Oregon’s claim of “following science” is belied and betrayed by failed mental health and substance use systems controlling public healthcare resources

by Clark Miller

Published October 11, 2018

Updated April 2, 2021; December 9, 2021

In rural Oregon hard-hit by the opioid crisis, Columbia Pacific Coordinated Care Organization is the managed care insurance provider using public healthcare funds to control clinical healthcare practices, as overseen by the Oregon Health Authority. Severity and consequences of substance use epidemics in Oregon are among the most dire nationwide, with the rural counties of NW Coastal Oregon – where use of public healthcare funds for Affordable Care Act (ACA) patients is overseen by Columbia Pacific  – ranking high as problematic among counties in Oregon, where the problem is described as a “public health crisis” and “epidemic”, with more prescription opioid pills (280 million) prescribed than in any other state and 150 deaths annually attributed to overdose by prescribed opioids.

Logged area on the Oregon coast

More recent findings identify Oregon with the highest rate of older adults hospitalized for opioid use problems . Tillamook County is fifth among counties for continued prescription of opioids, with Clatsop County, also in the region, in the top ten. Annual opioid overdose deaths in the three counties in this rural Oregon region exceed national rates by up to 40%.

In this and other posts, the capacity of managed healthcare organizations like Columbia Pacific to protect public health in the face of increasingly lethal opioid, substance use, and other behavioral health crises is examined from research, evidence-based practice, ethical practice, and an insider’s view

Columbia Pacific is one of multiple CCOs functioning as a managed healthcare organization across health delivery regions in Oregon, part of a history of mismanagement of public funds by OHA described, for example, here

The Oregon agency charged with managing health care for the state’s most vulnerable citizens likely misspent millions of taxpayer dollars, stymied an effort to shed light on its problems and failed to keep pace as the state’s Medicaid caseload nearly doubled.

. . . 

Once officials worked through a backlog of 115,200 Medicaid recipients, an approximate 41 percent of enrollees were found ineligible. “Failure to address this issue in a timely fashion resulted in approximately $88 million in avoidable expenditures (from March 1 to Aug. 31, 2017),” the audit states.

While the audit was underway, The Oregonian/OregonLive reported an additional $74 million of improper payments were made. A recent change of leadership also prompted the disclosure of another $112 million of wrongful payments, first reported by The Portland Tribune.

. . . 

The Oregon Health Authority did not like being under the microscope, according to auditors.

“At times, we were prevented direct access to staff, had our interviews with staff monitored, had our information requests delayed, and were occasionally provided with incomplete and/or inaccurate information,” the audit reports.

. . . 

In Oregon, the system is particularly convoluted because much of the service is administered through what are called coordinated care organizations. These organizations are a network of health care providers working in communities across the state to give a range of health care services to those under the Oregon Health Plan or Medicaid.

A glaring problem is the huge discrepancy in how the individual CCOs work to detect fraud and waste. Some of these health organizations don’t even track improper payments. The contracts with these organizations are unclear and don’t articulate clear expectations.

Systemic dysfunction, malfeasance and deception

predict public harms beyond squandering of public healthcare funds. 

For example, a failure to effectively use public healthcare funds to treat compulsive use of tobacco – smoking – has extremely high costs and drives broader epidemics because public health and social harms of tobacco use eclipse those of opioids and illicit substances combined, and because tobacco use is directly worsening the opioid crisis by contributing to the causes of chronic pain conditions and to worsened perception of chronic pain.

In rural Oregon hard-hit by the Opioid Crisis, Columbia Pacific’s approach as the business-model Managed Healthcare system managing state Medicaid funding for vulnerable Oregonians  rejects evidence-based practice and clinical expertise, instead supports with public funds invalidated practices with no predicted benefit including New Age remedies for smoking. Columbia Pacific CCO continued to attempt to recruit smokers to the group sessions – termed “Practice of Health” (POH), without a curriculum and without evidence-based interventions – and to use public healthcare (Medicaid) funds to reimburse unqualified group leaders, after three clinical programs withdrew support based on concerns.

