Author Archives: The Kaiser Patient Advocate

New Video Says “No More Suicides”

Kaiser’s illegal delays and denials of care have led to hardships for patients and families, even suicides, along with a growing number of lawsuits

To better explain the breakdown in care, NUHW released a three-minute video that documents Kaiser’s continuing neglect of its mental health patients. “No More Suicides” is available on Facebook, Twitter, YouTube, and at NUHW.org. The video was produced in tandem with Courage Campaign and families who contributed photos of loved ones lost to suicide due to Kaiser’s negligence and delays.

September 30, 2015 – LA Times: His 83-year-old wife jumped to her death from a Kaiser clinic — why?

The Los Angeles Times: His 83-year-old wife jumped to her death from a Kaiser clinic — why?

By Stuart Pfeifer (published September 26, 2015)

As Barbara Ragan stood atop a Kaiser Permanente parking garage in Northern California this summer, traces of Xanax, Prozac and a generic antidepressant were in her blood.

Yet the 83-year-old longtime Kaiser patient was distraught: The drugs had proved ineffective for her depression, and her next psychiatric appointment was weeks away, a wait she told her family felt interminable.

When she stepped off the roof and fell to her death, her suicide stunned onlookers — but was really directed, her husband believes, at her healthcare provider.

“She could have jumped anywhere, but she went right to Kaiser,” said Ragan’s husband, Denny. “It’s like sending a message right to them: ‘You couldn’t take care of me, so here I am.'”

The Oakland-based health maintenance organization has battled accusations for more than two years that its mental health services put patients at risk.

Now Ragan’s suicide has increased scrutiny of the giant healthcare provider, which last year paid a $4-million fine to resolve allegations by the state Department of Managed Health Care that it inadequately treated mental health patients, including some who waited weeks to see therapists. A follow-up report by the agency in February found that some patients were still waiting too long.

Kaiser spokesman John Nelson said the HMO should not be faulted for Ragan’s suicide. He noted that she received frequent psychiatric counseling and had spoken to a psychiatrist by telephone in the days before her death. An earlier in-person appointment, he said, was available if she had asked.

“Any time somebody is receiving care from us and they take their life, it’s a terrible tragedy,” Nelson said. “In this case, access was not an issue. She had received regular access to mental health professionals.”

He acknowledged, however, that it has been a challenge to improve Kaiser’s mental health services even as the HMO has increased staffing from 1,097 therapists in January 2011 to 1,508 this June. Kaiser even departed from its traditional business model — in which patients generally see only doctors who are members of its Permanente Medical Groups — to contract with an outside group of providers called ValueOptions.

“We’re not perfect. We said that all along,” Nelson said. “We had locations, and we said this two years ago, that were struggling to deliver timely access. We’ve been addressing that in hiring and bringing in outside providers.”

Some experts say the shortage has been exacerbated by more newly insured patients under the federal Affordable Care Act, while others say Kaiser’s size has made it an easy target for activists. The HMO also claims that a union contract dispute has fanned the flames.

William Arroyo, regional medical director for the Los Angeles County Department of Mental Health, said his agency has struggled to hire enough psychiatrists to meet demand.

“In California, we clearly have shortages,” he said. “Kaiser is a gorilla health plan, so the impact for them may be greater as a result.”

But such explanations carry little weight for Kaiser critics, who cite federal law that requires insurers to provide the same level of treatment for mental illness as they do for physical illness.

They also note Kaiser has been sued by families of two other patients who committed suicide. The families claim that their loved ones were often shuttled into group therapy, instead of giving them more costly — and effective — individual counseling. An Alameda County judge recently rejected Kaiser’s request to dismiss the lawsuit.

Yet another lawsuit contends Kaiser pressured some of its most seriously ill mental health patients to cancel their plans and accept government assistance for long-term hospitalizations.

Sonoma County Supervisor Shirlee Zane was outraged to learn of Ragan’s death, which touched a personal nerve for her. Zane’s husband committed suicide in 2011 while under Kaiser’s care.

“They have been saying, very arrogantly, that they have fixed the situation and are providing access,” Zane said. “This woman obviously didn’t get adequately treated, or she wouldn’t have killed herself.”

