COMPLAINT: Kaiser Permanente patients seeking mental health care throughout California are being triaged by unlicensed telephone operators – in violation of state law
Despite being cited for numerous mental health violations and ordered to pay a $200 million penalty, Kaiser has stopped using licensed therapists to assess the condition and the needs of patients reaching out for mental health care
When a Kaiser patient in California needs medical attention, they can call an advice nurse, who’s trained to connect them with appropriate care. But when it comes to mental health care, Kaiser now connects patients with an unlicensed telephone service representative who determines their treatment needs by asking a series of “Yes or No” questions — in violation of state law.
In a complaint filed today, the National Union of Healthcare Workers, which represents more than 4,700 Kaiser mental healthcare professionals in California, is requesting that the California Department of Managed Health Care order Kaiser to immediately stop the practice in Kaiser’s Northern California region, which includes the Bay Area, Sacramento and the Central Valley. The union previously filed a complaint in April asking the regulatory agency to stop a similar practice in Kaiser’s Southern California region and impose further penalties against the giant HMO.
Both complaints come as Kaiser’s behavioral health services remain under state oversight following a 2023 Settlement Agreement, in which Kaiser agreed to pay a $200 million penalty, including a $50 million fine for violating mental health access laws, including understaffing its services and consequently making patients wait too long for appointments.
The Settlement Agreement was supposed to lead to reforms that improved Kaiser’s behavioral health services and ensured that it was complying with state law. However, within months after signing the Settlement Agreement, Kaiser dramatically changed its process for triaging patients who are seeking mental health and addiction medicine services.
In Northern California, telephone triage assessments had been provided by licensed therapists who were specially trained in triage. These therapists used their expertise and clinical judgement to assess symptoms, risks and medical needs and determine whether patients required an urgent appointment, a non-urgent appointment, referral to a specialty clinic, or an immediate visit to the emergency room.
However, starting last year, Kaiser in Northern California replaced its licensed triage therapists with unlicensed telephone service representatives who pose scripted questions to patients and use an algorithm to determine their condition and when patients need to be seen by therapists.
“We’re seeing more patients with severe mental health conditions who should have gotten more immediate care but didn’t because Kaiser has removed licensed therapists from the triage process,” said Brittany Beard, a therapist at Kaiser in the Bay Area. “It’s alarming to hear Kaiser claim that it’s making improvements in its mental health services when some of the changes appear aimed at saving Kaiser money at the expense of patient care.”
Kaiser therapists report that unlicensed telephone service representatives routinely fail to appropriately triage patients leading to delays in care. In one instance, a therapist in March reported receiving a high-risk patient who had recently attempted suicide, but was incorrectly booked into a non-urgent intake assessment more than a week after being triaged. The patient’s symptoms were so severe during the intake assessment, that the therapist had to have the patient hospitalized on a psychiatric hold.
An unlicensed staff person may handle calls to ask questions on behalf of a licensed staff person to help ascertain the condition of the patient seeking care. However, California law states that “an unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional.”
NUHW has tried to engage Kaiser over its concerns with the new triage system since it was implemented last year, but Kaiser has refused to discuss the issue.
“Kaiser patients seeking mental health services should have their care guided by a licensed professional from the moment they seek help,” said NUHW President Sophia Mendoza. “Kaiser can’t claim it’s providing parity for mental health care when a patient with a sore throat is directed to a nurse, but a patient dealing with severe depression is directed to a telephone service representative. The only way for Kaiser to remedy its mental health violations is to work with its therapists on a model that provides quality care guided from the start by therapists in partnership with patients.”
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The National Union of Healthcare Workers is a member-led movement that represents 19,000 healthcare workers in California and Hawaii, including more than 4,700 Kaiser mental health professionals.
