Kaiser behavioral health workers turn up heat on employer in rally at California Capitol
Behavioral health clinicians from Kaiser Permanente rallied Thursday morning at the California State Capitol before taking to downtown Sacramento streets, chanting demands for tougher oversight of their employer by state regulators at the Department of Managed Health Care.
Psychologist Shay Loftus said she’s worked in Kaiser’s psychiatry clinics in Solano County for 12 years, but that she chose to join her colleagues in the National Union of Healthcare Workers in a public space Monday to draw attention to the inadequacy of Kaiser’s mental health care system.
“Kaiser has always had a method of constructing provider schedules that has shortchanged patients,” Loftus said. “Schedule management is not about health and healing. It’s not about helping someone stand up again after a personal tragedy. It’s not about offering care and compassion and evidence-based interventions to someone who is suffering so that they can recover or maintain some level of stability and go on with a meaningful life. ... Schedule management stands for a relationship of time to money.”
In an emailed statement to The Sacramento Bee on Thursday, Kaiser leaders say they are committed to providing access to high-quality mental health care and to making ongoing improvements, noting that the health care giant has done this in with other clinical care for which it has received national recognition as a best practice model.
“Like all health care providers, we have seen an increase in demand for mental health services, which is a reflection of the growing need nationally,” the statement noted. “We are meeting or exceeding the established standard for first time appointments for mental health. Our clinicians work with each member to create a care plan that works for them, based on the therapist’s clinical expertise, and we regularly monitor patient records to determine how well we meet recommendations for return therapy visits.”
The union’s research director, Fred Seavey, said Kaiser has made great strides in improving first-time access for members since eight years ago when the NUHW provided a mountain of evidence showing systemic failures to the Department of Managed Health Care, the state agency charged with monitoring health maintenance organizations. The agency fined Kaiser for the lapses and still is monitoring the organization to ensure patients are receiving timely care.
Survey: Wait times grow
Although Kaiser has improved access for first-time appointments, Seavey said, conditions have gotten worse for members when it comes to getting continuing appointments after that initial visit.
“We did a survey of therapists across the state at Kaiser in the spring, 71 percent reported that wait times for return treatment appointments among their patients has grown worse not better during the past two years,” Seavey said. “Nearly four of five therapists practicing in psychology said that daily, they must schedule their patients for return treatment appointments longer than is clinically appropriate.”
Seavey said he’s personally heard from Kaiser members whose loved ones committed suicide after experiencing delays in care. Protesting NUHW members held up signs with the names and photos in memory of Kaiser patients whose loved ones blame gaps in Kaiser’s care for their deaths. There were signs for Chloe Roston, 1996-2014; Elizabeth Brown, 1998-2018; and Brennen Smith, 1995-2015; among others.
In the Kaiser statement, executives said any therapist experiencing difficulty accommodating a patient’s need for an appointment is asked and encouraged to speak to their manager and work toward resolving the issue. Kaiser is always striving to be a better organization, company executives said, and a big part of improvement requires addressing the nationwide shortage of mental health professionals.
“We are focused on and committed to hiring more therapists; building and expanding treatment spaces; creating innovations that increase access to mental health care through the organization, including embedding therapists in primary care and emergency care settings; using innovative technology to monitor patients’ progress and track outcomes; and offering multiple ways to access care, based on patient preference (such as phone, video, in-person),” Kaiser leaders said. “Importantly, we are investing over $40 million to build a pipeline of new mental health professionals to help address the national shortage.”
Since July, Kaiser also has added a toll-free number — 800-390-3503 — where members can report any concerns related to mental health appointments and substance abuse services directly to a team of trained resolution specialists.
“We put significant effort and focus in our proposal to NUHW to ensure it includes substantial elements that will help improve mental health care for our members and patients,” Kaiser executives said. “This includes a proposal to work collaboratively with our therapists to innovate and redesign the mental health model of care; we are very pleased that our therapists have supported and expressed a strong desire to undertake these efforts together.”
But in remarks to roughly 300 NUHW members at the Capitol rally, Loftus said she was dismayed that Kaiser was inviting the union to redesign the model of care at the same time that it was quietly signing contracts to open tele-health call centers with non-union employees.
She said Kaiser is “pouring money into expanding tele-mental health, where employees make medical necessity decisions in 30-minute phone calls without ever seeing the patient in person, where they are encouraged to gate keep services rather than making a real investment in increasing the number of therapists in our clinics who can deliver treatment that meets recognized standards of care.”
Clinicians seek voice
Loftus joined Sarah Soroken, a marriage and family therapist in Fairfield, and other clinicians who spoke Thursday in urging Kaiser leaders to listen to them, collaborate with them, be transparent with them and treat them with respect and fairness.
Soroken said: “Patients who are struggling with suicidal thoughts, who have been sexually assaulted, who are experiencing symptoms of bipolar disorder and other serious illnesses, have to wait four to eight weeks to next see their therapist....In my experience as a triage and crisis therapist at Kaiser, I witness firsthand Kaiser’s frantic focus on meeting the state’s timely access law for the initial appointment at the cost of everything else.”
As Loftus, Soroken and other clinicians rallied outside DMHC headquarters near Cesar Chavez Park, a small delegation of NUHW leaders went upstairs and met with state regulators. They returned to tell the group that they had been able to relay their concerns and that regulators had assured them they wanted to see any evidence of problems with patient care.
The DMHC issued a news release Tuesday, saying Kaiser still had an obligation to provide timely care despite the strike and that regulators would be monitoring the Oakland-based company’s performance over the next few weeks. If Kaiser members experience problems, agency officials said, they can contact the DMHC Help Center at (888) 466-2219 or www.HealthHelp.ca.gov.
“The DMHC takes all issues related to access to care very seriously,” said DMHC Director Shelley Rouillard. “Health plans are required to provide medically necessary care to their enrollees appropriate with timely access and clinical standards even in the event of a strike.”
As the rally unfolded in Sacramento, other behavioral health clinicians marched on Kaiser’s Southern California headquarters in Pasadena and at the San Diego City Administration Building. The NUHW kicked off a five-day statewide strike Monday that was approved by more than 80 percent of the union’s 4,000-plus members. Roughly 88 percent of voted to reject Kaisers last, best and final contract offer.
Kaiser reports 30 percent of clinicians reported to work during the first three days of the strike. Labor experts have told The Bee that it is quite difficult to get health care professionals to go on strike because of the obligation they feel to their patients. The five-day labor action will end Friday with picketing at the South Sacramento Medical Center, 6600 Bruceville Road; the Fresno Medical Center, 7300 N. Fresno St.; and seven other California sites.
