In a conference room at the county administration complex, senior officials at Kaiser Permanente sat down with Sonoma County Supervisor Shirlee Zane last week to listen to her concerns about the quality and accessibility of the health care giant's mental health services, which she blames for the 2011 suicide of her husband.
In the plain room, with nothing but a clock on the wall, a long table and chairs, Zane propped up behind her a large portrait of the family she shared with Peter Kingston, who hung himself not long after seeking help from Kaiser mental health staff.
The meeting took place a week after Zane — in a blistering email to Kaiser officials — questioned whether she could support the county's $51 million contract with Kaiser for health coverage and demanded that Kaiser address allegations that it does not provide sufficient and timely one-on-one psychotherapy.
"We greatly appreciated the opportunity to talk with Ms. Zane about her experience and to personally express our deep sympathy for her loss," Judy Coffey, senior vice president and area manager for Kaiser's Marin-Sonoma territory, said in a statement after the meeting.
"We expressed our commitment to continuously learn from the feedback we receive, and talked constructively about opportunities to improve mental health care at Kaiser Permanente and in the community," Coffey said.
Kaiser provides health care to 2,957 current county employees, or 91 percent of the county's active workforce, and 1,481 county retirees. Zane said she is willing to use the contract as "leverage" to get Kaiser to provide more individual therapy for its members who receive mental health services.
Zane, a former family therapist, has been a long-time advocate of mental health services. But the issue struck her even more personally after her husband took his life. Kingston was a Kaiser patient and Zane said she believes the county's largest health care provider failed to properly assess her husband's severe depression.
"I want to assure that no county employee or their family member is at risk of losing their life because of Kaiser's insufficient care for mental health issues," said Zane.
Zane and county officials met with regional and local Kaiser representatives on Wednesday. Each side had a different interpretation of what emerged from the meeting.
Zane said Kaiser agreed to take a number of steps including offering group therapy as one alternative to members and not the only treatment available; examine delay times for follow-up one-on-one therapy appointments; work with the county to survey Kaiser members on their mental health services; and make efforts to integrate mental health services with physical health services.
Kaiser spokeswoman Gerri Ginsberg, who is based in Kaiser's regional corporate offices in Oakland, said Friday that Kaiser was already taking many of those steps before the meeting with Zane, including providing members with a range of mental health options and effective medication management.
Kaiser declined a request for a telephone interview but sent an email statement about the meeting.
Coffey said the meeting with the county was "productive" and offered an opportunity to discuss "broader mental health issues." Barbara Crawford, regional vice president for quality, and Dr. Don Mordecai, regional director of mental health and chemical dependency services, also attended the meeting with the county.
Aside from Zane, county representatives included Marcia Chadbourne, the county's risk manager, and Tom Morrison of the Segal Company, the health benefits consulting firm contracted by the county to negotiate health plan packages.
Zane's threat to use the county's Kaiser contract as leverage for change was made in a June 17 email to Kaiser regional representatives in Oakland, including Mordecai. In the email, Zane blasted the HMO for its response to recent criticism of its mental health services.
Some patients and former therapists have accused the HMO of giving short shrift to one-on-one therapy and under-staffing the ranks of therapists, a practice Kaiser critics say creates long waits between individual therapy sessions, leading to a deterioration in patients' mental health.
One such critic is former Kaiser psychotherapist Andy Weisskoff. In February, after giving his 90-day notice, Weisskoff began blogging about his frustration with what he calls an understaffed system that allows little time for crucial therapy.
Kaiser has dismissed Weisskoff's criticism as a union ploy and strongly rejects the accusation that it does not provide appropriate levels of mental health care to its members. Before he resigned, Weisskoff served as a shop steward for the National Union of Healthcare Workers, which represents Kaiser psychotherapists. The union has been in protracted labor negotiations with Kaiser for several years.