Spurred by whistle-blower complaints from Kaiser’s own mental health clinicians, an investigation by the state’s Department of Managed Health Care 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 levied a $4 million fine — the second-largest in the agency’s history — against Kaiser 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 now faces the prospect of a hearing, scheduled to begin Monday in Oakland, during which patients and whistle-blowers would give public testimony regarding Kaiser’s deficient care. For weeks, Kaiser has been negotiating a settlement with the DMHC in hopes of avoiding such a spectacle, and a settlement is indeed likely given Kaiser’s political connections.
The National Union of Healthcare Workers, 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 calling for the DMHC to hold Kaiser accountable.
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 three class-action lawsuits filed by patients and families who say Kaiser’s violations contributed to tragic outcomes, including suicides.
Yet the violations continue:
As of September, 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, 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 staffers could even listen to them, let alone respond to them.
In July, Kaiser instructed employees to falsify appointment records rather than provide patients with urgent appointments within 48 hours, as mandated by state law.
In May, 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, one of Kaiser’s Southern California clinics required patients with acute conditions — including auditory hallucinations — to wait more than seven weeks for an appointment.
Considering the severity of the violations, and considering that Kaiser clinicians have provided the DMHC with ample evidence that Kaiser continues to violate the law, we strongly urge 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 of 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 president of the Emeryville-based National Union of Healthcare Workers, which represents more than 10,000 workers throughout California, including 4,000 Kaiser employees.