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"content": "\u003cp>More than 2,400 Kaiser Permanente mental health care workers in Southern California began a strike this morning and established picket lines at locations from Los Angeles to San Diego, marking the second strike among Kaiser therapists in a little more than two years.\u003c/p>\n\u003cp>Mental health workers represented by the National Union of Healthcare Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.\u003c/p>\n\u003cp>Kaiser, in a written statement, said it is notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists if their regular provider is engaged in a strike,” the statement read.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/08/kaiser-mental-health-worker-strike/\" target=\"_blank\" rel=\"noreferrer noopener\">The previous strike in 2022\u003c/a> among mental health clinicians in Northern California lasted 10 weeks and led to a commitment from \u003ca href=\"https://nuhw.org/northern-california-kaiser-therapists-win-major-gains-as-strike-concludes/\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser to hire more therapists\u003c/a> and to give employees specific work hours away from face-to-face patient care.\u003c/p>\n\u003cp>Southern California Kaiser workers are now requesting more time between appointments to prepare for patients. They also want a wage increase and a pension benefit that the company provides to its Northern California clinicians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s pretty simple,” said psychological social worker William Johnson, a union steward who serves on the bargaining committee. “We’re looking for the same three top priorities that Kaiser already said ‘Yes’ to for our Northern California mental healthcare workers.”\u003c/p>\n\u003cp>Johnson said his current workload includes seeing 32 to 35 patients a week in one-hour sessions.\u003c/p>\n\u003cp>Kaiser released a statement in response to the union’s plans to strike, saying, “Unfortunately, this comes as no surprise, as this seems to have been their intention all along.”\u003c/p>\n\u003cp>The company has offered wage increases amounting to 18% over four years and a number of other perks, according to the statement. Kaiser representatives said they have invested more than a billion dollars in expanding mental health capabilities in California and increased the number of licensed mental health clinicians in Southern California by 30% over the past four years.\u003c/p>\n\u003cp>However, union members say \u003ca href=\"https://calmatters.org/health/2024/10/kaiser-permanente-strike-mental-health/\" target=\"_blank\" rel=\"noreferrer noopener\">turnover has been a problem\u003c/a>, with a quarter of therapists hired between January 2021 and August 2024 leaving their jobs. [aside postID=\"news_11964377,news_11964043,news_11923034\" label=\"Related Stories\"]\u003c/p>\n\u003cp>“Kaiser leadership has consistently been dismissive whenever we voice our concerns or experiences,” Johnson said. “They like to tell us things like, ‘We get that it’s not ideal,’ and they also add, ‘But it works for us.’”\u003c/p>\n\u003cp>Jared Garcia, another union steward on the bargaining committee, said he’s hoping the strike lasts less than a month, but he’s prepared to see it go on as long as it takes.\u003c/p>\n\u003cp>“Scabs aren’t going to work,” Garcia said. “Kaiser knows the limitations of finding mental health professionals — let alone to replace 2,400 of our union members at this time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A year ago, Kaiser entered into a \u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\" target=\"_blank\" rel=\"noreferrer noopener\">$200 million settlement agreement \u003c/a>with the state of California, agreeing to pay a $50 million fine and invest another $150 million over five years to address delays in behavioral health appointments.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than 2,400 Kaiser Permanente mental health care workers in Southern California began a strike this morning and established picket lines at locations from Los Angeles to San Diego, marking the second strike among Kaiser therapists in a little more than two years.\u003c/p>\n\u003cp>Mental health workers represented by the National Union of Healthcare Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.\u003c/p>\n\u003cp>Kaiser, in a written statement, said it is notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists if their regular provider is engaged in a strike,” the statement read.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/08/kaiser-mental-health-worker-strike/\" target=\"_blank\" rel=\"noreferrer noopener\">The previous strike in 2022\u003c/a> among mental health clinicians in Northern California lasted 10 weeks and led to a commitment from \u003ca href=\"https://nuhw.org/northern-california-kaiser-therapists-win-major-gains-as-strike-concludes/\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser to hire more therapists\u003c/a> and to give employees specific work hours away from face-to-face patient care.\u003c/p>\n\u003cp>Southern California Kaiser workers are now requesting more time between appointments to prepare for patients. They also want a wage increase and a pension benefit that the company provides to its Northern California clinicians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s pretty simple,” said psychological social worker William Johnson, a union steward who serves on the bargaining committee. “We’re looking for the same three top priorities that Kaiser already said ‘Yes’ to for our Northern California mental healthcare workers.”\u003c/p>\n\u003cp>Johnson said his current workload includes seeing 32 to 35 patients a week in one-hour sessions.\u003c/p>\n\u003cp>Kaiser released a statement in response to the union’s plans to strike, saying, “Unfortunately, this comes as no surprise, as this seems to have been their intention all along.”\u003c/p>\n\u003cp>The company has offered wage increases amounting to 18% over four years and a number of other perks, according to the statement. Kaiser representatives said they have invested more than a billion dollars in expanding mental health capabilities in California and increased the number of licensed mental health clinicians in Southern California by 30% over the past four years.\u003c/p>\n\u003cp>However, union members say \u003ca href=\"https://calmatters.org/health/2024/10/kaiser-permanente-strike-mental-health/\" target=\"_blank\" rel=\"noreferrer noopener\">turnover has been a problem\u003c/a>, with a quarter of therapists hired between January 2021 and August 2024 leaving their jobs. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Kaiser leadership has consistently been dismissive whenever we voice our concerns or experiences,” Johnson said. “They like to tell us things like, ‘We get that it’s not ideal,’ and they also add, ‘But it works for us.’”\u003c/p>\n\u003cp>Jared Garcia, another union steward on the bargaining committee, said he’s hoping the strike lasts less than a month, but he’s prepared to see it go on as long as it takes.\u003c/p>\n\u003cp>“Scabs aren’t going to work,” Garcia said. “Kaiser knows the limitations of finding mental health professionals — let alone to replace 2,400 of our union members at this time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A year ago, Kaiser entered into a \u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\" target=\"_blank\" rel=\"noreferrer noopener\">$200 million settlement agreement \u003c/a>with the state of California, agreeing to pay a $50 million fine and invest another $150 million over five years to address delays in behavioral health appointments.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "California's 'Groundbreaking' Mental Health Law Faces Scrutiny",
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"content": "\u003cp>Three years ago, California leaders passed legislation that promised \u003ca href=\"https://calmatters.org/health/2020/08/california-leader-mental-health/\">the most dramatic expansion \u003c/a>of mental health and addiction care coverage in decades.\u003c/p>\n\u003cp>As the state’s residents struggled with the stress and trauma of a raging pandemic and a record wildfire season, mental health advocates used words like “groundbreaking” to describe the new law. Finally, they said, California was poised to become a national leader in mental health.\u003c/p>\n\u003cp>Their optimism about that law, Senate Bill 855, has been fraying ever since. Advocates say health plans routinely fail to ensure enough mental health providers accept their coverage, making patients wait too long before being seen.\u003c/p>\n\u003cp>Case in point: Last week, the Department of Managed Health Care unveiled news of a historic $200 million settlement with Kaiser Permanente for failing to provide patients with\u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\"> timely mental health appointments\u003c/a>, among other issues.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Such issues will take center stage on Wednesday at a \u003ca href=\"https://www.senate.ca.gov/mental-health-and-addiction\">special oversight hearing\u003c/a> of the Senate Select Committee on Mental Health and Addiction.\u003c/p>\n\u003cp>Democratic state Sen. Scott Wiener of San Francisco, chair of the committee and author of the California Mental Health Parity Act, says he shares many of the mental health advocates’ concerns. [pullquote size=\"medium\" align=\"right\" citation=\"Sen. Scott Wiener, D-San Francisco\"]‘We know the plans have a long history of finding ways not to cover mental health treatment. The whole purpose of this law is to put an end to that.’[/pullquote] “We know the plans have a long history of finding ways not to cover mental health treatment,” he told CalMatters. “The whole purpose of this law is to put an end to that.”\u003c/p>\n\u003cp>Before the passage of the 2020 law, the state only required health plans to cover medically necessary treatment of nine serious mental illnesses. For years, mental health advocates have tried and failed to \u003ca href=\"https://calmatters.org/projects/california-mental-health-care-parity/\">expand that list\u003c/a>. With Wiener’s law, they were finally triumphant.\u003c/p>\n\u003cp>Beginning in January 2021, the state has required plans to pay for treatment of a much more extensive array of mental health issues, along with substance use disorder and addiction. This state law is separate from a \u003ca href=\"https://www.apa.org/topics/managed-care-insurance/parity-law-resources\">federal mental health parity\u003c/a> law passed in 2008. The concept of “parity” refers to requiring insurers to treat mental and physical health conditions equally.\u003c/p>\n\u003cp>Health plans say they “have been diligently working in good faith” to comply with these laws while facing industry-wide challenges like workforce shortages. They say they are navigating guidelines that are ambiguous and uneven while waiting for the Department of Managed Health Care to finalize regulations.\u003c/p>\n\u003cp>“This creates a situation of moving goalposts for plans, providers, and our enrollees,” said Mary Ellen Grant, spokesperson for the California Association of Health Plans, in an email.\u003c/p>\n\u003ch2>Mental health parity investigations\u003c/h2>\n\u003cp>Mental health advocates have also long criticized the Department of Managed Health Care, which oversees health plans in the state that receive monthly fees to provide health care for their members. And they, too, are concerned that it’s taking so long for the official rules to be decided.\u003c/p>\n\u003cp>This summer, more than a dozen advocacy groups signed a letter of concern to the department, questioning its commitment to enforcing some aspects of\u003ca href=\"https://steinberginstitute.org/wp-content/uploads/2023/08/Comments-to-DMHC-on-BH-Investigations_DRAFT.pdf\"> the new state parity law\u003c/a>. The organizations want the department to publish and publicize its investigations.\u003c/p>\n\u003cp>“It’s still a relatively secret process,” said Lauren Finke, a policy director at The Kennedy Forum, a national organization that cosponsored California’s parity legislation.\u003c/p>\n\u003cfigure id=\"attachment_11964805\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11964805\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-800x533.jpg\" alt=\"Kaiser workers on strike in front of a building.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kaiser workers strike in front of the Kaiser Permanente Oakland Medical Center in Oakland on Oct. 2, 2023. