Prison pay hikes drain staff at state hospitals

By Lee Romney

Jan. 26, 2007 12 AM PT

Times Staff Writer

ATASCADERO — Court orders mandating drastic pay increases for health personnel in California prisons have led to an exodus of workers from state mental hospitals and left the facilities struggling to provide adequate patient care.

Staff shortages at Atascadero State Hospital, where psychiatrist vacancies stand at 70%, have caused the facility to all but freeze new admissions.

All the state’s mental hospitals, which like the prisons are also under federal scrutiny, report staff departures for prison jobs that now pay about 40% more. And they fear that many more staffers will leave.

At Patton State Hospital in San Bernardino, the medical staff chief pleaded with the federal court-appointed monitor in a December letter, saying a mass exodus of Department of Mental Health “psychiatrists and physicians is expected, and we are already seeing the start of it affecting our institution. Recruiting new people has become increasingly difficult.”

In order to keep Napa State Hospital licensed, the state had to hire contract pharmacists after many fled for higher-paying prison jobs. Workers at Metropolitan State Hospital in Norwalk now refer to the facility as “the Titanic” as psychologists apply in droves for prison system jobs. Recruiting e-mails featuring a photo of happy correctional staff members were sent directly to hospital psychologists this month, noting that 1,000 positions must be filled at the new pay rates.

But nowhere is the crisis as pronounced as at Atascadero, which treats California’s most seriously mentally ill jail inmates, prisoners and parolees who cannot safely be released to the streets. The admissions freeze at Atascadero has left California prisons, which have long relied on the hospital to stabilize their most severely mentally ill inmates, scrambling to find acute care beds within the prison system.

Atascadero State Hospital Executive Director Mel Hunter said closing the door to most new patients was his only option.

“We had to limit the number of admissions in order to maintain the treatment, safety and security of the 1,230 patients we already had in treatment,” he said.

The last straw came Jan. 17, when three psychiatrists left for prison jobs -- swelling the number of psychiatrist departures over the last year to 10. The next morning, Atascadero Medical Director David Fennell told Hunter that the facility could not continue admitting the eight to 12 new patients a day it usually handled.

Hospital officials quickly spread the word to prisons across the state, but some inmates were already en route: Three severely mentally ill prisoners from Chino’s California Institution for Men arrived at the hospital gates late in the day after a 250-mile drive, only to be turned back.

Since then, 50 more patients have been denied admission, forcing prisons to hold on to sick inmates.

Parolees who are too ill and dangerous to be released to the streets are still being accepted at Atascadero, Hunter said, along with a handful of other extremely ill patients. And the hospital has been cleared by the Department of Mental Health to hire psychiatrists under short-term contracts as soon as possible.

“We are anxious to get our staffing back up to some adequate numbers so we can honor our commitments to the Department of Corrections,” he said.

The unprecedented restrictions come at a critical time for both the prison and the state mental health bureaucracies, which are closely intertwined. Although several of the state hospitals still accept patients committed through the civil courts, the vast majority of mental hospital patients statewide now are channeled through the criminal justice system.

Abysmal medical and mental-health care in the state’s prisons prompted federal overseers in two separate lawsuits to order the soaring pay increases as a way of luring competent clinicians to the California Department of Corrections and Rehabilitation.

The first order, which applied to medical care, triggered a mass departure of nurses last year from the state hospital system. (Department of Mental Health raises helped slow that flow somewhat but did not match the prison salaries.) The most recent order -- pertaining to mental health clinicians in the prisons -- took effect this month.

The departures come at a time when the Department of Mental Health is also struggling to satisfy federal regulators.

In May 2006, the U.S. Department of Justice filed suit against the 5,000-patient mental hospital system for faulty patient care. A 90-page consent decree spells out required improvements, including an increase in staff.

The departures are draining experience and numbers from the hospitals at a time when morale was already plummeting.

At Atascadero, high Central Coast housing costs have long made recruitment difficult, and a spike in assaults on staff in the last few years had contributed to departures even before the prison raises kicked in.

Psychiatrists who remain are saddled with increasingly demanding patient loads. The medical schedule for Thursday showed one psychiatrist assigned to 174 patients.

“When I saw so many other psychiatrists had left, I just felt my license would be endangered,” said Dr. James Dietch, an 11-year veteran of Atascadero who left this week to begin a new job at the nearby California Men’s Colony, where he will earn about 45% more. “I felt I would eventually be put in a position where I could not adequately provide care.”

Now, Dietch said, Atascadero psychiatrists can do little more than “put out fires, provide basic medication.”

The pull to the prison system is strong. A psychiatrist at Atascadero can make between $13,000 and $14,000 a month, but those in the prison system can make between $19,000 and $21,000 a month.

Marilyn Gill of San Diego, whose 30-year-old son is a patient at Atascadero, wrote to her state senator to plead for help, noting that her son’s psychiatrist is assigned 103 patients.

“I don’t understand how anyone’s son can receive adequate care at a psychiatric hospital with an inadequate number of psychiatrists,” Gill wrote.

Department of Mental Health Director Stephen Mayberg said he was “very concerned” about the staff departures. “It’s the highest priority to us to make sure we have clinical staff available.”

However, while the federal courts ordered the salary increases for the prison system, Mayberg said, his department cannot unilaterally match them. Instead, he said, the Department of Mental Health must convince the governor and the Legislature that some higher salaries might be necessary.

But that, he said, is an imperfect solution. If the Department of Mental Health matched the prison salaries, he said, it might prompt the federal receiver and monitor overseeing the prison improvements to simply order further pay increases in that system, triggering a bidding war.

“The priority has to be patient care,” he said, “so we aren’t shuttling staff between the institutions. How do we bring people into both institutions?”

Critics say the current crisis, though perhaps unintended, was not unforeseeable.

“Everyone in the world knew that once you raise the salaries of the [prison] clinicians that the DMH clinicians would literally sometimes walk across the hall or walk across the street” to higher-paying jobs,” said Donald Specter, an attorney with the Prison Law Center, which has pressed the mental health case on behalf of prisoners.

For the workers who remain at Atascadero, exhausting mandatory overtime is taking a toll, and an influx of young inexperienced students and recent graduates has further reduced safety in the patient wards, said John Ransom, a psychiatric technician who has been assaulted seven times in his eight years on the job.

He counts 16 friends among those who have departed in the last six months alone.

“I play golf with three of the guys that have left. They say the atmosphere is totally different. They feel safe. They’re making more money. And they’re telling their friends this,” Ransom said.

The gap in coverage took a toll when a patient released from restraints broke another patient’s nose in a unit bathroom earlier this week. Under normal circumstances, a psychologist would have crafted a plan to help that patient deal with his assaultive behavior. But the unit has no psychologist.

“There’s no one to write the plan,” said Dr. Bill Walters, the psychiatrist who now cares for 86 patients in two units at Atscadero. “I could do it -- if I had two other hands and another head.”

lee.romney@latimes.com

(BEGIN TEXT OF INFOBOX)

Hiring squeeze

Atascadero State Hospital is so shorthanded that it is turning away patients.

Comparison of highest salaries

*--* Psychiatrist Psychologist Prisons 2006 $160,000 $73,000 Prisons ordered for 2007 248,000 97,488 Mental hospitals now 143,460 62,412

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Staff transfers from Atascadero to prisons

*--* 2006 This month* Psychiatrists 4 3 Psychologists 3 5 Registered nurses 15 1 Psychiatric technicians 9 1

*--*

*Through Thursday