Prison health workers are among the highest paid public servants. Why are so many jobs vacant?

Despite spending hundreds of millions of dollars to fill vacant medical and psychiatric positions in state prisons and hospitals, California has little to show for it, according to a new state auditor’s report.

Vacancy rates have increased since 2019 at the three institutions audited, as the government’s reliance on part-time workers has increased. Atascadero County Hospital, Porterville Developmental Center and Salinas Valley County Jail had health-related vacancy rates increase by 30% in fiscal year 2023-24. At the Salinas Valley County Jail, more than 50% of medical positions were unfilled.

Workers argue that high vacancy rates lead to more workplace strikes, mandatory overtime and employee turnover.

“The high number of vacancies is a self-fulfilling prophecy,” said Dr. Stuart Bussey, president of the Union of American Physicians and Dentists, which represents about 1,300 state psychiatrists.

Vacancy rates continue despite targeted bonuses and pay raises for prison health workers through contracts and court orders during the Newsom administration. These include $42,000 bonuses for prison psychiatrists in the 2023 contract and the recent $20,000 bonuses the state had to hand out to mental health workers in a long-running inmate rights case.

In comparison, other public health workers are relatively well compensated. All 55 prison employees who earned more than $500,000 last year were doctors, dentists, psychiatrists or medical administrators, according to state comptroller data.

A board-certified psychiatrist at Atascadero State Hospital — some of the state’s highest-paid employees — can earn more than $397,000 in base salary. They also retire with pensions through the California Employees Retirement System. In comparison, the average salary for a psychiatrist in California is $328,560, according to the US Bureau of Labor Statistics.

But in some areas, local hospitals offer more. In Monterey County, hiring bonuses of $90,000 are common at private hospitals struggling to fill their vacancies, staff told state auditors.

Despite the pay, vacancy rates were highest among psychiatrists at Atascadero State Hospital and second highest at Porterville Developmental Center and Salinas Valley County Jail, auditors found.

All three of these researched institutions house people who have been arrested or institutionalized because the courts have deemed them dangerous or unfit to stand trial. Federal and state law and court decisions require the state to provide adequate health and mental health care. Because of this, most institutions are required to have less than 10% vacancies.

Over the past 30 years, California has consistently failed to meet that standard.

No government department that oversees these institutions has taken appropriate measures to ensure that there are enough workers, the auditors wrote.

The test found:

• The facilities had “a large number of vacant positions” that could not be filled by part-time or overtime staff.
• Neither the State Department of Hospitals nor the Department of Developmental Services, which accommodates individuals with developmental disabilities in Porterville, have adequate screening procedures or annual staffing needs budgets.
• State hospitals and developmental services departments and the Department of Corrections and Rehabilitation do not have a process to determine whether facilities meet minimum staffing levels for each shift.

In a letter to lawmakers, California State Auditor Grant Parks wrote that the state should launch a statewide recruitment drive to hire health care workers “due to the decades-long difficulty agencies have had in filling vacant health care positions and the current and perceived shortage of health care professionals.”

In response to the audit, the development departments and public hospitals partially agreed with the findings of the detailed documentation.

The Department of Public Hospitals, however, noted that vacancy rates during the study period were significantly affected by the COVID-19 pandemic and that salary savings were exceeded. “Our hospitals regularly meet or exceed staffing limits and have rare self-reported incidents due to unusual circumstances,” department spokesman Ralph Montano said in an email to CalMatters. The department agreed to implement many of the recommendations made in the report, Montano added.

In a statement, the Department of Corrections said it is “committed to providing adequate health care to incarcerated individuals, while ensuring financial responsibility.”

Workers say the government is wasting money to fill vacancies

Coby Pizzotti, an organizer for the California Association of Psychiatric Technicians, which represents about 6,000 psychiatrists, said the study confirmed what many public employee unions had suspected: The state has been refusing to improve wages, benefits and working conditions for workers, while spending money on part-time workers. This opposition to the unions, makes the problem of vacancies even more difficult.

“Actually, they are public servants who can be shadow. They are not just called public servants,” said Pizzotti.

The departments saved $592 million in payroll over six years by carrying the vacancies, the auditors wrote. But, auditors criticized government departments for not being able to track exactly how they spent the money. Departments argue that, in general, the money can be used to pay other expenses or be returned to the government.

But they also invested in temporary positions to meet the court-mandated minimum amount. During the six-year audit period, the state spent $239 million on contract workers to fill staffing gaps. Departments were authorized to spend more than $1 billion on part-time workers during that period, although they spent only a fraction of the money, according to the study.

Contract workers, although they make up less than 10% of health workers, are paid so much that they cost more per hour than government workers even after accounting for benefits, auditors also found.

Public service unions say that is more evidence for their claim that these programs do not save the government money.

“Contracting is not a good way to do business. It’s expensive,” said Doug Chiappetta, executive director of the psychiatric union.

Instead, public health workers’ unions want the state to raise wages and benefits, to make permanent positions more attractive to candidates instead of wasting them on higher-paid contract workers.

The Psychiatrists’ Union, the Psychiatrists’ Union and the state nurses’ union said contract workers earn two to three times more per hour than state workers, according to job advertisements from contracting agencies they collected. Those companies are also able to offer great benefits and flexibility that country jobs don’t have.

“It was a slap in the face to see how the state doesn’t care about our nurses,” said Vanessa Seastrong, chair of Bargaining Unit 17 of SEIU Local 1000, which represents about 5,100 registered nurses. “You are standing next to a nurse who does less work than you and earns more than you.

Major recruitment issues

Even relying on temporary contract workers, the state has in many cases failed to maintain minimum staffing levels in health care positions.

The vacancy rate increased significantly between 2019 and 2024. The Salinas Valley County Jail saw vacancies increase by 62% during the study period, and more than half of mental health and medical positions were unfilled by the 2023-24 fiscal year.

Atascadero State Hospital’s vacancy rate increased by 39% during the audit period for a total of 30% of vacancies. During the last three years of the audit period, Atascadero also lost 90 percent of its workforce to bankruptcy.

Porterville Developmental Center’s vacancy rate increased by just 6% during the audit period, but more than one-third of its positions remained unfilled in the last year of the audit.

In interviews with auditors, facility managers said the COVID-19 pandemic has resulted in increased staffing and increased reliance on contract workers to fill vacancies.

All three institutions, located on the Central Coast or Central Valley, are facing additional recruitment hurdles.

These areas suffer from a shortage of health professionals. The coastal area where Atascadero Regional Hospital and the Salinas Valley Regional Jail face a moderate shortage of behavioral health workers, while the Porterville Developmental Center is in the highest shortage, according to the Department of Health Access and Information.

“Places like the Central Valley have very few mental health workers per community compared to the rest of the state,” said Janet Coffman, a professor at UCSF’s Institute for Health Policy Studies who studies workforce issues. “Especially in Porterville, that’s a big part of the problem.”

At the same time, the need for mental health services has increased for many people, Coffman said.

Combined, that makes it more difficult for the government to compete with the private sector, which is also struggling to recruit health workers.

Some barriers are difficult to overcome with money alone. A sick population can make the job dangerous. Workers are often insulted or abused. Unsafe conditions make it difficult to hire new workers and sometimes cause long-time workers to retire early.

“There were 2,700 attacks on workers last year. It’s not a matter of when,” Pizzoti said.

The audit recommended that the state conduct a market analysis of all health care positions to determine whether pay was competitive, streamline the hiring process, and conduct a statewide hiring campaign.

Supported by the California Health Care Foundationwho works to ensure that people get the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

Kristen Hwang writes for CalMatters.