News & Opinion » Feature

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.



Page 3 of 5

Last October, after six Kaiser Redwood City mental health patients took their own lives, therapists from the hospital's Adult Psychiatry Department sent a letter to the hospital's chief of psychiatry, demanding that the department increase staffing. "As ethical and concerned citizens, we bring these issues to your attention in light of the recent spate of suicides in our clinic" the letter stated. "These tragedies have heightened our longstanding concerns that we do not have adequate resources to safeguard our patients and provide quality care. The workload we have struggled with for years and have been asked to even further increase is unsafe and unsustainable."

According to the therapists, their concerns were never directly addressed. "Since as long as I've worked at Kaiser, it [has been] well documented that you can't get therapy at Kaiser," said Clement Papazian, a social worker who has been at Kaiser for 26 years.

Clinicians have reported that they have knowingly made inadequate recommendations, such as recommending patients for group therapy when they knew that individual therapy would be more appropriate: "I want to offer something," said Jeanine Thomas, a Kaiser social worker. "Otherwise people drop out of treatment. And that's often what we see."

In an effort to increase access to services, some Kaiser facilities in recent months have reported implementing "cluster intakes," in which therapists bring in fifteen patients for a short period of time and meet with the first ten to arrive.

"It wouldn't be unusual to have someone calling me up wanting to harm themselves, and me not being able to see them," said Melinda Ginne, a Kaiser psychologist. "It's heartbreaking."

Ginne sent many emails to her managers at Kaiser Oakland that went unanswered, including one that read: "As a licensed Psychologist, my responsibility is to deliver appropriate care to my patients. That's what I'm trained to do. That's what my license and my ethical obligations require me to do. In my professional judgment, it's clinically unsound and unethical to force high-acuity patients to wait 4-5 months for an appointment. By ordering me to continue adding more patients into my already overburdened caseload, Kaiser will effectively block me from providing clinically appropriate care to my patients."

Kaiser clinicians are, in fact, the most vocal critics of Kaiser's mental health services. The NUHW, which represents 2,500 mental health clinicians in California, has led a campaign to raise awareness of Kaiser's alleged mental health deficiencies. The union is pushing to increase staffing numbers at Kaiser's medical centers, contending that understaffing is Kaiser's underlying problem. In 2011, the union released a report that detailed the inadequate mental health services found by their clinicians. Many suspect the report triggered the state's investigation and subsequent fine.

The union's report from November 2011, "Care Delayed, Care Denied," highlighted many of the deficiencies that the DMHC ultimately found. But it contained a few troubling claims that never made it into the state's findings. For example, more than 50 percent of the Kaiser mental health clinicians surveyed in the NUHW report stated that "patients were either frequently or very frequently 'assigned to group therapy even though individual therapy may be more appropriate.'" And more than 75 percent reported that "they are either frequently or very frequently 'forced to schedule return visits further into the future'" than they believed was appropriate.

The NUHW recently sent a letter in June 2014 to US Attorney General Eric Holder, requesting that the Department of Justice investigate Kaiser's mental health record in light of the VA hospital discoveries. The Department of Justice has yet to respond.

With 9.3 million members, Kaiser Permanente is the nation's largest nonprofit HMO and by far California's largest healthcare provider. It is widely recognized as a model healthcare company because its highly regarded integrated services facilitate nearly every aspect of patient care.

"The organization, which combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama's healthcare law encourages, " a recent New York Times article stated about Kaiser.

President Obama himself was quoted on in 2009 talking about Kaiser. "It's actually one of the models of high-quality, cost-efficient care that's out there right now," he said, "partly because they maintain such a stable base of patients and they construct a whole-team approach that has proven to be very effective."

Yet that efficiency may be exactly what is impeding Kaiser from delivering costly, resource-intensive mental healthcare. "Efficiency shouldn't be at the cost of providing services," said Latika Malkani, a lawyer representing Susan Futterman and the other plaintiffs in one of the class-action lawsuits.

"It is already rated the best health plan in the state by most measures so I think in the long run Kaiser is probably going to be an incredibly great plan. It's just the way that Kaiser has implemented the behavioral health side of things. If you look at the plan on paper it looks like they provide an incredible array of services. On the ground, it seems Kaiser isn't living up to its own contract with its enrollees," said Peter Schroeder, the immediate past president of the California Coalition for Mental Health and a board member of Mental Health Association in California, both of which are nonprofit groups that advocate for mental health services.