A guard tower at the California Health Care Facility prison in Stockton on March 2, 2022. Miguel Gutierrez Jr., CalMatters

Some of California’s highest-paid public employees are in an intensifying labor battle with the Newsom administration over staffing shortages at state prisons and hospitals that workers say endanger patients and staff.

The union representing doctors and psychiatrists working in California correctional facilities said that 91% of voting members authorized a strike Monday. Non-competitive salaries, strenuous working conditions and an overreliance on higher-paid contracted doctors, make it difficult to hire staff physicians, said Dr. Stuart Bussey, president of the umbrella Union of American Physicians and Dentists.

“We’d like to settle this thing without (striking), but our members are prepared to act,” Bussey said.

A strike authorization does not mean workers will not show up to work, although it could lead to a strike. Negotiations began in March, and the union’s contract expired July 1. The state and its physicians remain “very far apart,” Bussey said.

The California Department of Human Resources told CalMatters it “does not comment on ongoing negotiations.”

The biggest sticking point is salaries. Though doctors and psychiatrists pull down between $285,000 and $343,000 annually, according to California Correctional Health Care Services, temporary contracted workers make twice as much, said Dr. Nader Wassef, psychiatrist and chief of staff at Napa State Hospital.

“I am not going to claim poverty. What I’m trying to say is if we plan on getting trained, qualified psychiatrists to treat these patients, we are not going to get any because we are not competitive,” Wassef said.

The vacancy rate among on-site psychiatrists exceeded 50% in June, according to court documents filed by the state in an ongoing lawsuit over prison conditions and prisoner safety. Among all psychiatrists, including telehealth providers, the vacancy rate was 35%.

More than 20% of primary care doctor positions are vacant, California Correctional Health Care Services told CalMatters in an unsigned statement Tuesday. The agency did not respond to questions about contractor pay.

Labor strife during budget crunch

The strike authorization comes as the Newsom administration faces a battery of difficult contract negotiations, all in the midst of a $31 billion budget deficit.

Increasingly, state workers say salaries don’t cover basic needs with inflation and the cost of housing cutting deeply into paychecks. In July, contracts expired for the state’s two largest unions — SEIU Local 1000 and the California Correctional Peace Officers Association. They represent more than 125,000 workers, and SEIU is demanding double-digit raises. The union representing state scientists is also demanding salary increases commensurate with privately employed peers.

The state is offering the prison doctors’ union a 2% raise for each of the next three years, which members say will not be enough to help with recruiting and retaining doctors. The union wants at least a 15% raise in the first year of the new contract.

The prison doctor’s union is small, representing roughly 1,300 employees, but it is the “linchpin of California’s correctional medical system,” Bussey said. Doctors are responsible for assessing patients daily, writing prescriptions, overseeing drug treatment, providing behavioral and mental health interventions and giving court testimony.

Wassef, who has worked at Napa State Hospital for 13 years, said working in a correctional medical facility is more challenging than working in a typical hospital.

“Our patients are really very sick. I have patients that have been in the hospital 20 or 30 years,” Wassef said. “They become violent, some are in restraints… The patient population puts higher demand than what is in the community hospital.”

Wassef said his hospital has not been fully staffed since 2014. It has a 45% vacancy with 12 open positions.

Contract prison doctors paid more

Ten of those positions at Napa are filled by temporary contractors who are paid twice the hourly rate of staff doctors.

Bussey said the comparatively low take-home pay shows the state knows what a competitive salary looks like and has the money to foot the bill. The state spends approximately $100 million per year on contracted physicians, he said. Contractors do not get the benefits and pensions state workers do, but the pay differential makes it easy for staff members to quit and return as higher-paid contractors, Wassef said.

He said five psychiatrists recently quit staff jobs at Metropolitan State Hospital in Norwalk to work as contracting physicians instead.

The physician shortage in prisons also makes it difficult for the state to meet court-imposed staffing mandates that have been in place in state prisons for more than two decades.

In March, a U.S District Court judge for California’s Eastern District issued the state a $1,000 per day fine for failing to implement appropriate suicide prevention measures in state prisons over the past eight years, including reducing the psychiatrist and case manager vacancy rate to 10% or below. That 10% benchmark was originally set by a judge in 2002. More than one-third of state prisoners have serious mental health disorders, according to court documents.

“Faced with the persistently high population of mentally ill incarcerated persons, the state has failed to staff its prisons with the number of mental health professionals required to provide class members constitutionally adequate care,” Chief U.S. District Judge Kimberly Mueller wrote in the order.


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