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California Prison Psychiatrists Reap Rewards from State Bidding War

Following a competitive bidding war between California state mental hospitals and state prisons, both seeking psychiatrists to treat their mentally ill patients, the prison system has emerged as the winner – largely due to a federal court order to improve prisoner mental health care. However, the term “winner” is misleading because it is both patients at understaffed state mental hospitals and California taxpayers who turned out to be the losers.

The federal district court in the long-running Coleman case [Coleman v. Schwarzenegger, U.S.D.C. (E.D. Cal.), Case No. CIV S-90-0520 LKK JFM P] found that a major cause of understaffing at California prison mental health facilities – understaffing that was tied to excessive and preventable prisoner deaths – was the inadequate wages offered under then-existent state pay schedules, which made it hard to attract qualified psychiatrists.

There was not a long line at the unemployment office in California for out-of-work psychiatrists, however, so the California Department of Corrections and Rehabilitation (CDCR) had to try to entice such gainfully employed professionals away from their comfortable city offices where clients were able to walk in, to stark prison environments where their patients were violent criminals. In December 2006 the district court ordered the state to boost the wages for prison psychiatrists, which jumped from a monthly base pay of $13,311 to $24,267 for chief psychiatrists – an 82% increase. State mental hospitals were not included in the order.

Consequently, the CDCR wound up offering prison psychiatrists higher wages than psychiatrists employed in state mental hospitals – causing the latter to jump ship from hospitals to prisons to partake of the increased salaries. Predictably, this had a devastating effect on staffing levels in state mental hospitals. In fact, at least two patient suicides were linked to the vastly increased patient-to-staff ratios at the hospitals; one of those deaths resulted in a lawsuit and a $975,000 settlement with the state.

“Our pay was low and we were losing docs rather than gaining physicians,” said Michael Lisiak, a psychiatrist at Atascadero State Hospital. By early 2007, Atascadero had a 70 percent vacancy rate for psychiatrists and a 100-to-1 patient-to-psychiatrist ratio.

In June 2007 the district court ordered additional pay raises for psychiatrists at state mental hospitals, boosting their median annual pay to $251,060 by the following year.
The pay increases “stopped the migration of psychiatrists from mental health to the prison system,” said Stephen Mayberg, former head of California’s mental health department.
“We tried to make sure the systems weren’t competitive with each other after that.”

But the damage – in terms of significantly increased salaries for prison psychiatrists – had already been done. Merely boosting wages to get more psychiatrists on prison payrolls didn’t fulfill all of the CDCR’s court-ordered needs. Some psychiatrists remained on duty for extended hours; many were on-call on nights and weekends – all for extra pay, at increased wage levels due to the bidding war between state mental hospitals and CDCR facilities.

The highest-paid state prison psychiatrist is Dr. Mohammad Safi, 54, an Afghanistan-trained doctor who received $822,302 in 2011 (five times Governor Jerry Brown’s salary). On top of his regular wages of $273,950, Safi earned $548,352 in extra-duty pay, including for being on-call, and worked 3,990 additional hours as the “medical officer of the day” at Salinas Valley State Prison in Soledad. This represents average work days of almost 17 hours.

“I made so much because I work a lot,” Dr. Safi stated.

Such extreme work hours led Michael Bien, an attorney representing the prisoner plaintiffs in the Coleman class-action lawsuit, to question the quality of the CDCR’s mental health services, considering the obvious fatigue factor. “At some point someone becomes ineffective,” Bien noted. “You have to wonder if someone is watching quality.
Who is managing Dr. Safi to make sure he’s actually functioning well enough?”

Stuart Bussey, president of the Union of American Physicians and Dentists, which represents California’s psychiatrists, responded that he didn’t believe prison doctors are necessarily fatigued from working the extra hours.

“They’re not clinic hours,” he said. “You’re not working the same intensity as you would during regular clinic days, and I don’t think there’s a fatigue issue.” Normally, people need 7-8 hours of sleep each night. Bussey offered no explanation for why prison psychiatrists were somehow immune from fatigue caused by lack of sufficient sleep.

Dr. Safi’s situation, while extreme, is not unique. Husband-and-wife psychiatrists Joginder Singh and Mohinder Kaur earned a total of $4.7 million from 2005 through 2011, according to state records. Dr. Singh said he retired from a state mental hospital in Napa in 2006, only to return the next year to Coalinga State Hospital, where he was appointed medical director, due to higher pay after the federal district court ordered increased wages for prison psychiatrists. Coalinga houses civilly committed sex offenders and sexually violent predators.

According to state pay records, excluding Dr. Safi, 29 other prison psychiatrists earned wages ranging from $320,797 to $476,156 in 2011, including overtime and on-call time.

But David O’Brien, a spokesman for the California Department of State Hospitals, said that relying on the state’s currently-employed psychiatrists rather than hiring outside contractors is a cost-effective approach. A mid-step California staff psychiatrist makes about $123 an hour, for example, whereas a contract doctor is paid up to $180 per hour.

California union president Bussey said the state pays more for its psychiatrists because it’s more focused on controlling contractor costs and because California is a more expensive place to live. Also, a shortage of psychiatrists nationally has contributed to increased salaries, he noted.

Still, the wages earned by California prison psychiatrists such as Safi, Singh and Kaur are exceedingly high. In Dr. Safi’s case, his record 2011 pay drew the scrutiny of state officials, who suspended him in July 2012. His attorney, Ed-ward Caden, said his client was a “scapegoat” for staffing problems that the state had itself created. Safi is “being investigated for his use of time,” according to Kathy Gaither, chief deputy director of the state’s hospitals.

Pending the outcome of the investigation, he remained on paid leave.

Sources: Bloomberg News, www.dailynews.com, Los Angeles Times, www.gcc.sco.ca.gov, Mercury News

 

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