Last week, following his abrupt firing, outgoing OHSU Health CEO Tarek Salaway leveled a serious allegation.

Salaway said he was pushed out after raising concerns to university leadership regarding patient safety, quality of care, and conditions in the OHSU emergency department.

OHSU has declined to confirm or deny his account of why he was fired.

But the allegations highlight a reality at OHSU even the institution’s leadership acknowledges: OHSU’s performance has been slipping on important measures of patient safety.

One of the hospital’s metrics shows it’s now performing worse than a majority of its peers.

As the state’s only academic medical center, OHSU is widely considered the top hospital in Oregon and a center of excellence for specialties like cancer, neurology and cardiology. Yet in the past three years the hospital has incurred millions of dollars in federal penalties for poor performance in preventing harms like bed sores, life-threatening complications of surgeries, and hospital-acquired infections.

Meanwhile, its emergency department nurses have been raising the alarm for years about dangerous overcrowding. On Friday, they told the board of directors conditions there are “abhorrent” and that patients have referred to it as “the thunderdome.”

The nurses union, which is negotiating with OHSU over its next contract, is pushing the hospital to form a task force to solve the emergency department’s overcrowding.

Salaway had visited the emergency department multiple times in his brief tenure as CEO and had told nurses that relieving pressure on the department was a priority for him, a charge nurse in the department told OPB.

OHSU’s slide in quality metrics has gone largely unnoticed in public. But its leadership has been briefing the hospital’s board on the matter for the past three years.

On Thursday, President Shereef Elnahal acknowledged during a press conference on hospital finances that OHSU has been underperforming on patient safety and is struggling with serious overcrowding in the emergency room. But he disputed the idea that those problems are being ignored, or that one person was responsible for escalating them.

Those safety problems, he said, are well known across OHSU and were being taken seriously prior to Salaway’s hiring in December.

“I have not seen any evidence that new concerns have been raised by anybody since I’ve been here on patient safety and quality,” said Elnahal, who joined OHSU in August 2025.

Elnahal said safety is his first priority and is an area where he has deep professional experience. He previously worked as the chief quality and patient safety officer for the Veterans Health Administration.

“We’ve got some catching up to do on standards,” at OHSU, he said.

Elnahal said OHSU has a plan in place to improve. That plan includes a task force working on protocols that reduce preventable infections, and a strategic priority shared across the institution: a culture of zero harm to patients.

Slipping in the ranks

At the start of each year, OHSU’s chief medical officer, Renee Edwards, gives a public presentation to the institution’s board of directors about quality and safety.

One of the metrics Edwards discusses in detail is an annual quality and accountability study done by a healthcare analytics company called Vizient. Hospitals typically pay the company to provide these metrics, which Edwards has told the board can serve as “canary in the coal mine.”

Most of the nation’s academic medical centers work with Vizient to track their performance on metrics like patient mortality and to compare their performance with their peers.

Prior to the COVID-19 pandemic, Edwards’ presentations show, OHSU had regularly ranked among the best: as high as 10th out of more than 100 peer institutions.

But in 2023, that changed. OHSU’s rank fell to 56th. In 2024, it fell to 95th out of 115 academic medical centers ranked that year.

According to slides Edwards presented to the board, OHSU’s safety score has declined due metrics on bed sores, surgical site infections, collapsed lungs caused by medical procedures, and infections acquired in the hospital, among other issues.

Mortality — the number of observed patient deaths versus the number expected — was the other major contributing factor to OHSU slipping in Vizient’s ranks.

Edwards shared several caveats with the board as to why she believes OHSU is performing better than its ranking indicates, particularly on the mortality score.

For example, some patient deaths may have been counted differently by Vizient due to the closure of a hospice program. That could account for up to a third of the change in OHSU’s mortality grade, she said. And an internal review of the mortality data suggested that some OHSU patients’ medical charts weren’t accurately capturing how sick or complex they were.

Edwards presented to the board again this January. OHSU’s Vizient rank had improved, to 73, but was still well below its historic performance.

Penalized for preventable injuries, infections

OHSU has also been penalized by the Centers for Medicare and Medicaid Services for the past three years because of preventable harm to patients.

The federal agency scores hospitals on measures of preventable harm and it tracks five different major infections patients can pick up during a hospital stay, like antibiotic-resistant staff infections and the intestinal bacteria c-difficile.

The hospitals in the bottom 25% nationally on those measures of patient harm are penalized with a 1% reduction in the payments they get for patients on Medicare. OHSU has been penalized for its performance for the past three years, at approximately $1 million dollars annually.

