The Second 90 Days (Reader’s Edition)

A Game So Nice I’ll Play it Twice

Posted on September 25, 2014

I’ve launched a second ninety day campaign to reform the delivery of mental health services at Kaiser. After a rejuvenating summer, I’ve jumped off the fence to organize a new wave of challenges to the current system of care. While the first “90 Days” might be seen as a primer for fighting an institution from the inside out, the next segment (from October 2014 through New Year’s Day), will, if I’m lucky, demonstrate how one person can make a difference from the outside.

Now that I’m no longer an employee of The Permanente Medical Group (TPMG), and am no longer a card carrying member of the National Union of Healthcare Workers (NUHW), my standing to comment on the global deficits in Kaiser’s mental health program has changed. I speak now as a concerned member of the community. We all suffer when the number one provider of mental health services in California delivers less than adequate care. I speak also as a private therapist who sees the fallout of poor treatment in my Kaiser member clients, those who pay me on top of paying their premiums through their employer, privately, or through the Medicare or Medicaid system. And lastly I speak now as a payer of state and federal taxes, subsidizing these substandard, federally- and state-funded mental health programs.

On September 9, 2014, moments before they were slated to argue their case in front of an administrative law judge in Oakland, Kaiser dropped their appeal of the Department of Managed Health Care’s $4 million fine. (The fine, if you recall, was levied for delaying access to initial mental health appointments and for discouraging members from seeking services.) Just as remarkably, Kaiser has begun to develop protocols to subcontract the overflow of psychiatry department intakes to a behavioral managed health care group, ValueOptions.

These are incredible developments! Kaiser lawyers, it seems, knew they couldn’t prove Kaiser mental health administrators had responded to the DMHC’s allegations sufficiently or quickly enough, and told Kaiser executives not to fight the fines in court. And, by subcontracting mental health services to ValueOptions, Kaiser has admitted that they are unable to do the job the DMHC is mandating without hiring more help. They are admitting that they are, in fact, understaffed. Which is what therapists have been arguing  for three years now.

This is no time to take the pressure off! As a corporation, Kaiser will spend as little money as possible appeasing state regulators. They will continue to need their feet held to the fire if they are going to implement meaningful change.

So, whether you’re inside Kaiser, fighting to get your clients the basic help they need,  or out, trying to improve the mental health of our entire community, let’s keep this mighty ball a-rollin’!

(90 days (or so) to go.)

 

Let’s Talk Medicare Fraud

Posted on October 15, 2014

According to the Kaiser Family Foundation, in 2013 Kaiser had 8% of the Medicare Advantage market. That means that last year 1.1 million elderly and disabled Americans received their health care, including mental health care, through the Kaiser Advantage program. Medicare recipients get their care side by side with other Kaiser members whose premiums are paid by employers or privately. All of the deficits in care I observed while working as a therapist at Kaiser from September 2006 through May 2014, documented in the first “90 Days” of this blog, apply to Medicare patients too.

When a Medicare beneficiary chooses Kaiser as its provider, Medicare pays Kaiser a monthly premium on behalf of the beneficiary in expectation that the consumer will get a basic level of care. Medicare also pays additional fees as incentives for Kaiser to treat “sicker” patients. I read about the abuse of this additional fee system in an article by Fred Schulte of the Center for Public Integrity in Washington DC. He reports that Medicare Advantage patients get higher “risk scores” if they have diagnoses that lead to more expensive care, like hypertension. Like Major Depression, Recurrent. And higher risk scores translate to higher reimbursement rates that Medicare pays Kaiser, presumably for additional care.

According to federal parity laws, Kaiser is compelled to provide basic mental health care at a level comparable to physical health care, to all its clients, including Medicare clients. With the risk score system, Kaiser accepts additional funds to provide additional care for people with mental health diagnoses like Major Depression. But Medicare beneficiaries aren’t getting additional care. They’re not even getting basic care.

I made the argument in the first “90 Days” that Kaiser does not provide the most basic services expected by consumers and therapists, let alone parity services. The most standard treatment protocol in the Kaiser mental health model of care is a single hour of initial assessment, followed by referral to a skills group, with a follow-up one-on-one therapy appointment booked typically a month in the future. The drop out rate from the skills groups for major depression and panic disorder (two of the most utilized treatment tracks) is 75% or higher. Without the support of an individual therapist who meets weekly for at least the first month of treatment, most (75% or more of) new clients get discouraged and drop out.

Kaiser might claim that an initial drop out rate of 75% is par for the course for mental health treatment, and that this high rate doesn’t prove they need to hire more therapists. That might be a credible defense if they had a meaningful quality assurance program, as required by law, to back up the claim.

Last year in Santa Rosa, a fairly functional quality assurance panel of four therapists was replaced by a single MD reviewing all cases of suicide, near suicide, and other poor outcomes. I say it was fairly functional because it was always unclear how cases came to the panel for review. The two cases of suicide in which I had been one of the providers involved did not come up for review – at least not by the panel. In an effective quality assurance system, every single suicide would be reviewed by a multidisciplinary panel to assess for provider and system flaws. To prevent future bad outcomes.

The panel in Santa Rosa was de-authorized in an attempt to staunch the flow of damaging information to therapist whistle blowers. Kaiser does not want therapists to have precise information about the actual numbers of suicides in the department, nor to be party to the evidence that might demonstrate that suicides can be  linked to the current model of care — brief assessment and referral to groups.

These two deficits — a defective treatment model and the absence of meaningful quality assurance checks on the model — taken in tandem, result in a gross misrepresentation by Kaiser of the care paid for by the Medicare program. In 2013, as many as 1.1 million Americans were affected by this misrepresentation. In other words, Kaiser has been committing fraud, year after year, on an enormous scale.

To restate: our tax dollars are being given to Kaiser to take care of the health, including the mental health, of Medicare members. Extra money is being paid to Kaiser to care for people with certain mental illnesses. The money is being spent on programs that licensed providers within the system are calling insufficient at best and malpractice at worst. And the mechanism of quality assurance, the check on an HMO’s natural inclination to cut costs, exists in form only.

If that’s not fraud, what is?

(76 days to go.)

 

STRIKE!

Posted on October 27, 2014

The California Nurses Association (CNA) and the National Union of Healthcare Workers (NUHW) are considering a huge conjoint strike some time in November. I wonder how they’re going to message the array of problems behind this action. Why am I concerned about the messaging? The Kaiser Medical Group (TPMG) has been fairly successful, throughout the 3-year-and-counting NUHW contract battle, in clouding the therapists’ message of poor quality mental health care in psychiatry departments throughout California. Kaiser spokespeople have been consistent, telling the media at every opportunity that therapists created a smear campaign to improve their position at the bargaining table; and that the foundation of the smear — poor client care due to long waits between visits — is a groundless manipulation. While therapists certainly are interested in a contract that keeps their benefits in place, they’re also interested in improving client care. I believe this two-part message, even after three years of delivering it, on the picket lines and in press packets, has been heard by the public only partially.

Nurses now face the same challenge therapists have been facing for years, getting their two-part message across. Kaiser’s contract with 18,000 CNA-represented nurses in California expired this summer. They are now bargaining to keep their benefits AND to keep appropriate staffing levels. In terms of benefits, Kaiser has made it clear that the takeaways offered to NUHW therapists in contract talks are being rolled out to all employee groups as their contracts come due. This fall, it’s the nurses’ turn to be offered these takeaways, and to protest or submit as they will. And in terms of cutting staff, Kaiser spokespeople are advertising that current staffing levels in the hospital are excessive and outdated, indicating they intend to change nurse to patient ratios in their contract offers. (Listen to the 10/17/14 NPR report by April Dembosky.)

It might be wise for union spokespeople (for both unions) to include an “and” in every statement they make to the press.  As in: we’re interested in maintaining benefits AND in maintaining quality patient care. Contracts can, of course, do both. Staff to patient ratios have, historically, been part of the nurses’ contract. This creates, for nurses and patients, a certain amount of protection against the HMO’s endless efforts to cut costs. By contrast, therapist contracts have never included a provision to limit the number of clients on a therapists’ caseload, nor one to contain group size. If it’s not in the contract, therapists cannot “grieve” understaffing through the collective bargaining process. Which is why the NUHW and other interested parties (like moi) have turned to HMO watchdog agencies, like the California Department of Managed Healthcare, like the US Department of Health and Human Services, instead of the National Labor Review Board, to fight for mental health parity.

Contrary to Kaiser public relations rhetoric, there is no contradiction between taking care of oneself and taking care of one’s clients. Kaiser spokesfolk continue to claim that in order to contain consumer costs something has to give — either patient care or staff benefits. But as long as the CNA and the NUHW remind the public of Kaiser’s massive surpluses (now in the billions of dollars per quarter), I believe the public will draw a different conclusion…

Maybe it’s Kaiser’s surpluses that have to give.

(Don’t get me started on CEO salaries. Did you know that the current CEO of Kaiser is not even a healthcare professional?)

I’m excited about watching this power struggle play out, and I look forward to joining my former colleagues on the picket line. We all need to do what we can to support nurses and therapists as they go up against the corporate machine. I’ll say it here, now, as a pre-amble to the festivities:

Thank you, health care professionals, for taking a stand for patient care AND you deserve just compensation for your hard work.

(64 days to go.)

 

Doctors v. Lawyers

Posted on October 19, 2014

At the same time as trying to get the agencies that oversee Medicare to penalize Kaiser into providing parity mental health care, I’ve been curious about the potential of medical malpractice lawsuits to force the same change. To that end I’ve been sending emails to personal injury law firms in the Bay Area that specialize in medical malpractice — some even advertise that they hyper-specialize in Kaiser cases. I’ve been offering my services as a consultant or expert witness. I think I can help lawyers develop an argument that the structure of mental health treatment at Kaiser puts all patients at risk. I can also guide them to the kinds of questions that will demonstrate how this faulty structure led to their particular client’s bad outcome, e.g. suicide, hospitalization, loss of a job or a significant relationship.

