TIME TESTED Closing a loophole in drug safety PRIDE ACROSS OREGON Finding LGBTQ+ spaces in unexpected places Oregon nurses take to the streets July / August 2023 | OregonBusiness.com THE HEALTH CARE ISSUE OUT IN FORCE
⁄Contents⁄ July/August 2023 FEATURES 24 From the Bedside to the Picket Line Cover Story Oregon nurses are striking and picketing across the state this summer. We asked them why. 34 From Oregon With Pride Queer nightlife isn’t just limited to Oregon’s larger cities. REGULARS 06 Editor’s Letter 10 Newsfeed 14 Tactics Central City Concern CEO Andy Mendenhall talks about how the agency is recovering from the pandemic and addressing Portland’s mental health and housing crises. 18 Spotlight A new Oregon law will make it easier to get fentanyl testing strips and naloxone. 42 Powerlists Financial planners and health plans 46 Storyteller-in-Chief Barry Raber, president of Carefree Covered RV Storage, on how to find success not by solving problems but by figuring out what’s going right Follow @OregonBusiness for breaking news, blogs and commentary. Subscribe to our weekly e-newsletter featuring the best of OregonBusiness.com, plus articles from our print publication. To sign up, go to OregonBusiness.com. 18 BRAND STORY 12 Comcast Direct Comcast Business supports Corvallis-based Work Unlimited to help adults and children with intellectual and developmental disabilities. TIME TESTED Closing a loophole in drug safety PRIDE ACROSS OREGON Finding LGBTQ+ spaces in unexpected places Oregon nurses take to the streets July / August 2023| OregonBusiness.com THE HEALTH CARE ISSUE OUT IN FORCE COVER PHOTO: Jason E. Kaplan JASON E. KAPLAN CORRECTION The story “Using Wood Wisely,” which appeared in the June 2023 issue of Oregon Business, incorrectly described the credentials of one of its subjects. Valerie Carey holds a master’s degree in international management, not sustainable development and training. Oregon Business regrets the error. CHECK OUT THESE EXCLUSIVES (AND MORE) ON OREGONBUSINESS.COM 100 BEST NEWS Get notified and never miss again. Sign up to receive noti cations about upcoming 100 Best surveys. Go to OregonBusiness.com/100BestNotify. ■ Hood River Welcomes Country’s First NA Distillery and Tasting Room — Nonalcoholic category continues its exponential growth in Oregon. ■ German Sex-Toy Maker Awarded $2.2M Default Judgment Against Lora DiCarlo — Court documents say the current operational status of the Bend sex-tech startup is “entirely unknown.” ■ Applications Being Accepted for Oregon Semiconductor Firms Applying for CHIPS Funding — In April Gov. Tina Kotek signed SB4 to expand funding for semiconductor firms in Oregon. ■ Number of Unhealthy Air Days in Oregon Trending Upward, per DEQ Report — More robust tracking is measuring API levels across Oregon as wildfire seasons continue to worsen. 3
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⁄From the Editor⁄ With Care THE STATE OF EMERGENCY DECLARED in response to COVID-19 may have officially expired in May, but the effects of the pandemic are still with us. That was a recurring theme of nearly every conversation I had for this issue. Dr. Andy Mendenhall, reflecting on his first year as CEO of Central City Concern (Tactics, p. 14) talked about the ways COVID exacerbated existing mental health and substance abuse problems — and how it coincided with increased availability of fentanyl and a cheaper, more potent form of methamphetamine. And while investigating the rise of fentanyl use, I learned that the penalty for carrying fentanyl testing strips — which users of other drugs can use to determine whether what they are taking is contaminated—was higher than the penalty for carrying most drugs that could be laced with fentanyl. So for “To the Test” (p. 18), I spoke to lawmakers and advocates who were working to change that — and to a nightclub owner who was quietly flouting the law. One of the first stories I edited for Oregon Business described working conditions for nurses, who—one year into the pandemic —described being burned out and frustrated by long hours, inadequate staffing ratios and other difficult working conditions. Two years later, nurses are still frustrated — and they’re taking to the streets. For “From the Bedside to the Picket Line” (p. 24), Jason Kaplan and I talked to nurses about why caregivers in hospital systems all over the state have picketed, struck and voted to strike — and why they’ll continue to negotiate. As this issue went into production, two people were arrested after a clash involving counterdemonstrators at Oregon City’s Pride event. That event — and the increasing backlash against LGBTQ+ communities in Oregon and elsewhere — underscored the significance of the spaces featured in Andrew Jankowski’s story, “From Oregon With Pride” (p. 34), which discusses queer spaces around the state, with a particular focus on spaces and events outside larger cities. The story is “off-theme” for this issue—which focuses on health care — but describes a different kind of care: the kind of conscientiousness needed to create safe, welcoming spaces. In mid-June, Oregon’s Legislature reconvened, providing closure to two of these stories. A safe-staffing ratio bill championed by the Oregon Nurses Association passed, and so did a bill explicitly excluding fentanyl testing strips from the heavy penalties they previously carried. Legislators also passed an altered version of the bill that led to the walkout, protecting gender-affirming care and abortion rights. Along the way, we had a number of conversations with Oregonians who were frustrated by the impasse resulting from the walkout — and with those who were relieved when they finally took the care. VOLUME 46 ⁄ NUMBER 7 OREGON BUSINESS (ISSN 02798190) is published 10 times per year, monthly except Jul/Aug and Nov/Dec issues, by MEDIAmerica Inc. at 12570 S.W. 69th Ave., Suite 102, Portland OR 97223. Subscription inquiries should be directed to 503-445-8811. Subscription charge is $24.95 per year, $49.95 for two years in the USA. Single copies and back issues available at above address and at selected newsstands. The editor is not responsible for unsolicited manuscripts. Copyright © 2023 by MEDIAmerica Inc. All rights reserved. All material is protected by copyright and must not be reproduced without written permission from the publisher. Printed in Oregon. Periodicals Postage Paid at Portland, OR. POSTMASTER: Send address changes to Oregon Business, 12570 S.W. 69th Ave., Suite 102, Portland OR 97223 EDITORIAL EDITOR Christen McCurdy christenm@oregonbusiness.com ART DIRECTOR Joan McGuire joanm@oregonbusiness.com STAFF WRITER Sander Gusinow sanderg@oregonbusiness.com STAFF PHOTOGRAPHER Jason E. Kaplan jasonk@oregonbusiness.com COPY EDITOR Morgan Stone CONTRIBUTING WRITERS Andrew Jankowski, Barry Raber PUBLISHING PUBLISHER Courtney Kutzman courtneyk@oregonbusiness.com EVENTS MANAGER Craig Peebles craigp@oregonbusiness.com ACCOUNT EXECUTIVE Evan Morehouse evanm@mediamerica.net ADVERTISING AND PRODUCTION COORDINATOR Greta Hogenstad gretah@mediamerica.net DIGITAL PRODUCTION COORDINATOR Alison Kattleman alisonk@mediamerica.net PRESIDENT AND CEO Andrew A. Insinga CONTROLLER Bill Lee BOARD OF DIRECTORS CHAIRMAN André W. Iseli PRESIDENT Andrew A. Insinga SECRETARY William L. Mainwaring TREASURER Win McCormack 6
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HEALTH CARE ●Breached Trust. Saint Alphonsus M e d i c a l C e n t e r Baker City — which closed its intensive care unit earlier this year — announced it would close Baker City’s only maternity ward. The nearest hospitals with labor and delivery are in Ontario, 74 miles away, and in La Grande, 44 miles away. ●Call the Nurse. The Oregon Legislature passed Senate Bill 523, which allows Oregon’s 17 community colleges to offer a bachelor of science in nursing, a move that would allow students to continue on from shorter nursing degrees already offered at many schools. HOSPITALITY AND TOURISM ●Coming In Hot. A restaurant, a chef and a labor union — all based in Portland — took home honors at the 2023 James Beard Awards. Gregory Gourdet’s celebrated Portland restaurant, Kann, was named “Best New Restaurant,” and Vince Nguyen, who serves contemporary Vietnamese food at Portland’s Berlu, was named “Best Chef: Northwest and Paci c.” The Burgerville Workers Union took home the Emerging Leadership award. ●A Slice of Fame. Ken’s Artisan Pizza was named America’s No. 3 pizzeria by Italy’s Top 50 Pizza organization during a Manhattan ceremony. The Southeast Portland restaurant also received a Green Oven award from the organization for its commitment to sustainability. LEGAL DRUGS ●We ed ed Out . The Oregon Liquor and Cannabis Commission recalled batches of cannabis from two Oregon farms — one owned by Nectar and one owned by a Eugene farm called Rebel Spirit — after the product tested positive for a mold called aspergillus. in each of the next three biennia — totaling $1 billion over eight years. Washington state has already committed $1 billion toward the project’s $6 billion price tag. ARTS AND ENTERTAINMENT ●Will Lillard Scoot? The Portland Trail Blazers drafted 19-year-old point guard Scoot Henderson, fueling speculation that fellow point guard and seven-time NBA All-Star Damian Lillard would leave or be traded. At press time, Lillard had announced no such plans. ●Down Home. The 8 Seconds Juneteenth rodeo, the rst ever Black rodeo to take place in Portland, was held at Portland’s Expo Center June 17. Portland-based photographer Ivan McClellan organized the event. POLITICS ●A Novel Development. Gov. Kotek named Portland city auditor turned mystery novelist LaVonne Grif n-Valade Oregon’s new secretary of state, lling a vacancy left by Shemia Fagan, who left following reports of a lucrative consulting contract with the troubled cannabis dispensary chain La Mota. ●The Boys Are Back in Town. Three Senate Republicans returned to Salem June 15, allowing the Oregon Legislature to reconvene after six weeks without a quorum — the longest legislative walkout in state history. ●Bringing Out the Big Guns. The Oregon Legislature passed House Bill 2572, which allows the Attorney General to seek a court order if the state has “reasonable cause to believe that a person or group of persons has engaged in, or is about to engage in, paramilitary activity.” ENERGY AND ENVIRONMENT ●Fired Up. A Multnomah County jury found Paci Corp’s Oregon utility, Paci c Power, had a hand in causing or worsening four wild res in 2020. The company asked state regulators to increase rates in order to pay the damages, effectively passing the cost on to consumers. EDUCATION ●School’s In. Gov. Tina Kotek announced that Dr. Charlene Williams, formerly the deputy superintendent for Evergreen Public Schools in Southwest Washington, will take over as interim director of the Oregon Department of Education in July. TRANSPORTATION ●What a Gas. The Oregon Legislature passed House Bill 2426, which would require gas stations to staff at least half of their open pumps for customers who want assistance — but allows them to leave the others open for self-service. ●Bridging the Gap. The Oregon Legislature approved $250 million in bond revenue for the Interstate bridge project over the next two years and pledged another $250 million ⁄Newsfeed⁄ Uh, honey? I think we better start driving. Yes, please. No, thanks! Aftermath of the Two-Four-Two fire that burned parts of Chiloquin during Labor Day weekend, 2020. Vince Nguyen MY PHOTO BUDDY/SHUTTERSTOCK 10
