Kaiser mental health staffers prepare for second strike of the year

Clinicians from 50 Kaiser facilities across Northern California represented by the National Union of Healthcare Workers are calling for a strike beginning on Monday, November 16, after talks failed to reach an agreement on mental health staffing, scheduling and financial issues.

The walkout would be the second this year against Oakland-based Kaiser, the nation’s largest health maintenance organization (HMO). Picket lines would affect about 80 Kaiser facilities in the San Francisco Bay Area, Fresno, Santa Rosa, San Jose, the Central Valley and Sacramento, union representatives said.

The strike is forecast by the union to last “for as long as it takes to get Kaiser to do something,” said Clement Papazian, a psychiatric social worker who leads the union’s mental health clinicians in Northern California. “We want to see a substantial change in [Kaiser’s] position related to hiring, which they’ve said they’re willing to do, but we’ve seen no evidence.”

After a statewide strike in January of this year, the Northern California division of the union representing a group of therapists, psychologists and drug counselors is demanding Kaiser change its management of mental health employees and patients. The employees have been asking for changes since becoming represented by the union five years ago.

The union said it believes its requests put a priority on patient needs; the HMO sees their demands in dollar signs. The union is currently asking for improved staffing and patient scheduling, as well as increased wages and benefits. Kaiser representatives say the union’s requests represent a 19 percent increase in wages and benefits over three years, plus $15,000 in bonuses, which the HMO termed “excessive” in a statement on November 6 addressing the union’s announced strike.

But Justin DeFreitas, the union’s communications coordinator, characterized those figures as “a blatant lie.” He says the union views the dispute as a fight to improve patient care, staffing and scheduling, and to eliminate wage freezes and benefit cuts, which the union claims are unique to mental health staff. “Clinicians are asking only for what was given to 100,000 other unionized Kaiser employees,” DeFreitas said.  In a wage comparison chart, the union points out that Kaiser has offered significantly less in raises, wages, and benefits to its mental health clinicians than to other medical staff.

“Our employees deserve a fair contract, with great compensation for their important work,” Kaiser representatives said in a statement forwarded by media relations manager Jessie Mangaliman. “Our wage proposals are forward looking and intended to generously reward our therapists with wages that are competitive in the current market.”

In the same statement, Kaiser representatives said the organization’s “mental health care … is among the best in the industry, a fact supported by independent third-party ratings, including the National Business Coalition on Health, and the highest possible rating from the California Office of the Patient Advocate.”

Still, the union cited alleged understaffing of mental health clinicians for delays of care that have led to hardships for mental health patients and families. California’s state code requires that requests for urgent care appointments that do not require previous authorization be met within 48 hours. Requests for non-urgent appointments with specialist physicians, such as psychiatrists, must be met within 15 business days, and requests for non-urgent appointments with other mental health care providers must be met within 10 business days.

In 2013 the California Department of Managed Health Care (DMHC) responded to a report by the union accusing Kaiser of hiding documents showing how many weeks patients had to wait between appointments. The union’s report also alleged that Kaiser was violating the Knox Keene Act, which states that HMOs must treat mental health and other medical care employees equally, including in terms of wages and benefits.

Upon investigation, DMHC fined Kaiser $4 million after it issued a report finding that 22 percent of medical records reviewed among Kaiser’s Northern California facilities failed to meet these state guidelines for timely access to care. The state’s report confirmed the union’s charge that the HMO was in violation of the Knox Keene Law, and also concluded that Kaiser offered fliers and brochures to patients containing inaccurate information that could potentially dissuade patients from seeking long-term individual therapy.

The fine, the second largest in the agency’s history, was issued along with a cease and desist order against Kaiser, ordering the company to stop the following violations of California’s code: “having insufficient compliance monitoring policies and procedures that accurately measure the accessibility and availability of contracted providers … having insufficient written quality assurance systems, policies, and procedures designed to ensure [Kaiser’s] provider network is sufficient … and failing to utilize a system that accurately reports waiting times for appointments.”

