Assembly Budget Subcommittee No. 5 on Public Safety

[Roll Call].

Thank you. We will be moving now to vote only calendar. For vote only issues one through five. The action is approved as budgeted. Do I hear a motion?

So move.

And a second.

Second.

Thank you, staff, please take the roll.

[Roll Call].

Thank you. We'll put that on call for other Members to be able to vote. We'll move on now to our discussion items for the day. Panelists are listed in speaking order and we ask that you please introduce yourselves prior to speaking. We will begin with issue one, which is overview of SB 2. Proposed Trailer Bill, Spring proposal. Thank you. Please go ahead.

Good afternoon. There we go. Okay. Good afternoon. Chair Bonta and Members of the Subcommitee. My name is Annemarie Del Mugnaio. I'm the Assistant Executive Director for the Peace Officer Standards and Accountability Division. Before I provide a very brief history on the support for this proposal, I want to emphasize that the records POST refers to in the Bill will continue to be subject to disclosure by the law enforcement agencies that sent this record to POST pursuant to the Public Records Act and to the provisions of SB 1421 as they are relevant.

Senate Bill 2, Chapter 2021 vested POST with the responsibility of peace officer accountability through formalized licensing and enforcement. As of January 1, 2023 POST began receiving reports of serious misconduct from law enforcement agencies across the state. To date, we have over 6700 reports of potential serious misconduct, including 110 public complaints. The workload and resource commitment associated with responding to and analyzing serious misconduct reports from over 650 law enforcement agencies employing over 90,000 peace officers is significant.

Post has devoted resources to triaging and addressing these reports in an effort to meet the demand of ensuring public protection. We anticipate receiving millions of pages of documents from law enforcement agencies containing confidential information which in some fashion may be subject to release under the California Public Records Act.

These materials routinely contain information that is not subject to release, such as personal identifying information, the identity of confidential informants, victims, sensitive medical information, the identity, again, of victims that would like to remain confidential, crime scene and autopsy photos, all requiring significant time and effort to review, analyze, and redact. Background investigation files similarly contain confidential personal, medical, financial and other information requiring protection from public review.

The law enforcement agencies that conduct these investigations and compile material have an independent obligation under the existing law to respond to the Public Records Act requests. The agencies investigating the matter are in the best position to understand the complexities and sensitivities of the record and determine what information is subject to release of their own records. Should post be required to respond to the production of documents from a law enforcement agency's investigation, POST would otherwise consult with this agency that created the record to determine what documents and information may be released.

Ultimately, this will result in significant delays in the production of the record. If the proposed Trailer Bill Language is not adopted to achieve the necessary clarification as it pertains to the Public Records Act request, POST will be required to shift much needed resources away from its investigation and decertification duties, which represent the core responsibilities under SB 2 - to handle the review, analysis and redaction of this substantial volume of confidential material. POST would also likely be forced to request to request significant additional resources for personnel to cover the costs associated with redaction of video, audio and hard copy files. Thank you.

Thanks so much. We'll move on to the Legislative Analyst Office.

Jared Sippel with LAO. We have no comments on this proposal. Thank you.

DOF.

Sarah Tomlinson, Department of Finance. Also, no comments on this issue, but happy to answer questions..

Thank you. I'll just start with one basic question and then hand it off to my colleague. Have you received any feedback from the author's office on the proposed trailer Bill?

Right. We have discussed the Trailer Bill with Bradford's office, and they have no concerns with this being a separate provision since it does have a resource underlying component to it. And SB 449 is really a cleanup provision for SB two to allow us to better implement and close the gaps on some of the implementation guidance. Yeah.

Thank you. I don't think we have any other questions from the Committee, so that will be all. Thank you.

Thank you.

We'll be moving on to issue two, which is State and Local Cybersecurity Grant Program for the Spring proposal.

Good afternoon, Chair and Members. Heather Carlson, I'm the Assistant Director of Administration at the Office of Emergency Services, and we're here to talk about our Spring finance proposal to implement a new federal, state, and local cybersecurity grant program. Specifically, our request is for $8 million to implement the grant. There's no General Fund impact, and if there's any questions regarding the program, I've got Deputy Director Thomas Osborne here to speak to.

Thank you. And I think LAO and Department of Finance are just available for questions and answers. Okay. I don't have any questions on this item. Do any Members do? Thank you.

Thank you.

We'll now be moving on to issue three with the CDCR, which is the San Quentin proposal. Thank you. I think we'll begin with Mr. Lewis.

Good afternoon, my name is Dave Lewis. I'm the Director of Facility Plan Construction and Management for the California Department of Corrections and Rehabilitation. As you're aware, the Governor, in a press conference at San Quentin announced intention to change the name of San Quentin State Prison to the San Quentin Rehabilitation Center and to build an education center on the side of a former prison industry authority warehouse. At this time, we do not have a proposal to present to the Legislature pending the completion of that, and working with the Department of Finance and the Administration to develop the full proposal.

