Mental Health Workers Union Claims Kaiser Permanente Fails to Provide Psychiatric Crisis Care in Emergency Room

State and local health officials are investigating complaints that Kaiser Permanente made dangerous cuts to mental health staff at its emergency department in Santa Rosa, despite having a large number of patients in psychiatric facilities.

The union representing the striking mental health workers said emergency department staff cuts were leaving many psychiatric patients without care or monitoring between midnight and 6am

The union called on the state and county to investigate reports of at least two suicide attempts in the emergency room last weekend.

Kaiser officials dismissed the complaints as labor tactics amid ongoing contract negotiations. The health giant said in a statement that state investigators are required to look into all such complaints, regardless of their merit.

But the National Health Workers Union, which represents striking psychiatric staff, insists the complaints are real and that Kaiser is failing to provide 24/7 mental health care in its emergency department. Union workers have been on strike for a month.

In some cases, psychiatric patients are kept in the emergency room all night until a qualified mental health professional is available to do a psychiatric evaluation in the morning, said Fred Seavey, the alliance’s research director.

Seavey said that when the strike began on Aug. 16, Kaiser relied on a “skeleton crew” of psychiatrists and on-call managers to handle psychiatric patients who came to the emergency room during the night and early morning hours. When that didn’t work, he said, they took a more drastic step in late August.

“Instead of doing the right thing and finding staff … they just stopped caring for those from midnight to 6am,” he said.

Seavey added that Kaiser has since “lowered the level of care,” returning to virtual or “telepsychic” services between 6 a.m. and 7:59 a.m. and between 6 p.m. and 11:59 p.m.

A screenshot of a message obtained by the union from an emergency room manager describes those periods and lists the period between midnight and 5:59 a.m. as “No Psych Available.” The item is dated September 1st.

Company representatives said they would not comment on internal communications.

Union officials said emergency room staff reported that over the weekend of Sept. 9, the number of psychiatric patients held in the emergency room reached more than a dozen who were not receiving proper care or monitoring.

“It was reported that early Saturday morning (Sept. 10) two patients attempted suicide while in the (emergency room),” Seavey said. “The circumstances surrounding these (suicide attempts) were noted — one apparently by hanging and the other by slitting their throats … all of which raise concerns about the adequacy of psychiatric staffing in the emergency department.”

An emergency department official separately confirmed the two cases, which occurred at a time without any mental health experts on duty, although security was on hand, according to the official, who requested anonymity for fear of potential retribution.

Kaiser countered that it’s not unusual for hospital emergency rooms to see psychiatric emergency patients, and their volume at any given time is not staffed. The current strike is only making matters worse, company officials said.

“Instead, the increased volumes are due to the crisis of growing mental health care needs in our community and are being exacerbated by the shortage of mental health care providers across the state and nation and the ongoing COVID-19 pandemic and the effects of wildfires in our community,” , the company said in a statement.

In the past few weeks, the union has called on the California Department of Managed Health Care, which oversees HMOs, to investigate Kaiser’s emergency room staffing levels. On Sept. 11, the union raised concerns about reported suicide attempts with the Sonoma County Department of Health Services’ Behavioral Health Division.

Tina Rivera, director of health services, said last week that county staff have not received reports of suicide attempts from sources other than the union. But the county is looking into the reports, she said.

“We have been in discussions with Kaiser management who have raised these allegations with their local, state and national leadership,” Rivera said in an email. “It is my understanding that Kaiser is also in communication with the managed health department.”

The state Department of Managed Health Care is conducting a review of Kaiser’s mental health services in response to earlier union complaints that Kaiser failed to provide timely mental health appointments during the strike. Rachel Arrezola, a spokeswoman for the department, said the state’s “law enforcement investigation” involved complaints about emergency department personnel.

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