Mental health professionals employed by the nation’s largest nonprofit health care organization are pushing back against its embrace of AI transcription services over concerns that having a third party in the room could make patients less comfortable opening up about sensitive issues and that therapy transcripts could be exposed.

“Is five minutes of my time worth the possibility of a data breach?” said Jess Metzinger, an associate clinical social worker in Kaiser Permanente’s Walnut Creek office. “The temptation is not greater than all of the concerns I have.”

Kaiser announced in 2024 the rollout of an AI transcription service from a Silicon Valley venture capital-backed startup called Abridge to its more than 40 hospitals and more than 600 medical offices in eight states and Washington, D.C. In a promotional video, Dr. Daniel Yang, Kaiser’s vice president of AI and emerging technologies, called it “the largest deployment of a generative AI technology in clinical medicine in the entire country, if not in the entire world.”

Abridge, which did not respond to requests for comment, is one of the leading companies deploying artificial intelligence to transcribe patients’ medical visits and autogenerate notes for medical professionals. The company raised $550 million during its Series D and E funding rounds last year. It promises its technology improves efficiency and reduces provider burnout, and the company said it is now in more than 270 of the largest health systems in the U.S.

Kaiser mental health workers in Northern California are using bargaining to push for boundaries for AI use. In addition to privacy fears, two therapists told Proof News that they are concerned their employer will point to time savings gained from the scribe to increase their caseloads. Some are concerned that down the road, Kaiser could outsource mental healthcare duties to autonomous agents.

“If management can use AI to make their organization more profitable by replacing human therapists with AI tools that would be much less expensive, I have no doubt that Kaiser would do that,” said therapist Paul Boyer, who works in Kaiser’s adult psychiatry clinic in Oakland.

Kaiser spokesperson Vincent Staupe said tools like AI scribes are designed to support — not replace — healthcare workers. Use is optional for providers and patients, he said. 

“No technology we use makes clinical decisions or substitutes for the human connection that effective mental health care requires,” Staupe said.

EXAM TABLE VS. THERAPY COUCH

For doctors drowning in paperwork, AI scribes may be a lifeline. Abridge touts studies, co-authored by the company’s chief clinical officer, finding providers using the tool reported less documentation burden and after-hours work, and greater job satisfaction. In an article for the medical journal NEJM Catalyst, Kaiser researchers reported that AI scribes saved providers in Northern California more than 15,700 hours in documentation time over one year. 

“We have now shown that this technology alleviates workloads for doctors,” Dr. Vincent Liu, a Kaiser research scientist, said in an April 2025 statement. “Both doctors and patients highly value face-to-face contact during a visit, and the AI scribe supports that.”

Doctors’ desperation to ditch paperwork has translated to a meteoric rise for the startup. After securing hundreds of millions last year from the likes of venture capital firms Andreessen Horowitz and IVP, the company reported a valuation of more than $5 billion. 

Abridge, in press releases, says it expects to capture more than 100 million patient-clinician conversations this year alone. It leverages its unprecedented access: According to the company’s privacy policy, those personal conversations are de-indentified and used by the company to develop new products, including machine learning tools. (Staupe said Abridge does not use Kaiser patient data to train its AI models.) 

But mental health professionals told Proof there’s a difference between recording conversations about physical maladies and mental health struggles. Not only are they concerned about the “incredibly sensitive” information revealed, they are also worried about the sheer quantity shared during a nearly hourlong session, said Dr. Leanna Fortunato, director of digital health and health care innovation for the American Psychological Association.

“It’s not that they're anti-technology or anti-efficiency,” Fortunato said of therapists, “but the idea of introducing a recording of therapy sessions makes people really uneasy.”

Lisa Whelan, a licensed clinical social worker in a Kaiser pain clinic in San Jose, California, has found Abridge has some upsides. She likes being able to review the transcripts when she finishes writing clinical notes at the end of busy days. The progress notes it drafts, she confesses, are “pretty darn good.”

