“Who Will Hold Kaiser Accountable?” Patients Detail Deficiencies in Mental Health Care

A San Francisco mother whose daughter nearly jumped in front of a train has learned that a Kaiser Permanente therapist will be able to see her — in a month. A mentally unstable man, who had pleaded in vain for the Kaiser to hospitalize him, climbed a cliff and jumped to his death. A therapist whose client blamed Kaiser for her son’s mental health crisis agreed that therapists were stretched too thin and apologized.

Those were among the shocking stories revealed at a San Francisco Board of Supervisors hearing Tuesday as politicians tried to figure out why Kaiser is providing what patients, families and employees say is deeply inadequate mental health care, even though the city spends nearly 500 million dollars a year on health care giant.

About 2,000 Kaiser therapists in Northern California and the Central Valley have been on strike since Aug. 15, accusing their employer of neglecting the mental health needs of hundreds of thousands of patients. In San Francisco, about 70,000 city workers and retirees use Kaiser, which employs just 112 therapists to serve all of its patients in the city.

“I’m literally sitting here trying to contain my anger after everything I just heard,” said supervisor Kathryn Stefani. “It is
past time that mental health care should be treated the same as physical health care.

Particularly infuriating to Supervisor Hilary Ronen, who convened the hearing, was that Kaiser declined to attend, citing “the delicate nature of mental health care negotiations and out of respect for patients’ privacy and dignity.”

Kaiser officials told supervisors they would meet with them privately at another time.

“If you had shown up, you would have heard that your staff is spending a significant amount of time apologizing to their patients for you,” Ronen said, directing his comments to the absent executives. “You would have heard them tell how they were forced to violate their own license guidelines because of your negligence.”

Ronen was referring to a new state law that, effective July 1, requires providers to make appointments for non-emergency psychiatric care within 10 days of a request.

Ronen cited decades of Kaiser violations and complaints, starting with a $4 million state fine against the health care company in 2013 for failing to track the delivery of its mental health services. As a result, it remains unclear how much Kaiser patients pay out of pocket for counseling elsewhere, even though the critical service must be included in their fees.

“We have never seen such an impressive case of delayed access for follow-up,” Ronen said, citing a 2020 letter about Kaiser from the American Psychological Association to the California Department of Managed Health Care.

Asked to respond to criticism raised during the hearing, Kaiser Permanente issued a statement Wednesday saying it is “fully committed to meeting the needs of our patients, including mental health as an integral part of holistic health.”

If Kaiser patients are having difficulty getting mental health appointments, they can find support and “multiple services” by calling a toll-free hotline at 800-390-3503, the statement said.

As for the state law requiring mental health appointments to be made within 10 days, Kaiser called implementing the law “challenging for all health plans and providers” because of the shortage of trained providers. However, the company said it supports the intent of the law and that it is possible the legislation will lead to an increase in therapists.

During the hearing, executives heard from beleaguered employees and patients about their experiences with Kaiser’s mental health services.

Micaela Celli, a crisis clinician who is also a patient of Kaiser’s, told executives about the man who had begged Kaiser to hospitalize him before his suicide.

“Kaiser said no,” Celli said. Instead, the health care company offered the man two weeks of outpatient care, three times a week, to teach him how to manage his mental health, rather than actual therapy, she said. The man then disappeared and the Coast Guard found him on the beach at the bottom of the cliff.

“That man was my father,” Celli said. “Today would have been his 55th birthday.”

Alicia Cruz, a clinician who works with suicidal youth and is on strike, said she often finds herself apologizing to parents for Kaiser’s inadequate mental health care. One day, a mother whose son had been repeatedly denied appointments for treatment for his mild anxiety showed up at her urgent care clinic with her son, who was now in full crisis.

“She said, ‘You made my son sick.’ She was talking about me and I didn’t know what to say because I agreed with her,” Cruz said. “We provide 10 weeks of weekly treatment. Not enough.”

Ian Lewis, director of research at the National Health Workers Union, which represents Kaiser’s therapists, said the company can afford to improve services because it made $8 billion in profits last year.

Lewis said Kaiser bills itself as a nonprofit, but that designation “is a tax status and nothing more” and applies only to his foundation.

Based in Oakland, Kaiser Permanente has three components: Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and Permanente for-profit regional medical groups. It operates in eight states and the District of Columbia.

“If Kaiser was here, I’d be asking them what the hell is going on,” said executive Dean Preston, who asked if Lewis thought the company’s business model was intentionally “getting people out of the Kaiser system because of their mental health .”

Lewis said he couldn’t speak for Kaiser, but told Preston, “You’ve raised a really great point.”

Ilana Marcucci-Morris, another striking clinician, pleaded with the board: “Who is going to hold Kaiser accountable? How many more suicides will there be and who will punish Kaiser for not following the law and lining their pockets?

In its statement, Kaiser blamed the shortage of mental health professionals on a national shortage of therapists affecting all providers.

During the hearing, Lewis said the Bay Area is home to more therapists per capita than perhaps any other region.

“But there is certainly a shortage of people willing to work on Kaiser’s terms,” ​​he said.

Supervisor Connie Chan proposed issuing a subpoena to compel Kaiser to provide data they hoped would reveal more specifically how many people have been denied mental health services.

Ronen and others said the city, with its half-billion-dollar contract, should be able to pressure Kaiser to improve. More than 55% of current city workers are enrolled in Kaiser.

It was a legislative aide to Ronen who about five years ago got a terrifying call from her daughter saying she was suicidal and might jump onto the BART tracks.

“Her mother went to pick her up, then called Kaiser, who said, ‘I think we can pick you up in a month,'” Ronen told the hearing. “I called them and said, ‘Get her in now.’

“How many people don’t have that access? The vast majority of them don’t,” Ronen said, urging the city’s Kaiser liaison, Abby Yount, the executive director of the San Francisco Health System, to tell the company the city is worried about its employees.

But Yant made no promises. “I don’t want the public to hear the message that they’re not getting care.”

It seems likely that they already know.

Nanette Asimov is a contributor to the San Francisco Chronicle. Email: [email protected] Twitter: @NanetteAsimov

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