Members of the National Union of Healthcare Workers are accusing healthcare giant Kaiser Permanente of understaffing its mental-health services, and they're threatening to strike if their issues aren't resolved. Kaiser has responded that patients with urgent needs can be seen immediately, and it accuses the union in turn of sullying the system's reputation for its own organizing purposes.
The NUHW, founded in 2009 when it split from the Service Employees International Union-United Healthcare Workers West, says patients are waiting too long for appointments because there aren't enough mental-health staffers to meet demand. NUHW members, who represent about 2,500 of Kaiser's mental-health workers in California, voted in November to strike if the system doesn't make improvements.
But Dave Regan, president of the SEIU-UHW, which represents 45,000 Kaiser employees across the state, dismissed NUHW's concerns, saying that the staffing problem “was a limited one and is completely solved.”
However, this isn't the first time Kaiser has been accused of poor psychiatric care. The provider was fined $4 million by the California Department of Managed Health Care in 2013 for failing to provide timely care for its mental-health patients.
The agency also said that Kaiser's marketing materials detailing its mental-health services were confusing and unlawful, including an FAQ sheet informing patients that long-term psychotherapy was unavailable at Kaiser facilities, and would not be covered by Kaiser insurance. This statement and others were found to be in violation of the state's mental-health parity law, which requires mental illnesses to be covered and treated in the same manner as physical illnesses.
Kaiser contested the penalty but ultimately agreed to pay it. The company announced an overhaul of its mental-health services in September, pledging more convenient appointment times, office hours and locations for services, as well as allowing individual therapy to be a larger share of patients' treatment plans, and permitting patients to choose their own therapists.
NUHW president Sal Rosselli said new patients are seen promptly for their initial visit, but subsequent therapy appointments sometimes aren't available for one or two months.
“Scores of therapists are trying to get Kaiser to accept and work with them to rectify the problem, but they refuse to even admit there is a problem,” Rosselli said.
Kaiser spokesman John Nelson said the company “disagrees strongly” with NUHW and accuses the union of bullying Kaiser even though it has added to its therapist workforce in recent years. The system has hired 273 additional therapists since 2011, a 25% increase, while the health plan's membership has increased just 8% during the same period, he said.
“It's all part of their multi-year campaign to damage Kaiser Permanente's reputation so that they can pressure us to agree to their demands in bargaining,” Nelson said. He added that the company has contingency plans in place if the union follows through with a strike.
Nelson acknowledged that patients sometimes wait 4 to 6 weeks for a non-critical individual therapy appointment, but maintained that urgent appointments are always available for patients in crisis. Kaiser believes these wait times are competitive, he said.
Unlike its competitors, Kaiser has refused to establish management-labor staffing committees to work out these types of issues, Rosselli said. The union submitted a proposal to Kaiser's management in southern California in mid-November to avoid a strike and will do the same in northern California next week. The proposal includes a 3% wage increase and benefit maintenance.
Jim Clifford, a Kaiser therapist and NUHW member, said Kaiser makes up for its long wait times by emphasizing the availability of group therapy and classes, although some patients aren't comfortable with seeking therapy in a group setting. He worries that some patients won't be seen before their problems escalate.
“We've always felt that it's a major problem,” Clifford said. “All the therapists at Kaiser have had the experience on a weekly basis of having patients that they've seen saying they need to be seen again promptly, and we just simply don't have the appointments.”
The provider also is facing a class action lawsuit from patients who accuse Kaiser of requiring guardians of adult patients with severe mental illnesses to disenroll from the system's coverage and instead seek treatment at government hospitals under the Medi-Cal public insurance program. Kathryn Trepinski, the attorney bringing the case to court in January, said the system needs to invest more money in care for mentally ill patients.
“Kaiser's revenue, income, is up. Kaiser can afford this treatment and it's obligated to,” Trepinski said. “It needs to direct dollars to building out this level of care for its psychiatric patients.”
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