Kathy Ray has been working at Kaiser Permanente for 30 years. She said the organization is changing — now run by “MBAs” who she believes are far more concerned with profit than the wellbeing of patients and staff.

That’s why she joined thousands of fellow members of the National Union of Healthcare Workers (NUHW) on Monday as they began an open-ended strike at Kaiser facilities across Northern California. Through details on its website, Kaiser denies the claims the union has made.

The union comprises more than 4,000 Kaiser mental health clinicians, including psychologists, therapists, social workers and chemical dependency counselors. More than 2,000 of them are expected to hold the picket line this week across several Northern California cities, including San Francisco, Oakland, San Jose, Sacramento, Fresno and Modesto.

Ray, a licensed clinical social worker, spoke with MedCity News via phone while striking on the front lines on Tuesday. In her view, Kaiser is dealing with the nation’s uptick in demand for mental health services by “burying their heads in the sand and pretending like we don’t have a mental health care crisis.” 

She said NUHW is striking as part of its long battle to ensure mental health care achieves parity with other care provided at Kaiser. For example, if a Kaiser patient breaks her arm or gets diagnosed with diabetes, her clinicians are expected to respond to the issue quickly and establish a treatment plan that incorporates ongoing care. Kaiser does not hold its mental health workers to the same standard, according to Ray. She said with the way Kaiser is currently run, immediate access to care and sustained treatment is not possible for people seeking mental health care at its facilities.

Before she began striking, Ray said the new patients she saw would have to wait a month or more before their next returning appointment. Sometimes, if a patient was really in crisis, she would figure out a way to squeeze in an appointment during her charting hours. 

“We force them into an appointment that really isn’t there,” she said. “And then we work extra hours to get our paperwork done, because by law, we have to get it done within 24 to 48 hours. This was a common practice for us.”

Internal Kaiser documents demonstrate that patients who had an initial mental health assessment on June 13 weren’t scheduled for follow-up appointments for a month in San Francisco, more than two months in Sacramento and three months or more in other parts of Northern California.

Ray called this dilemma “ironic” because she claimed Kaiser trained her and its other mental health clinicians on a model where they were supposed to meet with their patient every week. She said that Kaiser trained them on this model and heralded it as a best practice when it knew its mental health clinicians were seeing patients every four to 11 weeks. 

Even though Ray agreed that seeing patients weekly is the most effective way to provide care, she said this kind of model just doesn’t work within Kaiser.

“The only way I can make it work is at my own expense,” she said.

Earlier this year, NUHW worked with the state government to pass a law stipulating that Kaiser must allow its mental health clinicians to see their patients within two weeks of a prior appointment. Kaiser does not have adequate staffing levels for this to become a reality, though, according to Ray.

“Kaiser is saying that it’s got enough clinicians to make that happen, but they don’t,” she said. “For instance, one of the things it keeps saying in the press is ‘We’ve hired 200 new clinicians since January 2021.’ But we’ve lost 377 clinicians since that time. They aren’t keeping up.”

The union recently surveyed the hundreds of clinicians who left their roles to learn more about their decisions to quit. Many workers cited burnout that came as a result of needing to use documentation time to see patients whose mental health issues seemed too severe to put on the backburner for weeks. Ray added that many also said they felt their work was unethical — that there was no way they could provide quality care to patients while only being able to see them every four to 11 weeks.

To Ray, Kaiser’s failure to meet the NUHW’s demands has to do with the fact that it is “focused on being a money-making institution, even though it is a nonprofit.”

“Kaiser is run by business people. it’s not run by medical professionals anymore,” she said. “Now it’s run by MBAs who are more concerned with profits than care. Kaiser had $8.1 billion in profits — if they threw $200 million at mental health and really invested in it, we would have some of the best mental health in the country.”

Kaiser posted a new page on its website last week in which it denied NUHW’s claims. It said is hiring mental health clinicians “at a higher rate than membership growth” and claimed that it has established escalation procedures therapists can turn to if they are unable to schedule a necessary follow-up appointment for a patient.

“We continue to believe that our differences are best addressed at the bargaining table and we have told NUHW we are willing to meet with the union at any time,” the health system said in a statement sent to MedCity News. “Our goal is to reach a fair and equitable agreement and bring this strike and our negotiations to a conclusion.”

In addition to the strike it began on Monday, the NUHW also began running full-page ads in Northern California’s larger newspapers. These ads say that the union has “made proposal after proposal to Kaiser for greater investments in timely care, but Kaiser has rejected all of them.”

Members of the union voted in June to go on strike after what they said was a year of failed contract negotiations. Though Kaiser did not avoid this strike, it averted about 40,000 Kaiser workers’ plans to strike last November. The workers had planned to strike at 14 West Coast hospitals to demand better pay and benefits, but they reached a four-year contract with the health system.

Still, this week’s strike is not the first mental health worker strike Kaiser has seen — mental health clinicians striked across Kaiser facilities in Hawaii in May, citing the same concerns as the workers currently holding the picket line in California.

These concerns seemed to have been raised for a while. California fined Kaiser $4 million in 2013 for problems with its mental health care access, including making patients wait exceedingly long periods for an appointment. The state is also currently investigating whether the health system is providing adequate health care to its patients after a sharp increase in complaints.

Photo: FilippoBacci, Getty Images

Update: This story has been updated with comment from Kaiser Permanente.