In response to questions from OPB, OHSU spokesperson Sara Hottman said that CMS halted patient safety reporting during the pandemic. OHSU only learned that its performance had declined relative to other hospitals nationally after that reporting resumed.

According to Hottman, the penalties reflect OHSU’s past performance. The data the federal government uses to calculate penalties can lag by 18 to 36 months.

But in a March 12 town hall for OHSU staff, Elnahal shared a frank assessment of OHSU’s current performance.

The president of OHSU showed the hospital’s most recent data on bed sores, patient falls that led to injury, and preventable infections in the hospital like c-difficile. Month to month, he told staff, OHSU was exceeding its targets.

He said OHSU would be rolling out a new set of best practices to reduce infections over the next five months, with a goal of 90% compliance by July.

At the same time the hospital’s safety metrics were slipping, front-line staff in the emergency department have been flagging their own set of patient safety concerns.

‘It’s gotten worse’

As OHSU has grown in recent years, expanding profitable services like complex surgeries and cancer care, its small emergency department has become overcrowded.

OHSU is among the state’s largest hospitals but has one of the smaller emergency departments, with just 32 beds.

Emergency room nurses say they feel like their department has been forgotten.

“We’ve been screaming about this for years,” says Tony Kyle, a charge nurse in the emergency department. Kyle says his colleagues have written many incident reports documenting near misses and issues with patient safety in the department. But he doesn’t think those reports have changed anything.

“It’s gotten worse,” he said.

As a charge nurse, Kyle is responsible for managing the flow of patients in the ED. He says OHSU’s ability to discharge patients — critical to freeing up beds for people who come in through the emergency department — hasn’t kept pace with the push to treat more people with highly complex conditions.

Often, when his morning shift starts, the beds in the emergency room are fully occupied by “boarders,” patients who have been admitted to the hospital, and are waiting for a bed on another floor to open up before they can move out of the emergency department.

According to Kyle, it’s not uncommon for the only empty beds to be the four beds in the trauma bay, a special part of the emergency department used to triage and stabilize patients with life-threatening conditions as quickly as possible.

Data provided by OHSU broadly corroborates the nurses’ description of the boarding crisis. On average, there were 27 daily boarders in OHSU’s emergency department last year. So far this year, that number is 28. That means nearly all of the emergency room beds are full, forcing nurses and doctors to provide care in the hallways and lobby.

Kyle said 11 stretchers have become permanent fixtures in the hallways of the emergency department.

Hallway beds have limitations. They’re a non-starter for elderly patients who cannot go to the bathroom on their own. Kyle tries not to put cancer patients or people recovering from organ transplants in the hallway, but sometimes has no choice.

Kyle said that when even the hallway beds are full, nurses are forced to place IVs and even give blood transfusions in the emergency room lobby. Sometimes, Kyle said, a patient receives treatment in the lobby and gets discharged without ever making it into the actual hospital.

“We’re not able to care for our patients in a manner that’s safe,” he said.

At Friday’s board meeting, emergency department nurse Tori Roberts said she personally had submitted more than 100 reports in the past year related to the boarding crisis.

According to Roberts, the patients who face delays in getting an appropriate placement in the main hospital are often ones who are elderly, don’t speak English, or are what Roberts described as “mentally altered.” They end up boarding in the emergency department for hours or days at a time.

‘An extremely disturbing situation’

Elnahal said he agrees with nurses about the intensity of the problems they’re facing. He said no patient should be treated in the lobby, and that he’d spoken with his team this week about immediate ways to find more beds for the boarders.

“It’s an extremely disturbing situation,” he said. “I say that as the leader of this institution.”

Elnahal noted that this month, the hospital opened a new tower dedicated to advanced cancer care, the Vista Pavilion. To date, that expansion has netted OHSU 30 new inpatient beds, but by the end of the year, that number will grow to more than 100 new beds.

That, he said, should help move some patients out of the emergency department more quickly. A plan to expand the Emergency Department itself is underway and will be complete in about three years.

During the staff town hall in March, Elnahal said OHSU has excellent caregivers providing “care that nobody else can, in so many different ways,” and that he didn’t believe in disciplining those caregivers over the hospital’s declining metrics. He said the hospital needs better tools to prevent harm to patients.

“This is something I strongly believe that you can’t really discipline people over, but rather it is something that we have to work together on to achieve better results,” he said.

“Preventable harm is not something that OHSU should rank highly in,” he said. “It’s just not something we’re going to accept.”

News Source : https://www.opb.org/article/2026/04/27/ohsu-grapples-with-falling-rank/