Striking Kaiser therapists say thousands of appointments likely to be cancelled

It didn’t happen. According to a document later filed by the state’s Department of Managed Health Care as part of a massive settlement and fine paid by Kaiser, more than 100,000 mental health care appointments were canceled by the company during the 10-week strike over working conditions and staffing. Cancelling the appointments was a direct violation of state law.

Two years later, it appears not much has changed. In a new complaint filed with state officials, the union representing more than 2,400 striking mental health care workers in Kaiser’s Southern California network says that Kaiser is again trying to get by with whatever staff remains and is employing tactics that will lead to huge numbers of missed or canceled appointments.

“They’re just trying to do it on the cheap,” said Fred Seavey, chief researcher for the National Union of Healthcare Workers, which filed the complaint. “All the reports we get say the clinics are vastly understaffed, just like in 2022.” (Disclosure: NUHW is a financial supporter of Capital & Main.)

According to the complaint, Kaiser’s tactics include leaving patients on long waitlists to even schedule appointments, and having clerical staff make fewer calls than advertised to patients about their appointments being cancelled. The filing asks the Department of Managed Health Care to look closely at Kaiser’s handling of its mental health care patients’ needs during the strike, “especially given Kaiser’s widespread violations of enrollees’ rights in 2022.”

Kaiser officials did not respond to multiple requests for comment by Capital & Main. During the first week of the strike in October, the organization said it had contacted all but 3% of its patients who had mental health care appointments scheduled for that week, “providing appointments to everyone who wanted one.” Kaiser has provided no care updates since that time.

Officials at the Department of Managed Health Care said in October they would monitor Kaiser patients’ access to mental health services during the strike, which is now in its seventh week. Under state law, health care providers must continue offering full access during a labor stoppage, outsourcing appointments to therapists outside the organization if necessary. Kaiser already routinely uses out-of-network providers, in part because of long-standing shortages of mental health care workers.

Kaiser has a history of providing inadequate mental health care services to its 9.4 million members in California. The company paid a $4 million fine to the state in 2013 for deficient access to such services, and four years later it agreed to redress similar failures.

As part of its $200 million settlement with the state last year, Kaiser again acknowledged deep deficiencies in its mental and behavioral care services, paid a record $50 million fine and agreed to undertake extensive corrective action to provide adequate mental health care to its members.

In its filing with the Department of Managed Health Care, the union said it had obtained a copy of an internal protocol memo issued by Kaiser that was at odds with the organization’s public statement about how it would handle mental health care issues during the 2024 strike. Sources said a Kaiser worker provided the memo to the union.

Kaiser’s public contingency plan for the strike, a document filed with the state, said it would try to contact patients three times if their mental health appointments were being canceled. But in Kaiser’s internal memo, the union claims, clerical staff was told to make only two attempts.

The public contingency plan calls for Kaiser to have patients on appointment waitlists for a maximum of two weeks (the “timeliness standard,” in Kaiser’s document). But the union says that under the guidelines in Kaiser’s internal memo, patients could be left on the list for a month, even though state law requires medically necessary follow-up appointments within two weeks.

“Kaiser’s actions are immoral and illegal,” said Sal Rosselli, president emeritus of the National Union of Healthcare Workers. “It’s deeply troubling that Kaiser not only has produced an inadequate plan to maintain mental health services during the strike, but is already violating its own procedures, leaving patients without legally mandated care.”

At this point, Kaiser and its 2,400 striking mental health care workers have no momentum toward a new contract. According to the union, no negotiations are currently scheduled. The union is seeking more staffing, more competitive pay and — critically — more time allotted for therapists and others to work on their patients’ cases outside of their scheduled appointments, which Northern California Kaiser therapists achieved after their strike.

In the meantime, union officials say they fear the same severe dropoff in care that Kaiser mental health patients endured two years ago. “It’s like they’re playing a kind of Russian roulette with these inadequate staffs,” Seavey said. “They’ve got to cover these patients and these sessions.”