Oregon Health Authority Director to Step Down

Dr. Sejal Hathi, director of the Oregon Health Authority, is resigning Aug. 1, ending a relatively brief tenure for a young leader who—charged with piloting one of the state’s most complex agencies through an uncommonly tumultuous period—did not, to some observers, seem sufficiently focused on the task at hand.

Gov. Tina Kotek announced the “leadership transition” Thursday morning. “Sejal Hathi has decided to step down from her position as director to focus on family, personal priorities, and the next chapter of life and service,” Kotek’s office said.

Former Oregon Department of Human Services director Fariborz Pakseresht will begin as interim director of OHA on July 6, at which point Kotek says he will “collaborate with Dr. Hathi on a thoughtful transition.”

OHA is a major force. Powered by a $20 billion-plus annual budget, its responsibilities range from public health coordination to regulating hospitals to managing Oregon State Hospital, the state’s highest-level psychiatric institution. It also runs the Oregon Health Plan, which provides health benefits to 1 in 3 Oregonians and shapes the broader health care ecosystem in seismic ways.

Hathi began her tenure heading OHA in 2024. She was in her early 30s, bearing a résumé filled with prestigious institutions from Massachusetts General Hospital to Stanford University to the White House. She served briefly as a deputy health commissioner in New Jersey before Kotek brought her to Oregon.

The governor tasked Hathi with managing an unwieldy bureaucracy over a particularly tough period. Emerging from the pandemic, medicine was evolving fast, the patient population was growing sicker and more complex, a fentanyl crisis raged at full force, the state budget was getting tighter, and federal policymakers were moving to radically alter the social safety net which the agency played a key role in administering.

“I don’t think anybody can succeed in this environment,” Dr. Eric Wiser, president of the Oregon Academy of Family Medicine, said in a phone interview Thursday.

And yet, he and other observers say Hathi did not seem as engaged with Oregon’s particular health system as hoped. There was a time when “I think we all wish we heard from her more,” he says, “and certainly in the last three months, there’s been not a lot of good press.”

In a 9 am email to OHA staff, Kotek framed the separation as Hathi’s decision and thanked her for “her steady work to strengthen health care and Oregon’s public health system during her time with us.” Four minutes later, Hathi delivered a note of her own.

“I am proud of what we have advanced together,” she wrote, citing the agency’s work expanding health care coverage, including by widening eligibility for Oregon Health Plan benefits, and establishing the West Coast Health Alliance, a response to changing Trump administration vaccine policies. She also touted the agency’s work expanding residential behavioral health capacity, and “working to stabilize and prepare Oregon’s Medicaid program amid seismic federal change.”

Hathi’s departure adds an interesting wrinkle to Portland’s civic anxiety over the fate of the Trail Blazers basketball team. Her husband, Sheel Tyle, owns a portion of the team and has presented himself as the local stakeholder in the Blazers, even as its majority owner, Texas billionaire Tom Dundon, plays a high-stakes game of chicken with the Portland City Council over public funding for an arena overhaul.

But more to the point, Hathi leaves the state with substantive health challenges. Costs are skyrocketing. Primary care wait times run long. The state’s mental health outcomes rank among the worst in the nation.

Hathi did not always take accountability when things went sideways on her watch. Oregon State Hospital, the state’s highest-level psychiatric institution, has faced much scrutiny in recent years over staffing problems, questionable caretaking practices, and a high-profile patient death—and it has churned through interim leader after interim leader, including under Hathi. In a recent hearing before lawmakers, Hathi tried to distance herself from the hospital’s problems, saying they were “confusing to all of us,” and insisting the operation was shaping up.

And despite Hathi’s publicized listening tours, some questioned early on whether Oregon had her full attention. Confusion and skepticism abounded when, in late 2024, she accepted an unpaid job at Stanford University Hospital—outside work she said she would complete in her free time.

“We all had very high hopes that she would bring innovation and compelling policies and ideas and relationships,” Lines for Life CEO Dwight Holton said by phone Thursday morning. But “it just didn’t play out.”

It was not just the attention issue. Effectively managing a large bureaucracy requires depth of experience, and it was unclear whether Hathi’s was sufficient for the task, he says. Meanwhile, he adds, great things are happening in Oregon: interesting compelling health care models with real promise. “And it felt often like the director’s attention was outside the state, as opposed to how to capitalize, grow, and support innovation that was happening here.”

As time went along there was, Holton says, a “very strong need for the governor to make the change,” and he was glad the reins were going to a steady hand—Pakseresht—who knows the state well.

In recent weeks, Hathi’s national profile rose when she penned a New York Times opinion piece describing her challenges getting adequate health care after giving birth to her child—drawing a response letter from the Oregon family medicine association, which noted that core aspects of an alternative health care model Hathi proposed already exist in the state, but could use more support from the health authority.

The article was a misstep, says Wiser of the family medicine association. Hathi presented a personal story about encountering maddening and common health care gaps, he says, but as OHA director her professional duty is to understand those gaps, fund those gaps and come up with concrete solutions—and here, he believes her article, which argued for an integrative care model in which she noted Finland had made strides, did not show great insight into the way Oregon worked. His association was set to meet with Hathi over the matter this past Monday before she canceled.

“Proposing a new system where you can get prenatal care next to pediatric care sounds great on paper,” Wiser says. “My question for her, which I was hoping to ask is, ‘Well, why don’t we invest in the current system that’s supposed to be doing that?’”