Kaiser Mental Health Clinicians Raise Privacy Concerns Over AI Scribe

Transparency gaps in AI documentation

Mental health clinicians at Kaiser Permanente are voicing concerns about an AI-powered documentation tool that records entire therapy appointments, saying the health system has failed to provide basic information about data handling and patient privacy protections.

Kaiser rolled out Abridge in 2024, describing it as "ambient listening technology" designed to reduce documentation burden for clinicians. The AI scribe captures clinical notes during patient visits, including mental health sessions. But multiple providers say they have been unable to obtain clear answers about how recordings are stored, how long data is retained, or who can access it — information they need to properly inform patients giving consent.

Ilana Marcucci-Morris, a licensed clinical social worker with Kaiser psychiatry in Oakland and union bargaining committee member, said leadership responses to privacy questions have been dismissive. "We are compliant. That's it. That's all you need to know," she recounted being told. "They won't show us... if you have nothing to hide and you're doing it totally ethically, then you would show us, prove it."

Why it matters

Mental health records contain uniquely sensitive information that can affect employment, custody cases, immigration status, and security clearances. When clinicians cannot explain data practices to patients, meaningful informed consent becomes impossible — a particular concern given the power imbalance in healthcare settings and the documented pressure on providers to adopt the technology.

Coercive adoption pressures

Providers describe workplace dynamics that effectively compel use of the AI tool. Marcucci-Morris said Kaiser has increased patient loads in recent years while treating failure to keep up with documentation as grounds for discipline. She regularly represents colleagues in workplace investigations related to delayed notes or heavy caseloads, where management recommends Abridge to avoid further action.

"I consider that to be coercive because you're putting someone in a position to either lose their job or use the software," she said.

Ligia Pacheco, a psychiatric social worker providing remote therapy in Southern California, said a colleague was told it was "unprofessional" to share personal beliefs about AI in the workplace. "We're supposed to be the voice of patients who are coming in their most vulnerable state. And we can't even be that voice for them," Pacheco said.

Consent concerns extend to patients

The consent process itself raises questions. While Kaiser requires clinicians to obtain patient permission before recording, providers say they cannot explain data handling because they do not know the details themselves. Pacheco experienced this firsthand during her own Kaiser appointment, when a doctor informed rather than asked about using Abridge. After she declined, she noticed discomfort from the physician and later changed doctors.

Marcucci-Morris said the scripted consent approach can feel manipulative, with patients told the tool helps reduce provider burnout and allows doctors more family time. "Patients may feel guilty declining the use of the tool because they do not want to make their provider's job harder," she explained.

Nicole Alvarez, senior analyst for technology policy at the Center for American Progress, emphasized that agreements between health systems and AI vendors vary widely on critical questions like whether data trains AI models, retention periods, and what happens when contracts end. Patients typically have little visibility into these arrangements.

Kaiser's response

A Kaiser spokesperson said clinicians must obtain patient consent and that "no one is recorded without their knowledge and consent." The statement said recordings are stored for no longer than 14 days, data processing meets HIPAA requirements and Kaiser's privacy standards, and patient data is not used to train AI models. Brian Hoberman, chief information officer for The Permanente Medical Group, said the technology was implemented "after careful review and diligent testing."

Abridge is now available in 40 Kaiser hospitals and more than 600 medical offices across eight states and the District of Columbia, operating in more than 14 languages. Abridge AI Inc. did not respond to multiple requests for comment.

"Therapy is most effective in privacy and when trust is achieved through two human beings," Marcucci-Morris said. "I believe recording a therapy session changes human behavior. It changes the patient's demeanor."

These details were first reported by CalMatters and American Community Media.