Mental health clinicians brought their contract fight with Kaiser Permanente straight to San Francisco City Hall on Tuesday, urging supervisors to block language they say could expand automated screening or outsource key parts of behavioral health care. Therapists warned that online e-visits and clerical triage are already shuttling patients into treatment tracks without a licensed clinician weighing in first, a setup they argue could worsen wait times and increase risks for people in crisis.
The hearing, held as a Committee of the Whole, was called by Supervisor Chyanne Chen and co-sponsored by Supervisors Rafael Mandelman, Shamann Walton and Myrna Melgar. Kaiser skipped the public grilling but sent a written statement instead, saying it has invested more than $2 billion since 2020 and insisting its tools do not make clinical decisions, according to the Board's Legistar record.
Supervisors did not hide their frustration at the no-show. "When this board of supervisors makes a request for an employer to attend a hearing, they most certainly should make sure they are in attendance," Supervisor Shamann Walton said, calling Kaiser’s absence extremely disrespectful, as reported by CBS News.
Therapists say automated triage is already happening
Clinicians told the board that more patients are being directed to a web-based e-visit questionnaire or to clerical staff rather than being first seen by a licensed clinician. They said the system can spit out a care recommendation almost instantly. The union’s regulatory complaint includes screenshots and test runs that The San Francisco Standard reports produced treatment-plan recommendations in under two seconds.
Union files formal complaint
This week, the National Union of Healthcare Workers filed a regulatory complaint with the California Department of Managed Health Care and the U.S. Department of Labor, documenting the e-visit testing and alleging the process violates state rules that require clinical triage to be done by licensed providers, according to KQED. Union leaders said they want regulators and city officials to scrutinize contract proposals they believe would make it easier to outsource or automate care.
Kaiser pushes back
Kaiser says its behavioral-health e-visit was built with clinician input, "helps connect members to care more quickly," and lists a phone number on every screen so patients can reach a live person. The company also disputed claims that the tool uses AI to diagnose patients, according to a company statement reported by CBS News and in the letter Kaiser submitted to the Board. The health care giant maintains that clinical decisions stay with licensed professionals and said both sides have agreed to mediation, per the filing.
Regulatory backdrop
The showdown unfolded against a heavy regulatory backdrop. Kaiser reached a $200 million settlement with the California Department of Managed Health Care in 2023 and federal investigators announced a roughly $28.3 million settlement earlier this year, according to the DMHC and the U.S. Department of Labor. Therapists also held a one-day strike in Northern California in March to protest contract language on AI and staffing, coverage that was reported by the San Francisco Chronicle.
What’s next
Supervisor Chen said she plans to introduce a resolution asking Kaiser to formally commit to using AI to assist clinicians, not replace them, and to pull back from proposals that would broaden referrals to third-party contractors, according to KQED. Mediation between Kaiser and NUHW is set to begin, and union leaders say they will keep pushing for explicit contract language that protects clinician judgment and patient access.
For now, the hearing put Kaiser on notice in a very public forum and gave therapists a platform to lay out specific examples they say show automated triage is already in play. Both sides say they are open to negotiation, but how much AI should influence mental health care decisions is poised to be a central battleground as mediation moves forward.