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12 BRAND STORY PRODUCED BY THE OREGON BUSINESS MARKETING DEPARTMENT Reliable internet has long been important but it became critical to consumers and businesses when the COVID-19 pandemic hit. For Work Unlimited — a Corvallis nonprofit serving people with intellectual and developmental disabilities — Comcast Business internet was a lifeline, keeping clients and staff connected during the prolonged period when in-person visitation was prohibited. “We have several homes in different cities, and entry was restricted to essential visitors only,” says Christina M. Reinikka, Work Unlimited CEO. “The people we serve were without their typical activities and opportunities for socialization in the community, so we did online Bingo every week. Thanks to Comcast Business, we were all able to connect, socialize, and check in with the people and the staff, which turned into a much-anticipated event throughout the dreary and isolating months of pandemic restrictions.” Work Unlimited serves around 100 clients in Benton, Polk, and Marion counties. In addition to 24-hour and supported living homes, the company also provides day support activities, Job coaching, and integrated, competitive, community employment , through its employment division. Comcast Business supports Corvallis-based Work Unlimited to help adults and children with intellectual and developmental disabilities grow in community. Growing Above Challenges
13 BRAND STORY The organization’s founder, H.D (Bud) Fredericks, was a career Marine Corps officer and Vietnam War veteran whose personal experiences led to a second career in special education. He and his wife, Dot, had five children, the fifth of whom was born in the late 1960s with Down’s Syndrome, and the couple found a dearth of services available to support their son’s special needs. After earning a Ph.D. in special education from the University of Oregon, Fredericks became a professor, author, and advocate. He founded Work Unlimited in 1985. “Dr. Fredericks was determined that his son was going to be able to participate in the world,” says Reinikka. “The great thing about our company is that all the things that are being mandated and legislated now were in our original philosophy of supports. Everybody has the same civil rights. My civil rights are no different than anybody in our group home. That ethos was here from the very beginning.” Reinikka started her career at Work Unlimited in 1989, working as a Direct Support Professional in a home for the first wave of people released from Oregon’s Fairview Training Center. This and a few other small homes were model projects established by Fredericks, the University of Oregon, and Western Oregon University’s Teaching Research Division, designed with the belief that even the most behaviorally challenged people can flourish when given the right support and opportunities. “The transition between incarceration in the institution and community living posed huge challenges. People who were denied their basic needs and civil rights learned that only aggressive, disruptive, and often self-injurious behavior gave them a fighting chance of survival in the overcrowded and chaotic institution,” says Reinikka. “Dr. Fredericks firmly believed that those undesired behaviors would become ineffective and inefficient over time if people were integrated into their communities and given opportunities to live, work, play, and build relationships, coupled with behavioral support and life skills training to maximize each person’s capacity for independence.” Reinikka notes that changing a person’s environment has the biggest impact on altering behavior, though that can take months or years. Work Unlimited’s Direct Support Professionals are trained to pay close attention to clients and gather data during positive or negative interactions to determine commonalities and make adjustments that might help. And though supporting youth and adults with behavioral challenges isn’t the job for everyone, many of the company’s long-tenured staff have a passion for helping and an appetite for challenge. “This job not only strengthens character and empathy but also builds patience, creativity, courage, collaboration, and critical thinking skills, assets that can be translated into any career or working environment,” says Reinikka. Or, like Reinikka, they might make a career out of watching people live, grow, flourish, and triumph at Work Unlimited. “People who were formerly considered ‘extremely dangerous’ live in their own homes, and have community jobs. Some ride the bus independently. Everyone takes part in events and activities the community has to offer,” says Reinikka. “Although it’s not work for the faint of heart, it’s been a stunning success, and I am very proud to be a part of that.”n “Thanks to Comcast Business, we were all able to connect, socialize, and check in with the people and the staff, which turned into a muchanticipated event throughout the dreary and isolating months of pandemic restrictions.” CHRISTINA M. REINIKKA, CEO, WORK UNLIMITED
