Hawaii mental health therapists authorize strike; seek state investigation of Kaiser Permanente

NewsNovember 8, 2021

HONOLULU — After three years of stalled contract negotiations, mental health clinicians at Kaiser Permanente in Hawaii have authorized a strike. The Nov. 2 strike authorization announcement came on the same day that NUHW filed a complaint with state regulators calling for an investigation into Kaiser’s apparent violations of state and federal mental health parity regulations.

In the 57-page complaint filed with the Hawaii Department of Commerce and Consumer Affairs, NUHW cited internal Kaiser records documenting how the HMO’s understaffing of its mental health clinics and external provider networks “severely delay thousands of enrollees’ access to mental health services and place their health and safety at risk.” The complaint’s findings include:

  • Due to Kaiser’s understaffed clinics, Kaiser members are waiting between six and seven weeks for both initial and return appointments to treat conditions such as depression, PTSD, anxiety, panic attacks and eating disorders. These wait times vastly exceed clinical practice guidelines set by national standard-setting organizations, including the National Committee for Quality Assurance, which accredits Kaiser’s operations in Hawaii.
  • Kaiser’s internal records show that only 28 percent of the out-of-network mental health therapists it contracts with to augment the care provided by its directly-employed clinicians are actually accepting Kaiser members for care.
  • With only five full-time clinicians assigned to Kaiser’s statewide mental health call center, Kaiser members seeking immediate care for mental health conditions are forced to wait on hold for up to 60 minutes before they can speak to a clinician. Members hang up while on hold 20 to 45 percent of the time, records show, and they wait up to four weeks for a call-back because the call center is so understaffed.
  • Kaiser appears to be violating state laws requiring that it conduct performance reviews of its behavioral health services and that it provide members with out-of-network care when it doesn’t have a healthcare provider available or has an insufficient number of providers available.

“I’m currently carrying a caseload of over 150 active therapy patients,” said Rachel Kaya, a psychologist at Kaiser Permanente Maui Lani clinic. “It would take more than five full-time therapists to provide my patients timely, clinically-appropriate care. The access problem causes repeated, shameful, horrifying violations of my professional code of ethics.”

News organizations covering the strike authorization included the Honolulu Star-Advertiser, Hawaii Public Radio and KITV.

Kaiser’s 51 psychologists, licensed clinical social workers, psychiatric nurses and chemical dependency counselors joined NUHW in 2018 in hopes of improving access to care. However, instead of hiring more therapists, Kaiser is proposing major pay and benefits cuts that would make it harder to recruit and retain staff. Despite reporting a combined $13.8 billion profit over the last two years, Kaiser is proposing:

  1. No raises for its current mental health clinicians, along with higher health insurance copays.
  1. The elimination of pensions and significantly lower pay for mental health clinicians hired after 2022. The wage scale Kaiser is proposing for new hires would cap their salaries far below what current clinicians are currently earning.

“How are we to attract quality clinicians who will stay with Kaiser, if they are not paid an adequate wage,” said Andrea Kumura, a licensed clinical social worker at Kaiser Permanente Waipio Medical Office. “We already have difficulty hiring, so imagine what it will be like with lower wages and poorer benefits? The only way to fix the massive appointment delays that our patients are experiencing is to hire more clinicians, but Kaiser’s proposal will make hiring even more difficult.”

The strike authorization vote compounds growing labor unrest for Kaiser. Last week, UNITE HERE Local 5 announced that 1,800 Kaiser Hawaii workers authorized a strike. Kaiser pharmacists, physical therapists, occupational therapists and speech-language pathologists in Hawaii represented by United Nurses Association of California/Union of Health Care Professionals have also authorized a strike.

The strike authorization by Kaiser mental health clinicians does not guarantee that a strike will take place. The clinicians have not yet submitted a formal strike notice to Kaiser and no strike date has been set.