ATASCADERO — Court orders mandating drastic pay increases for health personnel in California prisons have led to an exodus of workers from state mental hospitals and left the facilities struggling to provide adequate patient care.
Staff shortages at Atascadero State Hospital, where psychiatrist vacancies stand at 70%, have caused the facility to all but freeze new admissions.
All the state's mental hospitals, which like the prisons are also under federal scrutiny, report staff departures for prison jobs that now pay about 40% more. And they fear that many more staffers will leave.
At Patton State Hospital in San Bernardino, the medical staff chief pleaded with the federal court-appointed monitor in a December letter, saying a mass exodus of Department of Mental Health "psychiatrists and physicians is expected, and we are already seeing the start of it affecting our institution. Recruiting new people has become increasingly difficult."
In order to keep Napa State Hospital licensed, the state had to hire contract pharmacists after many fled for higher-paying prison jobs. Workers at Metropolitan State Hospital in Norwalk now refer to the facility as "the Titanic" as psychologists apply in droves for prison system jobs. Recruiting e-mails featuring a photo of happy correctional staff members were sent directly to hospital psychologists this month, noting that 1,000 positions must be filled at the new pay rates.
But nowhere is the crisis as pronounced as at Atascadero, which treats California's most seriously mentally ill jail inmates, prisoners and parolees who cannot safely be released to the streets. The admissions freeze at Atascadero has left California prisons, which have long relied on the hospital to stabilize their most severely mentally ill inmates, scrambling to find acute care beds within the prison system.
Atascadero State Hospital Executive Director Mel Hunter said closing the door to most new patients was his only option.
"We had to limit the number of admissions in order to maintain the treatment, safety and security of the 1,230 patients we already had in treatment," he said.
The last straw came Jan. 17, when three psychiatrists left for prison jobs -- swelling the number of psychiatrist departures over the last year to 10. The next morning, Atascadero Medical Director David Fennell told Hunter that the facility could not continue admitting the eight to 12 new patients a day it usually handled.
Hospital officials quickly spread the word to prisons across the state, but some inmates were already en route: Three severely mentally ill prisoners from Chino's California Institution for Men arrived at the hospital gates late in the day after a 250-mile drive, only to be turned back.
Since then, 50 more patients have been denied admission, forcing prisons to hold on to sick inmates.
Parolees who are too ill and dangerous to be released to the streets are still being accepted at Atascadero, Hunter said, along with a handful of other extremely ill patients. And the hospital has been cleared by the Department of Mental Health to hire psychiatrists under short-term contracts as soon as possible.
"We are anxious to get our staffing back up to some adequate numbers so we can honor our commitments to the Department of Corrections," he said.
The unprecedented restrictions come at a critical time for both the prison and the state mental health bureaucracies, which are closely intertwined. Although several of the state hospitals still accept patients committed through the civil courts, the vast majority of mental hospital patients statewide now are channeled through the criminal justice system.
Abysmal medical and mental-health care in the state's prisons prompted federal overseers in two separate lawsuits to order the soaring pay increases as a way of luring competent clinicians to the California Department of Corrections and Rehabilitation.
The first order, which applied to medical care, triggered a mass departure of nurses last year from the state hospital system. (Department of Mental Health raises helped slow that flow somewhat but did not match the prison salaries.) The most recent order -- pertaining to mental health clinicians in the prisons -- took effect this month.
The departures come at a time when the Department of Mental Health is also struggling to satisfy federal regulators.
In May 2006, the U.S. Department of Justice filed suit against the 5,000-patient mental hospital system for faulty patient care. A 90-page consent decree spells out required improvements, including an increase in staff.
The departures are draining experience and numbers from the hospitals at a time when morale was already plummeting.
At Atascadero, high Central Coast housing costs have long made recruitment difficult, and a spike in assaults on staff in the last few years had contributed to departures even before the prison raises kicked in.