California prison jobs remain vacant despite high pay

from Kristen HuangCalMatters

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Despite spending hundreds of millions of dollars to fill vacant medical and mental health positions in prisons and state 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 facilities examined in the audit, as has the state’s reliance on expensive temporary workers. Atascadero State Hospital, Porterville Developmental Center and Salinas Valley State Prison had health-related vacancy rates exceeding 30 percent in fiscal year 2023-24. At Salinas Valley State Prison, more than 50 percent of healthcare positions were unfilled.

Workers say the high vacancy rate leads to more workplace assaults, mandatory overtime and staff turnover.

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

The vacancy rate has persisted despite targeted bonuses and salary increases that prison health workers received under contracts and court order during the Newsom administration. The ones included $42,000 bonuses for prison psychiatrists in contract from 2023 and later $20,000 in bonuses the state had to hand out benefits to mental health workers through a lengthy inmate rights lawsuit.

At face value, some government health workers are relatively well compensated. All 55 prison employees who earned more than $500,000 in income last year were doctors, dentists, psychiatrists or medical directors, according to data of the state administrator.

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

But in certain places, local hospitals offer even more. In Monterey County, hiring bonuses of $90,000 are common at private hospitals struggling to fill their own vacancies, state auditors said.

Despite the pay, the vacancy rate was highest among psychiatrists at Atascadero State Hospital and second highest at Porterville Development Center and Salinas Valley State Prison, auditors found.

All three facilities audited housed individuals who were incarcerated or institutionalized because they were deemed by the courts to be dangerous or unfit to stand trial. Federal and state law and court decisions require the state to provide adequate medical and mental health care. As a result, most of the facilities should have vacancy rates below 10%.

For the past 30 years, California has consistently failed to meet this standard.

None of the state departments that oversee the facilities took the necessary steps to ensure adequate staffing, the auditors wrote.

The audit found:

• The facilities had a “significant number of vacant positions” that were not filled by temporary workers or overtime staff.
• Neither the Department of State Hospitals nor the Department of Developmental Services, which houses some people with developmental disabilities in Porterville, had procedures in place to adequately estimate or budget for staffing needs annually.
• State hospitals and the Department of Developmental Services and the Department of Corrections and Rehabilitation do not have a process to determine whether facilities meet minimum staffing levels during each shift.

In a letter to lawmakers, California State Auditor Grant Parks wrote that the state should conduct a statewide health care recruitment campaign “due to decades of difficulty that facilities have had in filling vacant health care positions and the current and projected shortage of health care professionals.”

In response to the audit, development services and government hospital departments partially agreed with the findings in detailed comments.

However, the Ministry of Public Hospitals wrote that the vacancy rate covered during the audit period was significantly affected by the COVID-19 pandemic and that the salary savings were overstated. “Our hospitals regularly meet or exceed the mandated minimum staffing and have self-reported rare cases where they have not due to extraordinary 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 for inmates while ensuring fiscal responsibility.”

Workers say the state is wasting money to fill vacancies

Coby Pizzotti, a lobbyist for the California Association of Psychiatric Technicians, which represents about 6,000 mental health clinicians, said the audit confirms what many state worker unions have suspected: The state has consistently refused to significantly improve wages, benefits and working conditions for employees while spending money on temporary workers. Unions say this makes the job vacancy problem worse.

“Effectively, it’s a workforce of shadow civil servants. They’re just not called civil servants,” Pizzotti said.

The departments saved $592 million in wages over six years by keeping the vacancies, the auditors wrote. But auditors criticized state departments for failing to track specifically how they later spent that money. The departments counter that generally the money can be used to offset other costs or can be returned to the state.

But they also poured money into temporary positions to meet court-mandated minimums. During the six-year audit period, the state spent $239 million on contract workers to fill vacancies. Departments were authorized to spend more than $1 billion on temporary workers during that period, although they used only a fraction of the money, according to the audit.

Contract workers, though they make up less than 10 percent of the health care workforce, are paid so highly that they cost more per hour than state employees even after benefits are accounted for, the auditors also found.

State worker unions say it’s further evidence to their argument that these agreements don’t save the state money.

“Bargaining is not a great way to do business. It’s expensive,” said Doug Chiappetta, executive director of the Psychiatric Association.

Instead, public health worker unions want the state to increase wages and benefits to make permanent positions more attractive to applicants, rather than spending them on high-paid contract workers.

The Psychiatric Technicians Union, the Psychiatrists Union and the State Nurses Union said contract workers are paid two to three times more per hour than state employees, according to agency job postings they collected. These companies are also able to offer generous benefits and schedule flexibility that government jobs don’t have.

“It was a slap in the face for us to see the state not looking out for our nurses,” said Vanessa Sistrong, president of Bargaining Unit 17 for SEIU Local 1000, which represents about 5,100 registered nurses. “You’re standing next to a nurse who does less work than you and gets paid more than you. How does that boost morale?”

Greater recruitment issues

Even relying on temporary contract staff, the state in many cases still fails to maintain minimum staffing levels for health posts.

The vacancy rate increased significantly between 2019 and 2024. At Salinas Valley State Prison, vacancies jumped 62% during the audit period, and more than half of mental health and medical positions were vacant in the 2023-24 fiscal year.

Atascadero State Hospital’s vacancy rate rose 39% during the audit period for a total vacancy rate of about 30%. In the last three years of the audit period, Atascadero also lost 90% of its staff due to attrition.

Porterville Developmental Center’s vacancy rate increased only 6 percent during the audit period, but more than a third of its positions remained unfilled in the most recent audit year.

In interviews with auditors, facility administrators said the COVID-19 pandemic has caused greater staff turnover as well as an increased reliance on contract workers to fill gaps.

All three facilities, which are located on the Central Coast or in the Central Valley, face additional barriers to recruitment.

These areas suffer from a shortage of health professionals. The coastal area, home to Atascadero State Hospital and Salinas Valley State Prison, faces a moderate shortage of behavioral health workers, while Porterville Developmental Center is in a severe shortage area, according to Department of Access to Health Care and Information.

“Places like the Central Valley have significantly fewer mental health professionals per population than the rest of the state,” said Janet Coffman, a professor at UCSF’s Institute for Health Policy Research who studies workforce issues. “Especially for Porterville, that’s a big part of the problem.”

At the same time, demand for mental health services has increased among the general population, Coffman said.

Taken together, this makes it difficult for the state to compete with the private sector, which is also struggling to hire health workers.

Other barriers are difficult to overcome with money alone. The patient population can make the job dangerous. Staff are often verbally or physically assaulted. Uncertain conditions make it difficult to hire new workers and sometimes cause long-time workers to retire early.

“There were 2,700 assaults on staff last year. It’s not a matter of if, it’s a matter of when,” Pizzotti said.

The audit recommends the state conduct a market analysis of all health care positions to determine whether pay is competitive, streamline the hiring process and conduct a statewide recruitment drive.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.