Kaiser patients share stories of delayed or canceled care, issues that Kaiser therapists say triggered the latest strike

Michael Bender has been trying to meet with a Kaiser Permanente therapist since May to talk through family issues that have made him chronically anxious and depressed.

When he got a Kaiser representative on the phone, he was told the health care giant was providing the services he wanted remotely, via conference call, using an outside contractor.

What followed were weeks of miscommunication, poor video and audio quality, and sudden cancellations.

Carrie Marvin of Windsor said her teenage son usually has to wait six weeks between appointments with a Kaiser therapist, a clear sign that Kaiser does not have enough mental health workers. She said she often has to go outside Kaiser’s network, paying out of pocket, if her son needs to see someone sooner.

It’s an option, she said, not everyone can afford.

One Kaiser member, a 34-year-old Santa Rosa resident who asked to remain anonymous because she worries about the stigma that some may attach to mental health issues, said she sought therapy from Kaiser in May. She has endured a frustrating odyssey with an outside contractor that, to this day, has yet to provide any substantive therapy, virtual or otherwise.

After Kaiser mental health care workers went on strike two weeks ago over working conditions they say are adversely affecting patient care, The Press Democrat asked readers to share their experiences accessing Kaiser mental health services.

Many who responded echoed accounts by the striking Kaiser workers, who say that a severe and persistent staffing shortage is leading to delayed care during a time of increasing mental health crises.

Asked to respond to the patient experiences, Tarek Salaway, senior vice president and area manager for Kaiser Permanente Marin-Sonoma service area, said patients are the company’s top priority.

Salaway Kaiser statement 8.28.22 Statement.pdf

“We are fully committed to meeting our patients’ needs, including mental health as an integral part of total health,” Salaway said in a statement. “We hear the frustration and worry in the comments solicited by the Santa Rosa Press Democrat and take these accounts very seriously, and we never want any patient to experience challenges.”

Salaway said that at a time of “unprecedented stress” on local communities, all health care providers in the county and across the country are being severely impacted by the surge in demand for mental health care.

“And no one should dispute the fact there is a shortage of mental health professionals — the shortage is real and well documented,” he said. “It was a crisis before the pandemic, and the pandemic further strained the mental health care system and its limited number of caregivers.”

Striking Kaiser therapists, who are represented by the National Union of health care Workers, have repeatedly said that many of their co-workers are quitting their Kaiser jobs, leaving unsustainable workloads that lead to appointment cancellations and delays, as well as compromised patient care.

The testimonials from Kaiser members strike a similar chord: Many empathize with the plight of Kaiser mental health workers.

Diana Wolfe, a Kaiser member who lives in Santa Rosa, said she reached out for mental health services last October. She was told to call back on Jan. 1, when appointment schedules “open up.”

Wolfe, who lost her home in the 2017 Tubbs Fire and has struggled with bouts of anxiety, said she sometimes waits as long as two months for appointments with a therapist — five or six weeks when she’s lucky.

“So, I spend the entire appointment telling (her therapist) about what has already happened,” Wolfe said. “It feels like I'm just updating Kaiser on my mental health status, and I'm not really getting anything out of it.”

A 34-year-old Santa Rosa woman, who asked to remain anonymous to maintain her privacy, said she reached out to Kaiser in early May and was connected to a Kaiser-contracted San Francisco-based therapy provider called Two Chairs in late May or early June.

The patient said that after an involved “matching appointment,” she was told the process of identifying an appropriate provider could take from six to eight weeks.

During her first session, the third week of July, she and the therapist agreed on biweekly sessions, but the therapist told her she’ll be going on maternity leave soon and won’t be able to continue beyond five sessions, the patient said.

The next session, on Aug. 1, was canceled by the therapist without rescheduling. While the patient waited for her next session, she contacted Two Chairs to find out if they’ve initiated another matching procedure.

The patient said midway into her next session, on Aug. 15, the therapist told her she cannot continue the sessions and that they were not a good match to begin with and that her caseload was too full.

“So, 14 minutes in she basically was like, ‘So, I’m going to go and give you back the rest of your night and, yeah, have a nice life, basically,’” the patient said, adding that shortly after that she received an evite for the Aug. 29 session, listing the same therapist.

“What the hell is going on here? Are you my therapist or not? Who is even helping me at this point in time?” she said.

Two Chairs, which provides both in-person and teletherapy services, said in a statement to The Press Democrat it could not directly respond to the patient’s account because of health care privacy laws.

“We cannot address the details due to patient confidentiality. But based on the specifics you shared, this is certainly far from an ideal care experience,” the statement read. “In fact, it’s emblematic of the kind of therapy journey Two Chairs set out to improve. We know the process of starting therapy can be daunting, and in our most fragile moments, we need our mental health care system to be accessible and welcoming.”

Two Chairs said one of the ways it is improving “the journey into care” is through an in-depth matching process that ensures clients find a therapist that, on the first try, best suits their needs. The company said that 98% of its clients are “happy with their first matched therapist and report a strong ongoing relationship with their therapist.”

But some Kaiser patients and union therapists argue that contracting with outside therapy groups is a way to avoid hiring more therapists -- the real solution to the problem.

“My gut tells me that obviously, as a society, we have not given mental health its due, really, quite frankly, ever,” said the Two Chairs patient.