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Managed Health Care declined to make anyone available to speak with CalMatters until later this fall. In an email, a representative said the department “is committed to ensuring enrollees have appropriate access to behavioral health care when they need it.”\u003c/p>\n\u003cp>In response to advocates’ critiques that the department isn’t adequately analyzing and publicizing how well plans are complying with state parity law, the department said in a statement that it is evaluating health plans’ compliance in other ways; including that analysis in the behavioral health investigations would slow them down too much, the statement said. [pullquote size=\"medium\" align=\"right\" citation=\"Meiram Bendat, attorney and psychotherapist, Santa Barbara\"]‘The historic network inadequacy around the state and the lack of meaningful fines, that’s a real failure on the part of the department.’[/pullquote] Meiram Bendat, a Santa Barbara attorney and psychotherapist who focuses on mental health parity, says that the three-year-old state law has improved patients’ ability to receive mental health care by creating a uniform definition of what is considered “medically necessary.”\u003c/p>\n\u003cp>But when it comes to ensuring that health plans maintain adequate provider networks, he said, the department is “failing miserably.” Too often, plans offer their members only outdated lists of providers who then prove to be unavailable, Bendat said. The Department of Managed Health Care hasn’t adequately held plans accountable for this and other problematic practices, he said.\u003c/p>\n\u003cp>“The historic network inadequacy around the state and the lack of meaningful fines, that’s a real failure on the part of the department,” he said.\u003c/p>\n\u003ch2>Kaiser mental health settlement\u003c/h2>\n\u003cp>Finke, of The Kennedy Forum, called the Kaiser settlement “long overdue” and “a very important first step in the Department holding plans more accountable for their performance [or lack thereof].” The settlement includes a $50 million fine and corrective action plan as well as a commitment by Kaiser to invest an additional $150 million over five years to improve behavioral health services. [aside label='More on Around California' tag='california-law'] But Finke and others also said the settlement itself provides evidence of the department’s failures to enforce a previous \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/2895/1500394196511.pdf\">settlement agreement\u003c/a> with Kaiser from 2017.\u003c/p>\n\u003cp>“Will DMHC do its job going forward? That’s the big question,” asked Fred Seavey, research director for the National Union of Healthcare Workers. The union represents 2,000 Kaiser mental health workers in Northern California who undertook a 10-week strike last year over heavy clinician workloads and long wait times for appointments.\u003c/p>\n\u003cp>He said he wrote complaints to the Department of Managed Health Care earlier this year, saying that Kaiser in Southern California has been illegally restricting the scope of behavioral health services.\u003c/p>\n\u003cp>Kaiser said, in an emailed statement, that “any accusation that we intentionally limit or restrict needed care is untrue.”\u003c/p>\n\u003cp>Southern California Kaiser members receive a wide range of behavioral health clinical offerings, the statement said. Despite a statewide shortage of clinicians, Kaiser is “doing all that we can” to expand its network of mental health providers.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three years ago, California leaders passed legislation that promised \u003ca href=\"https://calmatters.org/health/2020/08/california-leader-mental-health/\">the most dramatic expansion \u003c/a>of mental health and addiction care coverage in decades.\u003c/p>\n\u003cp>As the state’s residents struggled with the stress and trauma of a raging pandemic and a record wildfire season, mental health advocates used words like “groundbreaking” to describe the new law. Finally, they said, California was poised to become a national leader in mental health.\u003c/p>\n\u003cp>Their optimism about that law, Senate Bill 855, has been fraying ever since. Advocates say health plans routinely fail to ensure enough mental health providers accept their coverage, making patients wait too long before being seen.\u003c/p>\n\u003cp>Case in point: Last week, the Department of Managed Health Care unveiled news of a historic $200 million settlement with Kaiser Permanente for failing to provide patients with\u003ca href=\"https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/\"> timely mental health appointments\u003c/a>, among other issues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Such issues will take center stage on Wednesday at a \u003ca href=\"https://www.senate.ca.gov/mental-health-and-addiction\">special oversight hearing\u003c/a> of the Senate Select Committee on Mental Health and Addiction.\u003c/p>\n\u003cp>Democratic state Sen. Scott Wiener of San Francisco, chair of the committee and author of the California Mental Health Parity Act, says he shares many of the mental health advocates’ concerns. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> “We know the plans have a long history of finding ways not to cover mental health treatment,” he told CalMatters. “The whole purpose of this law is to put an end to that.”\u003c/p>\n\u003cp>Before the passage of the 2020 law, the state only required health plans to cover medically necessary treatment of nine serious mental illnesses. For years, mental health advocates have tried and failed to \u003ca href=\"https://calmatters.org/projects/california-mental-health-care-parity/\">expand that list\u003c/a>. With Wiener’s law, they were finally triumphant.\u003c/p>\n\u003cp>Beginning in January 2021, the state has required plans to pay for treatment of a much more extensive array of mental health issues, along with substance use disorder and addiction. This state law is separate from a \u003ca href=\"https://www.apa.org/topics/managed-care-insurance/parity-law-resources\">federal mental health parity\u003c/a> law passed in 2008. The concept of “parity” refers to requiring insurers to treat mental and physical health conditions equally.\u003c/p>\n\u003cp>Health plans say they “have been diligently working in good faith” to comply with these laws while facing industry-wide challenges like workforce shortages. They say they are navigating guidelines that are ambiguous and uneven while waiting for the Department of Managed Health Care to finalize regulations.\u003c/p>\n\u003cp>“This creates a situation of moving goalposts for plans, providers, and our enrollees,” said Mary Ellen Grant, spokesperson for the California Association of Health Plans, in an email.\u003c/p>\n\u003ch2>Mental health parity investigations\u003c/h2>\n\u003cp>Mental health advocates have also long criticized the Department of Managed Health Care, which oversees health plans in the state that receive monthly fees to provide health care for their members. And they, too, are concerned that it’s taking so long for the official rules to be decided.\u003c/p>\n\u003cp>This summer, more than a dozen advocacy groups signed a letter of concern to the department, questioning its commitment to enforcing some aspects of\u003ca href=\"https://steinberginstitute.org/wp-content/uploads/2023/08/Comments-to-DMHC-on-BH-Investigations_DRAFT.pdf\"> the new state parity law\u003c/a>. The organizations want the department to publish and publicize its investigations.\u003c/p>\n\u003cp>“It’s still a relatively secret process,” said Lauren Finke, a policy director at The Kennedy Forum, a national organization that cosponsored California’s parity legislation.\u003c/p>\n\u003cfigure id=\"attachment_11964805\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11964805\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-800x533.jpg\" alt=\"Kaiser workers on strike in front of a building.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/10/231004-KAISER-STRIKE-MD-03-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kaiser workers strike in front of the Kaiser Permanente Oakland Medical Center in Oakland on Oct. 2, 2023. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Managed Health Care declined to make anyone available to speak with CalMatters until later this fall. In an email, a representative said the department “is committed to ensuring enrollees have appropriate access to behavioral health care when they need it.”\u003c/p>\n\u003cp>In response to advocates’ critiques that the department isn’t adequately analyzing and publicizing how well plans are complying with state parity law, the department said in a statement that it is evaluating health plans’ compliance in other ways; including that analysis in the behavioral health investigations would slow them down too much, the statement said. \u003c/p>\u003c/div>",
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"content": "‘The historic network inadequacy around the state and the lack of meaningful fines, that’s a real failure on the part of the department.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Meiram Bendat, a Santa Barbara attorney and psychotherapist who focuses on mental health parity, says that the three-year-old state law has improved patients’ ability to receive mental health care by creating a uniform definition of what is considered “medically necessary.”\u003c/p>\n\u003cp>But when it comes to ensuring that health plans maintain adequate provider networks, he said, the department is “failing miserably.” Too often, plans offer their members only outdated lists of providers who then prove to be unavailable, Bendat said. The Department of Managed Health Care hasn’t adequately held plans accountable for this and other problematic practices, he said.\u003c/p>\n\u003cp>“The historic network inadequacy around the state and the lack of meaningful fines, that’s a real failure on the part of the department,” he said.\u003c/p>\n\u003ch2>Kaiser mental health settlement\u003c/h2>\n\u003cp>Finke, of The Kennedy Forum, called the Kaiser settlement “long overdue” and “a very important first step in the Department holding plans more accountable for their performance [or lack thereof].” The settlement includes a $50 million fine and corrective action plan as well as a commitment by Kaiser to invest an additional $150 million over five years to improve behavioral health services. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> But Finke and others also said the settlement itself provides evidence of the department’s failures to enforce a previous \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/2895/1500394196511.pdf\">settlement agreement\u003c/a> with Kaiser from 2017.\u003c/p>\n\u003cp>“Will DMHC do its job going forward? That’s the big question,” asked Fred Seavey, research director for the National Union of Healthcare Workers. The union represents 2,000 Kaiser mental health workers in Northern California who undertook a 10-week strike last year over heavy clinician workloads and long wait times for appointments.\u003c/p>\n\u003cp>He said he wrote complaints to the Department of Managed Health Care earlier this year, saying that Kaiser in Southern California has been illegally restricting the scope of behavioral health services.\u003c/p>\n\u003cp>Kaiser said, in an emailed statement, that “any accusation that we intentionally limit or restrict needed care is untrue.”\u003c/p>\n\u003cp>Southern California Kaiser members receive a wide range of behavioral health clinical offerings, the statement said. Despite a statewide shortage of clinicians, Kaiser is “doing all that we can” to expand its network of mental health providers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Some 2,000 Kaiser Permanente mental health care employees in Northern California are returning to work after voting almost unanimously to ratify a new contract on Thursday, ending a grueling 10-week standoff over staffing shortages, wages and patient care.\u003c/p>\n\u003cp>The four-year contract gives therapists nearly two hours of additional time per week to respond to patient emails, contact social service agencies and perform other administrative tasks. The deal also includes a commitment from Kaiser to hire more therapists, improve access to treatment for patients and increase initial consultation times for children.\u003c/p>\n\u003cp>“It took much longer than it should have to reach this agreement, but, in the end, we succeeded in securing important improvements in patient care that Kaiser negotiators told us across the bargaining table that they’d never agree to,” Jennifer Browning, a Kaiser social worker who served on the bargaining committee, said in a statement.