California's prison health care employees work hard – or so it would seem by their schedules. Many average 12 hours a day; others routinely log 16- to 18-hour shifts for months on end, creating a costly overtime free-for-all in this budget-strapped state.
An abundance of forced and voluntary overtime has driven some nurses beyond human endurance. In the process, the long hours have opened the door for deadly lapses in a health care system just beginning to recover from decades of neglect.
"People who are pushing it to that level, working a ridiculous number of hours, usually crash," said Yolanda Esparza, a certified nursing assistant who works evenings and some nights at the California Institution for Women in Corona.
"I myself have witnessed people sleeping at their posts – heavily, snoring, full sleep. They don't even notice people walking by. It's pretty common," Esparza said.
Asked what happens when nurses are found sleeping on the job – a gross violation of prison rules – one prison nursing director said simply, "We would wake them up." Often, she said, the nurse is then sent back to work.
A Bee investigation found that lax recruitment, worsened by the state budget crisis, and programs such as one for the suicidal that's exploited by savvy inmates, have contributed to extreme staff work schedules. Correctional officials have tolerated the practice despite criticism about the price of prison health care, which cost more than $2.1 billion in the year ending in June 2008.
In 2006, a federal judge appointed a receiver to combat substandard medical care in California prisons. Clinics were upgraded, services added and wages boosted – usually well above rates paid in regular hospitals. Incompetent doctors and nurses were ousted, and many new clinicians were hired. Care improved.
Yet, three years into the expensive overhaul, California's prisons in 2008 spent $60 million on health care overtime. That doesn't count an additional $111 million in overtime for guards who protect on- and off-site health workers during medical appointments – more than double the amount being spent when the receiver took over.
Rampant overtime, mostly for nurses, is the norm in this state, accounting for nearly 20 percent of all wages for prison nursing care. Nursing assistants logged the most overtime, equivalent to 1 1/2 extra work weeks a month, followed by licensed vocational nurses and registered nurses.
In New York prisons, by contrast, nursing overtime accounted for just 10 percent of wages. As a result, New York prison nurses earned about $100 per inmate in overtime for the full year, compared with about $300 per inmate in California.
Hundreds of California's prison nurses pulled down salaries more commonly associated with bankers. Three physician assistants and 52 nurses earned more than the $187,535 salary of Matthew Cate, corrections secretary and overseer of the prison system. (Most prison doctors also made more than Cate, without overtime.)
Compared to other state departments, the prisons stood out.
About 95 percent of prison nurses worked overtime last year – a higher proportion than for employees of any other state department, including those known for extreme schedules, such as the Department of Forestry and Fire Protection, the California Highway Patrol and nurses in state mental institutions.
Even temporary employees, supplied by employment agencies called registries, have managed to cash in – earning millions of dollars in overtime paid at up to twice the normal wage.
Vanessa Avila, a registry medical assistant at Deuel Vocational Institution in Tracy, worked a schedule that, even by prison standards, was superhuman: 26.5 hours a day on average. At least that's what the state paid for her. Avila could not be reached for comment; her registry said its books indicate that she worked fewer hours than the state's payment log indicates.
Deuel topped $4.3 million in health care overtime last year – among the most for any prison and more than double the average for the California Department of Corrections and Rehabilitation. Officials suggested that Deuel's demands may be greater because it processes new inmates before they are sent to other prisons, and those newcomers often arrive sick. But San Quentin, another intake center, spent just $1.3 million on overtime, far below the state average.
Read the full story at the Sacramento Bee.