September 7, 2022 • 26 mins
Bryan reviews the high profile strike of Kaiser Permanente with Sarah Soroken, Kaiser triage therapist, and Sal Rosselli, president of the National Union of Healthcare Workers. They explain the resources of nuhw.org, their goals, and ongoing efforts to demand change in the clinical environments throughout California.
(Originally aired September 6 22)
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S1 (00:00):
The views and opinions expressed in this programme are those
of the speakers and do not necessarily reflect the views
or positions of any entities they represent, including OLAS Media. OLAS Media.
(00:20):
OLAS Mass Media Presents Nation State of Play.
S2 (00:37):
Welcome to the Nation State of Play podcast. I'm your host,
Brian Miller. And each episode we explore the political stories
that are driving public policy in California. We explore these
stories with political insiders, business leaders, journalists and policymakers themselves
to get below the surface of the headlines and show
you the true forces shaping our nation state. Thanks so
(00:57):
much for listening. Today, we actually have two guests with
Sara Kelly and Sara Sorokin from the National Union of
Health Care Workers, talking about an issue you may have
seen in the press, a pretty big, high profile strike
going on for the Kaiser health care workers. We are
arming issues that patients are facing in an organization that
is by far the largest health care provider in the state.
(01:19):
A lot of political implications of this because of the
way that the state is not enforcing some laws related
to mental health care, but also some really practical implications
for the millions of Californians that rely on Kaiser for
health care. So really a privilege and sound, Sara, on
to unpack these issues. I hope you will listen and
go to their website, which we're going to give a
link to in the show a few times to find
(01:42):
out more about critical things that they're working on. So
stay with us. Sarah Sedghi and Sarah Sorokin coming up
right after this.
S3 (01:53):
American democracy is good, but we can make it better.
The National Association of Nonpartisan Reformers includes organizations across the
country that are working right now to build a better
democracy by opening primaries, implementing safe, secure voting systems, reducing
corruption and increasing transparency. Listen to our weekly podcast, How
to Win Friends and Save the Republic. To hear the
(02:15):
latest updates from the Democracy Reform Space, subscribe and learn
more about us at nonpartisan reformers dot org.
S2 (02:23):
Welcome back to the Nation State of Play podcast. Well,
Sarah and South, thanks so much for being here and
it's a pleasure to have both of you.
S4 (02:31):
Thank you.
S1 (02:32):
Good to be here.
S2 (02:34):
So we've got a quite a few issues I want
to try to cover in a short period of time.
And I want to jump right in by talking about
the current strike that urbanisation is engaged in there. Could
you give us kind of an overview of what the
issues are in the strike and what the current status
of it is?
S4 (02:50):
Yeah, so we are Kaiser Mental Health clinicians, we belong
to the National Union of Health Care Workers, and we're
on strike because we're unable to provide mental health and
substance use treatment for our patients that comply with the
professionally recognised standards of care in our field and mental
(03:15):
health parity laws. And we have tried everything that we
can to avoid a strike and to improve patient care.
But nothing to this point has changed the situation. In fact,
patient care issues only continue to worsen at Kaiser, and
(03:37):
we cannot tolerate our patients suffering and getting worse any longer.
S2 (03:43):
So this has been going on for about three weeks
at this point. Is that right? I'm answering. Yeah.
S4 (03:49):
We're on our third week of this open ended strike.
S2 (03:54):
And any progress in the meantime, as is Kaiser, seem
to be willing to come to the table and and
in these topics.
S1 (04:00):
None to date. Right. They haven't you? We've certainly made
sure that they know we're ready to go back to
the bargaining table and have notified their executives, the top leaders,
that we continue to want to work with them. You know,
we want collaboration with Kaiser Permanente to fix the behavioral
(04:21):
health system. No word from Kaiser at this point.
S2 (04:27):
Are these issues? Do you think you need to? KHIZR
I'm not going to speak for other companies, of course,
but but this just seems to be a problem that's
going on and state wide. What is your sense of
how widespread this is, or is there something specific about
Kaiser in this case that you think is particularly acute?
S4 (04:45):
So in my experience, I've never worked at a workplace
and I've worked in various public mental health settings in
which patients were not able to receive the medically necessary
care that they need to manage their symptoms and stabilize
(05:06):
and recover. And there are no shortages of mental health
clinicians in these major metropolitan areas of California, where most
of Kaiser's clinics are. So there really is no excuse.
What's happening is Kaiser has chronically understaffed its mental health
(05:27):
and substance use treatment services. And the working conditions have
gotten so bad that there are more therapists leaving than
they than Kaiser is hiring. So it is a crisis
that Kaiser itself has created.
S2 (05:46):
So it has coded, made these issues worse in any way.
I've seen some reference to this in the reporting, but
the curious as to how the last four years have
impacted the state of mental health care generally, but specifically
what's going on at Kaiser?
S4 (06:00):
Absolutely. The demand for mental health care and substance use
treatment has only risen with the COVID 19 pandemic, and
the general trend has been that demand has been rising
for many, many years now. A lot of collective traumas,
(06:20):
catastrophic fires, gun violence and the pandemic is another stressor
that has led to an increase in demand. But the
general trajectory of increase in demand isn't new.
