The Brief

Despite spending hundreds of millions of dollars to fill vacant medical and mental health positions at prisons and state hospitals, California has little to show for it, according to a new report from the state auditor.

Job vacancy rates have increased since 2019 at the three facilities examined in the audit, as has the state’s reliance on pricey temporary workers. Atascadero State Hospital, Porterville Developmental Center and Salinas Valley State Prison had health-related vacancy rates topping 30% during fiscal year 2023-24. At Salinas Valley State Prison more than 50% of health positions were unfilled.

Workers contend that the high vacancy rate leads to more on-the-job assaults, mandatory overtime and staff turnover.

“A high vacancy rate is a self-fulfilling prophecy,” said Dr. Stuart Bussey, president of the Union of American Physicians and Dentists, which represents about 1,300 state psychiatrists.

The vacancy rates persisted despite targeted bonuses and wage increases that prison health workers received in contracts and under court order during the Newsom administration. Those included $42,000 bonuses for prison psychiatrists in a 2023 contract and more recently $20,000 bonuses the state had to dole out to mental health workers through a long-running prisoner rights lawsuit.

At face value, some state health workers are comparatively well-compensated. All of the 55 prison employees who earned more than $500,000 in income last year were doctors, dentists, psychiatrists or medical executives, according to state controller data.

A board-certified psychiatrist at Atascadero State Hospital — some of the highest paid state employees — can earn more than $397,000 in base pay. They also retire with pensions through the California Public Employees’ Retirement System. In comparison, the mean wage for a psychiatrist in California is $328,560, according to the U.S. Bureau of Labor Statistics.

But in certain places, local hospitals are offering even more. In Monterey County, $90,000 hiring bonuses are common at private hospitals struggling to fill their own vacancies, staff told state auditors.

Despite the pay, vacancy rates were highest among psychiatrists at Atascadero State Hospital and second highest at Porterville Developmental Center and Salinas Valley State Prison, auditors found.

All three of the audited facilities house individuals who are either incarcerated or institutionalized because they were deemed by the courts to be dangerous or unfit to stand trial. Federal and state law as well as court rulings require the state to provide adequate medical and mental health care. As a result, most of the facilities are required to have vacancy rates less than 10%.

Over the past 30 years, California has consistently failed to meet that standard.

None of the state departments overseeing the facilities have taken necessary steps to ensure adequate staffing, auditors wrote.

The audit found:

• The facilities had a “significant number of vacant positions” that were not filled by temporary workers or staff overtime.
• Neither the Department of State Hospitals nor the Department of Developmental Services, which houses some people with developmental disabilities in Porterville, had procedures to adequately evaluate or budget for staffing needs annually.
• The state hospitals and developmental services departments as well as the Department of Corrections and Rehabilitation have no process to determine whether facilities are meeting staffing minimums during each shift.

In a letter to lawmakers, California State Auditor Grant Parks wrote that the state should conduct a statewide recruitment campaign to hire health care workers “because of the decades-long difficulties the facilities have had in filling vacant health care positions and a current and projected health care professional shortage.”

In response to the audit, the developmental services and state hospitals departments partially agreed with the findings in detailed comments.

The Department of State Hospitals, however, wrote that the vacancy rates covered during the audit period were significantly affected by the COVID-19 pandemic and that salary savings were overstated. “Our hospitals regularly meet or exceed mandated staffing minimums and have self-reported rare occurrences where they have not due to extraordinary circumstances,” department spokesperson Ralph Montano said, in an email to CalMatters. The department has agreed to implement many of the recommendations made in the report, Montano added.

In a statement, the corrections department said it was “committed to providing adequate health care for the incarcerated population, while ensuring fiscal responsibility.”

Workers claim state wastes money to fill vacancies

Coby Pizzotti, a lobbyist for the California Association of Psychiatric Technicians, which represents about 6,000 mental health clinicians, said the audit confirmed what many of the state worker unions had suspected: The state has continually refused to meaningfully improve wages, benefits and working conditions for employees, while spending money on temporary workers. This, the unions contend, makes the vacancy problem worse.

“Effectively, it’s a shadow state employee workforce. They’re just not called civil servants,” Pizzotti said.

