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NUHW In Kaiser Strike Demand That Newsom & Demos Prosecute Flagrant Violations Of CA Law
At an NUHW Kaiser strike rally at the Kaiser headquarters the union demanded that Governor Newsom and California politicians enforce the healthcare laws which Kaiser they charged is flagrantly violating. Workers and patients also spoke about what they are facing.
At a rally at Kaiser headquarters in Oakland by striking NUHW Kaiser clinicians, NUHW Kaiser president Sal Roselli demanded that Governor Newsom and the Democratic legislature enforce healthcare laws that were passed to protect patients with behavioral health problems.
California Senate Bills 855 and 221 were supported by NUHW to protect patients and were passed by the California legislature to require timely and proper care of patients who have behavioral health problems. Kaiser however according to Roselli is flagrantly violating these laws requiring that they also provide outside the network behavioral care if they cannot provide appointments and emergency care for members who need immediate care.
Kaiser is also engaged in a massive criminal fraud by not providing care to Kaiser patients for behavioral healthcare although they promise to provide this service and it is required as well by state and federal law. They are also collecting hundreds of millions of dollars for providing this care but according to clinicians and patients are not providing the care.
Attorney General Rob Bonta is responsible for enforcing the violation of state laws but he has been completely absent in prosecuting Kaiser for violations of recently passed state laws and also for prosecuting Kaiser for fraud for not providing services that they promise for members.
This also includes Federal Medicare and California Medi-Cal patients who are also entitled to such care. This amount to hundreds of millions of dollars that is being defrauded from the members and government agencies which are paying for this care.
Governor Newsom has also refused to demand that Kaiser provide services which are being paid for by the people of California.
This rally took place on 8/19/22
Additional Media:
No More Kaiser Suicides! NUHW Members Strike Kaiser Management's Attack On Staffing & Compensation
https://youtu.be/A9x_Dzm2EFQ
Kaiser, Don't Deny Patients need access to timely and consistent mental health services
https://nuhw.org/kaiser-dont-deny/kaiser-strike/
MLK Day Strike By NUHW Kaiser Mental Healthcare Workers To Stop Systemic Racism & To Provide Care
https://youtu.be/c-be9pAQAQs
Kaiser still in denial over patient suicides
https://www.youtube.com/watch?v=_rzGA1XWxgI&t=5s
https://nuhw.org/kaiser-still-in-denial-over-patient-suicides/
SEIU UHW Kaiser Workers Join IOUE 39 Members On Picket Line In SF
https://youtu.be/6bno55gGmps
Don't Deny My Patients! 4,000 NUHW CA Kaiser Healthcare Workers Start 5 Day Strike
https://youtu.be/es_9jkSXdUA
Kaiser Suicides And Murders From Profiteering & Cost Shifting: Justice For Patients & NUHW Workers!
https://www.youtube.com/watch?v=H3JCz2gbEow&t=47s
NUHW 2019 CA Kaiser Strike & NUHW President Sal Rosselli
https://youtu.be/z5oL7rN7wmo
Kaiser NUHW Workers Strike Against Short Staffing Threatening Healthcare
https://www.youtube.com/watch?v=j8SjlVXpmAI&t=12s
Kaiser Bosses STOP Killing Peri Ho! Family & Supporters Speak Out At SF Kaiser
https://www.youtube.com/watch?v=b_ESZtL6jU8&t=15s
IUOE 39 Kaiser Strike Workers Solidarity As 700 Continue Picketing
https://youtu.be/2xpMuOBIO8I
700 IUOE Local 39 Engineers Strike N. Cal Kaiser For Prevailing Wages & Conditions
https://youtu.be/o-hH5IsO5vM
Additional info:
http://www.nuhw.org
Production of Labor Video Project
http://www.labormedia.org
Therapists Flee Kaiser as Mental Health Patients Languish
With the health giant again under scrutiny by California regulators for alleged denial of care, many therapists are leaving for private practice.
https://capitalandmain.com/therapists-flee-kaiser-as-mental-health-patients-languish
LABOR & ECONOMY
Publishedon July 27, 2022By Jack Ross and Kristy Hutchings
Photo: Sundry Photography.
When Susan Whitney was a therapist at Kaiser Permanente, her colleagues missed working in prison.
Whitney’s co-workers first practiced mental health care in the region’s penitentiaries before joining the state’s largest health care provider. Working conditions for therapists at Kaiser were so deplorable, Whitney says, that her colleagues wanted to go back.
“They can provide better care,” says Whitney, who retired from Kaiser in late 2021. “It’s a better work environment.”
Mental health practitioners at Kaiser are so overburdened with patients that waiting periods between appointments can be six weeks or more, according to therapists who spoke with Capital & Main. (Industry standards mean therapists outside Kaiser generally see patients on a weekly or bi-weekly basis, though cases vary.)
Now California’s Department of Managed Health Care (DMHC) has launched a “non-routine survey” to determine whether Kaiser is offering adequate behavioral health care.
When asked about its access issues, Kaiser points to a nationwide shortage of mental health care practitioners.
“The need for mental health care in America has never been greater and at the same time harder to deliver,” Kaiser representatives said in May. “Across the United States, mental health experts have reported the demand for mental health services has increased as much as 30% since the beginning of the pandemic.”
“The challenge we face is that all mental health providers are drawing from the same, limited pool of talent.”
~ Yener Balan, vice president of behavioral health and specialty services, Kaiser Permanente
Kaiser says it has prioritized filling hundreds of therapist vacancies in California.
“We recently launched a $500,000 recruiting initiative to source and hire clinicians to fill more than 1,000 open mental health clinician positions across Kaiser Permanente, more than 400 of which are in California,” Yener Balan, Kaiser’s vice president of behavioral health and specialty services, told Capital & Main in a March 29 statement.
“The challenge we face is that all mental health providers are drawing from the same, limited pool of talent.”
Kaiser, whose mental health care deficiencies have been well documented, turned an $8.1 billion profit in 2021, a company record. In 2021, the Fitch credit ratings agency rated Kaiser bonds AA- for the company’s “track record of sound and consistent profitability.”
Susan Whitney attributes Kaiser’s staffing shortage to “a combination of greed and the lingering stigma over treating mental health the same as physical health.”
“I cannot believe that they would treat physical health issues in the same way,” she says.
* * *
Emily Ryan, a licensed clinical social worker, began working at Kaiser in Sacramento in 2005. Her caseload at Kaiser was “horrendous,” she says.
“I could believe that there is difficulty for them [hiring today], that there’s a shortage of every kind of worker right now,” she says. “In 2005 there was not. In 2008, when we had the economic crisis, there most certainly was not, and we were having the same exact problems.”
Therapist Mickey Fitzpatrick, who worked in the Bay Area town of Pleasanton, says he had caseloads into the hundreds at Kaiser before he left for private practice. “If even a fraction of those new clients wanted to meet as frequently as is recommended, I didn’t have the availability to see folks for multiple weeks to months at a time,” he says.
“Ever since mental health started being covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan.”
~ Richard G. Frank, senior fellow, Brookings Institution
In rural Kern County, Kaiser employs 35 mental health workers to serve approximately 100,000 Kaiser members, according to data from the National Union of Healthcare Workers. There is no cap on the number of cases therapists can take on, and they face a regular onslaught of new patients.
