Oakland, Calif.-based Kaiser Permanente is facing pushback from San Francisco, the first city to pass a resolution opposing the health system’s behavioral health contract demands related to AI, layoffs and outsourcing, according to a Sept. 1 report from the Board of Supervisors. Kaiser provides care and coverage to 69,000 employees of the city and county.
The 11-member board vote follows a year of opposition from Kaiser clinicians, whose contract expired in September 2025, according to a Sept. 1 news release from the National Union of Healthcare Workers. Four days of mediation in August did not produce an agreement, and no additional mediation dates have been scheduled. Clinicians held a one-day strike in March and have authorized a three-day strike, though a date has not been set.
The resolution follows a July 21 hearing convened by Supervisor Chyanne Chen, joined by Board President Rafael Mandelman and Supervisors Myrna Melgar and Shamann Walton. There, Kaiser mental health therapists, social workers, psychologists and behavioral health advocacy leaders warned that Kaiser’s proposals could significantly reduce the quality of its behavioral health services, according to the union release.
Kaiser officials declined to participate in the hearing but did submit a July 16 letter to the board “in the spirit of partnership and shared commitment to the health and well-being of San Franciscans.” Ms. Chen introduced the resolution afterward and said protecting workers and patients amid emerging technology “is more important now than ever.”
According to the board’s report, three contract provisions that clinicians have opposed and are named in the resolution include:
- Language establishing total authority over the deployment of AI, while rejecting contract language that specifies new technology will only support the work of staff therapists, not replace them.
- Language opening the door to mass layoffs and outsourcing of behavioral health services by replacing contract language that prohibits layoffs as a result of subcontracting with language that expressly allows it and details severance packages for Kaiser clinicians.
- Language on clinical authority that would give Kaiser sole discretion to set or modify its behavioral health operating and clinical models of care, without any requirement to work collaboratively with therapists.
Kaiser said it is currently using AI to record therapy sessions and screen patients seeking care. It has declined to adopt language from its Southern California contract stating that new technologies are not intended to replace clinicians. Kaiser clarified in the July 16 letter to the board that “AI does not make clinical decisions, replace licensed clinicians or provide therapy instead of therapists.”
Kaiser is also operating under two settlement agreements involving behavioral healthcare: a $200 million agreement with the California Department of Managed Health Care, signed in 2023, and a $31 million agreement with the U.S. Labor Department, signed earlier this year. Both agreements resolved investigations sparked in part by clinician testimony.
The NUHW represents 19,000 healthcare workers in California, Hawaii, Pennsylvania and Wisconsin, including nearly 4,700 Kaiser mental health clinicians and medical professionals.
Kaiser said in a statement shared with Becker’s that its behavioral health e-visit tool “was developed with input from therapists and NUHW representatives” and is “an additional path to getting care — not the only path.” The system said every screen in the e-visit process gives patients a phone number to reach a live person, and that the tool “does not use AI to diagnose patients, make clinical decisions, or determine medical necessity,” with clinical decisions remaining “with licensed health care professionals.”
Kaiser said it “disagree[s] with the union’s characterization of our behavioral health processes,” adding that its “focus remains on providing timely, high-quality mental health care for our members while reaching a fair agreement with NUHW that supports our clinicians, our patients, and the communities we serve.”
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