4,000 be­hav­ioral health work­ers plan strike at Kaiser over un­der­staffing

The Modesto Bee - - Front Page - BY CATHIE AN­DER­SON can­der­[email protected]

Roughly 4,000 be­hav­ioral health work­ers at Kaiser Per­ma­nente will walk out of their jobs Mon­day in a five-day statewide strike over what they de­scribe as chronic un­der­staffing that is lim­it­ing pa­tient ac­cess to mental health ser­vices at the na­tion’s largest man­aged care or­ga­ni­za­tion.

“We are con­stantly un­der pres­sure to see new pa­tients,” said Kenneth Rogers, a Kaiser psy­chol­o­gist who’s on the bar­gain­ing team for the Na­tional Union of Health­care Work­ers. “We have only a lim­ited amount of time to see any kind of pa­tients, but the more new pa­tients we have to see, the less time we have for the re­turn pa­tients . ... If there were more staff, there would be more clin­i­cians to see more new pa­tients, and they would take that pres­sure off the ex­ist­ing ther­a­pists’ pa­tient load.”

Union spokesman Matt Artz said that the ra­tio of mental health clin­i­cians to Kaiser mem-

bers has re­mained es­sen­tially un­changed since 2015 de­spite find­ings from the Cal­i­for­nia Depart­ment of Man­aged Health Care show­ing that pa­tients were hav­ing trou­ble ac­cess­ing care that year. NUHW said that Kaiser has main­tained roughly one full-time equiv­a­lent clin­i­cian for ev­ery 3,000 Kaiser mem­bers in Cal­i­for­nia.

The union rep­re­sents 325 Kaiser health care work­ers in the Sacra­mento re­gion, 58 in Fresno and 32 in Modesto and 66 in San Joaquin County, Artz told The Sacra­mento Bee. The NUHW site posted a strike sched­ule at var­i­ous lo­ca­tions, in­clud­ing Kaiser’s med­i­cal cen­ters in Sacra­mento on Morse Av­enue, South Sacra­mento on Wyn­d­ham Drive and Ro­seville on Eureka Road; the Fresno Med­i­cal Of­fice Build­ing on North First Street; the Modesto Med­i­cal Cen­ter on Dale Road; and the Stock­ton Med­i­cal Of­fice Build­ing on West Lane.

John Nel­son, KP’s vice pres­i­dent of com­mu­ni­ca­tions, said the union’s prin­ci­pal de­mands at the bar­gain­ing ta­ble have not been about im­prov­ing care and ac­cess but have in­stead fo­cused on gain­ing even higher wages and ben­e­fits. NUHW’s bar­gain­ing team, he said, has de­manded changes to per­for­mance stan­dards that would re­duce, not in­crease, the avail­abil­ity of mental health care for our mem­bers.

“The union wants to re­duce the amount of time care­givers spend see­ing pa­tients,” Nel­son said in a pre­pared state­ment. “The cur­rent goal is an av­er­age of 75 per­cent of their time, which the union agreed in 2015. Striv­ing for this in­dus­try stan­dard is one of the key ways we’ve been able to in­crease ac­cess to care for our pa­tients.”

Rogers said, in or­der to ap­pre­ci­ate how this union pro­posal will en­sure psy­chother­a­pists can ef­fec­tively treat pa­tients, you have to un­der­stand how Kaiser sched­ul­ing works. Right now, he said, Kaiser clin­i­cians must spend 75 per­cent of their time see­ing pa­tients.

“If you’re a teacher, you might teach high school stu­dents, and you might teach five out of eight or nine pe­ri­ods,” he said. “You get some pe­ri­ods for prep time. The Kaiser clin­i­cians get very lit­tle prep time – 75 per­cent is a lot of time to see pa­tients.”

Rather than re­quir­ing clin­i­cians to see pa­tients 75 per­cent of the time, Rogers said, clin­i­cians are seek­ing to have their sched­ules booked 80 per­cent of the time. Some pa­tients will can­cel ap­point­ments at the last minute, Rogers said, and that will leave time to work on notes or per­haps slide in a pa­tient who calls with an acute prob­lem.