“I have co-workers who’ve worked when they were very ill, but they felt like if they canceled one day, their patients would have to wait another six to eight weeks,” says Whitney. “People are waking up in the middle of the night worrying about patients.”
* * *
American health plans limit access to mental health care to keep expenses down, according to Richard G. Frank, a senior fellow at the Brookings Institution and director of the USC-Brookings Schaeffer Initiative for Health Policy. Other health care organizations have been accused of undermining their mental health care by not hiring enough therapists — or insufficiently reimbursing the ones they do have for counseling sessions — driving an exodus to more lucrative private practice.
This is by design, says Frank. Mental health patients are more expensive than physical health patients — not because the cost of care is higher, but because mental health patients tend to come with substantial physical health needs, too.
A 2020 study by the consulting company Milliman Inc. reviewed 21 million insurance holders and found that behavioral health patients cost plans 3.5 times more than patients without behavioral health needs.
“Ever since mental health started being covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan,” says Frank.
Over time, parity laws mandating that health plans offer mental health care on par with their physical health care have grown increasingly strict. On Oct. 8, 2021, Gov. Gavin Newsom signed SB 221, which requires that follow-up appointments for mental health sessions be scheduled within 10 days of the previous session.
When asked about proceeding against Kaiser under the new law, the California Attorney General’s Office declined to comment, citing “a potential or ongoing investigation.”
Regulation and enforcement of health plans in California falls to the Department of Managed Health Care, which fined Kaiser $4 million in 2013 for overbooking its therapists. Kaiser settled with the DMHC in 2017 following millions of dollars in fines and a litany of enforcement actions imposed against the company. The settlement established a six-point plan to address mental health access issues and forced Kaiser to hire a consultant to oversee the process.
A 2021 lawsuit filed against Kaiser by the San Diego City Attorney’s Office alleged that more than 30% of the therapists listed in Kaiser’s directory were not actually available to patients.
Following the settlement, Kaiser established Connect 2 Care, a system of call centers, to shorten wait times for new mental health patients. Therapists interviewed by Capital & Main said Kaiser created its call centers merely to satisfy regulators, and Connect 2 Care has been criticized by the American Psychological Association.
In May of 2022, the agency informed Kaiser of its investigation into the health care giant’s mental health services.
“We appreciate the DMHC’s interest and accountability in understanding how we are working to deliver clinically appropriate care to those who rely on us for their mental health services,” Kaiser wrote in a statement.
“Kaiser Permanente is meeting California’s regulatory standard for initial appointments for mental health and wellness on average more than 90% of the time. We encourage therapists to document treatment recommendations, including both initial appointments and follow-up appointment frequency, and to escalate any challenges in scheduling to their manager, per the established process.”
Kaiser’s network of mental health practitioners may be even less robust than the numbers it touts. A 2021 lawsuit filed against Kaiser by the San Diego City Attorney’s Office alleged that more than 30% of the therapists listed in Kaiser’s directory were not actually available to patients: Some were listed with the wrong contact information, some had retired, some were not practicing within Kaiser’s network, and some were not practicing altogether.
“Kaiser’s grossly inaccurate provider directories harm their own customers’ personal health, as well as their pocketbooks, while unlawfully and unfairly enabling the company to shed more costly enrollees to the detriment of its market competitors,” the city of San Diego asserted in its lawsuit.
San Diego also filed lawsuits against two other major providers, Molina Healthcare of California and Health Net, for maintaining inaccurate directories of mental health care practitioners.
* * *
Data from the National Union of Healthcare Workers, which represents Kaiser therapists, found practitioners have left Kaiser in steadily increasing numbers over the last three years: From June 2019 to November 2020, 469 practitioners left Kaiser, with annual turnover rates hovering around 8% per year in Northern California and 5% per year in Southern California. From December 2020 through May 2022, 850 practitioners left Kaiser, and the average annual turnover rate was more than 12% in Northern California and 10% in Southern California. (Disclosure: NUHW is a financial supporter of this website.)
Kaiser mental health practitioners and experts told Capital & Main that working conditions are to blame for the exodus of therapists from the company. Ex-Kaiser therapist Mickey Fitzpatrick handily beats his old hourly rate, he says, which was $73.73 in April of 2021, after 10 years at the plan. In the Bay Area, therapists regularly charge $250 or more for 50 minute sessions.
“My graduates want to go to Kaiser for work, and they do,” says Dr. Gilbert Newman, vice president for academic affairs at the Wright Institute, a private graduate school for psychology in California. “They often leave Kaiser because they don’t like the work they do. They don’t like being told you can’t see people enough to help them.”
Kaiser therapists can get in trouble with their managers when they recommend clients for regular follow-up appointments. In November of 2021, marriage and family therapist Tanya Veluz was summoned into a meeting with three of her superiors after she recommended patients for return sessions. The managers went through a list of those clients, questioning their need for care.
“They went through each case,” Veluz recalls, “and for a couple where the distress was really high they said, ‘Makes sense, we understand why you would want more support for this case.’ Every other case they challenged my clinical decisions. ‘Well … the questionnaire doesn’t indicate the level of distress you’re asking for.’”
“When you would ask, ‘Why are we selling a product we can’t really provide?’ you would get no answers.”
~ Ken Harlander, former Kaiser therapist
The managers also questioned her estimates for the duration of her patients’ treatment, Veluz says. Trauma patients, Veluz felt, would need sessions for two to six months.
According to Veluz, her manager told her it was impossible to know for how long a patient would need treatment. Veluz disagreed, citing her clinical experience as well as “plenty of research” supporting her diagnoses. She says one manager threatened her license.
When asked about the incident, Kaiser representatives did not directly comment. On July 19, the company said it is on a “multiyear journey to improve the way mental health care is delivered in America today” and has been expanding its virtual care and placing mental health professionals in medical settings. The company has “escalation procedures to support our therapists if they are unable to schedule a needed follow up appointment” and a “dedicated phone line.”
Ken Harlander, a licensed marriage and family therapist, practiced at Kaiser’s Bakersfield clinic with Susan Whitney, and left for private practice last year. Harlander avoided delays between appointments at Kaiser by booking returning clients in spots reserved for new patients, which got him summoned to “the principal’s office,” he says.
“That was what happened if you tried to push back,” he says. “When you would ask, ‘Why are we selling a product we can’t really provide?’ you would get no answers.”
* * *
Richard G. Frank agrees that post-pandemic demand bolsters Kaiser’s shortage argument, but says insurance plans’ refusal to compete with private practice is the real culprit behind practitioner shortages.
“I think there’s a kernel of truth there, but I think it’s exaggerated,” he says. “What health plans typically claim is that they can’t hire all the people they would like to hire at the current rate of pay. That’s not the same thing as saying, ‘Gee, there are none available.’”
But for Ken Harlander, it wasn’t the pay that drove him to private practice — the company’s excellent benefits made up for lower hourly wages. Harlander says he left because Kaiser overbooked him and prevented him from doing his job effectively.
“It’s just been so good to not work there anymore,” he says. “I actually practice good therapy.”
Because of its benefits, Kaiser always has willing applicants, according to Harlander. “People would rather work at Kaiser than the county or Medi-Cal work,” he says. “They could open slots and hire people away if they wanted to. They wouldn’t even have to change their pay structure. If they said we’re hiring five therapists, they’d get five candidates right now.”