By bizarre coincidence, there’s an initiative on this November’s ballot in California to increase the cap on medical malpractice payouts. Since the relatively low cap seems a barrier to influencing Kaiser’s policies, I wrote an editorial in favor of raising the caps and sent it to the LA Times, the San Francisco Chronicle, and the Sacramento Bee. All three have declined to publish it. I’ll send it to the Santa Rosa Press Democrat today, but thought it might be helpful to post it here.

Here’s what I wrote:

With seven million members in California alone, Kaiser Permanente is the state’s number one health care provider. That makes them the number one provider of mental health care too. One painful truth about mental health care at Kaiser today is that, with current caps on malpractice awards, it’s cheaper for the HMO to litigate a suicide than to prevent one. Consequently, significant flaws in their treatment programs go unaddressed year after year. As a psychotherapist who until recently worked within the Kaiser system, I believe an increase in the cap on malpractice lawsuits, as proposed in Proposition 46, could help steer the system toward competence.

From September 2006 until I was escorted from my office for whistle blowing this past May, I evaluated and treated Kaiser Permanente members with mental illness at the Santa Rosa Medical Center. During my last three months at Kaiser, I blogged about the myriad and widespread deficiencies in the managed mental health care system on my website 90daystochange.com.

First off, I argued, therapist staffing levels are unconscionable. Across California, the wait between one-on-one visits with a psychotherapist — the core of treatment — averages four weeks. Due to the absence of individual attention, the drop out rate for people with major depression and panic disorder, two of the most common conditions in psychiatry, is 75% or more within the first three months of treatment.

At the same time, quality assurance programs are grossly insufficient and out of compliance with state and federal laws. Quality assurance programs are a fundamental check on HMOs. Without them, specific provider problems (like incompetence) or system problems (like understaffing) continue unabated. Last year the panel of four therapists in Santa Rosa who conducted internal reviews of suicides and other negative outcomes was reduced to a single physician charged with reviewing all cases. Since physicians own the medical group, delegating quality assurance to an MD alone creates a dangerous conflict of interest.

Considering the breadth of these staffing and quality assurance problems, penalties from state and federal regulatory agencies have been slow and slim. After three years of campaigning, the union representing Kaiser therapists was able to leverage the California Department of Managed Health Care to fine Kaiser’s physician’s group TPMG $4 million. Four million dollars would pay for twenty-five new therapists for a year. But Kaiser California needs at least a thousand more therapists to make even a dent in their service gaps. In order for executives at the top to re-examine their bottom line, a fine would need to be more on the order of $100 million a year until the situation is resolved.

Since the feds and the state are unwilling to levy effective fines, individual lawsuits need to become a more prominent force for change. Raising the cap on penalties would bring increased numbers of lawyers and families to the arbitration table. As more compelling evidence about gaps in Kaiser’s treatment programs continues to emerge, family members will win these cases more consistently. The cost of litigation will go up.

And, eventually, Kaiser’s cost-benefit analysis will guide their executives away from litigation and towards care.

(72 days to go.)

 

Taking it to the Feds

Posted on November 13, 2014

A month ago I submitted an on-line report of suspected Medicare fraud at Kaiser using  the Medicare.gov website. I was not expecting any response beyond the automated email confirmation of receipt I got immediately. Imagine my surprise, then, when a snail mail letter dated October 23, 2014 indicated that a contract agency, Health Integrity LLC, was following up on my report. It said: “Your information will be reviewed and you will be notified of the results.” The letterhead indicated Centers for Medicare and Medicaid Services (CMS) and the letter was signed by a Complaint Specialist from the National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC).  The website for NBI MEDIC indicates that they investigate claims of fraud, including Medicare Advantage fraud. So it seems my complaint had fallen into the appropriate hands.

A week later I got another letter from the same agency, reporting: “After researching and reviewing your complaint, the NBI MEDIC has determined that issue has already been resolved by another agency therefore, your complaint will be closed and tracked in our database in an effort to identify trends with the subject of this complaint.” The letter was signed by Lisa Carson, Complaint Specialist. Of course I called up Lisa immediately. She called me back within a day, while I was on a hike with my dog Apollo in the redwoods. She let me know that the other agency, the one that had “resolved” Kaiser’s mental health care issues was the California Department of Managed Health Care (DMHC). But she knew nothing further and was not part of the investigation. She did, however, willingly pass on the name of her supervisor, Belinda Cross, and told me she would have Belinda give me a call to follow up.

I just got off the phone with Belinda who took the time to explain her agency’s role in investigating claims of Medicare fraud or abuse. She let me know that my on-line complaint started at the Office of Inspector General for Health and Human Services (OIG). It was sent to Health Integrity to see if the case has merit. If it does it will be returned to the OIG for further investigation, and, if appropriate, on to the Justice Department to pursue a remedy for the fraud. Otherwise, they’ll put my complaint in a database in which similar claims may add up eventually to a case. Then it will be forwarded to the OIG.

I told Belinda that the DMHC’s investigations and fines have, to this point, only addressed initial access to psychiatric care. How waits between visits with individual therapists across California Kaisers are 4-8 weeks. And how Kaiser bills Medicare for diagnosis-specific treatments, including Major Depression and Panic Disorder, without providing adequate treatment past the initial assessment. After a pause Belinda volunteered to investigate further, without saying she was re-opening the just-closed case. She told me she had an associate who knows more about “annual reconciliation” — a process I didn’t know existed prior to our conversation. My guess is that annual reconciliation means that once a year Medicare looks at Kaiser Advantage members who receive additional funds for expensive medical conditions (see my October 15 post) to make sure they got adequate services for the extra compensation.

If that’s the case, I would love to know how the review process operates for parity mental health conditions!

Belinda also encouraged me to pursue a complaint about quality of care with the Quality Improvement Organizations (QIO) arm of the CMS. Which indeed I will. She promised to email a link to the appropriate agencies to contact. But I’m also going to work with her to attempt to establish that Kaiser’s abuse of Medicare funds deserves attention at the OIG level. Considering the scale of under-staffing, the years that the abuse has continued, and the consequences to Medicare recipients, (past, present and future), the investigation deserves to go up the pike.

(47 days to go.)

 

Does Kaiser Advantage Have Integrity? Belinda’s on the Case

Posted on November 17, 2014

Today I sent the following email to Belinda Cross, the supervisor at the NBI MEDIC contract agency Health Integrity, (see my November 13 post, immediately below):

Hi Belinda,

Thanks for spending so much time with me on the phone last Thursday!

I hope I made it clear that I have a large personal investment in changing the Kaiser mental health care system for the better. I was a therapist in the psychiatry department of the Santa Rosa Medical Center for eight years ending in May 2014. I resigned my job because I was unable in good conscience to continue accepting payment for providing inadequate care. I am pursuing the claim of Medicare fraud because I believe that with the correct leverage from all available sources, Kaiser will change course and provide parity mental health services, as required by state and federal law.

On my way out of Kaiser this past spring, I blogged my efforts to change the system at 90daystochange.com. If you haven’t yet, please read this blog for clear documentation of my assertions. I have many colleagues, Kaiser therapists throughout California, willing to corroborate what I’ve written on my blog for your investigation of Kaiser Advantage fraud regarding Medicare recipients with mental illness.

I’m also telling you about my blog because I continue publicizing my efforts, including my contacts with you at Health Integrity. So far 90 Days to Change has had about thirty thousand visitors — primarily Kaiser therapists, managers, mental health clients and the media, including national and international reporters. This visibility contributed, I believe, to Kaiser’s eventual agreement to pay the California Department of Managed Health Care’s fine AND to Kaiser’s decision to start contracting with ValueOptions for therapist services to supplement their in-house staff.

Since transparency in government is a value I suspect that you and your agency subscribe to, I didn’t think you would object. But I also felt it fair to alert you that I am still blogging. This email will be today’s entry.

During our phone conversation last week, you agreed (1) to send me by email a list of quality assurance agencies within CMS and (2) to check with your colleague about the annual reconciliation  process for Kaiser Advantage members with mental health diagnoses that increase their risk scores.

While Kaiser claims that members identified with parity diagnoses (like Major Depression or Panic Disorder) are provided specific follow-up care through outpatient psychiatry clinics and/or behavioral health specialists, aside from an initial visit for evaluation, follow-up care is nearly non-existent. As I let you know on the phone, Kaiser Advantage members, regardless of severity of diagnosis, can only meet with their primary therapist on average once every one or two MONTHS. By comparison, Medicaid clients in California are covered to see a private therapist in the community at least once a week until their mental health condition resolves — indefinitely if it doesn’t.

Thanks again for the initial conversation. I look forward to hearing from you soon.

Andy

(43 days to go.)

 

Medicare Refresh

Posted on November 22, 2014

I decided it might make sense to hone my argument about why I believe the inadequate mental health services provided by Kaiser constitute Medicare fraud, and to email and snailmail my honed argument to Belinda Cross at Health Integrity. So here’s what I wrote and sent today. I incorporated what I learned from my conversation with Belinda on 11/13/14 regarding an annual process reconciling delivery of services with monies reimbursed. Even though there are big holes in my understanding of how the whole process works, it seems that those with a clearer understanding of the system will be able to fill in the blanks.

I am a former staff therapist who worked at Kaiser Santa Rosa’s Medical Center in the Psychiatry Department, starting in September 2006 and ending almost eight years later when I was escorted from my office in retaliation for whistle-blowing in May 2014. As a steward for the union of Kaiser’s psychotherapists, the National Union of Healthcare Workers, I was privy to information about policies, procedures, and their effects at Kaiser medical centers beyond Santa Rosa — throughout Northern and Southern California. And I believe the same policies that operate in California are in place at Kaiser medical centers throughout the United States which leads me to believe that the fraud I am reporting here is operating on an enormous scale.

My belief that The Kaiser Medical Group (TPMG) has defrauded the Medicare Advantage program is based on a partial understanding of how Medicare reimburses Kaiser. I will describe my experience with clinic policies and leave it up to you to assess if you believe, as I suspect, that there is a strong case for fraud. My understanding is that if there seems to be a strong case, then you forward your information on to the Office of Inspector General for further investigation.