Ragan, a retired Kaiser clerical worker who lived in Santa Rosa with her husband, had battled depression for many years, but her condition worsened this year.

Her psychiatrist told her to stop taking Prozac and instead prescribed depression drug Zoloft and anti-anxiety medication Xanax, her husband said, but she continued to struggle.

In June, she began trembling while grocery shopping and asked her husband to take her to the emergency room at Kaiser Permanente Santa Rosa Medical Center. There she was sent to another psychiatrist and this time received prescriptions for anxiety medication Ativan and Lexapro, an antidepressant.

A few weeks later, Kaiser sent her a notice by mail that she had an appointment with a psychiatrist on Aug. 25. “She said, ‘Two months, Denny? I can’t wait that long,'” he said.

The breaking point came July 3, her husband said. After speaking to clinical staff, she went to Kaiser to pick up a new prescription that she hoped would improve things. Waiting for her was a bottle of Prozac, the drug her psychiatrist had stopped a few months earlier.

“Then she got really down. She said, ‘What am I going to do? They told me Prozac wasn’t working,'” Denny Ragan recounted.

Two days later, Ragan, dressed in pajamas and slippers, slipped out of the couple’s home without saying goodbye, drove to the Kaiser facility in Santa Rosa and jumped from the three-story parking structure to the concrete below. Preliminary autopsy results found the Xanax, Prozac and citalopram in her blood. Her suicide was first reported by the Santa Rosa Press-Democrat.

Ragan’s son, Michael, said his mother could have benefited from more individual counseling.

“All they do is distribute drugs,” he said. “She was upfront with them and gave them every opportunity to help her out, but it was just, ‘This is all we’re going to do for you and we hope it works.'”

In its most recent report, the state Department of Managed Health Care said it reviewed medical records of nearly 300 Kaiser patients and found a continuing problem with long waits for treatment. In Northern California, patients didn’t get timely appointments in 22% of cases. In Southern California, Kaiser failed to meet the standard in 9% of cases.

Regulators cited several cases in an effort to illustrate the problem, including a sexual assault victim who was told to seek therapy from an outside clinician at the patient’s expense and another who was told by a Kaiser psychiatrist, “No one ever sees a therapist once a week in the Kaiser Health Plan. Not a covered benefit for the past 20-something years and will not be a benefit in the future.”

Rodger Butler, a spokesman for the state agency, said an investigation into Kaiser’s services is continuing.

Walter Bubnow, a 35-year-old Bell Gardens resident, said Ragan’s suicide was a painful reminder of his experience with Kaiser. He said the HMO declined to provide him with regular individual therapy after his diagnosis with panic disorder in 2008.

“I know exactly what she was going through,” he said. “When I was at rock bottom, couldn’t leave my house, they did nothing to help me. I deteriorated so bad between appointments it made things worse. They said you have to be a threat to yourself or other people in order for them to provide you weekly care.”

Instead, Bubnow said, he was given medication. “You go in there, the doctor asks you how you’re feeling and he bumps up the medication.”

When he told Kaiser staff that medication alone wasn’t helping, Bubnow said, they referred him to group therapy.

“It didn’t work,” he said. “They were all different mental illnesses: bipolar, depression, schizophrenia. When I’d go to therapy, they’d all talk about their pills. It was a medication class, that’s all it was…. How can you treat nine different disorders in 45 minutes? It’s simple: You can’t.”

Bubnow said he left his job with the Los Angeles County Public Works Department last year because of his disorder. Now unemployed, he receives treatment through Medi-Cal at Los Angeles County-USC Medical Center.

He said he has the illness under control, thanks to therapy he’s received. “It’s like night and day,” he said. “I get hands-on care at USC, a county hospital, that I never got at Kaiser.”

Kaiser spokesman Nelson declined to specifically comment on the details of Bubnow’s case, citing medical privacy laws. (Ragan’s family signed a waiver permitting Kaiser to discuss her case.) But he said individual therapy is available.

“It is absolutely not the case that somebody suffering from anxiety would not have access to individual therapy,” he said.

Ragan’s family has been working with a Kaiser ombudsman and has not yet decided whether to pursue legal action. Her husband said he’s still searching for answers about why his wife killed herself, and what Kaiser could have done differently.