August 11, 2022
Mary Watanabe, Director
Dan Southard, Chief Deputy Director
Sarah Ream, General Counsel
Sonia Fernandes, Deputy Director, Office of Enforcement Jennifer E. Marsh, Attorney III—Office of Enforcement Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725
Dear Ms. Watanabe, Mr. Southard, Ms. Ream, Ms. Fernandes and Ms. Marsh:
On behalf of the National Union of Healthcare Workers (NUHW), I am submitting evidence documenting Kaiser Foundation Health Plan’s illegal cancellation and suspension of multiple behavioral health services in Northern California in response to the impending strike by licensed non-physician behavioral health clinicians in Northern California, which begins August 15, 2022. Although California law requires health plans to arrange for care from out-of-network providers if timely and geographically accessible care is unavailable from in-network providers, Kaiser is not replacing the canceled services. Yesterday, Kaiser began canceling thousands of enrollees’ access to certain behavioral health services, including intensive services for enrollees recently discharged from psychiatric hospitals and those at risk of hospitalization due to their conditions.
I. Evidence
A. Exhibit A: Exhibit A contains TEAMS Chat messages exchanged between Kaiser staff and Dr. Andrew S. Corso, the manager of Kaiser’s Intensive Outpatient Program in the San Leandro/Union City area. Dr. Corso’s title is “Behavioral Health Manager II of Intensive and Case Management Services.” The messages were exchanged on August 9, 2022. Exhibit A has been redacted to protect patient and whistleblower confidentiality.
Some background information is necessary regarding terms and abbreviations contained in Exhibit A.
Kaiser’s Intensive Outpatient Program (IOP) “serves patients who have been identified as needing a higher level of care in an outpatient setting,” according to Kaiser’s website. “Many of the patients served in the Intensive Outpatient Program are referred by hospitals, crisis residential settings or partial hospital programs. Referrals made to the program from the clinic are prioritized by acuity, i.e., if there is a clinical indication for a higher level of care based upon a patient’s report of suicidal or homicidal ideation, plan or intent, or concerns that a patient may be declining in their ability to provide for themselves,” according to Kaiser’s website.1
Kaiser provides separate IOP programs for distinct patient populations such as adults, high school-aged patients, and middle school-aged patients. It also provides separate IOPs for patients with specific diagnoses, such as eating disorders.
1 https://thrive.kaiserpermanente.org/care-near-you/northern-california/eastbay/departments/mental- health/intensive-outpatient-program/ (captured August 10, 2022)
Kaiser’s IOP programs are structured to provide clinical services over three or more days a week for several hours per day per patient. During these sessions, patients receive individual psychotherapy, group psychotherapy, and medication management. For some diagnoses, IOP programs are designed to deliver care to a given patient for as many as 16 weeks. For example, Kaiser’s Eating Disorder IOP (EDIOP) for enrollees in the Sacramento area typically lasts 12 to 16 weeks, according to Kaiser’s website.2 This program is designed for enrollees with moderate to severe anorexia or bulimia.3
As far as other terms and abbreviations used in Exhibit A, the following text offers explanations:
CTC: Kaiser’s “Connect to Care” call centers where therapists perform the first half of enrollees’ diagnostic assessments at the onset of enrollees’ care episodes.
PHP: Partial Hospitalization Program.
SI: Suicidal Ideation.
Crisis Group: A once-a-week psychotherapy group provided virtually, which represents
a lower level of care than an IOP. Such groups are provided by licensed non-physician behavioral health therapists; consequently, it is unclear if and how Kaiser will provide such groups during the strike. Crisis Groups do not include individual psychotherapy treatment nor do they include medication management services.
The following is an image of the exchange contained in Exhibit A:
2 https://thrive.kaiserpermanente.org/care-near-you/northern- california/northvalley/departments/psychiatry-adult/emotional-health-programs/eating-disorders-intensive- outpatient-program-ediop/ (captured 8-10-22)
3 https://sacwellness.com/intensive-outpatient-and-partial-hospitalization-programs-in-the-greater- sacramento-area/ (captured 8-10-22)
2
In his messages, Dr. Corso (Kaiser’s IOP Director) reports that “IOP is not booking clinic referrals currently,” indicating that Kaiser ceased booking patients to receive care in the IOP as of August 9 (or possibly earlier). He continues: “We will not have intakes during the strike and the strike will be open-ended so we don’t know when it will end.” In order for patients to receive treatment in IOP programs, patients must first undergo “intakes” to the program performed by IOP clinicians. In other words, Kaiser will cease admitting enrollees to its IOP during the strike, including enrollees recently discharged from psychiatric hospitals as well as those with suicidal and homicidal ideation.
As far as the instant case of the enrollee referenced in the exchange in Exhibit A, Dr. Corso reports the following after reviewing the enrollee’s medical chart and noting the enrollee’s recent suicidal ideation: “I would normally say this is a homerun referral but given the circumstances we don’t have intake availability.”
Per California law, if Kaiser doesn’t have sufficient in-network clinicians to provide timely and geographically accessible care to its enrollees, it must arrange for its enrollees to receive such care from out-of-network providers at no additional cost. In this case, however, Dr. Corso indicates that Kaiser has no system in place to comply with the law. Instead, Dr. Corso discusses various options available to him:
Delay the patient’s access to IOP care: He states, “I can sit on the referral until sometime in the future when the strike is over” or “I can consider [patient] for IOP when the strike ends if [patient] still meets criteria at that time.”
Offer the patient lower levels of care that are inconsistent with the patient’s clinical needs: He states he can offer the patient a “crisis group” or “refer [patient] to outside outpatient therapy.” Both are lower, less intensive levels of care than IOP programs.
Refer the patient to a higher level of care: In his first message (apparently made before he reviewed the patient’s medical chart), Dr. Corso lists an option of referring the patient to a “PHP,” a partial hospitalization program. Another manager reportedly advised that patients like the one described in Exhibit A should be admitted to a psychiatric hospital given the unavailability of IOP services at Kaiser. Under SB 855, health plans must cover mental health treatment consistent with generally accepted professional standards, which require services to be delivered at the least restrictive, safe, and most effective level of care. Apart from the obvious fact that hospitals do not admit or retain patients (let alone children/adolescents) beyond the time for crisis stabilization, psychiatric hospitalization can result in stigma, curtail the ability to work or attend school, and lead to substantially higher co-pays and out-of-pocket costs for enrollees.
Dr. Corso’s statements are shocking for at least two reasons. First, they underscore the absence of any system or organized plan for Kaiser to deliver IOP services to enrollees during the impending work stoppage by clinicians. If such plans were in place, Dr. Corso would have instructed clinicians to refer the enrollee to out-of-network IOP programs identified by Kaiser. Instead, he toggles through a set of improvised and illegal options.
Second, his statements convey shocking callousness towards the patient. Although he characterizes the enrollee as “a homerun IOP referral” due to suicidal ideation and a decline in functioning, he nonetheless indicates his willingness “to sit on the referral until sometime in the future when the strike is over.” He offers this as an option even after noting that the strike will last for an indeterminate period of time. In NUHW’s view, this shocking indifference is a
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byproduct of Kaiser’s chronic underfunding and understaffing of its behavioral health services. Managers have become accustomed to recommending substandard options– including nothing at all. In fact, Kaiser’s practice of withholding care is so commonplace that managers (like Dr. Corso) show no apparent concern about actually memorializing illegal options in Kaiser’s electronic messaging system.
