Approximately 2,400 NUHW mental health clinicians at Kaiser Permanente held a one-day Unfair Labor Practice Strike this month, alongside engineers and 23,000 registered nurses, who share their concerns about Kaiser’s increasing use of artificial intelligence to the detriment of patient care.
“We’re standing up for high-quality, human-centered patient care,” Kaiser therapist Melissa Stevens said. “Kaiser executives say all the right things, but the actions they’re taking are putting the lives of patients at risk, and threatening to further diminish the quality of care patients receive.”
Workers walked picket lines in Sacramento, Fresno, Santa Rosa, Santa Clara and Oakland, where several hundred workers marched from Kaiser’s Medical Center to its downtown corporate headquarters for a massive rally.
The strike generated national coverage by NPR, The Guardian and the Associated Press, whose story also ran internationally. In California, coverage included Politico, KTVU-2, KRON-4, KTSF, NBC Bay Area, Sacramento Bee, Fox-40 (Sacramento), ABC-10 (Sacramento), Telemundo (Sacramento), Sacramento Business Journal, KCBS News Radio, the Bay Area Current, People’s World, LA Progressive, San Jose Mercury News/Vacaville Reporter, and the Santa Rosa Press Democrat.
The strike was predicated on an Unfair Labor Practice charge therapists filed against Kaiser for unilaterally overhauling its system for triaging patients seeking mental health services.
Patients entering Kaiser’s mental healthcare system are no longer guaranteed to talk to a human therapist trained to ask the right questions to determine what kind of treatment they need and how urgently they need it. Now, many patients do phone screenings with telephone operators who read a script of questions and decide what kind of appointment patients should receive or fill out an online questionnaire and have a form of artificial intelligence make those decisions, even though studies show A.I. underestimates the severity of medical emergencies.
Since Kaiser moved away from having human therapists conduct patient screenings, therapists report seeing more patients who should have been seen immediately or assigned to a different treatment program.
“Kaiser executives say they’re not using A.I. to make patient care determinations, but they won’t say what technology is underpinning the online questionnaires that automatically determine whether patients require urgent appointments and assess whether they may be a threat to themselves,” said Carolyn Staehle, a therapist in San Francisco. “Whatever Kaiser wants to call it, it’s not a human being making these potentially life and death decisions, and it’s not the same level of care as being assessed by a licensed therapist.”
The Unfair Labor Practice Strike is taking place as therapists, represented by the National Union of Healthcare Workers, have been without a contract since September. Both sides remain far apart with Kaiser sticking to extreme proposals that would reverse patient care safeguards previously won by therapists and open the door to replacing therapist jobs with artificial intelligence and further outsourcing care.
“Kaiser has been punished and fined so many times for mental health violations, we can’t let it get away with further lowering patient care standards,” Kaiser therapist Emma Olsen said. “Our patients need human therapists, who can work seamlessly with their doctors and have enough time to do our jobs right — and it’s clear Kaiser doesn’t want to pay for that level of care.”
Despite having $67 billion in reserves, Kaiser remains a serial violator of mental health parity laws. In 2023, the HMO acknowledged in a $200 million settlement agreement with the California Department of Managed Health Care that “it lacks sufficient behavioral health providers” and that “This lack of clinical staff has resulted in excessive wait times for enrollee individual therapy appointments…”
Last month, Kaiser entered into a $31 million settlement with the U.S. Department of Labor over violations of mental health parity laws. Under the 38-page settlement agreement, Kaiser must reimburse patients who had to pay out-of-pocket for mental health treatment they couldn’t get from Kaiser.
Despite still being under both state and federal monitoring of its mental health services, Kaiser has refused to work with therapists to improve care and has invested heavily into artificial intelligence, including a program that records therapy sessions.
When it comes to artificial intelligence, Kaiser is setting the stage to not just replace work done by therapists, but to replace therapists themselves.
In ongoing contract negotiations, The HMO is refusing to agree to the same language in its 2025 contract with Southern California mental health professionals stating that the intention of new technologies, including artificial intelligence, “is not to replace but to assist (therapists) in providing safe therapeutic and effective patient care and support.” When Northern California therapists on the union’s bargaining committee asked Kaiser management officials if their about-face on A.I. foreshadowed potential layoffs, Kaiser officials responded that they wanted “flexibility.”
“Kaiser is taking the humanity out of health care,” said Brittany Beard, a Kaiser therapist in the Bay Area. “We want to make therapeutic care more accessible, but not at the expense of patient privacy or patient safety. Kaiser should be working with us to improve its services, not trying to replace us so that it can mechanize them.”
Kaiser’s position on A.I. is one of several hardline stances in contract bargaining that would diminish patient care standards. The HMO is also seeking to:
- Exert unilateral authority to lay off therapists in order to further outsource mental health services, severing mental health care from the rest of Kaiser’s integrated services. Kaiser’s proposal even details severance packages.
- Reverse patient care safeguards therapists won in previous contracts including scheduling rules that reduce wait times for return appointments and give therapists enough time to respond to patient communications and prepare for appointments.