Before her death, Ragan wrote a one-page goodbye note to her family and left it inside her desk. Denny Ragan didn’t find it until two days after she died.

Her final words: “I couldn’t stand the pain.”

September 14, 2015 – NPR’s Here and Now: California Faces Uphill Battle To Improve Mental Health Care

The federal government has been lax in enforcing a 2008 law that requires insurers to treat mental illnesses just as they would treat any other illness. California has taken perhaps the most proactive stance in the nation in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But the state has found it difficult to enforce the rules and gain the cooperation of insurers, as Jenny Gold of Kaiser Health News reports (published Friday, September 11, 2015).

Click here to listen to the story.

August 1, 2015 – The Press Democrat: Kaiser Permanente faces renewed criticism over mental health services after Santa Rosa suicide

To read the National Union of Healthcare Workers’ press release in response to the tragic Santa Rosa suicide, highlighting the failures of Kaiser Permanente’s mental health care services, click here.

The Press Democrat: Kaiser Permanente faces renewed criticism over mental health services after Santa Rosa suicide

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Oakmont resident Denny Ragan, 86, Monday July 27, 2015 with a picture of his wife Barbara who jumped off a Kaiser Permanente parking structure and died. The Ragan family says that Kaiser failed to give her timely and adequate care and was having trouble with her medication. (Kent Porter / Press Democrat) 2015

Before she jumped to her death from the top of the parking lot at Santa Rosa’s Kaiser Permanente Medical Center over Fourth of July weekend, Barbara Ragan, 83, wrote a note to her children and her husband saying she “couldn’t stand the pain.”

Her medication routine had become a nightmare, upended by numerous prescription changes after the Prozac she’d used to treat her depression for years stopped working, her family said.

On July 5, dressed in a housecoat, nightgown, socks and slippers, Barbara Ragan drove the 10 miles from her home in Oakmont to the Kaiser medical center on Bicentennial Way. She went to the third level of the parking garage and stood on the edge. Santa Rosa police said witnesses below tried to talk her down, but she said nothing and let herself fall.

Denny Ragan said he believes his wife, who retired from Kaiser in South San Francisco more than two decades ago, was trying to make a statement. The only identification she had with her was her Kaiser medical card and her driver’s license, her family said.

“She drove right over to Kaiser … 16 years working there … she was very upset about them. She went right up to the parking area near the emergency room,” he said. “To me, that’s a statement of what they’re doing out there, how they treat people.”

Kaiser said this week that it extended its condolences to the Ragan family, but after thoroughly reviewing the case found that Barbara Ragan had received a “tremendous amount of care” in the weeks before her death. Officials said Kaiser mental health providers were in frequent contact with Ragan regarding her condition and the medications she was taking.

“We extend our deepest sympathies to the family,” said Dr. Mason Turner, Kaiser Permanente Northern California’s director of outpatient services for regional mental health.

“The care Ms. Ragan was receiving was exceptional care,” Turner said, adding that Kaiser was willing to work with the family to address their concerns.

But Ragan’s suicide has once again raised questions about what critics say are serious gaps in the company’s mental health services.

Specifically, critics say Kaiser fails to provide timely individual appointments to see a mental health therapist or psychiatrist. In recent years, Kaiser has been penalized by the state Department of Managed Health Care for serious “deficiencies” in its mental health care offerings.

Kaiser this week rejected such claims. Turner said the health plan has made great strides in expanding its network by hiring more mental health providers and contracting with an outside network to supplement its staff. The health plan said it hopes to become a national model for mental health care.

Worsening condition

For more than two decades, Barbara Ragan had been taking Prozac. But Denny Ragan said that his wife only recently began feeling like it was wasn’t working for her.

“You could always tell something was always there, but it was livable,” Ragan said, adding that about a month ago his wife’s condition was worsening.

On June 15, the couple were at the Trader Joe’s on Cleveland Avenue when Barbara Ragan said she didn’t think she could continue shopping. She got extremely quiet, her mood worsened and she asked her husband to take her to the “emergency hospital,” Denny Ragan said. He said he didn’t know exactly what his wife was going through; her condition changed so rapidly.