S2 (06:40):
So what are some of the specific issues that you
need to see tackled in order to end the strike?
You know, I think I think the reporting on this, unfortunately,
has been a little bit of a he said she
said stuff, but it's been hard for me to parse
out exactly what some of the specifics are. So what
exactly are you asking for?
S1 (06:58):
Well, first of all, we need Kaiser to obey the law.
You know, three years ago, these clinicians announced an open
ended strike. And by federal law, the union has to
give the health care provider a ten day notice so
that that provider has at least ten days to come
up with the plan to offer continuity of care while
(07:20):
the strike is happening. And when we did that three
years ago, you know, Speaker Rendon and Senate Pro-Tem Toni
Atkins and Kaiser CEO, a letter, you know, like saying,
what's the plan? You know, if this strike happens and
they Kaiser not only ignored the letter but immediately canceled
over 100,000 appointments. That was their plan. So the clinicians
(07:45):
rightfully canceled that strike because obviously only patients and then selves,
you know, would have suffered. But Kaiser would continue to
get premiums without providing any care at all. And what
we did since then was pass two very important, monumental
mental health parity laws. You know, I'm just so proud
of the fact that our folks have done such deep
(08:08):
education with the legislature and other elected officials, where the
first law provides that. And this this took effect about
two years ago, provides that providers have to provide a
wide range of mental health and substance abuse care. And
if they can't provide that care in-house, it's their ability
(08:31):
to find a clinician out of network, make the appointment
and pay for it. And the second law, which just
took effect July one, SB two, two, one, provides that
all therapy sessions. First of all, emergency emergency needs must
happen within 48 hours, and all other therapy appointments must
(08:52):
happen within ten business days unless the clinician deems it
not necessary. Well, before this strike, Kaiser was not adhering
to any of these laws. And obviously, since the strike,
it's gotten much worse. So, you know, our strategy simply is.
All right, California, time to enforce these laws. They're monumental laws,
(09:13):
but they're worth nothing if they're not enforced. Now, I
do want to say that, you know, we've a long
history of frustration with the Department of Managed Health Care,
which oversees HMOs, just horror stories about the years it's
taken to get minimal fines enforced. But the last couple
(09:34):
of years, they have been stepping up. And, you know,
I want to credit the Newsom administration for forcing damage
to the last. Couple of weeks to do more than
they've ever been before. For example, Kaiser's plan for this
strike was said to be confidential damage. Medici wouldn't release
(09:55):
it to us. And finally, a week or so ago,
they released 22 documents which, yes, demonstrate there's no plan
whatsoever for for taking care of folks. None whatsoever. So
there's been part some positive things going on. But but
we believe that, you know, the Newsom administration can do more. Right.
(10:17):
And it's time to force Kaiser to obey these laws
and leverage Kaiser to settle with these clinicians so that
they can begin what's going to be a very long,
not months, but years, a process of turning around Kaiser
Permanente's behavioral health system so that they not only adhere
to the law, but they provide the appropriate care for
(10:40):
Kaiser's patients.
S2 (10:42):
What are the enforcement mechanisms on these laws? Is this
purely left to the private advantage, health care to enforce it?
S1 (10:49):
Yes, yes. Sadly, yes. And and they don't have the
staff to go in and investigate Kaiser. I mean, ultimately
and this is all governed by Knox King, ultimately, the
state has the right and obligation to put a provider
in receivership if they can't provide care, if they can't
(11:11):
do the law. But obviously lots of court proceedings and
what would happen would take a long time to get
to that point. So, again, you know, it's we're urging,
you know, the governor to use his leverage to force
a settlement here, mediate if necessary, so that these 2000
(11:32):
clinicians can begin the long process of working with Kaiser
management to fix the behavioral health system.
S2 (11:39):
What are the other goals of the strike?
S1 (11:42):
Well to comply with the law. To do that, they
have to make sure that the environment is conducive to
retaining and recruiting more clinicians. You know, as Sarah said,
the last couple of years, the the rate of conversions
leaving Kaiser has doubled for the norm. And it's you know,
(12:03):
we have scores of examples of clinicians that have have
just had it, you know, that they can't stand the
stress of not being able to provide the care that
they're trained for that's ethically that ethically they're responsible for,
and they're leaving to go into private practice or to elsewhere.
There's examples of folks that just started as one clinician
(12:24):
from the Santa Clara County jail system who came to
Kaiser because frankly, some of the benefits were better. Right.
And she lasted months and went back to work in
the jails because the conditions are better there than in
Kaiser Permanente. And Sarah can speak more specifically to these conditions.
S4 (12:42):
Yeah. So when therapists are being forced to see patients
for return, individual psychotherapy appointments every four to 6 to
8 to even 12 weeks, they're not able to practice
within professionally recognized standards of care. They aren't able to
(13:03):
do effective work with patients. They see their patients suffering
and worsening severe emotional pain reductions in functioning at home
and at work, even suicide attempts. It's a moral injury,
and it's really unmanageable and intolerable. And when therapists have
(13:30):
options outside of Kaiser to practice their trade in a
way that does comply with state and federal mental health
parity laws, with their training and expertise, and that complies
with their profession's code of ethics. Kaiser no longer is
an attractive place for therapists to work.
