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The approval would be conditioned on the hospital having fewer beds than requested and treating underserved groups.

PMG FILE PHOTO - Advocates of proposed psychiatric hospital in Wilsonville say Unity Center for Behavioral Health in Portland has been insufficient. More than a quarter century after Dammasch State Hospital closed, a new psychiatric hospital may be coming to Wilsonville. But hurdles and questions remain. 

The Oregon Health Authority announced Friday, Aug. 27, that it had recommended the approval of an application submitted by Universal Health Services to build a new facility in Wilsonville. However, it did so with a series of conditions that Universal could contest. These include that the hospital provides 60 rather than the proposed 100 beds and that 45% of the beds go to persons with a court determination of mental illness, who are placed in emergency custody or are awaiting a hearing for detention or diversion. The OHA will issue a final ruling after a contested hearing or when it is established that no hearing has been requested.

The state recommended the 45% condition, according to OHA spokesman Jonathan Modie, to guarantee that the new facility substantially serves vulnerable populations who have meager financial resources and few connections with systems of care or support. He provided houseless individuals as an example and said the pandemic has exacerbated stressors for vulnerable and underserved populations. 

"Our role is to ensure that care is provided equitably in Oregon including to populations that are underserved by services such as this," he said. "By having that 45% condition, it does that. It ensures that the operators of this facility will take steps to and ensure that they are serving this population along with those who may have the resources for their care either with health insurance or provided by a commercial plan or some other means. The 45% is really directed toward those who don't have those resources, who are perhaps uninsured or less insured than others." 

Universal declined to comment on the conditions or whether it may contest the decision, but issued a statement. 

"We are pleased the Oregon Health Authority is interested in moving forward and has released its draft recommendation," Universal CEO and Group Director for the Pacific Northwest Ron Escarda said. "Pending final approvals, our new behavioral health hospital would represent an important piece in the larger solution that will best serve Oregonians. As a provider, we are stepping forward, providing a full continuum of behavioral health solutions." 

The state rejected a previous application from Universal in 2017 on the grounds that the company had not proven that the hospital would fill a need in the region. The main reason for that was the recent opening of the Unity Center for Behavioral Health in Portland. But that hospital hasn't quelled lingering problems with psychiatric health care services in Oregon. 

Now, the state hopes that the Wilsonville facility would reduce instances of emergency department boardings, which occur when there aren't inpatient beds available, and long waitlists for involuntary civil commitments. 

In the draft recomendation, OHA Manager of Health Care Regulation and Quality Improvement Dana Selover wrote that emergency department boarding can negatively impact patients and the broader health care system. 

Selover added that the lack of psychiatric hospital beds is apparent and that even though existing hospitals have the capacity to add such beds, there aren't plans in the works to do so. In the state's view, that option would be preferable to the development of a new hospital. "There is currently a statewide shortage of both inpatient beds and outpatient services. This shortage and lack of resources has contributed to the issue of ED boarding … The addition of acute inpatient psychiatric beds has the potential to reduce the number of individuals waiting in EDs and increase the likelihood that they will receive appropriate stabilization or treatment."

However, Selover said OHA is concerned that Universal would not be able to solve the issue because it serves relatively few Medicaid patients and doesn't have a contract with the largest coordinated care organization in the service area. Roughly half of longstaying emergency department patients are Medicaid clients or uninsured. 

OHA determined that 60, not 100, beds were needed based on population data and needs throughout the service area. The addition of 60 beds would result in there being .2 beds per 1,000 people. 

"OHA's analysis finds that the proposed size and scope, as modified, and subject to conditions is warranted to meet inpatient psychiatric bed need within the proposed service area," Selover wrote.

Over the years, the city of Wilsonville has supported Universal's plans to build the psychiatric hospital and former Mayor Tim Knapp was part of a coalition of leaders who asked the state to waive the certificate of need requirement so that facility would be built more quickly. Gov. Kate Brown did not acquiesce with the request. 

In the public comment period for this proposal, Tim Knapp wrote when he was Wilsonville's mayor that the proposal "provides Oregon with much-needed mental-health treatment resources and would be an excellent complement to existing behavioral health treatment facilities." 

During a public hearing on the proposal earlier this year, most commenters opposed the proposal and some noted abuses that had taken place at Universal facilities. The company also paid $127 million to settle a U.S. Department of Justice civil investigation regarding its Medicare and Medicaid billing practices. 

Ivana Foley, a legal coordinator for the Citizens Commission on Human Rights International, wrote to the state during the public comment period for the process. 

"Is this truly what Oregon needs? The alleged systemic abuse reported in UHS's behavioral sector should prompt stronger, not less legislative oversight and endorsement," Foley wrote. "In the interests of decent, effective and safe care — which those seeking mental health care need — CCHR strongly opposes UHS's application to build any psychiatric facility in Oregon and the wavering of any certificate of need for this reason." 

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