“They’re the only ones that can explain what they’re going through,” he said. “I said, ‘Gee, you’re feeling that bad?’ She said, ‘Yes, can you please take me to the emergency room?’ ”

Denny Ragan said emergency department staff told them the only thing they could do was give his wife a sedative and try to get her an appointment to see a psychiatrist.

Turner, the Kaiser mental health care director, said emergency department staff determined Ragan was not a danger to herself, and therefore they could not admit her. But they sought immediate help for her, he said.

Medical center staff were able to get her an appointment at Kaiser’s adult psychiatric services building on Round Barn Boulevard in 15 minutes, Denny Ragan said.

After seeing a psychiatrist there, Barbara was given prescriptions for Ativan and Lexapro. Denny Ragan said that since May 28, his wife’s medications were modified several times and that she was having an extremely difficult time with such repeated changes. Prior to the emergency room visit, Barbara Ragan had been prescribed Zoloft and Xanax, the family said.

Turner said such switches are not unusual when doctors are trying to find the right medications to meet a patient’s needs.

Denny Ragan said that after the emergency department visit, his wife called Kaiser’s advice nurse two or three times from June 15 until July 3 seeking guidance with her medications. That should have raised red flags among her providers, he said. Days before her death, when she learned that she was prescribed Prozac — the original drug that had stopped working — Barbara Ragan became desperate, her husband said.

“Why would they put her back on Prozac when they said it wasn’t doing any good?” Denny Ragan said. “She said, ‘Denny, I’m just not getting help.’ ”

In late June, she received an “appointment confirmation” from Kaiser. The card, which was dated June 27, was for an Aug. 25 appointment to see her psychiatrist.

“That really threw her off. She said, ‘Denny, I can’t wait that long,’ ” Denny Ragan said. “I said, ‘Barbara, if you just last the weekend.’ I said, ‘Just hang in and on Monday morning, we’ll go over there and I’ll make sure you get some treatment.’

“She didn’t wait. She just got fed up.”

He said his wife “was disgusted with the pills she was taking and the appointments she wasn’t getting.”

Kaiser defends treatment

Kaiser says mental health staff were attentive to Barbara Ragan’s needs in the weeks leading up to her death. Turner said that shortly after the emergency department visit, Ragan was offered both individual or group therapy but she declined.

He said that even though she was given an Aug. 25 appointment to see her psychiatrist, she could have seen a mental health provider at any time before that if the need was urgent. He said that just a few days before her suicide, she was evaluated over the phone by a psychiatrist.

“If she actually did call and in any way was urgent or needed to be seen, she would have been accommodated,” Turner said.

Denny Ragan said that wasn’t enough.

“The point is, they gave her a two-month appointment and all that medicine in a two-week period,” he said. “If that didn’t call their attention to something …”

Tragic outcome

On the evening of the Fourth of July, Denny Ragan said his wife’s condition reached an unprecedented low. The next morning, a Sunday, he said his wife went into the porch room where she usually has a cup of coffee and a cigarette.

“She was mumbling to herself, shaking,” he said. “She could hardly get the cigarette up to her mouth … just shaking and mumbling.”

Denny Ragan said he asked his wife to come read the newspaper with him in the bedroom, their usual Sunday morning routine. She asked him for a few minutes. A half-hour later, he came back and asked again that she come in. She agreed.

On the way to the bedroom, she asked if she could go into the den and sit in the leather armchair. He went into the bedroom and soon took a call from his daughter Denise. He said he called out to his wife to let her know that their daughter was on the phone, thinking that might cheer her up, but there was no answer.

He went into the den, but there was no sign of his wife. Her purse was still in the house.

Denny Ragan said his wife left a note in her desk, but it wasn’t found until two days after her death. He believes she wrote it just hours before she drove to Kaiser.

The note is simple and begins, “My children, I love you all so much, Mom. Denny, I love you, Barbara.”

He reported his wife missing at about 12:30 p.m.

At 1:53 p.m., an emergency dispatcher reported someone on the third level of the Kaiser parking garage threatening to jump. Police said there were witnesses below who tried to talk her down. At 1:55 p.m., a dispatcher reported, “CPR in progress. … She jumped.”

