Kaiser therapists stage one-day strike

They cite quality of patient care and the right to bargain separately as key issues in the dispute.

By Patrick A. McGuire
Monitor staff

Complaining of caseloads so heavy that new patients must wait weeks to see a therapist, a group of 54 behavioral health professionals in Denver staged a one-day strike in July protesting against its managed-care employer, Kaiser Permanente of Colorado.

The group?made up primarily of clinical psychologists and licensed social workers?says their heavy caseload undermines the quality of care available to Kaiser members. To better air their grievances, the group last year asked United Food and Commercial Workers Local 7 in Colorado to represent them in an attempt to be recognized by Kaiser as a separate bargaining unit.

Kaiser has resisted efforts to grant them a contract separate from its other medical services providers and denies that quality of care has been compromised. 'Patients really are first here,' says Kaiser Vice President of External Affairs Kristin Snyder. 'We will make sure mental health patients receive the care that they need.'

But the therapists, led by Rachael St. Claire, PsyD, a clinical psychologist, argue that Kaiser?s requirement that they take on 10 new patients a week?in addition to their regular caseload?so overloads the system that it takes about two weeks for a new patient to get an initial appointment with a counselor, and sometimes three to four weeks for a follow-up visit.

While Kaiser has lowered the number of required new 'intakes' to eight since the strike, the number is still double what it was when St. Claire joined Kaiser six years ago.

'With that many new intakes a week,' she says 'it makes it difficult to get an appointment to come in and see me. A two-week delay in getting an appointment is not a good way to start off a therapy relationship. A lot of patients never return for a second appointment.'

In a letter to Kaiser, Russ Newman, PhD, JD, APA?s executive director for professional practice, expressed concern over the delay issue. 'APA has serious concerns with any intake procedures that may delay access to treatment and disrupt continuity of services for patients in need of behavioral health-care services,' wrote Newman. 'Our paramount concern is assuring that appropriate quality health-care services are accessible to patients.'

He cited state and federal legislation?including a recently enacted Colorado parity law?aimed at ensuring that 'people receive the treatment they need and provide a remedy for a health-care system that is all too focused on costs and financing.'

Kaiser, meanwhile, denies St. Claire?s claim that it has not kept pace with staffing as growing membership rolls create new demands for service. But St. Claire says she sees the effect of the overload every day.

'In a typical case of major depression or anxiety disorder, there are good, effective treatments,' says St. Claire. 'If a patient had major depression and I wanted to do cognitive therapy, I might want to see that patient weekly for eight to 10 sessions.' Her workload, though, doesn?t allow that luxury. 'With these delays, you end up extending the same therapy into six to seven months. And people are not getting treatment in between sessions.'

Kaiser points to its patient satisfaction surveys, which, it says, show a 90 percent approval rating. St. Claire says those surveys, taken at the time of a patient?s first visit, are tainted. 'They reflect the positive feelings subjects have when they first enter treatment. What we don?t know is how many are dropping out, how many finish treatment, what are the outcomes. I think patient satisfaction surveys don?t measure treatment quality.'

Resolving the quality issue, says St. Claire, would be difficult if psychologists were unable to negotiate separately. Kaiser, though, would prefer all behavioral health professionals to remain part of a larger health-care provider contract it has with its 1,200 other medical specialists such as nurses, pharmacists and optometrists. 'We are concerned we will be so diluted as mental health professionals we will lose any ability to bargain,' says St. Claire.

In his letter, Newman agreed. He urged Kaiser to continue to negotiate with St. Claire?s group as a separate bargaining unit. 'We believe that behavioral health professionals have a commonality of interests not completely shared with other Kaiser health professionals,' he wrote.

In Colorado, he wrote, the state legislature had 'recognized the historical discrimination against behavioral health in the health-care system,' and that its parity law 'supports maintaining a separate bargaining unit for behavioral health professionals in order to give them a chance to establish a more level playing field.'

During their one-day strike on July 13, about 100 people attended a rally in front of the Kaiser offices in downtown Denver. 'We as a team have attempted to work with management to resolve these problems,' says St. Claire. 'It is discouraging to think our profession is being diminished and people are not getting the care they need.'

At press time, St. Claire?s group had met again with Kaiser, but was discouraged by the lack of progress in the talks. 'We may be left with no alternative but to escalate our efforts to get them to negotiate, to take another one day strike. It doesn?t look good.'

At Kaiser, Snyder says 'We are still talking. These things just take awhile. We are still optimistic we will get an agreement.'