A union representing therapists and other health workers has filed a state complaint accusing Kaiser Permanente of relying on an automated screening tool — rather than licensed clinicians — to steer mental health patients toward care, a practice the union says runs afoul of California law.
The National Union of Healthcare Workers filed the complaint with the state Department of Managed Health Care, taking aim at Kaiser’s e-visit screening system used for patients who suspect they may be dealing with anxiety or depression. Under the process, patients fill out a multiple-choice questionnaire, and the system immediately spits out care recommendations, according to the complaint. Those recommendations don’t necessarily mean a session with an in-person therapist — patients may instead be pointed toward virtual therapy, educational classes or self-help apps.
The Department of Managed Health Care, which regulates health plans statewide, said this marks the first time it has received a complaint from a union alleging misuse of algorithms or artificial intelligence in behavioral health services.
Union members say they’ve seen no proof that a licensed clinician reviews patients’ responses before the system generates its recommendations. At a San Francisco Board of Supervisors hearing last week, therapists and social workers testified that automated screenings simply can’t substitute for a trained professional’s judgment.
“Artificial intelligence and algorithms don’t capture what trained humans can,” said Ilana Marcucci-Morris, a therapist who sits on the union’s bargaining committee. She noted that people struggling with depression often downplay their symptoms, meaning a tool that relies purely on self-reported answers could easily overlook a more serious condition.
Kaiser did not send a representative to last week’s hearing. In a written statement to CalMatters, spokesperson Lena Howland disputed the union’s account of how the health system handles behavioral health screening.
The e-visit tool “does not use AI to diagnose patients, make clinical decisions, or determine medical necessity,” Howland said. “Clinical decisions remain with licensed healthcare professionals.” She declined to elaborate on the technology powering the tool.
Howland added that patients can still speak with a live person by calling a phone number provided during the e-visit process, describing the online tool as “an additional path to getting care — not the only path.”
A blog post Kaiser published last year touts the e-visit tool’s growing popularity, particularly among younger patients, noting it covers roughly 30 health concerns. The post states that patient responses “are reviewed by a health care professional” and that members typically get a reply within four hours.
Union representatives dispute that timeline, saying care recommendations often arrive almost instantly after a patient submits the questionnaire — too quickly, they argue, for any clinician to have reviewed the answers.
The union maintains Kaiser’s approach violates a state law requiring that medical decisions be made by licensed healthcare professionals and explicitly prohibiting “artificial intelligence, algorithms, or other software tools” from taking over that role.
The Department of Managed Health Care confirmed it received the complaint and is looking into it, though officials said details of the investigation remain confidential while it’s underway.
A change in how patients are triaged
The complaint arrives amid contract negotiations between the union and Kaiser Northern California that have stretched on for more than a year without resolution.
Workers who testified at last week’s hearing said the current system, including the e-visit tool, was rolled out in 2023. Previously, they said, dedicated triage teams of licensed clinicians took brief patient histories by phone, screened for signs of self-harm, and offered an initial diagnosis along with next steps — all while picking up on cues like tone of voice that a written questionnaire can’t capture.
Now, the union alleges, much of that triage work falls to clerical staff or the automated tool itself. The union filed a separate complaint last year claiming Kaiser was using telephone service representatives, rather than clinicians, to field mental health calls.
Marcucci-Morris said she often doesn’t see patients until roughly two weeks after they’ve been triaged under the new system. “The acuity and critical nature of symptoms I am seeing has increased significantly because the app, AI, an algorithm, or an unlicensed telephone operator incorrectly determined that 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 both Kaiser patients and employees in her district. Kaiser serves roughly a third of San Francisco’s population.
Chen called the company’s absence from the hearing “unacceptable,” saying it left many of her questions unanswered. “As a San Franciscan, I’m not against technology,” she said. “For me it’s making sure we’re not shortcutting our quality of care and safety.”
A pattern of scrutiny
This isn’t the first time Kaiser has declined to appear before lawmakers examining its mental health services. Last year, state legislators criticized the company after it skipped an informational hearing on the same topic.
Kaiser’s behavioral health track record has drawn scrutiny before. In 2023, the company agreed to pay a $50 million fine and invest $150 million toward improving its programs, settling state findings that behavioral health patients were facing serious delays in care. That settlement followed a 2021 spike in behavioral health complaints that prompted a state survey. Kaiser now operates under a corrective action plan and must submit quarterly progress updates to regulators.
Further back, in 2014, state regulators fined Kaiser $4 million over lengthy gaps between therapy appointments. Kaiser has largely blamed its past struggles on a broader shortage of mental health providers.
The company is also facing growing criticism over its use of artificial intelligence and digital tools more broadly. Kaiser’s own mental health staff have objected to transcription software that records patient sessions, arguing the company hasn’t been transparent about how that data is used or shared. Separately, call center nurses have raised alarms about Kaiser using AI-driven software to monitor their phone calls.
Original source: CalMatters
