The Brief

California regulators released a report this week that found Kaiser has yet to fix several “deficiencies” in behavioral health care for which it was cited years ago.

The report from the California Department of Managed Healthcare lists 20 deficiencies it found in 2022 based on state regulations, ranging from failing to provide non-urgent mental health and substance-use appointments within 10 days to not ensuring members are offered urgent care appointments within 48 hours of the request.

According to the report, Kaiser still had not corrected 19 of them.

The report comes as Kaiser mental health workers in Southern California prepare to enter the sixth month of a strike against the health care provider.

“This report shows why Kaiser Permanente mental health workers remain on strike,” Sal Rosselli, president emeritus of the National Union of Healthcare Workers, said in a statement. “Kaiser keeps saying everything is fine when its workers know that patients can’t get the care they need because Kaiser’s services are understaffed and underfunded.”

In a response included in the 88-page document, Kaiser Foundation Health Plan said it had made “substantial progress” in addressing issues brought up in the report as it “continues the transformation of its behavioral health program.”

“Despite the efforts of the National Union of Healthcare Workers to mislead the public, the Department of Managed Health Care has not identified new deficiencies in our mental health care,” Kaiser Permanente said in a statement to LAist, adding that the deficiencies in the report had not “gone unaddressed.”

The plan said all deficiencies outlined in the report had been addressed and were part of its corrective action plan to get in line with state regulations. 

What the report from state regulators found 

The strike comes more than a year after state regulators hit Kaiser with a $50 million fine for failing to provide timely access to mental health care and other problems.

As part of that settlement agreement, Kaiser committed to investing an additional $150 million over five years to expand and improve behavioral health care for members.

The report out this week from the Department of Managed Healthcare outlines 20 deficiencies that were found in Kaiser’s Northern and Southern California regions during a 2022 survey of operations and the status of the deficiency following the regulator’s review of compliance efforts.

They include:

• Failing to offer non-urgent mental health and substance use appointments within 10 days of the initial appointment request
  
• Not ensuring enrollees are offered urgent care appointments within 48 hours of the request
  
• Not enough oversight of suicide risk screenings.

“Health plans are required to provide their members with appropriate access to behavioral health care services, and the DMHC will continue to hold Kaiser Permanente accountable to these requirements in the law,” Director Mary Watanabe said in a statement.

Watanabe said Kaiser plans to remedy the deficiencies in the report through a corrective action plan required as part of the $200 million settlement agreement.

According to the report, state regulators will do a follow-up survey within 18 months to see if the issues have been corrected.

In a statement emailed to LAist, Kaiser Permanente said it was currently exceeding state requirements for timely access to care, meeting access timeframes “99.7% of the time for urgent care [and] 95% of the time for initial nonurgent care appointments.”

“The investments we’ve made over the last several years have resulted in significant improvements in access for our members,” the plan said. 

The ongoing strike 

In October, about 2,400 therapists, psychiatric nurses, psychologists and social workers represented by the union went on strike, pushing for better pay and pensions, as well as more time to conduct patient follow up.

In a statement this week, Kaiser said 60% of union-represented employees who chose not to strike or have since returned to work are continuing to serve patients, along with an outside network of “more than 13,000 providers.”

Last month, Gov Gavin Newsom urged the two groups to settle the strike through mediation, especially after the wildfires tore through Los Angeles County in January.

Newsom sent a letter to Greg Adams, CEO of Kaiser Permanente, and Sophia Mendoza, president of the National Union of Healthcare Workers, noting that Southern California residents “are grappling with extreme loss and displacement” after the fires.

Mark Ghaly, former California Secretary of Health and Human Services, and Darrell Steinberg, a former mayor of Sacramento, were tapped as mediators earlier this month, but negotiations have since stalled, according to the union.

Wednesday’s protest

More than 100 Kaiser employees and supporters rallied Wednesday outside the health provider's offices in Pasadena. Picketers held signs that read “Healthy workers equals health patients,” and “End the inequity.”

Patricia Arevalo-Porcelli, a licensed clinical psychologist, said she’s been a Kaiser employee for nearly three decades, and that some of her patients have shown up to support her on the picket lines over the course of the more than five-month strike.

Arevalo-Porcelli said she knows some mental health workers on strike are not only dealing with the financial stress of the work stoppage, but have also lost their homes in the Eaton Fire.

