Pay hikes at state hospitals ordered

A U.S. district judge Monday ordered the state Department of Mental Health to raise salaries for psychiatrists in an effort to reverse an exodus of clinicians from the beleaguered state hospitals to higher-paying prison jobs.

The brief hearing in the Sacramento courtroom of Lawrence K. Karlton came as part of a class-action lawsuit filed on behalf of the state’s mentally ill prisoners, the sickest of whom receive crucial care in the state hospitals.

In attempting to improve prison mental health care, Karlton in December ordered significant pay raises for that system’s clinicians -- helping to trigger the exodus of staff from the state hospitals. Early this spring he ordered the state to devise a plan to correct that problem by April 23 but, frustrated with its thin response, granted a reprieve until Monday’s hearing.

The departure of clinicians from state hospitals has left the Department of Mental Health in violation of state and federal staffing requirements and forced some facilities to dramatically slow admissions -- leaving sick prisoners and jail inmates who are too mentally ill to stand trial languishing for months awaiting hospital beds, legal filings in the case show. The state hospital system currently has 1,800 job vacancies.

Employees say the staffing shortage -- and reliance on less-experienced employees -- also has created unsafe conditions for patients and staff. Friday, a patient at Atascadero State Hospital died after choking in the dining room -- the fourth death there this year, a statistically unusual spate for the Central Coast facility.

It wasn’t immediately clear whether staffing shortages contributed to the choking death, but experienced hospital staff usually know how to prevent such deaths, said one Atascadero psychiatrist who asked not to be identified.

The psychiatrist also mentioned three assaults on staff members since April -- one in recent weeks with a sharpened plastic knife.

Atascadero State Hospital spokeswoman Barrie Hafler said the staff shortages remain a matter of great concern, as do assaults. But she said the number of assaults does not appear to be climbing, particularly since a near freeze on admissions has caused the number of overall patients to drop by nearly 20% since January.

Karlton, who is overseeing reforms to mental health care for prisoners, has repeatedly noted in court that his reach over the Department of Mental Health is limited: Only a small percentage of state hospital patients are currently serving a prison sentence. Many more arrive through some other avenue of the criminal justice system, and a small number are committed through the civil courts.

But in ordering state pay increases that would bring at least some psychiatrists up to the salary level of their prison counterparts, the judge expressed growing frustration with the state’s plans to fix the problem.

Karlton’s written order is expected within days, and he said in court that he might broaden it to other job categories, said attorney Michael Bien, who represents the mentally ill prisoners.

“His order might be more limited than what we want,” Bien said. “But it’s the first in assuring that these [hospital] resources are not lost.”

State Department of Mental Health officials declined to comment Monday, saying they had not yet seen a written order from Karlton. Deputy Atty. Gen. Lisa Tillman, who argued in court against the mandatory raises, also declined to comment. The office of Gov. Arnold Schwarzenegger, which helped craft the plan that Karlton rejected as inadequate, could not be reached for comment.

But many staff members at the hospitals reacted with despair to the ruling, which does not apply to psychologists, psychiatric technicians, rehabilitation therapists, social workers and other clinicians who earn far less than their prison counterparts.

As the hearing wrapped up, dozens of staffers at hospitals in Atascadero, Norwalk, San Bernardino, Napa and Coalinga protested outside their facilities to decry deteriorating conditions.

“This is going to be incredibly demoralizing for other disciplines,” said Napa State Hospital psychologist Thomas Knoblauch, a 20-year veteran of the facility who said a number of psychologists have left for prison jobs in the last few months.

Eddie Collaso, a psychiatric technician at Norwalk’s Metropolitan State Hospital for 28 years and president of the hospital’s union chapter, said frontline staff members are exhausted from forced overtime shifts, and they face increasing safety issues and other problems.

“Enough is enough,” he said. “People are tired. If we don’t get what we deserve ... there is talk” that more people will be exiting.

Last month, responding to a slim proposal from the state, Karlton gave officials more time to produce a detailed plan to reverse the exodus. The version submitted last week was slightly more specific. Like the old plan, it pointed to some raises for existing staff already approved through next month and requested the Legislature to extend those raises through the next budget year.

The raises fall short of the prison pay rates.

It also set forth a schedule to hire 750 new staffers over the next budget year. But it did not specify what those new recruits would be paid or how the hospitals would succeed in attracting them.

The new plan describes a number of recruiting techniques that could be employed but goes on to note how each is limited or even problematic.

They include applying to a federal program that would repay the school loans of some clinicians, asking the state Personnel Board to streamline its process and accept less-qualified applicants and increasing the use of emergency contracts or freelance employees.

The four oldest of the five state hospitals have been operating under federal scrutiny since a federal consent judgment last year laid out vast problems with patient care and a detailed plan to correct them. The judgment calls for staffing levels far greater than now exist.

lee.romney@latimes.com

scott.gold@latimes.com