The departments saved $592 million in payroll over six years by carrying the vacancies, the auditors wrote. But, auditors criticized the state departments for their inability to specifically track how they later spent that money. The departments counter that, generally, the money can be used to offset other costs or it can be given back to the state.

But they have also poured money into temporary positions to meet court-mandated minimums. During the six-year audit period, the state spent $239 million on contract workers to fill staff vacancies. The departments were authorized to spend more than $1 billion on temporary workers during that time period, though they used only a fraction of the money, according to the audit.

Contract workers, while making up less than 10% of the health care workforce, are paid so much that they cost more per hour than state workers even after accounting for benefits, auditors also found.

State workers’ unions say that’s more evidence toward their argument that these arrangements don’t save the state money.

“Contracting out is not a great way to do business. It’s expensive,” said Doug Chiappetta, executive director of the psychiatrists union.

Instead, state health worker unions want the state to increase salaries and benefits, to make permanent positions more attractive to candidates rather than spending it on highly paid contract workers.

The psychiatric technicians union, psychiatrists union and the state nurses union said that contract workers get paid two to three times more per hour than state employees, according to job advertisements from contracting agencies they have collected. Those companies are also able to offer generous benefits and scheduling flexibility that state jobs don’t have.

“It’s been a slap to our faces to see how the state doesn’t care for our nurses,” said Vanessa Seastrong, chair of Bargaining Unit 17 for SEIU Local 1000, which represents about 5,100 registered nurses. “You’re standing next to a nurse that is doing less work than you and getting paid more than you. How does that bring up morale?”

Bigger problems for recruitment

Even relying on temporary contract workers, the state has in many cases still failed to maintain staffing minimums for health care positions.

Vacancy rates increased significantly between 2019 and 2024. Salinas Valley State Prison saw vacancies jump 62% during the audit period, and more than half of mental health and medical positions were unfilled during fiscal year 2023-24.

Atascadero State Hospital’s vacancy rate rose 39% over the audit period for a total vacancy rate of about 30%. During the last three years of the audit period, Atascadero also lost 90% of its staff to attrition.

Porterville Developmental Center’s vacancy rate increased by just 6% over the audit period, but more than a third of its positions remained unfilled in the final year of the audit.

In interviews with auditors, administrators at the facilities said that the COVID-19 pandemic caused higher staff turnover as well as an increased reliance on contract workers to fill gaps.

All three facilities, which are located along the Central Coast or in the Central Valley, face additional barriers to recruitment.

These areas suffer from health care professional shortages. The area along the coast where Atascadero State Hospital and Salinas Valley State Prison are located faces a medium shortage of behavioral health workers, while Porterville Developmental Center is in an area with a severe shortage, according to the Department of Health Care Access and Information.

“Places like the Central Valley have substantially fewer mental health professionals per population than compared to the rest of the state,” said Janet Coffman, a professor at UCSF’s Institute for Health Policy Studies who studies workforce issues. “Particularly for Porterville, that’s a big part of the issue.”

At the same time, demand for mental health services has increased in the general population, Coffman said.

Combined, that makes it more difficult for the state to compete with the private sector, which is also struggling to hire health care workers.

Other barriers are difficult to address with money alone. The patient population can make the work dangerous. Staff are frequently verbally or physically assaulted. Unsafe conditions make it harder to recruit new workers and sometimes cause long-time workers to retire early.

“There were 2,700 assaults on staff last year. It’s not a matter of if, it’s when,” Pizzoti said.

The audit recommended that the state conduct a market analysis of all health care positions to determine whether payment was competitive, streamline the hiring process, and conduct a statewide recruitment campaign.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

Hop onto TikTok and you'll find lots of videos of young people — mostly women — fake baking under the glowing UV lights of a tanning bed. Seattle dermatologist Heather Rogers says this is an alarming trend that comes after years of decline in indoor tanning in the U.S.

She points to a 2025 survey from the American Academy of Dermatology which found 20% of Gen Z respondents prioritize getting a tan over protecting their skin. And 25% say it's worth looking great now even if it means looking worse later.

