SAN DIEGO (CN) — A health care workers union says in a complaint filed Tuesday that Kaiser Permanente violates California law by using unlicensed clerical staff and a computer algorithm to triage mental health patients in Southern California — a practice critics say creates serious risk for vulnerable patients, including those experiencing suicidal thoughts.
The National Union of Healthcare Workers, which represents 2,400 striking Kaiser mental health workers, submitted the complaint to the California Department of Managed Health Care, asking regulators to order an immediate end to the practice and to impose additional penalties against the health care giant.
According to the union, Kaiser patients seeking mental health services are routed not to trained professionals, but to unlicensed clerical staff who conduct scripted yes-or-no questionnaires. The patients’ responses are then processed by an algorithm that determines what kind of care, if any, they should receive.
“In 2019, Kaiser began implementing aggressive changes to its triage system in order to cut costs. It replaced licensed therapists with unlicensed, untrained clerical staff and sharply reduced the duration of each triage assessment to fewer than five minutes. During each triage assessment, an unlicensed clerical staffer employed by Kaiser poses questions to an enrollee, including about suicidal and homicidal ideation, and enters information into a Tridiuum (now LUCET) software tool. An algorithm then calculates an acuity score and, based on the score, generates a response that guides the clerical staffer in scheduling the enrollee for subsequent care. In most cases, these triage determinations are not reviewed by licensed and trained therapists,” the union said in the complaint.
Therapists say the system routinely results in patients being misclassified and sent to inappropriate treatment programs — sometimes with serious consequences. The union says patients with urgent needs, such as those suffering from suicidal ideation, are frequently triaged as having non-urgent conditions, leading to delays in care.
“It is a frighteningly common occurrence to be assigned a patient and quickly realize that their conditions are far too severe to be in our program and that they should have received immediate services,” said Zhane Sandoval, a psychiatric counselor, in a statement accompanying the complaint. “As therapists, we see how Kaiser doesn’t view mental health care as equally important to medical care, and that’s why we’re so determined to win this strike, and make Kaiser do right by all of its patients.”
Sandoval, who works in Kaiser’s ADAPT program, which provides short telehealth sessions for patients with mild-to-moderate conditions, is one of eight therapists participating in a five-day hunger strike outside Kaiser’s Los Angeles Medical Center this week. The hunger strike coincides with the 25th week of an ongoing strike by therapists, psychiatric nurses, social workers, and psychologists across Southern California.
The complaint follows a scathing 88-page report released two weeks ago by the Department of Managed Health Care, which found Kaiser had failed to correct 19 of 20 deficiencies identified in a 2022 investigation. That earlier review led to a record $50 million fine. Among the outstanding violations is a failure to ensure proper suicide risk screenings and assessments for patients seeking mental health services.
One of Kaiser’s uncorrected violations in Southern California is connected to its deficient triaging of patients who call for help with mental health conditions. The Department of Managed Health Care found that Kaiser lacks “sufficient level of oversight to ensure enrollees receive suicide risk screening, assessment, and treatment consistent with professionally recognized standards of practice.”
While the state has not explicitly cited Kaiser for its use of clerical staff and algorithms in triage, California law is clear on the matter. California’s Health and Safety Code states that screening must be done “by physician, registered nurse or other qualified health professional.”
An unlicensed staff person is allowed to handle calls to ask questions on behalf of a licensed staff person to help ascertain the condition of the patient seeking care, but there are caveats.
“An unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional,” the state Health and Safety Code states.
Kaiser Permanente did not immediately respond to a request for comment.
“This is yet another example of Kaiser Permanente putting patients at risk by refusing to provide the same level of care to those with mental health conditions as it does to those with medical conditions,” said Sal Rosselli, NUHW’s president emeritus, in a statement. “Kaiser can’t claim it’s providing parity for mental health care when somebody with a fever gets to talk to a nurse, but somebody having thoughts of ending their life is directed to a clerical worker feeding an algorithm.”
The hunger strike is scheduled to continue through Friday. Union organizers say supporters will join the striking workers outside Kaiser’s Los Angeles Medical Center each day, and that participating therapists are available for interviews.