B. Exhibit B: Exhibit B contains TEAMS Chat messages exchanged between a Kaiser clinician and Lisa Cooper, LCSW, a “Mental Health Manager” at Kaiser’s Walnut Creek behavioral health clinic. The messages were exchanged on August 10, 2022.
The following text offers explanations of two abbreviations contained in Exhibit B:
CSG: Community Stabilization Group—a psychotherapy group provided by Kaiser to high-acuity patients with Serious Mental Illness and other serious conditions such as suicidal ideation. The psychotherapy group is designed to complement enrollees’ individual psychotherapy treatment appointments.
SMI: Serious Mental Illness—a diagnosable mental, behavioral, or emotional disorder affecting individuals aged 18 or older that causes serious functional impairment that substantially interferes with or limits one or more major life activities. Examples of diagnoses include schizophrenia, other psychotic disorders, major depression with psychotic symptoms, bipolar disorder, and treatment-resistant depression.
The following is an image of the exchange contained in Exhibit B:
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In Exhibit B, the clinician asks Ms. Cooper, “what is the plan for the [Crisis Stabilization Group] if we are out on strike? will that group still be running? If not, what is the back up plan for those patients?”
Ms. Cooper responds: “all patients/group [appointments] will be canceled by support [staff] – one day at a time. today [August 10], all Monday [August 15] appts/groups will be canceled.”
The clinician poses a second question regarding Kaiser’s plans to deliver individual treatment to some of the high-risk patients in the clinician’s caseload during the strike. The clinician writes:
I am also getting together my list of patients who need to be called if I am out. these are pretty high risk patients with SMI and/or suicide risk. they are aware of crisis resources, but definitely need individual therapy or else they are at risk of destabilizing. i have about 6 or 7 patients that i will send to you with some notes on their specific needs.
In response, Ms. Cooper writes: “we will not be able to check in on patients. i would recommend making sure they have the crisis phone number.”
In sum, Ms. Cooper reports that Kaiser will cancel both individual and group treatment appointments for enrollees and that Kaiser will not arrange for timely and geographically accessible replacement services by out-of-network providers for the enrollees.
In fact, Ms. Cooper reports that Kaiser will not provide replacement treatment services even to a handful (6 or 7) of the most high-risk patients in the clinician’s caseload during the strike even after the clinician describes the patients’ risk of decompensation and suicide.
As in the case of Dr. Corso’s messages, Ms. Cooper’s responses betray a shocking callousness towards the life-threatening conditions affecting these patients as well as a cavalier attitude towards her responsibilities and Kaiser’s obligations under California law.
C. Exhibit C: Exhibit C is an email message authored by James Kempf, TPMG Area Director for Behavioral Health and Addiction Medicine Services for Kaiser’s Central Valley Service Area. The email, dated August 8, 2022 with a subject line of “Upcoming Work Stoppage,” was sent to several “all-staff” email addresses that automatically deliver the email to approximately 200 therapists and physician leads practicing in this service area.
In his email, Mr. Kempf discusses Kaiser’s plans to “cancel” enrollees’ appointments during the work stoppage. I highlighted in red the relevant text in Exhibit C. Mr. Kempf discusses canceling enrollees’ appointments on a mass basis, which is consistent with Kaiser’s practices during previous work stoppages. I use the term “mass basis” because each of the 200 clinicians in the Central Valley Service Area provides treatment to at least six enrollees per day, meaning Kaiser is canceling approximately 1,200 enrollee appointments per day in this area alone. Notably, Mr. Kempf makes no mention of any plans by Kaiser to arrange for affected enrollees to obtain replacement services by out-of-network providers.
Earlier this week, Kaiser’s managers of behavioral health services in Kaiser’s Napa-Solano Service Area explicitly stated that Kaiser does not have plans to provide timely and geographically accessible replacement treatment/services to the enrollees for whom it is canceling their scheduled appointments and other treatments or services. Specifically, on the
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morning of August 9, 2002, the top managers of Kaiser’s behavioral health services in the Napa-Solano Service Area conducted group meetings with clinicians practicing at Kaiser’s clinics in the service area. These managers included Mitchell Houston, PhD (Director of Mental Health Services for Kaiser’s Napa-Solano Service Area), Dr. Christine Lim (Site Chief, Kaiser Vallejo Psychiatry and Addiction Medicine Services), and Evan Marmol, LCSW (Manager II, IOP Program for the Napa-Solano Service Area). They told clinicians that Kaiser will cancel not only enrollees’ individual and group therapy appointments, but also will cancel and suspend IOP programs for adults, youth, and adolescents.
When clinicians asked the managers to describe Kaiser’s plan for replacing the services as required by California law, the managers stated the following about individual non-urgent treatment appointments: patients will be informed of the canceled appointments and when clinicians return to work at the conclusion of the strike, clinicians will be tasked with contacting the affected patients to schedule future appointments for them. Many of the affected patients have waited 4-8 weeks for their canceled individual treatment appointments and, according to Kaiser’s plan, will be placed “at the back of the line” when clinicians return to work and attempt to book them into clinicians’ schedules that typically are booked out 1-3 months into the future.
In response to clinicians’ questions about Kaiser’s plans for replacing enrollees’ IOP services, Dr. Houston stated that Kaiser has determined that IOP services for adolescents and youth are unnecessary during the strike and would not be replaced or otherwise provided by Kaiser or out- of-network providers. Likewise, Kaiser does not plan to replace IOP services for adults.
Clinicians reminded Kaiser’s managers that many of the child and adolescent patients receiving treatment in the IOP programs are high acuity teens in high school and middle school who are extremely fragile. Nonetheless, Dr. Houston and his colleagues stated that Kaiser has no plans to replace the canceled services with timely and geographically accessible ones delivered by out-of-network providers at no additional cost to enrollees.
It is unclear what plans, if any, Kaiser has to provide urgent behavioral health appointments.
II. Request
NUHW is extremely concerned about Kaiser’s plans to illegally withhold care from patients during the strike, including from patients with substantial risk of suicide and decompensation. On August 10, 2022, Kaiser canceled tens of thousands of enrollees’ individual, group and IOP treatment appointments scheduled to take place on August 15, 2022. Today, Kaiser reportedly canceled such care scheduled for August 16, 2022.
Individual complaints have been filed with DMHC on behalf of the enrollees affected by the practices detailed in Exhibits A and B.
We request that DMHC take urgent action to enforce California law and to protect the rights of Kaiser enrollees to obtain timely and geographically accessible behavioral health care. We request that DMHC employ all of the enforcement tools at its disposal, including seeking immediate injunctive relief to bar Kaiser from violating state law. Furthermore, we request that DMHC impose immediate penalties on Kaiser for any violations at a scale and intensity that will constitute an effective disincentive to Kaiser so it refrains from committing additional violations and rapidly remedies its existing violations, such as canceling tens of thousands of enrollees’
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appointments scheduled for August 15 and 16 without arranging for timely and geographically accessible replacement services by out-of-network providers at no extra cost to enrollees. NUHW stands ready to assist in whatever way may be helpful. Please contact me with any questions or requests.