Starting several years ago, therapists and psychiatrists in the Psychiatry Department in Santa Rosa were instructed to fill out a form known as “Medicare refresh” whenever the form appeared in our mail boxes. The form listed one or more diagnoses. Therapists had been instructed to check a box next to each diagnosis, verifying that the patient would be continuing to receive treatment for the diagnosis listed. Sometimes the forms contained “physical” diagnoses, like Hypertension. Therapists in Santa Rosa were instructed to comment on mental health diagnoses only. The most common diagnoses that we “refreshed” were Major Depression and Panic Disorder.  About a year before I left work for Kaiser, a more thorough training was given regarding the Medicare refresh process. In addition to filling out the paper forms, we were instructed to chart in each patient’s electronic medical record a plan to treat the conditions being refreshed.

My understanding is that these forms are part of a system that Kaiser uses to get reimbursed by Medicare Advantage for medical conditions that raise patients’ “risk scores.”  I further understand that there is a “reconciliation” process by which Medicare auditors review a sampling of cases in order to ensure that patients with higher risk scores are receiving diagnosis-specific treatments for the conditions that raised their risk scores. The reconciliation process implies that Medicare auditors compare treatment provided (services rendered) against a standard of care for each diagnosis.

If there is any standard of care expected for treating mental health conditions, I believe it is not being met by the behavioral health system in place at Kaiser in California. It appears fraudulent, therefore, that Kaiser accepts these payments for services never or only partially rendered.

Throughout my tenure at Kaiser, treatment of mental illness has been inadequate in at least two significant ways:  (1) markedly poor access to primary individual therapists and (2) an over-reliance on group programs. These inadequacies contradict the assumption (in the Medicare refresh process) that effective treatment plans for mental health patients are in place.

Markedly Poor Access to Primary Individual Therapists

Throughout my years at Kaiser in Santa Rosa, the waits between appointments with a primary individual therapist were, on average, 4 weeks, regardless of the seriousness of the patients’ symptoms. In the last year I was there, these waits got even worse in Santa Rosa, averaging 6 weeks. I was able, through my activities as a union steward, to confirm an average of 4-8 weeks between appointments with primary individual therapists across California and across conditions being treated. Due to the intervention of the California Department of Managed Health Care (DMHC), the amount of time a new patient currently waits for an initial appointment has in some medical centers improved. But according to my colleagues still at Kaiser, waits between follow-up appointments after that initial screen continue at their historical, unacceptable level.

Over-reliance on Group Programs

Kaiser has attempted to defend their short supply of individual therapy appointments by stating that their group programs provide better care than individual appointments. And this might be true, if it weren’t for the fact that most people do not attend the groups. Over the almost eight years I worked at Kaiser, the drop out rate for the groups addressing the two most often reimbursed categories of mental illness, Panic Disorder and Major Depression, had a drop out rate of 75%. That means that three out of four patients drop out of treatment between the initial referral to the group and the group’s final session. Without proper support from an individual therapist, the vast majority of patients do not complete the treatment plan that Medicare is reimbursing.

In summary, Kaiser is being reimbursed by Medicare to provide the additional resources necessary for treatment of certain mental health conditions. Therapists and psychiatrists are by rote signing off on the paperwork supporting this system. Therapists are unified in asserting that the supply of individual therapy hours is woefully inadequate to provide meaningful treatment and that group programs are only effective for the small percentage of patients that complete the programs. Under pressure from the DMHC, Kaiser is starting to increase its supply of individual therapy hours. It will be quite some time, however, before supply meets the ever-increasing demand.

Medicare Advantage should be refunded all the monies paid over the years to Kaiser for treatments promised through the risk score process but not provided. Future reimbursements for mental health conditions should be withheld until the supply of therapists is adequate to treat those conditions being reimbursed.

(38 days to go.)

 

A Quality Complaint

Posted on November 28, 2014

It hasn’t been easy, following up on Belinda’s recommendation to pursue a quality of care complaint regarding mental health services at Kaiser (see my post “Does Kaiser Advantage Have Integrity?“) I’ll spare you the tedious path I followed, but let you know the exciting conclusion: all roads lead to Livanta, the Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Area 5, which includes California. According to their website, Livanta “manage[s] all beneficiary complaints and quality of care case reviews.” A recording on their Helpline (877) 588-1123 indicated  I could email a “complaint specialist” at kroundtree@livanta.com.

I just emailed the following complaint to k…

I understand that Livanta is the BFCC-QIO responsible for Medicare quality of care case reviews in California. I am using every avenue possible to improve basic mental health care services at Kaiser Permanente — perhaps the largest provider of mental health services in California – and believe that a quality of care complaint is appropriate and has the potential to actualize these improvements.

I am a Licensed Clinical Social Worker, licensed to diagnose and treat mental illness in the state of California since December 2000. I worked as a staff psychotherapist at Kaiser Permanente’s Santa Rosa Medical Center, in their Psychiatry Department from September 2006 to May 2014. Throughout my time at Kaiser I witnessed and participated in a system-wide practice of under-treating mental health conditions, including those conditions that lead to suicide. This practice involves not hiring enough licensed psychotherapists to provide weekly individual sessions for people at risk for deterioration of their mental status without them. It also involves an over-reliance on educational groups in place of individual care.

To this point Kaiser has been able to maintain the appearance of quality care in its absence by minimizing meaningful quality care reviews and avoiding tracking suicides across the system. Despite national recognition of depression as a serious and prevalent medical condition, throughout my time at Kaiser suicide prevention was never stated as a programmatic goal, neither for the Psychiatry Department, nor for the Santa Rosa Medical Center. A quality goal of reducing suicide would necessitate developing an action plan to achieve that goal. It would also require a system to measure accurately suicides over time. But as far as I can determine, suicides are not now and have never been tracked anywhere in the Kaiser system.

The Psychiatry Department in Santa Rosa once had a quality assurance program, albeit with significant flaws, designed specifically to address system errors leading to patient suicides. Prior to 2013, we had an organized committee of therapists and psychiatrists, representing social worker, psychologist and MD disciplines, from the three teams that work in the department collaboratively – the adult team, chemical dependency team, and child and family team. The committee periodically received cases of suicide sent to them by the Medical Center’s “Chief of Quality.” The medical records were reviewed by committee members and other department staff of various disciplines; clinicians who had participated in the deceased patient’s care were often interviewed to further clarify the case.

The deepest flaws in this committee’s review process were: (1) inconsistent identification of new cases for review, (2) the committee’s lack of authority to implement changes, i.e. to turn their conclusions about system deficits into program improvements, and (3) the absence of communication between quality assurance committees across the state. I became aware of the first problem when two patients I had worked with killed themselves within a year. I found out about these suicides incidentally — in one case from a family member and in the other through the media. Neither case was reviewed by our quality assurance committee.

These flaws were exacerbated by the deteriorating situation between physicians and therapists over the course of a three-year therapist contract dispute, starting in 2011. At that time, Kaiser management began withholding from therapists any information that might be used in our dual campaign for an advantageous contract and quality care for our patients. In this context, in 2013, the quality chief in Santa Rosa stopped sending cases to the committee. Contrary to state and federal law, the committee’s work  was replaced by a single physician to review cases.  The committee members protested this change. Therapists within the department created a quality of care complaint, saying that the switch from committee review to physician review was in retaliation for whistle-blowing about poor (illegal) access to treatment. The retaliation case was reviewed by an investigator hired by Kaiser and dismissed as groundless. The single physician review of cases remains in place in Santa Rosa.

To review: Kaiser has yet to identify suicide prevention as a quality goal. As a result, they do not have effective systems in place to track suicides within medical centers and across the entire network. A process that they had set up to create at least the appearance of targeting suicide was dismantled in 2013 in the context of an ongoing labor dispute. Therapists at Kaiser are united in their belief that understaffing is contributing to poor outcomes including suicide. Currently there is no quality review system in place to confirm or disprove this assertion. There is, in fact, no meaningful quality of care system to review the management of mental illness at Kaiser at all, even as regards the most dire consequence of under-treated mental illness.

You can read more about poor quality mental health care at Kaiser on my blog site 90daystochange.com. I hope you are willing to help me get this complaint to the appropriate reviewer in a timely fashion.

(32 days to go.)

 

Yanking Up the Chain

Posted on December 1, 2014

I think I’m coming to the end of what I can do from outside the Kaiser system to impact the mental health services they provide. Which, I have to say, is a huge relief. The time has at last come to contact every politician I can, to formulate the best argument I can to encourage their involvement in these issues. And then to ease myself away, away, away.

Earlier this week I ran across a bill sponsored by U.S. Senator Tim Murphy (R) from Pennsylvania which addresses gaps in mental health services nation-wide. The bill seems focused on developing inpatient resources for people with serious mental illness and on removing barriers that prevent families from participating (usefully) in care. I tried to use Tim’s government website to send him a message encouraging him to broaden his campaign to include basic mental health care provided by HMOs. But I couldn’t change the pre-populated field for “state” from PA to CA. I suppose the problem was that I’m not exactly from Pennsylvania, so Tim’s not exactly my guy. I should have remembered this from my Schoolhouse Rock education. 

Instead of to Tim, I sent the following email today to my real guys — U.S. Senators Boxer and Feinstein. I’ve been voting for them for a long, long time.  But until this point I’ve never even asked them for the time of day. That’s about to change.

Dear Senator (insert Boxer or Feinstein here) and Staff:

Thanks so much for your efforts to date directed toward improving mental health services in California. I’ve been providing mental health treatment to residents of Northern California for the past twenty years and hope to continue for another twenty. I’m writing today to enlist your help in drafting new laws to promote mental health parity through HMOs, where the vast majority of mental health care takes place.

