Supervisor Shirlee Zane critical of Kaiser, therapist

For Sonoma County Supervisor Shirlee Zane, Andy Weisskoff's blog alleging inadequate mental health services at Kaiser brought back haunting memories of how — in her words — the health care giant "failed" her husband, Peter Kingston, shortly before he hung himself Jan. 18, 2011.

In the blog, Weisskoff described his concerns after one of his patients took his own life. The psychotherapist didn't use Kingston's name and he was vague about the circumstances of his death, mentioning only that "he killed himself" two weeks before Weisskoff was scheduled to see him again.

But Zane said she immediately recognized that the man Weisskoff described as a "very sweet man in his mid-fifties" was Kingston. And the criticism Weisskoff was leveling against Kaiser was accurate, she said.

"He's spot-on about Kaiser's failure to meet the mental health needs of their patients," she said. "They have failed."

Zane said Kaiser staff, including Weisskoff, did not conduct a thorough assessment of Kingston's mental health crisis. She said they failed to ask if he had ever attempted suicide, made him wait more than 40 days for his first one-on-one therapy session and did not adequately monitor the doses of his medication.

Weisskoff and Kaiser officials would not comment about Kingston's death, citing strict health care privacy laws.

In her office at the county complex in Santa Rosa, Zane keeps a large portrait of the family she and Kingston shared.

In the months leading up to his death, Kingston had become increasingly anxious about the financial situation at Ursuline High School in Santa Rosa, the all-girls Catholic school where he served as finance director.

Kingston was deeply troubled by the school's financial problems and the prospects of its closure, a fate that would affect the 130-year-old school's many students, parents and staff.

Just before Christmas 2010, Kingston sought help from Kaiser, the coverage he had through his job at Ursuline. Zane said her husband first met with Weisskoff for a brief screening and was brought back for an hourlong intake interview a week later.

"This was a scheme developed to make it seem like we were providing two relevant visits in a short period of time," Weisskoff wrote in his May 4 blog entry titled Cohort, which he has since removed from the blog at Zane's request.

Kaiser said the "scheme" was developed with the participation of Santa Rosa therapists as a way of having two appointments close together at the start of a patient's care. The goal is to get patients familiar with their care at the onset and to begin building a relationship between therapist and patient.

In the blog post, Weisskoff said that after the intake session he upgraded his diagnosis for Kingston — though, again, he does not use his patient's name — from adjustment disorder to panic disorder and major depression. He booked Kingston for an Introduction to Anxiety Disorders group and scheduled him for his next available appointment — 42 days out.

Kingston killed himself two weeks after the introductory group session and two weeks before Weisskoff's next scheduled appointment with him.

Zane said she feels Weisskoff and Kaiser should have done more to assess the potential for suicide.

She said they did not adequately monitor Kingston's existing medication doses, which she believes could have been increased or changed. Also, Zane said she later found out neither Weisskoff nor Kingston's primary care physician asked if Kingston had ever tried to kill himself — he did so 14 years earlier. She said that knowledge would have been essential in assessing the potential for another attempt.

"If they had (asked), they might have treated him a little more seriously instead of sending him to an anxiety group," she said.

In the blog post, Weisskoff ponders what could have been. He says he wished he could have told his patient's widow: "I have no idea what would have happened if I was able to meet with your husband weekly during his crisis. I wish I could have seen him more frequently, but had no time in my schedule to do so. We'll never know, now, if more frequent individual sessions could have saved him."

Kaiser officials objected to Weisskoff's use of anecdotal stories about unnamed mental health patients in his blog. After Weisskoff's May 5 post about the "very sweet man in his mid-fifties," Kaiser began a general review of possible ethical and privacy violations by Weisskoff.

At the same time, Kaiser officials said they were wrapping up transitioning Weisskoff's patients to other providers. On May 8, Weisskoff was placed on administrative leave and told that he was no longer actively employed and escorted off the premises.

"We really can never use patients for personal interest or gain," said Dr. Mason Turner, director of patient operations for regional mental health services at The Permanente Medical Group in Oakland, the plan's regional medical group for Northern California.

Weisskoff has repeatedly said he is bringing these concerns to light as a way of getting Kaiser to improve its care for mental health patients.

Turner said the nation is currently experiencing a "crisis" managing the increasing number of patients requiring mental health services.

"No one yet has the answer to the best and most effective ways to do this," Turner said in an email. "As an integrated system with thousands of mental health professionals in California, Kaiser Permanente has been well- positioned to lead in delivering high-quality mental health care — and, on behalf of our members and those in need of care, we will not rest until we have reached that goal."

Two years before his death, Kingston was treated in Kaiser's emergency department for heart palpitations, Zane said. She said he received excellent care and was kept for six hours and given a barrage of tests.

She said she wishes her husband's mental health crisis would have been medically treated with the same thoroughness.

"I believe if Peter's depression would have been treated with the same level of care as his heart palpitations, he would still be alive today," she said.

Zane, a trained family counselor and grief specialist, said Kaiser is only part of the problem. The larger problem, she said, is that mental illness continues to be shrouded in stigma and its treatment is still not fully integrated with physical health services.

President Barack Obama's Affordable Care Act and state and federal mental health parity laws call for mental health services to be covered the same as physical health services, but the health care industry has a long way to go, she said.

"It's not just Kaiser, but Kaiser has to take responsibility," she said. "The reason I didn't go after Kaiser is that I believe the whole system failed."

(You can reach Staff Writer Martin Espinoza at 521-5213 or

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