Sincerely,
Fred Seavey
cc: Rob Bonta, Californian Attorney General
Toni Atkins, Senate President Pro Tempore
Anthony Rendon, Speaker of the Assembly
Sen. Scott Wiener, Chair, Senate Select Committee on Mental Health Sen. Richard Pan, Chair, Senate Committee on Health Assemblymember Jim Wood, Chair, Assembly Committee on Health Don Moulds, CalPERS
Dr. Julia Logan, CalPERS
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EXHIBIT A
California Senate Bills 855 and 221 were supported by NUHW to protect patients and were passed by the California legislature to require timely and proper care of patients who have behavioral health problems. Kaiser however according to Roselli is flagrantly violating these laws requiring that they also provide outside the network behavioral care if they cannot provide appointments and emergency care for members who need immediate care.
Kaiser is also engaged in a massive criminal fraud by not providing care to Kaiser patients for behavioral healthcare although they promise to provide this service and it is required as well by state and federal law. They are also collecting hundreds of millions of dollars for providing this care but according to clinicians and patients are not providing the care.
Attorney General Rob Bonta is responsible for enforcing the violation of state laws but he has been completely absent in prosecuting Kaiser for violations of recently passed state laws and also for prosecuting Kaiser for fraud for not providing services that they promise for members.
This also includes Federal Medicare and California Medi-Cal patients who are also entitled to such care. This amount to hundreds of millions of dollars that is being defrauded from the members and government agencies which are paying for this care.
Governor Newsom has also refused to demand that Kaiser provide services which are being paid for by the people of California.
This rally took place on 8/19/22
Additional Media:
No More Kaiser Suicides! NUHW Members Strike Kaiser Management's Attack On Staffing & Compensation
https://youtu.be/A9x_Dzm2EFQ
Kaiser, Don't Deny Patients need access to timely and consistent mental health services
https://nuhw.org/kaiser-dont-deny/kaiser-strike/
MLK Day Strike By NUHW Kaiser Mental Healthcare Workers To Stop Systemic Racism & To Provide Care
https://youtu.be/c-be9pAQAQs
Kaiser still in denial over patient suicides
https://www.youtube.com/watch?v=_rzGA1XWxgI&t=5s
https://nuhw.org/kaiser-still-in-denial-over-patient-suicides/
SEIU UHW Kaiser Workers Join IOUE 39 Members On Picket Line In SF
https://youtu.be/6bno55gGmps
Don't Deny My Patients! 4,000 NUHW CA Kaiser Healthcare Workers Start 5 Day Strike
https://youtu.be/es_9jkSXdUA
Kaiser Suicides And Murders From Profiteering & Cost Shifting: Justice For Patients & NUHW Workers!
https://www.youtube.com/watch?v=H3JCz2gbEow&t=47s
NUHW 2019 CA Kaiser Strike & NUHW President Sal Rosselli
https://youtu.be/z5oL7rN7wmo
Kaiser NUHW Workers Strike Against Short Staffing Threatening Healthcare
https://www.youtube.com/watch?v=j8SjlVXpmAI&t=12s
Kaiser Bosses STOP Killing Peri Ho! Family & Supporters Speak Out At SF Kaiser
https://www.youtube.com/watch?v=b_ESZtL6jU8&t=15s
IUOE 39 Kaiser Strike Workers Solidarity As 700 Continue Picketing
https://youtu.be/2xpMuOBIO8I
700 IUOE Local 39 Engineers Strike N. Cal Kaiser For Prevailing Wages & Conditions
https://youtu.be/o-hH5IsO5vM
Additional info:
http://www.nuhw.org
Production of Labor Video Project
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Therapists Flee Kaiser as Mental Health Patients Languish
With the health giant again under scrutiny by California regulators for alleged denial of care, many therapists are leaving for private practice.
https://capitalandmain.com/therapists-flee-kaiser-as-mental-health-patients-languish
LABOR & ECONOMY
Publishedon July 27, 2022By Jack Ross and Kristy Hutchings
Photo: Sundry Photography.
When Susan Whitney was a therapist at Kaiser Permanente, her colleagues missed working in prison.
Whitney’s co-workers first practiced mental health care in the region’s penitentiaries before joining the state’s largest health care provider. Working conditions for therapists at Kaiser were so deplorable, Whitney says, that her colleagues wanted to go back.
“They can provide better care,” says Whitney, who retired from Kaiser in late 2021. “It’s a better work environment.”
Mental health practitioners at Kaiser are so overburdened with patients that waiting periods between appointments can be six weeks or more, according to therapists who spoke with Capital & Main. (Industry standards mean therapists outside Kaiser generally see patients on a weekly or bi-weekly basis, though cases vary.)
Now California’s Department of Managed Health Care (DMHC) has launched a “non-routine survey” to determine whether Kaiser is offering adequate behavioral health care.
When asked about its access issues, Kaiser points to a nationwide shortage of mental health care practitioners.
“The need for mental health care in America has never been greater and at the same time harder to deliver,” Kaiser representatives said in May. “Across the United States, mental health experts have reported the demand for mental health services has increased as much as 30% since the beginning of the pandemic.”
“The challenge we face is that all mental health providers are drawing from the same, limited pool of talent.”
~ Yener Balan, vice president of behavioral health and specialty services, Kaiser Permanente
Kaiser says it has prioritized filling hundreds of therapist vacancies in California.
“We recently launched a $500,000 recruiting initiative to source and hire clinicians to fill more than 1,000 open mental health clinician positions across Kaiser Permanente, more than 400 of which are in California,” Yener Balan, Kaiser’s vice president of behavioral health and specialty services, told Capital & Main in a March 29 statement.
“The challenge we face is that all mental health providers are drawing from the same, limited pool of talent.”
Kaiser, whose mental health care deficiencies have been well documented, turned an $8.1 billion profit in 2021, a company record. In 2021, the Fitch credit ratings agency rated Kaiser bonds AA- for the company’s “track record of sound and consistent profitability.”
Susan Whitney attributes Kaiser’s staffing shortage to “a combination of greed and the lingering stigma over treating mental health the same as physical health.”
“I cannot believe that they would treat physical health issues in the same way,” she says.
* * *
Emily Ryan, a licensed clinical social worker, began working at Kaiser in Sacramento in 2005. Her caseload at Kaiser was “horrendous,” she says.
“I could believe that there is difficulty for them [hiring today], that there’s a shortage of every kind of worker right now,” she says. “In 2005 there was not. In 2008, when we had the economic crisis, there most certainly was not, and we were having the same exact problems.”
Therapist Mickey Fitzpatrick, who worked in the Bay Area town of Pleasanton, says he had caseloads into the hundreds at Kaiser before he left for private practice. “If even a fraction of those new clients wanted to meet as frequently as is recommended, I didn’t have the availability to see folks for multiple weeks to months at a time,” he says.
“Ever since mental health started being covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan.”
~ Richard G. Frank, senior fellow, Brookings Institution
In rural Kern County, Kaiser employs 35 mental health workers to serve approximately 100,000 Kaiser members, according to data from the National Union of Healthcare Workers. There is no cap on the number of cases therapists can take on, and they face a regular onslaught of new patients.
“I have co-workers who’ve worked when they were very ill, but they felt like if they canceled one day, their patients would have to wait another six to eight weeks,” says Whitney. “People are waking up in the middle of the night worrying about patients.”
* * *
American health plans limit access to mental health care to keep expenses down, according to Richard G. Frank, a senior fellow at the Brookings Institution and director of the USC-Brookings Schaeffer Initiative for Health Policy. Other health care organizations have been accused of undermining their mental health care by not hiring enough therapists — or insufficiently reimbursing the ones they do have for counseling sessions — driving an exodus to more lucrative private practice.
