Board hearing spotlights clinician warnings about Kaiser’s use of algorithms in behavioral-health triage

San Francisco — At a committee-of-the-whole hearing on July 21, unionized therapists, nurses and professional associations told the Board of Supervisors they have documented cases in which Kaiser Permanente’s use of telephone operators, algorithmic screening tools and third‑party contractor networks has delayed access to licensed behavioral‑health clinicians and harmed patients.

Supervisor Shanyan Chen convened the hearing, saying the negotiations raise “potential consequences” for Kaiser enrollees and clinicians and that she has heard allegations that “Kaiser is using AI or machine learning to replace clinical judgment.” She said the board would exercise public oversight after NUHW and other workers filed complaints with state and federal agencies.

Benjamin Eichert, policy director for the National Union of Healthcare Workers, told the board that state and federal penalties totaling about $231 million and a Department of Labor order requiring reimbursement for out‑of‑pocket mental‑health costs show longstanding access problems. “Kaiser has been assessed $231,000,000 in state and federal penalties,” he said, and yet the union contends some bargaining proposals would reverse gains won in prior contracts.

Clinicians gave specific accounts of how the intake and triage process has changed. “Instead of being able to count on human licensed therapists to assess and decide the best first steps, Kaiser patients reaching out for our services now rely on questionnaires that are either read by telephone operators or self‑administered online,” licensed clinical social worker Alana Marcucci Morris said. She described cases in which patients later presented with higher acuity because an algorithm or unlicensed operator had not identified risk factors that a trained clinician would detect.

Therapists at the hearing also described outsourcing to platform providers that operate as independent contractors, limited visibility into external providers’ practices, and loss of continuity when patients are referred out. “The opposite is true when I’m seeing patients through third‑party contractors,” said Molly Parsons, a Kaiser therapist who also practices outside the HMO. “I don’t see any notes from their physicians. There’s no consultation.”

Experts and professional organizations warned about the limits of current AI tools. Dr. Linda Michaels, chair of the Psychotherapy Action Network, told supervisors that the therapeutic alliance is central to outcomes and that the evidence does not support substituting AI for licensed care. “AI can be a helpful tool to support administrative tasks or assist clinicians, but it should never replace the professional judgment of licensed behavioral‑health providers — especially when patients are in crisis,” she said.

Nurses represented by the California Nurses Association raised additional concerns about staffing cuts, remote monitoring systems and changes that they say ration nursing time and reduce oversight. “Kaiser’s vast investments in untested AI signals an effort to divert funding from in‑person caregivers to new untested technologies,” CNA member Sydney Simpson said.

Kaiser Permanente did not send a representative to the hearing. Several supervisors said the company’s absence was notable; Supervisor Walton said it was “extremely disrespectful” not to appear. Supervisor Chen said she planned to introduce a resolution the following Tuesday calling on Kaiser to withdraw the contract provisions clinicians call the “terrible three.”

The hearing record includes testimony that NUHW and others have filed complaints with the California Department of Managed Health Care and the U.S. Department of Labor alleging that automated tools and unlicensed staff are being used for clinical triage; speakers said state law requires certain assessments be performed by licensed clinicians. Representatives of the unions said regulators are still investigating.

The board filed the hearing record. No formal action or ordinance was adopted at the meeting; supervisors signaled they would pursue follow‑up, including a resolution and possible information requests of Kaiser.

What’s next: Supervisor Chen said she will introduce a resolution calling on Kaiser to drop the contested bargaining demands and to provide information to the city; the Board may vote on that resolution at a subsequent meeting.