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Clinicians warn supervisors Kaiser's bargaining proposals would let AI and contractors replace therapists
Summary
At a Board of Supervisors committee hearing, unionized Kaiser clinicians and professional organizations testified that Kaiser's contract proposals would expand use of algorithmic intake, subcontracting and manager control over clinical models — a move they say risks patient safety and continuity of care. Kaiser declined to attend.
A committee-of-the-whole hearing at the San Francisco Board of Supervisors on July 21 examined Kaiser Permanente's bargaining proposals and their potential effects on behavioral health patients and clinicians. Union representatives and clinicians told supervisors Kaiser's contract language would allow expanded use of automated intake tools and subcontracted providers, reduce clinicians' time for patient care, and weaken safeguards that currently protect continuity and clinical judgment.
"These proposals would degrade the standard of care for patients and set a dangerous course for the future of behavioral health services," said Benjamin Eichert, policy director for the National Union of Healthcare Workers, who told the board NUHW represents about 2,400 licensed behavioral health clinicians in Northern California. Eichert noted recent state and federal sanctions and settlements tied to Kaiser's behavioral health operations and said the company is proposing to reverse gains won in earlier contracts.
Clinicians described concrete examples of patient harm they attribute to algorithmic screening and nonclinician triage. "When an operator or algorithm decides a patient can wait 10 days, they may deteriorate; I've seen patients withdraw from substances on camera because nobody told them to go to the ER," said Alana Marcucci Morris, a licensed clinical social worker at Kaiser and a member of NUHW's bargaining committee. "I have to do service recovery — apologizing to patients when the system has already failed them."
Speakers repeatedly raised the risk that a contract provision giving Kaiser unilateral discretion to determine or modify behavioral health models would "mess with the therapeutic alliance," a phrase used by Dr. Linda Michaels, chair of the Psychotherapy Action Network. Michaels said decades of evidence show psychotherapy's effectiveness depends on individualized relationships and that a one-size-fits-all approach, or substituting AI for clinician assessment, would worsen outcomes and increase dropout rates.
Nurses and the California Nurses Association added concerns about staffing and patient safety. "Kaiser's CAST and similar systems determine appointment lengths and staffing assignments without accounting for language translation needs or hands-on nursing judgment," said Sydney Simpson of CNA.
Union witnesses outlined three central demands from Kaiser they call the "Terrible 3": (1) contract language that would permit AI or other technologies to substitute for licensed clinicians at intake and triage; (2) removal of contractual limits on subcontracting that could accelerate the outsourcing of therapy to third-party platforms; and (3) language granting Kaiser sole discretion over the operating model for behavioral health. Speakers said Kaiser agreed to more protective language in Southern California but refused identical language in Northern California.
Board members pressed the witnesses for details and expressed frustration that Kaiser declined to send representatives. "It is shameful that Kaiser wouldn't be here to answer our questions," Supervisor Walton said. Supervisor Chen, who called the hearing, said she would introduce a resolution asking Kaiser to drop the proposals and cited a new complaint filed with state and federal agencies.
Witnesses cited prior enforcement actions: they said Kaiser faced state and federal penalties and settlements for behavioral health access failures and alleged the company has used algorithmic questionnaires and scoring tools since 2023 to triage new patients. NUHW witnesses said the Department of Labor and the California Department of Managed Health Care had active or recent proceedings related to these practices.
After public testimony and questioning by supervisors, Chen told the board she would introduce a resolution next week calling on Kaiser to withdraw the contentious bargaining proposals. The matter was filed as a public hearing record.
What's next: Supervisor Chen said on the record she will bring a resolution asking Kaiser to abandon the disputed contract language; the board did not vote on any regulatory action at the hearing and Kaiser did not provide a response during the session.