S2 (13:50):
I mean, this sounds like some pretty deep seated structural issues.
You know, this is maybe the normal stuff you hear
in a strike and, you know, some specific wage increase
arguing about a set dollar amount or something like that.
This sounds like some pretty weighty stuff. Do you see
a path to resolving this without the governor's intervention or
some sort of mediated settlement here?
S1 (14:14):
You know, these folks have been bargaining with Kaiser for
over a year now. And from day one, they put
we put together a package of access to patient issues,
worksite issues that need to be resolved again to recruit
and retain clinicians and to hire hundreds more clinicians necessary
(14:36):
to comply with the law and the needs of patients.
In Kaiser's rejected all of those. Again, the economics were
accepted to us. That's not an issue. It's forcing Kaiser
to change its whole outlook on the way they do
behavioral health. You know, we're also calling on Secretary Mark Ghaly, who,
(14:57):
as you know, oversees the MHC. The other resources he
has in his department. Right. There are other parts of
his department with resources to get staff from other places
to go in and do inspections of Kaiser clinics so
people can witness the chaos that's going on. You know,
much like other departments, like cosmetology do thousands of inspections
(15:21):
of places under their jurisdiction every year. Now, that's not
happening here. And it's and it's necessary.
S2 (15:28):
Okay. So you've done a good job covering what the
administration can do from both maybe bringing the parties together
to mediators, but also enforcing existing law. Is there a
role for the legislature here or any other regulatory process?
Is that there are also current priorities where.
S1 (15:46):
You know, the legislature and again, speaker and then Toni
Atkins have been so incredibly supportive, in fact, with their leadership,
you know, S.B. two, two, one that passed that I
mentioned a few minutes ago, passed the assembly unanimously, co-sponsored
by Republican leadership. Right. You know, a couple of weeks
(16:10):
ago in the Senate, Senator Wiener, with Toni Adkins support,
convened a hearing before this strike happened, inviting DMC and
patients and clinicians and Kaiser Permanente to come in and
discuss how they are adhering to the law and discuss
the issues. Well, Kaiser didn't even show up. They didn't come.
(16:33):
Damage was very strong. You know, the elected director came
and spoke very strongly about Kaiser Permanente's obligation to adhere
to the law, even if this strike happens. Well, they're not.
And DMC doesn't have the sense of urgency from our
point of view to figure out how to enforce that,
(16:55):
how to document it and make it happen.
S2 (17:00):
Are there legislative committees specifically that have oversight of democracy,
that have a role here?
S1 (17:08):
Not to my knowledge. It really is Secretary Gailey in
the governor's administration that oversees it.
S4 (17:16):
Really, this is a social justice issue. These are services
that are basic mental health and substance use services, basic
health care services. And for them to be denied to
patients by such a profitable company is outrageous. And we
(17:40):
shouldn't have to accept this. Patients pay premiums to receive
this care and they're not receiving it. And this affects
all of our communities, the whole state of California. Kaiser
is one of if not the largest health care provider
in California. And this is something our legislators and governor,
(18:05):
I believe, should acknowledge and address and compel our regulatory
agencies to compel Kaiser to follow the law.
S1 (18:16):
You know, not just that it's incredibly satisfying to have
the support of Kaiser patients. Right. Kaiser is trying to
blame the commission clinicians for appointments being canceled. And we're
just getting the absolute opposite reaction from folks coming to
picket lines, sending us emails, going on our website and
you h.w. Dawg, offering support, calling us with stories that
(18:41):
they want to use us to help go public. Right.
To help force kaiser to provide care. And the reason
why we're getting that support is because everyone's got a story,
a terrible story about, you know, lack of access to
mental health care at Kaiser, which, you know, represents 10
million you know, 10 million Californians, almost 10 million Californians
(19:02):
are insured by Kaiser. So it's a huge problem.
S2 (19:08):
And I'm glad you brought up my patients. I was
going to be my next question. What should patients do?
What should current Kaiser patients do if listening to this
hearing about physicians experiencing problems on their own? I'm glad.
Feel free to plug the website again. But what's the
best way for them to make their voices heard?
S1 (19:23):
Or they should call DMC, right? And you know, it's
not an easy process, which is another problem and criticism
we have of damage. See, you know, you have to
go through a number of prompts, right, when you call in.
But it's fundamentally important to do that. It's to, like,
know your rights, rights to timely care within ten business days.
(19:48):
And if Kaiser can't provide it, they have to find
a therapist for you outside of their network and pay
for it. If they don't get that level of care,
call GMAC and file a complaint that'll help us demonstrate
to the government that they need to step in and
help us demonstrate that Kaiser is very far from providing
adequate care.
S2 (20:10):
Great. And if people want to join picket lines, find
out more about places to make their voices heard in
the strike. Is your website the best place to go
for that?