Allison Hewitt. Thanks.

Allison Hewitt, Department of Finance nothing to add. Looking forward to having more discussion with the Legislature following the release of the may revision. Thank you.

Thank you. And before we move to LAO, I just want to make a few comments. I was very thankful for being able to be present when the Governor talked about this incredible commitment to furthering our efforts to center rehabilitation and reimagining our prisons in a manner that supports successful reentry. Certainly made all of our hearts sing when we were together being able to lift up that vision that the Governor holds.

And the challenge is that we at this point, don't have any specifics on the proposal related to programming in particular. We have panelists who are here who are primarily able to speak to some extent to the facilities component, but really don't have enough to be able to speak to the programming aspects of that. So that's left us with quite a challenge here.

We know that many formerly incarcerated people have shared that all of the prisons, San Quentin is just one of the richest for programming, primarily due to the 3000 volunteers at this prison alone. And while I'm supportive, very, very supportive of efforts to make any prison more rehabilitative, I'm concerned about what we will be doing in the other 30 prisons. So we've heard from CDCR or will, that there's been a citation around the Norway program.

We've heard that before and prior presentations for the last three to four years. And we know that the news articles really reference the Scandinavian models. And the secretary this year talked about the California model. And I'm not at this point really clear on what differentiates the California model and would really appreciate some further elucidation to that in order to be able to make sure that we can be fiscally supportive as well as energetically and values based, supportive around such an endeavor. So with that, I will move it to the LAO for any additional comments.

Thank you. Caitlin O'Neill with the Legislative Analyst Office. We plan to do an in depth review of the proposal once it's provided to the Legislature at the May revision. But at this time, based on the broad outlines of the proposal that were described by the Governor at the press conference at San Quentin, we do have some key questions for the Legislature to start thinking about and to begin asking the Administration as details begin to be provided.

And those are one, the Department, as you noted, Madam Chair, is developing the California model. There's some pilot programs going on at prisons right now that are part of the California model, so it seems. And so yet it's not entirely clear what the California model is or will be when it's fully developed. It's also not clear what the results of those pilot programs are at this time.

So one question that the Legislature could ask the Administration is how does the San Quentin proposal fit into this California model. Two, there's many different possible approaches to applying Norwegian correctional principles, and those approaches can be selected based on the specific goals and objectives that are being targeted. And so the Legislature may want to ask, what are the goals and objectives of this proposal. And from there, does the particular approach that the Governor is outlining make sense?

Three, how were stakeholders, or how are stakeholders being consulted? Both stakeholders within the Department, in the incarcerated population and other stakeholders in the community being consulted as this proposal is being developed, and in particular in the selection of San Quentin. For the 20 million that's before you is being characterized as funding for planning activities. So what is the estimate of the full cost of the proposal and for the Legislature to consider.

How will that compete with other General Fund priorities, particularly given the state's current General Fund condition. Five, going forward, is there a plan to keep the Legislature informed of developments in the initiative at San Quentin if it is approved. And six, is there a plan for how the state will be able to learn from whatever changes are ultimately implemented at San Quentin, such as a plan to evaluate the program. Thank you.

Thank you. I know that we have an incredible opportunity, actually, with the growing empty prison beds. We have 15,000. We've talked about this in prior Committee hearings, and we know that that will increase to 20,000 in just a few years. And we are right now, we all know, experiencing an incredible lack of revenues at the level that we thought that we would be receiving and projected expenses moving forward. So I think for this Committee.

This is one of those areas where we have both an opportunity of a lot of bed closures. We have certainly a strong, very committed Committee in Legislature to focusing on making sure that we are supporting reentry efforts wholeheartedly. We have the opportunity of savings related to the number of empty beds that we have. We haven't heard any further action from the Department around whether or not we should be closing any additional prisons, which is certainly an option for us to be able to support additional savings.

And we have a wonderful opportunity and a vision. So I'm very much hoping that we can have more information so that we are actually in the position to, as a Legislature, make a confident decision about how we use our resources and taxpayer dollars. Do you have any response to any of what has been laid out from CDCR, DOF?

I don't think I want to talk about closure anymore after the last time, but yes, we look forward to engaging with the Legislature on all of the topics that you discussed. Clearly, this is a unique opportunity in the Department to examine our procedures and our practices moving forward and finding new and innovative ways to do our business.

And the secretary, as he's stated many times, is really looking to ensure that programming opportunities stay consistent throughout this whole process as we look at closing beds and institutions that we retain as our programming capacity so we can continue to provide that level of programming to inmates and the incarcerated population as we move forward.

I think timing is the issue. We just haven't received a budget change proposal. Our time is very limited. We're heading into May, and we would really love to be able to have something. Do you have a comment?

Corinne Von Robinhorst, Department of Finance. As my colleague Allison Hewitt already mentioned, we'll be in a better position to talk about the details after May revision. And I also wanted to address the 500,000 that was pointed out in the agenda item, that nothing has been spent yet, and we are currently reviewing how best to use those funds during the current year in light of the Governor's recently released revision.

