PORTLAND, Ore. (PORTLAND TRIBUNE) — The Portland-based hospital system Legacy Health has fired another nurse who had reported mismanagement and safety concerns at the Unity Center for Behavioral Health, adding to a growing roster of retaliation claims filed over the troubled psychiatric facility since it opened last year.
In a new complaint filed with the civil rights division of the Bureau of Labor and Industries last week, Heidi Domke accuses Legacy of retaliating against her for reporting unlawful practices last year after she began working at Unity in February 2017.
Legacy’s public relations director, Brian Terrett, said Legacy does not comment on pending complaints, and instead lets “the process occur in the appropriate venue.”
But the Domke filing is the latest development in a year of trouble for Legacy and Unity.
In March of this year, the Oregon Occupational Safety and Health Division of the Department of Consumer and Business Services fined Legacy after documenting 300 assaults and at least 23 injuries at Unity.
Investigators detailed a workplace in which management didn’t seem to know how often its own employees were being assaulted, where many employees questioned the basic model of care, and where some staffers were afraid to say anything about safety problems — fearing it would hurt their careers.
Since then, the Oregon Health Authority has released several inspection reports confirming numerous patient safety issues and noting mismanagement, poor safety protocols and understaffing. Among the problems cited in state documents: two patient deaths in which neglect by staff appeared to be a contributing factor.
Citing those findings and that patients were in immediate jeopardy of harm, the federal government in May effectively placed Unity on probation, threatening to revoke its certification to receive federal reimbursements — only to restore Unity’s certification last month while citing improvements there.
The new complaint by Domke, however, highlights the lingering legal issues Legacy continues to face even after the federal overseers have moved on.
After years of lobbying, and with some public funding and local and state support, Unity Center was set up to great public acclaim by Legacy, Adventist Health, Kaiser Permanente, and Oregon Health & Science University. It’s goal: to divert people in mental health crisis from emergency rooms where they often had been warehoused without appropriate care.
The Northeast Portland facility opened in January 2017 as a 24-hour hospital overseen by Legacy to provide mental health emergency services for adults and adolescents. It is available for walk-ins, transfers from other hospitals, and for police to drop off people who may be dangerous to the community or themselves, but don’t belong in jail.
But despite officials’ expectations that Unity would reduce violence perpetrated on or by people in distress in emergency wards, problems developed quickly at the facility.
In fact, some nurses have said in complaints that they warned Legacy before it even opened — including Domke.
“On two separate occasions in 2016 prior to the opening of Unity, I toured the Unity facility,” she wrote in her Nov. 28 complaint. “I noted grave concerns about safety of staff and patients due to the way Unity was being organized and structured.”
Later, after joining Unity in February 2017, she wrote, “I observed numerous serious problems with the way the hospital was organized and managed, including a chronic shortage of staff on shifts, unsafe facility conditions, and unsafe protocols or practices.”
Domke claims she raised these concerns to supervisors, and then to the Legacy vice-president in charge of nursing, and even George Brown, then the Legacy Health CEO.
She claims she also started cooperating with the state in September 2017.
Documents released by the state confirm that Domke was one of the nurses who spoke up to state investigators about assaults and safety issues.
In November 2017 she spoke with the Occupational Safety and Health division about weaknesses in the employee badge system as well as the Voicera communicators that were supposed to let staff alert security when a threatening situation was developing.
Domke, an on-call psychiatric nurse, says that in January 2018 she requested a special accommodation, or transfer, to deal with the lingering effects of an on-the-job injury she suffered in 2015.
And she says that she applied for between 15 to 20 positions within Legacy only to be rejected — which she said was consistent with a pattern of nurses over 40 years old being pushed out of their jobs. Legacy fired her in October.
While details of the reasoning Legacy cited for the termination are not known, the Domke case is at least the fifth retaliation complaint filed against Legacy by nurses who said they raised safety concerns about Unity.
One such case has been withdrawn from court, potentially indicating a settlement. Two others are pending.
Meanwhile, Domke’s is the second such claim received recently by BOLI. Typically such complaints are a precursor to suing.
Legacy, for its part, has denied retaliating against nurses and says it has made numerous improvements at Unity.
“Unity Center for Behavioral Health’s No. 1 priority is, and has always been, the safety and well-being of our patients and staff,” Legacy’s Terrett wrote in a recent email. “… We have made significant improvements to our environment of care, and our policies and practices. We have worked to create a culture of safety, through education and support for staff, many town hall meetings with staff and leadership, and continued dialogue.”