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Kaiser Clinicians Threaten to Strike

EMERYVILLE, Calif. (CN) - The National Union of Healthcare Workers said Thursday it would authorize a statewide strike by clinicians if Kaiser hospitals do not take "immediate actions" to improve care for mental health patients in California.

The union also called for the resignation of Cynthia Telles, a member of Kaiser's board of directors and the only board member with a mental health background.

Kaiser - whose 9.3 million members make it the nation's largest HMO - agreed in September to pay a $4 million fine levied in June 2013 by the California Department of Managed Health Care, after a 15-month investigation of the HMO's mental health services.

The state investigation found Kaiser guilty of forcing mental health patients to endure appointment waiting times whose length violated California's Timely Access laws. It also found that some clinicians were instructed to falsify appointment records to conceal the long waits.

The union said that Kaiser's agreement to pay the fine is not enough.

"Kaiser is failing its patients," said union president Sal Rosselli.

Kaiser's mental health department is inadequately staffed for its caseload, especially since Kaiser's California enrollment has increased by nearly 350,000 under the Affordable Care Act and since its mental health services have become responsible for 97,000 more patients as a result of the Medi-Cal carve-in, which reduced payments for Medi-Cal care, Rosselli said.

The case load is expected to increase when Covered California opens its enrollment on Jan. 1, 2015.

"Withholding services while increasing membership is a good way to score record profits," Rosselli said. Kaiser has made more than $14.5 billion since 2009, and this year's profits are up 40 percent from last year, but the service cutbacks prevent Kaiser mental health clinicians from carrying out "the ethical code that's inherently part of their jobs," Rosselli said.

Since it agreed to pay the fine, Kaiser has improved its service for first-time patients, Rosselli said, but patients still have to wait illegally lengthy times for follow-up appointments, contributing to outcomes as tragic as suicide.

Rosselli called this system "rapid access to no care."

Marcy Reda, a clinical social worker at Kaiser's facility in Walnut Creek, said that clinicians have often had to end first-time appointments unable to give patients - who suffer from illnesses such as depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder - a set return date.

"The impacts of these waits can be devastating," she said.

Clement Papazian, a clinical social worker who has worked at Kaiser's Oakland facility for 26 years, said that as the state's and the nation's largest HMO, "Kaiser can do better."

"Once you affect one part of the system like this, it's going to catastrophically affect all the other parts," he said.

Reda said that though some might suggest that Kaiser's mental health clinicians would let their patients down by striking, Kaiser, with its "shortsighted, profit-first mentality," is "letting these patients down every day."

Calling for the resignation of Telles, Rosselli said that the board member has treated the union's complaints as a "mere labor dispute" and has "remained silent as patients have suffered and even taken their own lives."

He said that should Telles resign, the union does not have a candidate for replacement in mind, but that the union would like to work with "a true advocate for mental health care."

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