“The need for us to get back and be of service to the community who is truly grieving, deeply, is now more than ever,” she said.

On a tour of Orange County’s voting headquarters on Wednesday, Registrar Bob Page demonstrated the careful, multi-step process through which voters’ ballots are validated and counted.

As the federal government raises the specter of unsubstantiated voter fraud, Page’s message was clear: “ I want voters to know that we're doing everything we can to make sure they can vote safely and securely."

More than 380,000 Orange County ballots have been returned as of Oct. 27, Page said. That’s about 80,000 more ballots than was received around the same time in 2022, the last mid-term elections.

Orange County Registrar of Voters Bob Page addresses the media and other members of the public in attendance as part of a tour of the voting operations on Wednesday, less than one week before Election Day.

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Kavish Harjai

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The journey of a ballot in Orange County

Collecting, and counting, all those ballots takes time. Page explained that two-person teams are dispatched to collect dropped-off ballots every day during election season.

The ballot drop-off boxes in Orange County are made of steel, weigh more than 1,000 pounds and are bolted to the concrete, Page said.

The ballot retrieval duos are required to follow a strict process to ensure the chain of custody remains secure, including taking photos showing they’ve picked up the ballots, properly locked the retrieval door and that the internal fire suppression canister is intact.

The locations of the two-person teams are GPS-tracked by separate teams, which also review the photo evidence before giving the ballot retrieval duos the green light to go to their next stops.

An overhead camera shows the process that occurs after the signatures on a ballot have been verified and the ballot is then ready to be counted.

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Kavish Harjai

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LAist.com

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Signature verification

Once a ballot reaches the Registrar of Voters’ office, the next step is ensuring the signature on the envelope matches the voter's signatures in their registration file.

“If we do challenge [a signature], we’re required under state law to send a first-class letter notice to that voter,” Page said, adding that state statute affords voters until the day before Thanksgiving this year to correct errant signatures.

Page said three election workers must agree that enough of a discrepancy exists before the decision to challenge a signature is made.

Around 1.9% of the nearly 718,000 vote-by-mail ballots returned in the June primary election in Orange County were rejected, largely due to signature mismatch or because they weren’t received in time, according to the California Secretary of State.

Verified ballots are then separated from their envelopes and sorted before they’re prepared to be scanned and, finally, counted. The equipment used to tally votes isn’t connected to the internet, and access to the room the equipment is housed in is limited, according to Page.

Threats from the federal government

On Wednesday evening, a federal judge denied an emergency request from the Department of Justice to segregate 20,000 ballots across California that the federal government said were sent to “likely” noncitizens.

More than 1,750 of those people identified were in Orange County, according to a letter Bill Essayli, top federal prosecutor for the Central District of California, delivered to the county registrar’s office Monday.

The Department of Justice said it will appeal the ruling from U.S. District Court Judge David Carter, who, in his decision, said the federal government’s attempted move could “wreak havoc and disrupt the election that is already underway.”

California Attorney Gen. Rob Bonta called the ruling an “important victory,” but warned “the fight is not over.”

On Wednesday, before the ruling came down, Bonta released resources about election integrity in the state, including guidance for local election officials if law enforcement attempts to “access election sites where ballots are cast, processed, or counted.”

Page said he’s fielded more questions from the public this year about the potential for law enforcement to interfere in the election. He said he will have open lines of communication with partners with the California Governor’s Office of Emergency Services and  Orange County Intelligence Assessment Center should the threat arise.

What’s on your ballot?

Our LAist Voter Game Plan is here to help guide you through the Nov. 3 election with guides to races across Los Angeles and Orange counties — and that long list of state propositions — to help you cast a ballot that’s in line with your own personal beliefs and values.

But the one thing we don’t do? We don’t tell you how to vote. That part is left up to you.

You can find it all at LAist.com/Vote.

The U.S. Justice Department has issued subpoenas to California officials in an escalation of its scrutiny of local election administration.

The Associated Press obtained copies of three subpoenas sent Oct. 21 to employees of the Los Angeles County Registrar-Recorder, ordering them to appear in court on Nov. 4, the day after the election. The documents request any records, documents and communications related to letters sent in July and October by federal officials to state election officials outlining allegations of noncitizens on the state’s voter rolls. The subpoenas also seek information relating to the office’s “methods for screening for unlawful voting by aliens” and anything about efforts to prevent noncitizen votes from being counted.

