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.

A federal judge on Monday temporarily blocked California from enforcing a new law that would have banned federal immigration agents from wearing masks during immigration sweeps.

U.S. District Judge Christina Snyder ruled that the state could not enforce the facial-covering provision of SB 627, the No Secret Police Act, while a legal challenge brought by the federal government moved forward. That lawsuit argued that SB 627 conflicted with federal authority and would improperly limit how federal agents could do their jobs.

The backstory

The law banning facial coverings took effect Jan. 1 and had already sparked confusion and backlash in Los Angeles after Los Angeles Police Department Chief Jim McDonnell said officers would not enforce the ban. McDonnell called the law bad policy and said enforcing it could put officers and the public at risk.

McDonnell’s statements drew sharp criticism from local elected officials, the authors of the laws, and immigration law attorneys and advocates.

The federal government sued California last year, arguing that SB 627 and a second law, SB 805, known as the No Vigilantes Act, unlawfully interfered with federal immigration enforcement. SB 627 sought, in part, to make it illegal for most officers, including federal agents, to conduct law enforcement operations while wearing masks. SB 805, in part, required agents to identify themselves.

About the ruling

Snyder ruled that the mask ban inconsistently applied to some law enforcement officers and not others, which is one of the reasons why the judge temporarily blocked it.

Federal attorneys had argued that agents should be allowed to wear masks for their safety against harassment and assault, such as doxxing. Snyder disagreed, writing that while federal agents and other public figures face security risks, masks were not essential for performing their duties.

“Security concerns exist for federal law enforcement officers with and without masks,” Snyder wrote. “If anything, the Court finds that the presence of masked and unidentifiable individuals, including law enforcement, is more likely to heighten the sense of insecurity for all.”

Reaction to the ruling

One of the law’s authors, Sen. Scott Wiener, D-San Francisco, announced Monday afternoon that he would be introducing new legislation aimed at revising the original law to apply to state officers it previously exempted. He characterized the ruling as a win and vowed to continue efforts to unmask federal agents.

“Now that the Court has made clear that state officers must be included, I am immediately introducing new legislation to include state officers,” Wiener said in a prepared statement, adding: “We will unmask these thugs and hold them accountable. Full stop.”

What's next

Monday’s ruling still required enforcement of SB 627 and SB 805’s remaining provisions, including that officers identify themselves. It also protected the pathway for civilians to directly sue agents for misconduct.

This temporary order will remain in effect until the federal case is resolved. The Department of Homeland Security did not immediately respond to requests for comment. This story will update if it does.

A new report from L.A. County offers a closer look at the economic damage to the region caused by federal immigration enforcement — and at the neighborhoods most affected.

The analysis, compiled by the Los Angeles County Department of Economic Opportunity and Los Angeles County Economic Development Corporation, identified the neighborhoods hardest hit by ICE, and found that they were more economically precarious.

Researchers determined that the most targeted ZIP code in the county is 91402, which spans Mission Hills, Panorama City and North Hills in the San Fernando Valley.

The report, which was commissioned by the county Board of Supervisors, also found that many small businesses county-wide have lost revenue and customers since ICE ramped up its presence in Los Angeles last year.

The Department of Homeland Security has detained more than 10,000 people in the L.A.-area since June, according to numbers released in December. Its aggressive deportation campaign has altered daily life in Los Angeles, where nearly one in five people is undocumented or lives with someone who is undocumented.

The report lays out the ripple effect of that campaign on communities, local businesses, and workers, and its uneven influence on the region as a whole.

Vulnerable neighborhoods

The survey created an index of most vulnerable areas.

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Courtesy L.A. County Economic Development Corporation

)

The report lays out the economic consequences for communities repeatedly hit by ICE sweeps.

The Los Angeles County Economic Development Corporation, a nonprofit research group, used census data and reports on detentions from the Los Angeles Rapid Response Network to assess how vulnerable each L.A. County ZIP code was to immigration enforcement.

Researchers looked at four other factors for each ZIP code: shares of foreign-born population from Latin America, renter households, Spanish-speaking households and non-citizen workforce.

The 10 most vulnerable ZIP codes, they determined, are primarily in working class, immigrant neighborhoods including Bell, Pico Rivera and Southeast L.A.

Researchers used employment data for the county and found that those ZIP codes were over-represented in industries, including manufacturing and retail, which have a significant number of undocumented workers. Businesses in these neighborhoods also tended to have fewer employees on average compared to the rest of the county, and employees were paid less.

"Taken together, these exhibits show that areas facing heightened immigration enforcement differ from the rest of Los Angeles County and appear more economically vulnerable," the report states.

