Who will hold Kaiser to account? Patients detail mental health care failures

A San Francisco mom whose daughter was nearly jumping in front of a train learned that a Kaiser Permanente therapist would be able to see her — in a month. A mentally unstable man begged Kaiser in vain to rescue him into a cliff and jumped to his death. A doctor whose client blamed Kaiser for her son’s mental health crisis agreed that the therapists were too stressful and apologized.

These were among the shocking stories revealed during a hearing of the San Francisco Board of Supervisors on Tuesday as politicians sought to understand why Kaiser provided what patients, families, and staff called inadequate mental health care, even as the city spent nearly $500 million annually. on health. Giant care.

About 2,000 Kaiser processors across Northern California and the Central Valley
They have been on strike since August 15th,
They accuse the employer of ignoring 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 all I just heard,” said Supervisor Catherine Stephanie. “that it
In the past, mental health care should be treated like physical health care.”

Particularly infuriated by supervisor Hilary Ronen, who summoned the hearing, Kaiser declined to attend, citing “the sensitive nature of mental health care negotiations and with regard to patient privacy and dignity.”

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

“If I had attended, I would have heard that your employees spend a lot of time apologizing to their patients for you,” Ronin said, directing her comments to the absent executives. “You would have heard them tell how they were forced to violate their licensing guidelines because of your negligence.”

Ronin was referring to new
State Law
That, effective July 1, requires providers to make non-urgent mental health care appointments within 10 days of the request.

Ronen ensued a decade’s worth of Kaiser abuse and complaints, starting with a $4 million fine against the health company in 2013 for failing to track the provision of its own mental health services. As a result, it remains unclear how many Kaiser patients would pay out of pocket for advice elsewhere, even though critical service is supposed to be included in their fee.

“We’ve never seen such a terrible case of late follow-up appointments,” 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 the criticism raised at 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 overall health.”

The statement said that if Kaiser patients have difficulty getting mental health appointments, they can find support and “many services” by calling a toll-free hotline, 800-390-3503.

As for a state law requiring mental health appointments within 10 days, Kaiser described law enforcement as “a challenge to all health plans and providers” due to a lack of trained providers. However, the company said it supports the law’s goal and that the legislation could lead to an increase in therapists.

At the session, supervisors heard from distressed staff and patients about their experiences with Kaiser’s mental health services.

Michaela Seely, a crisis physician who is also a Kaiser patient, told supervisors about the man who begged Kaiser to hospitalize him before he committed suicide.

“The Kaiser said no,” Chile said. Instead, the health care company offered the man outpatient care for two weeks, three times a week, to teach him ways to manage his mental health rather than actual treatment, she said. Then the man disappeared, and the Coast Guard found him on a beach just below the cliff.

“This guy was my dad,” Seeley said. “Today will be his fifty-fifth birthday.”

Alicia Cruz, a doctor who works with suicidal youth while on strike, said she often finds herself apologizing to her parents for Kaiser’s inadequate mental health care. One day, a mother whose son was repeatedly denied appointments to treat his mild anxiety attended her emergency clinic with her son, who was now in complete crisis.

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

Ian Lewis, director of research at the National Federation of Health Care Workers, which represents Kaiser’s therapists, said the company is able to improve services because it made $8 billion in profit last year.

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

Headquartered in Auckland, Kaiser Permanente has three components: the Kaiser Foundation Health Plan, the Kaiser Foundation Hospitals, and the for-profit Permanente Regional Medical Groups. It operates in eight states and the District of Columbia.

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

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

Another striking physician, Ilana Marcucci Morris, appealed to the council: “Who is going to hold Kaiser accountable? How many suicides will there be, and who is going to punish Kaiser for breaking the law and stuffing their pockets?”

In her statement, Kaiser blamed the shortage of mental health professionals on a national shortage of therapists that affects all providers.

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

“But there is certainly a lack of willingness to operate under Kaiser conditions,” he said.

Supervisor Connie Chan proposed a subpoena to force Kaiser to provide data she hoped would reveal more specifically how many people are 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 registered with Kaiser.

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

“Her mother went to get her, and then she called the Kaiser, who said, ‘I think we can get you in in a month,’” Ronen said at the hearing. “I called them and said, let her in now.”

“How many people don’t have that kind of access? The vast majority don’t,” Ronen said, urging the city’s coordinator with Kaiser, Abby Yant, CEO of the San Francisco Health System, to tell the company that the city is concerned about its employees.

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

It seems likely that they already know.

Nanette Asimov is a staff writer for the San Francisco Chronicle. Email: nasimov@sfchronicle.com Twitter:NanetteAsimov

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