[aside label=\"related coverage\" tag=\"kaiser-strike\"]The hard-fought deal between the Oakland-based health care giant and the National Union of Healthcare Workers — the union representing Kaiser therapists, social workers, chemical dependency counselors and other mental health staffers in the Bay Area and Central Valley — \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/tentative-agreement-reached-with-nuhw-to-end-strike\">was reached earlier this week\u003c/a> after Sacramento Mayor Darrell Steinberg stepped in to mediate. Thursday’s official approval of the agreement ends the longest strike among mental health care workers in U.S. history, according to the union.\u003c/p>\n\u003cp>In a statement, Kaiser officials said they were “very pleased at the outcome” of the vote. \u003c/p>\n\u003cp>“We appreciate our therapists’ confidence in this agreement, which addresses the concerns they expressed, while upholding Kaiser Permanente’s commitment that any agreement must protect and enhance access to mental health for our members,” the statement said. “We are glad to have all our employees back, caring for their patients.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">Workers first walked out on August 15\u003c/a>, amid accounts of widespread burnout, retention issues and unsafe therapist-to-client ratios — sometimes resulting in patients having to wait as long as three months to see a therapist, workers said. \u003c/p>\n\u003cp>Early on in the strike, Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, said burnout and poor working conditions were contributing to dismal retention rates among employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” Marcucci-Morris \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking\">told KQED’s Forum in August\u003c/a>. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical.”\u003c/p>\n\u003cp>Pressure mounted on Kaiser to resolve the impasse, as striking workers garnered support from notable state lawmakers, including Lt. Governor Eleni Kounalakis, state Senate President Pro Tempore Toni Atkins, state Sen. Scott Wiener (D-San Francisco), and Assembly Speaker Anthony Rendon.\u003c/p>\n\u003cp>“The day is going to come where the people of this country … truly have access to behavioral health care and mental health care that they need, that they deserve,” NUHW President Sal Rosselli told striking workers last Friday, speaking from the steps of Kaiser’s downtown Oakland offices, after announcing that Steinberg had agreed to mediate. “And when that day comes, historians are going to point to this strike, this union strike, as the catalyst that made it happen.”\u003c/p>\n\u003cp>Natalie Rogers, a Kaiser therapist in Santa Rosa, was among scores of employees who breathed a collective sigh of relief on Thursday, after not receiving any compensation for 10 weeks.\u003c/p>\n\u003cp>“I think we are all happy that we are going back to work. As you could imagine, it was definitely a financial strain, and an emotional strain,” Rogers said. “But I think that we have formed a unity like no other. I think that we now know … what we are capable of doing if we stick together.”\u003c/p>\n\u003cp>And because of that, she added, morale will be higher. “We will have the support from one another that we need to help push Kaiser to where we feel our patients will get the best care,” she said.\u003c/p>\n\u003cp>\u003ci>This story includes reporting from KQED’s Lesley McClurg.\u003c/i>\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some 2,000 Kaiser Permanente mental health care employees in Northern California are returning to work after voting almost unanimously to ratify a new contract on Thursday, ending a grueling 10-week standoff over staffing shortages, wages and patient care.\u003c/p>\n\u003cp>The four-year contract gives therapists nearly two hours of additional time per week to respond to patient emails, contact social service agencies and perform other administrative tasks. The deal also includes a commitment from Kaiser to hire more therapists, improve access to treatment for patients and increase initial consultation times for children.\u003c/p>\n\u003cp>“It took much longer than it should have to reach this agreement, but, in the end, we succeeded in securing important improvements in patient care that Kaiser negotiators told us across the bargaining table that they’d never agree to,” Jennifer Browning, a Kaiser social worker who served on the bargaining committee, said in a statement.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The hard-fought deal between the Oakland-based health care giant and the National Union of Healthcare Workers — the union representing Kaiser therapists, social workers, chemical dependency counselors and other mental health staffers in the Bay Area and Central Valley — \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/tentative-agreement-reached-with-nuhw-to-end-strike\">was reached earlier this week\u003c/a> after Sacramento Mayor Darrell Steinberg stepped in to mediate. Thursday’s official approval of the agreement ends the longest strike among mental health care workers in U.S. history, according to the union.\u003c/p>\n\u003cp>In a statement, Kaiser officials said they were “very pleased at the outcome” of the vote. \u003c/p>\n\u003cp>“We appreciate our therapists’ confidence in this agreement, which addresses the concerns they expressed, while upholding Kaiser Permanente’s commitment that any agreement must protect and enhance access to mental health for our members,” the statement said. “We are glad to have all our employees back, caring for their patients.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">Workers first walked out on August 15\u003c/a>, amid accounts of widespread burnout, retention issues and unsafe therapist-to-client ratios — sometimes resulting in patients having to wait as long as three months to see a therapist, workers said. \u003c/p>\n\u003cp>Early on in the strike, Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, said burnout and poor working conditions were contributing to dismal retention rates among employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” Marcucci-Morris \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking\">told KQED’s Forum in August\u003c/a>. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical.”\u003c/p>\n\u003cp>Pressure mounted on Kaiser to resolve the impasse, as striking workers garnered support from notable state lawmakers, including Lt. Governor Eleni Kounalakis, state Senate President Pro Tempore Toni Atkins, state Sen. Scott Wiener (D-San Francisco), and Assembly Speaker Anthony Rendon.\u003c/p>\n\u003cp>“The day is going to come where the people of this country … truly have access to behavioral health care and mental health care that they need, that they deserve,” NUHW President Sal Rosselli told striking workers last Friday, speaking from the steps of Kaiser’s downtown Oakland offices, after announcing that Steinberg had agreed to mediate. “And when that day comes, historians are going to point to this strike, this union strike, as the catalyst that made it happen.”\u003c/p>\n\u003cp>Natalie Rogers, a Kaiser therapist in Santa Rosa, was among scores of employees who breathed a collective sigh of relief on Thursday, after not receiving any compensation for 10 weeks.\u003c/p>\n\u003cp>“I think we are all happy that we are going back to work. As you could imagine, it was definitely a financial strain, and an emotional strain,” Rogers said. “But I think that we have formed a unity like no other. I think that we now know … what we are capable of doing if we stick together.”\u003c/p>\n\u003cp>And because of that, she added, morale will be higher. “We will have the support from one another that we need to help push Kaiser to where we feel our patients will get the best care,” she said.\u003c/p>\n\u003cp>\u003ci>This story includes reporting from KQED’s Lesley McClurg.\u003c/i>\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>The union representing Kaiser Permanente mental health care workers in Northern California on Tuesday reached a tentative four-year agreement with the health care giant, potentially ending a two-month strike among thousands of workers.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"kaiser-strike\"]The tentative agreement would benefit patients and “drive collaborative efforts aimed at improving access to mental health care, while at the same time recognizing and better supporting mental health therapists” in their work, according to a \u003ca href=\"https://twitter.com/NUHW/status/1582454798242050053\">joint statement by Kaiser and the National Union of Healthcare Workers (NUHW)\u003c/a>.\u003c/p>\n\u003cp>“The day is going to come where the people of this country … truly have access to behavioral health care and mental health care that they need, that they deserve,” NUHW President Sal Rosselli told striking workers on Friday, speaking from the steps of Kaiser’s downtown Oakland offices, where he announced that Sacramento Mayor Darrell Steinberg had agreed to mediate negotiations. “And when that day comes, historians are going to point to this strike, this union strike, as the catalyst that made it happen.”\u003c/p>\n\u003cp>“The day is going to come where the term ‘mental health care’ no longer exists — it’s simply ‘health care,’ because of your sacrifice,” Rosselli added.\u003c/p>\n\u003cp>https://twitter.com/HeterodoxThis/status/1582471048334671872\u003c/p>\n\u003cp>Some 2,000 Kaiser Bay Area and Central Valley mental health workers — including therapists, social workers and chemical dependency counselors — \u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">began their open-ended strike on August 15\u003c/a>, to ask for increased staffing, a wage hike and better health care access for patients. Striking employees described widespread burnout, retention issues and unsafe therapist-to-client ratios that meant patients sometimes had to wait as long as three months to see a therapist.\u003c/p>\n\u003cp>Early on in the strike, Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking\">told KQED’s Forum\u003c/a> that there were 2,600 patients for every mental health worker in the Northern California Kaiser system. She said burnout and poor working conditions were contributing to dismal retention rates among employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” Marcucci-Morris said. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical.”\u003c/p>\n\u003cp>Union leaders \u003ca href=\"https://www.kqed.org/news/11925882/one-month-into-grinding-strike-negotiations-break-down-between-kaiser-permanente-and-mental-health-workers\">rejected a previous contract\u003c/a> offer from Kaiser last month that included wage increases, but did not meet the union’s demands for increased staffing and more time allotted for administrative work.\u003c/p>\n\u003cp>The striking workers garnered support over the last two months from notable state lawmakers including Lt. Governor Eleni Kounalakis, state Senate President Pro Tempore Toni Atkins, state Sen. Scott Wiener (D-San Francisco), and Assembly Speaker Anthony Rendon.\u003c/p>\n\u003cp>More details on the tentative agreement are expected to be available after a two-day ratification vote among workers later this week.\u003c/p>\n\u003cp>\u003ci>This story includes reporting from KQED’s Emma Silvers and Matthew Green, and Bay City News.\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The union representing Kaiser Permanente mental health care workers in Northern California on Tuesday reached a tentative four-year agreement with the health care giant, potentially ending a two-month strike among thousands of workers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The tentative agreement would benefit patients and “drive collaborative efforts aimed at improving access to mental health care, while at the same time recognizing and better supporting mental health therapists” in their work, according to a \u003ca href=\"https://twitter.com/NUHW/status/1582454798242050053\">joint statement by Kaiser and the National Union of Healthcare Workers (NUHW)\u003c/a>.\u003c/p>\n\u003cp>“The day is going to come where the people of this country … truly have access to behavioral health care and mental health care that they need, that they deserve,” NUHW President Sal Rosselli told striking workers on Friday, speaking from the steps of Kaiser’s downtown Oakland offices, where he announced that Sacramento Mayor Darrell Steinberg had agreed to mediate negotiations. “And when that day comes, historians are going to point to this strike, this union strike, as the catalyst that made it happen.”