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For decades, Oregon’s rural clinics have struggled to survive in the face of provider shortages, negligent operating margins and slow reimbursement rates while trying to provide otherwise-nonexistent care to rural, underserved communities.

"Quite frankly, every single rural health clinic in the state is facing a crisis," said Dr. Lisa Dodson, director of Oregon Health & Science University’s Area Health Education Centers program. The majority of the state’s clinics run at razor thin margins.

Oregon has 53 Rural Health Clinics, a federal designation established by the Rural Health Clinic Service Act of 1977. The purpose of RHCs is to increase primary care services for Medicaid and Medicare patients in rural communities by reimbursing rural clinics at a higher rate than their urban counterparts. RHCs can be public, private or non-profit entities. A public clinic is operated either by the state or a charter approved by the state and is accountable to elected public officials; a private clinic is a for-profit business, typically owned by a lone or small group of practitioners; a non-profit clinic is governed by a community-based board of directors and is tax exempt.

Earlier this month, the state’s Psychiatric Review Board agreed to alert local law enforcement officials in communities where patients just released from the State Hospital are seeking housing.

This new policy might make it difficult for recent recipients of Department of Human Services (DHS) grants made to providers of transitional housing for the mentally ill. The grants, totaling roughly $13 million were established to provide transitional housing to 307 Oregonians with mental illness. Grant recipients include organizations and agencies that provide residential and treatment facilities to young adults, the homeless and patients being discharged from state psychiatric hospitals.

In February, the Oregon Association of Hospitals and Health Systems announced that its 57 members have agreed not to charge patients or their payers for certain medical errors that should never occur within a health facility. These medical errors are also known as "never events." The National Quality Forum (NQF), a not-for-profit membership organization, defined this list of 28 medical errors in 2002 and updated it in 2006.

Never events fall into categories known as serious preventable events and include: surgery performed on the wrong patient; the use of contaminated drugs or devices; an infant being discharged to the wrong person; medication error; electric shock or burn and the assault of a patient.

Minnesota is arguably a leader in establishing never events policy. In 2003, the state began requiring its hospitals to report medical errors and in 2004 began publishing an annual report which details the errors naming the facilities where they were made. In 2005, HealthPartners, a leading payer in Minnesota, became the first insurer to refuse to pay hospitals for never events.

An office of the Department of Human Services has launched an initiative to educate people with developmental or mental disabilities, their families, caregivers and other stakeholders about preventing and recognizing mistreatment.

As part of this effort, the Office of Investigations and Training, which probes reports of abuse, recently completed a training film about abuse and neglect. Nyla McCarthy, training and prevention unit director at OIT, has scheduled 30 focus groups throughout Oregon, to gather input from consumers and their families, case managers and other professionals.

"We’re trying to get a broad picture of the system and find out what end users think of it," she said. "I call it a listening tour."

The effort follows a similar one McCarthy led five years ago. The film and feedback are intended to guide OIT on where best to expend resources and what initiatives should be supported. "In a dreamer’s world, [the effort] would end abuse and neglect of vulnerable people," said McCarthy, who is also vice chair of the Human Rights and Relations Advisory Commission in Salem. "In the shorter term, we’d like to reduce those instances [of abuse and neglect] considerably."

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