S1 (20:18):
Absolutely. There's access to our picket lines there. Absolutely. Yes.
And you h.w. Dawg.
S2 (20:27):
Other issues facing your organization. I know this is the
most urgent and timely thing. But but it sounds like
you deal with a host of issues and you've got
a long track record of legislative success here. There are
other things going on in the political arena that folks
should be aware of.
S1 (20:45):
Well, you know, really proud of organization. You know, first
of all, I want to mention that we've been dealing
with the Department of Labor federally, and they are they
are in the middle of three investigations with Kaiser, two
in California and one in Hawaii, where, by the way,
we also represent the Kaiser clinicians. And they just started
a strike this week, the first week of a strike
(21:07):
over the same issues. Right. And the Department of Labor
is investigation is around Kaiser not obeying federal parity laws.
You know, our team has been working very closely with
them and we're confident that they're going to come out
with some very strong findings against Kaiser, who I'm not
(21:27):
exactly sure when, you know, we believe this, what we're
doing in California, in Hawaii, to be an example for
the rest of the country. You know, these these psychologists
and other behavioral health clinicians have become radicalized. Right. Now,
Sarah mentioned earlier, too, to make it a civil rights issue.
(21:50):
And the goal is that one year soon the expression
mental health care won't exist anymore. It'll be simply health care.
S2 (22:00):
Yeah. Yeah. Well, so sad. And I'm glad you brought
that up. But other states, I tend to think of
Kaiser as a California company. What is the reach of
the company? Just just so folks understand what we're talking
about here?
S1 (22:12):
Oh, sure. You know, they operate in addition to Hawaii
in Washington state and Oregon and D.C., Virginia, Maryland and Georgia.
So multiple other states.
S2 (22:25):
Okay. So we've got a legislative session supposed to wrap up,
I think almost exactly 12 hours from now. I'm sure
they'll take it to the very, very last minute. And
at that point, is your expectation and maybe, maybe hope
that there'll be some more bandwidth in Sacramento and within
the administration to to focus on this topic? Or is
(22:47):
that am I being fairly optimistic here?
S1 (22:51):
No. You know, one thing I want to say about credit.
Governor Newsom, you know, when these bills were passed and signed,
invited us to the signings and credited New H.W. with
help getting them passed and our folks leadership. And he
also stated that a lot of folks are being unhappy
about this. You know, I'll never forget this moment. You know,
(23:14):
like the plans, like Kaiser Permanente, like the hospital industry,
and said that this isn't the end game, this is
just a step toward accomplishing parity for mental health care.
So I know that Gavin Newsom gets it in actually
on his desk as we speak is another bill that
Senator Wiener offered that, you know, the current fines for
(23:34):
incidents once they're established is 20 $500. And that's been
in place for a number of decades now with a
bill that's on Gavin's desk increases those fines for every
incident to $25,000, which obviously is much more appropriate. And
hopefully it will be helpful to force organizations like Kaiser
(23:55):
to realize that, you know, the current role model that
they have. Right. And they figure the cost of doing
business it's okay to pay fines, cost a lot less
than having the clinicians to provide the appropriate care. We
hope that that'll turn things around and we'll certainly be
working with the legislature as a result of this strike
(24:17):
and what we've learned to figure out next steps to
truly establish parity for mental health care.
S2 (24:23):
And this is a common issue that we have with
regulations where, you know, it can be forever for regulators
to get to it. But when you suddenly incentivize private
litigation and, you know, you you put the potential out
there for class action suits, suddenly you're kind of enlisting
private help in ways. And we've had other guests on
the show in totally different areas. That has made a
(24:45):
big impact. I'm just curious, it's something that you've thought
about as you as you deal with the sort of
lack of enforcement topic.
S1 (24:52):
You know, in back in 2013, there was a class
action lawsuit filed by attorneys that we assisted several patients
who lost loved ones due to suicide that were getting
adequate care from Kaiser. That was like eight or nine
years ago, and it still hasn't gone to trial. One
(25:14):
thing Kaiser has deep in their organization is lawyers. They
are really lawyered up very.
S2 (25:23):
Health, health, health care workers. That's a burgeoning industry. Well, listen,
Sal and Terry, I want to thank both of you
primarily for what you're doing. Of course, every day on
the front lines of this, literally on the front lines.
But raising awareness of these topics, you know, it's such
an important issue these days with all the mental health
problems facing Californians. But but every American. And I was
(25:46):
I was I was definitely surprised to see some of
these in the news. I'm glad we get to have
you on to talk about it. And, you know, Sal,
why don't you give the website one more time for
anybody who wasn't able to write it down? If they're
listening to something and people want to get more involved,
find out more information on this. This is where to go.
S1 (26:02):
Thanks, Brian. The National Union of Health Care Workers, the
website is in U, h, w dawg.
S2 (26:10):
Great. Well, thanks again for being here.
S4 (26:12):
Thank you. Thank you.
S2 (26:19):
We invite you to share ideas for guests, ask questions
in the comments. You can find us at Neptune shops
dot com. Follow us and subscribe or listen to your
podcasts as we continue to explore the inside stories in
California politics. This is The Nation State of Play podcast.
