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California Prison Health Care System Plagued by Understaffing, Overtime

The rampant use of overtime to fill gaps in medical staffing in California’s prison system has resulted in windfalls for some of the state’s prison health care workers, fatigue for others, and lapses of judgment that endanger the health of prisoners entrusted to their care, according to a December 2009 investigative report by the Sacramento Bee.

The Bee’s investigation found that many prison health care employees average 12 hours a day, while others routinely log 16- to 18-hour shifts for months at a time. The impact of such extreme work schedules has both financial and clinical consequences.

A report from the independent, non-profit Institute of Medicine – the health arm of the National Academy of Sciences – found that prolonged wakefulness has the same effect on skills and judgment as being drunk. According to Charlene Harrington, a professor at the University of California San Francisco School of Nursing and co-author of the Institute of Medicine study, “Above eight hours a day, the errors [in medical judgment] start going up exponentially.”

Such errors include misdiagnoses, communication breakdowns and medication blunders, which contributed to nearly 300 “extreme departures from the community standard” of medical care in California prisons in 2007.

“Last year we had a couple of nurses who collapsed due to exhaustion,” admitted Orelene Sargenti, a licensed vocational nurse at the Deuel Vocational Institution. Asked what happens when health care workers are found sleeping on the job, a prison nursing director said, “We would wake them up.”

The Bee’s investigation found that prison health care staffing problems were the result of a state budget that routinely underestimated the need for doctors, nurses and other health care workers.
“The people who are writing the budgets aren’t acknowledging the reality,” stated J. Clark Kelso, the federal Receiver appointed to oversee health care in California state prisons (see this issue’s cover story).

Another contributing cause for the excessive hours worked by prison medical staff is California’s mandatory furlough program for state employees, which results in overtime to cover vacant – but necessary – positions. [See: PLN, June 2010, p.36]. Plus in some cases there has been outright fraud and corruption, such as the indictment of six doctors at Salinas Valley State Prison in November 2008 for falsifying time sheets. [See: PLN, Feb. 2009, p.29].

What is less clear from the Bee’s investigation is whether the negative effects of prison health care staffing problems outweigh the improvements made by the Receiver over the past several years – including greater access to medical care, better qualified physicians, upgraded clinics and new equipment.

One common measure of a prison health care system’s efficacy is the death rate. According to Dr. Dwight D. Wins-low, the Receiver’s acting chief executive for medical services, improvements by the Receiver’s office have led to a dramatic drop in prisoner deaths, which reached historic highs in 2006. Notwithstanding that rosy assessment, the current death rate in California prisons – 205 deaths per year for every 100,000 prisoners – is still 9 percent higher than the aver-age rate from 1996 to 2001, before intervention by the federal courts.

The Bee’s investigation found that prison nursing assistants logged the most overtime, averaging 1½ extra work weeks per month. About 95 percent of prison nurses worked overtime in 2008 – a higher proportion than the employees of any other state agency. Fifty-two nurses earned more than $187,535 in base pay plus over-time – that is, more than the salary of California’s Secretary of Corrections.

One registered nurse, Marie Punla, earned $300,000 (including benefits) by logging 93 hours a week at Corcoran State Prison – the equivalent of six 16-hour shifts a week. Even more astounding, Vanessa Avila, a medical assistant employed as a temp worker at the Deuel Vocational Institution, reportedly worked a time-clock-defying 26.5 hours a day, on average, according to her state pay records.

California’s prison system paid approximately $60 million in overtime to health care employees in 2008, plus another $111 million in overtime pay for guards to provide security for those workers during in-prison and off-site medical appointments.

Source: Sacramento Bee

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