In September, after more than a year of stonewalling its patients and employees, Kaiser Permanente finally paid a $4-million fine levied against it by state regulators because of the HMO's chronic, illegal, and too often tragic failures in mental health care.
Spurred by whistleblower complaints from Kaiser's own mental health clinicians, an investigation by the state's Department of Managed Health Care (DMHC) found the HMO guilty of "serious" and "systemic" violations of California law that put mental health patients at risk. The result: In June 2013 the DMHC hit Kaiser with a $4-million fine -- the second largest in the agency's history -- for forcing thousands of patients to endure illegally lengthy waits for care, falsifying patients' appointment records, and violating the California Mental Health Parity Act, which requires HMOs to provide psychiatric services that are on par with their primary health services.
Kaiser appealed, of course, but, faced with the prospect of a hearing during which patients and whistleblowers would have given public testimony regarding Kaiser's deficient care, the HMO's lawyers finally threw in the towel. Kaiser had attempted to negotiate a settlement with the DMHC in hopes of avoiding such a spectacle but failed. And when, on the hearing's first day, Administrative Law Judge Ruth Astle declined to seal all the hearing's documents and questioned the ethics of Kaiser's star witness -- a former DMHC prosecutor now in private practice defending HMOs against regulators -- Kaiser's attorneys finally saw the writing on the wall.
The National Union of Healthcare Workers (NUHW), which represents 2,500 mental health professionals at more than 100 facilities throughout California, stands with the thousands of patients who have suffered as a result of Kaiser's violations in applauding the DMHC for holding Kaiser accountable. But Kaiser's mental health care crisis is far from over. Kaiser clinicians have provided the DMHC with ample evidence that Kaiser continues to delay and deny care to its mental health patients, in violation of state and federal law.
Kaiser simply does not staff its psychiatry departments with enough psychologists, therapists, and social workers to handle the caseload. And that caseload is growing rapidly. This year Kaiser's enrollment has increased by 387,000 members in California under the Affordable Care Act. Withholding services while increasing membership is an effective way to score record profits -- Kaiser has made more than $13 billion since 2009, and this year's profits are on pace to double last year's -- but it has led to woefully inadequate care, as well as five class-action lawsuits filed by patients and families who say Kaiser's violations contributed to tragic outcomes, including suicides.
And the violations continue:
• As of September 2014, pediatric patients requiring neuropsychological testing waited 22 weeks before receiving a phone call from Kaiser's San Francisco psychiatry department to schedule an appointment, according to Kaiser's records.
• In August 2014, Kaiser's psychiatry department in San Francisco was so severely understaffed that dozens of patients' calls to the "Triage Team" languished in the voicemail system for more than a week before staff could even listen to them, let alone respond to them.
• In July 2014, Kaiser instructed employees in at least one clinic to falsify appointment records rather than provide patients with urgent appointments within 48 hours, as mandated by state law.
• In May 2014, Kaiser failed to provide timely mental health appointments to more than 60 percent of the patients seeking care at Kaiser's Oakland and Richmond facilities, according to data supplied by Kaiser.
• In April 2014, one of Kaiser's Southern California clinics required patients with acute conditions -- including auditory hallucinations -- to wait more than seven weeks for an appointment.
The parallels with the scandal that engulfed the Veterans Affairs Administration earlier this year are striking and prompted NUHW in June to call for a federal investigation into Kaiser's mental health services.
The DMHC is expected to release a follow-up survey of Kaiser's mental health services in November. While the findings in that survey are not yet known, a hint was proffered last month by a DMHC official. At a mental health forum in Santa Rosa, California, hosted by U.S. Rep. Mike Thompson and Sonoma County Supervisor Shirlee Zane, during which Kaiser was blasted by patients who had suffered as a result of its inadequate psychiatric services, Sherrie Lowenstein, the DMHC's deputy director for legislative affairs, vowed, "We are not done with Kaiser."
Considering the severity of the violations, and considering the preponderance of evidence that Kaiser continues to violate the law, NUHW strongly urges the DMHC to stay true to its mission by forcing Kaiser to fix its dangerously inadequate mental health services.
Without strict enforcement, Kaiser mental health patients will continue to endure illegal and unethical wait times for appointments; patients in need of ongoing one-on-one therapy will be forced to seek care outside Kaiser; and many patients in need of acute care will go untreated, sometimes with tragic consequences.
For more on Kaiser's mental health failures and the efforts of Kaiser clinicians to reform the HMO, see NUHW.org/Kaiser.
Sal Rosselli is the president of the National Union of Healthcare Workers (NUHW), a member-led movement for democracy, quality patient care, and a stronger voice in the workplace. NUHW represents more than 10,000 workers throughout California, including 3,000 Kaiser employees.