State and local health officials are investigating complaints that Kaiser Permanente has made dangerous reductions in mental health staffing at its emergency department in Santa Rosa, despite having a large number of patients in psychiatric prisons.
The union representing striking mental health workers said emergency department staffing cuts are leaving many psychiatric patients without care or supervision between midnight and 6am.
The union has called on the state and county to investigate reports of at least two suicide attempts in the emergency department last weekend.
Kaiser officials dismissed the complaints as a work tactic amid ongoing contract negotiations. The health care giant said in a statement that state investigators are obligated to review all such complaints, regardless of their merit.
But the National Health Care Workers Union, which represents striking mental health staff, insists the complaints are real and that Kaiser is failing to provide 24/7 mental health care in its emergency department. The union employees have been on strike for a month.
In some cases, psychiatric patients are kept in the emergency department overnight until a qualified mental health professional is available to do a psychiatric evaluation in the morning, said Fred Seavey, the union’s director of research.
Seavey said that when The strike began on August 16, Kaiser relied on a “skeleton crew” of psychiatrists and on-call managers to handle psychiatric patients who came to the emergency department during the night and early morning hours. When that didn’t work, he said, they took a more drastic step in late August.
“Instead of doing the right thing and getting staff … they just suspended care for them from midnight to 6 a.m.,” he said.
Seavey added that Kaiser has since “lowered the level of care” by returning to virtual or “tele-psychic” services between 6 a.m. and 7:59 a.m. and between 6 p.m. and 11:59 p.m.
A screenshot of a communication, obtained by the union from an emergency department manager, describes those periods and lists the period between midnight and 5:59 a.m. as “No Psych Available.” The article is dated September 1.
Company officials said they would not comment on internal communications.
Union officials said emergency department staff reported that over the weekend of Sept. 9, the number of psychiatric patients being held in the emergency department reached more than a dozen who were not receiving adequate care or supervision.
“Early Saturday morning (Sept. 10) two patients reportedly attempted suicide while inside (the emergency room),” Seavey said. “The circumstances surrounding those (attempted) suicides were noted — one apparently by hanging and the second by a cut to the throat … all of which raise concerns about the adequacy of psychiatric staffing in the emergency room.”
An emergency department employee separately confirmed the two cases, which occurred at a time with no mental health experts on the job, although there were security guards, according to the employee, who requested anonymity for fear of possible retribution.
Kaiser countered that it is not unusual for hospital emergency departments to receive patients undergoing a psychiatric emergency, and their volume at any given time is not staffed. The current strike only makes matters worse, company officials said.
“Instead, the increased volumes have been driven by the crisis of growing mental health care needs in our community and exacerbated by the shortage of mental health care providers across the state and nation and by the ongoing COVID-19 pandemic and its consequences of fires in our community. “, says the company’s statement.
Over the past few weeks, the union has called on the California Department of Managed Health Care, which oversees HMOs, to investigate Kaiser’s emergency department staffing levels. On September 11, the union raised concerns about reported suicide attempts with the behavioral health division of the Sonoma County Department of Health Services.
Tina Rivera, director of health services, said last week that district staff have not received reports of suicide attempts from sources other than the union. But the district is looking into the reports, she said.
“We have been in discussions with Kaiser leadership who have raised these allegations with their local, state and national leadership,” Rivera said in an email. “I understand that Kaiser is also in communication with the Department of Managed Health Care.”
The state Department of Managed Health Care is conducting a review of Kaiser’s mental health care services in response to earlier union complaints that Kaiser was not providing timely mental health appointments during the strike. Rachel Arrezola, a spokeswoman for the department, said the state’s “enforcement investigation” includes complaints about emergency department personnel.