“You’ll have that (new) pa­tient who doesn’t re­port a high acu­ity ini­tially but then calls back later and they’re in se­ri­ous trou­ble,” Rogers said. “And, there isn’t any room for flex­i­bil­ity based upon the way the or­ga­ni­za­tion treats its book. You’ve booked up ev­ery­body. There’s no room at the inn, so to speak, so you have to make a de­ter­mi­na­tion: Can you squeeze in a phone call? Some­times you don’t even have time for that.”

If the pa­tient is at risk of harm­ing them­selves or oth­ers, Rogers said, he works to get them to emer­gency ser­vices. If the pa­tient’s mental state is head­ing down­hill but is not life-threat­en­ing, he said, he can send them to an in­ten­sive group ther­apy.

How­ever, Rogers said, that is hap­pen­ing of­ten enough that pa­tients aren’t get­ting the qual­ity of care they de­serve. That shouldn’t hap­pen at an or­ga­ni­za­tion with Kaiser’s re­sources. Re­cently, Kaiser re­ported a $2.9 bil­lion profit over the first nine months of 2018, NUHW pointed out, and a $3.8 bil­lion profit for 2017.

Rogers said: “If I’m on a desert is­land, and there are only two ba­nanas, I un­der­stand we have to all split that up, and peo­ple are go­ing to be get­ting less, and we have to fig­ure out a way to be eco­nom­i­cal. This is an is­land with many, many, many ba­nanas, and they’re telling me the so­lu­tion is cut­ting the ba­nanas in half. It’s just ab­surd, just ab­surd.”

Nel­son said that Kaiser ther­a­pists are not rou­tinely send­ing peo­ple to the emer­gency room or to group ther­apy.

“We are meet­ing the es­tab­lished reg­u­la­tory stan­dard for first ap­point­ments for mental health and well­ness on av­er­age more than 90% of the time, statewide,” Nel­son said. “We also mon­i­tor re­turn vis­its and are en­sur­ing that we fol­low ther­a­pists’ care plan rec­om­men­da­tions for the tim­ing of these vis­its. As doc­u­mented by the ther­a­pists them­selves, we are meet­ing their rec­om­men­da­tions be­tween 86-94% of the time.”

The Cal­i­for­nia Depart­ment of Man­aged Health Care is­sued a re­port in June 2017 say­ing it would con­tinue to mon­i­tor Kaiser’s per­for­mance for 18 months to as­sess whether it was pro­vid­ing timely ac­cess to care for pa­tients with be­hav­ioral health problems. DMHC reg­u­la­tors said that, in July 2017, they reached an agree­ment with Kaiser to cor­rect vi­o­la­tions and en­list an out­side con­sul­tant to help it do so. The agency has been mon­i­tor­ing Kaiser since 2013 when it levied a $4 mil­lion against the HMO for vi­o­lat­ing the Cal­i­for­nia’s Mental Health Par­ity Act and stan­dards for timely ac­cess to care.

Kaiser, in its re­sponse to the lat­est DMHC re­port, stated that it had greatly en­hanced ac­cess by ag­gres­sively re­cruit­ing and hir­ing ther­a­pists, in­creas­ing the hours for con­tract clin­i­cians, can­cel­ing or re­duc­ing va­ca­tions of staff, and in­creas­ing the pro­duc­tiv­ity of staff.

“We have been work­ing pro­duc­tively over sev­eral years now to im­prove care and the care ex­pe­ri­ence for our mem­bers,” Nel­son said. “Over the last three years in par­tic­u­lar we have demon­strated that by work­ing to­gether we can ad­vance the qual­ity and reach of our mental health care and cre­ate a more pro­fes­sion­ally sup­port­ive work en­vi­ron­ment.”