But Whelan questions why recordings are stored long after she has used them. “The longer you have those recordings and those transcripts out there, the more likely there could be a breach,” Whelan said. “I would like to see the videos destroyed after I complete my note.”

Staupe did not disclose how long Kaiser keeps Abridge recordings and transcripts, telling Proof that any documentation generated “is retained for a limited period consistent with applicable privacy laws, then permanently deleted.” Guidance on AI scribes from the American Psychological Association states that providers should store data for the minimum time necessary.

A recent Proof News investigation found that a telehealth platform was using de-intentified therapy sessions to train an AI model, and one patient’s transcripts were exposed in court.

Linda Michaels, a psychologist and co-founder of the nearly 7,000-member-backed advocacy group Psychotherapy Action Network, described the data mining as “awful.” In a traditional therapy session, therapists might scribble only a few sentences recording a patient's progress, she explained. By creating a transcript of the exact back-and-forth of a digital therapy session, tech companies are creating a new window into people’s private lives.

“It is really taking advantage of vulnerable people at a vulnerable time of their life,” Michaels told Proof News in March. 

Several states, including Illinois, Maine, and Colorado, have passed laws banning the use of AI to record or transcribe a therapy session unless patients give consent. Rep. Amy Kuhn, who cosponsored the legislation in Maine, said AI can assist providers and clinicians in supporting their patients, “but it is not a replacement.”

“At its core, mental health treatment is reliant on trust, professional judgment and human connection,” Kuhn said in a statement to Proof. “Prohibiting the recording or transcribing of a therapy session unless patients give consent will help to maintain trust and preserve the integrity of the patient-provider relationship.”

‘KAISER DON’T A.I.’

Kaiser mental health workers and nurses across Northern California staged a one-day strike in March to protest the health system’s use of AI which, they allege, is to the detriment of patient care. Parading more than a mile to Kaiser’s corporate headquarters in Oakland, people chanted, banged noisemakers and hoisted signs reading “KAISER DON’T A.I.”

Therapists who attended the rally told Proof they are already seeing parts of their job outsourced. Licensed therapists used to provide triage for behavioral health patients, they said, but now Kaiser uses phone operators who lack mental health training to route patient care.

“We’re out here fighting for our right to exist,” Alan, a Kaiser psychologist who declined to provide his last name, told Proof during the rally.

The mental health clinicians, represented by the National Union of Healthcare Workers, want an agreement that limits new technologies to assisting, rather than replacing, employees. Their counterparts in Southern California won those terms in 2024, but Northern California management won’t agree to it, the union contends, leaving some therapists to assume that Kaiser intends to replace therapists’ tasks with AI tools.

Staupe did not respond to Proof’s questions about labor concerns.

The skirmish over AI is the latest in a long-running fight for adequate mental health services at Kaiser. State and federal agencies have slapped Kaiser with penalties over deficiencies in its behavioral health care services: In 2023, the state Department of Managed Health Care fined Kaiser $50 million for long wait times for appointments and other issues. And Kaiser will pay at least $28 million to members who paid for out-of-network mental health care, following a settlement reached earlier this year with the U.S. Department of Labor that resolves allegations that it failed to maintain adequate mental health provider networks.

In a February statement issued in response to the Labor Department settlement, Staupe attributed patients’ challenges accessing care to an "unprecedented rise” in the need for mental health services amid the pandemic and a labor strike by mental health workers. Kaiser has been on a “multi-year journey” to transform mental health care delivery in California and now meets state requirements, he said.

Given the pressure to see more patients, some therapists worry AI will become mandatory. Ilana Marcucci-Morris, a licensed clinical social worker in Oakland and a member of the union’s bargaining team, said she's concerned mandatory AI transcription could result in less time for documentation — despite the need to check for AI errors – and ultimately higher caseloads.

When asked if she has voluntarily used AI transcription for therapy, Marcucci-Morris was clear: “No, I keep up without it.”