For the past eight years or so, I’ve been a staff psychotherapist at Kaiser Permanente’s Santa Rosa Medical Center. As you probably know, Kaiser is the number one provider of health and mental health services in California. I worked in the outpatient mental health clinic from September 2006 through this past May 2014. I resigned my position because, due to severe understaffing, I was unable to offer my patients the individual attention they needed. Over the years, I believe at least one of my patients killed himself because he didn’t receive timely care from me. Countless others declined in their health and missed opportunities to improve their quality of life because I couldn’t offer them the one-on-one time they needed.

For the last three months of my time at Kaiser, I blogged my efforts to change the system at 90daystochange.com. I was relieved of duty three weeks ahead of the agreed-upon resignation date, the day after I began documenting that my patients were at risk for decompensation and suicide due to understaffing. Please read my blog for a thorough description of Kaiser’s misbehavior toward its mental health patients. This letter to you is today’s entry!

Primary physical treatment at Kaiser is structured around the ongoing relationship between a primary care doctor and patient. This relationship is understood by patient and provider alike to be central to effective ongoing care. Though parity laws require otherwise, a mental health patient who comes to a Kaiser psychiatry clinic seeking a similar relationship from a primary therapist rarely gets the kind of relationship they need in order to recover from their condition. Over the course of my almost eight years at Kaiser, waits between one-on-one appointments were, on average, 4-8 weeks, regardless of severity of symptoms. That average held true across therapists and across Kaiser medical centers throughout California. As a result of the scarcity of individual appointments, the most common treatment course for a new mental health patient at Kaiser was and is: meet with a therapist once for an hour; schedule a follow-up with this therapist in one to two months; get a referral to a psycho-educational group (regardless of readiness or willingness to attend); and (not surprisingly) lose hope and drop out of treatment.

Recently I’ve been following up on my advocacy of Kaiser members with the Centers for Medicare and Medicaid Services. I’ve made a report of Medicare fraud/abuse (case #31144 being investigated by Health Integrity LLC) and a quality of care complaint (currently with the BFCC-QIO Livanta). Though well-substantiated, I believe my reports will be ignored due to the low priority given mental health treatments versus medical treatments. You can read my reports on the 90daystochange website. If there’s anything you can do to promote the investigation of Medicare abuse by Kaiser psychiatry, I would appreciate it.

The greatest barrier to enforcing quality standards for mental health treatment is imprecise language in state and federal health codes. The DMHC was only able to fine Kaiser $4 million because Kaiser was failing to meet clear standards for initial access to care. Unfortunately the codes do not describe standards for treatment once a client is in the door, so the DMHC can only go so far. I think the best fix for this flaw is to change the codes to specify: (1) that each mental health patient is assigned a primary therapist, (2) that this therapist has the authority to initiate the optimum treatment plan, and (3) the therapist has the capacity (room in their schedule) to see their patients weekly or twice weekly when necessary. Language in MOUs between Kaiser and Medicare Advantage are, no doubt, as vague as state laws concerning frequency of individual visits, and so need similar attention.

Kaiser is swiftly becoming the standard of health and mental health care for the United States, making it extremely important that they provide and model appropriate mental health treatment. The $4 million fine from the DMHC has nudged Kaiser in the direction of improving services, but it is ultimately insufficient to prompt long term significant change. It is in the nature of managed care to provide the minimum required by law. And since that’s what Kaiser is doing, the laws must change if we are to expect improved care.

If there’s any additional information I can provide, please get in touch. And thanks too for all your years of service!

Sincerely,

Andy Weisskoff, Licensed Clinical Social Worker
LCS -20126

(29 days to go.)

 

Dear Mr. President

Posted on December 8, 2014

I had to break this letter into three parts to get it through the whitehouse.gov website which has a 2500 character limit for email correspondences. (The things we do for love.)

Dear President Obama,

I am a mental health professional living and working in Northern California. I very much appreciate all your efforts to date improving access to quality health care.  As some health services are becoming available to a wider swath of Americans, I am concerned that availability of behavioral health services is lagging far behind. My most recent professional experience, eight years as a staff therapist working for the largest HMO in the US, Kaiser Permanente, taught me that despite federal and state parity laws, even the most basic mental health treatments are not being provided in the HMO setting. Since more and more Americans receive their care from HMOs, including the millions of people supported by Medicare Advantage and Medicaid programs, I have spent a good deal of energy attempting to raise awareness of these deficits. I am writing to you because consumers and providers need the help of political leaders to advocate for the profound changes required. Without refinements to our health codes and enforcement by our justice departments, HMOs will continue on their current course of extreme negligence.

Since February 2014 I have been documenting Kaiser’s mental health care deficits on my website 90daystochange.com. To summarize, over the course of my time in the Psychiatry Department at Kaiser Permanente’s Santa Rosa Medical Center, the waits between individual appointments with a primary therapist averaged 4-8 weeks, regardless of the severity of the patient’s symptoms. As you may know, California’s HMO regulatory agency fined Kaiser $4 million last year for delaying initial access to therapists and psychiatrists. In an attempt to address the regulators’ specific concerns, Kaiser made some superficial changes. These changes have not impacted the basic structure of how Kaiser provides behavioral health services. The four- to eight-week waits between individual appointments continue.

Kaiser members have much more reliable access to their primary care physicians (PCPs). PCPs authorize follow-up care, including with themselves. They have the authority to regulate frequency of visits with their patients. PCPs also have panel limits: when their availability becomes unacceptable, according to well-defined standards, their panels are closed. If there aren’t enough PCPs to meet demand, Kaiser hires more. Psychiatry Departments at Kaiser lack analogous structures. As a result, behavioral health patients are denied comparable access to their therapists. With next available appointment slots one to two months away, therapists cannot offer weekly or bi-weekly therapy, even in acute cases. For therapists, there is no limit to panel size and no patient to therapist ratio to inform Kaiser when to hire more staff.

Effective treatment in the mental health world, just as in the physical health world, requires a trusting relationship between provider and patient. Mental health treatment is, in large part, provided in one-on-one private conversations. PCPs are often able to address health conditions in a 15 or 30 minute visit, but therapists cannot — especially not during the first few critical sessions when trust is required for the patient to disclose the wider clinical picture. Trust is also required before patients will follow therapist recommendations to attend skills groups that teach strategies for managing strong emotions. Due to a lack of one-on-one support from individual therapists, the drop-out rate from Kaiser skills groups is 75%.

Quality assurance mechanisms to address treatments for “physical” conditions at Kaiser are stunningly absent for mental health conditions. If a regulator wants to know how Kaiser is doing at preventing heart attacks, diabetes, or hospital-based infections, as examples, the data is readily available. But how about for suicides? Suicide is the preventable consequence of untreated or unsuccessfully-treated depression. But Kaiser neither tracks suicides across its vast database, nor does it hold suicide prevention as a goal. In fact, Kaiser does its best to suppress information about suicide in order to avoid accountability. Some Kaiser therapists and physicians have lost their jobs attempting to address concerns about patient safety due to lack of therapist resources. Over the last two years in Santa Rosa, Kaiser went so far as to disband its functional, multi-disciplinary quality assurance committee, whose job (delineated in state and federal health codes) was to investigate suicides in order to prevent future treatment failures.

I am sending this letter to a variety of government officials, including to you, Mr. President, hoping it finds its way to those parties already working on improving mental health care within HMOs. I know your list is long, but please add mental health care to your priorities for the remaining time you have in office.

I am available for any assistance you may need: additional information, suggestions, encouragement. You can reach me by email at andyweisskoff@gmail.com or telephone at (707) 799-4125.

Thanks, again, for your attention to the health care of all Americans.

With Plenty of Admiration,

Andy Weisskoff, Licensed Clinical Social Worker

(22 days to go.)

 

Here Fishing

Posted on December 19, 2014

I know I can’t, in a letter, convince politicians to prioritize the cause of parity mental health care. A politician either has the issue on their radar and embraces it or they don’t. By writing senators and presidents (well, one president) I’ve been fishing for collaborators, advertising that I’m available to participate in the discussion, and hoping someone influential bites.

A couple of months ago my friend Andy Raskin wondered out loud why Kaiser hadn’t tried to hire me as a consultant. It would be good PR, he thought. I didn’t give it much thought at the time, imagining Kaiser executives laughing their heads off at the suggestion. Ironically it was at Kaiser that I learned and then taught the principles of assertiveness, including: You don’t know how another person will respond until you ask directly. So, since we won’t know until I ask, and since I really do think it would be a productive collaboration, and since he might see business advantages to the arrangement, I sent the following message by email and snail mail to the CEO of Kaiser Permanente, Bernard Tyson.

Dear Mr. Tyson,

I am a former employee of the Santa Rosa Medical Center and author of 90 Days to Change, a website providing advocacy for those members receiving behavioral health within the Kaiser model. I’m writing with a sincere offer to help you restructure Kaiser’s mental health services. As you know, TPMG stands on the brink of a series of prolonged and potentially damaging strikes by Kaiser therapists and nurses. I believe you can do some proactive damage control by (1) declaring Kaiser’s intent to address the long waits between individual psychotherapy appointments and (2) hiring me as a consultant to help restructure. In addition to improving public relations in the face of strikes, by restructuring, your corporation may avoid future malpractice lawsuits, class action lawsuits (from members and therapists), future fines from the Department of Managed Health Care (DMHC) and the Centers for Medicare and Medicaid, as well as other possible consequences like loss of membership.

The new model of care I recommend builds on what has started to emerge in response to the DMHC fines — a triage system that separates conditions with high service needs from those with low service needs and sends clients to either contracted therapists for low needs or to in-house therapists for high needs. Here’s what’s missing in this approach. For both tracks, the therapists need the same level of authority as primary care physicians (pcps) have for “physical” conditions – the authority to diagnose, treat, and refer to other components within the system as needed. Unlike pcps, psychotherapists treat the vast majority of conditions themselves, in a series of (relatively) long visits, without referral to specialists like physical therapists. Therapists must have the capacity in their schedules to meet with their clients for frequent (often weekly or twice weekly) visits. As is currently true for pcps, systems will need to be put in place to identify therapist availability and to close or open psychotherapist panels as needed to maintain access to these treaters. While Kaiser’s psychoeducational groups are an essential component of care, therapists need the authority to refer or not to refer members to groups according to each member’s ability to benefit from them. The current model of care, with severe limitations on individual therapy time, means that in most cases groups are the only offering.