Man smoking a cigarette

public health and social harms of tobacco use eclipse those of opioids and illicit substances combined, and . . . tobacco use is directly worsening the opioid crisis by contributing to the causes of chronic pain conditions and to worsened perception of chronic pain.

The Columbia Pacific staff member promoting the POH group practices compared them favorably to the invalidated practices of a religious subculture (Alcoholics Anonymous) for substance use problems, those practices not constituting treatment or providing benefit  for substance use problems. That staff member expressed personal positive orientation to practices of religious self-help groups, citing personal life experience with them. She misrepresented herself as having a background in research in a clinical meeting about the group sessions, and misrepresented evidence about effectiveness of the group activities. That’s not good.

In the context of a lethal opioid crisis and national substance use epidemic, the public has a right to accountability and to know whether use of public healthcare funds is being driven by research and evidence, or the religious allegiances of insurance company staff.

Practice of Health (POH) is a proposed group session “treatment program”, without curriculum or elements registered or supported by research as evidence-based (as beneficial)  – not found under the Substance Abuse and Mental Health Services Agency (SAMHSA) registry of evidence-based practices.

Instead, POH as envisioned is made up of elements of New Age spiritualism and Integral Transformative Practice from the Esalen Institute with “long-term, positive activities” like the Kata,  “movements [which] are intended to articulate all the muscle groups and joints in the body and to offer an opportunity for deep rhythmic breathing, relaxation, transformational imaging and meditation”. POH was advertised to Medicaid patients by Columbia Pacific CCO as treatment for tobacco use disorder with public (Medicaid) funds allocated for payment by Columbia Pacific CCO. There is no evidence that the practices serve as treatment whatsoever for lethal compulsive substance use, mood disturbance, or any other issue.

mystical image

To protect patients in our clinic from ineffective treatments and the public from abuse of Medicaid funds, I evaluated Practice of Health and found no basis in evidence for any beneficial effects, moreover evidence of harm to patients who would be encouraged to believe and continue to act on the beliefs that the components of POH constitute treatment of some type for life-threatening substance use problems.

The stated plan for the POH group sessions was to have the licensed clinical social worker proposing the series, based on his past experiences with the Esalen Institute and Integral Transformative Practice, pass on the role of providing group treatment for the life-threatening condition of tobacco dependence to a non-professional, a community member with no credentialing, training, or competence in behavioral health or substance use treatment, Columbia Pacific dedicating Medicaid funds for payment.

I shared findings with my clinic, which then declined to refer patients to the program, as had been requested by Columbia Pacific. Two additional area treatment programs then also withdrew support for POH. Columbia Pacific continued to advertise, advocate for, and commit public (Medicaid) funds to the fictional “treatment” program.

Practice of Health is not an isolated example

Columbia Pacific has supported (paid staff members arranging and facilitating the presentations) healthcare presentations and treatment advice to local communities, with themes similar to those represented by Practice of Health – personal journey and spiritual or personal growth experience as treatment for life-threatening conditions – in this case symptoms of trauma or PTSD that often include increased risk of depressed mood, suicidal behavior, and substance use problems.

The invited speaker was Elaine Waters of the Trauma Healing Project based in Eugene, Oregon. Ms. Waters advised audiences that she is “not a clinician” then went ahead and offered recommendations for “healing” from traumatic experiences throughout her presentations to vulnerable Oregonians, also alluded to her “work with” young people and adults living with trauma-related symptoms.

Ms. Waters contrasted professional, evidence-based practice (EBP) therapies for trauma-related symptoms and conditions, warning that they are often “not very effective” and can often be traumatizing themselves, versus “the healing and recovery part” offered by the practices she provides “at my center” based on her personal journey recovering from trauma, “I have wisdom about it”. Those practices include:

 – “energy work”
– “group movement work”
– “acupuncture healing circle”
– “cognitive emotional wellness acupuncture”
– “support groups”
– “healing arts program”
– “acupuncture”
– “massage”

None of those activities constitute EBP for trauma effects and in any case are not substitutes for EBP therapies.