The Cal­i­for­nia Of­fice of the Pa­tient Ad­vo­cate awarded KP’s North­ern Cal­i­for­nia divi­sion its high­est rat­ing of five stars for be­hav­ioral health, mak­ing it the only health plan in the state to achieve this, Nel­son said.

The or­ga­ni­za­tion has im­ple­mented “tele­vis­its” for pa­tients who find that more con­ve­nient, he said, and it is us­ing pa­tient feed­back to mea­sure ther­a­pist per­for­mance. It also has in­creased the num­ber of ther­a­pists on its staff by 30 per­cent since 2015, de­spite a na­tion­wide short­age of such pro­fes­sion­als, Nel­son said, and it has spent $175 mil­lion on build­ing new clin­ics.

“It’s par­tic­u­larly dis­heart­en­ing that the union lead­er­ship would call this strike dur­ing the hol­i­day sea­son, when many of our pa­tients with mental health needs may be at their most vul­ner­a­ble,” Nel­son said. “Strikes are not an ef­fec­tive bar­gain­ing tac­tic. They put pa­tients, mem­bers and em­ploy­ees in a dif­fi­cult sit­u­a­tion, un­nec­es­sar­ily.”

La­bor ex­pert Kate Bron­fen­bren­ner of Cor­nell Univer­sity told The Bee by phone that strikes are par­tic­u­larly ef­fec­tive when ex­er­cised at a time when com­pany man­age­ment will feel a pinch point and there­fore un­der­stand the union mem­bers’ power.

Artz and Rogers said that a set­tle­ment would avert next week’s strike but that the com­pany has not budged on its po­si­tion over 16 or so ses­sions. The NUHW and Kaiser’s ne­go­tia­tors have been work­ing since June to reach an agree­ment, they said, but the con­tract ex­pired in Septem­ber.

Rogers said he didn’t have to spend any­time or­ga­niz­ing this strike, as he did with past job ac­tions: “The clin­i­cians at our clinic ... came to me and said, ‘Look, we’ve got to go.’ I didn’t talk any­body into it. As their elected rep­re­sen­ta­tive, I sent the mes­sage, but I didn’t or­ga­nize it. It’s to a point where peo­ple are like, ‘We can’t do this. We can’t han­dle this. There’s too much.’ ”

The key is­sue here are work­ing con­di­tions and pa­tient ac­cess, Rogers said, but the union is also seek­ing wage in­creases be­cause the raises alone in the 2015 con­tract did not make up for go­ing roughly five years with­out wage in­creases. The prior con­tract ex­pired in 2011.

Mem­bers in NUHW’s South­ern Cal­i­for­nia unit also want to see the com­pany re­store tra­di­tional pen­sion for mem­bers hired af­ter the 2015 con­tract was in­sti­tuted, Artz said. That’s be­cause Kaiser im­posed terms on new hires in that unit strip­ping away the tra­di­tional pen­sion and leav­ing them with only a 401(k)-style plan, ac­cord­ing to NUHW doc­u­ments from Aug. 1, 2014.

In the end, af­ter five years with­out a deal, NUHW’s South­ern Cal­i­for­nia mem­bers con­ceded this take­away in or­der to forge a con­tract, said NUHW Pres­i­dent Sal Ros­selli, but they did so only be­cause man­age­ment told them they would be ne­go­ti­at­ing sim­i­lar deals with other unions. Kaiser didn’t, Ros­selli said.

Kaiser said it has of­fered NUHW-rep­re­sented work­ers guar­an­teed wage in­creases that will en­sure it can re­main com­pet­i­tive in re­cruit­ing top tal­ent. In 2015, Nel­son stated, NUHW mem­bers re­ceived gen­er­ous wage in­creases, pay scale ad­just­ments, and bonuses rang­ing from $5,000 to $10,000.

JOAN BAR­NETT LEE [email protected]­bee.com

The Kaiser Per­ma­nente health work­ers say chronic un­der­staffing is lim­it­ing pa­tients’ ac­cess to mental health ser­vices.

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