To this point the greatest stumbling blocks to implementing this new model of care are the challenges of specifying the conditions Kaiser treats, standardizing procedures to identify members with these conditions, developing treatment standards for each condition, and clarifying when offers of treatment will end. There are no doubt a series of legal roadblocks to declaring which mental health conditions an HMO will treat and how they will treat them, but these must be hashed out in order to provide adequate services to the people in need. Not all mental health conditions are treatable and not all treatments work for everybody. Kaiser members, their families, and the larger public are sympathetic to these facts. Just as most Americans have accepted that HMOs don’t provide every available treatment for every medical condition, I believe most will accept limits on mental health treatment … if these limits are the result of a transparent analysis.

I am quite interested in collaborating. I hope you will accept my offer and we can meet to discuss a future working arrangement. You can phone me at (707) 799-4125 or write me at LCSWAndy@gmail.com.

Sincerely,

Andy Weisskoff, LCSW

(11 days to go.)

 

The Prize Within Reach

Posted on December 29, 2014

In the last ninety days I’ve put offers out to politicians, (hoping they might collaborate with me to change healthcare regulations), to regulatory agencies, (encouraging them to enforce the regs already on the books), and even to the CEO of Kaiser, (asking if he’d let me help restructure behavioral health services throughout Kaiser). I haven’t gotten any direct response to these offers yet. Even though these offers are sincere, I won’t hold my breath. In the next week, I’ll consolidate the blog entries for the last three months under the heading, “The Second 90 days – Reader’s edition,” and consider this phase of advocacy work done.

I’ve had emails and voicemails over the last ten months (since I started blogging here) from Kaiser mental health clients and their family members, from Kaiser therapists, and from Kaiser physicians, all encouraging me to keep this website active indefinitely. It has become a credible source of information and a source of hope to those struggling to improve the system. So, for the foreseeable future, I plan to leave “90 Days to Change” open. I’ll convert the blog area to a forum for stories from therapists and clients to provide up to date information as changes emerge. It is essential that we continue to counter Kaiser’s propaganda (which claims that adequate changes have already been made) with real time data about what’s really going on in clinics and emergency rooms throughout California.

Initially, the power of this blog came from the unique position I was in while preparing to leave my job. Kaiser could not fire me because I was resigning, and they couldn’t threaten to withhold my retirement benefits, since I hadn’t been on the job long enough to earn a pension or medical benefits. This unique position left me free to speak up. Kaiser clients and therapists still in the system, however, are kept silent by fear of retaliation. I hope that “90 Days to Change” will continue to be a safe space for protest, a place where like-minded clients and clinicians can commiserate without endangering their jobs or the healthcare services they receive.

I’m starting a new job in the new year with a non-profit public health clinic a stone’s throw from my home. (I know! No commute!) My private practice is growing nicely. But not nicely enough to pay the bills. And, as the bumper sticker says: I owe, I owe, so off to work I go. I still plan on joining my colleagues on the picket lines in January 2015. I’ll edit and publish new stories from therapists and clients on the front lines of this debate using this blogsite. And I’ll continue to be available to politicians, other lawyers, and Kaiser executives should any of these parties seek out my help. But otherwise, I’ll consider my Kaiser career over.

Thanks, everybody, for your enthusiasm over the last (almost) year. I’m proud and excited beyond all expectation about what we’ve set in motion. Look for the revamped “90 Days to Change” early in January 2015. And continue to support the efforts of the NUHW’s members as they begin their strike on January 12.

The battle has begun in earnest. Onward and upward all!

 

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30 thoughts on “The Second 90 Days (Reader’s Edition)

  1. I plan to call tomorrow since they do not take calls on the weekend and this is what I will tell them: Our family went through a very difficult time with our son (age 13 when this started) and we sought mental health services for him at Kaiser. It took us over 2 years to get him on medication he can tolerate and we still have not found a good medication match but the appointments are so spead out that it is difficult to make changes very quickly. I am actually happy with this area of his mental health care. His psychologist appointments with a wonderful and talented psychologist were always 6 weeks apart or more and this included us driving to a clinic that was an hour away where he splits his time to get sooner appointments because his appointments at our closer clinic were even more difficult to get. Our son got worse and began getting more violent and even placed himself in danger by climbing onto our roof once due to his mental anguish. We are capable and educated parents are were able to care for him ourselves so he never needed to be hospitalized which might have allowed him more services in retrospect. We eventually opted to pay out of pocket for a therapist weekly in the community. This weekly individual therapy was extremely helpful and our son is improving now. Unfortunately Kaiser refuses to cover this cost and we have spent thousands on his therapy with constant denials for reimbursement. Our family has the highest plan Kaiser offers and also has a supplemental medical plan and yet we pay thousands to get our son the timely help he needs. If Kaiser cannot offer return INDIVIDUAL appointments within two weeks then they should reimburse outside therapy.

  2. I called the DMHC today and tried to make an anonymous complaint and was told this was not possible. I read the statement from Marta Green and a manager was consulted and I was told either a formal form had to be filled out or a complaint of illegal activity as a whistleblower could be submitted anonymously. So sadly the complaint has not yet been recorded or registered according to the people who answered today.

  3. Hi Andy,
    Just wanted you to know I conducted a seminar on aging at Calif Psych Assoc annual meeting last weekend (4/12/14) . I dedicated the talk to Kaiser mental health workers and put up a slide with your blog address on it and explained what the blog is about . I also announced the blog address at every meeting I went to that weekend. And if I’m able I am going to carry a picket sign at Oakland this Wednesday with the blog address on it! Thanks for all of your brilliant work!

    PS I just sent the email below out to one of my professional organizations – the Alameda County Psychological Association- and I am getting tons of positive feedback. The subject line was
    “Kaiser Mental Health on STRIKE!”

    Hi all,

    I want to let you know that the Kaiser Mental Health non-MD providers (Adult team) are going on strike this Wednesday. We have been represented by The New Union of Healthcare Workers (NUHW) since 2011, but Kaiser has failed to negotiate in good faith with the union since we voted to join it.

    We are striking to improve patient care – currently patients wait 1-2 months for a return appt and are funneled into group therapy rather than being able to elect to have individual treatment, regardless of the presenting problem.

    We are striking to increase staffing because we are severely understaffed.

    We are striking to preserve our benefits and pensions.

    We are striking because the management has dismantled a very important treatment service, the dedicated on-call staff, which provides mental health care night and weekends through the emergency dept. A few years ago they dismantled the Behavioral Medicine Service, the providers who specialized in treating the psychological aspects of medical illness. The results of that dismantling has been disastrous with patients being turfed to mental health providers with absolutely no training in Behavioral Medicine. The same has already happened with on-call services. Providers are now being forced to provide on-call services to patients who are presenting in the ER with severe mental problems including suicide, homicide, bi-polar, or psychotic crisis. These providers do not typically provide these services but now must be making life and death decisions for these Kaiser patients.

    We are striking to restore quality mental health care.

    The issues affecting the mental health patients and providers can be read about on a very articulate, insightful, and engaging blog — 90daystochange.com Please go there to read about what is going on at Kaiser.

    Also very importantly:

    In March 2013 the Department of Managed Health Care (DMHC) the regulatory agency for Kaiser and all other medical institutions in the State of California, fined Kaiser $4 million for lack of initial access to mental health, for understaffing, for keeping 2 sets of records about mental health access, and for producing literature designed to discourage members from seeking mental health treatment.

    Although Kaiser has admitted that the DMHC’s finding were valid, they are protesting the fine. There is going to be a hearing in front of an administrative law judge starting May 12. I hope you will follow this important news. This is an important David vs Goliath fight with implications for all of us who provide mental health services and interface in any way with medical and insurance institutions. And two members of ACPA have been subpoenaed to testify for the DMHC about the affect that lack of access has on patient’s lives. I am one of the psychologists who will testify.

    Please offer your support by reading the blog, by wishing us well, and by driving by Kaiser on Weds morning from 9-11 to show your support.

    Best,

    Melinda Ginne (ACPA president 2007)
    Psychologist – Behavioral Medicine Specialist
    Kaiser Oakland

    PLEASE POST TO ALL OF YOUR NETWORKS – THANKS!

  4. I have Kaiser my Daughter is bi polar I have been trying for years to get help for her @ one point she turned to drugs heavy drugs I had her in treatment 3 to four times if I could find her . Finally she got off drugs Then trying to get Mental health help from Kaiser When she wanted bi polar meds they branded her Drug seeking Finally after finding the right combo Seiquill and Adavan they took adavan away saying she was drug Seeking and she was not abusing them. Appointments were every 3 months if that. At one point they wanted to send her to Vallejo for 90 days for therapy we live in Santa Rosa they said she should stay in a hotel there. I said she had a problem Drugs and she is Bi Polar and can’t stay in a motel by herself for 90 days. She has ben 51/50 several times ended up in hospital in Oakland because Kaiser has no facility. She also was told to do group therapy she would not go again no apoointment but every 3 months she stopped going . We tried to ask if Kaiser would pay for outside help for one on one once a week , we were
    told NO because Kaiser offers Mental Health. This has been going on with Kaiser for over 10 years. The only thing we can do is when she has a meltdown go to emerency for help I have spend so many hours there . They still will not let her have adavan which really helped her. Then we Changed doctors still do Adavan oh yeah a prescription for 3 pills a month that caused more anxiety because she knew she would feel worse if she only had 3 pills for a month. I hope they get their act together because my Daughter is still suffering . She is 28 years old cannot hold a job she has level2 Bi Polar . 3 months between appoints and no real help has been hell.
    She cannot afford Mental health Services outside Kaiser. This is ongoing with Kaiser. I am sure this is not an Isolated Case. Thank you

  5. I am speaking up in support of Kaiser’s adult mental health. Unfortunately I am diagnosed with a mental health illness. I have had many in-patient hospitalization a, ECT, PTSD Seeking Safety groups, Chemical Dependency program both intensive and long term, intensive out patient program after hospitalizations, medication management, weekly individual sessions, emergency crisis care,.
    At times Due to my disability I needed the assistance of an advocate to work on my behalf to ensure appropriate care. I am very pleased with the cooperation and team work kaiser had/has with my advocate.
    I have at times been in situations where I disassociated and my kaiser care provider has left her office, came to my location to assist with ensuring my safety and care. I have experienced cooperation between my medical and mental health care providers.
    I have always been treated with care; dignity; and respect from Kaiser mental health providers.
    Kaiser provides 24 hour services for mental health and crisis. I have experienced excellent and timely response to both phone and email services.
    Have I ever been frustrated? Sure!! I do believe I would be dead today if it were not for the care received through the Kaiser Mental Health Services.