⁄Tactics⁄ What is your agency seeing right now that it was not seeing when you started in 2017? Central City Concern is an agency that’s been around in the region for, now, 43 years. We provide health care, we provide housing and we provide employment services, and we’re serving upwards of 13,000 to 14,000 people annually. We know that about 75% of the folks that start receiving services here at Central City Concern step into our health-services programming through Hooper Detoxi cation Center, which has been around for decades and is located near the Rose Quarter. Hooper is a medically supervised withdrawal-management program where we’re serving more than 2,500 individuals annually. It’s a 24/7 program; we serve a ton of folks year-round. We help those individuals get medically stabilized and detoxi ed from opioids, from methamphetamine, from alcohol, from benzodiazepines and other substances. Half of the folks we serve at Hooper come in with a primary diagnosis of opioid-use disorder, and the vast majority of those individuals over the last two years have shifted from using heroin to using fentanyl. Most of those individuals have been smoking fentanyl, but now we’re starting to see a shift back toward injecting fentanyl. And many people report that they have a history of overdose. We also have thousands of people who we’re providing a housing resource to. We have about 3,500 people who live with us in our housing continuum. Some of those are folks who have permanent housing with us and some of those are folks who have transitional housing with us. We know that substance-use disorder is represented in the community of folks who live with us. We have, over the last 18 months, been very intentional about developing a zero-overdose strategic approach whereby we are providing wide access to naloxone, which is the medicine used to reverse opioid overdose. It doesn’t mean that there aren’t folks still experiencing overdose. But what it does mean is that all of our housing staff are trained to respond, which is a really signi cant investment for us. On the back end, the goal is to provide support and to hope to get folks to a place where they’re open to engaging in withdrawal management and, better yet, engaging in treatment. Talking about that 40% of people who need acute mental health services, what are your thoughts on how the system is both addressing and not addressing the needs of people who are acutely mentally ill but not necessarily substance-affected? We do not currently have a fully resourced or fully functional continuum of psychiatric care within the region, nor do we have a state mental hospital or mental health hospital system at the Oregon State Hospital that can fully meet the needs of the population of the state of Oregon. That is our truth. Our truth is that we know that there is a signi cant gap between the demand and the need and the availability of inpatient and residential beds. That has been exacerbated by the COVID pandemic, which had a signi cant impact in terms of creating isolation; folks with severe mental illness and substance-use disorders need a lot of contact. They need a lot of support and accountability. Many of those regular connections became disrupted. During the same time period, there was a reduction in the behavioral health workforce, both in terms of psychiatric care and also in terms of substance-use disorders care. The Alcohol and Drug Policy Commission report from PSU and OHSU calculated that we were de cient 36,000 behavioral health care workers in the state of Oregon — in a prepandemic estimate. Central City Concern is one of several agencies in the region that is suffering from persistent vacancies among our behavioral health workforce. Then we layer in an inadequate system of care for higher levels of acute psychiatric care that’s been persistent for a long time; all of that is contributing to create the ecosystem that we live in within this region. It’s really dif cult for me as a physician — and for me as a leader of the organization — to know that we’re providing housing to individuals who are challenged to take care of themselves: They lack capacity to make decisions and therefore might be deemed incompetent. Our current state commitment standards have a really high bar. I think it’s really important for us in the region and in the state to evaluate our commitment standards to lower that bar, to do a better job of caring for people who lack the capacity to make decisions in their own best interest. It’s a false ag of freedom to think that somebody who lacks capacity actually is making decisions — because again, they lack capacity to make decisions. Let’s not mistake that lack of capacity with freedom more broadly, especially when we’re talking about treatable psychiatric conditions. Andy Mendenhall Urges ‘Courageous Optimism’ Amid Behavioral Health Crisis Central City Concern’s CEO talks about how his organization has responded to the pandemic, the escalating behavioral health crisis and what’s next. INTERVIEW BY CHRISTEN McCURDY This July Andy Mendenhall celebrates one year as CEO of Central City Concern. Mendenhall, who comes from Phoenix originally, attended college at the University of Portland and medical school at Oregon Health & Science University. Board-certi ed in addiction medicine and family medicine, he co-founded an outpatient integrated substance-abuse treatment program called HealthWorks NW, which was acquired by Hazelden Betty Ford in . Mendenhall joined CCC in as senior medical director for substance-use disorder services and became chief medical o cer in . He succeeded Rachel Solotaroff, who left the organization last summer after ve years as CEO and years total with the organization. CCC was founded in as Burnside Consortium and tasked initially with addressing the prevalence of alcoholism in Portland’s Old Town area. e organization purchased and began managing multiple downtown hotels, and assumed management of Hooper Detoxi cation Stabilization Center in . The organization now manages multiple addiction treatment centers, addiction clinics and a ordable-housing buildings in Portland. is interview has been edited for space and clarity. 14