They feel like "it's better to be tan than it is to worry about skin cancer," Rogers says.

A new study in the journal Science Advances reinforces just why they should worry.

Researchers found that tanning bed users were nearly three times as likely to develop melanoma — the deadliest form of skin cancer — compared to people who'd never tanned indoors. They also had DNA damage that can lead to melanoma across nearly the entire surface of the skin.

"Even in skin cells that look normal, in tanning bed patients, you can find those precursor mutations" that lead to melanoma, says Dr. Pedram Gerami, one of the study's authors and the IDP Foundation professor of skin cancer research at Northwestern University.

Gerami and his collaborators compared the medical records of nearly 3,000 patients who used tanning beds to an age-matched control group of patients who didn't tan indoors. They found that the more people used the tanning beds, the higher their risk of melanoma.

"If they had 10 to 50 tanning bed exposures, their risk was twice as high as the control group," Gerami says. If they had over 200 tanning bed visits, their risk was more than eight times as high.

"If you think about it, getting 200 tanning bed exposures can happen really quickly. If you go once a week for four years, there you are," he says.

The researchers also performed genetic sequencing on normal skin cells from tanning bed users. Most were younger women, which makes sense, because studies have shown that young women in their teens and 20s are the heaviest users of indoor tanning, says study co-author Hunter Shain, an associate professor of dermatology at the UC San Francisco.

Shain says when the researchers compared these skin samples to normal skin cells from people in the general population who were twice the age of the indoor tanners, they were "stunned" by what they found.

"Women in their 30s and 40s had more mutations than people in their 70s and 80s from the general population," says Shain, whose research focuses on the biology of skin cancer. "They somehow were able to cram in two lifetimes' worth of UV damage in 30 years."

Dr. Heather Rogers, who was not involved in the study, notes that tanning beds can emit ultraviolet radiation that is 10 to 15 times stronger than what you'd get from the sun. She says that tanning beds are often marketed as being safer than the sun, but this study shows how wrong those claims are.

Dr. Pedram Gerami says many of the patients he sees at a high-risk melanoma clinic are women who started indoor tanning as teens wanting to look better for events like homecoming and prom.

"Now, as young adults, they're having to deal with frequent skin checks, frequent doctor visits, frequent biopsies, lots of anxiety, and the emotional burden of having been diagnosed with cancer at a young age," Garami says. "So they have a lot of heaviness to deal with."

He says some of these patients chose to donate skin samples to the study in hopes of helping other young people avoid the same fate.

Copyright 2025 NPR

Nearly every pop music holiday song written in the past 80 years owes at least some of its DNA to one Christmas tune in particular: "White Christmas," written by Irving Berlin and sung by Bing Crosby, which he first recorded in 1942.

It's reportedly still one of the best-selling songs of all time in any genre, though chart data from decades ago is unreliable. Even given that murkiness, the Guinness Book of World Records named it as the best-selling physical single of all time in 2012.

"White Christmas" wrote the formula for modern secular holiday songs — despite its complex and troubling history.

Songwriter Irving Berlin wasn't destined to be a Yuletide magic maker. He was born Israel Baline in Siberia to an Orthodox Jewish family; his father was a cantor turned kosher butcher. But Berlin embraced assimilation — he married an Irish Catholic woman and had Christmas trees in his house. Even so, for Berlin, Christmas was a holiday shadowed by personal tragedy.

"On Christmas Day, 1928, his only son died. He always told members of his family that he disliked Christmas for this reason, that he could never, never get past the sadness that he experienced on Christmas Day," said author and New York Times contributing writer Jody Rosen, who wrote a book called White Christmas: The Story of an American Song.

The infant Irving Berlin Jr. died suddenly, less than a month after he was born. And at its heart, "White Christmas" is a deeply melancholic song.

Most Christmas carols and pop songs were unabashedly joyful. Berlin's song represented a turn, Rosen said: "It was strange to have a song that was all about this nose-pressed-up-to-the-glass feeling."

It also set a certain standard for Christmas songs that are about nostalgia, about some lost Christmas past. (Think, for example, of another enduring hit that came shortly after Berlin's smash: "Have Yourself A Merry Little Christmas," which Judy Garland sang in the 1944 film Meet Me in St. Louis, and which was written by Hugh Martin and Ralph Blane.)

