Turmoil hammers Legacy child psych unit

From The Portland Business Journal, September 22, 2000

A child and adolescent treatment program at Hospital & Health Center is in turmoil-and facing physician backlashafter the swift exit of four prominent child and adolescent psychiatrists.

State children’s agencies and mental health professionals are also disturbed by the staff turnover, which has left the 17-bed Legacy unit without a child psychiatrist.

“We’re concerned,” said Nancy Allen, regional resource liaison for Service to Children and Families. “They [Legacy] are adamantly reassuring me that they have things in the works to bring child psychiatrists on. But there aren’t that many around and they had the best. I’ve been trying to find out what is going on.”

At this point, she said the state agency is taking a wait-and-see attitude.

“I don’t think CareMark would put kids in jeopardy,” she said of the company which manages the joint program for Legacy and Adventist Health.

Allen and other children’s advocates say they’re baffled by the firings and resignations, which gutted the unit. No reasons were given by hospital management. The child/adolescent unit was apparently making a profit and had ongoing contracts with CAPP Care, Ceres and PacificCare.

Insiders say the unit has been in some turmoil since Legacy management revealed its intention to move to hospital employed physicians for that unit. Until now, Legacy has used private practitioners to staff the unit.

Word of the policy change got out about six months ago. Then in August, a prominent member of the team, Dr. Keith Cheng, resigned in what was viewed as a forced resignation. Insiders say the treatment of Cheng generated low morale in the department.

“Essentially he was pushed out,” said one Legacy employee, who asked not to be named. “It was getting nasty up there.”

Legacy spokeswoman Claudia Brown said Legacy is committed to keeping the program. New child psychiatrists are being recruited, she said.

“This is not related to any change in philosophy or program,” she said. “It’s safe to say we’ve had an upset in the physician ranks and we are currently recruiting child psychiatrists. We are confident that the unit will very soon be back up to snuff and we have no plans of discontinuing this service through CareMark. As early as next week we hope to provide full service from age 5 to 18 years.”

The departures forced Legacy to temporarily increase its minimum admittance age from 10 to 12 years old, said Brown. The policy change led the state Services to Children and Families this week to send a child to Providence Portland Medical Center’s 25-bed child psych unit instead.

The American Academy of Child and Adolescent Psychiatry guidelines recommend a child 14 and younger should be treated with a psychiatrist specialized in child and adolescent psychiatry For now, two general psychiatrists are covering the Legacy unit.

The upheaval triggered a protest from the four remaining Legacy adult psychiatrists, who are expected to appeal to administrators to investigate the child and adolescent program before it is dismantled.

On top of that, Oregon Health Sciences University has temporarily suspended its child psychiatry residency program there because of staff and management issues relating to child and adolescent services. The health systems are in negotiations, and OHSU released a statement saying “We are confident that the psychiatric residency position at Legacy/Emanuel will be resumed in the near future.”

The departure of Cheng, clinical director of adolescent psychiatry since 1993 and an OHSU faculty member, and others comes at a critical time.

The child psych unit, along with one at Providence Portland Medical Center, hasbeen running near capacity since January Providence has seen an average increase of 28 percent in inpatient admitting, from 12 to 15 kids to 20 since the same time last year because there are fewer treatment options for kids, said spokeswoman Lisa Godwin.

“There’s not that much out there right now, ” said Carolyn Wiley, nurse manager for Providence’s children and adolescent inpatient mental health unit. “This represents a rise in the crumbling of the mental health system.”

Both hospitals admit children from 10 to 18 years suffering from depression, drug and alcohol substance abuse problems, and psychiatric disorders. The average age at Legacy’s unit is 12 to 13 years, Brown said.

Many of the children are covered by CAPP Care, which covers mental health benefits for teens covered by Medicaid, and Ceres, the mental health benefit program offered through the Oregon Health Plan.

Patrick Payton, Ceres regional director of managed care, said the staff issues at the Legacy unit would have little or no impact on its referrals because hospitalization of children is rare.

“We look to the system to make those adjustments and manage their staff,” he said. “Periodic adjustment are made. You have a brief period of adjustment and then things are back to normal.”

Doctors say about six months ago CareMark sought to hire hospitalbased physicians, rather than use psychiatrists from private practice. Since July, one doctor after another has left. Dr. John Beamer took a three-month leave of absence. Dr David White resigned. Dr. Cheng’s contract was not renewed. A fourth doctor, Edward Stanford, was placed on 90-day notice earlier this week.

Stanford, who treats children covered by CAPP Care and PacifiCare kids which makes up about 50 percent of the Legacy cases, had apparently refused to cover for any doctor who wasn’t a child and adolescent psychiatrist.

Other staff members said the child psychiatrists were upset that the unit’s medical director Dr. Norwood Knight-Richardson was reducing Cheng’s responsibilities. None of the doctors, including KnightRichardson, returned calls.

Brown admitted it will be difficult to recruit child psychiatrists so quickly.

“I’m sure it’s not easy to find someone in a subspeciality like that,” she said.