Mohammad Safi, a graduate of a
medical school in Afghanistan, began working as a psychiatrist at a California mental hospital in 2006, making $90,682 in his
first six months. Last year, he took home $822,302, all of it paid by
taxpayers.
Safi benefited from what
amounted to a bidding war after a federal court forced the state to improve
inmate care. The prisons raised pay to lure psychiatrists, the mental health
department followed suit to keep employees, and costs soared. Last year, 16 California
psychiatrists, including Safi, made more than $400,000, while only one did in
the other 11 most populous states, according to data compiled by Bloomberg.
The jockeying between agencies
for the same doctors demonstrates a payroll system run amok and chronic
mismanagement, said Jeffrey Sonnenfeld, senior associate dean at the Yale University School
of Management and founder of a training institute for chief executive officers.
“Even though this all took
place in California, such apparent recklessness is almost too over the top for
Hollywood,” Sonnenfeld said. “These irresponsible public officials have
artificially constrained the market with an unnaturally limited supply pool, either
due to laziness, incompetence, corruption or all of the above.”
17-Hour Days
Safi’s compensation was almost
five times as much as Governor Jerry Brown’s last year. The psychiatrist was paid for an average
of almost 17 hours each day, including on-call time, Saturdays and Sundays,
although he did take time off, said David O’Brien, a spokesman for the
Department of State Hospitals, formerly the Department of Mental Health. Safi
is under investigation by the department, and he was placed on administrative
leave July 12, O’Brien said in an e-mailed statement.
“I made so much because I work
a lot,” Safi said in a brief interview at his Newark, California, home.
The comparatively high pay of
mental-health physicians in California is among the findings of a data review
in which Bloomberg compiled payroll records for 1.4 million employees of the 12
largest states. The compensation of public workers is far greater in
California, from prison operations to health care, base salary to overtime, the
data show.
Brown, who granted state
workers collective-bargaining rights during his first tenure as governor more
than three decades ago, has sought to reduce costs by limiting pensions for new
employees, while leaving most retirement benefits for current workers intact.
Last year, the 74-year-old Democrat ordered an overhaul of the mental health
agency aimed at reducing overtime and the use of outside staff.
Bidding War
The 2007 bidding war for
psychiatrists in California took a human toll, said Michael Bien, a lawyer for
prison inmates who successfully sued California over mental-health care. A
mental hospital drained of such specialists was the scene of two suicides
within three months of the salary increases at prisons. The state settled a
lawsuit filed by one family for $975,000 without admitting liability.
Management failings by state
officials were to blame, Bien said. While the salary increases that enticed
psychiatrists to leave mental hospitals for higher-paying prison jobs were
court- ordered, it was the state that determined who would get pay raises and
created the disparity, according to Bien and a Jan. 30, 2007, report filed by
Michael Keating, a court-appointed monitor of the prison mental-health system.
‘Tremendously Disruptive’
“What they did was
tremendously disruptive to the department of mental health,” Bien said. “Why
would anyone not take a salary increase of 50 percent or more?”
The pay boosts caused staff
costs for mental-health practitioners to rise elsewhere, said Stephen Mayberg,
head of California’s mental health department in early 2007, when the raises
started. Psychiatrists are among the highest paid employees in California, Florida, Georgia,Michigan, New Jersey, New York, North Carolina and Pennsylvania, data show.
“The psychiatrists were
working with the same patients, just in different systems, and followed the
higher salaries, putting the systems in conflict,” Mayberg said in an
interview. “With higher salaries, recruitment across the nation became easier.
Of course that had a ripple effect on other states.”
Most Generous
Even in California, the most
generous state among the country’s 12 largest, psychiatric compensation stands
out, data compiled by Bloomberg show. Last year, 93 California psychiatrists
made more than $300,000, a level matched by only 12 in the other states,
according to the data.
Cliff Allenby, the 76-year-old
acting director of the state hospitals department, declined to be interviewed,
said O’Brien, the agency’s spokesman. Allenby has worked for the state for
about 42 years, under seven administrations, O’Brien said.
Allenby has retired and
returned to run the hospitals department part-time, said his son Craig Allenby,
a prison guard who earned $106,957 last year, according to state records.
“Instead of paying a director
a full salary, they’re using him to temporarily fill the job,” Craig Allenby
said. “They’re able to fill the job for less and draw on his experience to work
through some of the big problems they have there.”
Safi worked an average of more
than 76 hours a week in addition to his regular shifts, according to records
provided by O’Brien. Four other highly-paid mental-health department
psychiatrists worked an average of 24 extra hours, prompting critics to
question the quality of care.
‘Watching Quality’
“At some point someone becomes
ineffective,” Bien said. “You have to wonder if someone is watching quality.
Who is managing Dr. Safi to make sure he’s actually functioning well enough?”
