Northern California Kaiser Therapists Hold 1-Day Strike Over AI, Patient Care Concerns

Up to 2,400 mental health professionals at Kaiser Permanente in Northern California are set to hold a one-day strike on Wednesday over what they warn is the company’s increasing use of artificial intelligence to the detriment of patient care and, potentially, of their jobs.

Unions representing tens of thousands of nurses, as well as hospital and facility maintenance professionals, announced they will join picket lines in support of the therapists, including psychologists and social workers, in the Bay Area, Central Valley and Sacramento regions.

During monthslong labor contract negotiations, Kaiser has proposed making it easier to lay off therapists and has resisted language stating that the company won’t use AI to replace them, according to the National Union of Healthcare Professionals, which represents the striking mental health employees.

“It’s really sad that this is how they are choosing to behave,” said Leemore Federman, a Kaiser therapist in San Leandro who specializes in post-traumatic stress disorder and anxiety and is part of the union’s bargaining team. “If Kaiser wanted to, they have abundant resources to make the mental health department at Kaiser the best, and instead they’re doing everything to make it the worst.”

The Oakland-based health care giant, which has been under pressure to improve timely access to mental health and substance use disorder services, denies that AI makes any medical or care decisions or is being used to replace therapists.

Kaiser said it has invested nearly $2 billion since 2020 to expand mental health facilities, hire and train clinicians, and grow its provider network so its more than 9 million California health plan enrollees can get care faster.

“We are growing our workforce, not shrinking it, and our commitment to building a pipeline of trained therapists is unquestionable,” the company said in a statement. “We see technology — and AI, in particular — as a way to support our clinicians in managing their practice and provide them with tools that facilitate greater access to care and connection with patients — all to achieve the best possible outcomes for our patients.”

“We believe AI can be helpful when it supports clinicians — by reducing administrative work or improving efficiency — but it does not replace clinical judgment or human assessment,” Kaiser said.

As the AI boom advances with few guardrails, workers in health care and other industries are feeling anxiety about how their employers may use the technology, said Adam Horwitz, an assistant professor at the University of Michigan’s Department of Psychiatry.

So far, health care companies have introduced AI tools mostly for administrative support tasks, such as note-taking during appointments or patient scheduling, rather than direct patient care. But company decisions to roll out the technology are often happening at high-level meetings behind closed doors without much worker input, which fuels mistrust, he said.

“It’s connected to the broader anxiety that we just don’t know where all this is going,” said Horwitz, who studies how digital technologies, including AI, can improve access to care. “Across industries, there’s a lot of like, ‘Well, wait a minute, having these AI things definitely makes money for people at the top at the expense of workers doing the jobs. Why are we all getting in line to just try to keep propelling this forward without having a thoughtful approach to it?’”

On Wednesday morning, therapists walked off their jobs and headed to picket lines outside Kaiser facilities in Oakland, Sacramento, Santa Rosa, Santa Clara and Fresno.

In Oakland, Harimandir Khalsa, 55, said her team of clinicians who screen patients seeking mental health services in the Walnut Creek area has been reduced by two-thirds. Instead, Kaiser is increasingly using telephone operators and online surveys or questionnaires that use AI to screen patients.

“I have seen firsthand patients who were screened by a telephone service operator and sent to an external referral network. In some cases, they were self-harming … they should never have been sent out, they should have talked to a clinician to assess risk, to come up with safety planning and get them a more urgent appointment,” Khalsa told KQED.

This latest walkout comes about a month after the end of a four-week strike that initially involved up to 31,000 nurses, physician assistants, physical therapists, optometrists and other health care employees in California and Hawaii. Those workers are currently voting on whether to ratify tentative agreements the union said included wage increases, as well as staffing and AI protections.

In 2022, therapists at Kaiser represented by the same union went on strike for 10 weeks, over concerns about patient care delays, workloads, understaffing and other issues.

Kaiser has agreed to multimillion-dollar settlements with state and federal regulators in recent years related to long wait times for patients seeking mental health services. Last month, the U.S. Department of Labor announced the company will pay a $2.8 million penalty, and at least $28.3 million to reimburse patients who sought out-of-network care after Kaiser delayed or improperly denied care.

In 2023, the state’s largest health plan said it would invest $150 million over five years to improve behavioral health for its patients and pay a $50 million fine to resolve a California Department of Managed Health Care investigation.

A spokesperson for the agency, which oversees mental health services in the state, said it is monitoring Kaiser’s progress and investigating a union complaint alleging that Kaiser is flouting a state law requiring licensed health care professionals to initially assess patients to determine what care they need.

UNHW maintains that beginning in 2024, Kaiser changed how it screens patients when they call or go online seeking care. The company unilaterally replaced many trained clinicians with unqualified telephone operators and an online questionnaire with AI to make recommendations on next steps, according to the union, which considers the move an unfair labor practice.

Federman, the therapist in San Leandro, said the new system is missing high-risk patients, making them wait longer than recommended to see a provider.

“I’m seeing a lot of people, where it’s like, ‘wow, they’re really acute,’ and by the time triage [sends them], it’s been a month that they’ve waited — and that’s really dangerous,” she said.

The therapists’ contract with Kaiser ended last September. During bargaining, the company has sought to eliminate current workload limits that allow therapists to have enough time to care for existing patients, Federman said. She worries that the employer may seek to lay off in-house therapists and increasingly refer patients to outside contractors, who won’t offer the same quality of integrated care Kaiser advertises.

The nonprofit health organization countered that it is seeking flexibility to adjust to a “higher than ever” demand for its services, and does not plan to eliminate therapists’ jobs.

“Our contract proposals are aimed at achieving the flexibility we and our therapists need to improve mental health access for our members even as patient needs continue to rise,” the company’s statement said. “We have nearly doubled our mental health workforce over the last 10 years and have never had a reduction-in-force of mental health clinicians in Northern California.”