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Caregivers for Multnomah County’s most vulnerable patients say a design error in the county’s new $94 million health building needlessly imperiled highly vulnerable patients.
In spring 2019, the county health department began serving patients, including those with HIV and hepatitis C, in the nine-story Gladys McCoy Building across from Union Station in Old Town. The state-of-the art structure, billed as “modern, durable, flexible and efficient,” replaced a decrepit, 1923 health building downtown.
But in documents obtained exclusively by WW, workers now say a fundamental flaw in the new building may have put users—including county caregivers—in peril.
The McCoy Building’s entire third floor is a clinic for HIV and hepatitis C patients, many of whom are homeless, struggling with mental illness, or suffering from substance abuse.
One room on that floor was supposed to have specialized ventilation that would keep possibly dangerous air from leaving the room. Room 327 was a “negative pressure,” or isolation, room for patients exhibiting symptoms of respiratory illnesses, including tuberculosis and COVID-19.
Special ventilation keeps the air pressure lower inside the room than outside it, so airborne germs stay inside the room to be scrubbed by filters. That safety feature was supposed to keep patients in the other 44 rooms on the third floor from breathing contaminated air.
For more than a year and a half after the building opened, workers in the clinic say, they brought patients with signs of respiratory illness into the room for treatment, believing the negative pressure would protect the rest of the third floor from airborne illnesses, such as COVID-19.
But after a COVID outbreak among staff on the third floor in late 2020 left 11 sick, the county confirmed employees’ suspicions: The negative pressure room was just an ordinary room with ordinary ventilation. The precautions to reduce risk of airborne illness were an illusion.
“It’s unacceptable that this type of failure occurred,” says Eben Pullman of the American Federation of State, County and Municipal Employees, which represents county employees and filed a labor grievance in April 2021. “It’s more unacceptable that this went unnoticed and unresolved well into the pandemic. Our members and our patients deserve better from the county.”
The county has offered no answers as to how the misidentified room escaped notice for nearly two years.
County spokeswoman Julie Sullivan-Springhetti says the county is moving forward with a $365,000 project to convert two of the clinic rooms to negative air pressure rooms and is “working to answer [questions] around the history and use of the room.”
About 55 workers staff the county’s HIV clinic, which serves 1,300 patients.
Staffers say Room 327 was clearly labeled as an isolation room: A laminated sign on the door read “RESPIRATORY PRECAUTION ROOM” in all caps.
A former medical assistant at the clinic, who asked to remain anonymous for fear of retaliation, said anywhere from seven to 10 patients were treated in the room per day.
“We serve the underprivileged,” the former employee says. “Many are homeless and outside for weeks on end. They could get pneumonia, tuberculosis, now COVID. But we put them in the room and we assume they’re safe.”
Dr. Dat Tran, medical director of the Healthcare-Associated Infections program at the Oregon Health Authority, says negative pressure rooms are important measures to prevent airborne diseases from spreading.
“Its main intent is to protect the adjacent space,” says Tran. “We know that if you have a vulnerable population, you want to optimize infection control practices.”
Internal documents shared with WW show that clinic managers repeatedly referred to Room 327 as an isolation room and instructed employees to use it as such.
One current employee, who also asked to remain anonymous, said that if someone had a respiratory condition, that person was immediately brought to Room 327 to be treated.
“That was just the procedure, to take them to that room,” the employee says.
Staff raised concerns about the room’s efficacy to their clinic manager and to the union after the COVID-19 outbreak among employees in late 2020.
Union representatives with AFSCME Local 88 requested building plan documents. Construction blueprints from 2017 show no indications that Room 327 was built as a negative pressure room.
The county requested an inspection of the room in January. The inspector wrote that Room 327 wasn’t included in “the respiratory precaution design” of the building.
The county acknowledged as much in a Feb. 2, 2021, email to the clinic manager at the time, obtained by WW.
“I was able to verify that in building the Gladys McCoy, the only negative pressure rooms were on the fourth floor,” a county administrator told the manager. “There were never any negative pressure rooms planned for the third floor.”
AFSCME Local 88 first filed a grievance with the county in April 2021, as did the Oregon Nurses Association, which represents seven employees at the clinic, in May. In response, the county promised in a May 2021 email, “Facilities is currently working on contracting to an engineering firm to add two negative respiratory precaution rooms on level 3.”
The unions, however, say that nothing has happened.
“That assurance was made over six months ago, and we’ve seen no evidence that this project is in fact underway,” AFSCME wrote in its updated grievance to the county in September.
It’s been nine months since the unions first filed grievances with the county, and nine months since the county said it would fix the problem. It remains unclear how the mistake happened and who is responsible.
“There hasn’t been any clear analysis of where the problem started,” says Kevin Mealy, a spokesman for the Oregon Nurses Association. “We are more concerned about getting this problem fixed than whose fault it was. The fact that we have neither is incredibly frustrating for nurses who relied on this room to keep patients safe.”
AFSCME Local 88, in its latest attempt to get answers, sent a letter to Multnomah County Auditor Jennifer McGuirk on Dec. 16, asking for an investigation. McGuirk initially told WW that the year’s audit schedule had already been set and the issue was unlikely to make the list, but that she was looking at different avenues to pursue the concerns. She later said: “My office is concerned about the allegations, particularly the allegation that the Gladys McCoy Building doesn’t have a negative pressure room. My office will look into this.”
Employees just want the room fixed.
“Trust was betrayed with the people they serve,” says Local 88 president Joslyn Baker. “The inability of management to admit they were wrong and fix it is unconscionable. They have the opportunity every day to fix it.”
This article was published with support from the Jackson Foundation, whose mission is: “To promote the welfare of the public of the City of Portland or the State of Oregon, or both.”