The San Francisco Board of Supervisors has adopted a resolution urging Kaiser Permanente to limit the use of artificial intelligence in the delivery of mental health services.
The resolution, approved Tuesday, called on the healthcare provider to revise its proposed contracts with behavioral health professionals that gave Kaiser the ability to replace therapists with AI, lay off clinicians, and leave them out of decisions about models of care.
The resolution was adopted following a hearing in July, when Kaiser Permanente behavioral health clinicians, represented by the National Union of Healthcare Workers, spoke about how these demands would adversely impact their ability to serve patients.
The union is currently in mediation with Kaiser Permanente to settle on a contract for 2,400 Northern California psychologists, social workers, and marriage and family therapists that it represents.
“Kaiser officials should be eager to work with their clinicians to improve services, but instead they want to sideline them to escape accountability for under-resourcing behavioral healthcare,” said NUHW president emeritus Sal Rosselli in a news release issued by the union Tuesday. “By taking this stand, San Francisco supervisors are making it clear to Kaiser that it needs to work with therapists, not replace them with AI that won’t advocate for patients.”
Kaiser Permanente is already using AI to record therapy sessions and is using algorithms to screen patients seeking care, the union’s news release said, adding that Kaiser Permanente is unwilling to add language to the contract stating explicitly that AI will not replace clinicians, something that the healthcare provider agreed to do for its contract with Southern California clinicians in 2024.
Other language in the proposed contract would allow Kaiser to refer patients to third-party contractors and lay off Kaiser clinicians and retain the sole discretion to determine or modify the ways in which mental health services are delivered. The resolution calls on the removal of these terms too.
After the supervisors adopted the resolution, Kaiser Permanente said in an email statement Wednesday that its screening tool “does not use AI to diagnose patients, make clinical decisions, or determine medical necessity. Clinical decisions remain with licensed health care professionals.”
Union alleges AI performing unsupervised triage
In July, the NUHW filed a complaint with the California Department of Managed Health Care alleging that Kaiser Permanente’s “digital, automated algorithm autonomously assesses enrollees’ multiple-choice answers to provide referrals and recommendations for specific levels of care without the oversight of licensed clinicians.”
This, the complaint alleged, violated state law that mandates that licensed clinicians triage patients seeking care.
This is not the first time that Kaiser’s practices surrounding its behavioral health services have come under scrutiny.
In 2023, Kaiser Permanente settled with the California Department of Managed Health Care and agreed to pay a $50 million fine after the latter found several violations and deficiencies in Kaiser’s provision of behavioral health care services to enrollees, including timely access to care and oversight of the plan’s providers and medical groups.
As part of that settlement, Kaiser Permanente also agreed to invest $150 million to improve its mental health services.
“Kaiser Permanente is evaluating technology that can reduce administrative burden, improve care navigation, and help clinicians spend more time with patients. Patient safety, quality, privacy, and clinician oversight remain paramount.”
Kaiser Permanente statement
Then, in February of this year, Kaiser Foundation Health Plan Inc. — the arm of Kaiser Permanente that sells and administers health insurance plans — reached a $31 million settlement with the U.S. Department of Labor to resolve investigations into its failure to provide timely and appropriate mental health services.
Kaiser Permanente did not participate in the Board of Supervisors’ hearing in July but submitted a letter emphasizing its commitment to expand mental health services.
“Kaiser Permanente is evaluating technology that can reduce administrative burden, improve care navigation, and help clinicians spend more time with patients,” the letter stated. “Patient safety, quality, privacy, and clinician oversight remain paramount.”
The news release from the NUHW said that four days of mediation with Kaiser Permanente in August did not lead to a settlement, and that no additional mediation dates have been set.
In March, clinicians held a one-day strike, and while they have authorized a three-day strike, no date has been set for that.