I'm your host, Brian Miller, and thank you for listening.
S1 (26:42):
No lost media.
The views and opinions expressed in this programme are those
of the speakers and do not necessarily reflect the views
or positions of any entities they represent, including OLAS Media. OLAS Media.
(00:20):
OLAS Mass Media Presents Nation State of Play.
S2 (00:37):
Welcome to the Nation State of Play podcast. I'm your host,
Brian Miller. And each episode we explore the political stories
that are driving public policy in California. We explore these
stories with political insiders, business leaders, journalists and policymakers themselves
to get below the surface of the headlines and show
you the true forces shaping our nation state. Thanks so
(00:57):
much for listening. Today, we actually have two guests with
Sara Kelly and Sara Sorokin from the National Union of
Health Care Workers, talking about an issue you may have
seen in the press, a pretty big, high profile strike
going on for the Kaiser health care workers. We are
arming issues that patients are facing in an organization that
is by far the largest health care provider in the state.
(01:19):
A lot of political implications of this because of the
way that the state is not enforcing some laws related
to mental health care, but also some really practical implications
for the millions of Californians that rely on Kaiser for
health care. So really a privilege and sound, Sara, on
to unpack these issues. I hope you will listen and
go to their website, which we're going to give a
link to in the show a few times to find
(01:42):
out more about critical things that they're working on. So
stay with us. Sarah Sedghi and Sarah Sorokin coming up
right after this.
S3 (01:53):
American democracy is good, but we can make it better.
The National Association of Nonpartisan Reformers includes organizations across the
country that are working right now to build a better
democracy by opening primaries, implementing safe, secure voting systems, reducing
corruption and increasing transparency. Listen to our weekly podcast, How
to Win Friends and Save the Republic. To hear the
(02:15):
latest updates from the Democracy Reform Space, subscribe and learn
more about us at nonpartisan reformers dot org.
S2 (02:23):
Welcome back to the Nation State of Play podcast. Well,
Sarah and South, thanks so much for being here and
it's a pleasure to have both of you.
S4 (02:31):
Thank you.
S1 (02:32):
Good to be here.
S2 (02:34):
So we've got a quite a few issues I want
to try to cover in a short period of time.
And I want to jump right in by talking about
the current strike that urbanisation is engaged in there. Could
you give us kind of an overview of what the
issues are in the strike and what the current status
of it is?
S4 (02:50):
Yeah, so we are Kaiser Mental Health clinicians, we belong
to the National Union of Health Care Workers, and we're
on strike because we're unable to provide mental health and
substance use treatment for our patients that comply with the
professionally recognised standards of care in our field and mental
(03:15):
health parity laws. And we have tried everything that we
can to avoid a strike and to improve patient care.
But nothing to this point has changed the situation. In fact,
patient care issues only continue to worsen at Kaiser, and
(03:37):
we cannot tolerate our patients suffering and getting worse any longer.
S2 (03:43):
So this has been going on for about three weeks
at this point. Is that right? I'm answering. Yeah.
S4 (03:49):
We're on our third week of this open ended strike.
S2 (03:54):
And any progress in the meantime, as is Kaiser, seem
to be willing to come to the table and and
in these topics.
S1 (04:00):
None to date. Right. They haven't you? We've certainly made
sure that they know we're ready to go back to
the bargaining table and have notified their executives, the top leaders,
that we continue to want to work with them. You know,
we want collaboration with Kaiser Permanente to fix the behavioral
(04:21):
health system. No word from Kaiser at this point.
S2 (04:27):
Are these issues? Do you think you need to? KHIZR
I'm not going to speak for other companies, of course,
but but this just seems to be a problem that's
going on and state wide. What is your sense of
how widespread this is, or is there something specific about
Kaiser in this case that you think is particularly acute?
S4 (04:45):
So in my experience, I've never worked at a workplace
and I've worked in various public mental health settings in
which patients were not able to receive the medically necessary
care that they need to manage their symptoms and stabilize
(05:06):
and recover. And there are no shortages of mental health
clinicians in these major metropolitan areas of California, where most
of Kaiser's clinics are. So there really is no excuse.
What's happening is Kaiser has chronically understaffed its mental health
(05:27):
and substance use treatment services. And the working conditions have
gotten so bad that there are more therapists leaving than
they than Kaiser is hiring. So it is a crisis
that Kaiser itself has created.
S2 (05:46):
So it has coded, made these issues worse in any way.
I've seen some reference to this in the reporting, but
the curious as to how the last four years have
impacted the state of mental health care generally, but specifically
what's going on at Kaiser?
S4 (06:00):
Absolutely. The demand for mental health care and substance use
treatment has only risen with the COVID 19 pandemic, and
the general trend has been that demand has been rising
for many, many years now. A lot of collective traumas,
(06:20):
catastrophic fires, gun violence and the pandemic is another stressor
that has led to an increase in demand. But the
general trajectory of increase in demand isn't new.
S2 (06:40):
So what are some of the specific issues that you
need to see tackled in order to end the strike?