The agency has issued several follow-up surveys to check the HMO’s compliance. Dr. Mason Turner, assistant director of regional mental health services at Kaiser, issued a statement to Oakland North last week saying that “Since the follow-up survey was conducted in 2013-14, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. Kaiser Permanente has increased the number of its mental health therapists by nearly half in California from January 2011 to June 2015.” According to Turner, Kaiser had hired 411 therapists since 2011.

But after another follow-up survey conducted after the strike this January, the state agency issued another report finding that Kaiser continues to violate state code. A resulting fine will be implemented by the end of this year, said Sal Rosselli, president of the union.

A Kaiser press release in September responding to the agency’s fine states that the company boosted its mental health staff by 45 percent between 2011 and 2015.

But a union statement announcing the strike claims this number is “inaccurate and misleading,” because it doesn’t take into account a 20.6 percent statewide increase in patients due to the Affordable Care Act. “The only solution is to hire many more mental health clinicians, ” said.Rosselli.

Last month the union released a video entitled “No More Kaiser Suicides,” linking long wait times between appointments to cases in which patients took their own lives. The two sides have also carried their dispute into a series of opposing billboards on BART. An ad by an organization called the Courage Campaign Institute reads: “Delays, Denials, Deaths: The Real Kaiser Permanente,” and offers a website where patients share their negative experiences. A spokesperson for Kaiser stated the HMO believes the CCI’s ads are funded by the union. Kaiser’s own ads, in similar shades of green, claim that “a small union decides to wage a smear campaign against Kaiser Permanente, and its top-rated mental health care.”

According to the union, five class action suits by patients have been filed against the HMO regarding wait times for mental health care. And in August, the Santa Rosa Press Democrat reported that Denny Regan lost his 83 year-old wife when she jumped from a Kaiser parking garage, her driver’s license and Kaiser ID card in hand. According to the Press Democrat’s report, her medications were altered numerous times, and after she was prescribed a medication she had used before and said had lost effect, she received a psychiatric appointment confirmation a month away. Regan told the paper he believes his wife was trying to make a statement with her death.

One patient, who is not involved in any litigation, spoke of similar wait times for therapy in interviews and written statements to Oakland North. Chelsie Martinez, a patient since 2009 at Kaiser’s Santa Rosa site, said that while the doctors and therapists she’s seen through Kaiser have been “wonderful,” the system didn’t allow her enough access to mental health care to effectively treat her history of trauma and mental illness, including suicide attempts.

Martinez said she was placed in group therapy, although she said she told her psychiatrist it wasn’t for her. Her therapist, Andy Weisskoff, confirms: “She was pretty miserable in the group.” When Martinez was able to see a therapist individually, she said she had to wait four to eight weeks between appointments. Eventually, Martinez said, she began to foster a trusting relationship with Weisskoff.

After a few years of therapy, Weisskoff let Martinez know that he had submitted his 90-day notice at Kaiser, and that he could see her at his private practice. But before the 90 days were up, Weisskoff said in an interview, the HMO let him go. The day before her appointment, Martinez said, a receptionist called to inform her that Weisskoff wouldn’t be seeing patients anymore. This news sent her into a downward spiral. “I was reminded why I didn’t trust people,” Martinez said.  At this point, she said, she planned to end her life, even organizing the work she would assign her coworkers so that her office would continue to run smoothly in her absence.

“[Martinez] was told she would be contacted in a week to arrange an appointment with her psychiatrist to discuss future therapist options,” wrote Weisskoff in a statement. Martinez said in an interview she was offered an appointment three weeks away. But she believed she would be gone by then.

However, Martinez managed to reconnect with her old therapist after finding his blog online, through which he said he hoped to reach out to patients.  Now Martinez said she sees Weisskoff privately once a week, with texts or phone calls in between sessions, paying for the therapy out of pocket. Since beginning private therapy, she said, she has been able to quit two of her medications.