This is by design, says Frank. Mental health patients are more expensive than physical health patients — not because the cost of care is higher, but because mental health patients tend to come with substantial physical health needs, too.
A 2020 study by the consulting company Milliman Inc. reviewed 21 million insurance holders and found that behavioral health patients cost plans 3.5 times more than patients without behavioral health needs.
“Ever since mental health started being covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan,” says Frank.
Over time, parity laws mandating that health plans offer mental health care on par with their physical health care have grown increasingly strict. On Oct. 8, 2021, Gov. Gavin Newsom signed SB 221, which requires that follow-up appointments for mental health sessions be scheduled within 10 days of the previous session.
When asked about proceeding against Kaiser under the new law, the California Attorney General’s Office declined to comment, citing “a potential or ongoing investigation.”
Regulation and enforcement of health plans in California falls to the Department of Managed Health Care, which fined Kaiser $4 million in 2013 for overbooking its therapists. Kaiser settled with the DMHC in 2017 following millions of dollars in fines and a litany of enforcement actions imposed against the company. The settlement established a six-point plan to address mental health access issues and forced Kaiser to hire a consultant to oversee the process.
A 2021 lawsuit filed against Kaiser by the San Diego City Attorney’s Office alleged that more than 30% of the therapists listed in Kaiser’s directory were not actually available to patients.
Following the settlement, Kaiser established Connect 2 Care, a system of call centers, to shorten wait times for new mental health patients. Therapists interviewed by Capital & Main said Kaiser created its call centers merely to satisfy regulators, and Connect 2 Care has been criticized by the American Psychological Association.
In May of 2022, the agency informed Kaiser of its investigation into the health care giant’s mental health services.
“We appreciate the DMHC’s interest and accountability in understanding how we are working to deliver clinically appropriate care to those who rely on us for their mental health services,” Kaiser wrote in a statement.
“Kaiser Permanente is meeting California’s regulatory standard for initial appointments for mental health and wellness on average more than 90% of the time. We encourage therapists to document treatment recommendations, including both initial appointments and follow-up appointment frequency, and to escalate any challenges in scheduling to their manager, per the established process.”
Kaiser’s network of mental health practitioners may be even less robust than the numbers it touts. A 2021 lawsuit filed against Kaiser by the San Diego City Attorney’s Office alleged that more than 30% of the therapists listed in Kaiser’s directory were not actually available to patients: Some were listed with the wrong contact information, some had retired, some were not practicing within Kaiser’s network, and some were not practicing altogether.
“Kaiser’s grossly inaccurate provider directories harm their own customers’ personal health, as well as their pocketbooks, while unlawfully and unfairly enabling the company to shed more costly enrollees to the detriment of its market competitors,” the city of San Diego asserted in its lawsuit.
San Diego also filed lawsuits against two other major providers, Molina Healthcare of California and Health Net, for maintaining inaccurate directories of mental health care practitioners.
* * *
Data from the National Union of Healthcare Workers, which represents Kaiser therapists, found practitioners have left Kaiser in steadily increasing numbers over the last three years: From June 2019 to November 2020, 469 practitioners left Kaiser, with annual turnover rates hovering around 8% per year in Northern California and 5% per year in Southern California. From December 2020 through May 2022, 850 practitioners left Kaiser, and the average annual turnover rate was more than 12% in Northern California and 10% in Southern California. (Disclosure: NUHW is a financial supporter of this website.)
Kaiser mental health practitioners and experts told Capital & Main that working conditions are to blame for the exodus of therapists from the company. Ex-Kaiser therapist Mickey Fitzpatrick handily beats his old hourly rate, he says, which was $73.73 in April of 2021, after 10 years at the plan. In the Bay Area, therapists regularly charge $250 or more for 50 minute sessions.
“My graduates want to go to Kaiser for work, and they do,” says Dr. Gilbert Newman, vice president for academic affairs at the Wright Institute, a private graduate school for psychology in California. “They often leave Kaiser because they don’t like the work they do. They don’t like being told you can’t see people enough to help them.”
Kaiser therapists can get in trouble with their managers when they recommend clients for regular follow-up appointments. In November of 2021, marriage and family therapist Tanya Veluz was summoned into a meeting with three of her superiors after she recommended patients for return sessions. The managers went through a list of those clients, questioning their need for care.
“They went through each case,” Veluz recalls, “and for a couple where the distress was really high they said, ‘Makes sense, we understand why you would want more support for this case.’ Every other case they challenged my clinical decisions. ‘Well … the questionnaire doesn’t indicate the level of distress you’re asking for.’”
“When you would ask, ‘Why are we selling a product we can’t really provide?’ you would get no answers.”
~ Ken Harlander, former Kaiser therapist
The managers also questioned her estimates for the duration of her patients’ treatment, Veluz says. Trauma patients, Veluz felt, would need sessions for two to six months.
According to Veluz, her manager told her it was impossible to know for how long a patient would need treatment. Veluz disagreed, citing her clinical experience as well as “plenty of research” supporting her diagnoses. She says one manager threatened her license.
When asked about the incident, Kaiser representatives did not directly comment. On July 19, the company said it is on a “multiyear journey to improve the way mental health care is delivered in America today” and has been expanding its virtual care and placing mental health professionals in medical settings. The company has “escalation procedures to support our therapists if they are unable to schedule a needed follow up appointment” and a “dedicated phone line.”
Ken Harlander, a licensed marriage and family therapist, practiced at Kaiser’s Bakersfield clinic with Susan Whitney, and left for private practice last year. Harlander avoided delays between appointments at Kaiser by booking returning clients in spots reserved for new patients, which got him summoned to “the principal’s office,” he says.
“That was what happened if you tried to push back,” he says. “When you would ask, ‘Why are we selling a product we can’t really provide?’ you would get no answers.”
* * *
Richard G. Frank agrees that post-pandemic demand bolsters Kaiser’s shortage argument, but says insurance plans’ refusal to compete with private practice is the real culprit behind practitioner shortages.
“I think there’s a kernel of truth there, but I think it’s exaggerated,” he says. “What health plans typically claim is that they can’t hire all the people they would like to hire at the current rate of pay. That’s not the same thing as saying, ‘Gee, there are none available.’”
But for Ken Harlander, it wasn’t the pay that drove him to private practice — the company’s excellent benefits made up for lower hourly wages. Harlander says he left because Kaiser overbooked him and prevented him from doing his job effectively.
“It’s just been so good to not work there anymore,” he says. “I actually practice good therapy.”
Because of its benefits, Kaiser always has willing applicants, according to Harlander. “People would rather work at Kaiser than the county or Medi-Cal work,” he says. “They could open slots and hire people away if they wanted to. They wouldn’t even have to change their pay structure. If they said we’re hiring five therapists, they’d get five candidates right now.”
