When Help Hurts: Failures in Northern California Healthcare

Health Plan of San Mateo building, representing the challenges and systemic failures within Northern California's healthcare system.
A person having an online therapy session via Zoom, highlighting the struggle for mental health care in Northern California's healthcare system.

Broken Promises: The Hidden Failures of Northern California's Healthcare System

Dealing with mental health struggles is exhausting and disheartening, especially when fighting for basic care and information. My therapist and the Health Plan of San Mateo (HPSM) should have provided clear, timely, and comprehensive medical records. Instead, I was met with systemic healthcare issues, silence and resistance, undermining the very essence of what healthcare should represent.

 In Northern California healthcare, the healthcare system is failing its patients. Despite the fundamental principle of “do no harm,” I, like many others, have experienced significant neglect and mistreatment. My journey through the healthcare maze began with a simple need for mental health support and ended with a battle for my rights and a proper diagnosis.

Initial Mental Health Struggles

In 2021, I sought help from a therapist, hoping to gain insight and support for my mental health struggles. I was referred to her through behavioral health services with the Health Plan of San Mateo (HPSM) and she was working with the Peninsula Adult Wellness Center (PAWC).

Instead, I faced an unexpected and unjust termination of my treatment. I was given no paperwork, no formal diagnosis, and no explanation. During a Zoom session, my therapist told me I didn’t “look or seem depressed,” which left me believing I was not diagnosed with any condition.  For two years, I self-reported my symptoms of depression, anxiety, and possible phobias because I was left uninformed about any official diagnosis. 

In 2024, after the health plan reached out, I was finally given my diagnosis of sensory-related trauma and mood-related disorders, including depression and anxiety. This left me questioning whether I was diagnosed at the time of treatment or only after my grievance. It wasn’t until I filed a grievance with the health plan and the  Department of Managed Health Care (DMHC)  that I finally received a summary of my diagnosis. Despite repeated requests, my therapist refused to provide and acknowledge my full medical report or any documentation regarding the termination of my treatment. 

The Health Plan of San Mateo (HPSM) refused to help me obtain my medical records from the therapist. I communicated my concerns to member services, various representatives, and even a case manager, but received no assistance. The situation became so dire that a member service representative had to Google the therapist to find their contact information because the health plan didn’t have it. Additionally, the therapist initially ignored requests for my medical records, claiming she had a new job and didn’t check her previous email. Out of the 13 items I requested, she provided only 3 in summary form. 1) The diagnosis name’s, 2) The treatment plan at the time and 3) her recommendations. 

When asked to provide the reasons and policies behind the missing information, she ignored my requests. Despite repeated attempts, I was never given a full explanation or documentation of my treatment or its termination. This represents repeated violations of HIPAA, the Health Insurance Portability and Accountability Act, which mandates patients’ rights to access their medical records amongst other violations. I also filed a complaint with the Board of Behavioral Sciences (BBS).

Healthcare System Duties and Failures

 Both the health plan and the doctor have a duty to ensure patients receive appropriate care, recieve their diagnosis in a timely fashion and have access to their medical records. The health plan is responsible for facilitating access to necessary healthcare services and ensuring that providers comply with regulations. The doctor has a duty to provide timely, accurate, and complete medical information to the patient and to act in the patient’s best interest. In my case, both parties failed to fulfill these responsibilities, resulting in significant distress and delayed treatment.

As an informal family caregiver, I support my brother who has multiple mental disabilities, including schizophrenia, anosognosia, dysgraphia, non-verbal learning disability, and superior intellect. He is a patient of Kaiser Permanente, and has faced his own systemic issues in receiving treatment and services. Diagnosed twelve years ago, he has only received medication with no comprehensive treatment plan or accommodations. Despite his conditions, which include a lack of insight into his illness (anosognosia), the system holds him accountable for giving consent, making it nearly impossible to access the necessary care.

 

My mother and I have tirelessly fought for proper care for him, but we continually encounter mental health discrimination, systemic denials, and malpractice. We’ve sought help from organizations like NAMI, but often find he doesn’t fit within their criteria. We’ve even attempted to secure legal assistance, but the challenges persist. Homelessness and drug addiction are rampant in California, often stemming from untreated mental health conditions. Many individuals use drugs to cope with their untreated mental illnesses, exacerbating their situations and contradicting Governor Gavin Newsom’s initiatives in the Bay Area.

The Broader Issue with Northern California Healthcare System

My story is not unique, Many patients in Northern California face similar challenges with healthcare providers, particularly within HPSM. The lack of transparency, accountability, and proper documentation is a systemic issue that leaves patients vulnerable and without the support they need. This neglect not only harms individuals but undermines the entire healthcare system’s integrity.

