After 11 weeks on strike, behavioral health workers at Kaiser Permanente’s Southern California offices will head back to the bargaining table on Jan. 9. 2,400 members of the National Union of Healthcare Workers (NUHW) have been manning picket lines across Southern California since Oct. 21, 2024. At the heart of their struggle is a fight to push California’s largest healthcare provider to bring Southern California workers’ pay, pensions, and working conditions up to the level of  their Northern California counterparts, and to solve the chronic understaffing crisis that has plagued Kaiser SoCal mental health clinics for years.  The quality of patient care in Kaiser’s Southern California system has dropped precipitously for over a decade, long before the start of the strike. These conditions have only worsened since workers walked off the job last October. Now, as the strike enters its 11th week, workers and patients are increasingly concerned that if Kaiser continues to drag their feet at the bargaining table, behavioral health care for the nearly 5 million enrollees in Southern California will remain interrupted, with potentially devastating consequences. Workers and patients alike say that an improved contract will drastically improve the quality of mental health care that enrollees receive. For patients seeking care, wait times are a stressful hurdle For patients seeking behavioral health care within the Kaiser system, the process is stressful, even retraumatizing. Even before the strike began, patients and behavioral health workers complained that Kaiser continued to impose an illegal “non-quantitative treatment limitation,” or one-appointment-at-a-time rule, which disallows patients from scheduling multiple mental health appointments at the same time. As a result, some patients are forced to wait weeks or even months between mental health appointments, effectively preventing them from accessing regular behavioral health care.  For some patients, these extended wait times can mean the difference between life and death. Patients like Ezekiel Koontz have found the process of securing regular therapy appointments to be “arduous,” even with their particularly emergent case. Koontz, who survived multiple suicide attempts, described being subjected to a revolving door of therapists and waiting six weeks or more for a therapy appointment. “Kaiser constantly, kind of… throws you around and around [and] for me, in my case, I was constantly waiting for months and months between appointments while I was suicidal,” Koontz said. “It’s very rare that a patient ends up with a therapist at Kaiser that sees them regularly and for the duration of time that they need them,” said Jeremy Simpkin, a case manager who has been with Kaiser for five years. “For the most part, it is a revolving door.” He says certain things have improved over time, but clarified that other processes like the external referral system, which allows patients to access behavioral health care that Kaiser doesn’t provide (programs like dialectical behavior therapy, for example), are often byzantine and demoralizing for patients who are forced to navigate them. A mountain of complaints from behavioral health providers about the deteriorating conditions inside Kaiser’s behavioral health clinics and patient experiences like Koontz’s led the NUHW to file a complaint with the DMHC in 2018. A lengthy investigation by the DMHC found that Kaiser had broken state law numerous times, finding that, “[w]hile the [Kaiser Health] Plan has worked to address [maintenance of adequate provider networks and effective and functional quality assurance programs], despite multiple enforcement actions, and comprehensive corrective action plans, the Plan’s shortfalls have continued and have impacted the Plan’s ability to ensure adequate and timely access to behavioral health services to its enrollees.” In 2023, the DMHC issued a $50 million fine against the plan (the largest in state history), and required that Kaiser enter into a settlement with the DMHC to correct the issues that had plagued employees and patients for over a decade.  The union maintains that, despite the detailed corrective actions laid out in the 2023 settlement, Kaiser has continued to fall short of the settlement’s objectives. Patients have continued to suffer long appointment wait times, high provider turnover, and lack of access to emergent mental health programs that would improve their chances of recovery. Koontz blamed their frustration with the process on Kaiser itself, saying, “I keep having very well meaning people [therapists] offer me everything because they really do want to see the best for their patients… Kaiser is not a human. Kaiser is a company that wants your money. And so while the people are genuinely trying to do what they can for, you know, people like me, who, again, nearly died multiple times, it doesn’t seem like anyone’s really capable of that, of actually making good on many of the promises that they genuinely want to keep.”  “I keep having very well meaning people [therapists] offer me everything because they really do want to see the best for their patients… Kaiser is not a human. Kaiser is a company that wants your money. These issues have only worsened since the strike began, despite Kaiser’s promises that there were comprehensive contingency plans in place. The union alleges in a new complaint filed with the DMHC that, since the start of the SoCal strike, Kaiser has routinely failed to “provide timely and appropriate individual treatment” for enrollees, among other issues. According to the complaint, filed Dec. 20, 2024, “Kaiser’s practices constitute violations of multiple California laws… Patients who do not receive timely and appropriate [Substance Use Disorder] care are more likely to experience relapses and other harms, including death. NUHW has confirmed relapses among Kaiser’s Southern California enrollee[s] since October 21, 2024.”  A new, similar complaint filed Jan. 4 with the California Department of Health Care Services also alleges that Kaiser “failed to provide required mental health services for parents and families at Fontana Medical Center NICU and PICU, leaving patients at risk of not receiving critical care.” According to the union, Kaiser has repeatedly understaffed the two critical care units since workers began their strike last October, which has affected dozens of patients. For Koontz, the options that Kaiser has offered them while workers are on strike have been inadequate for their needs. Kaiser has offered Koontz and other patients the option of seeing a new therapist, but it’s unclear if they will be able to return to sessions with their regular providers after the strike is over. Additionally, the union alleges in their new complaint that, in some cases, temporary staff covering caseloads in Kaiser’s addiction medicine clinics during the strike are only working in two-week rotations, placing undue stress on the patients who are in need of their services.  