Stuart Bussey, president of
the Union of American Physicians and Dentists, which represents California’s
psychiatrists, said he doesn’t believe the doctors are fatigued from the extra
hours, which include time when they’re sleeping.
“They’re not clinic hours,”
Bussey said. “You’re not working the same intensity as you would during regular
clinic days, and I don’t think there’s a fatigue issue.”
The bidding war’s effect on
the state’s mental-health costs is evident in the Bloomberg payroll data, which
shows that from 2005 to 2008, the median income for California’s government-
employed psychiatrists rose 58 percent to $251,060. Psychiatrists in the U.S.
earn a median income of $194,748, according to salary.com, a website that tracks salaries for various
professions using data collected from employers.
In 2006, when he worked half a
year, Safi earned $90,682. In 2008, his next full year of state employment, he
got $236,108.
‘Aren’t Enough’
“They ask me to work because
there aren’t enough people, and then they send me home,” Safi said in the
interview. He said the state has forced him to take leave and declined further
comment.
An increase last year in
patient capacity at Safi’s mental- health facility added pressure on him to put
in more hours, said Ed Caden, his lawyer. As chief psychiatrist, Safi was
required to cover shifts when others wouldn’t and was allowed to do some of the
work from home, phoning in needed prescriptions to nurses, Caden said.
Last year, in addition to his
regular salary of $273,950, Safi earned $548,352 in extra-duty pay, working
3,990 additional hours as the “medical officer of the day” at the prison
mental-health facility in Soledad, about 130 miles (209 kilometers) south of San Francisco. His home in Newark, about 100 miles north of the
prison, is valued at $730,000, according to the Alameda County assessor’s
office.
Reaping Rewards
Safi isn’t alone in reaping
rewards from court intervention and the competition for mental-health
professionals.
Husband-and-wife psychiatrists
Joginder Singh and Mohinder Kaur earned a total of $4.7 million from 2005
through 2011, according to California payroll data. In an interview outside his
Coalinga home, Singh said he retired from a mental hospital in Napa in 2006,
and returned the next year to Coalinga State Hospital, where he was appointed
medical director, for the higher pay after the court intervened.
“When the pay scales went up,
that’s when I joined as medical director,” Singh said. “If you join the job
again, and work for at least three years, then you are entitled to an enhanced
pension.”
In 2006, Singh earned a base
salary of $145,965. In 2008, his first full year back, his base was $270,258,
an 85 percent jump. Kaur, who also retired in 2006 and then went to work at
Coalinga in 2007, saw her base pay almost double, to $252,796 from 2006 to
2008, state records show.
Better Hours
The two were married in India and immigrated to California in 1991, Singh
said. Until then, he had practiced internal medicine for 20 years. He switched
to psychiatry for the better hours and started working for the state in 1995,
Singh said.
Bussey, the union president,
said higher salaries were needed to get good doctors to take difficult jobs.
“You have to get someone to
leave a nice cushy office in San Francisco where they’re making $233,000, and
go out to the desert and deal with rapists and armed robbers,” Bussey said in
an interview. “You have to give them an incentive.”
Psychiatrists receive the same
medical training as other physicians and are typically paid salaries matching
that expertise. Many at the top of public payrolls in California, Pennsylvania,
Michigan, Ohio and New Jersey attended foreign medical schools.
On Call
Each of the five states has
rules requiring mental-health agencies to have a trained medical therapist on
call at all hours. That allows psychiatrists willing to put in extra shifts to
earn more than other employees.
Some states have been able to
hold down compensation for the specialists, data compiled by Bloomberg show. In
Michigan, only 12 psychiatrists made more than $200,000 last year, led by
Laurence Co at $301,996. Unlike California, where on-call hours are paid at a
straight hourly rate, Michigan’s Community Health Department psychiatrists are
paid one hour for every five hours they’re on-call, said Angela Minicuci, an
agency spokeswoman. Through Minicuci, Co declined to comment.
The events that led to
escalation of California’s psychiatrist pay started in June 2006, when U.S
District Judge Lawrence Karlton brought the mental health department into a
lawsuit that had already led the court to take over prison mental health services, after determining that care was so poor it was
unconstitutional. The mental health department provided psychiatric care to
inmates in state hospitals and some prisons.
Vacancies Increased
In response to the order, the
department was required to recruit more psychiatrists. Yet psychiatrist vacancy
rates increased, and Keating, the monitor, asked the state to develop a plan
for salary increases to attract more.
The state proposed that a
chief psychiatrist’s pay rise to $24,267 per month from $13,311. Left out of
the plan were psychiatrists working at mental hospitals including Atascadero,
Coalinga and Patton, and mental wards inside prisons at the California Medical
Facility in Vacaville and Salinas Valley State Prison in Soledad.