JASON E. KAPLAN We talked about fentanyl. Another thing I hear is that the meth people are using now is different than the meth people were using 10, 20 years ago. It’s a lot more potent, and it’s a lot cheaper. That is driving a lot of the behavioral health acuity that we see that is distressing for members of the community. And a more potent, more reinforcing drug is also harder for folks to quit. I need to emphasize that we have a behavioral health workforce crisis of unprecedented proportion. Folks have simply left the industry. Folks got tired. Folks, in particular, got tired of referring people to nowhere and trying to coordinate people to nowhere. That leads to a certain level of moral injury, emotional fatigue and burnout. It is absolutely critical that we have a statewide strategy for recruiting individuals into the behavioral health treatment continuum of all stripes: drug and alcohol counselors, peers, bachelor’s-level behavioral health folks, master’s-level behavioral health folks. It’s going to take time to build up that workforce, to meet the needs of the state. It is probably the most important part of how we actually get to having enough capacity to meet the community need. CCC is working in partnership with a variety of different parties to establish a learning academy. We’re supporting an apprenticeship program with our partners at AFSCME. And we are in a holding pattern right now regarding being able to have enough folks to do the supervision, to actually do the training of the next generation. It’s important for leaders to be courageously patient as we navigate this. I have good reason to be optimistic that the right leaders at the state, metro, city and county level levels and CCO levels are engaged, they’re communicating, they’re starting to row in the same direction. They’re really starting to see this as the public health issue and challenging crisis that it is, and also understand that this is complex and multilayered. The reason to be optimistic is that people are communicating and people are agreeing that we need to be grounded in good public health data in order to align strategies to solve these challenges for the state and for the region. Policy-wise, what do you feel Central City needs from local governments? What are the things that you’re watching? I think, most importantly, we’re really watching how we are working together. And I’m really encouraged that Central City Concern and other community-bene t organizations are able to participate in new and different ways with the Joint Of ce of Homelessness Services, with County Behavioral Health and with the city. I see a level of collaboration and partnership and commitment that is refreshing, is new and unique, and it gives me a great sense of optimism in terms of coordination of strategy. We are very hopeful that the Oregon Health Authority will engage in intentional design and strategy work to ensure that folks who need an inpatient level of psychiatric care and stabilization will have access to that resource. In addition, the Medicaid 1115 demonstration waiver is really exciting. It is the functionality that gives states discretionary spending opportunity for the Medicaid bene t. Oregon is one of ve states in the country that has a housing bene t as part of the Medicaid waiver. We’re really hopeful that the Oregon Health Authority will see the 1115 Waiver as the opportunity that it is for this region and ensure that there is coordinated deployment of that bene t. It’s an opportunity for the very rst time in Oregon for housing to be paid for as a bene t out of the Medicaid system. We know through some pilot work that that saves money and saves a lot of unnecessary spending and health care dollars related to the complications of being houseless. 15
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⁄Spotlight⁄ To the Test BY CHRISTEN McCURDY JOSH DAVIS HAS WORKED IN NIGHTLIFE most of his adult life. Davis, 49, opened Star Bar in Southeast Portland in 2010, having previously owned a bar in Seattle and having worked as a bar manager and bartender for years before that. It’s fair to say drug use is common in the industry, both for bar staff who may use stimulants to get through long shifts and for patrons — and Davis has seen the human cost firsthand. “In the ’90s, growing up in Seattle, I had a lot of friends overdose from heroin, and that was not something that I would like anybody else to go through,” the soft-spoken Davis tells Oregon Business. In recent years, the increase in fentanyl use — and attendant overdoses — became impossible for him to ignore. “The fentanyl deaths started to mount, and then it was suddenly introduced into cocaine, then people kind of on the periphery of this bar started to overdose, and we’d hear about it,” Davis says. The Legislature also passed House Bill 2395, which redefines “drug paraphernalia” to exclude single-use drug test strips, hypodermic needles or “any other item designed to prevent or reduce the potential harm associated with the use of controlled substances” — thus doing away with the prior penalty. As this issue went to press, the bill was on its way to Gov. Tina Kotek’s desk; it will be effective as soon as it’s signed into law. The bill also makes it legal for a law enforcement officer, firefighters and emergency medical services providers