Two thousand northern California Kaiser Permanente mental health practitioners, members of the National Union of Healthcare Workers (NUHW) have voted to strike the giant California health maintenance organization (HMO). The result of the late May balloting was 91% in favor of walking out – the date yet to be determined.

The vote follows a three-day strike in Hawaii. In May, Hawaiian psychologists, social workers, psychiatric nurses and chemical dependency counselors walked picket lines on Oahu, Maui, and the Big Island to protest Kaiser’s severe understaffing at clinics and medical facilities. Staffing, patient loads, working conditions, these issues are the same right throughout the Kaiser’s vast system. The wealthy and powerful corporation that self-advertises as non-profit and patient centered cynically refuses to meet minimal staffing requirements (mandated by state regulations and the law) while enforcing working conditions that demoralize clinicians and place mental health patients in danger (often severe, even fatal)– all in the name of the bottom line. 

These hospital strikes are the workers’ fightback; they represent a sort of trench warfare, front lines in a war of attrition, with Californians’ lives and livelihoods at stake.

There have been half a dozen such strikes at Kaiser in the past decade, as mental health care workers, unheralded, have fought to make it possible to treat patients with the attention and treatments they deserve (and pay for). They are part of a much wider movement that seeks to raise mental health care to a level, if not a right, at least equal to parity with medical care. And this at a moment when few can deny that this country is experiencing a deep crisis (depression, addiction, suicide) made all the worse by COVID 19, the rash of massacres, a political malaise, and the spectacle of war, altogether producing an ubiquitous anxiety, always in the background, all of which undermine resilience and resistance.

The California health care strikers, then, truly are still heroes, still on the front lines even as COVID is pronounced over, which it isn’t.

The California health care industry is massive, a corporate kingdom employing hundreds of thousands, cashing in with billions in profit - for profit and not for profit alike.

Kaiser Permanente, one of the largest not-for-profits in the country, is the pacesetter in California. Kaiser is based in the Bay Area with 39 nine hospitals and some 700 medical facilities. In recent years, it has expanded to Washington State, Oregon, Hawaii, Colorado, Maryland, Virginia and Georgia. Since just before COVID its membership had grown by 600,000; it now employs some 300,000 workers, including 80,000 nurses and doctors. In 2020, its profits were $6.4 billion. In 2021, its net worth, according to the California Department of Managed Health Care, was $43.3 billion. CEOs are compensated handsomely. Salaries compared to workers: 231-1!  Greg Adams, the chief executive in Oakland received $17.3 million in total compensation in 2020. He and the 100 top executives have the benefit of eight separate retirement plans.

The NUHW represents 4000 Kaiser mental health technicians, clinicians (psychologists, social workers, psychiatric nurses and chemical dependency counselors), this including another 2000 in southern California who settled earlier in the year.

Ken Rogers works at Kaiser’s South Sacramento/Elk Grove clinic. He is psychologist and a NUHW shop steward and an elected member of the NUHW’s executive board. He’s been at Kaiser for nineteen years.  “There are two overriding issues here,” he insists. “We have been pushing Kaiser to increase staffing and invest more in behavioral health care so that we can actually address the needs of our patients, but Kaiser keeps refusing.” In response to the union’s demands and threatened by the state, Kaiser has, at times, increased hiring. Even when Kaiser does hire therapists, however they “rarely last.”  Therapy, Rogers explains requires “face to face time” but “we aren’t allowed that time, the time we need and the patients deserve. More time for face-to-face visits, more visits and more time for all the other things we have to do -–charting, answering emails and phone calls. COVID has made this all that much worse.” So patients “endure unconscionable delays, and we’re always behind, we just keep working, no breaks, always ‘above and beyond.’ This isn’t what we were hired to do,” he says, “this isn’t what the new hires expect.” 

Shay Loftus is a psychologist at Fairfield Mental Health and Wellness Center in Sonoma County.  She’s a steward, a member of NUHW ‘s executive board, and a member of the bargaining committee.  She too says this is all about patient care and provider retention. “We’ve been in bargaining since July.  These sessions,” she says,” move at a glacial pace. Most proposals come from the union. Management will listen (sometimes), go into caucus but come back out with nothing. Kaiser does not present proposals and does not respond to ours.”

 “Kaiser just doesn’t get it,” says Rogers. “Kaiser is highly bureaucratic. Its reps think bargaining is just about wages and benefits, that’s all.” So, there’s been a long stall.  “There are negotiations, but they get nowhere. Kaiser management,” Rogers agrees, “doesn’t seem interested in bringing this to a conclusion.  We present our proposals, Kaiser presents nothing. We end up negotiating against ourselves.”

In the meantime, the staffing crisis continues, there’s burnout (turnover now is higher than ever, more people leave than are hired); “the new people cycle in and out, disappearing into greener pastures, while the patients wait... and wait.”

Loftus explains just how this works (or doesn’t work), “Someone phones in and spends ten minutes in virtual (phone or video) triage, then, within ten days, is assigned thirty minutes with an intake coordinator, who, as required by law, must schedule the patient with a secondary appointment. At that point, though this may take four to eight weeks, they see an assigned therapist. They have one session with the therapist, only then wait four to eight weeks for follow-up. I’m getting appointments now for August.” And when confronted with acute illness? “We find ways to squeeze them in,” says Loftus, “on our lunch time, during administrative time, or at the end of the day, but this just doesn’t work. It’s not sustainable.” Kaiser likes to say “it offers group sessions as a more-timely alternative, but these sessions can include at once seventy or eighty participants.”