\u003c/p>\n\u003cp>“The day is going to come where the term ‘mental health care’ no longer exists — it’s simply ‘health care,’ because of your sacrifice,” Rosselli added.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Some 2,000 Kaiser Bay Area and Central Valley mental health workers — including therapists, social workers and chemical dependency counselors — \u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">began their open-ended strike on August 15\u003c/a>, to ask for increased staffing, a wage hike and better health care access for patients. Striking employees described widespread burnout, retention issues and unsafe therapist-to-client ratios that meant patients sometimes had to wait as long as three months to see a therapist.\u003c/p>\n\u003cp>Early on in the strike, Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking\">told KQED’s Forum\u003c/a> that there were 2,600 patients for every mental health worker in the Northern California Kaiser system. She said burnout and poor working conditions were contributing to dismal retention rates among employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” Marcucci-Morris said. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical.”\u003c/p>\n\u003cp>Union leaders \u003ca href=\"https://www.kqed.org/news/11925882/one-month-into-grinding-strike-negotiations-break-down-between-kaiser-permanente-and-mental-health-workers\">rejected a previous contract\u003c/a> offer from Kaiser last month that included wage increases, but did not meet the union’s demands for increased staffing and more time allotted for administrative work.\u003c/p>\n\u003cp>The striking workers garnered support over the last two months from notable state lawmakers including Lt. Governor Eleni Kounalakis, state Senate President Pro Tempore Toni Atkins, state Sen. Scott Wiener (D-San Francisco), and Assembly Speaker Anthony Rendon.\u003c/p>\n\u003cp>More details on the tentative agreement are expected to be available after a two-day ratification vote among workers later this week.\u003c/p>\n\u003cp>\u003ci>This story includes reporting from KQED’s Emma Silvers and Matthew Green, and Bay City News.\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Negotiations between Kaiser Permanente and the union representing its mental health care workers collapsed Wednesday night, \u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">one month into a strike\u003c/a> that still has no end in sight.\u003c/p>\n\u003cp>The National Union of Healthcare Workers, which represents some 2,000 Kaiser psychologists, therapists, social workers and chemical dependency counselors in Northern California, said in a statement that Kaiser refused to consider proposals to increase staffing and provide therapists with additional time to complete crucial administrative work. The union has also demanded the company cap caseloads if therapists are unable to see patients as quickly as state law requires.\u003c/p>\n\u003cp>Kaiser declined to schedule future bargaining sessions, leaving workers and their many thousands of patients in an ongoing state of limbo, union officials said.\u003c/p>\n\u003cp>“It’s so frustrating to be on the front lines of a mental health crisis only to have your employer be in complete denial about it,” Matt Hannon, a Kaiser psychologist in South San Francisco, and a member of the union’s bargaining committee, said in a statement. “Kaiser officials showed once again that they have no interest in providing timely mental health care that complies with state law or meets the needs of patients.”\u003c/p>\n\u003cp>Kaiser said in a statement that it has already made extensive compromises, including concessions on pay, and that the union is essentially pushing for its workers to spend less time with patients in need.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"kaiser-permanente\"]“Frustratingly, NUHW leadership continued to refuse to resolve any remaining issues or acknowledge how far Kaiser Permanente has already moved for the sake of reaching agreement,” a spokesperson for the Oakland-based company said.\u003c/p>\n\u003cp>But the union emphasizes that the ongoing fight is about staffing resources, not compensation, noting that it already agreed to Kaiser’s wage-increase offer. It argues that Kaiser has failed to meaningfully address the severe mental health staffing shortages at its facilities that have resulted in massive turnover rates among workers and excessive wait times for patients.\u003c/p>\n\u003cp>The union has also accused the company of not providing its mental health patients timely access to services during the strike, in violation of state law, a claim currently under investigation.\u003c/p>\n\u003cp>The California Department of Managed Health Care said in a statement that it is “concerned about the potential for immediate harm to enrollees based on the very serious nature of allegations that the plan is not providing timely appointments to enrollees required by the law.”\u003c/p>\n\u003cp>As part of their investigation, state regulators are assessing whether Kaiser made sufficient arrangements to provide out-of-network services to patients in anticipation of the strike.\u003c/p>\n\u003cp>When the investigation was announced, the health care giant said it was in the process of reaching agreements with hundreds of community-based mental health care providers to partially fill the void left by striking workers.\u003c/p>\n\u003cp>Kaiser also said it is aggressively working to recruit and hire more therapists.\u003c/p>\n\u003cp>But Fred Seavey, a NUHW research director, told KQED last month that Kaiser has a history of failing to provide timely care, even though it has the resources to do so.\u003c/p>\n\u003cp>“Members are paying their premiums. They deserve to receive the care that they need and they paid for,” Seavey said. “If an HMO doesn’t have enough providers available, then it must arrange for members to get care from out-of-network providers at no additional cost to the member.”\u003c/p>\n\u003cp>Union members say they are determined to keep striking until Kaiser makes more concessions, but as the strike enters its second month, and workers remain unpaid, many are feeling the financial impact of not receiving their paychecks.\u003c/p>\n\u003cp>“It’s been a hard month, but going without a paycheck is nothing compared to what our patients have endured for years at Kaiser waiting months between therapy sessions,” Kimberly Hollingsworth-Hornor, a Kaiser therapist in Fresno and bargaining committee member, said in a statement. “We are going to keep striking until Kaiser stops gambling with patient lives and works with therapists to create a system that provides patients the care they need to get better.”\u003c/p>\n\u003cp>\u003ci>KQED’s Sara Hossaini contributed reporting to this story.\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Negotiations between Kaiser Permanente and the union representing its mental health care workers collapsed Wednesday night, \u003ca href=\"https://www.kqed.org/news/11922524/kaiser-mental-health-workers-in-northern-california-begin-open-ended-strike-over-staffing-shortages\">one month into a strike\u003c/a> that still has no end in sight.\u003c/p>\n\u003cp>The National Union of Healthcare Workers, which represents some 2,000 Kaiser psychologists, therapists, social workers and chemical dependency counselors in Northern California, said in a statement that Kaiser refused to consider proposals to increase staffing and provide therapists with additional time to complete crucial administrative work. The union has also demanded the company cap caseloads if therapists are unable to see patients as quickly as state law requires.\u003c/p>\n\u003cp>Kaiser declined to schedule future bargaining sessions, leaving workers and their many thousands of patients in an ongoing state of limbo, union officials said.\u003c/p>\n\u003cp>“It’s so frustrating to be on the front lines of a mental health crisis only to have your employer be in complete denial about it,” Matt Hannon, a Kaiser psychologist in South San Francisco, and a member of the union’s bargaining committee, said in a statement. “Kaiser officials showed once again that they have no interest in providing timely mental health care that complies with state law or meets the needs of patients.”\u003c/p>\n\u003cp>Kaiser said in a statement that it has already made extensive compromises, including concessions on pay, and that the union is essentially pushing for its workers to spend less time with patients in need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Frustratingly, NUHW leadership continued to refuse to resolve any remaining issues or acknowledge how far Kaiser Permanente has already moved for the sake of reaching agreement,” a spokesperson for the Oakland-based company said.\u003c/p>\n\u003cp>But the union emphasizes that the ongoing fight is about staffing resources, not compensation, noting that it already agreed to Kaiser’s wage-increase offer. It argues that Kaiser has failed to meaningfully address the severe mental health staffing shortages at its facilities that have resulted in massive turnover rates among workers and excessive wait times for patients.\u003c/p>\n\u003cp>The union has also accused the company of not providing its mental health patients timely access to services during the strike, in violation of state law, a claim currently under investigation.\u003c/p>\n\u003cp>The California Department of Managed Health Care said in a statement that it is “concerned about the potential for immediate harm to enrollees based on the very serious nature of allegations that the plan is not providing timely appointments to enrollees required by the law.”\u003c/p>\n\u003cp>As part of their investigation, state regulators are assessing whether Kaiser made sufficient arrangements to provide out-of-network services to patients in anticipation of the strike.\u003c/p>\n\u003cp>When the investigation was announced, the health care giant said it was in the process of reaching agreements with hundreds of community-based mental health care providers to partially fill the void left by striking workers.\u003c/p>\n\u003cp>Kaiser also said it is aggressively working to recruit and hire more therapists.\u003c/p>\n\u003cp>But Fred Seavey, a NUHW research director, told KQED last month that Kaiser has a history of failing to provide timely care, even though it has the resources to do so.\u003c/p>\n\u003cp>“Members are paying their premiums. They deserve to receive the care that they need and they paid for,” Seavey said. “If an HMO doesn’t have enough providers available, then it must arrange for members to get care from out-of-network providers at no additional cost to the member.”\u003c/p>\n\u003cp>Union members say they are determined to keep striking until Kaiser makes more concessions, but as the strike enters its second month, and workers remain unpaid, many are feeling the financial impact of not receiving their paychecks.\u003c/p>\n\u003cp>“It’s been a hard month, but going without a paycheck is nothing compared to what our patients have endured for years at Kaiser waiting months between therapy sessions,” Kimberly Hollingsworth-Hornor, a Kaiser therapist in Fresno and bargaining committee member, said in a statement. “We are going to keep striking until Kaiser stops gambling with patient lives and works with therapists to create a system that provides patients the care they need to get better.”\u003c/p>\n\u003cp>\u003ci>KQED’s Sara Hossaini contributed reporting to this story.\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>On Friday, the fifth day of an open-ended strike by Kaiser Permanente mental health workers across Northern California, some 200 employees and supporters marched to the health care giant’s Oakland headquarters, demanding that management increase staffing and resources.\u003c/p>\n\u003cp>They were among the roughly 2,000 Kaiser therapists, social workers and other mental health care staffers across Northern California — represented by the National Union of Healthcare Workers — who formed picket lines outside Kaiser facilities this week, after negotiations with management ended without resolution last weekend. Those striking said employee morale is dangerously low and patient care has become substandard due to long wait times for treatment. [aside label=\"Related Stories\" postID=\"news_11922524,news_11922748,news_11921580\"] Kaiser officials have called the strike unethical to patients and counterproductive, pointing to the shortage of mental health professionals nationwide. A company representative declined to participate in an interview, citing ongoing negotiations.