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• Persistent violations of state laws governing mental health care
• Failure to provide its members with timely, quality mental health services
• Profit-driven refusal to staff its clinics adequately to meet ever-growing demand
• Retaliation against the whistleblowers who have brought Kaiser’s legal and ethical violations to light
A tentative schedule of pickets and contact information for local clinicians will be available to journalists next week. Kaiser patients will also be available to discuss their experiences with Kaiser’s mental health services.
The strike and picket lines will impact nearly 80 Kaiser facilities between Fresno and Santa Rosa, including Kaiser medical centers in the San Francisco Bay Area, the San Jose area, the Sacramento area, and the Central Valley. Notice of the strike was filed yesterday after Kaiser refused in a November 4 bargaining session to amend its “last, best and final offer” to the clinicians to include crucial patient-care protections, a functional and appropriate schedule management plan, and end to its retaliation against whistleblowers. After bargaining concluded, Kaiser notified clinicians that Kaiser would unilaterally implement the retaliatory benefit cuts that Kaiser has not demanded from any of the thirty or so other unions within Kaiser. If it wasn’t clear before it is certainly clear now: Kaiser is punishing its clinicians for advocating for their patients.
“The problem is simple and so is the solution,” said NUHW President Sal Rosselli. “Kaiser needs to hire enough clinicians to provide timely, appropriate care to the ever-growing number of Kaiser members seeking help and end its retaliation against the caregivers who are courageously standing up for their patients.”
Lengthy Delays Continue Despite State Fines and Reprimands
California’s Department of Managed Health Care (DMHC) has raised alarms and imposed penalties on Kaiser for “serious” and “systemic” violations of state laws governing mental health care. Healthcare workers at many Kaiser facilities report that patients frequently endure waits of between four and eight weeks for a return appointment, making effective, ongoing treatment nearly impossible.
“For patients suffering from depression, anxiety, and other debilitating mental conditions, these delays can be insurmountable obstacles, sometimes leading to tragic outcomes,” said Clement Papazian, a clinical social worker at Kaiser in Oakland and president of NUHW’s Northern California chapter of mental health clinicians. “Kaiser’s actions are doing real harm. Even suicides have been linked to Kaiser’s delays and denial of care. Yet Kaiser has done nothing but stonewall its patients and retaliate against caregivers who dare to advocate for them.”
The DMHC has investigated and cited Kaiser twice in two years and forced the HMO to pay a $4 million fine for violating mental health parity laws, for providing misleading information to patients and subscribers, and for falsifying records to conceal illegal appointment delays. In its second investigative report, released in February 2015, just a month after Kaiser denied clinicians’ documented allegations during a weeklong statewide strike, the DMHC found that Kaiser’s violations continue and that the HMO failed to deliver timely care to 22 percent of its Northern California mental health patients. “That is not a good performance,” DMHC Director Shelley Rouillard told the Los Angeles Times. “Fundamentally it comes down to there are not enough providers in the Kaiser system to serve everyone who needs mental health services.”
The Santa Rosa Press Democrat and the Los Angeles Times recently reported on the July suicide of Barbara Ragan, a Kaiser patient and former employee who jumped to her death, Kaiser card in hand, from the parking structure of the HMO’s Santa Rosa hospital after struggling to endure an eight-week wait for individual therapy. Ragan’s death was “a statement,” her husband said, “about the way [Kaiser] treats people.”
Kaiser frequently touts a four-star rating for its mental health services from the California Office of the Patient Advocate, but OPA’s ratings are narrow in scope and do not examine critical areas of mental health services such as assessment, treatment planning, individual and group psychotherapy, crisis management, and clinical case management. Nor do they consider the core access measures cited by the DMHC. Click here for a fact sheet on the OPA’s ratings: http://nuhw.org/wp-content/uploads/2015/10/Kaiser-OPA-Factsheet-11-04-2015.pdf
Profits before Patients
These violations have occurred during a time of unprecedented profits for “nonprofit” Kaiser. California’s largest HMO, with more than seven million members, has made $16.6 billion since 2009, including $3.1 billion in 2014, and has amassed a reserve of $23 billion. Kaiser’s mental health care deficiencies have been compounded by an explosion in enrollment that has boosted the HMO’s revenues while dramatically increasing demand for its mental health services. In the first six months of 2015, following the implementation of the Affordable Care Act, Kaiser’s California enrollment increased by 406,647. That’s in addition to 407,453 new enrollees in 2014 for a total of 814,100 new members during an 18-month period.
Inadequate Staffing
Meanwhile, Kaiser’s mental health clinics remain vastly understaffed. Kaiser’s recent claims of staffing increases did not take into account its greatly expanded enrollment, staff attrition as clinicians buckle under ever-growing caseloads, or looming retirements — nearly 30 percent of Kaiser’s California clinicians are at or approaching retirement age.