But there's other stuff going on too. Irving Berlin was a hit machine as a Tin Pan Alley and Broadway songwriter. As a New Yorker and an immigrant himself, he was intimately familiar with a particular genre of songs, Rosen said: "That tradition of so-called 'home songs,' you know, songs that pine for a lost place, a lost ideal. These songs are so huge because we have an immigrant population, lots of people who've done a lot of moving. So there were songs about Irish people longing for Ireland and Italians longing for the old country there."

He said Berlin took that genre and flipped it into a Christmas song.

That's especially true of a largely forgotten, tongue-in-cheek introductory verse Berlin originally wrote for "White Christmas." The narrator is a New Yorker stuck in California (as Berlin frequently was, churning out songs for Hollywood): "The sun is shining, the grass is green, the orange and palm trees sway ... but it's December the 24th, and I am longing to be up north!" the protagonist sings.

Rosen said most people listening to "White Christmas" are missing additional subtext. He said that much of that nostalgic vibe in "White Christmas" — all that longing for a pristine, innocent Christmas of yore — is a reference to explicitly racist minstrel songs like Stephen Foster's "Old Kentucky Home," sung by Al Jolson and others — music that was still a staple in Berlin's day.

Foster was inspired by the Harriet Beecher Stowe novel Uncle Tom's Cabin and the song, hailed by Frederick Douglass and Paul Robeson, was meant to be empathetic to the abolitionist cause — the narrator is longing to be reunited with his wife and children, but their family has been torn apart by slaveholders. It later became a popular tune at minstrel shows, with its saddest lines omitted and its meaning twisted.

In "Old Kentucky Home," Rosen said, "You have, grotesquely, the freed Black man longing for life back below the Mason-Dixon line, back on the plantation. Here, instead of a Black man in the north longing for the sultry south, we have a well-to-do white person longing for the wintry north."

But the racial dynamics of "White Christmas" aren't just a matter of subtle references to older songs. Irving Berlin had great commercial expectations for "White Christmas." He built a whole movie around it: 1942's Holiday Inn, starring Bing Crosby and Fred Astaire.

Holiday Inn is stuffed with racist stereotypes and an entire blackface number. (That scene is usually excised from TV broadcasts today, but the whole film is available to stream online.) As Crosby and his love interest, played by Marjorie Reynolds, prepare to perform a song about Abraham Lincoln, Crosby spreads greasepaint on her face, as the orchestra plays "White Christmas" underneath. Not only is "White Christmas" the movie's biggest hit, it's also the film's romantic theme.

Blackface on stage and on screen was very much a recent memory for 1940s audiences, said scholar Brynn Shiovitz. She's the author of the book Behind the Screen: Tap Dance, Race, and Invisibility During Hollywood's Golden Age.

In Holiday Inn, Shiovitz said, "We get a pairing of nostalgia for Christmas, but also nostalgia for blackface, because so many of the people that were watching Holiday Inn when it premiered in the theaters grew up watching vaudeville, grew up watching their parents maybe even perform in blackface."

Audiences loved the song "White Christmas" and its spotlight in Holiday Inn — and American GIs stationed abroad during World War II clamored for the Armed Forces Radio Service to play the song. "White Christmas" was so sturdily successful that Hollywood made another movie centering the song in 1954 — also called White Christmas — this time starring Bing Crosby, Danny Kaye, Rosemary Clooney and Vera-Ellen.

Since then, legions of musicians have recorded their own versions of "White Christmas" — including The Drifters, Elvis Presley, Iggy Pop and Sabrina Carpenter. And of course, each generation adds new layers of meaning to the song as it is stitched into our holiday season each year, said Shiovitz.

"With all of these other memories that people have of Christmas, whether it's being piped in while you're shopping, or it's playing on the radio in the car as you're driving to visit family — it's easy to kind of separate it from its history. People develop new memories with it. People have their own ideas of what the song represents, so it's just incredibly complex," Shiovitz said.

