New evidence shows Kaiser Permanente continues to violate California law

KaiserJanuary 8, 2015

Fremont, Calif., Psychiatry Chief orders clinicians to delay care to mental health patients

EMERYVILLE — Today, mental health clinicians presented brand new evidence to state investigators showing that Kaiser Permanente is continuing to violate California law by forcing mental health patients to endure lengthy, illegal wait times for appointments. Clinicians also called on the Department of Managed Health Care (DMHC) to immediately pursue sanctions against Kaiser for violating patients’ rights. The evidence presented today consists of written instructions, dated January 2, 2015, that a Chief of Kaiser’s Department of Psychiatry recently delivered to clinicians and managers.

Four months ago, Kaiser paid a $4 million fine to the California Department of Managed Health Care (DMHC) for multiple violations including forcing thousands of patients to endure lengthy and illegal wait times and maintaining a parallel set of paper appointment records that concealed patients’ excessive wait times.

California’s timely access regulations require HMOs to provide patients with non-urgent mental health appointments within 10 business days of a patients’ request. The DMHC’s $4 million fine is the largest penalty ever issued by the agency for mental health violations.

On January 2, 2015, one day after tens of thousands of new Kaiser patients became eligible for services following 2014 open enrollment, a “Chief” of Kaiser’s Department of Psychiatry at Kaiser Fremont Medical Center (Fremont, Calif.) sent an e-mail to clinicians entitled “Booking Instructions for Intakes” that instructs clinicians to begin segregating patients requiring psychiatric care into two groups. A “priority” group of patients will receive an appointment in two weeks, as is required by California law. The second group, labeled “routine” patients, will wait longer than two weeks for appointments, in violation of California law.

Kaiser’s failure to comply with California law is a result of its refusal to staff its clinics with sufficient numbers of psychologists, therapists, and others to treat Kaiser’s patients. Kaiser’s staffing failures have grown more acute as the HMO added 250,000 new members last year through Covered California, allowing Kaiser to enjoy record profits of more than $3.1 billion during 2014.

The evidence submitted today by clinicians indicates just how serious Kaiser’s staffing crisis has become. The e-mail’s author, a Chief in the Department of Psychiatry, instructs clinicians to reserve space in the “priority” group for those patients with serious diagnoses such as “passive Homicidal Ideation” and “passive Suicidal Ideation.”

The Chief’s e-mail instructs clinicians to participate in another illegal downgrading of Kaiser’s mental health services. Historically, clinicians have placed patients at risk of psychiatric hospitalization into a more intensive regime of outpatient psychiatric care, which Kaiser calls its “Intensive Outpatient Program” (IOP). In the e-mail, the Chief instructs clinicians that those services will no longer be available for such patients. The e-mail states: “Only book hospital discharge patients for adult IOP appointments… Any new patients that IST [Immediate Service Team] is screening and deems appropriate for adult IOP should go to the Priority booklist.” The term “booklist” refers to a waiting list of patients who have requested and are waiting to be booked into an initial appointment. “Hospital discharge patients” are those who have recently been discharged from a psychiatric hospital.

“Clinicians refuse to participate with Kaiser’s instructions to illegally withhold care from our patients. It’s outrageous that Kaiser continues to break the law 18 months after the DMHC fined it $4 million and ordered it to cease and desist from committing further violations of California law,” said Clement Papazian, a Kaiser clinical social worker in Oakland, Calif., and the President of NUHW’s Northern California chapter of mental health clinicians. “For more than four years, we have pleaded with Kaiser to staff its psychiatric services so that our patients can get the care they need and deserve. Enough is enough. It’s time to hold Kaiser accountable.”

Kaiser’s refusal to uphold the law and to respect patients’ rights is the reason why 2,600 psychologists, therapists, and psychiatric RNs will be conducting a week-long, statewide strike of Kaiser’s facilities beginning January 12, 2015.