Kaiser Uses Algorithms to Diagnose Mental Health Patients in Violation of State Law

Therapists say system routinely results in patients at risk of suicide not getting immediate and appropriate care

In the vibrant landscape of Southern California, Kaiser patients seeking medical assistance have the advantage of connecting with a skilled advice nurse, expertly trained to guide them toward the appropriate care.

However, the journey takes a dark turn when it comes to mental health services.

Instead of receiving the compassionate support they deserve, mental health patients at Kaiser are instead referred to an unlicensed clerical worker.

This unlicensed individual evaluates treatment needs through a simplistic series of "Yes or No" questions, inputting responses into a computer algorithm. This approach not only undermines the complexity of mental health care, but it also is a violation of the law, which places vulnerable patients at further risk of suicide.

In a complaint submitted today, the National Union of Healthcare Workers, representing 2,400 Kaiser mental health professionals currently engaged in a strike in Southern California that has lasted six months, is urging the California Department of Managed Health Care to mandate that Kaiser immediately cease this practice in the region and to impose additional penalties on the large HMO.

This complaint underscores the significant structural changes implemented by Kaiser, accompanied by alarming reports from Kaiser therapists. These professionals frequently encounter situations where they are assigned patients with conditions that are excessively severe for the clinical programs currently available. This includes individuals who are at risk of suicide, raising serious concerns about the adequacy of care provided.

It is so bad, that mental health workers in Los Angeles have implemented a hunger strike.

“It is a frighteningly common occurrence to be assigned a patient and quickly realize that their conditions are far too severe to be in our program and that they should have received immediate services,” stated Zhane Sandoval, a psychiatric counselor in Kaiser’s ADAPT Program, which offers 25-minute telehealth therapy sessions for patients with mild-to-moderate mental health issues.

“As therapists, we see how Kaiser doesn’t view mental health care as equally important to medical care, and that’s why we’re so determined to win this strike and make Kaiser do right by all of its patients,” Sandoval added, as one of eight therapists participating in a five-day hunger strike this week outside of Kaiser’s Los Angeles Medical Center.

The complaint stems from a recent report by the California Department of Managed Health Care, issued just three weeks ago, revealing that Kaiser has not addressed 19 out of 20 deficiencies in its mental health services identified in a 2022 investigation, leading to a record $50 million fine.

One of the unresolved violations in Southern California pertains to Kaiser’s inadequate triaging of patients seeking help for mental health issues. The agency determined that Kaiser lacks “sufficient level of oversight to ensure enrollees receive suicide risk screening, assessment, and treatment consistent with professionally recognized standards of practice.”

Although Kaiser has not been explicitly cited by state authorities for using unlicensed clerical workers and algorithms in mental health patient triaging, this practice is illegal.

According to California’s Health and Safety Code, health plans are required to provide 24/7 triage (screening) services via telephone, defined as “communication with a physician, registered nurse, or other qualified health professional acting within their scope of practice and who is trained to screen or triage an enrollee who may need care for the purpose of determining the urgency of the enrollee’s need for care.”

While it is legal for unlicensed staff member to handle calls and may ask questions on behalf of a licensed professional to help determine the condition of the patient seeking care, it is NOT legal for unlicensed staff to provide mental health assessments.

California law clearly states that “an unlicensed staff person shall not, under any circumstances, use the answers to those questions in an attempt to assess, evaluate, advise or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional.”

“This is yet another example of Kaiser Permanente putting patients at risk by refusing to provide the same level of care to those with mental health conditions as it does to those with medical conditions,” remarked NUHW President Emeritus Sal Rosselli.

“Kaiser can’t claim it’s providing parity for mental health care when somebody with a fever gets to talk to a nurse, but somebody having thoughts of ending their life is directed to a clerical worker feeding an algorithm. Instead of collaborating with us to enhance care, Kaiser seeks shortcuts to save money and deny patients the services they’re entitled to receive.”