\u003c/p>\n\u003cp class=\"p1\">But in a statement issued Friday, Deb Catsavas, senior vice president of human resources at Kaiser Permanente Northern California, reiterated the company’s stance that the strike and “disruption to patient care” were unnecessary.\u003c/p>\n\u003cp class=\"p1\">“While [the National Union of Healthcare Workers] claims it is fighting for increased access to care, its primary demand is for union members to spend less time seeing patients,” said Catsavas. “Our patients cannot afford a proposal that significantly reduces the time available to care for our patients and their mental health needs.”\u003c/p>\n\u003cp>The strike comes amid what the White House has described as an unprecedented mental health crisis among Americans of all ages.\u003c/p>\n\u003ch2>Why are Kaiser mental health care workers striking?\u003c/h2>\n\u003cp>“We’re striking because it’s demoralizing to work for a company that actively does things to capitalize on burnout,” Naomi Johnson, an associate clinical social worker for Kaiser, told KQED Forum. “We’re really working very hard as clinicians to try to see patients as frequently as we can, and to provide the care that we’re trained [for] and good at providing. And we’re not supported in doing that by the company.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kaiser tells patients that “if you have any sort of concerns or you want to come to therapy, please reach out,” added Johnson. “And then as providers, we’re told, ‘Only treat people who meet medical necessity.’ So it’s really difficult because we have this huge influx of people trying to seek services, but there aren’t enough of us to actually meet the demand, so we’re just completely overwhelmed. … We’re drowning, as clinicians.”\u003c/p>\n\u003cfigure id=\"attachment_11923078\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923078\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"a protest\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers rally before a march from Oakland Kaiser Medical Center to Kaiser’s corporate headquarters on Friday, Aug. 19, 2022, the fifth day of an open-ended strike. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>How does understaffing affect patients seeking treatment?\u003c/h2>\n\u003cp>“There are currently 2,600 Kaiser patients for every mental health worker in (the) Northern California Kaiser system,” Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, told Forum. That means the average Kaiser therapist sees between seven and 12 patients per day, while someone in private practice might see between three and six. After a series of initial intake calls, the majority of Kaiser patients calling with a “nonurgent” need wait between two and three months to see a therapist.\u003c/p>\n\u003cp>The National Union of Healthcare Workers points to \u003ca href=\"https://nuhw.org/more-than-2000-kaiser-permanente-mental-health-clinicians-to-start-open-ended-strike-august-15/\">internal Kaiser documents illustrating\u003c/a> that “patients who received an initial mental health assessment on June 13 weren’t scheduled for follow-up appointments for a month in San Francisco, more than two months in Sacramento and three months or more in other parts of Northern California.” That length of time, experts say, does a disservice to those who have already taken the often-difficult first step of seeking support.\u003c/p>\n\u003cp>“The goal is to help people get better and terminate,” said Marcucci-Morris. “But the system within Kaiser does not allow for that. It’s the opposite. People are waiting longer, and deteriorating to where they either give up and pay [for therapy] out of pocket, which sets up a system for folks who have those resources to pay a private practice therapist and get better.” She said people who can’t afford private therapy and insurance premiums aren’t able to get better. “They get worse and they stay in Kaiser and they just stay sick,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11923083\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923083\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"protestors reflected in a bus window\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers and supporters hold signs on the picket line outside Oakland Kaiser Medical Center. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>What is causing the understaffing?\u003c/h2>\n\u003cp>Kaiser administrators point to what they describe as a nationwide staffing shortage. “Across the country, there are not enough mental health care professionals to meet the increased demand for care,” said Kaiser’s Catsavas in an Aug. 15 statement. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”\u003c/p>\n\u003cp>Company administrators say they have worked to combat the shortage by hiring new mental health clinicians, including nearly 200 new clinicians since January 2021; improving mental health care access through virtual care; and launching a $500,000 initiative to recruit new employees.[pullquote align=\"right\" size=\"medium\" citation=\"Ilana Marcucci-Morris, Kaiser psychiatrist\"]‘There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser.’[/pullquote]But those on strike said the severity of the shortage is specific to Kaiser, and that burnout and poor working conditions are contributing to low retention of existing employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” said Marcucci-Morris. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical. And I personally have a handful of colleagues and friends who are therapists with time in their schedules who I’ve tried to recruit for Kaiser. But the reputation is just so poor.”\u003c/p>\n\u003cp>It’s more appealing, said those striking, for qualified therapists to work for a private practice. “Workers just don’t want to work for Kaiser anymore, and that’s the real crisis we’re facing,” said Marcucci-Morris.\u003c/p>\n\u003cp>The union said the rate at which mental health clinicians are leaving Kaiser nearly doubled in the past year, with 668 clinicians leaving between June 2021 and May 2022, compared to 335 clinicians the previous year. In a union survey of 200 of those departing clinicians, 85% said they were leaving because their workload was unsustainable or because they felt they did not have enough time to complete the work, and 76% said they were unable to “treat patients in line with standards of care and medical necessity.”\u003c/p>\n\u003cp>“We need to grow the mental health workforce, there’s no doubt about that,” California state Senator Scott Wiener told KQED Forum. “It is also the case that the shortage is not as severe right now as the health plans say … health plans can take steps to expand their workforce, including paying better, providing better reimbursements to private providers, and those are investments that they should be making that they have not made.”\u003c/p>\n\u003cp>“I don’t think it’s the case that they can just throw up their hands and say, we have some challenges with the workforce, and so therefore, we’re going to make people wait three months,” he added. “We have real shortages of physical health care providers, but we don’t tolerate around physical health what we have long tolerated around mental health, which is effectively denying people access to lifesaving care.”\u003c/p>\n\u003cfigure id=\"attachment_11923080\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923080\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"a baby in a stroller as part of a protest \" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers carry signs on the picket line outside Oakland Kaiser Medical Center on Friday, Aug. 19, 2022, the fifth day of an open-ended strike. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Has California passed any recent laws to address this shortage?\u003c/h2>\n\u003cp>\u003ca href=\"https://openstates.org/ca/bills/20212022/SB221/\">Senate Bill 221\u003c/a>, which passed in 2021 and went into effect July 1, 2022, said that “health plans, including Kaiser, must provide timely access to mental health and addiction treatment,” Senator Wiener told Forum. “And that means a prompt first visit.”\u003c/p>\n\u003cp>The law codifies existing regulations from the Department of Managed Health Care and the Department of Insurance that require a health care service plan or an insurer to ensure that “for an enrollee requesting a non-urgent appointment with a non-physician mental health care provider … appointments are offered within 10 business days of the request for an appointment.” Follow-up visits have to happen within two weeks, added Wiener.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=202120220SB858\" target=\"_blank\" rel=\"noopener noreferrer\">Senate Bill 858\u003c/a>, which recently passed on the California State Assembly floor and will now move to Gov. Gavin Newsom’s desk, would update the way health insurance companies are fined for violations, something that hasn’t been updated or even adjusted for inflation since the 1970s, said Wiener. Currently, the maximum fine possible stands at $2,500 per violation; the bill, if passed, would increase that amount to $25,000.\u003c/p>\n\u003cp>“We think that will create a much larger incentive to actually follow the law and provide people with timely and appropriate access to health care,” he said.\u003c/p>\n\u003ch2>What exactly are the strikers asking for? What’s the current status of negotiations?\u003c/h2>\n\u003cp>In negotiations that led up to the strike, the National Union of Healthcare Workers accepted Kaiser’s wage-increase offer. But the union held fast on its demand that nine hours per week — up from the current six hours — be allotted for administrative work. Kaiser rejected that demand, arguing it would not leave adequate time to see patients. The company’s counteroffer, of an additional 1.2 hours for that work, was flatly rejected.\u003c/p>\n\u003cp>“We wouldn’t be striking right now if money was the primary [issue],” said Marcucci-Morris, pointing to burnout, retention issues and poor morale — as well as what the union describes as the lack of a clear plan for how the company is going to meet the requirements laid out by SB 221.\u003c/p>\n\u003cp>“It’s not going to fix the problems to buy the therapists out and pay us more,” she said. “What good is more pay when you’re drowning and can’t come up for air?”\u003c/p>\n\u003ch2>How is the strike affecting patients in need of care?\u003c/h2>\n\u003cp>Kaiser is legally obligated to continue providing care for its members during a labor strike.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Beginning this week, our patients will receive care from those mental health clinicians who choose patient needs over the strike, as well as from our psychiatrists, clinical managers, and other licensed professionals,” said Catsavas in a statement on the first day of the strike, while noting that “some nonurgent appointments may need to be rescheduled” and that patients whose appointments might be affected “will be directly contacted prior to the date of the appointment to ensure they receive the care they need.”\u003c/p>\n\n",
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"excerpt": "On the fifth day of an open-ended strike, Kaiser mental health workers gathered in Oakland to protest outside the health care giant's corporate headquarters. Here's what they're marching for.",