to distribute and administer naloxone, an opioid agonist that can reverse overdose. “This acute, sudden overdose increase has really been traumatic and really concerning as a frontline physician taking care of people who overdose,” says Maxine Dexter (D-Portland), who is also a pulmonologist and critical-care physician. “This all came about because I have rushed in as a critical-care doctor to rooms where patients stopped breathing: They have had a cardiopulmonary arrest, meaning their heart has stopped or Josh Davis, owner of Star Bar Before this summer, the penalty for distributing fentanyl testing strips — which can help people determine whether other drugs are contaminated with it — was higher than the penalty for carrying most illegal drugs. A new law does away with that discrepancy. Davis says he heard about FentCheck — a nonprofit that makes and distributes fentanyl testing strips — through a friend who owns a retail store. He got in touch with the organization’s co-founder, Dean Shold, and started making the test strips available at the bar. They’re in a fish bowl on the bar counter, where customers can easily grab them without having to ask questions. As recently as last month, distributing such strips was illegal in Oregon. An Oregon law modeled on federal legislation from the 1970s classifies testing equipment as drug paraphernalia and issues a fine between $2,000 and $10,000 for possessing items in that category. Under Measure 110, which Oregon voters passed in 2020, possession of most controlled substances is a Class E civil violation punishable with a $100 fine. (The Legislature rolled back part of 110 this session, making it a misdemeanor to possess “a mixture or substance containing a detectable amount of fentanyl” or five “user units”—that is, pills—of a drug that contains a detectable amount of fentanyl.) PHOTOS BY JASON E. KAPLAN 18
they’re no longer breathing. The first thing that I do is give naloxone, because no matter who it is, it’s safe. It quickly revives people if they are suffering from an overdose. It’s just part of our urgent response to an arrest, and I know it’s safe. I know that it is effective. And we need it everywhere in our community to make sure people are, you know, kept alive long enough to get into recovery, if at all possible.” House Bill 2395 passed out of the House of Representatives in early March. But for much of the spring its fate was uncertain, due to a six-week walkout by Republican senators that left the Legislature without the quorum required under the state’s Constitution to pass new laws. That hamstrung legislative business until mid-June, leaving observers concerned that testing strips would remain in a legal gray area until the next session. But an amended version of the bill passed out of both chambers June 24, the day before the Legislature adjourned. “Oregonian lives will be saved through this bill,” Shold says. He is originally from Portland and recently moved back but had previously worked as chief technology officer at Alameda Health System, a public health care system in the San Francisco Bay Area. Fentanyl is a synthetic opioid that is sometimes prescribed for patients in extreme pain — such as patients recovering from surgery or for advanced-stage cancer patients — but that’s also manufactured and sold by black-market dealers. The Centers for Disease Control describe the drug as 50 times stronger than heroin and 100 times stronger than morphine. It’s also lethal in smaller amounts than other drugs: Shold says just 2 milligrams can be a lethal dose. He says in his previous role, he started researching the opioid epidemic and learned that one of the contributing factors is an increase in other illegal drugs — like cocaine and heroin — laced with fentanyl. Shold doesn’t believe that’s intentional. “Killing customers is not high on their list,” he says of drug dealers. Rather, he says dealers are often handling, measuring and bagging multiple types of drugs using the same equipment in the same facilities. But because fentanyl can be so dangerous in such small quantities, the results can be devastating. “The audience we really wanted to focus on was people who were effectively ingesting fentanyl nonconsensually — meaning they didn’t think they were going to be ingesting it. They thought they were doing cocaine or they thought they were getting a Percocet pill off the street,” Shold says. “Those are the people that we are trying to help find a way to check their drugs, to make sure that they don’t contain fentanyl if they don’t want to be consuming fentanyl.” He and Alison Heller created FentCheck in 2019 because, at that time, fentanyl testing strips existed but were difficult to find. Prior to the passage of HB2395, the easiest place to get fentanyl testing strips was through syringe-exchange programs. But, Shold points out, not all drug users know about or regularly visit such locations. His organization has done outreach to nightclubs, dive bars and strip clubs, and he says a number of business owners have expressed interest — but have been reluctant because of the legal issue. (For his part, Davis says law enforcement have left him alone.) The CDC estimates that about 150 Americans die every day from overdoses related to synthetic opioids. The Oregon Health Authority’s data dashboard on illicit fentanyl overdoses ends in 2019 but shows a slight drop in the number of deaths that year from the previous year — 62 deaths versus 73 in 2018 — after years of steadily increased deaths from 2015. The OHA says fentanyl is the most frequent drug involved in overdose deaths in Oregon, and that