Today's audiences and artists don't necessarily hear or even know about the song's racist history, Shiovitz said — but that doesn't mean it's not there.
This story was edited for radio and digital by Jennifer Vanasco.
Copyright 2025 NPR

From Los Angeles to Sacramento, teachers unions, many fueled by the “We Can’t Wait” campaign organized by the California Teachers Association and a slew of contract renewals, are rallying for higher pay, better benefits, smaller class sizes and other classroom improvements. Some are threatening to strike.

In the West Contra Costa Unified School District, the call for improved pay and benefits, and classroom improvements, resulted in a six-day strike by the district’s 1,450 teachers that ended earlier this month. The teachers won an 8% pay raise over two years and will no longer have to pay healthcare premiums.

The strike is emboldening other teachers unions that are at an impasse with their districts over contract negotiations.

“We are leading a historic wave of resistance to demand safe staffing, affordable healthcare and student-centered budgets, and local chapters are organizing to strike if needed,” said David Goldberg, president of the California Teachers Association. “Richmond showed us exactly what is possible: When we stand up for what schools educators and students deserve, we can transform public education.”

There are at least 14 school districts around the state that are at an impasse with teachers unions over contract negotiations. They are: Los Angeles Unified, San Francisco Unified, Oakland Unified, Berkeley Unified, Madera Unified, Evergreen School District, Little Lake City, Upper Lake Unified, Duarte Unified, Newport-Mesa Unified, Oak Grove Union, Apple Valley Unified, Twin Rivers Unified and Natomas Unified.

CTA campaign ratchets up the pressure

Most of these districts’ unions are part of the CTA’s “We Can’t Wait” campaign, which has spent the past few years aligning contracts to end on the same date in order to add pressure on districts in areas where multiple unions would be negotiating and could potentially strike at once.

The campaign has also shared demands for smaller class sizes and caseloads for special education educators, and more counselors, nurses and mental health professionals in schools, as well as competitive wages and benefits to retain and recruit teachers.

“It is our belief that we’ve been siloed,” said Brittoni Ward, president of Twin Rivers United Educators in Sacramento County. “Unified districts all over the state have been dragging themselves year after year through contract bargaining that gets us nowhere. We don’t make any progress, and we all essentially are fighting for the same things. So why not unify on our common goals and make change happen.”

School districts are largely pushing back on union demands, saying that with declining enrollment and rising costs, there isn’t enough money to pay teachers more. Teachers disagree, pointing to expensive outside contracts, high administrative salaries and ample reserves in some districts.

Now, teachers in several districts, including San Francisco Unified, Natomas Unified, Twin Rivers Unified, Madera Unified and Upper Lake Unified, have indicated — by vote or informal survey — that a majority are ready to strike.

Will L.A. teachers strike again?

United Teachers Los Angeles plans a strike vote in January and has already begun polling teachers to determine if there is interest. A strike in the Los Angeles Unified School District would affect 516,000 students.

There is precedent. UTLA took to the picket lines twice in recent years — in 2019, when they went on strike for six days for higher wages, and in 2023, when they walked out in support of school staff in another union.

“I will say that, like in previous years, we have gone on strike, and we’re certainly ready to go on strike,” said Julie Van Winkle, UTLA vice president. “And we feel like we need to be ready in case the district keeps ignoring our demands and making counterproposals that are inadequate. But, we’re also very open to a settlement.”

Los Angeles Unified teachers and the district are negotiating a three-year contract that would have started at the beginning of this school year. Teachers want a complete overhaul of their salary schedule, beginning with an $80,000 starting salary for new teachers, instead of the current $65,000, Van Winkle said.

They also want more arts and physical education teachers, lower class sizes in 11th and 12th grades, free child care centers in closed schools, additional resources for special education, and more psychiatric social workers, attendance counselors and pupil services staff.

Los Angeles Unified district leaders have increased their offers to UTLA multiple times in ongoing negotiations, most recently offering a 4.5% raise and 1% bonus, according to a district spokesperson. The district estimates that UTLA’s demands throughout the 2027-28 school year total more than $4 billion above the district’s current expenditures.