    • How in the world did you find an advocate to help you?

      I am on a long-term disability (PTSD, DID, Major Depression) but Kaiser refuses to provide therapy. They said they would allow one session every six weeks but they would not treat my PTSD or DID, rather just check-in with me to see how I am doing.

      When I applied for therapy, Kaiser actually sent me a letter saying (and I quote), “You may think you need weekly therapy, but you don’t.” How in the world can they say such a thing when I am on long-term disability?

      Now, I do have an excellent psychiatrist to provide my medication (An anti-d plus Ativan), but I don’t receive any other help. They will not even allow me to attend the PTSD group because I am a male (they worry that female PTSD clients will be troubled by a male presence, and there is no PTSD group for men).

      I had wonderful therapy – twice per week – before I came to Kaiser. I’ve been with kaiser for four years without ANYTHING.

      Medicare said Kaiser may not refuse me therapy because, as a Medicare beneficiary, I am on a Medicare Advantage Plan – they even said Kaiser could loose their entire Medicare plan by denying weekly therapy – but they don’t want to take action, they want me to sue Kaiser.

      We patients need a class-action suit against Kaiser.

  6. I just read your whole blog, after reading the article in The PD.
    You are my hero for speaking out about this issue!

    As a patient of Kaiser Santa Rosa, and dealing with PTSD these past seven years, I have had to deal with every issue you spoke of. Not only do these groups not work, for women with sexual assault trauma, having mixed gender groups is completely inappropriate!! Having worked in the counseling field for twelve years, I knew I needed therapy at least once a week, if not more in the beginning of my recovery. Had I not spoken up, and caused a scene, I would have never been put into an out-patient program three days a week for eight months. I still do not get therapy every week through Kaiser, that I need. I have to go outside of Kaiser’s Mental Health to have this!!!

    Thank you for bringing this to light!
    Suzanne Carlin

      • Kaiser provides a Seeking Safety program. I too struggle with Co-Ed groups. The groups I attend are meant to teach me skills, so I can manage symptoms. The ones I attend are not meant to be dumping ground for details of trauma. Listening to others talk about their Trauma details would be triggering and most likely result in a mental health crisis.

      • God Bless You, Andy! I think you’ve really got something here. Your blog inspired me to try calling DMHC again [I have ten useless & self-serving replies from the Pleasanton Member Case Resolution Center which did not resolve my grievance]. I do not have any mental health issues, but I have an extensive surgical history . When I went thru my medical records, I discovered that NONE of the progress notes from my visits to the Spine Surgery Clinic in Oakland-four years worth: 2009-2013- were in there! Yet each of those visits is documented on my “Past Visit Summary” at kp.org. you would think this would be an easy fix.
        But Member Case Resolution sez: Medical Secretaries claims it is my spine surgeons fault & they have notified him of the missing records. 2 months later, Oakland Spine Surgery tells me it has heard nothing from Medical Secretaries. These surgical notes are important because the fact that I was hit by a car as a pedestrian, have had 4 spine surgeries, and an ALIF/PSO has been planned to treat my post-traumatic kyphoscoliosis is ENTIRELY MISSING from my medical chart & active problem list. It is as if Kaiser keeps separate medical & surgical charts for me [& probably others-why should I be special]. But get this: because I will not stop trying to correct my medical record & have filed so many grievances, I have been labeled with a “Personality Disorder”, even though there is no objective documentation for such a diagnosis in my chart. [I am 58, have completed 2 professional doctorates at the University of California, & my mental status has never been questioned by anyone in my life, until I actually won one of my grievances-at least on paper. Kaiser admitted I had a valid grievance [no treatment plan] but the problem was never corrected]. Worst of all, I also found documented in my medical chart, that I was refused hospital admission from the ED, for an acute abdomen a few years ago, because HBS [hospital based specialities] felt my “personality disorder would cause havoc on the floor”. Those words are actually in my chart! I do not have a personality disorder, or any mental health issues, but if Kaiser Oakland is denying hospital admission to mental health patients for medical problems, BECAUSE of their mental health issues, this is a serious problem that really demands further investigation!

        I called DMHC last week, sat by the phone for half a day, never got thru or received a call-back. Last nite, I did get a call back, but the DMHC person said she wasn’t an analyst and could not take a complaint over the phone. After 20 minutes of trying to convince her DMHC had in previous years taken my phone complaints, & sent me written confirmations, she gave me the number of health Consumer Alliance, which I called immediately, and was connected to Bay Area Legal Aid. Barbara told me there was no reason why DMHC should not have taken my phone complaint, and Barbara called DMHC & left a message to that effect. Said DMHC would call me the next day [today]. but 30 min after I hung up with Barbara, “Seemi Amand” called me from DMHC. She wasn’t an analyst either & couldn’t take a complaint over the phone. Then why did she call me? Because Barbara left her a message to do so. Seemi said Barbara shouldn’t have told me DMHC could take a complaint over the phone….aahhh!!!
        Kaiser is EVEN WORSE than the VA…because my monthly premiums are more than $1100…for this??? Kaiser Surgery, Radiology, Pharmacy, Laboratory are all top-notch but there is no excuse for this atrocious primary care and retaliatory use of psychiatric labels. All while the needs of authentic mental health clients go unanswered!

  7. I pray that change will indeed come to Kaiser patients in need of psychiatric care. I am a fifty year old woman who has struggled with major depression since the age of eighteen. During the summer of 2012, my husband began working for the County of Sonoma and Kaiser became our elected healthcare option. After paying out of pocket or receiving benefits through other insurance carriers for therapists and psychiatrists most of my adult life, I was absolutely astonished by the code of conduct employed and practiced at SR Kaiser Psychiatric Department. I remember feeling eternally grateful that I had the knowledge of what an effective therapeutic environment entails and that the care that I was receiving at kaiser, was not ‘as good as it gets.’ Had if not been for that knowledge, I quite likely might have thrown in the towel. As a result I found myself deeply concerned for individuals in crisis who were seeking therapeutic assistance for perhaps the first time in their life. Unfortunately, I was experiencing a major crisis throughout the two year period I was a Kaiser patient and in need of intensive support. That support never materialized. I received not only an inadequate number of appointments but experienced a quality of care that simply was not beneficial in any way. I was in disbelief as one therapist after another attempted to herd me into this group or that when it was blatantly apparent that I was in dire need of intensive one-on-one support. Thankfully, I persevered and am now receiving the care that I need. I pray that the department will be restructured in a way that will provide adequate care to those in need. The debilitating effects of struggling with a mental illness are difficult enough without having to fight for effective care. I cannot express enough appreciation and gratitude to Dr.Weisskoff for taking a stand in the effort to bring forth quality care for patients suffering from a mental illness.

  8. Thanks Andy for all of your courage in promoting quality mental health.
    It only takes one to initiate change and you have set the bar high.

    Your loving compassionate care is obvious. Thanks, blessings, Sandy Steele RNMSN.

  9. Hello I have been reading thru your blog…I tried to get thru the provided number and waited forever so I hung up. I had been an employe of kaiser for 17 yrs. I started seeking therapy, after a new manger joined our Dept, (who) was harassing and terrorizing me attempting to create a paper trial, to have me fired. it was horrible…my therapist was very supportive and suggested she put me on stress leave last summer..I was fearful of Kaiser, believing they would use this against me so I suffered tremendously and was trying to be tough..I was told by EAP that HR stated ‘why did you refer ( ME ) to Dept of Psychiatry it was only inevitable I would be fired’ … This was shocking to me. It became crystal clear at that time; Kaiser does not care for it’s patients and staff, they are about big business and money, corporate greed. I have experienced this first hand.. Kaiser will do anything to cut costs and provide inadequate staffing, where the patients and or staff suffer..why is this happening?
    Since I did run out of benefits at the end of Nov of this year I was no longer able to see my therapist. I was told by reception that it would cost me $500 out of pocket if I wanted to see my therapist, since I had no health coverage.. It took forever to get benefits thru the affordable care act by Obamacare > I did see my therapist 4 months later.. and this was a set back since I was cut off mid-stream during my treatment.. I have found that it was a month to 6 wks wait time before I could be seen again. I don’t understand this at all? How is this considered appropriate-care? there are patients who are suffering, who would benefit greatly to be seen for individual therapy more than the 4-6 week allotted time. Mental Health is seen as such a stigma. Patients are seeking help, shouldn’t they receive the same care and dignity that any other patient would expect if they were seen in any other Dept at Kaiser? I feel that Kaiser offers bare-bones minimum treatment at Kaiser for Mental health – ( as if to say this part of medicine doesn’t matter ) I believe Kaiser needs to revamp their Mental Health care system … Include intensive groups – so patients can attend more than once a week. More individual therapy every 2- 3 weeks with their therapist. It has been my experience with some of the team I have worked with that they do care, especially my therapist—but are restricted and limited in the care that they can provide..leaving patients to suffer – this shouldn’t be the Kaiser MOTTO…

    • I had a similar experience as a Kaiser employee with a power mad supervisor that was determined to drive me out of my job. I ended up with a severe recurrence of my life long depression and anxiety and also went out on disability for several months. I was on the verge of being admitted for suicidal ideation. I was able to go to an intensive outpatient program (IOP) two times a week at Kaiser but had to travel 30+ miles one way because there are limited KP facilities near my home. Many of the other patients I met there lived near me and several dropped out because of transportation issues. I ended up carpooling with another patient. The IOP program is a group setting that was not helpful for me. It is Kaiser’s way to deal with a number of people all at once with one therapist in one time slot. It is more of a way to deal with access issues than an effective means of treatment for people in crisis. I was not able to see an individual therapist more often than every four to five weeks. The therapist eventually told me, not in so many words, that she would not be able to continue seeing me because she had too many other patients that needed her help more than I did. I was discouraged from booking any further return appointments. Had I known about ways to complain to the state agencies I would have done so at the time. I hope this is a wakeup call for Kaiser to pay as much attention to the quality of their mental health services as they do for their medical services.

