Administrators defend management of Legacy's Unity Center even though employees describe it as 'hell hole.'

PORTLAND TRIBUNE FILE PHOTO - Legacy Health's Unity Center, set up in January 2017, by cooperating health systems to address emergency mental health issues, has faced multiple investigations. sinceFor the first time, Legacy Health is defending its management of a special facility set up to be the region's emergency room for the distressed and mentally ill — even as the state is wrapping up an investigation of employees' complaints that the center is a "hell hole."

The Unity Center for Behavioral Health was created by local hospitals and health systems after local doctors and advocates for the mentally ill pushed Portland to emulate what's known as the Alameda model: a specialized emergency ward for people in need of psychiatric care — including those who are homeless.

In March, a report by the state Occupational Safety and Health division of the Department of Consumer and Business Services documented safety problems at Unity and what appeared to be a concern widespread among some employees that the model is not working.

The state investigation found about 300 assaults and at least 23 injuries to employees in the first seven months of the center's operation. Investigators reported on a culture in which management didn't seem to know how often employees were being assaulted, and some staffers were afraid to say anything about the assaults — fearing it would hurt their careers.

The state fined Unity $1,650, considered a fairly typical slap on the wrist for a first-time offense. Legacy at the time refused to comment, citing a lawsuit filed by its employees that faulted it for similar concerns.

Now a record newly obtained by the Portland Tribune sheds light on another ongoing investigation conducted by a different agency, the Oregon Health Authority. And Legacy is starting to respond.

The state, which licenses health care facilities, is investigating a patient care complaint made to the state by two nurses who worked at Unity. Both spoke with OHA Ombudsperson Ellen Pinney in February of this year.

While they generally echo the lawsuit, which alleged the center fires employee for complaining about unsafe practices at Unity, the employees went into more graphic detail.

Due to poor safety practices, "Numerous employees have been beaten and assaulted by patients," said one employee, adding that management there is so "wedded" to a "trauma-informed" model of care, "that they do not intervene in cases like this" — such as one case when the employee was getting pummeled in the head.

"If you get two or three manic sociopaths, they start running unit," the employee said. "Patients are chronically under-medicated ... A number of staff have been driven away because it is such a hell hole."

The center's trauma-informed model is itself causing trauma, the employee said.

Another employee noted that while the earlier state investigation focused on violence against employees, patients often assault other patients as well. That employee asked the Oregon Health Authority to "help prevent additional assaults by patients on other patients by recommending to Unity that no treatment model should be implemented at the risk of other patients."

This was not the original intent of Unity Center. In one presentation shared by Legacy before the new facility opened, its list of key principles was topped with one word: "safety."

Last week, Legacy Chief Operating Officer Everett Newcomb III issued a statement saying that while mistakes were made during the center's first year, officials are committed to fixing things and being fully transparent, citing safety concerns highlighted by OHA.

New model

Unity Center opened in late January 2017 as a 24-hour hospital providing mental health emergency services for adults and adolescents, with about 450 employees.

At its core — and, some say, the source of the surprising assault rate on patients and staff — is a sort of living-room model where patients who've been admitted sit in dozens of recliners in one large room. There, staff medicate them, calm them down, and try to connect them with services.

Earlier this year, Multnomah County Commissioner Sharon Meieran, a former emergency room doctor and longtime booster of the Unity Center idea, called the state OSHA report that raised questions about the model "clearly concerning."

But while the county board did receive a briefing on the issue, Neal Rotman, a senior Multnomah County mental health manager, told the Tribune the county has no oversight role over the facility, which was funded with $50 million from hospital chains, receiving only $3 million from the county.

Jason Renaud, of the Mental Health Association of Portland, said he is concerned that nobody seems to take responsibility for the center's oversight — not the state, not the county and not Health Share of Oregon, the local state-sanctioned Oregon Health Plan administrator of which Legacy Health is a part.

Renaud said the model needs to be re-examined to ensure that all types of patients are served properly, and to see if the intent of the city of Portland's agreement with the U.S. Department of Justice — to improve its treatment of the mentally ill — is being complied with.

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