You know, I think I think the reporting on this, unfortunately,
has been a little bit of a he said she
said stuff, but it's been hard for me to parse
out exactly what some of the specifics are. So what
exactly are you asking for?
S1 (06:58):
Well, first of all, we need Kaiser to obey the law.
You know, three years ago, these clinicians announced an open
ended strike. And by federal law, the union has to
give the health care provider a ten day notice so
that that provider has at least ten days to come
up with the plan to offer continuity of care while
(07:20):
the strike is happening. And when we did that three
years ago, you know, Speaker Rendon and Senate Pro-Tem Toni
Atkins and Kaiser CEO, a letter, you know, like saying,
what's the plan? You know, if this strike happens and
they Kaiser not only ignored the letter but immediately canceled
over 100,000 appointments. That was their plan. So the clinicians
(07:45):
rightfully canceled that strike because obviously only patients and then selves,
you know, would have suffered. But Kaiser would continue to
get premiums without providing any care at all. And what
we did since then was pass two very important, monumental
mental health parity laws. You know, I'm just so proud
of the fact that our folks have done such deep
(08:08):
education with the legislature and other elected officials, where the
first law provides that. And this this took effect about
two years ago, provides that providers have to provide a
wide range of mental health and substance abuse care. And
if they can't provide that care in-house, it's their ability
(08:31):
to find a clinician out of network, make the appointment
and pay for it. And the second law, which just
took effect July one, SB two, two, one, provides that
all therapy sessions. First of all, emergency emergency needs must
happen within 48 hours, and all other therapy appointments must
(08:52):
happen within ten business days unless the clinician deems it
not necessary. Well, before this strike, Kaiser was not adhering
to any of these laws. And obviously, since the strike,
it's gotten much worse. So, you know, our strategy simply is.
All right, California, time to enforce these laws. They're monumental laws,
(09:13):
but they're worth nothing if they're not enforced. Now, I
do want to say that, you know, we've a long
history of frustration with the Department of Managed Health Care,
which oversees HMOs, just horror stories about the years it's
taken to get minimal fines enforced. But the last couple
(09:34):
of years, they have been stepping up. And, you know,
I want to credit the Newsom administration for forcing damage
to the last. Couple of weeks to do more than
they've ever been before. For example, Kaiser's plan for this
strike was said to be confidential damage. Medici wouldn't release
(09:55):
it to us. And finally, a week or so ago,
they released 22 documents which, yes, demonstrate there's no plan
whatsoever for for taking care of folks. None whatsoever. So
there's been part some positive things going on. But but
we believe that, you know, the Newsom administration can do more. Right.
(10:17):
And it's time to force Kaiser to obey these laws
and leverage Kaiser to settle with these clinicians so that
they can begin what's going to be a very long,
not months, but years, a process of turning around Kaiser
Permanente's behavioral health system so that they not only adhere
to the law, but they provide the appropriate care for
(10:40):
Kaiser's patients.
S2 (10:42):
What are the enforcement mechanisms on these laws? Is this
purely left to the private advantage, health care to enforce it?
S1 (10:49):
Yes, yes. Sadly, yes. And and they don't have the
staff to go in and investigate Kaiser. I mean, ultimately
and this is all governed by Knox King, ultimately, the
state has the right and obligation to put a provider
in receivership if they can't provide care, if they can't
(11:11):
do the law. But obviously lots of court proceedings and
what would happen would take a long time to get
to that point. So, again, you know, it's we're urging,
you know, the governor to use his leverage to force
a settlement here, mediate if necessary, so that these 2000
(11:32):
clinicians can begin the long process of working with Kaiser
management to fix the behavioral health system.
S2 (11:39):
What are the other goals of the strike?
S1 (11:42):
Well to comply with the law. To do that, they
have to make sure that the environment is conducive to
retaining and recruiting more clinicians. You know, as Sarah said,
the last couple of years, the the rate of conversions
leaving Kaiser has doubled for the norm. And it's you know,
(12:03):
we have scores of examples of clinicians that have have
just had it, you know, that they can't stand the
stress of not being able to provide the care that
they're trained for that's ethically that ethically they're responsible for,
and they're leaving to go into private practice or to elsewhere.
There's examples of folks that just started as one clinician
(12:24):
from the Santa Clara County jail system who came to
Kaiser because frankly, some of the benefits were better. Right.
And she lasted months and went back to work in
the jails because the conditions are better there than in
Kaiser Permanente. And Sarah can speak more specifically to these conditions.
S4 (12:42):
Yeah. So when therapists are being forced to see patients
for return, individual psychotherapy appointments every four to 6 to
8 to even 12 weeks, they're not able to practice
within professionally recognized standards of care. They aren't able to
(13:03):
do effective work with patients. They see their patients suffering
and worsening severe emotional pain reductions in functioning at home
and at work, even suicide attempts. It's a moral injury,
and it's really unmanageable and intolerable. And when therapists have
(13:30):
options outside of Kaiser to practice their trade in a
way that does comply with state and federal mental health
parity laws, with their training and expertise, and that complies
with their profession's code of ethics. Kaiser no longer is
an attractive place for therapists to work.