Family members have requested a copy of the police report, the coroner’s report, medical records and any video surveillance of the parking structure and emergency department area. They said they don’t know if she tried to seek help in the emergency room before she died.

“Video does not lie; people can,” her son Patrick Ragan said.

Patrick Ragan said his mother never showed signs of being “suicidal.”

“In her right mind, that is not my mom,” said Patrick Ragan, who rejected Kaiser’s claim that his mother received proper care.

“In my opinion, Kaiser failed to notice her cry for help,” he said. “With a deadly mix of drugs, you are not in your right mind.”

Supervisor’s criticism

Last week, the family reached out to Sonoma County Supervisor Shirlee Zane, a vocal critic of Kaiser mental health services. Zane said the death of Barbara Ragan was the latest example of Kaiser’s troubled mental health network.

She criticized Kaiser’s repeated claims that the health plan has taken the necessary corrective steps to alleviate problems identified by the state in 2013.

Those problems led to a $4 million fine by the Department of Managed Health Care, which is charged with protecting the rights of health plan patients. Kaiser at first challenged the penalty but last fall opted to pay the fine, though it did not concede the state’s findings of wrongdoing.

Zane disputes assertions that Kaiser has since greatly improved its mental health services.

“Clearly that was not Barbara Ragan’s experience,” Zane said. “She didn’t get what she was seeking; neither did her husband or her children.”

Zane has publicly stated that Kaiser’s lack of mental health services played a role in her husband’s 2011 suicide. She said the HMO’s ongoing problems with access to therapists continue to endanger the lives of those suffering severe mental health issues.

Kaiser, she said, is bound by the state’s Mental Health Parity Law, which mandates that if a health plan offers mental health benefits, they must be offered at the same level as physical health services.

“How many more wake-up calls do they need?” she said. “They have completely and utterly made these public statements that they have improved their services.”

Zane said Kaiser is “exactly where they were two-and-a-half years ago” when the DMHC issued a scathing report criticizing the health plan’s mental health services.

Timely appointments

That report, which came out of a routine survey of Kaiser medical services, found among other things that Kaiser was not providing timely appointments to its mental health patients.

Earlier this year, in a follow-up to the survey, the department found that while Kaiser had corrected two of four troubling deficiencies found in previous evaluation of the plan’s medical services, Kaiser still was not providing timely appointments for a significant portion of the HMO’s patients in Northern California.

The DMHC reported in its follow-up that appointments for mental health services did not occur within the required regulatory time frame in 22 percent of the medical records it reviewed in Kaiser’s Northern Region, which includes Santa Rosa facilities. In Kaiser’s Southern Region, timely appointments did not occur in 9 percent of the medical records that regulators reviewed.

Struggling with demand

Rosemary Milbrath, who until recently was the executive director of the Sonoma County chapter of the National Alliance on Mental Illness, said many health plans are struggling to meet patient demand for services.

“All the health plans are facing the same challenges of how to provide effective mental health services in a cost-effective way under the new guidelines of health parity,” Milbrath said. “I hear the same frustration that people express from those individuals who are insured by BlueShield, by UnitedHealthcare — all of them.”

Milbrath said patients often report limitations on the number of individual therapy visits and also trouble getting emergency mental health care.

“Kaiser has been singled out, I guess, because they have so many patients,” she said. The HMO has just over 200,000 patients in Sonoma County, a Kaiser official said.

Kaiser said this week it had made more progress since the follow-up survey was conducted and that staff is working closely with DMHC. That survey was based on site visits to Kaiser facilities in October 2013, March 2014 and April 2014.

Turner, the Kaiser mental health care director, said mental health care staffing has increased by 25 percent across the state and that the health plan has also contracted with a “high-quality” third-party mental health care network of 4,500 clinicians. The health plan also has incorporated other initiatives, such as establishing more flexible extended hours to accommodate patients.

Turner said that Kaiser has taken to heart lessons learned in the couple of years since the DMHC report was issued.

Union’s position

Sal Rosselli, president of the National Union of Healthcare Workers, said Ragan’s death was the result of Kaiser’s failure to hire more behavioral health staff. The union, which represents about 1,600 mental health clinicians (including psychologists, therapists and psychiatric social workers) in Northern California, has said the provider lacks enough staff to handle its mental health patients, particularly after President Barack Obama’s Affordable Care Act brought in more members.