Mental illness “can convince you that you’re actually hurting the people you love by being alive,” Martinez said. “Today I know that’s not true. People can get better as long as they’re given an opportunity.” She went on: “The unfortunate part here is that not everyone has an Andy in their life, helping them to see how important they really are.”

Asked to comment on Martinez’s case, Kaiser’s spokesperson emailed a statement from Dr. Mason Turner: “While we can’t discuss specific cases for privacy reasons, we recognize that mental health issues are complex and impact not only individuals, but their families,” Turner wrote. “The length of treatment for a patient is based on medical necessity, the person’s clinical status and care plan. There is no one-size-fits-all approach.”

“Over the last year, we have done intensive work to gather and analyze direct feedback on our mental health services from members, patients, and others,” Turner wrote. “We have used what we heard and learned from them, as well as from customers, independent experts, and from our own physicians, therapists, and staff. We have identified many areas of strength in our services and care, and also identified opportunities to improve.”

As a result of this analysis, Turner said, Kaiser identified a number of areas for possible improvement, including recruiting and hiring new therapists; building more time into therapists’ schedules for individual return therapy appointments; improving wait times for initial, non-urgent therapist appointments; developing ways to better include and prepare members for psychiatry visits, group therapy visits, and individual therapy; and renovating behavioral health care and office environments.

In the first week of October, Kaiser offered a “last and final offer” on its contract with the union, which the HMO didn’t amend in bargaining. In this offer, Kaiser takes a centralized approach, meaning it treats hiring, staffing and pay the same way at all clinics. But union representatives disagree with this method, claiming each clinic has different needs due to different patient populations. “We’ve advocated for clinician-management committees at each facility that can work together to determine and meet staffing needs,” Papazian said.

This proposed system includes a scheduling standard requiring therapists to meet a greater number of patients, Papazian said, puts a strain on their schedules.

The offer also includes a proposed 1:4 new-to-return patient ratio. (This means, in effect, that every therapist would only receive one new patient for every four returning patients they see in their practice.) Papazian said this proposition is “in the right direction,” but he finds fault in the proposal’s disciplinary actions toward clinicians who fail to meet a “75 percent [of patients] seen” metric. Papazian claimed this would create a scheduling bind that “creates sweatshop conditions for clinicians that essentially have the effect of undoing the benefit of the ratio, and merely shift the problem.” Papazian said the solution lies in hiring more staff, not regimenting the existing staff’s schedules.

Rosselli said the union is asking for “however much more staff it takes to meet the 10-day legal requirement” for appointment scheduling. Union members also want the caregivers to be able to determine the frequency of care, which they say is impossible with the proposed scheduling rules.

On Monday November 16, over a thousand Kaiser mental health professionals are expected to report not to their clinics but to an array of picket lines and rallies across the northern half of California. Rosselli said that since union members gave their employer proper 10-day notice of the strike, it’s Kaiser’s responsibility to cover patients’ care during this time. Kaiser has known about the strike since early October, Rosselli said, since 88 percent of the 1,400 Northern California clinicians employed by Kaiser voted in favor of it.

Turner’s statement said Kaiser does not expect disruption to hospital and most outpatient services. “We have contingency plans in place to continue to provide high quality mental health services to our patients and members during the strike,” Turner wrote. “Mental health care will be provided for our members by skilled physicians and clinical managers, as well as by contracted high-quality mental health professionals in the community.”

Rosselli said that if an “urgent situation” arises regarding a patient at a care center, clinicians would “walk back in” to help provide care. “The last thing the workers want to do is go on strike,” said Rosselli, “but Kaiser’s been unresponsive to everything else we’ve done over the past going-on-6 years. The reason for this drastic measure is to attract attention of people … and of city officials, and to achieve the quality of care these people pay for.”