‘thank God They’re Still Alive’: Kaiser Therapists Claim Its New Screening System Puts Patients At Higher Risk By Delaying Their Care

Ilana Marcucci-Morris is worried astir nan patients she treats and really agelong it took for them to get successful her office. At Kaiser Permanente’s psychiatry outpatient session successful Oakland, California, she says she progressively finds herself assessing group experiencing terrible intelligence wellness issues whom she believes should person been sent to nan emergency room weeks earlier. For those who do make it to their appointments, she thinks: “Thank God they’re still alive.”

It wasn’t ever this way, according to Marcucci-Morris, a licensed objective societal worker. Licensed professionals utilized to almost ever beryllium nan first constituent of interaction for patients pinch behavioral wellness issues astatine Kaiser, she said. She has noticed a alteration since January 2024, aft nan healthcare elephantine introduced a caller screening process for first-time patients. The caller strategy introduced clerical workers who are not licensed practitioners, who inquire scripted “yes” aliases “no” questions to measure nan severity of patients’ conditions and really urgently they request to beryllium seen. Around nan aforesaid time, Kaiser besides rolled retired a different measurement to surface immoderate patients: e-visits, fundamentally online questionnaires patients return earlier getting scheduled pinch a licensed wellness attraction professional.

Marcucci-Morris joined astir 2,400 bluish California intelligence wellness professionals employed by Kaiser and represented by nan National Union of Health Care Workers (NUHW) connected a one-day onslaught connected Wednesday to protestation changes to nan company’s diligent screening processes – and to raise concerns that Kaiser has plans to usage AI to switch licensed therapists for definite kinds of work.

“Human activity needs to enactment pinch quality beings,” Marcucci-Morris said.

Five licensed Kaiser therapists besides said that since nan California healthcare elephantine began rolling retired its caller diligent appraisal process, they’ve seen patients pinch high-risk cases hold longer for care. At nan aforesaid time, these therapists opportunity lower-risk patients are sometimes being fast-tracked to appointments pinch clinicians and clogging up an already strained system. Since January 2025, therapists person reported much than 70 examples of Kaiser’s intelligence wellness screening strategy resulting successful antagonistic attraction outcomes, according to an administrative complaint pinch nan California Department of Managed Health Care that nan NUHW successful bluish California revenge against Kaiser.

Kaiser Permanente drugstore and laboratory workers spell connected onslaught successful beforehand of nan Kaiser Permanente Los Angeles Medical Center successful California, connected 9 February. Photograph: Kayla Bartkowski/Los Angeles Times/Getty Images

Kaiser said successful an emailed remark that NUHW activity has made misleading claims astir entree and care, and that “AI and Clerical unit are not conducting immoderate assessments, making immoderate objective determinations nor conducting objective triage.” The connection besides noted that clerical unit are trained to escalate cases to objective unit done an contiguous transportation to a situation therapist. Kaiser has besides said it is “growing our workforce, not shrinking it”, though NUHW representatives opportunity they judge nan number of triage therapists has decreased significantly.

“We judge AI tin beryllium adjuvant erstwhile it supports clinicians – by reducing administrative activity aliases improving ratio – but it does not switch objective judgement aliases quality assessment,” Kaiser’s connection reads.

‘The penning connected nan wall’

Wednesday’s NUHW onslaught was based, successful particular, connected nan union’s title pinch nan California section of managed wellness attraction filed past year successful bluish California that alleged Kaiser’s caller diligent screening strategy is illegal. A separate, but similar, title was besides revenge by NUHW successful southern California successful 2025.

In a 2025 soul study of Kaiser’s intelligence wellness workers successful bluish California that nan Guardian obtained, much than one-third of labor “reported that Kaiser has already rolled retired AI aliases different technologies they fearfulness could negatively impact their activity aliases nan attraction patients receive”. Almost half of Kaiser workers said they are “somewhat aliases very uncomfortable pinch nan preamble of AI devices into their objective practice”.

Many were peculiarly worried astir transparency and information retention policies tied to nan companies’ usage of AI package Abridge for note-taking. A Kaiser typical has said that nan company’s unit are not required to usage nan tool, and that it requires diligent consent.

Kristi Reimer, a licensed scientist who says she utilized to do intelligence wellness triage assessments successful Kaiser’s Walnut Creek facility, said she pre-emptively near her position because she saw “the penning connected nan wall”. She says she wouldn’t person near for different section if Kaiser hadn’t changed nan quality of its intelligence wellness appraisal strategy truthful drastically.

Harimandir Khalsa, who does triage for Kaiser successful Walnut Creek, California, said that her squad of 9 unit has been reduced by two-thirds complete nan past 2 years.