“This tragic situation is the inevitable cost of a system run by accountants rather than caregivers,” Rosselli said. “How many people have to die before Kaiser listens to the clinicians they hired to fix the problem?”

Kaiser has dismissed such criticism as a labor bargaining ploy.

Loss and grief

For Denny Ragan, the loss of his lifelong partner has been devastating.

The couple, who would have celebrated their 63rd wedding anniversary July 13, met at a birthday party in San Francisco, where they both grew up.

“She was nice and quiet and sweet. She was considerate, she was beautiful … made a lot of friends easily. She just listened to everybody,” he said. “She just fit the bill.”

Denny Ragan owned a number of businesses in the Bay Area, including a gas stations, a furniture store and a carpet cleaning business, mostly down in Millbrae, he said. After raising five children, his wife went to college for a degree and got a job at Kaiser Permanente South San Francisco Medical.

She worked for about 16 years as a medical records transcriber, transcribing doctors’ notes. She retired in her early 60s. Shortly after that, the couple moved to Oakmont to a home they had built with a beautiful view of Annadel State Park.

In the note she left, Barbara Ragan’s writing is strained, the product of a shaky hand, her husband said. Some of the words are hard to make out — the last word in the note, “pain,” was at first difficult to make out, he said.

Denny Ragan struggled to understand the kind of pain that would drive someone to take her life. He said he understood physical pain but couldn’t grasp the kind of mental and emotional pain his wife was going through.

“What’s the pain? It’s not physical, it’s mental,” he said. “What was the pain? It must have been horrible.”

June 24, 2015 – Wait Times Make Kaiser Psychiatrist Quit, New Lawsuit Alleges

According to Courthouse News Service, a new lawsuit alleges that wait times and patient safety issues made a Kaiser psychiatrist quit. The story is included below; for the direct link and legal complaint, click here.

June 24, 2015 | SAN DIEGO, Calif. (CN) – Kaiser’s retaliation for complaints of wait times and patient safety made a psychiatrist quit, she claims in San Diego County Superior Court.
Laura Wakil, M.D., sued Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and Southern California Permanente Medical Group. Wakil sues for injunctive relief and damages, including punitive damages, plus attorneys fees and costs of suit.

According to the lawsuit: “Having personally observed Kaiser psychiatric patients routinely placed in jeopardy by Kaiser’s negligence and cavalier failure to adequately provide care and treatment, and having witnessed Kaiser’s chronic failure to provide adequate staffing for these patients (which further compromised patient care), plaintiff, convinced that her internal efforts to provide proper staffing and treatment were being ignored, directly contacted and complained to California Department of Managed Health Care (DMHC). She further complained that Kaiser was increasing patient loads on psychiatrists, psychologists, therapists and other staff, to the point that it was impossible for these dedicated professionals to provide proper care to their patients. Defendants effectively ordered and directed plaintiff and other physicians to effectively treat the patients as if they were widgets or other commodities, running them through the Kaiser system within strict time limits, which ignored the patients’ true conditions and needs. Physicians were directed to set patient appointments three (3) months in advance, disregarding the fact that many of these patients were mentally unstable, in some cases in urgent need of immediate and continuous psychiatric care and needed prompt access to their physicians to avoid dire consequences.”

When Plaintiff refused to remain silent and refused to engage in conduct that she believed was below the appropriate standard of care and in violation of state or federal statute, Kaiser tried to silence her by making her job unbearable and forcing her to resign.

Adverse actions against Wakil included suspending her with pay so that she could “think more about her letter [to the DMHC],” denying her additional staff, including physicians, to alleviate overflow of transfer patients, and denying her access to patients who were in a severe mental state.

She sues for violation of California Health & Safety Code and Business and Professions Code, retaliation, negligent supervision or retention of employee, wrongful constructive termination, hostile work environment, failure to prevent discrimination or harassment, racial, gender and disability discrimination, failure to reasonably accommodate disability or engage in the interactive process, family medical leave rules and adverse actions in violation of public policy. She demands a jury trial.

Wakil is represented by Charles Mathews of the Mathews Law Group in Culver City.