S2 (13:50):
I mean, this sounds like some pretty deep seated structural issues.
You know, this is maybe the normal stuff you hear
in a strike and, you know, some specific wage increase
arguing about a set dollar amount or something like that.
This sounds like some pretty weighty stuff. Do you see
a path to resolving this without the governor's intervention or
some sort of mediated settlement here?
S1 (14:14):
You know, these folks have been bargaining with Kaiser for
over a year now. And from day one, they put
we put together a package of access to patient issues,
worksite issues that need to be resolved again to recruit
and retain clinicians and to hire hundreds more clinicians necessary
(14:36):
to comply with the law and the needs of patients.
In Kaiser's rejected all of those. Again, the economics were
accepted to us. That's not an issue. It's forcing Kaiser
to change its whole outlook on the way they do
behavioral health. You know, we're also calling on Secretary Mark Ghaly, who,
(14:57):
as you know, oversees the MHC. The other resources he
has in his department. Right. There are other parts of
his department with resources to get staff from other places
to go in and do inspections of Kaiser clinics so
people can witness the chaos that's going on. You know,
much like other departments, like cosmetology do thousands of inspections
(15:21):
of places under their jurisdiction every year. Now, that's not
happening here. And it's and it's necessary.
S2 (15:28):
Okay. So you've done a good job covering what the
administration can do from both maybe bringing the parties together
to mediators, but also enforcing existing law. Is there a
role for the legislature here or any other regulatory process?
Is that there are also current priorities where.
S1 (15:46):
You know, the legislature and again, speaker and then Toni
Atkins have been so incredibly supportive, in fact, with their leadership,
you know, S.B. two, two, one that passed that I
mentioned a few minutes ago, passed the assembly unanimously, co-sponsored
by Republican leadership. Right. You know, a couple of weeks
(16:10):
ago in the Senate, Senator Wiener, with Toni Adkins support,
convened a hearing before this strike happened, inviting DMC and
patients and clinicians and Kaiser Permanente to come in and
discuss how they are adhering to the law and discuss
the issues. Well, Kaiser didn't even show up. They didn't come.
(16:33):
Damage was very strong. You know, the elected director came
and spoke very strongly about Kaiser Permanente's obligation to adhere
to the law, even if this strike happens. Well, they're not.
And DMC doesn't have the sense of urgency from our
point of view to figure out how to enforce that,
(16:55):
how to document it and make it happen.
S2 (17:00):
Are there legislative committees specifically that have oversight of democracy,
that have a role here?
S1 (17:08):
Not to my knowledge. It really is Secretary Gailey in
the governor's administration that oversees it.
S4 (17:16):
Really, this is a social justice issue. These are services
that are basic mental health and substance use services, basic
health care services. And for them to be denied to
patients by such a profitable company is outrageous. And we
(17:40):
shouldn't have to accept this. Patients pay premiums to receive
this care and they're not receiving it. And this affects
all of our communities, the whole state of California. Kaiser
is one of if not the largest health care provider
in California. And this is something our legislators and governor,
(18:05):
I believe, should acknowledge and address and compel our regulatory
agencies to compel Kaiser to follow the law.
S1 (18:16):
You know, not just that it's incredibly satisfying to have
the support of Kaiser patients. Right. Kaiser is trying to
blame the commission clinicians for appointments being canceled. And we're
just getting the absolute opposite reaction from folks coming to
picket lines, sending us emails, going on our website and
you h.w. Dawg, offering support, calling us with stories that
(18:41):
they want to use us to help go public. Right.
To help force kaiser to provide care. And the reason
why we're getting that support is because everyone's got a story,
a terrible story about, you know, lack of access to
mental health care at Kaiser, which, you know, represents 10
million you know, 10 million Californians, almost 10 million Californians
(19:02):
are insured by Kaiser. So it's a huge problem.
S2 (19:08):
And I'm glad you brought up my patients. I was
going to be my next question. What should patients do?
What should current Kaiser patients do if listening to this
hearing about physicians experiencing problems on their own? I'm glad.
Feel free to plug the website again. But what's the
best way for them to make their voices heard?
S1 (19:23):
Or they should call DMC, right? And you know, it's
not an easy process, which is another problem and criticism
we have of damage. See, you know, you have to
go through a number of prompts, right, when you call in.
But it's fundamentally important to do that. It's to, like,
know your rights, rights to timely care within ten business days.
(19:48):
And if Kaiser can't provide it, they have to find
a therapist for you outside of their network and pay
for it. If they don't get that level of care,
call GMAC and file a complaint that'll help us demonstrate
to the government that they need to step in and
help us demonstrate that Kaiser is very far from providing
adequate care.
S2 (20:10):
Great. And if people want to join picket lines, find
out more about places to make their voices heard in
the strike. Is your website the best place to go
for that?
S1 (20:18):
Absolutely. There's access to our picket lines there. Absolutely. Yes.
And you h.w. Dawg.
