Unity’s top executive on why he’s not worried, despite psychiatric center’s woes

Portland Business Journal – August 7, 2018

The psychiatric center’s leader is confident it can make fixes by Sept. 11 to keep state, federal compliance

In five weeks, the Unity Center for Behavioral Health faces a crucial milestone: Will the psychiatric facility retain or lose its federal certification, and ability to receive reimbursement from Medicare and Medicaid?

The Oregon Health Authority revealed on Friday that Unity has until Sept. 11 to fix problems related to staff and patient safety. If not, the U.S. Centers for Medicare and Medicaid Services will terminate Unity Center’s certification.

Trent Green, who is president of Legacy Emanuel Medical Center and Unity, said he’s confident that changes underway, including modifications to the physical environment and stepped-up nurse training, will satisfy state and federal regulators.

“The ball is squarely in our court,” Green said in an interview at Unity Center on Tuesday. “We know exactly what we need to do. I’m not concerned about Sept. 11.”

Too much is riding on the success of Unity Center to turn back the clock to the less centralized landscape for mental health services that existed before the facility opened in January 2017, he said.

Legacy operates the center in conjunction with Adventist Health, Oregon Health & Science University and Kaiser Permanente, all of whom pooled their psychiatric beds and resources in one place. Unity Center also includes an emergency room specifically for psychiatric emergencies, envisioned as a way to prevent patients in crisis from seeking care at regular emergency rooms, which aren’t well equipped to deal with those cases.

“Nationally, we are in the midst of a mental health crisis,” Green said. “You don’t have to go very far driving through downtown Portland to see it. Several years ago, leaders from Legacy, Kaiser, OHSU and Adventist decided to stop looking the other way and operating substandard mental health care in their existing institutions and build a brand new concept in Unity Center.”

The rollout hasn’t gone smoothly. Two nurses sued the hospital earlier this year, alleging they were fired after reporting safety concerns. Others complained to the state that employees were being assaulted by patients, who were “chronically under-medicated.”

The state launched its investigation in February, finding two “immediate jeopardy” situations, patient self-harm and suicide attempts, hazards in the physical environment and lack of assessment and observation.

Green said Unity represents a “new model of care.”

“The volume and acuity of the population, no doubt, exposed shortcomings in the planning and implementation of the model,” he said. “We acknowledge that and have made enormous strides in improving our policies, procedures and practices.”

Unity is replacing bathroom doors with Velcro-attached curtains, removing cupboard doors altogether and modifying window hinges to prevent a patient from attempting to hang themselves. The center removed pens, pencils, utensils and other sharp objects from the reach of patients and took steps to enhance observation of patients in their rooms by reducing blind spots, and documentation.

In June and July, every staff member went through a three-day “refresh” of their education, Green said.

“We take this obligation seriously,” Green said. “We are 100 percent committed to the success of Unity. Our patients need us to be successful. The community needs us to be successful. The state needs us to be successful.”