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"title": "'We're Drowning': Why Kaiser Mental Health Workers Are Striking | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On Friday, the fifth day of an open-ended strike by Kaiser Permanente mental health workers across Northern California, some 200 employees and supporters marched to the health care giant’s Oakland headquarters, demanding that management increase staffing and resources.\u003c/p>\n\u003cp>They were among the roughly 2,000 Kaiser therapists, social workers and other mental health care staffers across Northern California — represented by the National Union of Healthcare Workers — who formed picket lines outside Kaiser facilities this week, after negotiations with management ended without resolution last weekend. Those striking said employee morale is dangerously low and patient care has become substandard due to long wait times for treatment. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Kaiser officials have called the strike unethical to patients and counterproductive, pointing to the shortage of mental health professionals nationwide. A company representative declined to participate in an interview, citing ongoing negotiations.\u003c/p>\n\u003cp class=\"p1\">But in a statement issued Friday, Deb Catsavas, senior vice president of human resources at Kaiser Permanente Northern California, reiterated the company’s stance that the strike and “disruption to patient care” were unnecessary.\u003c/p>\n\u003cp class=\"p1\">“While [the National Union of Healthcare Workers] claims it is fighting for increased access to care, its primary demand is for union members to spend less time seeing patients,” said Catsavas. “Our patients cannot afford a proposal that significantly reduces the time available to care for our patients and their mental health needs.”\u003c/p>\n\u003cp>The strike comes amid what the White House has described as an unprecedented mental health crisis among Americans of all ages.\u003c/p>\n\u003ch2>Why are Kaiser mental health care workers striking?\u003c/h2>\n\u003cp>“We’re striking because it’s demoralizing to work for a company that actively does things to capitalize on burnout,” Naomi Johnson, an associate clinical social worker for Kaiser, told KQED Forum. “We’re really working very hard as clinicians to try to see patients as frequently as we can, and to provide the care that we’re trained [for] and good at providing. And we’re not supported in doing that by the company.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kaiser tells patients that “if you have any sort of concerns or you want to come to therapy, please reach out,” added Johnson. “And then as providers, we’re told, ‘Only treat people who meet medical necessity.’ So it’s really difficult because we have this huge influx of people trying to seek services, but there aren’t enough of us to actually meet the demand, so we’re just completely overwhelmed. … We’re drowning, as clinicians.”\u003c/p>\n\u003cfigure id=\"attachment_11923078\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923078\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"a protest\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57886_021_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers rally before a march from Oakland Kaiser Medical Center to Kaiser’s corporate headquarters on Friday, Aug. 19, 2022, the fifth day of an open-ended strike. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>How does understaffing affect patients seeking treatment?\u003c/h2>\n\u003cp>“There are currently 2,600 Kaiser patients for every mental health worker in (the) Northern California Kaiser system,” Ilana Marcucci-Morris, a licensed clinical social worker in Kaiser’s psychiatry department in Oakland, told Forum. That means the average Kaiser therapist sees between seven and 12 patients per day, while someone in private practice might see between three and six. After a series of initial intake calls, the majority of Kaiser patients calling with a “nonurgent” need wait between two and three months to see a therapist.\u003c/p>\n\u003cp>The National Union of Healthcare Workers points to \u003ca href=\"https://nuhw.org/more-than-2000-kaiser-permanente-mental-health-clinicians-to-start-open-ended-strike-august-15/\">internal Kaiser documents illustrating\u003c/a> that “patients who received an initial mental health assessment on June 13 weren’t scheduled for follow-up appointments for a month in San Francisco, more than two months in Sacramento and three months or more in other parts of Northern California.” That length of time, experts say, does a disservice to those who have already taken the often-difficult first step of seeking support.\u003c/p>\n\u003cp>“The goal is to help people get better and terminate,” said Marcucci-Morris. “But the system within Kaiser does not allow for that. It’s the opposite. People are waiting longer, and deteriorating to where they either give up and pay [for therapy] out of pocket, which sets up a system for folks who have those resources to pay a private practice therapist and get better.” She said people who can’t afford private therapy and insurance premiums aren’t able to get better. “They get worse and they stay in Kaiser and they just stay sick,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11923083\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923083\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"protestors reflected in a bus window\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57866_005_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers and supporters hold signs on the picket line outside Oakland Kaiser Medical Center. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>What is causing the understaffing?\u003c/h2>\n\u003cp>Kaiser administrators point to what they describe as a nationwide staffing shortage. “Across the country, there are not enough mental health care professionals to meet the increased demand for care,” said Kaiser’s Catsavas in an Aug. 15 statement. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”\u003c/p>\n\u003cp>Company administrators say they have worked to combat the shortage by hiring new mental health clinicians, including nearly 200 new clinicians since January 2021; improving mental health care access through virtual care; and launching a $500,000 initiative to recruit new employees.\u003c/p>\u003c/div>",
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"content": "‘There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But those on strike said the severity of the shortage is specific to Kaiser, and that burnout and poor working conditions are contributing to low retention of existing employees, and making it difficult for the company to recruit new ones.\u003c/p>\n\u003cp>“There isn’t a shortage of clinicians. There’s only a shortage of clinicians that want to work for Kaiser,” said Marcucci-Morris. “We get into this field to help people, and it’s hard to recruit therapists when Kaiser’s reputation is known to make people wait so long for therapy sessions. It’s really, really not ethical. And I personally have a handful of colleagues and friends who are therapists with time in their schedules who I’ve tried to recruit for Kaiser. But the reputation is just so poor.”\u003c/p>\n\u003cp>It’s more appealing, said those striking, for qualified therapists to work for a private practice. “Workers just don’t want to work for Kaiser anymore, and that’s the real crisis we’re facing,” said Marcucci-Morris.\u003c/p>\n\u003cp>The union said the rate at which mental health clinicians are leaving Kaiser nearly doubled in the past year, with 668 clinicians leaving between June 2021 and May 2022, compared to 335 clinicians the previous year. In a union survey of 200 of those departing clinicians, 85% said they were leaving because their workload was unsustainable or because they felt they did not have enough time to complete the work, and 76% said they were unable to “treat patients in line with standards of care and medical necessity.”\u003c/p>\n\u003cp>“We need to grow the mental health workforce, there’s no doubt about that,” California state Senator Scott Wiener told KQED Forum. “It is also the case that the shortage is not as severe right now as the health plans say … health plans can take steps to expand their workforce, including paying better, providing better reimbursements to private providers, and those are investments that they should be making that they have not made.”\u003c/p>\n\u003cp>“I don’t think it’s the case that they can just throw up their hands and say, we have some challenges with the workforce, and so therefore, we’re going to make people wait three months,” he added. “We have real shortages of physical health care providers, but we don’t tolerate around physical health what we have long tolerated around mental health, which is effectively denying people access to lifesaving care.”\u003c/p>\n\u003cfigure id=\"attachment_11923080\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11923080\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg\" alt=\"a baby in a stroller as part of a protest \" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/08/RS57907_044_KQED_KaiserStrikeOakland_08192022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser mental health care workers carry signs on the picket line outside Oakland Kaiser Medical Center on Friday, Aug. 19, 2022, the fifth day of an open-ended strike. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Has California passed any recent laws to address this shortage?\u003c/h2>\n\u003cp>\u003ca href=\"https://openstates.org/ca/bills/20212022/SB221/\">Senate Bill 221\u003c/a>, which passed in 2021 and went into effect July 1, 2022, said that “health plans, including Kaiser, must provide timely access to mental health and addiction treatment,” Senator Wiener told Forum. “And that means a prompt first visit.”\u003c/p>\n\u003cp>The law codifies existing regulations from the Department of Managed Health Care and the Department of Insurance that require a health care service plan or an insurer to ensure that “for an enrollee requesting a non-urgent appointment with a non-physician mental health care provider … appointments are offered within 10 business days of the request for an appointment.” Follow-up visits have to happen within two weeks, added Wiener.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=202120220SB858\" target=\"_blank\" rel=\"noopener noreferrer\">Senate Bill 858\u003c/a>, which recently passed on the California State Assembly floor and will now move to Gov. Gavin Newsom’s desk, would update the way health insurance companies are fined for violations, something that hasn’t been updated or even adjusted for inflation since the 1970s, said Wiener. Currently, the maximum fine possible stands at $2,500 per violation; the bill, if passed, would increase that amount to $25,000.\u003c/p>\n\u003cp>“We think that will create a much larger incentive to actually follow the law and provide people with timely and appropriate access to health care,” he said.\u003c/p>\n\u003ch2>What exactly are the strikers asking for? What’s the current status of negotiations?\u003c/h2>\n\u003cp>In negotiations that led up to the strike, the National Union of Healthcare Workers accepted Kaiser’s wage-increase offer. But the union held fast on its demand that nine hours per week — up from the current six hours — be allotted for administrative work. Kaiser rejected that demand, arguing it would not leave adequate time to see patients. The company’s counteroffer, of an additional 1.2 hours for that work, was flatly rejected.\u003c/p>\n\u003cp>“We wouldn’t be striking right now if money was the primary [issue],” said Marcucci-Morris, pointing to burnout, retention issues and poor morale — as well as what the union describes as the lack of a clear plan for how the company is going to meet the requirements laid out by SB 221.\u003c/p>\n\u003cp>“It’s not going to fix the problems to buy the therapists out and pay us more,” she said. “What good is more pay when you’re drowning and can’t come up for air?”\u003c/p>\n\u003ch2>How is the strike affecting patients in need of care?\u003c/h2>\n\u003cp>Kaiser is legally obligated to continue providing care for its members during a labor strike.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Beginning this week, our patients will receive care from those mental health clinicians who choose patient needs over the strike, as well as from our psychiatrists, clinical managers, and other licensed professionals,” said Catsavas in a statement on the first day of the strike, while noting that “some nonurgent appointments may need to be rescheduled” and that patients whose appointments might be affected “will be directly contacted prior to the date of the appointment to ensure they receive the care they need.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Thousands of mental health care workers maintained picket lines Wednesday in front of Kaiser Permanente facilities in the Bay Area and Central Valley, the third day of an open-ended strike to demand the health care giant increase mental health staffing and wages.\u003c/p>\n\u003cp>“This strike is a long time coming,” said state Sen. Scott Wiener, D-San Francisco, among a growing number of state legislative leaders backing the workers. “There have been major issues at Kaiser in terms of providing people with timely access or any access to mental health and addiction treatment and the workers have been advocating for years to have more staffing and compliance with the law and that hasn’t happened.”\u003c/p>\n\u003cp>Jason Lechner, a therapist focused on addiction services for youth, was among a throng of protesters outside a Kaiser Oakland facility on Tuesday, where workers chanted, “What do we want? Patient care. When do we want it? Now!”\u003c/p>\n\u003cp>Lechner said Kaiser doesn’t offer him enough time to carry out essential tasks like answering phone calls and emails, or referring patients to other experts, forcing him and his colleagues to regularly work extra hours in order to complete crucial administrative tasks.