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Mental health workers' union claims Kaiser Permanente not providing psychiatric crisis care in emergency room
The Press Democrat - 9/17/2022
Sep. 17—State and local health officials are investigating complaints that Kaiser Permanente has made dangerous reductions in mental health staffing at its emergency department in Santa Rosa, despite having large numbers of patients on psychiatric holds.
The union representing striking mental health workers said the staff reductions in the emergency department are leaving many psychiatric patients without care or supervision from midnight to 6 a.m.
The union has called on the state and county to investigate reports of at least two attempted suicides in the emergency department last weekend.
Kaiser officials dismissed the complaints as a labor tactic amid current contract negotiations. The health care giant said in a statement that state investigators are obliged to review all such complaints, regardless of their merit.
But the National Union of Healthcare Workers, which represents striking mental health staff, insists the complaints are real and that Kaiser is failing to provide 24/7 mental health care in its emergency department. Union workers have been striking for a month.
In some cases, psychiatric patients are being held in the emergency department all night until a qualified mental health professional is available to do a psychiatric assessment in the morning, said Fred Seavey, the union's research director.
Seavey said that when the strike started Aug. 16, Kaiser relied on a "skeleton crew" consisting of on-call psychiatrists and managers to handle psychiatric patients that came into the emergency department during night and early morning hours. When that didn't work, he said, they took a more drastic step in late August.
"Rather than doing the right thing and finding staff ... they simply suspended care for those from midnight to 6 a.m.," he said.
Seavey added that Kaiser has since "downgraded the level of care" by reverting to virtual or "tele-psych" services between 6 a.m. and 7:59 a.m. and between 6 p.m. and 11:59 p.m.
A screenshot of a communication, obtained by the union from an emergency department manager, describes those periods and lists the period between midnight and 5:59 a.m. as "No psych available." The item is dated Sept. 1.
Company officials said they would not comment on internal communications.
Union officials said emergency department staff reported that during the weekend of Sept. 9 the number of psychiatric patients being held in the emergency department reached over a dozen who were not receiving proper care or supervision.
"Early on Saturday morning (Sept. 10) two patients reportedly attempted suicide while they were inside the (emergency room)," Seavey said. "The circumstances related to those (attempted) suicides were noted — one apparently by hanging and a second by a cut to their throat ... all of this stuff raises concerns about the adequacy of the staffing of psychiatric personnel in the emergency room."
An emergency department employee separately confirmed the two instances, which occurred at a time without any mental health experts at work, though there were security guards on hand, according to the employee, who requested anonymity for fear of potential retribution.
Kaiser countered that it's not uncommon for hospital emergency departments to receive patients undergoing a psychiatric emergency, and their volume at any given time does not depend on staffing. The current strike only makes things worse, company officials said.
"Instead, the increased volumes are driven by the crisis of spiking mental care needs in our community and are exacerbated by the shortage of mental health care providers across the state and nation and the ongoing COVID-19 pandemic and aftermath of wildfires in our community," the company's statement said.
Over the past several weeks, the union has called on the California Department of Managed Health Care, which oversees HMOs, to investigate Kaiser's staffing levels in the emergency department. On Sept. 11, the union raised concerns about the reported suicide attempts with the behavioral health division of Sonoma County'sDepartment of Health Services.
Tina Rivera, director of health services, said last week that county staff have not received reports of the suicide attempts from sources other than the union. But the county is looking into the reports, she said.
"We have been in discussion with Kaiser leadership who have elevated these allegations to their local, state, and national leadership," Rivera said in an email. "It is my understanding that Kaiser is also in communication with the Department of Managed Health Care."
The state Department of Managed Health Care is conducting a review of Kaiser's mental health care services in response to earlier union complaints that Kaiser was not providing timely mental health appointments during the strike. Rachel Arrezola, a spokeswoman for the department, said the state's "enforcement investigation" includes complaints about emergency department staffing.
On Thursday, Kaiser spokeswoman Adriann McCall said she could not comment on the suicide attempt reports because of patient privacy laws.
In a Sept. 14 statement to The Press Democrat, Kaiser called the union's complaints "contract negotiations tactics" aimed at garnering media attention during the current labor strike.
"This is a tactic the union has used in every bargaining cycle with Kaiser Permanente," the statement said. "While every complaint, no matter the source, requires a thorough investigation, quite often the union's complaints during bargaining require clarification, context, and even flat-out corrections of false information."
Kaiser said it is working to make sure the Department of Managed Health Care "has the most complete and accurate information, including case details, rather than what the union contends to be true."
The company said its emergency department meets or exceeds all applicable legal requirements and is "staffed by a mental health team, including both psychiatrists and licensed behavioral health clinicians" trained and designated by the county to conduct psychiatric assessments.
On Friday, several dozen NUHW members and supporters rallied in front of Kaiser's Santa Rosa hospital, echoing calls for greater investment in mental health staffing that have underscored the monthlong strike.
The health workers union represents about 100 Kaiser mental health workers in Sonoma County, including therapists, psychologists, social workers and counselors. The union represents about 2,000 mental health workers across numerous Kaiser facilities in Northern California.
Union officials and striking mental health workers say Kaiser has a long history of failing to provide adequate mental health services. They say the state needs to take stronger action to ensure Kaiser makes greater investments in mental health services.
In June 2013, the California Department of Managed Health Care imposed $4 million in fines on Kaiser for "serious deficiencies" in providing members with timely access to mental health. Kaiser initially challenged the fine but a year later agreed to pay and promised to make improvements the quality and availability of mental health services.
"The crisis in Santa Rosa is the direct result of Kaiser Permanente's total disregard for mental health care, and California regulators' failure to get this company to obey the law," said union president Sal Rosselli. "This pattern has played out repeatedly for years, especially in Sonoma County. Unless state officials get serious about protecting patient rights, we fear people will continue to be harmed at Kaiser."
Kaiser said it's committed to "around-the-clock" mental health-related coverage at its Santa Rosa emergency department.
The provider acknowledged that county public health department staff recently visited the department and "spent the entire day reviewing our Emergency Department processes, consultations, safety protocols, coverage, and care transitions for patients undergoing treatment for psychiatric conditions, where our processes were recognized as thorough and compliant, pending a final report in the next 30-60 days."
You can reach Staff Writer Martin Espinoza at 707-521-5213 or firstname.lastname@example.org. On Twitter @pressreno.
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