“And now we are dealing with the relentless, collective trauma of a pandemic that is stretching an already underfunded, understaffed, overworked health care (system) to its absolute brink, where now the people that we're supposed to be relying on are themselves not in the best place mentally, physically, spiritually, emotionally, and we're all just dealing with this burnout and nobody is equipped to handle it.”

Bender of Santa Rosa said he’s been experiencing daily anxiety and depression over family issues. He’d hoped to sit down with a mental health professional to help him “unpack the issues and make them less intrusive on my daily activities.”

Bender, a retired CalTrans employee who several years ago worked as a union organizer, said he previously had Kaiser health coverage. Last October, he chose to return to Kaiser, despite criticism of the plan’s mental health services.

He “checked into it a little bit (and) it seemed like they had improved their program.”

Kaiser sent Bender to a teletherapy service (different from Two Chairs) and scheduled his first appointments May 25 and 26. He waited, but the call never came.

“I was anxiously looking forward to those appointments,” Bender said in a text message. “I set aside time in my schedule to be sure of privacy and a good, quality cellphone signal.”

He said the day before the first session, he still had heard nothing about how to access the remote session. Bender said he called the teletherapy service and was told there was no record of his appointment.

On May 26, after again waiting and receiving no phone call, Bender called the service to find out what was going on.

“Sometime around 3 p.m., I got word from the therapist that she had an emergency room incident, which caused her to miss our appointment,” he said.

Bender said the next appointment, June 16, was of little help because of poor cellphone connection. He declined teletherapy appointments for June 23 and 30, fearing the same technical problems. He contacted Kaiser and asked for a “sit-down with someone in person.”

Bender said he was able to schedule an appointment for Aug. 30. He was considering canceling due to the striking therapists, with whom he sympathizes. He said Kaiser ended up canceling the appointment on Friday.

Kaiser said the stories of delayed care do not reflect the experience of most of its members. The company said its own year-to-date audits indicate Kaiser regularly exceeds targets for urgent and non-urgent initial visits, with 97% falling within the state-required time frame.

“For first follow-up return appointments, through June we are at 83% in accordance with therapists’ care plans,” the company said in a statement, adding that implementation of new access requirements under state Senate Bill 221, are “well underway.”

On Aug. 22, the state Department of Managed Health Care, which oversees nearly 50 health plans in California, notified Kaiser it had begun an “enforcement investigation” into complaints that Kaiser was not providing timely appointments during the strike.

In a statement to The Press Democrat, Rachel Arrezola, a spokeswoman for the Department of Managed Health Care, said the agency’s help center had received 19 access complaints against Kaiser from Aug. 15 to Aug. 20.

She said the agency has also received complaints from the National Union of Healthcare Workers that Kaiser is out of compliance with labor requirements during strikes.

“The DMHC notified Kaiser on Monday, Aug. 22 that the Department opened an enforcement investigation, Arrezola said in an emailed statement. “The DMHC will continue to monitor the plan closely during the strike to ensure the plan is in compliance with the law.”

She said such monitoring includes tracking consumer complaints to the agency’s help center, which are being taken “very seriously.” She added access complaints can be made directly to Kaiser or to the state agency’s help center, at 1-888-466-2219 or www.HealthHelp.ca.gov.

Some of the Kaiser members who responded to the Press Democrat inquiry said they had appointments canceled since the strike began. But most described a pattern of delayed or inadequate care that predated the strike.

In his statement, Salaway said the union has “deliberately tried to create a crisis in access to mental health” for Kaiser and its members.

“First, union leaders were intent on calling a strike, even though we were very close to reaching an agreement in bargaining,” he wrote.

“Next, the union encouraged our therapists not to cooperate in assessing their patients’ needs before the strike. Once the strike started, NUHW activists began calling on community therapists to refuse to provide care to our patients. Now the union is criticizing our efforts to arrange for community-based therapists to treat our patients who need care,” Salaway said.

One independent therapist who was contacted by Kaiser and offered temporary work said he sympathizes with striking mental health workers. The therapist, who asked that his name not be used because he has contracted with Kaiser in the past, said he was asked if he could see a minimum of five Kaiser patients a day for eight weeks, for which he would be given a $10,000 bonus and paid a session rate equal to 110% of Medicare’s current reimbursement rate.

The therapist said he used to work as a Kaiser therapist several years ago and “it was horrible then.”

“They need to put their resources to actually serving their people,” he said, adding that Kaiser’s contracts with outside teletherapy services “sounds more like a workaround, rather than putting the resources on the ground where people need them.”

Salaway insists that Kaiser is doing what it can to address the mental health crisis and the worker shortage. That includes investing $30 million to build a “pipeline” for new, culturally diverse mental health professionals.

“To date we have enrolled and provided tuition support for 236 Kaiser Permanente employees across the state in master’s and doctoral degree programs through the Mental Health Scholars Academy,” he said.

He said two-thirds of the fall 2022 class identify as people of color, black or Indigenous, and 46% are bilingual, speaking more than 20 different languages.

Salaway said there is “no one solution” to the shortage of mental health care professionals.

“It will take all of us collaborating and working together on solutions that meet the mental health needs of our communities,” he said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.