Declined revenue, less foot traffic

Researchers also distributed a survey to small businesses county-wide to assess how federal immigration enforcement has affected the communities they operate in and their bottom lines since summer.

More than 200 small businesses responded. Most reported having fewer than 10 employees, and the majority were in industries like restaurants, retail, professional or personal services and manufacturing.

The majority of respondents — 82% — reported being negatively affected by federal immigration enforcement. Around half reported lost regular customers, less foot traffic or reduced daily sales. Around a quarter reported temporary closures due to concerns from community members.

Many surveyed business owners reported a climate of fear that has led people to stay home and avoid certain places altogether.

"Businesses reported that customers expressed fear about their location, that customers asked about safety in the neighborhood, and that customers avoided shopping or dining in their neighborhood," the report states.

Undocumented workers generate 17% of county's economic activity

No corner of Los Angeles is exempt to the ongoing immigration sweeps that have become a new reality for the region. Nearly 950,000 undocumented immigrants live in L.A. County, according to recent estimates. That's more than 9% of people in the county who lack legal status.

Undocumented workers also play a huge role in many of L.A.'s key industries. Recent research from the USC Equity Research Institute estimates that 37% of cleaning and maintenance workers and 25% of food preparation and service workers in L.A. County are undocumented.

The industry with the highest percentage of undocumented workers is construction, at 40%.

The county's undocumented population together generates just under $240 billion in economic output, according to the county's report. That's around 17% of the county's total economic activity.

The Los Angeles Unified School District rescheduled a Tuesday meeting where the board was expected to vote on layoffs as part of a larger plan to cut spending.

“The district has adjusted the date of the upcoming board meeting to ensure adequate time for preparation, public engagement, and responsible deliberation on items of significant impact and interest to our workforce and community,” an LAUSD spokesperson wrote in a statement to LAist.

They wrote the proposed reduction in force would be presented at a “future meeting.” Tuesday’s meeting is currently re-scheduled for Tuesday, Feb. 17.

In a Friday letter, the unions representing LAUSD teachers, support staff and principals asked the board to delay the RIF vote until there is more information available about state funding and the public has more time to understand the proposed cuts.

“The notion that these are dark times for education requiring harmful cuts when there are record high state revenues is fearmongering,” the union letter reads.

LAUSD's financial challenges

For the last two years, the district has relied on reserves to backfill a multi-billion-dollar deficit. That deficit comes enrollment has declined steeply but expenses have not. There are more than 40% fewer students compared to the early 2000s. At the same time, as costs have increased, the district has not closed schools or significantly reduced staff. LAUSD hired more staff to support students during the pandemic, and now the federal relief dollars that initially funded those positions are gone.

The layoff vote is part of a $1.4 billion “fiscal stabilization plan.” Reductions in force are proposed for several categories including “un-funded” positions, central office staff, and at schools that support higher needs students.

LAUSD must vote on the reduction in force before March 15, the deadline for California school districts to notify staff they may be laid off.

 “It is not a foregone conclusion that people will lose jobs,” said Superintendent Alberto Carvalho at a Jan. 20 board meeting. For example, he said staff may be reassigned to vacant positions or given the opportunity to transfer to another school.

Where are the plan details?

At that same meeting, several board members pressed LAUSD staff for more details.

“When are we going to know the central office reductions? When are we going to know how many of those [there] are?” Karla Griego, a board member who represents District 5, asked, adding: “In a couple of weeks, I hope.”

“No, sooner,” responded Saman Bravo-Karimi, LAUSD's chief financial officer. Bravo-Karimi said the board would be provided with the number of positions impacted and their job classifications.

LAist requested information about the proposed layoffs last week and was told by a district spokesperson that the information would not be available until the board materials were publicly posted.

California’s Brown Act requires public agencies, including school districts, to post information about their regular meetings, including a description of each matter to be discussed, at least 72 hours in advance. Some agencies opt to publish the information even earlier.

No materials related to the Feb. 10 meeting were posted by that 72-hour deadline, and the meeting was rescheduled Sunday.

LAist reached out to Scott Schmerelson, LAUSD board president, who represents District 3, to discuss the delayed meeting. As of Monday evening Schmerelson had not responded.

Weigh in on LAUSD’s planned layoffs

The next meeting where the board could vote on the layoff proposal is Tuesday, Feb. 17. The agenda for the meeting must be publicly posted by Saturday, Feb. 14 at 10 a.m.— 72 hours before the start of the meeting. Sign up to get the agendas emailed here.