Hiding In Plain Sight...Understanding the OHA Scandal
Last month, The Oregonian published the results of a “shocking” analysis that showed serious failures within the Oregon Health Authority’s plan to move people living in residential facilities with severe mental illnesses into less-restrictive environments.
This story is rather complicated, and it has not received proper attention. As such, we at NAMI Clackamas would like to explain what happened and why it matters.
The Oregon Health Authority (OHA) has been the subject of news stories and complaints over the past few years related to moving patients with severe mental illnesses out of residential care facilities.
OHA’s decision to move mentally ill patients came from a joint 2012 Agreement between the state and the U.S. Department of Justice.
In order to implement the Agreement, OHA hired KEPRO, a Pennsylvania-based contractor, to conduct a “utilization review” of people in residential care facilities. OHA hoped to cut costs and transfer patients into less-restrictive care settings.
In August 2018, Sarah Radcliffe of Disability Rights Oregon (DRO), an advocacy group, wrote to OHA about complaints that DRO received about KEPRO’s utilization review and the management of patient transfers.
The complaints stated that KEPRO had not properly notified individuals about denials of care, that patients were not informed of their rights, and that transitions were poorly handled.
After several months, DRO received some of the information they requested from OHA;
however, one point remained: OHA’s accounting for patients who were denied care under KEPRO’s utilization review.
In December, Radcliffe requested data on individuals who were impacted by KEPRO’s utilization review. In addition, she identified three concerns regarding the management of patient transitions:
1. The contract between KEPRO and OHA incentivized KEPRO to move patients out of residential care facilities. Long-term health outcomes were not monitored; as a result, OHA could not follow up with patients or improve the system.
2. OHA was not properly funding less-restrictive levels of care despite the fact that patients were supposed to be transitioned into these levels. This was especially true of supportive or independent housing (the least-restrictive care).
3. OHA failed to give patients, and their loved ones, control over their services and living situation.
In February, Patrick Allen, head of OHA, responded to Radcliffe. He acknowledged Radcliffe’s concerns and explained how OHA had addressed them. Furthermore, he released data on what had taken place during these transitions.
Here is what we know today:
· Between July 2017 to June 2018, 1,004 people were either transferred to another less-secure facility or released from a facility altogether.
· Within six months, around 400 people wound up in emergency rooms (likely due to OHA failing to ensure individuals were connected with primary care physicians).
· Within six months, 59 people became homeless (likely because OHA did little to ensure individuals were connected with housing and supportive services).
· Ironically, 90 people who were kicked out of residential facilities (the lowest levels of care) ended up in state hospitals (one of the highest levels of care).
· Within six months, 35 people died after being transitioned or moved out of residential facilities.
Moreover, as part of KEPRO’s utilization review, the company considered whether people in state facilities were eligible for Medicaid. KEPRO had revoked Medicaid eligibility for 88 people. The state has since overturned 44 of KEPRO’s decisions and granted extensions to 37 others. Only seven of KEPRO’s decisions have been upheld by the state.
Why This Matters
This is a scandal that has happened in plain sight. 35 Oregonians are dead and hundreds have been harmed as a result of KEPRO’s utilization review and the OHA’s failure to incentivize positive health outcomes and properly plan transitions of over a thousand mentally ill patients.
This is unacceptable.
This story has not received the proper media coverage that it should. If these were patients with physical—rather than mental—illnesses, we have to wonder whether this story would receive more attention.
While some may argue that OHA only tried to give patients more freedom, it should again be stated that 90 patients, who were moved out of less-restrictive levels of care, later wound up in state hospitals. This means that, despite good intentions, many patients were not given more freedom. They were given less freedom.
OHA has made changes to their contract with KEPRO which is set to expire in June. The state does not plan to renew it.