“We deeply value the educators and professionals who serve our students,” the spokesperson said. “We also have a responsibility to maintain long-term financial health so that every generation of Los Angeles students — today and in the future — receives the high-quality, equitable education they deserve.”

District wants to cut benefits

Teachers in the Little Lake City School District in southeastern L.A. County have yet to call a strike vote, but Maria Pilios, president of their teachers union, is preparing them for the possibility.

The 205-member union isn’t asking for a wage increase; instead, they want smaller class sizes and fully staffed special education classrooms. But the district is negotiating to reduce the amount it pays for its healthcare premiums. It currently pays 100%.

The district intends to start taking the contributions from teachers’ paychecks in January while negotiations resume, Pilios said.

Teachers and staff, many of whom grew up in the community, feel betrayed, Pilios said. She said teachers have gone without raises in the past to ensure they could retain full health benefits.

“This has changed the relationship between the staff and the district,” Pilios said.

The district’s decision means a $12,000 annual pay cut for teacher Mabel Manzur. The eighth-grade math teacher was diagnosed with cancer for the second time recently and was in the middle of treatments when she learned about the insurance change.

Manzur had to make a difficult decision: keep the doctors and treatment she had or move to a cheaper policy and start over with another doctor and possibly new treatments. She worried that her cancer history would make it difficult for her to be accepted into a new plan.

Still negotiating last year’s contract

Madera Unified teachers are tired of waiting for a contract for the 2024-25 school year, so more than 90% have indicated they are ready to strike if an agreement can’t be reached, according to David Holder, president of the Madera Unified Teachers Association.

The union wants a retroactive 8% raise on base salary, but the district is offering 4%.

According to the district, teachers have received a total compensation increase of nearly 38% over the last decade.

“A new teacher coming to Madera, on average, is making about $9,000 less in their first year than the surrounding districts, Holder said. “And so, Madera Unified is almost like a training district where we have young educators — a lot of probationary interns coming in here, finishing their credentials, getting some experience, and then they leave.”

Holder said there are still 30 to 40 open teaching positions in the district being filled by substitute teachers.

Madera Unified had 284 teachers resign from the district since the 2021-22 school year, a 93.5% retention rate, according to a statement from the district.

The union won’t bring forth proposals for this year or next until last year’s contract is completed, Holder said. The union and district started state mediation over the contract last week.

Sacramento could have two districts on strike

Two Sacramento County teachers unions are at an impasse with their districts, meaning potential strikes could affect 60,000 of the county’s students. Both districts are part of the “We Can’t Wait” campaign.

Teachers unions for both Twin Rivers Unified and Natomas Unified are seeking increased pay, a reduction in healthcare costs, smaller class sizes and more special education staff, among other things.

Twin Rivers teachers and district administrators have a long way to go before they reach an agreement. The teachers want a 12% increase in salary over two years. The district has offered 2.5% the first year and no guarantee for the next year, said Ward of Twin Rivers United Educators.

The district’s proposal would mean teachers at the top of the salary schedule would earn $152,000 annually, according to a letter from the district sent to staff in November. Beginning teachers would start at almost $77,000.

Twin Rivers Unified leaders said that the district’s salaries are among the highest in the state and that class sizes remain low.

The teachers union is also asking that the district pay more of the insurance premiums. Twin Rivers currently pays the full premium for a basic plan, but asks teachers to pay for higher-cost health plans, according to the letter.

A family of two on the Kaiser family plan pays about $1,600 a month for insurance, and others with more family members pay more, Ward said.

The district and union began their negotiations in February and are now working with a state mediator. The parties might end up having the contract negotiations move to a state fact-finding panel because of the district’s reluctance to bargain, Ward said.

Twin Rivers United Educators' executive board has already authorized a strike vote, and 80% of its membership signed a petition indicating they are ready to strike if necessary. A strike could happen as soon as March, Ward said.

The union has been at odds with the school district before, getting as far as the fact-finding stage, but it has never gone on strike.

“This time we are mobilized, and we’re ready,” Ward said. “Our membership is ready. And they see what’s going on in Richmond. They’re seeing things happening around the state, and they’re like, if that’s what it takes, we’re ready. We’re here for it.”

EdSource data journalist Daniel Willis contributed to this report.