S2 (20:27):
Other issues facing your organization. I know this is the
most urgent and timely thing. But but it sounds like
you deal with a host of issues and you've got
a long track record of legislative success here. There are
other things going on in the political arena that folks
should be aware of.
S1 (20:45):
Well, you know, really proud of organization. You know, first
of all, I want to mention that we've been dealing
with the Department of Labor federally, and they are they
are in the middle of three investigations with Kaiser, two
in California and one in Hawaii, where, by the way,
we also represent the Kaiser clinicians. And they just started
a strike this week, the first week of a strike
(21:07):
over the same issues. Right. And the Department of Labor
is investigation is around Kaiser not obeying federal parity laws.
You know, our team has been working very closely with
them and we're confident that they're going to come out
with some very strong findings against Kaiser, who I'm not
(21:27):
exactly sure when, you know, we believe this, what we're
doing in California, in Hawaii, to be an example for
the rest of the country. You know, these these psychologists
and other behavioral health clinicians have become radicalized. Right. Now,
Sarah mentioned earlier, too, to make it a civil rights issue.
(21:50):
And the goal is that one year soon the expression
mental health care won't exist anymore. It'll be simply health care.
S2 (22:00):
Yeah. Yeah. Well, so sad. And I'm glad you brought
that up. But other states, I tend to think of
Kaiser as a California company. What is the reach of
the company? Just just so folks understand what we're talking
about here?
S1 (22:12):
Oh, sure. You know, they operate in addition to Hawaii
in Washington state and Oregon and D.C., Virginia, Maryland and Georgia.
So multiple other states.
S2 (22:25):
Okay. So we've got a legislative session supposed to wrap up,
I think almost exactly 12 hours from now. I'm sure
they'll take it to the very, very last minute. And
at that point, is your expectation and maybe, maybe hope
that there'll be some more bandwidth in Sacramento and within
the administration to to focus on this topic? Or is
(22:47):
that am I being fairly optimistic here?
S1 (22:51):
No. You know, one thing I want to say about credit.
Governor Newsom, you know, when these bills were passed and signed,
invited us to the signings and credited New H.W. with
help getting them passed and our folks leadership. And he
also stated that a lot of folks are being unhappy
about this. You know, I'll never forget this moment. You know,
(23:14):
like the plans, like Kaiser Permanente, like the hospital industry,
and said that this isn't the end game, this is
just a step toward accomplishing parity for mental health care.
So I know that Gavin Newsom gets it in actually
on his desk as we speak is another bill that
Senator Wiener offered that, you know, the current fines for
(23:34):
incidents once they're established is 20 $500. And that's been
in place for a number of decades now with a
bill that's on Gavin's desk increases those fines for every
incident to $25,000, which obviously is much more appropriate. And
hopefully it will be helpful to force organizations like Kaiser
(23:55):
to realize that, you know, the current role model that
they have. Right. And they figure the cost of doing
business it's okay to pay fines, cost a lot less
than having the clinicians to provide the appropriate care. We
hope that that'll turn things around and we'll certainly be
working with the legislature as a result of this strike
(24:17):
and what we've learned to figure out next steps to
truly establish parity for mental health care.
S2 (24:23):
And this is a common issue that we have with
regulations where, you know, it can be forever for regulators
to get to it. But when you suddenly incentivize private
litigation and, you know, you you put the potential out
there for class action suits, suddenly you're kind of enlisting
private help in ways. And we've had other guests on
the show in totally different areas. That has made a
(24:45):
big impact. I'm just curious, it's something that you've thought
about as you as you deal with the sort of
lack of enforcement topic.
S1 (24:52):
You know, in back in 2013, there was a class
action lawsuit filed by attorneys that we assisted several patients
who lost loved ones due to suicide that were getting
adequate care from Kaiser. That was like eight or nine
years ago, and it still hasn't gone to trial. One
(25:14):
thing Kaiser has deep in their organization is lawyers. They
are really lawyered up very.
S2 (25:23):
Health, health, health care workers. That's a burgeoning industry. Well, listen,
Sal and Terry, I want to thank both of you
primarily for what you're doing. Of course, every day on
the front lines of this, literally on the front lines.
But raising awareness of these topics, you know, it's such
an important issue these days with all the mental health
problems facing Californians. But but every American. And I was
(25:46):
I was I was definitely surprised to see some of
these in the news. I'm glad we get to have
you on to talk about it. And, you know, Sal,
why don't you give the website one more time for
anybody who wasn't able to write it down? If they're
listening to something and people want to get more involved,
find out more information on this. This is where to go.
S1 (26:02):
Thanks, Brian. The National Union of Health Care Workers, the
website is in U, h, w dawg.
S2 (26:10):
Great. Well, thanks again for being here.
S4 (26:12):
Thank you. Thank you.
S2 (26:19):
We invite you to share ideas for guests, ask questions
in the comments. You can find us at Neptune shops
dot com. Follow us and subscribe or listen to your
podcasts as we continue to explore the inside stories in
California politics. This is The Nation State of Play podcast.
I'm your host, Brian Miller, and thank you for listening.
S1 (26:42):
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