Health & Medicine

Thousands of nurses, behavioral health workers picket Kaiser statewide over patient care

Kaiser Permanente’s workers launch a five-day strike over patient care

Kaiser Permanente’s behavioral health workers launched a five-day strike over patient care Monday, Dec. 10, 2018. Registered nurses walked out in sympathy with them at the Sacramento Medical Center on Morse Avenue as they did elsewhere in the state.
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Kaiser Permanente’s behavioral health workers launched a five-day strike over patient care Monday, Dec. 10, 2018. Registered nurses walked out in sympathy with them at the Sacramento Medical Center on Morse Avenue as they did elsewhere in the state.

As thousands of Kaiser Permanente behavioral health workers launched a strike over patient care and contract issues Monday morning, registered nurses walked out in sympathy with them in Sacramento and across the state.

At the Kaiser Permanente Sacramento Medical Center on Morse Ave., behavioral health counselor Cesar Mardones and nearly 200 other workers chanted their displeasure over deadlocked bargaining on their labor contract at the start what is planned to be a five-day walkout.

“When health care workers are under attack, what do we do? Stand up! Fight back,” they yelled as more than a dozen passing motorists honked their support, stirring the picketers to whoop with joy and wave their signs.

The National Union of Healthcare Workers said its roughly 4,000 union members authorized the strike because Kaiser is not providing timely, quality care to people with mental health conditions. Kenneth Rogers, a Kaiser psychologist who’s on the union’s bargaining team, told The Bee that he and other therapists are under constant pressure from Kaiser to see new patients.

“We’re not seeing our patients in quality time. It’s not good mental health,” said Mardones. “We have excellent therapists. I work in the emergency department myself. ... I’ve had patients and their families tell me multiple times that they have amazing therapists but they just wish they could see them more often.”

Michelle Gaskill-Hames, the chief nurse executive at KP Northern California, said the company is working to ensure patients will receive high-quality care during the strike.

“All our hospitals and medical offices are open,” Gaskill-Hames said in a written statement. “Anyone in need of urgent mental health or other care will receive the services they require, although some non-urgent services are being rescheduled. We apologize for any inconvenience caused by this unnecessary strike.”

In her statement, Gaskill-Hames said: “Alongside our therapists, Kaiser Permanente has been on a path to be the best mental health and addiction care program in the nation. The quality of the care we provide has been recognized by the state’s Office of the Patient Advocate, and by national quality organizations. We don’t think there is any other organization that is doing more than we are to make mental health care better in the United States.”

NUHW leaders have said that the ratio of mental health clinicians to Kaiser members has remained essentially unchanged since 2015 despite findings from the California Department of Managed Health Care showing that patients were having trouble accessing care that year. NUHW said that Kaiser has maintained roughly one full-time equivalent clinician for every 3,000 Kaiser members in California.

The DMHC issued a report in June 2017 saying it would continue to monitor Kaiser’s performance for 18 months to assess whether it was providing timely access to care for patients with behavioral health problems. DMHC regulators said that, in July 2017, the agency reached an agreement with Kaiser to correct violations and enlist an outside consultant to help it do so. The agency has been monitoring Kaiser since 2013 when it levied a $4 million against the HMO for violating California’s Mental Health Parity Act and standards for timely access to care.

DMHC regulators continue to monitor Kaiser over its performance on these statistics, Rogers said, and the company has stressed getting more new patients in for sessions. Meanwhile, he said, patients are waiting longer to see a therapist for follow-up visits.

DMHC survey of Kaiser

Kaiser, in its response to the latest DMHC report, stated that it had greatly enhanced access by aggressively recruiting and hiring therapists, increasing the hours for contract clinicians, canceling or reducing vacations of staff and increasing the productivity of staff.

“We have been hiring therapists, increasing our staff by 30 percent since 2015 – that’s more than 500 new therapists in California – even though there’s a national shortage,” Gaskill-Hames stated. “We’ve invested $175 million to expand and improve our mental health care offices, to provide environments that offer our patients convenience, comfort and privacy.”