the amount of fentanyl seized by law enforcement in the state increased from 690 counterfeit pills in 2018 to more than 2 million in 2022. Haven Wheelock has run Outside In’s syringe exchange for 17 years and has worked in harm reduction for more than 20 years, starting with HIV-prevention work in high school in 1998. She holds a master’s in public health from Johns Hopkins University, focusing on overdose and addiction policy. “I love people who use drugs a lot,” Wheelock says. Outside In’s needle-exchange program was one of the first in the United States, modeled on programs in Europe that were developed to curb the transmission of HIV through intravenous drug use. Fentanyl “really has become dominant” in use in recent years, Wheelock says. In late 2021, there was a decline in the number of people coming in for injection equipment. The nonprofit has begun to offer pipes — partly to encourage people to smoke fentanyl rather than inject it, because the risk of overdose is much lower with smoking — as well as fentanyl testing strips. “Fentanyl test strips are a relatively new intervention in the world of harm reduction. I mean, we’ve been using them for about 10 years as a harm-reduction community, but that’s still pretty new, right?” Wheelock says. “I don’t think when they were drafting [the drug paraphernalia law], they were thinking, ‘Oh, we’re going to keep people from inadvertently using substances that are dangerous, right? I don’t think their intention was to bar people from having fentanyl test strips. But it’s how it’s playing out today.” Davis says the fentanyl epidemic has hit home just recently, with news reports that eight people in Portland overdosed in a single weekend in May and stories from friends working at other bars. And a little less than a year ago, he says, a regular customer who he considered a friend had a girlfriend who overdosed, and then overdosed himself the following day. “Drug use has happened, to the best of my knowledge, ever since bars existed, and I’m just providing another tool for people to make an informed decision,” Davis says. “I’m not saying ‘Yeah, go ahead and do it’ or ‘No, don’t do it.’ It’s more, ‘You’re going to make your own decisions. Be safe about those decisions.’” 19
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The picket line at Providence Portland Medical Center in Northeast Portland 24
It’s shaping up to be a hot summer for labor activity in health care. Nurses at Providence Health Systems in Portland and Seaside held a five-day strike. Nurses at St. Charles medical center in Bend voted to strike but reached an agreement with the hospital system before the strike was to begin. Nurses at Oregon Health & Science University held informational pickets in Portland, Astoria and Hillsboro, and nurses at PeaceHealth held similar pickets in Eugene and Springfield. And—with the exception of the St. Charles strike vote, which happened in late May — that’s just June. While this summer has so far shaped up to be an exceptional one when it comes to labor activity in health care, it’s not coming out of nowhere. First, though the numbers tell a more complicated story, it’s true that there’s more awareness of and support for labor unions in general—and more workers organizing and raising awareness of labor issues. Nationally, the rate of union membership is at an alltime low, with just 10.1% of American workers This summer has seen a flashpoint of labor activity among Oregon health care workers. FROM THE BEDSIDE TO THE PICKET LINE BY JASON E. KAPLAN AND CHRISTEN McCURDY PHOTOS BY JASON E. KAPLAN 25
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belonging to a union in 2022, according to Bureau of Labor Statistics data. Oregon tends to have a higher rate of union membership than the nation as a whole, with 15.7% of Oregon’s workers belonging to a union, per the same dataset. But the absolute number of Americans in unions has grown in recent years, and the number of union petitions filed with the National Labor Relations Board was 53% higher in 2022 than it was in 2021. The number of strikes rose by 52% in 2022 versus 2021, according to Cornell University’s Labor Action Tracker report. The absolute number of work stoppages — 417 strikes and seven lockouts — is far lower than it was in past decades, though support for unions is at an all-time high, per Gallup polls. Much of that increase in activity was driven by the pandemic, which inspired frontline workers — including retail and warehouse workers — to raise awareness about their compensation and benefits, but also about safety amid the pandemic, access to personal protective equipment and paid time off. Health care workers, of course, were in the thick of that. And while public health officials have declared an end to the COVID-19 public health emergency, nurses say they’re still struggling. Recent labor activity has focused less on compensation and more on working conditions, though during actions like the Providence strike, nurses have asked for more compensation in the form of more paid time off and increased access to mental health services. “The pandemic for the past two years has only highlighted what has been in existence for decades,” says Anne Tan Piazza, executive director of the Oregon Nurses Association. “The fracture the inequities, the structural barriers in our health care system, our nurses. It’s more than nurses, it’s caregivers and other health care workers who are absolutely at a breaking point. We are frustrated, we’re angry, we’re exhausted, we’re burnt out.” Picketers supporting a new contract for nurses at Riverbend PeaceHealth in Springfield Registered nurse Jonathan Mears pickets at University District PeaceHealth in Eugene. 27
