Kaiser mental-health workers strike enters fifth week; city officials and patients press for state and company action

San Francisco ' At a committee-of-the-whole hearing Sept. 27, hundreds of Kaiser Permanente mental-health clinicians, patients and union leaders described long wait lists, last-minute cancellations and instances where patients in crisis went unmonitored, and urged state and company action as the strike by Kaiser mental-health workers entered its fifth week.

The hearing brought clinicians and patients into the Legislative Chamber to give first-hand accounts about care delays they say have continued for years despite repeated state citations. "The short answer is that they lied to you last year," said Ilana Marcucci Morris, a licensed clinical social worker and member of the Kaiser bargaining committee, referring to Kaiser's public statements about appointment access. "They told you they meet return access mandates by 84%. That was a clear result of data manipulation tactics."

Why it matters: Kaiser is the largest insurer for many city employees and covers large numbers of San Franciscans. Clinicians, patients and public officials said the strike has exposed persistent gaps in behavioral health access even after state fines and investigations, and called on regulators and the company to act quickly.

Union and clinician testimony

Union representatives and clinicians described a system where initial triage calls may occur quickly but timely therapeutic follow-up is rare. "Anytime I see a San Francisco patient coming up on my schedule, I cringe," said Marcucci Morris. She testified that, in August, an initial assessment she completed had the earliest follow-up through Kaiser scheduled "well into the month of November." Alicia Cruz, an intensive-outpatient clinician who treats suicidal youth, said her program now sees 7- and 8-year-olds for intensive care because earlier care is unavailable. "If I had a broken leg and my doctor said I needed physical therapy once a week, Kaiser would provide it. There is no excuse for treating mental health differently," patient Greta Christina said.

Union research and regulators

Ian Lewis, research and political director at the National Union of Healthcare Workers, summarized a history of state enforcement: the California Department of Managed Health Care fined Kaiser in 2013 and cited the company again in subsequent years, and launched a non-routine investigation this year. Lewis said state law requires follow-up therapeutic appointments "within 10 business days" for new commercial-plan patients, with urgent cases within two days, and that Kaiser was not meeting those standards before the strike. "Kaiser patients simply don't get what they're entitled to under the law," he said.

City agency response

Abby Yant, director of the city's Health Service System, told the board HSS receives routine utilization reports from plans and operates a member-services unit that helps people who cannot get needed care. She said HSS had not received a surge of formal complaints tied to the strike but that member services and the city's employee assistance program have been fielding questions. "We treat all members the same," she said, adding HSS had not sent a separate notice specifically telling city employees about patients' rights under state law.

Kaiser's absence and calls for state action

Kaiser did not send a company representative to the hearing. Speakers on the dais and in public comment urged the governor and state regulators to intervene. "The governor has been asked to intervene. He has not directly intervened," the union's bargaining committee said. Attendees urged the city to press regulators to require more transparent data on appointment offers, wait times and when out-of-network care was arranged on an enrollee's behalf.

What officials and experts proposed

- Greater regulatory pressure and data transparency from the Department of Managed Health Care and other state agencies; several speakers urged Gov. Gavin Newsom to act. - Immediate steps to ensure continuity of care for patients during the strike, including stronger continuity-of-care plans from Kaiser. - City-level outreach informing employees of state rights on behavioral-health access and improving HSS's ability to triage enrollees through member services. - Union proposals for contract terms that would limit caseloads, secure family-health coverage and improve staffing; union negotiators said the company had been unwilling to accept key health-and-benefits provisions.

Voices from the hearing

"Therapy every five or six weeks is not real therapy," patient Greta Christina told the board, describing how long delays had worsened her chronic depression. "Kaiser claims they're in compliance because they outsource, but the organizations they outsource to are understaffed at best and broken at worst," Ian Lewis said. Clinicians also warned that the company's reliance on short triage contacts could mask the true access problem.

Next steps and outlook

City officials said they would continue to press the state for oversight and asked Kaiser to provide plans for continuity of care. Union leaders said the strike would continue until they reached a contract that guarantees adequate wages, caseload limits and family health coverage. Several supervisors said they would press both the state and the company to move urgently to protect patients.

Ending

The hearing made clear there is little confidence among clinicians, patients and union leaders that the status quo will protect timely access to behavioral health care. Several speakers urged immediate action from state regulators and the company to reduce the risks flagged repeatedly by clinicians at the hearing.