Regional leaders and entities, including Wilsonville Mayor Tim Knapp and the Wilsonville Chamber of Commerce, believe that the COVID-19 crisis is cause for the State of Oregon to fast track an application to develop a for-profit psychiatric hospital in Wilsonville.
Recently, the group sent a letter to Gov. Kate Brown requesting that she waive the Oregon Health Authority's Certificate of Need process used to vet such applications so that construction can begin immediately.
"I think it's clear that the mental health and behavioral health facilities and resources we have in Oregon are not adequate to the need we have. This has been true for a period of years," Knapp said in an interview. "The COVID crisis and the needs for people to change the way they function within this time are clearly going to exacerbate mental health needs within our society and within our state. The urgency of doing more than we have been doing seems clear to me."
At this point, though, Brown's press secretary Liz Merah indicated that the governor might not acquiesce.
Merah said the application filed by Universal Health Systems' subsidiary NEWCO Oregon is incomplete and hasn't answered how the facility would allow the state to better respond to the COVID-19 crisis.
"Our office is reviewing the letter, but currently waiving the Certificate of Need requirement for this facility to begin construction is not a recommendation we have received from our public health experts as a measure that is immediately necessary for COVID-19 response efforts," Merah wrote via email.
The debate over a potential psychiatric hospital in Wilsonville is not new. In 2017, the Oregon Health Authority rejected NEWCO Oregon's application to build the hospital, saying that there wasn't a need for it because the opening of Portland-based Unity Center for Behavioral Health in 2016 took care of capacity issues. This was after Wilsonville City Council had approved the land use application for the project.
The Unity Center, though, has been mired with issues ranging from financial problems to abuse, deaths, and escapes.
NEWCO Oregon filed another application in mid-2019, and the OHA Certificate of Need process has been ongoing since then. The purpose of the process is to "discourage unnecessary investment in unneeded facilities and services, according to the OHA website." If the process is approved, NEWCO Oregon can begin development.
How would the new hospital help?
Proponents of the proposed hospital cite Oregon's second-to-last place national ranking, according to Mental Health in America, in terms of the prevalence of mental illness and access to care.
And they say the COVID-19 crisis has exacerbated issues.
Michael Sorensen, who has worked on NEWCO Oregon's application and is the director of business development at Cedar Hills Hospital (owned by NEWCO Oregon), said patients facing mental health crises often wait for days or weeks in hospital emergency departments because there aren't enough psychiatric treatment beds.
"Someone's in crisis, is a threat to themselves or others, they're more often than not taken to the emergency department first," said Chris Edmonds, a spokesperson for the project. "The emergency department then has to stabilize the patient, and they try to find a bed, a place for them to go. We've seen that people are getting boarded in emergency rooms for an incredible period of time."
Sorensen said these departments aren't well-equipped to treat mental health patients and sometimes rely on medication, which alleviates symptoms but not the root of the problem.
Ben West, a Wilsonville City Councilor and a nurse at Oregon Health & Science University, said the COVID-19 crisis has exacerbated challenges for emergency departments.
"It (COVID-19) changes the allocation of resources that at times were already thin," he said.
However, Sorensen said NEWCO Oregon hopes to build the hospital in nine months, and estimates differ on how long the COVID-19 crisis will last.
West also supports the idea of waiving the Certificate of Need requirement.
"We have to have more beds, more access. It's a moral problem that this has been allowed to stay the way it is," he said.
The hospital application posits that the facility could reduce emergency department boarding significantly, citing a study from the College of Public Health and Human Sciences at Oregon State University that shows that psychiatric capacity reduces emergency visits.
Another problem is that patients in need of care simply being sent home.
Cedar Hills Hospital was sent about 11,500 people for psychiatric stays from January 2018 to June 2019 and had to reject about 7,500 of those placements, according to data NEWCO Oregon provided to OHA.
"If they're deflected from Cedar Hills, they are released from the medical system back into the community," Edmonds said.
And Edmonds found it curious that many of the hospitals that are against the NEWCO Oregon application (Adventist Health, Kaiser Permanente, Legacy Health, and Oregon Health & Science University, which collaborated on the Unity Center project) are often sending patients to Cedar Hills and thus passing on responsibility.
"All of them have lobbied against building the facility," Edmonds said.
One issue NEWCO Oregon has run into is that few Medicaid providers will contract with them for services. Medicaid-eligible individuals make up a sizable portion of psychiatric patients who wind up in emergency departments, according to the aforementioned OSU study.
"The rest (of Medicaid providers) have refused to contract with us. They told us their network is adequate," Sorenson said.
Sorensen suggested nefarious reasons why the application has yet to be accepted.
"I don't understand why someone would not want a hospital to be built in a metropolitan community that has such a crisis when it's going to cost nothing to the government, the community (NEWCO Oregon would build the facility without public financing). It doesn't make sense. The motivations have to be otherly," he said.
On the other hand, Chris Bouneff, the executive director for NAMI Oregon, a state chapter of the National Alliance on Mental Illness, said a new psychiatric hospital in Wilsonville is not the right way to solve mental health issues in the state and that the hospital would suck up state funding to serve a small number of patients (the facility would have a capacity for 100 patients).
"Those dollars are spent at the expense of helping more people in the community," Bouneff said.
Bouneff believes the state should focus less on building more capacity for the short term, intensive care, and more on programs like community therapy and support, crisis respite services and peer services. The NEWCO Oregon application indicates that the average length of stay for patients would be nine days and that the hospital would take in 10-12 patients a day.
"There is no way you can build fast enough, and there's not enough money to rely solely on hospital beds," Bouneff said. "I hope we dispense with this distraction this letter is causing and focus on what Oregonians need more immediately and what we can make available."
Bouneff also posited that, if a hospital were to be built, it should locate in more underserved communities along the Oregon Coast or in southern Oregon rather than the Portland metro area.
Bouneff advocated for the state to continue the certificate of need process on its normal path.
"This is about making sure the process is followed and thorough analysis is done," he said.
A long process
Edmonds said NEWCO Oregon is on round four of questioning from the health authority. Some of the questioning NEWCO Oregon responded to in January regarded clarifications on data and which health organizations project leaders had reached out to.
Knapp said that the state and others should focus less on nitpicking the application and instead on evidence that Oregon lacks enough beds for mental health patients.
"There's a whole gamut of assertions that really do not address the question of do we have adequate facilities for mental health treatment in Oregon or not," he said. "I think it's clear from many studies and sources that we do not."
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