“Kaiser’s recent hiring doesn’t even keep pace with enrollment much less address the staffing deficits we’ve been saddled with for years,” said Papazian. “It’s just the latest in a string of PR blitzes Kaiser has launched to avoid dealing with the problem while pocketing billions in profits.” Click here for a fact sheet that debunks Kaiser’s inflated hiring claims: http://nuhw.org/wp-content/uploads/2015/10/201509-NUHW-Kaiser-hiring-fact-sheet.pdf
Kaiser has consistently refused clinicians’ commonsense solution: clinician–management committees in each facility that can work together to determine adequate staffing levels and outsourcing needs, with help from a neutral, outside expert if the two sides cannot agree. It’s a simple and effective solution already in place in other health care systems.
Kaiser Trying to Implement Factory Model for Mental Health Care
Kaiser is trying to implement a factory model of care that forces therapists to churn through patients as quickly and cheaply as possible, rather than meet patients’ individual needs based on best practices.
“Mental health care takes time,” said Papazian. “It is about building a therapeutic relationship of trust between patient and caregiver and creating a safe space for discussion, reflection, and introspection. Treatment plans should be highly customized to the patient’s unique, individual needs and history, and should provide a sufficient number of regular visits, scheduled closely enough together. Rather than staff its facilities properly, Kaiser is instead trying to accelerate this process to get patients in and out as rapidly as possible, with no regard for the quality of care. They’re treating their members like widgets, not people.”
Kaiser mental health clinicians currently book 75% of their time for direct patient care providing therapy appointments, with 25% of their time reserved for indirect patient care, including preparation before visits, charting after visits, consultations and referrals, responding to patient calls and e-mails, and scheduling appointments. To complete these important indirect patient care duties, and to see returning patients in need of additional care, therapists use the time that is freed up when patients cannot make their scheduled appointments.
This system works in the very few Kaiser clinics that have adequate staffing. But rather than provide adequate staffing in all of its clinics, Kaiser is proposing a false solution that would speed up the process and cram even more patients into therapists’ schedules. Kaiser now wants therapists to guarantee that 75% of their time is spent on appointments, with no allowance for cancellations or no-shows. Not only would this reduce the amount of time available for therapists’ indirect care duties, it would require them to spend much of their remaining time scrambling to fill open slots with anyone who would show up, regardless of which patients most need their support.
To avoid getting disciplined or even fired, therapists would have to book 100% of their time to guarantee that cancellations and no-shows didn’t bring their direct care time below 75%. And if there weren’t enough cancellations or no-shows, their important indirect care duties would suffer, leaving patients short-changed and clinicians even more overworked. This system would maximize Kaiser’s profits by minimizing therapists’ ability to treat patients as their clinical judgment and professional ethics require, making even worse the exact problem Kaiser claims it is attempting to solve.
“With soaring profits and a $23 billion reserve, Kaiser needs to step up and lead the way in finally making mental health care a priority in this country,” said NUHW President Sal Rosselli. “The law requires it and Kaiser’s ethical obligations as a healthcare provider demand it.”
Retaliation against Clinicians and Whistleblowers
Kaiser clinicians throughout the state have been working without a contract for four years because the HMO refuses to agree to common-sense staffing levels and patient protections. Furthermore, Kaiser has retaliated against its clinicians and doctors for blowing the whistle on the company’s illegal and unethical delays of care. Among those singled out was Fremont psychologist Alex Wang who was terminated for noting “patient needs to be seen sooner” in a patient’s chart. Kaiser has also denied mental health clinicians the raises and benefits it has given to 100,000 other employees. A comparison of wages and benefits for Kaiser union-represented employees is available upon request.
“Kaiser’s retaliation against its mental health clinicians for their patient advocacy is outrageous,” said NUHW President Sal Rosselli. “They’ve harassed and fired respected psychologists, withheld standard pay increases given to 100,000 other Kaiser employees, and are trying to drastically cut their retirement benefits. Kaiser is trying to intimidate and silence the caregivers who are responsible for bringing Kaiser’s failures to light, and whose criticisms have been fully affirmed and vindicated by state regulators.”
A Growing Number of Lawsuits by Families of Suicide Victims
Kaiser has been hit with five class-action lawsuits, the most recent of which was filed last month in Los Angeles Superior Court. A woman suffering from depression and suicidal ideation after having endured molestation and incest claims Kaiser denied her timely, appropriate care, tried to steer her into group therapy against her will, and ultimately forced her to seek care outside of Kaiser at her own expense.
Another lawsuit is progressing through Alameda County’s courts after an administrative law judge ruled in September that the case should proceed despite Kaiser’s motion to dismiss. Fred Paroutaud, the husband of lead plaintiff Susan Futterman, committed suicide while waiting weeks for Kaiser to provide him with a therapy appointment. “All of the Plaintiff’s claims,” wrote Judge Wynne Carvill, “whether focused on long wait times or the predominance of group therapy as opposed to individual therapy, may well be accounted for by a shortage of providers.”