ChrisRompala,chair of the bargaining team for the two PeaceHealth facilities in the Eugene area and a PeaceHealth staff nurse, told OB nurses were picketing in front of PeaceHealth Sacred Heart Medical Center in Springfield because they had 25 failed negotiation sessions for nurses to get fair wages and safe staffing conditions. Tamie Cline, ONA’s president and a nurse at Good Shepherd in Hermiston, said the union is asking for PeaceHealth for the same ratios the House Bill 2697 would require. (These ratios vary depending on the department but are one-to-one in departments like the emergency room and one-to-four in departments like telemetry and postnatal care.) But the hospital system had said they would only adopt the required staffing ratio if the law passes. Cline spoke with OB before the legislative session reconvened after a six-week walkout and passed HB 2697. That bill does not take effect until next summer, however. Cline says some hospitals in the state have already achieved the staffing levels recommended in the bill, but that PeaceHealth was unwilling to consider such a move unless required to by law. A spokesperson for PeaceHealth did not respond directly to a question about that claim about negotiations, but did say the hospital system would comply with the law. “PeaceHealth remains committed to reaching agreements on contracts that our Home and Community and Sacred Heart Medical Center nurses can be proud of and support. We continue to make progress at the table and are hopeful we can reach agreements with ONA soon so that our nurses may benefit from the improvements these new contracts would provide,” said a written statement from PeaceHealth spokesperson Stefanie Valentino. “We are committed to making sure we remain an employer of choice so our caregivers want to continue their career here with us. In terms of staffing, this topic is of utmost importance and a priority for everyone. That is why we are also in the process of recruiting over 300 RNs to RiverBend/Sacred Heart. In addition PeaceHealth is committed to following any applicable local, state and federal law,” Valentino added. “Our nurses need a change to provide the care they know they can provide,” Rompala says. Kyle Cook, a registered nurse at Providence and member of the ONA bargaining team, told OB during the strike that Providence refused to come to the table for the 10 days between the strike vote and the strike. Nicole Zapata, R.N., leads picketers at Providence Portland Medical Center. Tamie Cline, ONA’s president and a nurse at Good Shepherd in Hermiston, speaks at the Southeast Portland headquarters of AFL-CIO. 28
Cook says nurses bargained with Providence for eight months before deciding to strike. “I don’t feel they were making meaningful movement, and we were,” he says. The strike had a five-day limit and ended as expected. Cook says that for many years there has been a “rising wave against union work.” During the past 3.5 years of the pandemic, “working conditions were morally and ethically unjust,” and nurses have suffered moral injury—a term for mental health distress in response to witnessing or participating in events that go against one’s values. After the Providence strike wrapped, the ONA wrote a letter asking Attorney General Ellen Rosenblum to investigate the hospital system’s handling of the strike, specifically in hiring nurses from U.S. Nursing to ensure patient care while nurses struck. Providence sent a letter to Rosenblum asking her office to deny ONA’s request, writing, “In the interest of public safety, it is imperative that Providence’s ministries be able to continue caring for patients in the event of a strike.” Tan Piazza says the problem is not that the hospital hired substitute workers during the strike but that U.S. Nursing has an explicit mission of strikebreaking, which places the hospital in violation of state law against hiring strikebreakers. (Providence has also described that law as outdated.) U.S. Nursing’s website says, “Since 1989, U.S. Nursing has been working with healthcare facilities and professionals to provide turn-key staffing solutions during labor disputes.” Tan Piazza says there are alternative nursing agencies that allow hospitals to hire nurses on contract that don’t advertise in quite the way U.S. Nursing does. Looking ahead, Tan Piazza says ONA will continue to bargain and fight on behalf of caregivers — including not just nurses but physicians, physical therapists and others who have begun to organize as well. “Our members—our nurses and caregivers—know what the actual patient needs are in their hospitals, in their care settings. They will continue to come up in our collective bargaining to advocate for standards that are appropriate and needed for their specific population at that particular hospital or care setting,” Tan Piazza says. “I would say that the continued discussion and conversations around recruitment and retention and respect keep coming back to the same themes. The staffing law, we believe, will make a significant difference in providing a baseline in terms of improving working conditions for nurses. But again, there are specific things that are unique to each care setting and unique to each hospital. That is going to be bargained over.” Travis Nelson, State Representative for House District 44 and a registered nurse, speaks at an ONA Providence press conference. At top, picketers at Providence Portland Medical Center in Northeast Portland. 29
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