The Real Cost of Prisons Weblog

"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.

Officials in the receiver's office discounted the prospect that huge
overtime claims might be fraudulent, because supervisors closely monitor and confirm time sheets.

Last year, however, six physicians ­ five from registries, and their
supervisor, a state employee at Salinas Valley State Prison ­ were indicted for allegedly filing false work-hour claims. That case is still in court.

J. Clark Kelso, appointed in January 2008 as receiver to manage prison care, said he recently hired an internal auditor to check for possible fraud and find out "where do we have vulnerabilities?"

Kelso told The Bee he was most concerned about small but frequent fraud that can be hard to detect. "We don't have good systems in place," he said.

Suicide watch

Inmates use rampant fakery to manipulate the suicide watch program ­ one of the systems enhanced by the receiver to reduce inmate deaths ­ in ways that vastly increase unnecessary overtime.
Rayshawn Taylor, 30, an African American gang member from the Meadowview neighborhood in south Sacramento, said a recent cellmate at Deuel was a white man festooned with swastikas and racist tattoos.

"You want me to go to sleep (in that cell)? Hell no," said Taylor, who said he's in prison for kidnapping.

To prevent someone from being hurt ­ himself or his cellmate ­ Taylor said he told a doctor that he was ready to kill himself. He was switched to aprivate cell and watched 24 hours a day by a medical worker.

Since the receivership began, Deuel has seen an epidemic of such "suicidal"inmates, said James Simmons, a supervising nurse there. A daily average ofthree or four inmates in the suicide ward has jumped to eight or nine.

Simmons has seen it as high as 26, he said in an interview at the prison.Inmates "know that game," he said. "Less than 1 percent are actuallysuicidal."

Suicides are rare at Deuel. None was recorded in 2005 or 2006, before the receiver's program took hold, according to the California Department of Justice. Two inmates killed themselves in 2007, one in 2008, and none
through June of this year.

Michelle Gorman, director of nursing at Deuel, said the prison recently brought in temporary nursing assistants for suicide watch to cut back on using nurses for the job. But union rules allow staff nurses to bump any temp.

Karen Rea, statewide nursing director, said she is considering hiring moreassistants as state employees, who can't be bumped.

That's because, for a nurse, the seemingly mind-numbing work has a special allure: It pays up to $84 an hour.

According to internal tracking documents obtained by The Bee, Deuel spent more than $250,000 on suicide-watch salaries in December 2008 alone.

Effects on patient care

The impact of extreme work schedules is more than financial.
When clinicians are exhausted, "you don't see sharpness, the excellence in the workplace," said Dr. Jack St. Clair, chief medical officer at the Sierra Conservation Center, a prison in the foothills east of Stockton. "It's not safe."

Yet prison nurses said they routinely grab extra shifts to recoup wages lost on furlough days. Those with stamina treat overtime as a fast track to a higher standard of living, sometimes working 16-hour shifts five days a week.

"It doesn't leave a lot of room for rest," acknowledged Orlene Sargenti, licensed vocational nurse and union shop steward at Deuel, who averaged about 56 hours a week in 2008.

"Last year we had a couple of nurses who collapsed due to exhaustion," Sargenti said. Ironically, overwork generates more overtime, she said, when nurses working extreme hours call in sick from fatigue.

Gorman said nurses who sleep on the job jeopardize their licenses. "Nursesdo tell us that 'I'm tired and I can't work,' " she said.

The request is granted, she added, only if another nurse is available to take over. Staffing gaps often require forced overtime.

Union contracts allow unlimited voluntary overtime. Last year Marie Punla, 37, a registered nurse at the California Substance Abuse Treatment Facility and State Prison in Corcoran, Kings County, took advantage of that provision to log 93 hours a week ­ more than all but seven prison clinicians in the state. That's equivalent to six 16-hour shifts every week.