Kaiser made $8 billion in profits last year. So why are patients struggling to get mental health care?

A San Francisco mother whose daughter nearly jumped in front of a train learned that a Kaiser Permanente therapist would be able to see her — in a month. A mentally unstable man who begged in vain for Kaiser to hospitalize him drove to a cliff and leaped to his death. A therapist whose client blamed Kaiser for her son’s mental health crisis agreed that therapists were stretched too thin and apologized.

Those were among the shocking stories revealed during a San Francisco Board of Supervisors hearing Tuesday as politicians sought to understand why Kaiser delivers what patients, families and employees called deeply inadequate mental health care, even as the city spends nearly $500 million a year with the health care giant.

About 2,000 Kaiser therapists across Northern California and the Central Valley
have been on strike since Aug. 15,
accusing their 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 its patients in the city.

“I’m literally sitting here trying to contain my rage after everything I’ve just heard,” Supervisor Catherine Stefani said. “It is
past time that mental health care must be treated the same as physical health care.”

Particularly infuriating to Supervisor Hillary Ronen, who called the hearing, was that Kaiser declined to attend, citing “the sensitive nature of mental health care negotiations and in deference to patient privacy and dignity.”

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

“If you had showed up, you would have heard that your employees spend a significant amount of time apologizing to their patients for you,” Ronen said, directing her comments to the absent executives. “You would have heard them tell how they are forced to violate their own license guidelines because of your negligence.”

Ronen was referring to a new
state law
that, as of July 1, requires providers to make appointments for non-urgent mental health care within 10 days of a request.

Ronen recited a decade’s worth of Kaiser violations and complaints, beginning with a state fine of $4 million against the health company in 2013 for failing to track the delivery of its mental health services. As a result, it remains unclear how many Kaiser patients are paying out of pocket for counseling elsewhere, even though the critical service is supposed to be included in their fees.

“We have never seen such an egregious case of delayed access for follow-up appointments,” Ronen said, quoting a 2020 letter about Kaiser from the American Psychological Association to the California Department of Managed Health Care.

Asked to respond to criticisms raised in the hearing, Kaiser Permanente issued a statement Wednesday saying it was “fully committed to meeting our patients’ needs, including mental health as an integral part of total health.”

If Kaiser patients have difficulty getting mental health appointments, they can find support and “a multitude of services” by calling a toll-free hotline, 800-390-3503, the statement said.

As for the state law requiring mental health appointments within 10 days, Kaiser called the law’s implementation “challenging for all health plans and providers” because of a shortage of trained providers. However, the company said it supports the goal of the law and that it’s possible that the legislation will lead to an increase in therapists.

At the hearing, the supervisors heard from anguished employees and patients about their experiences with Kaiser’s mental health services.

Mikaela Celli, a crisis clinician who is also a Kaiser patient, told the supervisors about the man who had begged Kaiser to hospitalize him before his suicide.

“Kaiser said no,” Celli said. Instead, the health care company offered the man two weeks of outpatient care, three times a week, to teach him ways of managing his mental health rather than actual therapy, she said. Then the man went missing, and the Coast Guard found him on a beach at the bottom of cliff.

“That man was my father,” Celli said. “Today would be his 55th birthday.”

Alicia Cruz, a clinician who works with suicidal youth and is out on strike, said she often finds herself apologizing to parents for Kaiser’s inadequate mental health care. One day, a mother whose son repeatedly had been denied appointments to treat his mild anxiety showed up at her emergency care clinic with her son, who was now in full-blown crisis.

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

Ian Lewis, a research director with the National Union of Healthcare Workers, which represents the Kaiser therapists, said the company could afford to improve services because it made an $8 billion profit last year.

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

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

“If Kaiser were here, I’d be asking them what the hell is going on,” said Supervisor Dean Preston, who asked if Lewis thought the company’s business model was to intentionally “drive people to go outside the Kaiser system for their mental health.”

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

Ilana Marcucci-Morris, another striking clinician, implored the board: “Who is going to hold Kaiser accountable? How many more suicides will there be, and who will punish Kaiser for disobeying the law and padding their pockets?”

In its statement
Kaiser blamed its shortage of mental health professionals on a nationwide shortage of therapists affecting all providers.

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

“But there is certainly a shortage willing to work under Kaiser’s conditions,” he said.

Supervisor Connie Chan suggested issuing a subpoena to force Kaiser to provide data she hoped could reveal more specifically how many people are being denied mental health services.

Ronen and others said the city, with its half-billion-dollar contract, ought to be able to pressure Kaiser to improve. More than 55% of current city workers are enrolled in Kaiser.

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

“Her mom went to get her, then called Kaiser, which said: ‘I think we can get you in in a month,’” Ronen said at the hearing. “I called them and said, ‘You get her in now.’

“How many people don’t have that kind of access? The vast majority don’t,” Ronen said, and urged the city’s liaison with Kaiser, Abbie Yant, executive director of the San Francisco Health System, to tell the company that the city is worried about its employees.

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

It seems likely that they already know.

Nanette Asimov is a San Francisco Chronicle staff writer. Email: [email protected] Twitter: @NanetteAsimov

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