Ilana Marcucci-Morris is anxious about the sufferers she treats and the way lengthy it took for them to arrive in her workplace. At Kaiser Permanente’s psychiatry outpatient clinic in Oakland, California, she says she more and more finds herself assessing individuals experiencing extreme psychological well being points who she believes ought to have been despatched to the emergency room weeks earlier. For many who do make it to their appointments, she thinks: “Thank God they’re nonetheless alive.”
It wasn’t all the time this manner, in accordance to Marcucci-Morris, a licensed medical social employee. Licensed professionals used to virtually all the time be the first level of contact for sufferers with behavioral well being points at Kaiser, she stated. She has observed a change since January 2024, after the healthcare big launched a brand new screening course of for first-time sufferers. The brand new system launched clerical employees who are not licensed practitioners, who ask scripted “sure” or “no” questions to assess the severity of sufferers’ situations and the way urgently they want to be seen. Round the identical time, Kaiser additionally rolled out a distinct method to display some sufferers: e-visits, basically on-line questionnaires sufferers take before getting scheduled with a licensed well being care skilled.
Marcucci-Morris joined about 2,400 northern California psychological well being professionals employed by Kaiser and represented by the Nationwide Union of Health Care Staff (NUHW) on a one-day strike on Wednesday to protest modifications to the firm’s affected person screening processes – and to increase considerations that Kaiser has plans to use AI to change licensed therapists for sure varieties of labor.
“Human work wants to stick with human beings,” Marcucci-Morris stated.
5 licensed Kaiser therapists additionally stated that since the California healthcare big started rolling out its new affected person evaluation course of, they’ve seen sufferers with high-risk circumstances wait longer for care. At the identical time, these therapists say lower-risk sufferers are typically being fast-tracked to appointments with clinicians and clogging up an already strained system. Since January 2025, therapists have reported greater than 70 examples of Kaiser’s psychological well being screening system leading to unfavourable care outcomes, in accordance to an administrative complaint with the California Division of Managed Well being Care that the NUHW in northern California filed towards Kaiser.
Kaiser stated in an emailed remark that NUHW management has made deceptive claims about entry and care, and that “AI and Clerical workers are not conducting any assessments, making any medical determinations nor conducting medical triage.” The assertion additionally famous that clerical workers are skilled to escalate circumstances to medical workers by way of a right away switch to a disaster therapist. Kaiser has additionally stated it is “growing our workforce, not shrinking it”, though NUHW representatives say they imagine the variety of triage therapists has decreased considerably.
“We imagine AI might be useful when it helps clinicians – by decreasing administrative work or bettering effectivity – nevertheless it does not change medical judgment or human evaluation,” Kaiser’s assertion reads.
‘The writing on the wall’
Wednesday’s NUHW strike was primarily based, specifically, on the union’s grievance with the California division of managed well being care filed last year in northern California that alleged Kaiser’s new affected person screening system is unlawful. A separate, however related, grievance was additionally filed by NUHW in southern California in 2025.
In a 2025 inner survey of Kaiser’s psychological well being employees in northern California that the Guardian obtained, greater than one-third of staff “reported that Kaiser has already rolled out AI or different applied sciences they concern may negatively have an effect on their work or the care sufferers obtain”. Virtually half of Kaiser employees stated they are “considerably or very uncomfortable with the introduction of AI instruments into their medical observe”.
Many have been notably anxious about transparency and knowledge retention insurance policies tied to the corporations’ use of AI software program Abridge for note-taking. A Kaiser consultant has stated that the firm’s workers are not required to use the instrument, and that it requires affected person consent.
Kristi Reimer, a licensed psychologist who says she used to do psychological well being triage assessments in Kaiser’s Walnut Creek facility, stated she pre-emptively left her place as a result of she noticed “the writing on the wall”. She says she wouldn’t have left for an additional division if Kaiser hadn’t modified the nature of its psychological well being evaluation system so drastically.
Harimandir Khalsa, who does triage for Kaiser in Walnut Creek, California, stated that her staff of 9 workers has been diminished by two-thirds over the final two years.