March 27, 2015 – SF Examiner: Kaiser CEO’s vision may need checking

Check out the new op-ed out today on the SF Examiner from Courage Campaign’s Dr. Paul Song and National Alliance of Mental Illness Marin County Chapter’s Rick Roose, critiquing the SF Chronicle’s choice to nominate Kaiser CEO Bernard Tyson as a Visionary of the Year.

KAISER CEO’s VISION MAY NEED CHECKING

The San Francisco Chronicle will host a gala dinner Tuesday to present its new Visionary of the Year Award to one of 13 nominees. Most of the nominees are worthy of the honor.

But the selection of Kaiser Permanente CEO Bernard Tyson as a candidate for a visionary award requires a willful blindness on the part of the nominating committee. Just a few weeks ago, for the second time in as many years, slammed Kaiser for violating California laws by forcing thousands of patients to endure lengthy, illegal waits for basic mental health care.

In 2013, California’s Department of Managed Health Care fined Kaiser $4 million for these violations — the second-largest fine in the agency’s history. This year, Kaiser denied that these violations persist. In a full-page Chronicle ad in January, four Kaiser executives said allegations to the contrary were “factually wrong,” and Kaiser spokesman John Nelson told London’s Guardian newspaper that Kaiser had “resolved the issues identified by regulators” and there was “no truth in the allegations that there were lapses or delays.”

Yet last month, the DMHC released its follow-up report, showing that two years later, Kaiser is still violating the law and may face additional fines. The report contains heart rending stories, including the experiences of a sexual assault victim who turned to Kaiser, her HMO, for help. Diagnosed with major depression and post-traumatic stress disorder, the patient was prescribed an antidepressant but given no follow-up appointment, even after she sent numerous emails seeking treatment. Kaiser suggested she seek care outside Kaiser at her own expense, wrongfully claiming services for her condition were not offered at Kaiser. It took five months for her to finally obtain an appointment with a Kaiser therapist.

The consequences of these delays can be tragic. Sonoma County Supervisor Shirlee Zane has spoken publicly about her husband’s suicide during a 42-day wait for treatment for major depression. Milpitas City Councilwoman Marsha Grilli has shared the story of her sister’s suicide during a six-week wait for treatment following a serious bout of depression and a psychotic break. And Chronicle columnist Jon Carroll has written about his own difficulty obtaining care from Kaiser.

“Kaiser can throw around as much smoke as it can find,” Carroll wrote in the Chronicle’s Jan. 13 edition. “The paucity of its mental health services is pretty well known locally. If it’s going to consciously gut the programs, it should just say so and move on. But it can’t pretend that black is white.”
Meanwhile, nonprofit Kaiser has raked in $15 billion over the past five years, and this year’s haul is up 15 percent over last year’s record.

“People aren’t getting rich off Kaiser,” Tyson says. Except, of course, Tyson and other top executives.
In 2013, outgoing CEO George Halvorson pocketed $10.2 million while incoming CEO Tyson commanded $4.3 million — plus a chauffeur-driven, company-paid car. “[Our] employees expect that when they retire, they’re going to get their benefits,” Tyson says. Yet Kaiser is eliminating pensions for employees while maintaining as many as nine separate pension plans for each of Kaiser’s top execs.

If this is Tyson’s vision of healing, he needs a new prescription.

Dr. Paul Song is executive chairman of the Courage Campaign, and Rick Roose is the vice president of the National Alliance of Mental Illness Marin County Chapter.

NPR: Calif. Strike Highlights Larger Issues With Mental Health System

Kaiser-Workers-Strike-638x461NPR’s All Things Considered covered last week’s strike by mental health clinicians and other workers at Kaiser facilities throughout California. NPR’s April Dembosky reports that Kaiser has shifted resources to provide initial mental health appointments at the expense of follow-up appointments. A Kaiser member may have to wait several weeks for a follow-up therapy appointment after their initial assessment. Not only that, but patients who need individual one-on-one therapy are told that that group therapy–or classes–is all that’s available. The main culprit? A severe shortage of staff. If Kaiser hired more therapists, psychiatric RNs, and psychologists, the quality of Kaiser’s mental health services would improve dramatically. To listen to the story, go here: All Things Considered on the Strike at Kaiser.