\u003c/p>\n\u003cp>“If I need to communicate with your primary care physician about what substances you’re abusing, where’s my time to do that?” he said.[aside label=\"Related Stories\" postID=\"news_11922524,forum_2010101884368,stateofhealth_21358\"]The National Union of Healthcare Workers, which represents Kaiser psychologists, therapists, social workers and chemical dependency counselors in Northern California, is in the thick of negotiating a new contract with Kaiser, and demanding the company hire more mental health workers to ease the burden placed on current staff. The union said negotiations with management this weekend ended without resolution, with Kaiser rejecting the union’s “proposals to increase staffing and end dangerously long waits for mental health therapy appointments.”\u003c/p>\n\u003cp>Nicole Riddle, a labor and delivery nurse, said she has experienced the consequences of staffing shortages, not only as a health care worker, but also as a Kaiser member who has tried to access mental health services for herself.\u003c/p>\n\u003cp>“I’ve had my own experiences, both trying to advocate for myself throughout really traumatic birth experiences, postpartum depression, and then for my own child,” she said. “And I feel like Kaiser kind of banks on people being burnt out enough to not keep escalating and advocating for themselves. And then those who are privileged enough to do so pay out of pocket.”\u003c/p>\n\u003cp>“We deserve a better situation,” she added.\u003c/p>\n\u003cp>\u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/committed-to-reaching-a-fair-and-equitable-agreement\">In a statement\u003c/a> issued Sunday, after negotiations stalled, Deb Catsavas, Kaiser’s regional senior vice president of human resources, said the Oakland-based company has “the deepest appreciation and gratitude for our mental health professionals and the extraordinary care they provide to our members.” But, she noted, “there are not enough mental health care professionals to meet the increased demand for care,” both locally and nationwide.\u003c/p>\n\u003cp>The company has hired “nearly 200 new clinicians since January 2021” and launched a $500,000 initiative to recruit new mental health practitioners, Catsavas added.\u003c/p>\n\u003cp>“Despite the union’s harmful tactics, we remain committed to bargaining in good faith to reach a fair and equitable agreement that is good for our therapists and our patients,” she said.\u003c/p>\n\u003cp>In negotiations, the union accepted Kaiser’s wage-increase offer, but held fast on its demand that nine hours per week — up from the current six hours — be allotted for administrative work. Kaiser, however, rejected that demand, arguing it would not leave adequate time to see patients. Its counteroffer, of an additional 1.2 hours for that work, was flatly rejected.\u003c/p>\n\u003cp>California law requires health care providers like Kaiser to offer patients timely care even during labor strikes, and state regulators say they are closely monitoring consumer complaints about the company’s compliance. Kaiser has said it will prioritize urgent mental health situations, but may have to reschedule some ongoing appointments.\u003c/p>\n\u003cp>Oakland City Councilmember Dan Kalb, who joined Oakland staffers on the picket line on Tuesday, said mental health care has been undervalued for far too long.\u003c/p>\n\u003cp>“Mental health care is health care. And (it) needs to stop being seen as the stepchild of health care,” Kalb said, pointing to the longstanding demand for services that has only further escalated since the start of the COVID-19 pandemic. “Kaiser should be ashamed of themselves for not staffing up the mental health care clinicians that they need and not paying them a fair wage. It’s inexcusable.”\u003c/p>\n\u003cp>Kalb called for “unanimous support” for mental health workers, not just at Kaiser, but in all health care settings “to make sure that there are enough health care workers everywhere to meet the needs that people have.”\u003c/p>\n\u003cp>\u003cem>KQED’s Matthew Green contributed reporting.\u003c/em> [ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thousands of mental health care workers maintained picket lines Wednesday in front of Kaiser Permanente facilities in the Bay Area and Central Valley, the third day of an open-ended strike to demand the health care giant increase mental health staffing and wages.\u003c/p>\n\u003cp>“This strike is a long time coming,” said state Sen. Scott Wiener, D-San Francisco, among a growing number of state legislative leaders backing the workers. “There have been major issues at Kaiser in terms of providing people with timely access or any access to mental health and addiction treatment and the workers have been advocating for years to have more staffing and compliance with the law and that hasn’t happened.”\u003c/p>\n\u003cp>Jason Lechner, a therapist focused on addiction services for youth, was among a throng of protesters outside a Kaiser Oakland facility on Tuesday, where workers chanted, “What do we want? Patient care. When do we want it? Now!”\u003c/p>\n\u003cp>Lechner said Kaiser doesn’t offer him enough time to carry out essential tasks like answering phone calls and emails, or referring patients to other experts, forcing him and his colleagues to regularly work extra hours in order to complete crucial administrative tasks.\u003c/p>\n\u003cp>“If I need to communicate with your primary care physician about what substances you’re abusing, where’s my time to do that?” he said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The National Union of Healthcare Workers, which represents Kaiser psychologists, therapists, social workers and chemical dependency counselors in Northern California, is in the thick of negotiating a new contract with Kaiser, and demanding the company hire more mental health workers to ease the burden placed on current staff. The union said negotiations with management this weekend ended without resolution, with Kaiser rejecting the union’s “proposals to increase staffing and end dangerously long waits for mental health therapy appointments.”\u003c/p>\n\u003cp>Nicole Riddle, a labor and delivery nurse, said she has experienced the consequences of staffing shortages, not only as a health care worker, but also as a Kaiser member who has tried to access mental health services for herself.\u003c/p>\n\u003cp>“I’ve had my own experiences, both trying to advocate for myself throughout really traumatic birth experiences, postpartum depression, and then for my own child,” she said. “And I feel like Kaiser kind of banks on people being burnt out enough to not keep escalating and advocating for themselves. And then those who are privileged enough to do so pay out of pocket.”\u003c/p>\n\u003cp>“We deserve a better situation,” she added.\u003c/p>\n\u003cp>\u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/committed-to-reaching-a-fair-and-equitable-agreement\">In a statement\u003c/a> issued Sunday, after negotiations stalled, Deb Catsavas, Kaiser’s regional senior vice president of human resources, said the Oakland-based company has “the deepest appreciation and gratitude for our mental health professionals and the extraordinary care they provide to our members.” But, she noted, “there are not enough mental health care professionals to meet the increased demand for care,” both locally and nationwide.\u003c/p>\n\u003cp>The company has hired “nearly 200 new clinicians since January 2021” and launched a $500,000 initiative to recruit new mental health practitioners, Catsavas added.\u003c/p>\n\u003cp>“Despite the union’s harmful tactics, we remain committed to bargaining in good faith to reach a fair and equitable agreement that is good for our therapists and our patients,” she said.\u003c/p>\n\u003cp>In negotiations, the union accepted Kaiser’s wage-increase offer, but held fast on its demand that nine hours per week — up from the current six hours — be allotted for administrative work. Kaiser, however, rejected that demand, arguing it would not leave adequate time to see patients. Its counteroffer, of an additional 1.2 hours for that work, was flatly rejected.\u003c/p>\n\u003cp>California law requires health care providers like Kaiser to offer patients timely care even during labor strikes, and state regulators say they are closely monitoring consumer complaints about the company’s compliance. Kaiser has said it will prioritize urgent mental health situations, but may have to reschedule some ongoing appointments.\u003c/p>\n\u003cp>Oakland City Councilmember Dan Kalb, who joined Oakland staffers on the picket line on Tuesday, said mental health care has been undervalued for far too long.\u003c/p>\n\u003cp>“Mental health care is health care. And (it) needs to stop being seen as the stepchild of health care,” Kalb said, pointing to the longstanding demand for services that has only further escalated since the start of the COVID-19 pandemic. “Kaiser should be ashamed of themselves for not staffing up the mental health care clinicians that they need and not paying them a fair wage. It’s inexcusable.”\u003c/p>\n\u003cp>Kalb called for “unanimous support” for mental health workers, not just at Kaiser, but in all health care settings “to make sure that there are enough health care workers everywhere to meet the needs that people have.”\u003c/p>\n\u003cp>\u003cem>KQED’s Matthew Green contributed reporting.\u003c/em> \u003c/p>\u003c/div>",
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"content": "\u003cp>Some 2,000 Kaiser Permanente psychologists, therapists, social workers and chemical dependency counselors in Northern California began what they called an “open-ended” strike Monday over staffing shortages that their union said have overwhelmed workers and resulted in patients waiting months to get help. Workers formed picket lines at Kaiser facilities in San Francisco, San José, Fresno and Sacramento.\u003c/p>\n\u003cp>The National Union of Healthcare Workers, which represents the workers, is negotiating a new contract with the Oakland-based health care giant, and demanding the company hire more mental health workers to ease the burden placed on current staff. The union said negotiations with management ended without resolution this weekend.\u003c/p>\n\u003cp>Kaiser rejected “union proposals to increase staffing and end dangerously long waits for mental health therapy appointments,” organizers said in a statement Sunday.\u003c/p>\n\u003cp>“We’ve been telling Kaiser executives since Day One that this isn’t about money,” said Jennifer Browning, a Kaiser social worker in Roseville, and part of the union’s bargaining team, noting that organizers did accept Kaiser’s wage-increase offer. “It’s about our professional integrity and our ability to provide care that will help patients get better.”\u003c/p>\n\u003cp>At a picket line outside a Kaiser center in San Francisco on Monday, employees held signs that read “patients over profits.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jeffery Chen-Harding, a clinical social worker with Kaiser who was picketing there, said his patients are having to wait longer and longer for care.\u003c/p>\n\u003cp>[aside postID=\"news_11921580\" hero='https://ww2.kqed.org/app/uploads/sites/10/2022/08/RS40555_KAISER-MENTAL-HEALTH-CASES-photo-qut-1020x680.jpg']“We have people waiting six to eight weeks to get an appointment,” he said.\u003c/p>\n\u003cp>Petaluma clinical psychologist Alexis Petrakis, also picketing in San Francisco, echoed Chen-Harding’s comments about the wait times, describing her caseloads as unrelenting.\u003c/p>\n\u003cp>“I meet somebody new, they tell me their story, and maybe they even are honest about trauma that they’ve experienced,” she said. “I try to find a 30-minute phone call just to check in, but it’s not the care that I know that they deserve.”\u003c/p>\n\u003cp>Deb Catsavas, Kaiser’s senior vice president of human resources in Northern California, said in a statement Sunday that \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/committed-to-reaching-a-fair-and-equitable-agreement\">the company has hired hundreds of new mental health workers\u003c/a>, including 200 since January 2021. She also pointed out that the shortage in mental health care professionals is happening nationwide.\u003c/p>\n\u003cp>There are two main issues, Catsavas noted. “One is wage increases and the other is the union’s demand to increase the time therapists spend on tasks other than seeing patients,” she said. “The primary role — and essential need — for our therapists is to provide mental health care and treat our patients.”