She nonetheless can’t think about leaving her function. She loves utilizing her many years of analysis and medical expertise to assist a lot of individuals at such a weak juncture of their lives.
As she watches her division’s triage workers dwindle round her, she will’t assist however really feel anxious about her future. She worries that clerical workers and questionnaires are already doing part of her job – even when she thinks they’re not doing it properly. She will’t assist however surprise: “Am I subsequent?” “What is my future?”
Why a licensed therapist make a distinction
A affected person’s preliminary level of contact when searching for psychological assist can decide whether or not they see a licensed clinician in any respect, in addition to the kind of appointments they obtain, in accordance to the NUHW.
That’s why the union is so involved about Kaiser’s latest affected person evaluation modifications, and is pushing for extra information on how the firm makes use of tech in preliminary assessments.
In the NUHW’s southern California complaint with the California division of managed well being care from final 12 months, the union says that clerical staffers ask sufferers questions on suicidal and homicidal ideas, before getting into information right into a software program instrument. This instrument’s algorithm then generates a rating and recommended response to information the staffer in scheduling the individual for additional care, in accordance to the union. Kaiser is utilizing an algorithm to make triage choices, in violation of state regulation, the administrative grievance alleges; the firm denies that this screening counts as triage and stated its clerical workers are not making assessments or medical determinations. It’s at the moment unclear whether or not an algorithm is additionally utilized in northern California, though the union suspects it is, and Kaiser did not make clear.
Kaiser has already confronted state and federal scrutiny over offering well timed entry to psychological well being providers. In 2023, Kaiser agreed to a $200m settlement with California to resolve investigations over these delays. Simply final month, the US Division of Labor introduced a $31m settlement with Kaiser over related allegations. The labor division claimed that Kaiser “used affected person responses to questionnaires to improperly forestall sufferers from receiving care”. Kaiser additionally agreed to reforms, in the labor division investigation, that would scale back appointment wait instances and develop entry to high quality care.
However Kaiser staff query that dedication. They identified the many ways in which questionnaires and clerical employees can fall brief.
For one, triage is difficult. Relying on employees who are not licensed practitioners who stick to restricted scripts has main limitations. Therapists typically want to draw on their experience to suss out the “actual” which means behind a sufferers’ statements. If a caller brings up suicidal ideas, a healthcare employee needs to know: are these ideas lively or passive? Have they already considered a way? If they are saying they aren’t positive about what they’re going to do, what are they referring to? The reply to these questions is not often easy, Khalsa, a Kaiser therapist, stated.
On the flip aspect, sufferers could self-diagnose in a method that exaggerates their signs and takes key sources away from those that want them extra urgently.
Therapist Carolyn Staehle began in the consumption and evaluation division at Kaiser, in Pleasanton, California, in Might 2023. After the new system rolled out, Staehle – whose function at the time was supposed to focus on non-emergency circumstances popping out of triage – recalled assembly many extra individuals having harmful delusions and severe suicidal ideas. “They wanted me to name an ambulance for them as a result of they may not assure their security or work on a security plan,” she says.
Extra just lately, Staehle has been working on a disaster staff supposed for larger severity circumstances. They maintain receiving “individuals who don’t want [them],” she says. “That gums up and slows down the work, in order that individuals who are in speedy, determined want would possibly not get by way of.”
Kaiser says that it delivers “well timed, high-quality care to meet members’ wants”. It claims that its members obtain non-urgent psychological well being appointments, on common, sooner than the state requires.
Staehle is anxious for different workers, who, regardless of Kaiser’s claims, concern being changed by AI, and overwhelmed sufferers, who she says typically don’t get the well timed and empathetic care they want, particularly in the triage course of. “It’s not the identical stage of care as being assessed by a licensed therapist,” says Staehle. “It takes longer for every affected person to discover out whether or not they are going to be a hazard to themselves or a hazard to others, or is this an emergency or not? We even have to waste time caring for a few of this basic stuff that used to be finished by triage.”
For now, she and different employees are targeted on ratifying a brand new contract – and getting Kaiser to commit to not changing licensed social employees like herself with AI.
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