  10. Ben,
    I am so sorry for your difficulties. I can start by saying that I have a great support system outside of kaiser. I have two people outside of kaiser (friends) who advocate for me, when I am unable to do for myself.
    Regarding the PTSD Seeking Safety program, they may have changed the rules on having the groups co-ed. I did not catch what county you are in. I am in Sonoma County, and have experienced co-ed in one of the groups I attended. That was however about 3 years ago, so I am not knowledgable regarding current rules. If you are in Sonoma County, I can get back with you on Monday. I will be seeing one of the group facilitators.
    Regarding the frequency of one on one, I am seen on a weekly basis and have on occasion had more frequent visits.
    My care is provided through the Intensive Out Patient (IOP) staff. My illness can take me down fast and has resulted in many hospitalizations. The support I receive is OUTSTANDING, and prevented quite a few imminent hospitizations. In addition to the toll hospitilations have on me, the cost to kaiser is very high. Kaiser contracts with other facilities for psychiatric in-patient. The also employ a team of Who work with the facilities to ensure quality care, discharging plans, medication plans etc. those staff are very hands on (ABSOLUTELY OUTSTANDING), to ensure safety and support after discharge. Additionally kaiser contracts with several residential facilities if members aren’t quite ready to go home. The same IOP staff work with the facility and member to ensure safety and support when the member goes home. Those staff are very hands on, addressing members concerns about facilities. The also participate every step of the way as a member of the Members medical planning team. After hospitilization members are encouraged to attend the IOP Program. The program is both supportive and educational. Like the Seeking Safety, Chemical Dependancy, Chronic Pain and others, IOP attempts to teach skills for managing symptoms. The One-on One through IOP also focuses on teaching coping skills.
    Unfortunately there is no cure for our disabilities, but we can learn symptom management skills. I do believe my support system outside of Kaiser has made impact on the treatment I have received. My advocate works with the Kaiser staff as a member of my medical care team. That includes at times attending appointments, hospital commitment or discharge meetings, medication management and compliance monitoring etc.
    In closing I encourage you not to give up. Try to get an outside advocate who you can authorize to act on your behalf. Kaiser has a 24 hour mental health crisis system. Try to hang in there, have your advocate do a little pushing on your behalf. Remember you are a survivor.

    • Thanks for reading and taking the time to respond!

      You are, in a strange way, ‘fortunate’; your repeated and very expensive hospitalizations and other crisis care encouraged Kaiser to treat you outpatient. It is much cheaper for Kaiser to provide you with excellent outpatient services than it is for them to ignore you only to have you go inpatient and cost them the big bucks!

      Fortunately (or unfortunately, depending on how one looks at it), I have been stable for many years. Also, I do not act out with drugs, alcohol, cutting, gambling or sex. While all of this is ‘good news’, Kaiser uses my stability against me and so claims I don’t need therapy or any other help.

      So, strangely, in a way I am being ‘punished’ for my stability. Very, very sad.

      Someone pointed out I could claim that I was suicidal, be hospitalized, and then sit inpatient long enough for Kaiser to realize it would be cheaper to treat me outpatient; I might then possibly garner the care you currently receive. I am not, however, willing to regress in order to gain services.

      I’ve been denied services for the last four years. I haven’t had a lick of therapy. I’ve received two formal Denial of Coverage letters regarding my request for therapy.

      This week, I made my last bid for help. I’m supposed to get an answer this upcoming week. If they deny me again, I’m filing a formal complaint with the Department of Managed Health Care.

  11. Thank you for trying to raise awareness of this issue.

    I left Kaiser three years ago in order to get help for my son with substance abuse/mental health problems. Their group approach and lack of individual therapy on a regular basis does not meet the parity standards as I understand them. Kaiser substance abuse treatment did not provide in patient drug treatment when my son needed it and the therapist confirmed. He was supposed to go to outpatient and fail first but outpatient was located 30 miles away and he had lost his driver’s license/was at risk of driving, so I would have to transport him on a daily basis. Kaiser often refused individual therapy or appointments were scheduled three to four weeks apart even though my son was diagnosed as bipolar. Groups were not convenient or interfered with work/school. The inconvenience and rigid rules related to attending groups are just as bad as the long wait times. My son was told he had to do substance abuse treatment before mental health therapy but he had just completed a substance abuse treatment program elsewhere and needed to continue with ind. therapy. I think the strategy is to discourage patients from accessing care by making it inconvenient and inaccessible. I was told several times by providers to get care outside of Kaiser (at a steep price) and even given referrals.

    Next I tried Blue Shield PPO. I would like to say that it, also provided by employer, is much better, but it is still very inadequate. It does allow individual appointments without limits which is great, but very few providers actually are in the network because the rate of reimbursement is very low. The plan provides only a fraction of the cost of out of network providers. My plan does not cover residential treatment for substance abuse (which I believe is a violation of the parity act), and one provider refused to take him as outpatient because he was assessed as needing inpatient ($27,000 for 28 days not covered by my plan). When we did find treatment that billed the residential part separately, Blue Shield stepped him down after only a few days of intensive outpatient care. After not being able to get adequate help/diagnosis for years, my son had progressed to heroin addiction and the plan did not cover detox either unless he was in danger of death, so I had to pay $1000s for detox in addition to the residential part of the care. Now Blue Shield is paying for my son’s counseling and family counseling and my counseling (for depression/PTSD from dealing with a drug addicted family member) on a regular basis. I am over 65 but I am still working so my son can remain covered until he is 26 as allowed under parity.

    Despite parity, the gaps in health care coverage for mental health and substance abuse are still causing a nightmare for sufferers. One of the problems is that the severely mentally ill/sa don’t feel they need to be treated because their brains are too messed up. Having an adult child with an sa or mental health issue is especially challenging because they are “adults” even if they are totally financially dependent on their parents. Family members are often shunted to the side and not told what is going on. I have spent thousands of hours on the phone with both these insurance cos tangled up in bureaucracy over trying to get help for my son. It should not be this way.

  12. My deepest gratitude to you and Sonoma County Supervisor
    Shirlee Zane for opening a discussion regarding the problem
    of Kaiser’s preference for people without problems when it
    comes to providing mental health services.

    I had found your blog and Supervisor Zane’s critiques while using
    Google to find the email address for the Director of Kaiser’s
    “Behavioral Health.” program.

    To be honest I was scared when I found your blog
    and the article about Supervisor Zane.

    On some level, I wanted to be wrong.

    I had just finished writing a very angry email to my case manger
    regarding the inadequacy of care in the face of the “evidence
    based studies” that show that people with Complex Post-
    Traumatic Stress Disorders do not benefit from short term
    behavioral interventions and generic group therapy.

    So when I found that there were two other people
    who were angry about the same problems I was
    very surprised.

    What patient wants to believe that the quality
    of his life is in the hands of “professionals”
    who won’t say no to budget cuts made by
    people who are paid not to care?

    I want to be clear; what we are seeing at Kaiser
    is a reflection of the mess privatized health care
    has made of our national public health system.

    Whether conservatives “broke,” the public
    system intentionally or not is incidental
    to the damage they and their enablers
    have done.

    A profession that accepts homelessness as a
    “self induced” treatment outcome for patients
    who are gravely ill and unable to make
    reasonable decisions is a reflection of a
    system held hostage to passion without mercy.

    Our legal system is used for the
    punishment and destruction of
    those deemed weak; patients
    who can’t “fake it till they make
    it.; patients who might require
    the misery merchants to sacrifice
    a portion of their fat bank rolls
    in order to give patients what
    they deserve as human beings.

    If I sound angry, it is because I am.

    I am in pain and there is more I want
    to do with my life.

    I resent suffering this pain in front of
    people who are too shallow to
    understand it.

    My illness is life long, and there are
    periods when I am not functional.

    When I first read your blog, I wanted
    to respond but felt too vulnerable.

    I feel stronger now and want to make sure that
    my voice is added to those who are willing
    to say enough!

    I will not allow one more second of my life
    to be used to enrich people who already have
    more than they need.

    I exchanged an email with Supervisor
    Zane.

    I am posting it to your blog because
    in a sense, it was also a response to your
    blog and because it might prove helpful
    to someone else.

    “Supervisor Zane,

    Thank you for your kind response.

    My first real job was with a long-term psychodynamic
    treatment facility.

    And my last real job was as program director of a residential
    mental health facility in San Francisco.

    I have watched psychiatry remove psychiatry from psychiatry.

    I was a very strong advocate for my patients.

    The treatment of psychic pain requires more than
    pushing pills and teaching patients the
    skill of living in silent pain.

    Emotional pain is unbearable without a context that
    gives it meaning.

    I believe that we humans have souls and that psychiatry,
    at its best, is the art of healing the wounded soul.

    Thank you for your advocacy,

    Rob Goldstein”

    Below is a link to an open letter
    that I wrote to ‘Psychiatry” in May
    for Mental Health Awareness
    Month:

    An Open Letter To....