Will the threat of an open-ended strike, move Kaiser? Possibly, And, if not, these clinicians will strike. They’ve done it before and Kaiser knows it.  

Astonishingly, we learn now that Kaiser is bringing thousands of new members into the system. Earlier in the year, California’s governor, Gavin Newsom, struck a deal, outside the normal bidding process, to expand its Kaiser’s Medi-Cal enrollment, perhaps by as much as 200,000 new members, many of whom, of course, will require mental health treatment.

There are reasons, members suggest, that Kaiser has consistently played hard ball (and worse) with NUHW – clearly apparent in comparison with any of the other half dozen unions that represent Kaiser workers. First, certainly, NUHW is a union that is present on the “shop [hospital] floor,” that fights for its members, that doesn’t do concessions. Second, NUHW’s Kaisers workers have steadfastly refused to give up their watchdog role – their responsibility to their patients and to the community; it has consistently rejected Kaiser’s insistence on “gag rules” imposed in contracts and elsewhere. Why? The union and its members have from the beginning joined other mental health campaigners in advocating for patients and in exposing Kaiser’s negligence, while calling for parity with medical health care and supporting the rights of mental health care patients. Just this year, they joined with others in pressing for the passage of senate bill 221 (SB221), a bill that hopefully will but some teeth into existing California staffing laws and regulations – laws and regulations “that have resulted in failures to provide enrollees follow up appointments with nonphysician providers of mental health and substance use disorder services within the time frames consistent with generally accepted standards of care.” (SB221)

Now the California Department of Managed Health Care has informed Kaiser Permanente that it will be examining whether the company is providing adequate mental health care services to its twelve million members. “This non-routine survey is based on complaints received from enrollees, providers, and other stakeholders concerning the plan’s behavioral health operations,” said Amanda Levy, the department’s deputy director of health policy and stakeholder relations.

Levy says regulators “would evaluate Kaiser’s internal and external provider networks, timely access to care, processes for intake and follow-up appointments, appointment scheduling processes, levels of care and associated decision-making processes, medical record documentation and retention practices, and monitoring of urgent appointments.”

The California Department of Managed Health Care “Help Center “received a 20% increase in behavioral health complaints for Kaiser in 2021 compared to 2020,” writes Rachel Arrezola, a spokesperson for the department.

This is scandalous, to say the least, all the more so in a corporation that began as union friendly and was supported by unions as it recruited tens of thousands of members from Bay Area unions in the years following World War II. It is, however, industrial healthcare in California, where any distinction between profit and not for profit is long gone and corporate corruption rules.

In the trenches, NUHW carries on its own fight, today in its contract fight “pushing Kaiser to increase staffing and invest more in behavioral health care so that we can actually address the needs of our patients,” says Rogers. “Hopefully these investigations will finally force Kaiser to stop denying that is failing its mental and behavioral patients and start working with us to improve its services.”

In the meantime, one suspects that NUHW members will continue to march and picket and organize. In March, 850 nurses at the Fountain Valley Hospital in Orange County voted 77% to 23% to join NUHW. Fountain Valley is a Tenet hospital where NUHW, already represented respiratory therapists, nursing assistants, lab technicians, operating room technicians, pharmacy technicians and radiology technicians. The union reports 1400 new members within the year.

It will continue to call out the corporation when necessary, as it has done repeatedly, above all in the acclaimed report, “Care Delayed is Care Denied” (https://nuhw.org/news-and-press/kaiser/care-delayed-care-denied-executive-summary/) and on the union’s website   (https://nuhw.org/about/) a goldmine for advocates of mental healthcare reform.

NUHW president Sal Rosselli sees the hospitals and the health care industry as situated squarely in the corporate world. As others did, they were quick to adopt the strategy of the “lean” corporation, always alert to the bottom line, with “just in time” the mantra in regard to staffing, resources and facilities.

Consequently, yet predicably this was catastrophic in the face of the most severe public health crisis and economic collapse in recent memory. It also exposed the health system’s weaknesses that left the US unprepared for COVID-19. Rosselli says, “there were shortages of everything from doctors and nurses to beds and PPEs. They had no plan for a real emergency.”

In the US today, the health care system is highly unequal in its care especially for people of color but for virtually all working-class families, seen vividly in the debacle of testing and vaccine distribution.  The primary care system is in crisis, it is disappearing in rural and impoverished urban settings. Life expectancy is in decline. The insurance system leaves millions uninsured, while millions more face exorbitant commercial insurance prices - prices that fuel growth in health spending exposing people to high premiums and deductibles. The elderly face bankruptcy; they lose their homes. Working people with plans tied to their employers are forced to make wage concessions to keep their benefits. Anxiety and depression have become near universal.

In the face of all this, Rosselli insists, Kaiser “is doing nothing,” even as health care workers abandon their careers in tens of thousands, leaving Kaiser and the industry just that much more unprepared for the next crisis. “This is why we fight,” says Rosselli.

The hope now is that the new movements of teachers, baristas and warehouse workers signal the beginning of a new labor movement and can join the fight. “It’s about time. I think the conditions are right.  That’s our experience.”  At the same time, Rosselli still has hopes that here in California Medicaid for All can be forced back on to the table.  “I’m sure it’s coming, if not this year, then next,” he says. “We’ve never needed it more. We’re all for it, we have to get it.”

 In the meantime, they will – when necessary - strike! They deserve our support.

[Cal Winslow’s latest book is Radical Seattle, The General Strike of 1919.  He is also author of Labor’s Civil War in California. He lives with his family near Caspar on the Mendocino coast.]