Kaiser Permanente Holds Smoking Gun

Therapists Dodge Bullet – Kaiser Permanente Holds Smoking Gun

by Gordon I. Herz, PhD

Ordinarily during the week before our newsletter deadline I would have been preparing a column on items of interest from Psychotherapy Finances. (Who am I kidding? I mean the night before.) But compelling events which were strangely and uncomfortably familiar happened in Colorado during that time frame, events which grabbed my attention, and seem to me to say all that needs to be said about the current health of psychotherapists.

On Monday, July 13, more than 50 psychologists and social workers who are employed by Kaiser-Permanente in the Denver/Boulder region staged a one-day strike. (Yes, you read that right: psychotherapists went on strike). Five days before, they had been told by Kaiser management that if they engaged in this action, they should not return to work the next day, and that Kaiser would “develop alternative plans to provide…care for our patients”. The therapists were locked out.

What led to this? While full details are certainly only available to those closely involved with the situation, the following facts are clear. The Kaiser therapists were not advocating for their own salaries (which had seen no increases in three years) or benefits. They were advocating for ethical care, and against what they perceived to be sub-standard care and serious under treatment of Kaiser mental health patients. During the course of their talks with Kaiser, the psychologists, social workers and therapists employed by Kaiser joined the United Food and Commercial Workers Union Local 7, described as “the largest union in Colorado”. (Yes, you read that right: psychotherapists unionized). At the time they joined, about 1200 Kaiser professionals from the Denver/Boulder region were already represented by UFCW Local 7.

Data the therapists collected showed that Kaiser members were waiting 2-3 weeks for an initial appointment and 2-6 weeks for return visits. The average wait time for an initial psychiatric medication consultation was 21 days. The therapists had been required to perform 10 initial evaluations per week (up from 4). Consequently, patients were being seen for three visits, at which time there would be room only for new patients on therapists’ schedules. “Kaiser promises to provide increased benefits…but has not increased the number of providers to be able to honor these contracts”, noted Rachael St. Claire, PsyD, psychologist with Kaiser in Denver and active in the negotiations, in a letter requesting support from the Colorado Psychological Association. The therapists had “first hand knowledge of psychological harm to patients that have resulted from these patient care practices” and reported “…the emotional toll of observing the harm done and the helplessness of witnessing our professional standards eroded”.

The therapists defined “ethical care” to include: patients having ready access to providers of their choice; treatment decisions being made by therapist and client; patients being offered a full range of services (not “one size fits all” time-limited therapy or groups); each therapy episode being completed as fully as possible without harmful administrative interruptions in care; patients being provided with possible treatment options and outcomes; and sufficient resources being available to provide consistently high quality treatment.

After extended discussions during which management’s engagement was described as “pseudo-bargaining”, and an offer by Kaiser to decrease the required number of intakes to 8 per week, the therapists decided to stage the one day strike to call local and-if possible-national attention to their concerns about patient care.

The strike was supported publicly by the National Coalition of Mental Health Professionals and Consumers, and praised by Dr. Harold Eist, past president of the American Psychiatric Association. The Clinical Social Work Federation joined the Office and Professional Workers International union, “to give social workers job protection and the power to curtail this kind of managed care abuse”.

I did not see any local news coverage or support and I am ashamed to acknowledge that I have not seen any public statements of support by either the Wisconsin or American Psychological Association.

At the time of the strike, the therapists believed they had no jobs to return to the following day. Late on the 13th, Kaiser management withdrew the lockout. This was seen by the therapists as “…a partial victory in that Kaiser has decided to not retaliate for bringing the truth about Kaiser practices out into the public eye”. As this goes to print, as far as I know, the therapists are still employed by Kaiser, and conditions under which they provide care remain unchanged.

To express your support for the Denver/Boulder therapists, email Dr. St. Claire at stclairer@aol.com

This article was previously published by Preferred Mental Health Professionals, Inc., Madison, WI, in the July PMHP Newsletter. Views expressed are those of the author and do not necessarily represent the views of MHA or PMHP. Permission is granted by the author to reproduce this article in part or in its entirety, with appropriate reference to the source. This article posted 7 September 1998, Labor Day, which seems fitting.

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