\u003c/p>\n\u003cp>The union is demanding that nine hours per week be allotted for administrative work, which would leave only 31 hours to see patients, the company said. It said it proposed increasing the time for administrative tasks from 6 to 7.2 hours, leaving 32.8 hours to see patients.\u003c/p>\n\u003cp>“Our patients cannot afford a proposal that significantly reduces the time available to care for them and their mental health needs,” Catsavas said. “In recognition of our therapists’ concerns and priorities, we have proposed an increase in the scheduled time allocated to administrative tasks, but the union is demanding still more administrative time.”\u003c/p>\n\u003cp>But Chen-Harding argued that the time in question is actually important work related to patient care.\u003c/p>\n\u003cp>“What they’re calling administrative time, it’s actually time when I am calling people who are in a crisis. It may be time when I am learning about the patient that I’m about to meet with,” he said.\u003c/p>\n\u003cp>A shortage in mental health clinicians has been a sticking point between the company and the union for years. In December 2019, Kaiser mental health care workers held a five-day strike over staffing shortages.\u003c/p>\n\u003cp>Catsavas said Kaiser recently reached an agreement with the same union in Southern California, representing about 1,900 mental health professionals.\u003c/p>\n\u003cp>Kaiser said some clinicians will remain on the job during the strike. It also has expanded its network of “high-quality community providers and will continue to prioritize urgent and emergency care” through the duration of the strike, it said, adding that some nonurgent appointments may need to be rescheduled and patients whose appointments may be affected will be contacted directly prior to the date of the appointment.\u003c/p>\n\u003cp>The union said state law requires Kaiser to pay for out-of-network services if it’s unable to provide urgent mental health appointments within 48 hours, and nonurgent appointments within 10 business days, unless the therapist determines that a longer wait would not be detrimental to the patient’s health.\u003c/p>\n\u003cp>No date has been set for further negotiations.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story includes reporting from The Associated Press, Bay City News and KQED’s Lesley McClurg.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The National Union of Healthcare Workers, which represents Kaiser mental health employees, is demanding the company hire more personnel to ease the burden on current staff and lessen appointment wait times for patients.",
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"title": "Kaiser Mental Health Workers in Northern California Begin 'Open-Ended' Strike Over Staffing Shortages | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some 2,000 Kaiser Permanente psychologists, therapists, social workers and chemical dependency counselors in Northern California began what they called an “open-ended” strike Monday over staffing shortages that their union said have overwhelmed workers and resulted in patients waiting months to get help. Workers formed picket lines at Kaiser facilities in San Francisco, San José, Fresno and Sacramento.\u003c/p>\n\u003cp>The National Union of Healthcare Workers, which represents the workers, is negotiating a new contract with the Oakland-based health care giant, and demanding the company hire more mental health workers to ease the burden placed on current staff. The union said negotiations with management ended without resolution this weekend.\u003c/p>\n\u003cp>Kaiser rejected “union proposals to increase staffing and end dangerously long waits for mental health therapy appointments,” organizers said in a statement Sunday.\u003c/p>\n\u003cp>“We’ve been telling Kaiser executives since Day One that this isn’t about money,” said Jennifer Browning, a Kaiser social worker in Roseville, and part of the union’s bargaining team, noting that organizers did accept Kaiser’s wage-increase offer. “It’s about our professional integrity and our ability to provide care that will help patients get better.”\u003c/p>\n\u003cp>At a picket line outside a Kaiser center in San Francisco on Monday, employees held signs that read “patients over profits.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jeffery Chen-Harding, a clinical social worker with Kaiser who was picketing there, said his patients are having to wait longer and longer for care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“We have people waiting six to eight weeks to get an appointment,” he said.\u003c/p>\n\u003cp>Petaluma clinical psychologist Alexis Petrakis, also picketing in San Francisco, echoed Chen-Harding’s comments about the wait times, describing her caseloads as unrelenting.\u003c/p>\n\u003cp>“I meet somebody new, they tell me their story, and maybe they even are honest about trauma that they’ve experienced,” she said. “I try to find a 30-minute phone call just to check in, but it’s not the care that I know that they deserve.”\u003c/p>\n\u003cp>Deb Catsavas, Kaiser’s senior vice president of human resources in Northern California, said in a statement Sunday that \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/committed-to-reaching-a-fair-and-equitable-agreement\">the company has hired hundreds of new mental health workers\u003c/a>, including 200 since January 2021. She also pointed out that the shortage in mental health care professionals is happening nationwide.\u003c/p>\n\u003cp>There are two main issues, Catsavas noted. “One is wage increases and the other is the union’s demand to increase the time therapists spend on tasks other than seeing patients,” she said. “The primary role — and essential need — for our therapists is to provide mental health care and treat our patients.”\u003c/p>\n\u003cp>The union is demanding that nine hours per week be allotted for administrative work, which would leave only 31 hours to see patients, the company said. It said it proposed increasing the time for administrative tasks from 6 to 7.2 hours, leaving 32.8 hours to see patients.\u003c/p>\n\u003cp>“Our patients cannot afford a proposal that significantly reduces the time available to care for them and their mental health needs,” Catsavas said. “In recognition of our therapists’ concerns and priorities, we have proposed an increase in the scheduled time allocated to administrative tasks, but the union is demanding still more administrative time.”\u003c/p>\n\u003cp>But Chen-Harding argued that the time in question is actually important work related to patient care.\u003c/p>\n\u003cp>“What they’re calling administrative time, it’s actually time when I am calling people who are in a crisis. It may be time when I am learning about the patient that I’m about to meet with,” he said.\u003c/p>\n\u003cp>A shortage in mental health clinicians has been a sticking point between the company and the union for years. In December 2019, Kaiser mental health care workers held a five-day strike over staffing shortages.\u003c/p>\n\u003cp>Catsavas said Kaiser recently reached an agreement with the same union in Southern California, representing about 1,900 mental health professionals.\u003c/p>\n\u003cp>Kaiser said some clinicians will remain on the job during the strike. It also has expanded its network of “high-quality community providers and will continue to prioritize urgent and emergency care” through the duration of the strike, it said, adding that some nonurgent appointments may need to be rescheduled and patients whose appointments may be affected will be contacted directly prior to the date of the appointment.\u003c/p>\n\u003cp>The union said state law requires Kaiser to pay for out-of-network services if it’s unable to provide urgent mental health appointments within 48 hours, and nonurgent appointments within 10 business days, unless the therapist determines that a longer wait would not be detrimental to the patient’s health.\u003c/p>\n\u003cp>No date has been set for further negotiations.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story includes reporting from The Associated Press, Bay City News and KQED’s Lesley McClurg.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get",
"title": "There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?",
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"headTitle": "There’s Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get? | KQED",
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"content": "\u003cp>[dropcap]W[/dropcap]hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven’t slept in three days. I haven’t really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>“I was desperate,” McDonald said. “I was like, ‘I’m trying to help myself, but things are just getting worse.’ So what am I left with?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn’t try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that’s like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.”\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"State Sen. Scott Wiener, D-San Francisco\"]‘If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.’[/pullquote]\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive” and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to “generally accepted standards of care,” including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>‘It Saved My Life’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it’s all going to go away,’ ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and ‘happy enough to want to live.’ \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>‘There Is No Place Where We Say Kaiser Is Exempt’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser’s Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>[aside postID=stateofhealth_185796,stateofhealth_193386,stateofhealth_191734 label='Related Coverage']\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women’s Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Marcus Worthington, husband of Whitney Worthington\"]‘The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit … It finally got on somebody’s radar who wasn’t going to ignore it.’[/pullquote]\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>‘This Is How You Treat Postpartum Mental Health?’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn’t my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son’s birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I felt like I’ve been robbed really of all those moments,” she said, “of those little milestones, that I’m never going to get back.” \u003c/span>\u003c/p>\n\n",
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"excerpt": "Kaiser's practices around the new drug, brexanolone, may run afoul of a new California law designed to limit unfair denials of mental health treatment.",
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"title": "There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven’t slept in three days. I haven’t really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>“I was desperate,” McDonald said. “I was like, ‘I’m trying to help myself, but things are just getting worse.’ So what am I left with?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn’t try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that’s like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.”\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive” and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to “generally accepted standards of care,” including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>‘It Saved My Life’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it’s all going to go away,’ ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and ‘happy enough to want to live.’ \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>‘There Is No Place Where We Say Kaiser Is Exempt’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser’s Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women’s Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit … It finally got on somebody’s radar who wasn’t going to ignore it.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>‘This Is How You Treat Postpartum Mental Health?’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn’t my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son’s birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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},
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"tagline": "Art is where you find it",
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"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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