  13. Adding to the blog… Kaiser doesn’t have adequate care for adults with eating disorders. They have systematically reduced if not eliminated any kind of support at their Walnut Creek facilities. First they reassigned the one and only NP who had any ED training; this was several years ago. They recently reassigned the one and only RN who worked with ED patients. (The RN for chemical dependency patients is still there.) The reassignment was done literally overnight, with no transition time or advance notice to patients; I’ve never seen Kaiser move so fast in my life. They do not have any MD that has ED specialization; I’ve asked; they say they have several; they have yet to give me an actual name. The runaround I’ve been given and the inconsistencies Kaiser has offered up are mind boggling and stunningly lacking any standard of care. I have notified DHMC; I hope they are working on it as they have said they are. (Initially they referred me back to Kaiser. Wha…?????) What is perhaps the greater issue that all Mental Health patients face is that we shouldn’t have to fight for the care we need and deserve when so many of us are already fighting an illness and struggling with day to day living. Their lack of care only continues to stigmatize mental illness and subjugate those of us who are unfortunately afflicted to the status of second class citizens.

  14. What Ann N. is doing is great. Do notify DMHC. And TAKE NAMES. Demand that Kaiser give you a Name to go with a position. Back in 2008, Kaiser grievance resolution letters actually contained the names of the health care providers who had reviewed the complaint. Now there are no names at all [except the Pleasanton Case Manager who wrote the letter & had nothing to do with addressing your complaint]. “Your concerns were reviewed by the Team Leader, the Assistant Chief, and the Liaison. They all agreed that your needs appeared to be addressed.” What a bunch of crap. Who are these people? What are their names? Are they even health care professionals? “Strict confidentiality requirements prevent us..” From what? From caring? From doing your job of treating patients? The only confidentiality Kaiser is supposed to protect is mine, & the other patients. Not the identities of the people deciding whether or not our “needs were addressed.” Kaiser has made a complete mockery of the Member Grievance process. It must stop!

  15. You wrote: What is perhaps the greater issue that all Mental Health patients face is that we shouldn’t have to fight for the care we need and deserve when so many of us are already fighting an illness and struggling with day to day living. Their lack of care only continues to stigmatize mental illness and subjugate those of us who are unfortunately afflicted to the status of second class citizens.

    My reply: You have touched on the core problem.

    This is not just a Kaiser problem; this is a national problem.

    The stigma against people with psychiatric illnesses
    is as immoral as racism and homophobia.

    CBT and DBT are very effective for problems related to
    substance abuse and emotional dysregulation.

    But most people with schizophrenia or Complex PTSD
    can not “fake it till they make it.”

    1. No patient should have to suffer because his illness
    does not fit the preferred theoretical paradigm of his
    treatment providers.

    2. One size does not fit all; Kaiser should offer DBT and
    Psycho dynamic Psychotherapy as policy.

    3. If a Kaiser case manager thinks that a patient needs
    psychotherapy, then he or she should be skilled enough
    to provide it.

    4. If Kaiser is treating a rare illness then it must provide
    training to its staff. It is unacceptable for a patient to be at
    the mercy of professional ignorance.

    5. Professional assessments of the patients’ progress
    must include all factors of the patient’s life, including
    the effect of the patient’s illness on his relationships.

    6. Provide family therapy.

    7. Provide hospitalizations with length of stays based on
    the patient’s needs. A month long hospitalization with
    intensive treatment is not an unreasonable request.

    8. Psychiatric patients do not necessarily benefit
    from treatments designed for problems of substance
    abuse.

    9. Homelessness is not an acceptable treatment outcome.
    Kaiser should provide intensive case management as
    a matter of course.

    10. The nation’s policies regarding the treatment of people
    with mental illness have failed and must change.

    Homelessness is not a symptom of mental illness.

    It is the face of the corruption that grips our nation.

    Rob Goldstein

  16. Andy,

    I’m very pleased that you have decided to continue your work. I have been thinking that
    the system relies on our silence. It expects the mentally ill to silently accept death by
    exclusion.

    The only solution is the kind of radical action that gay men used in 1987 when we formed
    ACT-UP.

    It’s very simple. Silence-Death and Acquiescence = Complicity.

    When I last spoke with my Kaiser psychiatrist about creating a treatment plan
    based on the accepted guidelines for treating dissociative disorders I was
    told that I should file the request as a grievance.

    I couldn’t believe it….

    I can’t see a single reason I should have to go to such extremes
    to get an intensive case manager who can help me to work with a staff of
    behaviorists who sneer at Freud and know nothing about illness of the
    mind.

    It’s outrageous to think that the primary treatment modality for treating the human
    soul is based on the observations of a man who conditioned tortured animals
    to drool.

    A History of ACT-UP
    http://www.unitedinanger.com/

    Anyway,

    Thank you,

    Rob Goldstein

  17. Hi, I’ve been going through some really bad depression recently to the point that I am suicidally ideating frequently. I’m 22, I lived in Maryland and I have Kaiser through my dad(federal government employee for the CDC) but I work full-time on night shift(very rough on its own) and I’m eligible for Aetna through my employer for a little under $2,000 a year. Is it even worth wasting my time with Kaiser for mental health issues or should I just switch to Aetna?

    My mother also has Aetna in case for some reason I lose that job but it will significantly drive up her insurance costs and she doesn’t think I should switch to my own plan and won’t let me switch to hers until I try Kaiser(she thinks their horrible mental care is just the words of a few people so she won’t listen to me), but I have read here and in various other places that Kaiser is worthless for mental health and their own website says nothing about one on one counseling, only group therapy which is not enough for me. I don’t want to go through the hassle of going to appointments just to be told I have no real options other than pills when I could potentially be getting the help I need

    So I’m asking everybody: Should I bother wasting my time and remaining sanity trying to get what I need with Kaiser, has Kaiser ever worked for anybody with mental health issues? Or should I just switch to my own plan with Aetna?

    • I know you asked this a long time ago, but I’m just reading it now. I got some good advice from a Kaiser salesman when I was stealthily trying to find out what Kaiser was offering new customers. He recommended calling the local psychiatry clinic directly and asking what they offer. (There is a lot of variation clinic by clinic.) Usually you will get someone other than a supervisor on the phone, either a receptionist or a triaging therapist, who are more prone to give the straight poop.

      Good luck!

  18. Andy, I saw you once at Kaiser last year. I knew you’d left, but I had no idea about the circumstances. I applaud your advocacy. I was a first time mother experiencing extreme anxiety and chronic PTSD (I was severely abused in my childhood, and motherhood triggered a great deal of grief and depression for me). For 2 years following the birth of my daughter, I repeatedly asked Kaiser for psychotherapy and was denied it. I was put on many drugs–Ambien, Prozac, Ativan. I did my best with my daughter but the depression would not lift. One day, I crashed and felt like I wanted to die. I could not get out of bed. My (non-Kaiser) therapist recommended I seek a med eval from Kaiser psych. I called and was scheduled for an appointment the next morning. I had no plan to kill myself–I was only so sad that I stated I felt like I wanted to die, and I needed to consult with a psychiatrist for a med eval. The social worker I saw at Kaiser spent 20 minutes with me, asked me if I had a plan to kill myself (I said no), then asked me if I were going to kill myself, how I would do it. I replied that I would go into the woods and cut myself. I agreed to be hospitalized, thinking that my drug and hormone levels would be checked, I would receive a thorough psych eval and therapy, and could rest for a few days until I was on the other side of this breakdown. I did not know that I had agreed to a 5150. I was put in a room off the Kaiser waiting room under security for 3 hours in full view of staff and patients. Medics came to put me on a stretcher in front of the waiting room. I was driven 75 miles to Oakland, where I was locked in a dirty, horrific facility where men and women wandered about in gowns. Some people screamed and beat at the windows to get out. I did not see a psychiatrist until the next day, and the one I saw scolded me for my leaking breasts (I was still nursing my 18-month-old) and told me to look at this as a chance to wean her and relax. I was told by staff to act normal and eat if I wanted to get out. I was given any drug I wanted and put on the same meds by the psychiatrist that I had already been on. Once I got out, there was no follow-up from Kaiser and I was again denied psychotherapy. I had to demand to see a psychiatrist at Kaiser within the following week to get the help I’d originally asked for.

    I wrote letters and called the head of the psych dept at SR Kaiser. She talked at length with me and apologized for what had happened. But Kaiser formally took no responsibility for my complaint and replied to my written plea that their treatment of me was justified by my diagnosis of major depression.

    I remember telling you how traumatic this experience at Kaiser was. It still is. And I now carry the stigma of having been 5150’d. For Kaiser, my 5150 cost thousands of dollars that they could have spent in preventative care for me when I begged for it and needed it most as a new mother. What happened to me was not treatment–it was simple risk management. An opportunity to help someone in need of compassion, evaluation, and attentive treatment was wasted on a prison lock-up that left me totally shattered and whipped.

    I could not pursue a legal medical malpractice case (I was a medical malpractice investigator for a physicians insurance company, ironically, at the time) because no plaintiff attorney will take on a mental health case like this–there’s not enough money in them potentially due to the 250K cap on special damages (the nucleus of what is being fought over in Prop 46). And I was tired and needed to find my way back to health, on my own, without wasting energy on an angry fight. My husband and I took out a loan to get me the therapy I desperately needed, I went off the medications, and we made changes in our lives that reduced our stress. And I got better, without the help of Kaiser. I HAD to get better, for my daughter and my family, and I had to do it alone. I am thankful I had the resiliency to do it.

    Kaiser never did give me psychotherapy, not until years later, after I saw you and you referred me to an intern who made himself as available as he could, but was never available on a weekly basis. So my husband and I have continued to take out loans to get the treatment I and we have needed as other stressors and a second child have presented challenges to overcome in order to keep ourselves and our family emotionally intact.

    I thank you for your kindness in the brief moment I met you. I’m sorry you left Kaiser and were treated like a corporate security threat to them. But I feel, finally, after all these years, so much better knowing that it wasn’t just me who experienced something that made me feel terribly abandoned, punished, and ashamed of myself when I was most vulnerable.

    Thank you for being a truth teller.

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