Contradicting Governor Newsom’s Initiatives

Governor Newsom’s Initiatives:

Governor Gavin Newsom has been actively working to address the homelessness crisis and mental health issues in the Bay Area. His initiatives focus on increasing access to mental health services, providing supportive housing, and reducing the stigma associated with mental health conditions. One significant effort is the “Care for All” initiative, which aims to expand mental health services and integrate them with housing and social services to provide comprehensive support for those in need.

Health Plan and Doctor’s Failures: Unfortunately, the actions of the Health Plan of San Mateo (HPSM) and my therapist go against these very efforts. Governor Newsom is pushing for comprehensive and compassionate care, but my experiences tell a different story—one of neglect and unnecessary hurdles.

Lack of Continuity of Care: The health plan and the therapist have a duty to ensure patients receive continuous and coordinated care. Instead, I was left to figure everything out on my own, despite my ongoing mental health struggles. Just because I can articulate my issues doesn’t mean I don’t need help. The system’s neglect forced me to self-report my difficulties without any support or proper guidance, which only added to my stress and confusion.

Patient Burden: The burden of navigating the healthcare system shouldn’t fall on the patients, especially those dealing with mental health issues. It’s exhausting and disheartening to have to fight for access to basic care and information. My therapist and HPSM should have provided clear, timely, and comprehensive medical records, but instead, I was met with silence and resistance. This lack of support undermines the very essence of what healthcare should be.

Representative Manager’s Response: In response to my grievance, a representative manager from HPSM stated that they reviewed my records and found that I was not in any programs identifying me as having special needs. This further shows that HPSM did not have records of a diagnosis from my therapist. They did not seek clarification from the therapist either, leaving it to me—the person seeking support and accommodations—to chase down this information. This is a clear abdication of their responsibility to ensure continuity of care and support for their patients.

Potential Discrimination: Beyond the administrative failings, there are deeper issues at play, including potential discrimination. As an African American woman, I often find myself as the only black person in the room, which makes me question if my race plays a role in the treatment I receive. It’s not just about being overlooked; it’s about feeling invisible and undervalued. This experience isn’t unique to me—many African American and Latino women face similar struggles in the healthcare system. The possible intellectual discrimination and the systemic barriers we face are not only disheartening but also dangerous. Governor Newsom’s initiatives aim to provide equitable care for all, but the reality on the ground shows that there is still a long way to go. The actions of HPSM and my therapist not only contradict the governor’s vision but also highlight the urgent need for reform at every level of the healthcare system.

Call to Action: We need immediate policy changes and better oversight to ensure healthcare providers are held accountable. Patients must have access to their medical records, clear diagnoses, and fair treatment processes. I urge Governor Gavin Newsom, healthcare administrators, and patient advocacy groups like NAMI to take these issues seriously and implement reforms that protect patients’ rights.

 

Healthcare should be a sanctuary of support and healing, not a source of additional harm and stress. By sharing my story, I hope to shed light on these critical issues and encourage a collective push for better healthcare practices. We deserve a system that truly prioritizes patient well-being, health equity, and patient education. Regardless of ethnicity, class, or ability/disability, everyone has the right to transparent communication, timely access to medical records, clear diagnoses, and fair treatment. It is imperative that our healthcare system upholds the principle of “do no harm” and ensures that all patients receive the respect, care, and support they need.

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FAQs

What are the main issues with Northern California’s healthcare system?
The main issues include lack of transparency, inadequate documentation, and failure to provide continuous and coordinated care. Patients often face neglect and are left to navigate the system on their own.

How did the Health Plan of San Mateo fail in providing care?
The Health Plan of San Mateo failed to assist in obtaining medical records, did not communicate effectively, and did not ensure continuous care. They also did not have adequate records of my diagnosis.

What steps did you take to address the failures in your healthcare?
I filed grievances with the health plan and the Department of Managed Health Care, and a complaint with the Board of Behavioral Sciences. Despite these efforts, I received little to no response or assistance.

How do Governor Newsom’s initiatives contrast with your experience?
Governor Newsom’s initiatives focus on increasing access to mental health services and providing comprehensive care. My experience, however, was marked by neglect, lack of support, and systemic barriers that contradict these initiatives.

What are the potential reasons for discrimination in the healthcare system?
Discrimination in the healthcare system can be based on race, gender, and intellectual ability. Many African American and Latino women face systemic barriers and potential discrimination, which can lead

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