November proved to be one of the most tumultuous months in the now year-and-a-half-long contract negotiations between Kaiser Permanente and its mental health clinicians.
Mid-month, the National Union of Healthcare Workers released a 35-page report that made a number of bold claims against Kaiser, including a suggestion that Kaiser violates California laws that ensure mental-health patients are seen in a timely manner, and that Kaiser falsifies its records to avoid the backlash of violating those laws. By the end of the month, the union had filed a formal request to the state to launch an investigation.
“We’ve been bargaining for 20 months and Kaiser still refuses to acknowledge that there’s a patient care problem with their mental health services,” said NUHW Representative Leighton Woodhouse. “That’s why we decided to go public and to ask for the state to intervene.”
The report, titled “Care Delayed, Care Denied: Kaiser Permanente’s Failure to Provide Timely and Appropriate Mental Health Services,” also claims Kaiser directs patients who need one-on-one therapy to group therapy, and that its initial evaluations of patients are too brief and do not meet clinical standards.
“We don’t have enough staff to really handle the amount of patients we see every week,” said Tom Painter, a clinical psychologist who works at Kaiser’s Richmond hospital. “The typical full-time therapist, like myself, has to do six new intakes every week, and fit them into our schedule somehow.”
Kaiser officials were unable to comment, but a statement released shortly after the report went public called the NUHW study “inaccurate and biased,” and denied claims that the organization has manipulated its records. The statement did, however, encourage employees to provide proof of such violations so they could be investigated internally.
“NUHW is the sole source of the data for this survey,” the Kaiser statement reads. “Based on what we know of the questionnaire NUHW used with its members, there is no indication the union used a valid methodology that would provide meaningful, unbiased results.”
The statement also noted that Kaiser is still in contract talks with NUHW, a negotiation that included a highly publicized strike by NUHW members in September. The California Nurses Association walked out in sympathy, causing a major interruption in staffing at Kaiser hospitals across the state (see sidebar for related stories).
According to the NUHW report, the study was conducted by analyzing survey results, interviews and discussions with Kaiser clinicians and patients, and records from the California Department of Managed Health Care, a regulatory body that oversees health-insurance plans that contract with health-care providers and medical facilities, including HMOs like Kaiser.
The study calls on the DMHC and the California Department of Insurance, which oversees Kaiser’s fee-for-service offerings, to launch an investigation into Kaiser’s practices. It also encourages investigation by other officials, including the Attorney General, the U.S. Department of Health and Human Services, public and private payers and the California Assembly and Senate.
The document demands that Kaiser increase staffing at mental-health facilities and limit the number of new patients each clinician sees weekly. It also demands a halt to what it calls record mismanagement and the practice of 30-minute intake evaluations for patients, which it says is too brief to assess the type and amount of treatment an individual needs.
Painter, who has worked for Kaiser for 10 years, said he is unfamiliar with cases of intentional record mismanagement, but that he has seen the effects of insufficient staffing.
“After the initial intake, we’re unable to see the person in a timely way,” Painter said, adding that weekly therapy is the standard in the mental-health field. “If they’re suicidal or psychotic, then there’s a range of services we can refer them to, like day service. But if they’re moderately depressed, still working and functioning, they might benefit from weekly therapy, but we’re encouraged to send them to a group.”
Group therapy is one of the things Kaiser does best, Painter said, but it’s not for everyone. Patients who are motivated and comfortable talking about personal issues with others benefit most, but individuals who don’t meet that criteria often don’t show up.
“One thing about people in mental healthcare, they often feel very disenfranchised, disempowered,” Painter said. “Many people have a lot of shame about being depressed, so for a lot of people, going to a group to talk about their sadness is just too much.”
In regards to intake evaluations, Painter said he usually has enough time to evaluate a patient to determine what kind and how much treatment he or she will need, but he is crunched for time when it comes to the paperwork involved. He also noted that unlike private practices, Kaiser does not cap the number of patients a clinician can be assigned at one time.
“I’d like to see more staffing; it’s very simple,” he said. “When you see someone once a month, it kind of dilutes the relationship.”
Kaiser’s statement reiterated that the nonprofit will not make public the details of its contract negotiations with NUHW, and that it plans to continue bargaining with the union in good faith.