In a Dec. 18, 2006, court
filing, Bien, the attorney representing the inmates, said psychiatrists would
follow the pay raise to the prisons department because it wasn’t applied
evenly.
“In a system consistently
plagued by clinical staff shortages, it is not only imprudent, but reckless and
indifferent, to implement a salary proposal that will inevitably exacerbate
staffing difficulties for inpatient psychiatric programs,” Bien wrote, pressing
for a salary increase for all mental health department psychiatrists who worked
with inmates.
Not ‘Justified’
The state agreed to include
the wards in Salinas Valley and Vacaville though not the hospitals. Such a pay
raise would go beyond the court’s purview and “cannot be justified,” the state
said in a Jan. 17, 2007, response to Bien’s request.
The next day, three mentally
ill inmates were denied admission to Atascadero State Hospital as the departure
of psychiatrists left those behind with caseloads of more than 100 patients
each, according to a Jan. 23, 2007, letter to Keating by the mental health
department. A previous court order required a ratio of one psychiatrist for
every 15 patients suffering from the most acute mental health issues.
“It took six months to get pay
raises at Atascadero and the other hospitals,” Bien said in a telephone
interview. “In the interim, lives were lost.”
Patient Suicides
In the first three months of
2007, two patients at Atascadero committed suicide. Matthew Miller hanged himself from his bedroom locker in
February, and Roland James did the same in March, according to court documents
in a lawsuit filed by Roland James’s mother on behalf of the four sons the
43-year-old left behind.
“His sons are doing the best
they can, trying to live without their father and make good decisions,” James’s
mother, Christine James, said in an interview. “Your son isn’t supposed to die
before you.”
Michael Lisiak, James’s
psychiatrist at Atascadero, told state investigator Bill Swift that the
hospital was understaffed.
“Our pay was low and we were
losing docs rather than gaining physicians,” Lisiak said according to Swift’s
report on the James suicide. “We had doctors running around putting out fires.”
$975,000 Settlement
California settled the lawsuit
for $975,000 last year without admitting liability. O’Brien said the state
generally doesn’t comment on litigation.
Efforts to reach Lisiak for
comment, including phone calls and a visit to his home in Pismo Beach,
California, were unsuccessful. Lynda Gledhill, a spokeswoman for the
California’s attorney general’s office, which defended the state in the
lawsuit, also declined comment.
Understaffing is a common
problem in California’s mental hospitals and is one of the reasons state
psychiatrists make so much, said Singh, the former medical director at Coalinga
State Hospital. When pay rose at psychiatric facilities operated by the prisons
department in 2007, it was only natural mental- health professionals would
follow the higher salaries, he said.
“Pleasant Valley Prison and
Coalinga Hospital, they are next to each other,” Singh said. “If the prison
system offers more money, then people will move from the hospital to the
prison.”
450 Patients
When Singh came out of
retirement to take advantage of the higher pay, he was the only psychiatrist at
Coalinga hospital for its 450 patients, he said.
By April 2007, Atascadero
hospital had a 70 percent psychiatrist vacancy rate, according to a court
document filed by Bien. In June, Karlton ordered the state to raise pay for
psychiatrists at mental hospitals.
The rising salaries “stopped
the migration of psychiatrists from mental health to the prison system,” said
Mayberg, the former mental health department director. “We tried to make sure
the systems weren’t competitive with each other after that.”
Psychiatrists continued to
clock extra hours that boosted their pay well beyond their base.
America's Great
State Payroll Giveaway: Read Bloomberg's full
reporting on how out-of-control pay burdens states around the country.
Other states also pay extra to
keep psychiatrists on duty at all hours. The highest-paid state employee in
Ohio last year who didn’t work for a public pension fund was Zinovi Goubar, who
earned $318,261 with $164,820 coming from 2,747 hours in addition to his
40-hour work week, according to data compiled by Bloomberg and Trudy Sharp, a
spokeswoman for the Ohio Department of Mental Health. Goubar didn’t return phone
calls seeking comment.
Less Expensive
Placing physicians on call is
less expensive than hiring more, and the state monitors performance to ensure
quality, said Mark Hurst, Ohio’s medical director for state hospitals.
California’s O’Brien also said
relying on the state’s own psychiatrists rather than outside contractors is
cost-effective. A mid-step California staff psychiatrist earns $122.73 an hour,
O’Brien said. A contracted doctor can earn up to $180 an hour, he said.
Bussey, the California union
president, said the state pays more for its psychiatrists because it’s more
focused on controlling contractor costs than other states, and it’s more
expensive to live there.
A nationwide shortage of
psychiatrists is helping raise their salaries everywhere and is one reason why
so many of the highest paid are foreign-trained, Bussey and Hurst said.
Hurst said the long hours
don’t affect care.
“There are people who can do
that and there are people who can’t,” Hurst said. “We first trust people to monitor that internally.”
No comments:
Post a Comment