.
It’s unclear whether the company will accept the recommendation.
“There are obvious hurdles and the conditions need to be considered in light of the original proposal,” company spokesman Michael Sorenson told The Lund Report on Friday. The company may have a response next week, he said.
In making the recommendation, Dr. Dana Selover, OHA’s manager of health care regulation, found there’s a clear need for more psychiatric beds in the Portland area and that no general hospital in the region has proposed converting any of its inpatient beds into psychiatric units. These circumstances merit giving Universal Health the go-ahead, Selover wrote.
But there’s only a need for 60 inpatient psychiatric beds, Selover concluded. Selover based that on the population size of the tri-county area and the specific psychiatric health care needs of the metro area.
Selover recommended mandating that 45% of the new facility’s capacity be devoted to alleviating hospital emergency departments swamped by behavioral health patients and taking in involuntarily civilly committed people who are waiting for placement.
“Individuals facing a mental health crisis are spending as long as 57 hours awaiting appropriate care,” Selover wrote.
So-called “ED boarding,” the holding of mental health patients in secure emergency department rooms until space is found for them at a mental health facility, is a well-recognized problem in Oregon, Selover wrote.
“The volume and duration of ED boarding and lack of placements available for those in acute crisis supports increasing capacity for acute inpatient psychiatric services,” Selover wrote.
The practice of holding mentally ill people in jails because there are no other facilities for them is also common.
As another condition, Selover recommended the new hospital be required to report to the OHA if it refuses care to a patient who has been held at an emergency department of another secure facility, if that person is uninsured or on Medicaid.
Critics for months have attacked Universal Health’s plan on numerous fronts. The charge has been led in part by Legacy Health, the hospital system that manages the Unity Center for Behavioral Health, a 107-bed facility in Portland that is the city’s principal mental health facility.
Critics said the Wilsonville site is too far away from the central metropolitan area where the need for psychiatric services is most acute, that it has poor access by public transit, and that there is no guarantee the proposed hospital would have room to take patients from hospital emergency rooms or for low-income residents on Medicaid. They also said that what the region really needs is more supported housing for mentally ill people and more community-based outpatient support for them.
For its part, Universal Health has responded that, despite such criticisms, there is still a strong need for more in-patient psychiatric beds and that its hospital would fill that need.
Selover concluded that Universal Health met requirements set down by Oregon regulations for approval.
Hold Hospital Accountable
One critic of the hospital plan, Multnomah County Commissioner Sharon Meieran, said Selover’s proposed conditions may have merit.
“The conditions look good on paper, but unfortunately, the OHA doesn’t have a great track record in holding organizations accountable. The OHA has (proposed requiring) that 45% of the new hospital’s beds will be held for committed patients. I will be the first to celebrate when I see the relief that should bring to our mental health system. But we need to be clear - the real impact will turn on the OHA actually holding the hospital to account,” Meieran wrote to The Lund Report in an email.
She also said that the proposed condition on reporting care rejections to OHA don’t ensure that patients who are on Medicaid or uninsured “are treated on par with insured patients. This is a real problem, and again, I don’t see a mechanism for accountability.”
Universal Health Services owns 185 psychiatric hospitals nationwide.
Opponents of its Wilsonville plan include the Providence Health & Services hospital system; Legacy; Service Employees International Union Local 49, which represents thousands of Oregon hospital workers; Health Share of Oregon, the nonprofit coordinated care organization that oversees Medicaid insurance for more than 380,000 low-income people in Multnomah, Clackamas and Washington counties; Disability Rights Oregon; and some elected officials.
Backers are eclectic. They include Portland Public Schools and a Baptist church in Beaverton and some individual letter writers.
Residential Options Lacking
Critics of the proposal are as much frustrated with Oregon’s lack of mental health care in general as they are with Universal Health.
“The ‘crisis’ has to do with a critical lack of lower level/less intensive services and facilities, not inpatient hospital beds,” wrote Trent Green, Legacy’s chief operating officer, to the OHA in June during the comment period on the Universal Health plan. “More inpatient beds are not the answer: The answer is more beds for civilly committed and more residential options. … The current high occupancy at Unity is wholly attributable to civilly committed patients occupying beds because there are no available discharge options,” he wrote.
Unity “serves a disproportionate share of the chronically and persistently mentally ill, as well as those that are homeless or housing insecure. Unity also receives a disproportionate share of civilly committed patients,” he wrote. The new Universal Health facility “would not address the current population mix of those needing care including those who are civilly committed,” he wrote.
Legacy did not respond Friday to a request for comment on the proposed approval.
This is the second formal certificate of need process Universal Health has gone through for the proposed Wilsonville facility.
The company’s previous application ended with state denial in 2017. The state said Universal Health Services had failed to show a need for the facility.
The certificate process aims to prevent construction of unnecessary major capital projects that could drive up health care expenditures in the state.
State regulations say that Oregon should maximize behavioral health services “in the community where the person lives, in order to achieve maximum coordination of services and minimum disruption in the life of the person,” and that the state should “encourage and assist community general hospitals to establish psychiatric services.”
You can reach Christian Wihtol at [email protected].