Mental Health Clinicians at Kaiser on Strike!

picket signToday, January 12, is the first day of a week-long strike by over 2,600 therapists, psychologists and psychiatric nurses at Kaiser facilities in California. The strike is to protest Kaiser’s inaction in the face of huge failures in its mental health services, including delayed care. Kaiser members suffering from mental illness must often wait for several weeks to see a therapist. In 2013, the Department of Managed Healthcare levied a $4 million fine against Kaiser for its delays in providing the mental healthcare Kaiser members need. Late last year, Kaiser finally conceded to paying the fine, an implicit acknowledgement of the problems with its provision of mental healthcare.

Mental health clinicians point to severe understaffing as the primary reason for these delays in providing mental health care. Joining the mental health workers are about 700 other Kaiser workers, also represented by the National Union of Healthcare Workers. They include optical workers in northern California and medical social workers, speech pathologists, health educators, audiologists, and dieticians, who also criticize Kaiser about issues related to short staffing.

The strike will last all week, with picket lines will be up at 35 Kaiser facilities. Many news outlets have covered the strike. To stay up to date and to show your support, visit the NUHW website.

Also see an article in the San Jose Mercury News.

Thousands of Mental Health Clinicians Plan at Kaiser Plan to Strike Jan. 12-16

better patient care imageThe National Union of Healthcare Workers, the union that represents 2,600 mental health clinicians at Kaiser hospitals and clinics across California, plan to strike for a week starting January 12. Mental health clinicians are striking to improve patient care. For years Kaiser has refused to address the systemic problems in its mental health division, including delayed care, falsifying records to conceal long wait times, slotting patients into group therapy when individual therapy would be more appropriate, and so on.

Clement Papazian, a clinical social worker at Kaiser Oakland and president of NUHW’s northern California chapter, said: “For patients suffering from depression, anxiety, and other debilitating mental conditions, these delays can be insurmountable obstacles, sometimes leading to tragic outcomes…. We don’t want to see patients being ignored. Kaiser’s actions are doing real harm. Even suicides have been linked to Kaiser’s delays and denial of care.”

Kaiser clinicians on strike will include social workers, psychologists, and therapists. Over 700 other Kaiser workers–medical educators, optical workers, speech pathologists, audiologists, etc–will join the strike as well. The strike will affect 35 locations across California.

To read NUHW’s press release about the strike, click here: “Kaiser Permanente Clinicians to Launch Nation’s Largest Ever Mental Health Workers’ Strike Jan. 12.”

To read press reports, click on the following links: Santa Rosa Press Democrat; San Jose Mercury News; ABC News.

Mental Health Clinicians to Kaiser Board Member Cynthia Telles: Resign!

tellesSal Roselli, the president of the National Union of Healthcare Workers, the union that represents over 2,500 mental health clinicians at Kaiser, explains in The Huffington Post why Kaiser Board Member Cynthia Telles has reneged on her commitments and must resign her position with Kaiser.

Roselli writes, “As a psychologist, Telles is bound by this same ethical code to protect the interests of a highly vulnerable population seeking care from Kaiser. But Telles has utterly failed to live up to that obligation. Telles refused to meet with her mental health peers working inside Kaiser clinics when they first sounded the alarm. She did not speak up when Kaiser patients took their own lives. She did not speak up when lawsuits were filed. She did not speak up when journalists took up the story. She did not speak up when the reputation of Kaiser’s psychiatric services plummeted. She did not reply to scores of signed letters written by Kaiser clinicians, imploring her to intervene and correct these problems.”

He continues, “This is the state of Kaiser Permanente mental health services: leaders hiding in the corporate bunker, hoping the crisis will just go away. Unwilling to take action or to admit mistakes, Cynthia Telles and the rest of Kaiser’s executives have hunkered down and lawyered up.”

This hypocrisy has lost Telles the faith and confidence of Kaiser mental health clinicians. We call on Cynthia Telles to resign in hopes that Kaiser will replace her with a true advocate for its psychiatric patients.”

Read the entire op-ed: “Kaiser Mental Health Clinicians for Board Member’s Resignation”