She still can’t ideate leaving her role. She loves utilizing her decades of investigation and objective acquisition to thief a ample number of group astatine specified a susceptible juncture successful their lives.

As she watches her department’s triage unit dwindle astir her, she can’t thief but consciousness anxious astir her future. She worries that clerical unit and questionnaires are already doing a portion of her occupation – moreover if she thinks they’re not doing it well. She can’t thief but wonder: “Am I next?” “What is my future?”

Why a licensed therapist make a difference

A patient’s first constituent of interaction erstwhile seeking intelligence thief tin find whether they spot a licensed clinician astatine all, arsenic good arsenic nan type of appointments they receive, according to nan NUHW.

That’s why nan national is truthful concerned astir Kaiser’s caller diligent appraisal changes, and is pushing for much accusation connected really nan institution uses tech successful first assessments.

In nan NUHW’s southern California complaint pinch nan California section of managed wellness attraction from past year, nan national says that clerical staffers inquire patients questions astir suicidal and homicidal thoughts, earlier entering accusation into a package tool. This tool’s algorithm past generates a people and suggested consequence to guideline nan staffer successful scheduling nan personification for further care, according to nan union. Kaiser is utilizing an algorithm to make triage decisions, successful usurpation of authorities law, nan administrative title alleges; nan institution denies that this screening counts arsenic triage and said its clerical unit are not making assessments aliases objective determinations. It’s presently unclear whether an algorithm is besides utilized successful bluish California, though nan national suspects it is, and Kaiser did not clarify.

Healthcare workers locomotion a picket statement extracurricular Kaiser Permanence Los Angeles Medical Center, successful California, connected 4 October 2023. Photograph: Caroline Brehman/EPA

Kaiser has already faced authorities and national scrutiny complete providing timely entree to intelligence wellness services. In 2023, Kaiser agreed to a $200m settlement pinch California to resoluteness investigations complete these delays. Just past month, nan US Department of Labor announced a $31m settlement pinch Kaiser complete akin allegations. The labour section claimed that Kaiser “used diligent responses to questionnaires to improperly forestall patients from receiving care”. Kaiser besides agreed to reforms, successful nan labour section investigation, that would trim assignment hold times and grow entree to value care.

But Kaiser labor mobility that commitment. They pointed retired nan galore ways that questionnaires and clerical workers tin autumn short.

For one, triage is complicated. Relying connected workers who are not licensed practitioners who instrumentality to constricted scripts has awesome limitations. Therapists often request to tie connected their expertise to suss retired nan “real” meaning down a patients’ statements. If a caller brings up suicidal thoughts, a healthcare worker wants to know: are those thoughts progressive aliases passive? Have they already thought of a method? If they opportunity they aren’t judge astir what they’re going to do, what are they referring to? The reply to those questions is seldom straightforward, Khalsa, a Kaiser therapist, said.

On nan flip side, patients whitethorn self-diagnose successful a measurement that exaggerates their symptoms and takes cardinal resources distant from those who request them much urgently.

Therapist Carolyn Staehle started successful nan intake and appraisal section astatine Kaiser, successful Pleasanton, California, successful May 2023. After nan caller strategy rolled out, Staehle – whose domiciled astatine nan clip was expected to attraction connected non-emergency cases coming retired of triage – recalled gathering galore much group having vulnerable delusions and superior suicidal thoughts. “They needed maine to telephone an ambulance for them because they could not guarantee their information aliases activity connected a information plan,” she says.

More recently, Staehle has been moving connected a situation squad intended for higher severity cases. They support receiving “people who don’t request [them],” she says. “That gums up and slows down nan work, truthful that group who are successful immediate, hopeless request mightiness not get through.”

Kaiser says that it delivers “timely, high-quality attraction to meet members’ needs”. It claims that its members person non-urgent intelligence wellness appointments, connected average, faster than nan authorities requires.

Staehle is worried for different staff, who, contempt Kaiser’s claims, fearfulness being replaced by AI, and overwhelmed patients, who she says sometimes don’t get nan timely and empathetic attraction they need, particularly successful nan triage process. “It’s not nan aforesaid level of attraction arsenic being assessed by a licensed therapist,” says Staehle. “It takes longer for each diligent to find retired whether they are going to beryllium a threat to themselves aliases a threat to others, aliases is this an emergency aliases not? We really person to discarded clip taking attraction of immoderate of this basal worldly that utilized to beryllium done by triage.”

For now, she and different workers are focused connected ratifying a caller statement – and getting Kaiser to perpetrate to not replacing licensed societal workers for illustration herself pinch AI.