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A Flawed Model for Care

Kaiser Permanente has been held up as a national model for healthcare, but critics contend that it routinely fails to adequately serve patients with mental health problems.



Fred Paroutaud had a gift. Music was a language he had been speaking his entire life. He loved the way he could express himself with his long fingers and piano keys. Tall and slim with salt-and-pepper hair, the Richmond resident had even found a way to make a successful living from it: composing scores for television and movies.

Yet despite having no history of mental illness or drug addiction, Paroutaud suffered a psychotic breakdown at age 57. Unsure of what was happening, his wife, Susan Futterman, took him to see his regular doctor at their health provider Kaiser Permanente Medical Center in San Rafael and was referred to the emergency room. ER staffers then promptly sent Paroutaud to a private, Kaiser-contracted psychiatric facility in Vallejo — St. Helena Hospital Center for Behavioral Health. During Paroutaud's 72-hour stay at the facility, doctors diagnosed him with having bipolar disorder, otherwise known as manic-depressive illness. Yet despite the fact that Paroutaud was still suffering from hallucinations, doctors discharged him.

Kaiser mental health therapists put Paroutaud in an intensive outpatient group therapy program that included four-hour-a-day sessions four days a week. But most of the other patients in the program were recovering from substance abuse, so Paroutaud felt out of place. He requested to see a therapist one-on-one. Instead, doctors prescribed him with medication, which proved ineffective. Soon he stopped taking it.

Futterman didn't know what to do with him. He was no longer the confident, caring husband she knew. One day, she found him standing alone in the kitchen of their home in the city's Point Richmond district, staring at the floor, his eyes unfocused. He was getting worse.

Paroutaud's unresponsiveness worried Futterman more than his psychotic outbursts. He had a large group of friends that he suddenly had no interest in. He had been an avid vintage car enthusiast and owned a 1967 Lamborghini that he restored himself. He had even helped create an online forum about vintage Lamborghinis. But he had become consumed by a deep depression and was no longer interested in his hobby.

Futterman called Kaiser and asked to set up an appointment between Paroutaud and his psychiatrist. She said she was told that the psychiatrist was on vacation and that no one was covering his patients while he was away. Kaiser staffers recommended that Paroutaud return to group therapy and continue taking his medication. She said she was told repeatedly that Kaiser doesn't offer one-on-one therapy.

Desperate, Futterman called Kaiser every day for two weeks begging to have her husband seen by a therapist. On June 28, 2012, exactly two months after Paroutaud's initial breakdown, Futterman came home to find her husband in their living room hanging from a rope tied around his neck. She cut him down and frantically tried to revive her husband with CPR.

It was too late. Paroutaud's suicide was a tragic end to his brief-yet-intense battle with mental illness.

Unfortunately, this was not an isolated case. Even though federal and state laws mandate that hospitals provide mental healthcare programs that are on par with their primary healthcare services, a growing chorus of patients, state regulators, and clinicians are raising questions about Kaiser Permanente's mental health services, saying the healthcare giant delays patients' access to care in violation of the law.

"No one at Kaiser ever looked at my husband as a human being. They treated him like a medical record number. They never really tried to understand what he was going through. Never," Futterman said. "They claimed to provide the full spectrum of medical services. Either they do not or they chose not to."

In June 2013, the California Department of Managed Health Care (DMHC) fined Kaiser $4 million — the second-largest penalty in the agency's history — for providing inadequate mental healthcare, and issued a cease-and-desist order against the healthcare giant for mental health violations. The large fine and intense criticism of Kaiser also come at a time when the nonprofit is being held up as a national model for healthcare.

Kaiser has stated in written reports that the criticisms leveled by DMHC and the $4 million fine are unwarranted. Kaiser officials also contend that the company is being targeted by a healthcare workers' union campaign to increase staffing.

However, since the DMHC issued the fine to Kaiser a year ago, the number of critics of Kaiser's mental healthcare programs has grown. Moreover, the problems promise to intensify with the expansion of the Affordable Care Act. The company is dealing with a flood of new patients who signed up for insurance under Obamacare. In addition, the Affordable Care Act mandates that all insurance plans include mental health coverage, a requirement that will likely increase the number of patients seeking mental health services at Kaiser.

While much attention has been focused in recent months on extended wait times at Veteran's Affairs hospitals — leading to the recent resignation of VA Secretary Eric Shinseki — far less scrutiny has been given to similar problems involving California's largest health provider.

Susan Futterman filed a class-action lawsuit against Kaiser in October 2013, along with two other plaintiffs from around the state who claim they were denied and delayed access to mental healthcare. Their lawsuit joins two other class-action lawsuits filed in recent months against Kaiser for denying access to mental health services. A fourth suit, a wrongful termination lawsuit filed by a Kaiser psychologist in Sacramento, claims the doctor was fired for advocating for patients to get access to mental healthcare.


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