Kaiser Permanente’s, one of America's largest not-for-profit health plans, serving approximately 9.5 million members,  2,600 California mental health clinicians — psychologists, therapists, and social workers represented by the National Union of Healthcare Workers — will launch a statewide strike on Monday, January 12, 2015 to protest Kaiser’s chronic failure to provide its members with timely, quality mental health care. Kaiser staff will be on 65 picket lines at more than 35 locations throughout the state during the scheduled week-long strike. Notice of the strike was filed.

More than 700 other Kaiser workers will join the picket lines, including Northern California optical workers and Southern California medical social workers, speech pathologists, audiologists, health educators, and registered dietitians, all of whom also report problems with inadequate staffing.

Despite huge profits — “nonprofit” Kaiser has made more than $14 billion since 2009, and this year’s profits of more than $3 billion are up 40 per cent over last year’s record— Kaiser Permanente does not staff its psychiatry departments with enough clinicians to treat the ever-growing number of patients seeking mental health care. Kaiser’s systemic understaffing forces patients to endure lengthy waits for treatment — weeks and even months — in violation of California law and industry standards. Last year Kaiser was fined $4 million for imposing lengthy and illegal appointment delays on mental health patients. Since then, Kaiser has failed to correct the violations. Compounding the crisis, during the first nine months of 2014, Kaiser added 422,000 new members nationwide, many as a result of the Affordable Care Act.

“For patients suffering from depression, anxiety, and other debilitating mental conditions, these delays can be insurmountable obstacles, sometimes leading to tragic outcomes,” said Clement Papazian, a clinical social worker at Kaiser in Oakland and president of NUHW’s Northern California chapter of mental health clinicians. “We don’t want to see patients being ignored. Kaiser’s actions are doing real harm. Even suicides have been linked to Kaiser’s delays and denial of care.”

For more than four years Kaiser has refused to acknowledge the problems caused by its lengthy appointment delays, much less fix them. Having exhausted every other means, Kaiser’s mental health clinicians are adhering to their ethical responsibility to advocate for their patients by conducting a strike aimed at forcing Kaiser to uphold its contractual and ethical obligations to its patients.

NUHW’s ten-page summary, which provides a history of the crisis, its impact on patients, and evidence of ongoing violations. The few key items:

In 2013, California’s Department of Managed Health Care (DMHC) fined Kaiser $4 million for systemically understaffing its psychiatry department, falsifying patients’ appointment records to conceal long wait times, and providing patients with misleading information regarding the care available to them — a situation nearly identical to the scandal that engulfed the Veterans Affairs Administration last year.

Rather than staff their clinics appropriately, Kaiser merely shifted resources, directing clinicians to see more first-time patients at the expense of returning patients. Healthcare workers at Kaiser facilities report that patients frequently endure waits of between four and twelve weeks for a return appointment, making effective, ongoing treatment nearly impossible.

The situation is getting worse. This year, under the Affordable Care Act, Kaiser’s California enrollment has increased by a quarter million members. Staffing levels, already too low, are not keeping pace with enrollment of new patients. Withholding services while increasing membership is an effective way to score record profits but it has led to woefully inadequate care, as well as four class-action lawsuits filed by patients and families who say Kaiser’s violations contributed to tragic outcomes, including suicides.

In September, Kaiser implicitly acknowledged the problems by agreeing to pay the DMHC’s $4 million fine. Also, Kaiser revealed plans to outsource Northern California mental health services to Value Options. Kaiser’s mental health clinicians believe outsourcing is necessary as a temporary, stop-gap measure while Kaiser hires enough staff to meet its patients’ needs. However, Kaiser has ignored Value Options’ dubious track record. In July 2009, New Mexico discontinued its use of Value Options because of the company’s denial of services to patients. In June 2014, California’s Department of Managed Health Care fined Value Options for “repeated deficiencies.” And in July 2014, New York’s attorney general assessed $1.2 million in penalties to Value Options and up to $31 million in restitution to patients for denial of access to mental health care.

In contract bargaining in December, Kaiser’s mental health clinicians presented Kaiser with a commonsense solution: clinician–management committees in each facility that can work together to determine adequate staffing levels and outsourcing needs, with help from a neutral, outside expert if the two sides cannot agree. It’s a simple and effective solution already in place in other health care systems. But once again, Kaiser failed to act, triggering this statewide strike.

“With soaring profits and a $30 billion reserve, Kaiser needs to step up and lead the way in finally making mental health care a priority in this country,” said NUHW President Sal Rosselli. “The law requires it and Kaiser’s ethical obligations as a health care provider demand it.”