Shirlee Zane questions county’s Kaiser contract after mental health dispute

June 28--In a conference room at the county administration complex, senior officials at Kaiser Permanente sat down with Sonoma County Supervisor Shirlee Zane last week to listen to her concerns about the quality and accessibility of the health care giant's mental health services, which she blames for the 2011 suicide of her husband.

In the plain room, with nothing but a clock on the wall, a long table and chairs, Zane propped up behind her a large portrait of the family she shared with Peter Kingston, who hung himself not long after seeking help from Kaiser mental health staff.

The meeting took place a week after Zane -- in a blistering email to Kaiser officials -- questioned whether she could support the county's $51 million contract with Kaiser for health coverage and demanded that Kaiser address allegations that it does not provide sufficient and timely one-on-one psychotherapy.

"We greatly appreciated the opportunity to talk with Ms. Zane about her experience and to personally express our deep sympathy for her loss," Judy Coffey, senior vice president and area manager for Kaiser's Marin-Sonoma territory, said in a statement after the meeting.

"We expressed our commitment to continuously learn from the feedback we receive, and talked constructively about opportunities to improve mental health care at Kaiser Permanente and in the community," Coffey said.

Kaiser provides health care to 2,957 current county employees, or 91 percent of the county's active workforce, and 1,481 county retirees. Zane said she is willing to use the contract as "leverage" to get Kaiser to provide more individual therapy for its members who receive mental health services.

Zane, a former family therapist, has been a long-time advocate of mental health services. But the issue struck her even more personally after her husband took his life. Kingston was a Kaiser patient and Zane said she believes the county's largest health care provider failed to properly assess her husband's severe depression.

"I want to assure that no county employee or their family member is at risk of losing their life because of Kaiser's insufficient care for mental health issues," said Zane.

Zane and county officials met with regional and local Kaiser representatives on Wednesday. Each side had a different interpretation of what emerged from the meeting.

Zane said Kaiser agreed to take a number of steps including offering group therapy as one alternative to members and not the only treatment available; examine delay times for follow-up one-on-one therapy appointments; work with the county to survey Kaiser members on their mental health services; and make efforts to integrate mental health services with physical health services.

Kaiser spokeswoman Gerri Ginsberg, who is based in Kaiser's regional corporate offices in Oakland, said Friday that Kaiser was already taking many of those steps before the meeting with Zane, including providing members with a range of mental health options and effective medication management.

Kaiser declined a request for a telephone interview but sent an email statement about the meeting.

Coffey said the meeting with the county was "productive" and offered an opportunity to discuss "broader mental health issues." Barbara Crawford, regional vice president for quality, and Dr. Don Mordecai, regional director of mental health and chemical dependency services, also attended the meeting with the county.

Aside from Zane, county representatives included Marcia Chadbourne, the county's risk manager, and Tom Morrison of the Segal Company, the health benefits consulting firm contracted by the county to negotiate health plan packages.

Zane's threat to use the county's Kaiser contract as leverage for change was made in a June 17 email to Kaiser regional representatives in Oakland, including Mordecai. In the email, Zane blasted the HMO for its response to recent criticism of its mental health services.

Some patients and former therapists have accused the HMO of giving short shrift to one-on-one therapy and under-staffing the ranks of therapists, a practice Kaiser critics say creates long waits between individual therapy sessions, leading to a deterioration in patients' mental health.

One such critic is former Kaiser psychotherapist Andy Weisskoff. In February, after giving his 90-day notice, Weisskoff began blogging about his frustration with what he calls an understaffed system that allows little time for crucial therapy.

Kaiser has dismissed Weisskoff's criticism as a union ploy and strongly rejects the accusation that it does not provide appropriate levels of mental health care to its members. Before he resigned, Weisskoff served as a shop steward for the National Union of Healthcare Workers, which represents Kaiser psychotherapists. The union has been in protracted labor negotiations with Kaiser for several years.

Zane, whose husband was treated by Weisskoff before his 2011 suicide, railed against Kaiser for dismissing the complaints as part of a "labor dispute."

"To blame a labor dispute for the deficiency in Kaiser's delivery of mental health services is the lowest form of scapegoating I have ever seen," Zane wrote in her June 17 email. "As the widow of a Kaiser patient who was so grossly under-treated for severe depression that he hung himself, I am literally sickened that you have concocted such a callous and unfounded defense for the broken healthcare system you represent."

Kaiser declined to comment on Zane's email, describing it as a private message. Zane, however, copied the email to a Press Democrat reporter.

Zane said the meeting with Kaiser on Wednesday was "really positive." She said she informed Kaiser officials that she intended to reach out to county employees, possibly through a survey and/or focus groups, to find out whether they are satisfied with their health coverage, particularly mental health services.