August 11, 2022
Mary Watanabe, Director
Dan Southard, Chief Deputy Director
Sarah Ream, General Counsel
Sonia Fernandes, Deputy Director, Office of Enforcement Jennifer E. Marsh, Attorney III—Office of Enforcement Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725
Dear Ms. Watanabe, Mr. Southard, Ms. Ream, Ms. Fernandes and Ms. Marsh:
On behalf of the National Union of Healthcare Workers (NUHW), I am submitting evidence documenting Kaiser Foundation Health Plan’s illegal cancellation and suspension of multiple behavioral health services in Northern California in response to the impending strike by licensed non-physician behavioral health clinicians in Northern California, which begins August 15, 2022. Although California law requires health plans to arrange for care from out-of-network providers if timely and geographically accessible care is unavailable from in-network providers, Kaiser is not replacing the canceled services. Yesterday, Kaiser began canceling thousands of enrollees’ access to certain behavioral health services, including intensive services for enrollees recently discharged from psychiatric hospitals and those at risk of hospitalization due to their conditions.
I. Evidence
A. Exhibit A: Exhibit A contains TEAMS Chat messages exchanged between Kaiser staff and Dr. Andrew S. Corso, the manager of Kaiser’s Intensive Outpatient Program in the San Leandro/Union City area. Dr. Corso’s title is “Behavioral Health Manager II of Intensive and Case Management Services.” The messages were exchanged on August 9, 2022. Exhibit A has been redacted to protect patient and whistleblower confidentiality.
Some background information is necessary regarding terms and abbreviations contained in Exhibit A.
Kaiser’s Intensive Outpatient Program (IOP) “serves patients who have been identified as needing a higher level of care in an outpatient setting,” according to Kaiser’s website. “Many of the patients served in the Intensive Outpatient Program are referred by hospitals, crisis residential settings or partial hospital programs. Referrals made to the program from the clinic are prioritized by acuity, i.e., if there is a clinical indication for a higher level of care based upon a patient’s report of suicidal or homicidal ideation, plan or intent, or concerns that a patient may be declining in their ability to provide for themselves,” according to Kaiser’s website.1
Kaiser provides separate IOP programs for distinct patient populations such as adults, high school-aged patients, and middle school-aged patients. It also provides separate IOPs for patients with specific diagnoses, such as eating disorders.
1 https://thrive.kaiserpermanente.org/care-near-you/northern-california/eastbay/departments/mental- health/intensive-outpatient-program/ (captured August 10, 2022)
Kaiser’s IOP programs are structured to provide clinical services over three or more days a week for several hours per day per patient. During these sessions, patients receive individual psychotherapy, group psychotherapy, and medication management. For some diagnoses, IOP programs are designed to deliver care to a given patient for as many as 16 weeks. For example, Kaiser’s Eating Disorder IOP (EDIOP) for enrollees in the Sacramento area typically lasts 12 to 16 weeks, according to Kaiser’s website.2 This program is designed for enrollees with moderate to severe anorexia or bulimia.3
As far as other terms and abbreviations used in Exhibit A, the following text offers explanations:
CTC: Kaiser’s “Connect to Care” call centers where therapists perform the first half of enrollees’ diagnostic assessments at the onset of enrollees’ care episodes.
PHP: Partial Hospitalization Program.
SI: Suicidal Ideation.
Crisis Group: A once-a-week psychotherapy group provided virtually, which represents
a lower level of care than an IOP. Such groups are provided by licensed non-physician behavioral health therapists; consequently, it is unclear if and how Kaiser will provide such groups during the strike. Crisis Groups do not include individual psychotherapy treatment nor do they include medication management services.
The following is an image of the exchange contained in Exhibit A:
2 https://thrive.kaiserpermanente.org/care-near-you/northern- california/northvalley/departments/psychiatry-adult/emotional-health-programs/eating-disorders-intensive- outpatient-program-ediop/ (captured 8-10-22)
3 https://sacwellness.com/intensive-outpatient-and-partial-hospitalization-programs-in-the-greater- sacramento-area/ (captured 8-10-22)
2
In his messages, Dr. Corso (Kaiser’s IOP Director) reports that “IOP is not booking clinic referrals currently,” indicating that Kaiser ceased booking patients to receive care in the IOP as of August 9 (or possibly earlier). He continues: “We will not have intakes during the strike and the strike will be open-ended so we don’t know when it will end.” In order for patients to receive treatment in IOP programs, patients must first undergo “intakes” to the program performed by IOP clinicians. In other words, Kaiser will cease admitting enrollees to its IOP during the strike, including enrollees recently discharged from psychiatric hospitals as well as those with suicidal and homicidal ideation.
As far as the instant case of the enrollee referenced in the exchange in Exhibit A, Dr. Corso reports the following after reviewing the enrollee’s medical chart and noting the enrollee’s recent suicidal ideation: “I would normally say this is a homerun referral but given the circumstances we don’t have intake availability.”
Per California law, if Kaiser doesn’t have sufficient in-network clinicians to provide timely and geographically accessible care to its enrollees, it must arrange for its enrollees to receive such care from out-of-network providers at no additional cost. In this case, however, Dr. Corso indicates that Kaiser has no system in place to comply with the law. Instead, Dr. Corso discusses various options available to him:
Delay the patient’s access to IOP care: He states, “I can sit on the referral until sometime in the future when the strike is over” or “I can consider [patient] for IOP when the strike ends if [patient] still meets criteria at that time.”
Offer the patient lower levels of care that are inconsistent with the patient’s clinical needs: He states he can offer the patient a “crisis group” or “refer [patient] to outside outpatient therapy.” Both are lower, less intensive levels of care than IOP programs.
Refer the patient to a higher level of care: In his first message (apparently made before he reviewed the patient’s medical chart), Dr. Corso lists an option of referring the patient to a “PHP,” a partial hospitalization program. Another manager reportedly advised that patients like the one described in Exhibit A should be admitted to a psychiatric hospital given the unavailability of IOP services at Kaiser. Under SB 855, health plans must cover mental health treatment consistent with generally accepted professional standards, which require services to be delivered at the least restrictive, safe, and most effective level of care. Apart from the obvious fact that hospitals do not admit or retain patients (let alone children/adolescents) beyond the time for crisis stabilization, psychiatric hospitalization can result in stigma, curtail the ability to work or attend school, and lead to substantially higher co-pays and out-of-pocket costs for enrollees.
Dr. Corso’s statements are shocking for at least two reasons. First, they underscore the absence of any system or organized plan for Kaiser to deliver IOP services to enrollees during the impending work stoppage by clinicians. If such plans were in place, Dr. Corso would have instructed clinicians to refer the enrollee to out-of-network IOP programs identified by Kaiser. Instead, he toggles through a set of improvised and illegal options.
Second, his statements convey shocking callousness towards the patient. Although he characterizes the enrollee as “a homerun IOP referral” due to suicidal ideation and a decline in functioning, he nonetheless indicates his willingness “to sit on the referral until sometime in the future when the strike is over.” He offers this as an option even after noting that the strike will last for an indeterminate period of time. In NUHW’s view, this shocking indifference is a
3
byproduct of Kaiser’s chronic underfunding and understaffing of its behavioral health services. Managers have become accustomed to recommending substandard options– including nothing at all. In fact, Kaiser’s practice of withholding care is so commonplace that managers (like Dr. Corso) show no apparent concern about actually memorializing illegal options in Kaiser’s electronic messaging system.
B. Exhibit B: Exhibit B contains TEAMS Chat messages exchanged between a Kaiser clinician and Lisa Cooper, LCSW, a “Mental Health Manager” at Kaiser’s Walnut Creek behavioral health clinic. The messages were exchanged on August 10, 2022.
