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The case of a 50-year-old man diagnosed with schizophrenia who died earlier this year while under restraint in a Portland hospital is illustrative of the severity of the mental health system crisis in Oregon.

Glenn Shipman was transported to Legacy Emanuel’s busy emergency room after being tasered by police in Scapoose. He died after becoming brain dead, the result of being asphyxiated while being restrained for several minutes face down on the floor.

The cause of death was originally reported by Legacy as cardiac arrest. However, this was later changed in large part because of an investigation conducted by the state’s Health Care Licensing and Certification program on behalf of the Centers for Medicare and Medicaid. HCLC published findings of its investigation earlier this year citing a number of violations of Mr. Shipman’s rights as well as departures from required policy and procedure. Anchored by the HCLC report, a recent investigative article in the Portland Tribune also raised questions about disclosure and violations of patient rights and policy and procedure at Legacy Emanuel.

Both the strengths and defects of Oregon’s myriad emergency preparedness apparatuses were on display during the recent fatal floods on the coast, when heroic personal efforts were carried out, oftentimes, with obsolete equipment and a cash-strapped infrastructure ill-prepared for a tsunami or other natural disaster.

Many funding problems stem from the state’s poor economic climate – the University of Oregon’s Index of Economic Indicators points toward a coming recession based on unemployment claims, a decline in building permits and other factors – which has tremendous ramifications for state and local emergency planning efforts.

As head of Oregon’s Public Health Division, Dr. Susan Allan oversees an annual budget of about $20 million. How much of her budget is devoted to disaster readiness?

"Not a penny," she said. "Oregon has chosen not to fund public emergency preparedness."

Despite Kaiser Permanente’s continued upswing, overall net income for the state’s eight largest insurers dropped 11.2 percent in third quarter 2007, compared to the same period a year ago.

Kaiser boosted its bottom line 114.7 percent, while PacifiCare improved by 94.8 percent. The increases weren’t enough to overcome a 35.7 percent drop by the state’s largest insurer, Regence BlueCross BlueShield, as well as similar decreases from Providence Health Plans, PacificSource Health Plan and ODS Health Plan. Health Net Health Plan of Oregon joined Kaiser and PacifiCare, climbing 25 percent. LifeWise Health Plan of Oregon experienced the largest drop, plummeting 123.3 percent from third quarter 2006 to third quarter 2007.

Before launching a comprehensive transformation initiative, the Oregon Department of Human Services did what any responsible organization would do. It asked the advice of a retired southern Oregon farmer.

Receiving the pro bono help of John Ramsey, however, may have been one of the department’s largest scores. Ramsey’s dove in head first, utilizing decades of experience in the consulting world. He’s largely responsible for the acquisition of McKenzie and Company, a San Francisco-based consulting company with a track record in the public and private sectors.

With the DHS Transformation Initiative, the department hopes to build off the success of a pilot project in its financial services that produced a return in savings in less than a year.

Editor-in-chief Tim Stumm recently caught up with Ramsey to learn more about the Japanese term Kaizen, the project’s $3.2 million price tag, and why he thinks his background in the private sector is just what the state’s largest agency needs.

OHN: It’s my understanding you came to Oregon to retire and live a peaceful life on a farm. Why have you gotten involved in this?

JR: Sen. Alan Bates (D—Ashland) talked me into it. He was my neighbor and had a small ranch here before he was gerrymandered out of the area. I really saw a chance to take something that I learned how to do and make a substantial contribution.

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• Medical professional liability rates come back down for state insurers
  
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