"I hear good things about Kaiser's other health services," said Zane. "But I rarely hear anything positive about Kaiser's mental health programs."

Zane said she is not proposing to eliminate Kaiser coverage as a county employee benefits option. Such a move would likely prove unpopular, given so many current employees are covered by Kaiser's HMO plan. But she is seeking to use the county contract as leverage to force Kaiser to address her concerns.

"I am beginning to wonder how I can, in good faith, approve for County employees healthcare services that I know to be dangerously inadequate," she said in the June 17 email.

Zane said Kaiser expressed interest at last week's meeting in participating in any survey of county employees regarding their concerns about health care coverage. She said Kaiser told her that gaps in one-on-one therapy were likely caused by "attrition" of mental health staff.

"They agreed that they need to look at subcontracting with outside therapists," she said.

Kaiser said that any move to subcontract with outside therapists is a labor issue that would require negotiations with unions.

Aside from Kaiser, the county offers employees its own health plan, an EPO and PPO that are adjudicated by Anthem Blue Cross and utilize Anthem's provider network. The county health plan is more costly than the Kaiser HMO and only 273 current employees are enrolled in it. The county plan, however, does have 1,323 retirees enrolled.

Chadbourne, the county's risk manager, said that any changes to the county employee benefits package would have to be negotiated with employee unions and approved by the entire Board of Supervisors. The county's Joint Labor Management Benefits Committee, which includes representatives of the county's largest unions, including the Service Employees International Union and the Sonoma County Law Enforcement Association, would also be brought in for input on the changes.

Kaiser's policy, which is renewed annually, runs from June 1 to May 31, Chadbourne said. The $51 million annual figure is the total premium paid by employees and the county's contribution. It does not include Kaiser HMO co-payments made by employees during medical visits.

As a matter of course, the county regularly examines health coverage options for its employees.

"We're just now getting started on re-evaluating alternative coverage options available in our area," Chadbourne said.

Health plan alternatives under consideration by county officials include Sutter Health, which plans to launch its own insurance product, Sutter Health Plus, in Sonoma County beginning next year. Sutter spokesman Shaun Ralston said Sutter intends to "solicit/negotiate" a plan for Sonoma County employees. The plan's mental health services would be provided by Optum, a national behavioral health network with more than 130,000 providers and 1,000 licensed clinicians and board-certified psychiatrists.

Western Health Advantage, a newcomer health plan that is aggressively marketing itself in the North Bay, said it is also interested in becoming an option for county employees.

Gary Maisel, president and CEO of Western Health Advantage, said it has significant contracts in the Central Valley, including covering Sacramento County employees, school districts and other municipal employees. In the North Bay, Western has formed partnerships with a number of hospitals, including Santa Rosa Memorial, Petaluma Valley, Sonoma Valley, Marin General and Queen of the Valley Medical Center in Napa.

Western partners with the Meritage IPA network of physicians and its mental health services would be provided by Magellan Behavioral Health, which Maisel said has a roster of 466 behavioral health providers in Sonoma, Marin and Napa counties. In Sonoma County alone, Magellan has 258 contracted providers, including psychiatrists, psychotherapists and family therapists, he said.

"We would just love to be added as an option under the county's health insurance program," Maisel said. "We would love to be offered alongside Kaiser."

Kaiser would not disclose the number of therapists it employs in Sonoma County or the number of patients they treat for mental health problems. Kaiser said such numbers do not say anything about a provider's availability to see a particular member. Kaiser said most health plans do not employ their own therapists but contract with other providers, who may or may not be available to take patients at a given time.

Other county supervisors said they would support looking at expanding health plan options for county employees, but that such a move must be done by the full board.

Though Supervisor Susan Gorin would not comment on Zane's specific complaints with Kaiser, she said health care providers historically have had "weak" mental health services. She said the county should look at all options for employee health coverage.

"I would be very supportive of the county investigating other plans as they become available," she said, adding that the county itself is taking significant steps to close mental health gaps with its own programs.

"This is the time when we really need to be reviewing the needs of our community and our employees and offer the services they need," she said.

Supervisor Efren Carrillo said Zane's experience gives her a unique and personal perspective when looking at the issue of Kaiser's mental health services. Carrillo, who has acknowledged he sought treatment for alcoholism, said he was served well by Kaiser's chemical dependency programs.

He said any decision to enhance or expand health plan options for county employees and retirees is a discussion for the entire board, not just one or two supervisors.

"Our interest should be ensuring the best services for our county employees," Carrillo said.

Supervisors David Rabbitt and Mike McGuire did not return telephone calls and email seeking comment.

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