The following text offers explanations of two abbreviations contained in Exhibit B:
CSG: Community Stabilization Group—a psychotherapy group provided by Kaiser to high-acuity patients with Serious Mental Illness and other serious conditions such as suicidal ideation. The psychotherapy group is designed to complement enrollees’ individual psychotherapy treatment appointments.
SMI: Serious Mental Illness—a diagnosable mental, behavioral, or emotional disorder affecting individuals aged 18 or older that causes serious functional impairment that substantially interferes with or limits one or more major life activities. Examples of diagnoses include schizophrenia, other psychotic disorders, major depression with psychotic symptoms, bipolar disorder, and treatment-resistant depression.
The following is an image of the exchange contained in Exhibit B:
4
In Exhibit B, the clinician asks Ms. Cooper, “what is the plan for the [Crisis Stabilization Group] if we are out on strike? will that group still be running? If not, what is the back up plan for those patients?”
Ms. Cooper responds: “all patients/group [appointments] will be canceled by support [staff] – one day at a time. today [August 10], all Monday [August 15] appts/groups will be canceled.”
The clinician poses a second question regarding Kaiser’s plans to deliver individual treatment to some of the high-risk patients in the clinician’s caseload during the strike. The clinician writes:
I am also getting together my list of patients who need to be called if I am out. these are pretty high risk patients with SMI and/or suicide risk. they are aware of crisis resources, but definitely need individual therapy or else they are at risk of destabilizing. i have about 6 or 7 patients that i will send to you with some notes on their specific needs.
In response, Ms. Cooper writes: “we will not be able to check in on patients. i would recommend making sure they have the crisis phone number.”
In sum, Ms. Cooper reports that Kaiser will cancel both individual and group treatment appointments for enrollees and that Kaiser will not arrange for timely and geographically accessible replacement services by out-of-network providers for the enrollees.
In fact, Ms. Cooper reports that Kaiser will not provide replacement treatment services even to a handful (6 or 7) of the most high-risk patients in the clinician’s caseload during the strike even after the clinician describes the patients’ risk of decompensation and suicide.
As in the case of Dr. Corso’s messages, Ms. Cooper’s responses betray a shocking callousness towards the life-threatening conditions affecting these patients as well as a cavalier attitude towards her responsibilities and Kaiser’s obligations under California law.
C. Exhibit C: Exhibit C is an email message authored by James Kempf, TPMG Area Director for Behavioral Health and Addiction Medicine Services for Kaiser’s Central Valley Service Area. The email, dated August 8, 2022 with a subject line of “Upcoming Work Stoppage,” was sent to several “all-staff” email addresses that automatically deliver the email to approximately 200 therapists and physician leads practicing in this service area.
In his email, Mr. Kempf discusses Kaiser’s plans to “cancel” enrollees’ appointments during the work stoppage. I highlighted in red the relevant text in Exhibit C. Mr. Kempf discusses canceling enrollees’ appointments on a mass basis, which is consistent with Kaiser’s practices during previous work stoppages. I use the term “mass basis” because each of the 200 clinicians in the Central Valley Service Area provides treatment to at least six enrollees per day, meaning Kaiser is canceling approximately 1,200 enrollee appointments per day in this area alone. Notably, Mr. Kempf makes no mention of any plans by Kaiser to arrange for affected enrollees to obtain replacement services by out-of-network providers.
Earlier this week, Kaiser’s managers of behavioral health services in Kaiser’s Napa-Solano Service Area explicitly stated that Kaiser does not have plans to provide timely and geographically accessible replacement treatment/services to the enrollees for whom it is canceling their scheduled appointments and other treatments or services. Specifically, on the
5
morning of August 9, 2002, the top managers of Kaiser’s behavioral health services in the Napa-Solano Service Area conducted group meetings with clinicians practicing at Kaiser’s clinics in the service area. These managers included Mitchell Houston, PhD (Director of Mental Health Services for Kaiser’s Napa-Solano Service Area), Dr. Christine Lim (Site Chief, Kaiser Vallejo Psychiatry and Addiction Medicine Services), and Evan Marmol, LCSW (Manager II, IOP Program for the Napa-Solano Service Area). They told clinicians that Kaiser will cancel not only enrollees’ individual and group therapy appointments, but also will cancel and suspend IOP programs for adults, youth, and adolescents.
When clinicians asked the managers to describe Kaiser’s plan for replacing the services as required by California law, the managers stated the following about individual non-urgent treatment appointments: patients will be informed of the canceled appointments and when clinicians return to work at the conclusion of the strike, clinicians will be tasked with contacting the affected patients to schedule future appointments for them. Many of the affected patients have waited 4-8 weeks for their canceled individual treatment appointments and, according to Kaiser’s plan, will be placed “at the back of the line” when clinicians return to work and attempt to book them into clinicians’ schedules that typically are booked out 1-3 months into the future.
In response to clinicians’ questions about Kaiser’s plans for replacing enrollees’ IOP services, Dr. Houston stated that Kaiser has determined that IOP services for adolescents and youth are unnecessary during the strike and would not be replaced or otherwise provided by Kaiser or out- of-network providers. Likewise, Kaiser does not plan to replace IOP services for adults.
Clinicians reminded Kaiser’s managers that many of the child and adolescent patients receiving treatment in the IOP programs are high acuity teens in high school and middle school who are extremely fragile. Nonetheless, Dr. Houston and his colleagues stated that Kaiser has no plans to replace the canceled services with timely and geographically accessible ones delivered by out-of-network providers at no additional cost to enrollees.
It is unclear what plans, if any, Kaiser has to provide urgent behavioral health appointments.
II. Request
NUHW is extremely concerned about Kaiser’s plans to illegally withhold care from patients during the strike, including from patients with substantial risk of suicide and decompensation. On August 10, 2022, Kaiser canceled tens of thousands of enrollees’ individual, group and IOP treatment appointments scheduled to take place on August 15, 2022. Today, Kaiser reportedly canceled such care scheduled for August 16, 2022.
Individual complaints have been filed with DMHC on behalf of the enrollees affected by the practices detailed in Exhibits A and B.
We request that DMHC take urgent action to enforce California law and to protect the rights of Kaiser enrollees to obtain timely and geographically accessible behavioral health care. We request that DMHC employ all of the enforcement tools at its disposal, including seeking immediate injunctive relief to bar Kaiser from violating state law. Furthermore, we request that DMHC impose immediate penalties on Kaiser for any violations at a scale and intensity that will constitute an effective disincentive to Kaiser so it refrains from committing additional violations and rapidly remedies its existing violations, such as canceling tens of thousands of enrollees’
6
appointments scheduled for August 15 and 16 without arranging for timely and geographically accessible replacement services by out-of-network providers at no extra cost to enrollees. NUHW stands ready to assist in whatever way may be helpful. Please contact me with any questions or requests.
Sincerely,
Fred Seavey
cc: Rob Bonta, Californian Attorney General
Toni Atkins, Senate President Pro Tempore
Anthony Rendon, Speaker of the Assembly
Sen. Scott Wiener, Chair, Senate Select Committee on Mental Health Sen. Richard Pan, Chair, Senate Committee on Health Assemblymember Jim Wood, Chair, Assembly Committee on Health Don Moulds, CalPERS
Dr. Julia Logan, CalPERS
7
EXHIBIT A
For more information:
https://youtu.be/m0CjsqaCr8w
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