The complaint, filed with state regulators by the National Union of Healthcare Workers, targets Kaiser’s online e-visit screening tool, which patients use when they believe they’re dealing with anxiety or depression. Patients answer a series of multiple-choice questions, and the system then generates care recommendations and referral pathways “automatically and instantly” based on those answers, according to the filing.

Those recommendations don’t necessarily lead to a session with an in-person therapist. The complaint states that patients may instead be directed toward virtual therapy, health education classes or self-guided wellness apps.

The union represents therapists, social workers and other clinicians employed at Kaiser facilities. The state’s Department of Managed Health Care says this marks the first time a union has filed a grievance against a health plan specifically over the alleged use of algorithms and artificial intelligence in mental health treatment decisions.

Union members say they have seen no proof that licensed mental health professionals review patients’ e-visit answers in real time — or at all — before the tool spits out follow-up care recommendations. At a hearing held last week by the San Francisco Board of Supervisors examining the issue, therapists and social workers testified that automated digital screenings cannot substitute for a trained clinician’s judgment.

“AI and algorithms don’t capture what trained humans can,” said Ilana Marcucci-Morris, a therapist and member of the union’s bargaining committee. She noted that people experiencing depression often downplay their symptoms, meaning a tool relying solely on self-reported answers could miss warning signs of a more serious condition.

Kaiser did not send a representative to last week’s hearing. But in a written statement emailed to CalMatters, the company pushed back on the union’s characterization of its mental health processes.

The e-visit tool “does not use artificial intelligence to diagnose patients, make clinical decisions, or determine medical necessity. Clinical decisions remain the responsibility of licensed health care professionals,” said Kaiser spokesperson Lena Howland. She did not provide additional details about the technology powering the tool.

Howland added that patients can still reach a live person by calling a phone number provided during the e-visit process. “The online assessment tool is an additional pathway to care, not the only one,” she said.

In a blog post published last year, Kaiser described the e-visit tool as increasingly popular, particularly among younger members, and said it’s available for roughly 30 different health concerns. The post stated that patient responses “are reviewed by a health care professional” and that members “receive a response by secure message within 4 hours, and often sooner.”

Union leaders counter that care recommendations often arrive almost instantly after a patient completes the questionnaire — far too quickly, they argue, for any clinician to have actually reviewed the responses.

The union contends Kaiser’s screening practice violates state law, which requires that medical decisions be made by a licensed health care professional and bars “artificial intelligence, algorithms or other software tools” from replacing that judgment.

The Department of Managed Health Care confirmed it received the union’s complaint and is looking into the matter. “Details of ongoing investigations are confidential, pursuant to law and to protect the integrity of the investigation,” the department said in a statement.

A Shift in Mental Health Triage

The complaint arrives amid stalled contract negotiations between the union and Kaiser Northern California, which have dragged on for more than a year without resolution.

Therapists and health workers who spoke at last week’s hearing said a new triage system, which includes the e-visit tool, was rolled out in 2023. Before that, Kaiser relied on specialized triage teams made up of licensed clinicians — professionals trained to pick up on cues like tone of voice — who gathered patient history over the phone, screened for self-harm risk, and offered preliminary diagnoses along with next steps for care.

Now, the union says, much of that case evaluation work has shifted to administrative staff or the digital tool itself. The union filed a separate complaint last year alleging that Kaiser was using call-center representatives, rather than clinicians, to field mental health-related calls.

Marcucci-Morris said she often doesn’t see patients until roughly two weeks after they’ve gone through Kaiser’s new screening system. “The severity and critical nature of the symptoms I’m seeing have increased significantly because the app, the AI, an algorithm or an unlicensed phone operator wrongly determined they could wait 10 days to see me,” she said.

San Francisco Supervisor Chyanne Chen said she called last week’s hearing after hearing concerns from constituents — both Kaiser employees and patients — about the health system’s mental health services. Kaiser provides coverage to roughly a third of San Francisco’s population.

Chen called Kaiser’s absence from the hearing “unacceptable,” saying it left many of her questions unanswered.

“As a San Francisco resident, I’m not against technology,” Chen said. “For me, this is about making sure we’re not compromising the quality of our care and safety.”

Kaiser’s Troubled Mental Health Record

This isn’t the first time Kaiser has skipped a hearing focused on its mental health services. Last year, state lawmakers criticized the health plan after it declined to participate in an informational hearing on its behavioral health programs.

Kaiser’s mental health struggles are well documented. In 2023, the company agreed to pay a $50 million fine and invest $150 million to improve its programs, settling state findings that mental health patients faced serious delays in care. In 2021, California regulators noted a rise in mental health-related complaints, prompting a survey that ultimately led to that settlement. Kaiser currently operates under a corrective action plan and must submit quarterly progress reports to the state.

Back in 2014, state regulators fined Kaiser $4 million over lengthy waits between therapy appointments. Kaiser has largely attributed its past troubles to a shortage of mental health professionals statewide.

The health plan is also facing growing scrutiny over its expanding use of artificial intelligence and digital tools across its broader operations.

Kaiser’s own mental health clinicians have pushed back against transcription tools used to record patient appointments, arguing the company hasn’t disclosed how that data is used or shared. Separately, call-center nurses have raised concerns about Kaiser’s use of AI and software to monitor their calls.

This coverage is supported by the California Health Care Foundation, which works to ensure people have access to the health care they need, when they need it, at a price they can afford.

Original source: CalMatters

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Plaintiffs in a lawsuit challenging California’s gig economy law Proposition 22 have made good on their promise to take the case to the state’s highest court.

The Service Employees International Union and a group of rideshare drivers on Friday petitioned the California Supreme Court to review a recent appeals court ruling that largely upheld the 2020 law, the union said.

Proposition 22, which has been in effect since December 2020, allows giant ride-hailing and delivery companies, including Uber, Lyft and DoorDash, to classify their workers as independent contractors rather than employees.

The companies spent upwards of $200 million funding the voter initiative in a move to legalize their business model. Californians approved the ballot measure with a clear majority. SEIU’s attorneys argue primarily that Proposition 22 unconstitutionally revokes the state legislature’s authority over California’s workers’ compensation system.

“Uber, Lyft and Doordash have used Prop. 22 to carve out gig workers from our state’s workers compensation system and deprive those same workers of paid sick leave, meaningful health care coverage, overtime pay and more,” said David Huerta, President of SEIU California and SEIU United Service Workers West in an emailed statement on Friday. SEIU, SEIU California and a handful of drivers first brought the lawsuit in January 2021.

They sought to take the case directly to the California Supreme Court, filing a petition for review that was quickly declined, but left open the option for plaintiffs to pursue the case in a lower court — which plaintiffs did. Alameda County Superior Court Judge Frank Roesch in August 2021 dealt a blow to gig companies with a ruling that deemed Proposition 22 unconstitutional and unenforceable.

An appeals court last month largely reversed the lower court ruling, upholding the law almost in its entirety. The union said it timed its petition with the first International Gig Workers Congress, a convening of drivers and delivery workers from across 15 countries scheduled in Los Angeles for Monday.

The California Gig Workers Union, a statewide gig worker group affiliated with union locals SEIU 721 and SEIU 1021 in Southern California and Northern California, respectively, organized the event and plans to hold rallies next week in downtown Los Angeles as well as outside Uber’s headquarters in San Francisco.

A coalition of gig companies that backs Proposition 22, Protect App-based Drivers & Services, celebrated the appeals court ruling last month and has said invalidating the law would infringe on voters direct democracy rights.

The California Supreme Court, once it receives a petition, has 60 days to decide whether to review the case, but can request a 30-day extension.

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