On Tuesday, around 4,000 mental health care workers employed by hospital giant Kaiser Permanente across California entered their second day of a five-day strike over patient conditions. Workers have been kept on the job without a contract by the National Union of Healthcare Workers (NUHW) for well over a year—since September 2018.
In late September, Kaiser Permanente announced that a tentative deal had been reached with a coalition of its unions, calling off a scheduled strike by more than 80,000 workers, including 67,000 in California. The agreement came only two weeks before a strike date of October 14 after a near unanimous vote of workers authorizing strike action.
The strike was called off unilaterally by the Service Employees International Union (SIEU) without any input from the workers. The deal was hatched by the Coalition of Kaiser Permanente Unions, whose largest union is the SEIU. By calling off the strike when workers were in a powerful position to fight, the union coalition demonstrated they are interested in protecting the interests of the company, not the workers.
The current five-day strike by Kaiser mental health care workers is yet another effort by the unions to allow the workers to let off steam in the hope of wearing down the determination of all Kaiser Permanente workers to fight.
Workers spoke to a World Socialist Web Site reporting team in Oakland about the conditions they face and their attitude toward the strike.
Jason, a mental health care worker for over 15 years, has been at Kaiser for four years. “We’ve been trying to push for a long time for Kaiser to give better patient access,” he said. “Kaiser measures their access by front end, how soon does someone have an initial contact. What they don’t talk about is return access, which is how quickly or how often you can see a therapist after your first meeting. Right now, you cannot see a provider at Kaiser any sooner than about every six to eight weeks. When you’re dealing with mental health conditions like depression, anxiety, suicidal ideation, this is unethical.
“We have patients who have killed themselves because they weren’t able to get the care that they needed when we were at work under normal conditions. Kaiser tries to insult us, saying that we’re taking away care from our patients during this delicate time of year, when they don’t care that people are killing themselves 51 other weeks of the year.
“Kaiser pushes for us to meet with patients via phone instead of face to face, so that they can move more people through the system. Kaiser doesn’t see the need for us to have enough return access to see our patients regularly face to face.
“The primary psychiatry departments are suffering the burden of these cost-cutting measures. I have co-workers with 40, 50, 60 patients on their caseloads. If you were a therapist in private practice, you might manage 20 people.”
Jason expressed concern that everything would just go back to “business as usual” after the strike with no change. He said, “When it’s only 4,000 workers on strike, Kaiser can say ‘we’ll see you in a week.’ They don’t mind paying out a bunch of money to bring in scab workers. In the past, they’ll bring in unqualified people to staff the call centers, to do screenings and triage. Last year, they brought in a bunch of people that weren’t licensed in the state of California. Kaiser just figures they can throw money at the problem, wait out a week of bad press, and everybody will forget about it and we can go back to business as usual.”
Asked about the broader political issues behind the strike, Jason said, “I think there’s a complete disconnect between those at the top of society and those at the bottom. Whether it’s a Democrat or a Republican in the office, the fundamental things never seem to change.”
He added, “Kaiser just paid $300 million to put their name on the outside of the Chase Center in San Francisco. They put a sign up that says ‘Thrive’ while their patients are killing themselves because they can’t get appointments, despite the fact that Kaiser owns 10 buildings around Oakland. They’re building themselves a new $900 million headquarters in downtown Oakland. Instead of just putting up signs around Oakland telling people to be healthier, they can actually invest in programs that will help make them healthier.”
These sentiments were echoed by other workers. Kathy, who has worked as a therapist for 25 years with children and families, said, “What our patients really need is more access to care. Right now, there’s just no way to meet patient needs with our staffing. The way things are, if you have a teenager who’s subclinical, maybe they’re occasionally suicidal, maybe they’re cutting, the only way we can see them enough is by scheduling them in our charting time when we’re supposed to be updating our notes on patients. So now, if we want to meet that patient’s need, we have to do that paperwork afterhours. In a given 40-hour week I have to work at least 5 hours outside of the time I’m paid for.”
Kathy said that her clientele was different from a private practice and that therapists at Kaiser were exposed to the broader social crisis. She said, “You don’t make close to as much money at Kaiser as you do in private practice. Here, we’re serving the working class and we see the whole social crisis in our caseload. Many of the kids I see come in here with no hope for the future; there are so many kids with trauma, who see homelessness or hunger.”
Speaking about the “initial contact” issue raised by Jason, she said, “Kaiser puts a lot of emphasis on initial contact because the Department of Managed Health Care puts a premium on it. That means we’re getting pushed to keep starting new patients but not given the resources to actually help them. At the same time, chronicity and acuity in our caseloads have gone up. The patients we’re seeing are coming with more-severe problems that are taking longer to treat.
“There was a big change about 10 years ago. That’s when we started seeing upper management pulling huge bonuses. Kaiser is part of the whole problem of corporate greed in this country. They won’t give us our pensions in Southern California. The CEO who just passed away was the highest paid CEO in health care, making $16 million a year.”
Alice, a clinical social worker, said she was on strike in defense of “professionalism in the field of mental health.” She explained, “They say we have a choice in how we treat our patients and members, but in reality, we’re not given the freedom to choose the services that we feel are needed. Patients are primarily driven into group therapy systems, even when they need one-on-one therapy.
“I think the Kaiser executives should ask themselves whether they would send their own children to receive therapy at Kaiser. If you’re sitting on a pedestal and high up, and are never really in touch with the common people and what they experience, how would you know? They’re running things from a purely numbers perspective, and not from a human perspective.”
Alice also explained how her work had changed amidst deepening political crisis. “Since Trump was elected, there’s been a huge growth in fear, anger and anxiety,” she said. “I work in triage, we’re the first clinicians that patients speak to, and never in my career have I had so many Tarasoff cases, in which people are forced to break confidentiality and call the police because someone has made a real, credible threat that they’re going to harm somebody else. We’ve seen a particular growth in the child services department.”
On Tuesday, a total of two day-long pickets took place, in Oakland and Los Angeles, as will be the case on Thursday.
Workers from Calabasas, Mission Hills, Riverside, Chico, Irvine, Anaheim, San Diego and Oceanside were loaded onto charter buses to Kaiser in Los Angeles, while workers from Daly City, Pleasanton, Redwood City, Roseville, Sacramento, San Jose, San Rafael, Santa Clara, Santa Rosa, South San Jose, Tracy, Vacaville and Vallejo were all bused to the Kaiser Oakland Medical Center.
The decision by the NUHW to load up all striking health care workers from these locations amounts to cutting all of these locations down from three to five days of pickets. This is yet another tactic by the union to wear down workers on their already limited strike. The buses to the two key centers for pickets on Tuesday amount in some cases of 4–6 hours each day being spent on a charter bus, while pickets disappear from at least 21 sites.
Kaiser Permanente workers should form rank-and-file committees to take control of their struggle out of the hands of the union, with the aim to call an all-out strike and unified struggle to win the demands of all of the hospital giant’s workers.