If Ms. Waters had been addressing a somewhat different chronic health condition with associated life-threatening conditions and effects when unmanaged by professional care – like Type 2 Diabetes – would she provide the same types of warnings against use of professional health care services, and the same recommendations for substitute, unvalidated practices like “energy work” and “acupuncture healing circle” ?

Her messages to vulnerable Oregonians struggling with life-threatening conditions were promoted, supported and tacitly endorsed by Columbia Pacific CCO, using public healthcare funds.

Is it possible that POH and the Trauma Healing Center are flukes –

that misuse of public funds for unsupported practices like those described are exceptional incidents, corrected and not repeated by Columbia Pacific in its public duty and responsibility to manage those funds competently, supporting effective clinical practices ?

On examination, it becomes apparent that examples like POH and other New Age healing practices were driven by personal religious allegiances and lack of clinical and ethical competence and orientation of CP CCO staff who are in positions to influence the way public funds are used to address lethal substance use including opioid epidemics. It appears critically important to evaluate and provide accountability for potentially malfeasant use of public funds by examining Columbia Pacific CCO staff scope of competence in:

  • ability to understand and evaluate research
  • planning appropriate evidence-based practices for specific behavioral health problems
  • capacity to understand the nature and treatment needs for mental health and substance use problems.

A review of Columbia Pacific funding and clinical guidance practices generated a 29-page press release that documented:

  – Medication-Assisted Treatment (MAT) for the opioid crisis

Columbia Pacific CCO clinical oversight and support for two clinics where no EBP treatments are used for opioid dependence, at one clinic for example, patients placed in self-help group sessions and billed for those sessions.


 – Bridges to Pathways detoxification center

Endorsed and supported with public funds by Greater Oregon Behavioral Health Inc. (GOBHI) and Columbia Pacific, and where a patient in detox was sent to a program of faith healing, Mountain Ministries Religious Center Church in Rainier, Oregon, where she found she would need to commit to a year-long program of religious indoctrination, with only the Christian Bible allowed as reading material, and strict rules of conduct, experienced by her as programing aimed at her being “brainwashed” and “pretty much a cult . . . I left”.

  – Helping Hands (HH) homeless shelter, Tillamook County

Supported with public funds by Columbia Pacific, and where residents and their children are evicted back to homelessness if they do not comply with mandatory participation in religious programming, a violation of their constitutional rights as Americans and the opposite of “trauma-informed care”.

  – Columbia Pacific CCO clinical trainings to disseminate “best practice” clinical practices by experts to clinical professionals.

The Columbia Pacific CCO “experts” lack credentialing, training, and competence in evaluation of research and in EBP for substance use disorders, neglecting to review research and disseminating false information about effectiveness of nicotine replacement therapy (NRT) for smoking.

  – Clinical Oversight and Direction for addressing the opioid crisis and substance use epidemic: Columbia Pacific’s Northwest Regional Substance Use Steering Committee (NRSUSC)

None of the committee members, charged with providing clinical guidance to CPCCO for prevention and treatment of substance use disorders, has expertise in those areas or in evaluation of research-informed EBP. 

At Columbia Pacific, grossly incompetent practice predicting harm to vulnerable Oregonians has been standard operation

Practice of Health and Columbia Pacific CCO’s promotion to communities of “energy work” and other unvalidated activities for chronic PTSD are not flukes, exceptions, but represent systematic malfeasance and profound clinical ignorance in the management of public healthcare funds by Columbia Pacific and other Oregon business-model managed care organizations, including coerced religious programming.

That failed responsibility to vulnerable Oregonians trapped in lethal opioid and substance use epidemics represents an abdication of critical thought and critical discourse, an abdication of evidential, scientific and ethical reasoning.

An expression of institutional and cultural pathology in Progressive Oregon, no less than in North Carolina

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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