The NUHW represents 325 Kaiser health care workers in the Sacramento region, 58 in Fresno, 32 in Modesto and 66 in San Joaquin County, spokesperson Matt Artz told The Bee. The NUHW site posted a strike schedule at various locations, including Kaiser’s medical centers in Sacramento on Morse Avenue, South Sacramento on Wyndham Drive and Roseville on Eureka Road; the Fresno Medical Office Building on North First Street; the Modesto Medical Center on Dale Road; and the Stockton Medical Office Building on West Lane.

Late last week, the California Nurses Association, representing 19,000 Kaiser RN’s and nurse practitioners statewide, and the IUOE Stationary Engineers Local 39, whose workers operate and maintain the physical plant systems of hospitals and other facilities, announced that they would honor the picket line.

Kaiser has stated that the union’s principal demands at the bargaining table have not been about improving care and access. Rather, in addition to seeking higher wages and benefits, Kaiser said, the union is demanding changes to performance standards that it argues would reduce, not increase, the availability of mental health care for patients.

Rogers, the union negotiator, said the union proposal would ensure psychotherapists have more time to effectively treat and see more returning patients. Right now, he said, Kaiser clinicians must spend 75 percent of their time seeing patients. The union would like that metric changed from time spent with a patient to the percentage of time a therapist has appointments scheduled. That way, said union representatives, when a patient cancels, the therapist isn’t pushed to immediately rebook but can use that time to plan, make notes or review notes.

“If you’re a teacher, you might teach high school students, and you might teach five out of eight or nine periods,” Rogers said. “You get some periods for prep time. The Kaiser clinicians get very little prep time – 75 percent is a lot of time to see patients.”

Rogers said clinicians are seeking to have their schedules booked 80 percent of the time. Some patients will cancel appointments at the last minute, Rogers said, and that will leave time to work on notes or perhaps slide in a patient who calls with an acute problem.

“You’ll have that (new) patient who doesn’t report a high acuity initially but then calls back later and they’re in serious trouble,” Rogers said. “And, there isn’t any room for flexibility based upon the way the organization treats its book. You’ve booked up everybody. There’s no room at the inn, so to speak, so you have to make a determination: Can you squeeze in a phone call? Sometimes you don’t even have time for that.”

Behavioral health worker Cesar Mardones joins strikers at Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave., on Monday, December 10, 2018. Health care workers will be changing up strike locations all week around Sacramento.

The last time that the NUHW bargained for a new agreement with Kaiser, it took five years to reach a deal. That pact, which was in effect from 2015 until September 2018, included a cut in pension benefits for new hires in the Southern California unit of the union. Union negotiators said they agreed to give up the traditional pension for new hires at the time because company bargainers told them they would insist on this provision with other unions, but the SoCal unit ended up being the only one to accept that reduction.

Rogers said the union is bargaining for wage increases along with other issues. Raises in the 2015 contract did not make up for about five previous years without wage increases, he said. The prior contract expired in 2011.

Kaiser said it has offered NUHW-represented workers guaranteed wage increases that will ensure it can remain competitive in recruiting top talent. In 2015, the company reported, NUHW members received wage increases, pay scale adjustments and bonuses ranging from $5,000 to $10,000.

Mardones, who works in the emergency room at the Morse Avenue hospital, said his principal concern is ensuring patients get the care they need. He assesses patients to determine whether they are a danger to themselves or others and need to be held for further treatment.

A lot of time, therapists aren’t available immediately for appointments with their patients, said Mardones, who earned his master’s in social work from Sacramento State, so they come to the emergency room.

Central Valley strike schedule

The NUHW will be picketing various Kaiser facilities in the Central Valley each day. Here’s a partial schedule:

Monday

Fresno Medical Center, 7300 N. Fresno St.

Sacramento Medical Center, 2025 Morse

Tuesday

Fresno Medical Office Building, 4785 N. First St.

Modesto Medical Center, 4601 Dale Road

Sacramento Medical Center, 2025 Morse

Wednesday

Fresno Medical Office Building, 4785 N. First St.

Roseville Medical Center, 1600 Eureka Road

Stockton Medical Office Buidling, 7373 West Lane

Thursday

Fresno Medical Office Building, 4785 N. First St.

South Sacramento Medical Center, 6600 Bruceville Road

Stockton Medical Office Buidling, 7373 West Lane

Friday

Fresno Medical Center, 7300 N. Fresno St.

Modesto Medical Center, 4601 Dale Road

South Sacramento Medical Center, 6600 Bruceville Road

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