The subpoenas were being issued by all four U.S. attorneys in California, according to a person familiar with the matter who insisted on anonymity to discuss an ongoing investigation.

Dean Logan, the Los Angeles County registrar, said, “threats and intimidated have no place in elections.”

Subpoenas come amid ongoing court battle

The Trump administration has sued to force California to set aside up to 20,000 ballots it suspects went to noncitizens and not count them until citizenship can be verified. A district court judge on Tuesday rejected that request, then on Thursday appointed a special master to evaluate the administration’s claims.

U.S. District Judge David O. Carter did not specify the exact scope of special master Daniel B. Garrie’s responsibilities, but said he would be tasked with “developing the factual record” for the court.

In a Tuesday court hearing, Carter said he wanted to vet the federal government’s list of over 20,000 alleged noncitizen voters since there has been extensive debate over its reliability and both sides have agreed that it includes an unspecified number of citizens.

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Carter also said at the hearing that a special master could investigate California’s claims that it cannot logistically separate the ballots in time for the county election certification deadline on Dec. 3. The federal government has contested that assertion.

It is not clear what would happen if a special master did find a substantial number of noncitizen voters on the federal government’s list or whether it would affect the certification of California’s election results. The 20,000 people on the DOJ’s list constitute only a small fraction of California’s 23 million voters.

Trump administration appeals to higher court

Meanwhile, the Trump administration asked a federal appeals court to quickly weigh in.

The Justice Department said in a late Wednesday filing that it’s essential the 9th Circuit Court of Appeals issue a ruling as soon as possible due to “irreversible ballot processing occurring on an ongoing basis.”

Carter’s decision was the latest legal setback for President Donald Trump in his efforts to expand federal control over state-run elections in the midterms that will decide control of Congress for the rest of his term. The Justice Department has made similar demands in other states, including Washington. Noncitizen voting has been a central focus of Trump’s political messaging for years, although available data indicates it is exceedingly rare.

Trump blasted Carter’s ruling against the federal government on Thursday morning before heading to a campaign rally in South Carolina.

“California is very corrupt. The elections are extremely corrupt. The judge should not have done that but we’ll appeal that, of course,” he told reporters. Trump added without evidence that there are “hundreds of thousands” and then amended it to “millions, in my opinion” of “bad ballots” in California.

Carter, an appointee of Democratic President Bill Clinton, argued that the Justice Department’s demands were a clear violation of the National Voter Registration Act, which prohibits changes to voter rolls or election procedure within 90 days of an election.

A number of US citizens were included in the Justice Department’s list of names

Both sides agree that an unspecified number of citizens were inadvertently included. Carter argued that separating the ballots at this point would risk disenfranchising citizens and “wreak havoc” on the election certification process.

Over 500,000 votes have already been processed in Los Angeles County alone, according to court filings. The system also protects voter privacy: Once a vote is processed, it cannot be traced back to the person who cast it.

Carter is to rule on the government’s renewed request for a preliminary injunction, which would bar the state from counting the ballots until the litigation is resolved. He said he will do so after a Nov. 13 evidentiary hearing with input from the special master.

He said that if the federal government suspected noncitizens were voting, it could continue to prosecute those cases criminally. Federal authorities have charged over two dozen foreign nationals in California as part of a statewide sweep targeting people officials allege have illegally registered or voted in U.S. elections.

Appeals panel judges have said they wouldn’t support setting aside ballots this close to midterms

The appeal will be the second time that the 9th Circuit Court of Appeals will consider the case.

The first time was just last week when the Justice Department argued before an appeals court panel that a fast ruling on its request was needed to stop any counting of the ballots.

Although the panel ruled it was premature for an appeals court to get involved before a lower-court ruling, two of the three judges wrote separate concurrences making it clear they wouldn’t support setting aside ballots at this late date. They questioned the accuracy of the federal government’s list of alleged noncitizen voters and argued that to set aside votes risks disenfranchising citizens.

One judge dissented, arguing that federal law bars noncitizens from voting and requires California to vet the potentially illegal ballots before counting them. The failure to do so, he wrote, would cause irreparable harm to the election.