The therapeutic relationship in behavioral therapy is often the most important aspect in determining how successful a patient is in reaching their therapeutic goals. In short, patients must be able to stick with a therapist long enough to build a relationship of trust and open communication. The revolving door, as some call it, doesn’t allow for that relationship to be built. “In my experience, how would you expect to have a meaningful connection with somebody who you know is only there because Kaiser doesn’t want to pay the person you’re normally there with?” Koontz said. “Are you going to realistically have a connection with somebody who you know is going to vanish?” “What they’re offering is stabilization, not care,” Koontz continued. “They’re trying to make sure we don’t off ourselves in between, because that looks really bad for their bottom line. You know, people can’t pay when they’re dead.”  Striking workers worry about the quality of care that their patients are receiving while they walk the picket lines. “There’s a lot of major worries for the patients, and that was from the very beginning. Knowing that even though Kaiser is saying, ‘We’ll provide comprehensive care and people will get therapy while you’re out,’ we know that that’s not happening,” Simpkin said. Simpkin added that while the striking providers feel anxiety and concern for their patients while out on strike, they know that this new contract will have an immediate positive effect on their patients. “We wholeheartedly believe that what we’re striking for will immediately and directly improve the [sic] patient care,” he said. A union fighting for their patients, and themselves Striking Kaiser workers believed that many of these long-standing problems could be addressed at the bargaining table, and negotiations began in late July 2024. When negotiations failed to produce a new agreement before their previous contract expired at the end of September, workers began preparing for a strike and walked off the job in late October. There have been no negotiations since the first week of the strike. In December, Kaiser finally allowed a bargaining date to be scheduled for Jan. 9 after state lawmakers weighed in and urged the health plan to get back to the table. The union has prioritized solutions in their proposals that have already been proven to have a positive impact on patient outcomes in the wake of the Northern California strike in 2022, where behavioral health workers walked off the job for 10 weeks in order to secure a contract that would improve working conditions for themselves and, by extension, their patients. In a Dec. 23, 2024, press conference by the union, NUHW President Emeritus Sal Rosselli made a statement underscoring this fact, saying, “There is no reason for Kaiser to be fighting us at the bargaining table, because what we’re proposing isn’t anything that the vast majority of Kaiser employees [don’t] already have. What we’re proposing are prerequisites for Kaiser to live up to the [2023] settlement agreement: end the chronic understaffing of its mental health clinics and provide behavioral health care that meets state standards and the needs of its patients.”  Among the proposals that NUHW is bringing to the table are pay parity with their Northern California counterparts, restoration of pensions for newer Southern California employees, and more time to work on patient care duties outside of face-to-face appointments. Improved working conditions, pay, and benefits would certainly make the job more competitive in an already competitive behavioral health care market, meaning that Kaiser can maintain safe staffing levels and reduce turnover. This, in turn, translates directly into better patient outcomes for Kaiser’s enrollees. For workers like Simpkin, who began his Kaiser career working in Northern California, there’s no reason for Kaiser to refuse the terms laid out by the union. He says that the NorCal contract already drastically changed the lives of the workers and their patients for the better. “I saw it happen in Northern California,” he said. “It doesn’t fix all of the problems. There’s still a lot of work to do. But as soon as we started implementing those contract changes in Northern California, the working conditions improved, the patient care [and] conditions improved. People’s morale improved. They were able to hire more people. People stayed in their jobs. So I know that it will work, because I’ve seen it.” “As soon as we started implementing those contract changes in Northern California, the working conditions improved, the patient care [and] conditions improved. … I know that it will work, because I’ve seen it.” Still, the delayed bargaining schedule has signaled to some workers that Kaiser remains unwilling to work with the union to come to an agreement, before more of their patients fall through the cracks. “If something was really important to you and you wanted to resolve it right away, you wouldn’t wait, you know?” said Jade Rosado, a striking licensed clinical social worker in Southeast LA County. “So that’s what that tells me, that was my initial reaction, like, oh, they’re really not serious.”  From her place on the picket line, Rosado has received positive feedback from patients and community members alike. Despite their frustrations, the focus remains on Kaiser’s inaction in maintaining a continuity of care that meets patient needs. “The feedback that we’ve gotten, even from the community when we’ve been on the picket line, it’s been supportive,” Rosado said. “I’m sure that there are people that are frustrated too—patients that are frustrated that are not getting the care that they need. So while they support us, they’re also frustrated.” As Rosselli told reporters at NUHW’s Dec. 23 press conference, “Instead of working with its behavioral health professionals to improve care, Kaiser is trying to cement their second-class status at the expense of its nearly 5 million patients in Southern California.” Despite these scheduling setbacks, the union is ready to get back to the bargaining table on Jan. 9 and work to come to an agreement. In the meantime, spirits are still high on the picket line, with workers hunkered down for the long haul. Rosado credits the solidarity she shares with her fellow union members as having a galvanizing effect. “Even though this is hard, like, we’re gonna get through it,” she said. “We’re gonna be okay. We have each other, and we’re supporting each other, and we got this.” If I did kill myself, what would Kaiser think? They wouldn’t blink. I’m just a random guy, another number that just vanishes off their list. As Kaiser continues to cancel appointments and force patients through a confusing external referral process, patients’ ongoing care remains in limbo. For Koontz, they hope that Kaiser will come to the table ready to come to a solution, but they worry that further delays in negotiations will create an untenable situation for their own recovery, and are skeptical that Kaiser even cares in the first place. “But also realistically, though, I’m just truly being completely honest, if I did kill myself, what would Kaiser think? They wouldn’t blink. I’m just a random guy, another number that just vanishes off their list. Who cares? It is a very impersonal system.” The Real News has reached out to Kaiser for comment about these patient concerns, and will update the story when they respond.