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Health giant Kaiser faces strike by mental health care workers

The union says therapists are leaving Kaiser Northern California at record levels amid increasing demand for mental health care across the state.

OAKLAND, Calif. (CN) — About 2,000 Kaiser Permanente Northern California mental health workers announced on Wednesday plans to start an open-ended strike on Aug. 15. The workers’ union representatives cited high clinician workloads, with patients waiting weeks or even months for mental health care.

For therapists like Sarah Soroken in Fairfield, it is “a dire situation,” after years of asking Kaiser to fund resources to address rapidly growing numbers of patients and relieve strain on ballooning caseloads.

This would be the union’s first strike without an end date.

Soroken said after six years at the provider, she has seen people’s access to mental health treatment worsen, with people waiting longer than ever for therapy appointments — including those with health concerns like bipolar disorder, borderline personality disorder and PTSD. She said Kaiser has always been understaffed and as demand grows, lack of staffing worsens the outlook for patients. 

“The delay prevents these patients from getting better or stabilizing, or it puts them at risk for a worse prognosis, suicide attempts or other outcomes,” she said. “These are children and adults we’re talking about here.”

As a result, she said therapists are leaving at record rates to escape “crushing” caseloads and knowing they cannot meet ethical standards for adequately servicing all patients. She said some therapists may go to private practice or choose work in public health clinics, which may receive more support from the state under a revised budget proposal from Governor Gavin Newsom.

The health provider said a shortage of clinicians is a major challenge, but has drawn scrutiny from elected officials for how it handles and provides mental health services.

The National Union of Healthcare Workers and Kaiser have a bargaining session set this Friday, according to union spokesperson Matt Artz. He said mental health workers are tired and frustrated, which is why psychologists, social workers, therapists and addiction counselors have gone on strike six times in the past 4 years. 

The union reports that mental health clinicians are leaving Kaiser at nearly double the rate of the last year, with 668 clinicians leaving between June 2021 and May 2022, compared to 335 clinicians in the prior year. 

A survey the union conducted showed that of 200 departing clinicians, 85% said they were leaving because their workload was unsustainable or they felt they did not have enough time to complete the work. About 76% said they were unable to “treat patients in line with standards of care and medical necessity.”

In an emailed statement, Kaiser’s human resources senior vice president Deb Catsavas confirmed the provider’s contract with the union expired in September of last year.  She said at the last bargaining session, the two parties’ wage proposals were 1% apart.

“Unfortunately, union leadership delivered a fully new economic proposal from NUHW that avoids reaching agreement and pushes us further apart,” Catsavas said. She said the union’s “bargaining tactic” to strike is “unethical and counterproductive” since the company is still engaged in active bargaining, and several tentative agreements were reached.

“It is especially disappointing that NUHW is asking our dedicated and compassionate employees to walk away from their patients when they need us most,” Catsavas said. “We take seriously any threat by NUHW to disrupt care.”

Soroken said in a phone interview that she was shocked by Kaiser’s claims.

“We have never been close to reaching a contract or deal with Kaiser in over one year of bargaining,” she said. “They have rejected all of the proposals we have made about staffing, patient care, workload... our most important issues. Bringing up wages, I think, skips over the most important thing in bargaining and the reason why we’re striking.”

Kaiser Northern California has 4.6 million enrollees in Northern California and the company has been under scrutiny for how it manages mental health treatment for years. The Department of Managed Health Care said in May it will conduct a non-routine audit of Kaiser’s mental health services after fining Kaiser $4 million for failure to provide adequate mental health treatment in 2013. 

The union sent the department a letter Sunday asking it to ensure that Kaiser continues providing mental health care to patients during the strike.

Spokesperson Amanda Levy said the department is continuing to monitor access to services for Californians enrolled in Kaiser who may be impacted during a strike by behavioral health care workers in Northern California. 

"The law requires health plans provide enrollees with medically necessary care within timely access and clinical standards at all times, which includes during an employee strike," Levy said. "Health plans must continue to comply with the law during a labor strike, including meeting timely access standards and providing appropriate mental health and substance use disorder care to enrollees."

There are multiple efforts from state lawmakers to find new ways to enforce mental health parity laws. Soroken said Senate Bill 855, passed last year, made it law that a health insurance agency that cannot provide care in-network is required to pay for care performed by an out-of-network provider to be provided. 

“Even that seems to be something Kaiser isn't making an effort to do,” she said.

State Senator Scott Wiener has introduced a bill to significantly increase fines for health plans that fail to comply with state laws. His other bill Senate Bill 221, which took effect July 1, is intended to ensure patients do not wait in long delays for follow-up treatment through commercial providers. As sponsored by the union, the new law requires that patients receive follow-up mental health care within 10 business days — unless a provider finds that a longer wait will not harm a patient. 

Wiener said by phone that he is concerned about the current pace of implementing SB 221. 

“I’m glad the union is standing up for prompt access to mental health treatment,” he said. “I would like to see Kaiser and other health plans have enough staffing to comply with the law and provide timely access to mental health treatment.”

In a hearing this spring, lawmakers said they are concerned about the state’s plans to move an additional 200,000 Medi-Cal members onto Kaiser, CalMatters reported. Kaiser mental health practitioners said the company is not close to meeting the requirements.

Soroken called it “unconscionable” to push these patients onto Kaiser when it already does not meet the needs of existing patients. She said Medi-Cal members are often the most vulnerable patients with complex needs, and Kaiser often does not provide the intensive outpatient services or in-home treatment which public clinics might cover. 

These patients also often do not have the resources to pay for anything out of pocket. Soroken said if Kaiser cannot see them, people with serious mental illness concerns are most at risk for becoming unhoused while waiting for therapy, amid a massive homeless crisis. 

“It’s their obligation and duty. Because these patients, this is their health insurer that has promised them that in exchange for being paid, to be their health insurer, that they will get the care they need,” she said. 

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