A union representing Kaiser Permanente mental health workers has accused the health care giant of using an automated computer program, rather than licensed clinicians, to screen patients and steer them toward treatment — a practice the union says runs afoul of California law.
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