Mr. Lackey, do you have a comment.

Yeah just a couple of clarifications that I'd like to inquire about. First of all, is this $20 million that's being referred to - is that supposed to come in this budget cycle, or are we supposed to wait till the May revise to find that out?

The $20 million was included in the Governor's Budget essentially as almost a placeholder for some planning funding for this program. As we go forward, the details for that, as well as the entire program will be forthcoming as part of the May revision.

Bcause I'm really confused because especially when we're talking about the capital outlay, it's going to be an incredible amount of budget money that's going to be committed here, because I read that $100 million is being attributed to just the kitchen. So this is a huge project. This is a huge undertaking. And so is there any kind of estimation at all? I mean, a ballpark figure of what we're looking at here, or we have to just wait? Are we completely in the dark, or do we have at least some estimate?

We are still working with the Department of Finance and the Administration on fully developing the proposal.

I mean, can you give me any kind of framework at all, or what is met as far as scope in this reimagining? That's really a broad. Doesn't give us much to go on. There's got to be something.

Well, as far as reimagining San Quentin, I think there's multiple avenues that we need to look at as far as the reimagining San Quentin. One is the programming aspects. As the Chair pointed out, San Quentin is the source of a lot of - there's a lot of volunteers at San Quentin. There's a lot of people that are willing to participate in programs. And being in an urban location, it does provide opportunities that maybe some of our other institutions do not provide. To allow for programming levels.

So part of San Quentin has obviously been the home of our condemned inmate program for many, many years. And so this gives us an opportunity to change the culture of San Quentin altogether from being one where it was very much. While there's a lot of program and a lot of program opportunities, there's still a significant population there that has not had access to that. We obviously have language now that allows us to disperse that population throughout the system.

That gives us opportunities at San Quentin to leverage the opportunities there related to program and give more of our incarcerated population those opportunities. So this is really looking to change the entire culture of San Quentin from one that's really focused on those dual missions of programming and keeping the condemned population secure to one that's really completely focused on programming and reentry into society. As the Chair spoke, these inmates are coming back to our communities.

And so a lot of the California model is focused on changing the dynamic that results in high recidivism rates for the Department and focusing instead on providing programming and providing opportunities to improve on that dynamic. And that's what San Quentin reimagining is really all focused on, is changing that dynamic and providing those opportunities where we can best leverage those programming opportunities at San Quentin.

Well, clearly it's a noble goal. I just think we need to balance our goal with affordability, and there's just a lot of uncertainty in the future. And it seems like there's a lot of uncertainty as to what direction we're going with this. And as far as these questions, as far as capital outlay and so forth, there's just a lot of ambiguity. A lot. And so it's very hard to really wrap our minds around the affordability of this whole project. So, anyways, we'll look forward to more information.

Mr. Jones-Sawyer.

Actually, I'm really excited. I'm someone that has actually gone to Norway, and I've seen the Norway model and I've seen how it works. I haven't had a chance to see the Scandinavian model. And now I see we have a California model, which I hope is it marries the two, or we look at what they did, take the best parts of all of that, and then move something forward.

I think it is really important that we get an idea of what vision, even if it's just a sketchy outline of what you want to do. And the reason I say that, I know there's a dollar amount here, but what if you need more? What if you need more than the 20 million to 500,000? I don't want to confine ourselves to trying to have the model meet the money instead of the other way around. Let's make sure this is done right.

It's done right the first time, because I truly believe the ROI on rehabilitation is much greater than the initial expense that you put out. And if we can put some accountability measures in these types of programs, and whatever we're going to do, we can now prove to the public that not only are they successful at people not recidivating and coming back and being a menace to California, but most important, we can save taxpayer money if we do and spend our money much more effectively and efficiently.

And so, as you probably can tell, I'm excited about what the California model will look like. And if you need any input from the Legislature, especially those of us that have gone to Norway, that's why you want to have input from us, because some of us have seen this in action and could probably be very helpful at developing what moving forward.

Mr. Patterson.

Great. Thank you so much. Sorry for being late and appreciate the Chair for giving me an opportunity. In terms of the kinds of individuals that would be under the reimagined San Quentin, is that going to change from who's there now, or is there going to be a special emphasis or focus on certain types of inmates, or is there a plan on who's going to be there?

Yes, there's certainly a plan that will be forthcoming as part of the whole proposal that will discuss the population that would be served at San Quentin. Obviously, with the move to really focusing on rehabilitation programs and reentry, it needs to have a population that's conducive to that programming and really looking at serving the needs of the population that will be rejoining the community soon and addressing some of the issues surrounding that so that we can return them in a situation where we can address those underlying issues that cause the recidivism that have caused the criminality in the first place.

And all of those things need to be reflected in the population that's served as well. So, certainly the population that's there now being largely San Quentin as the condemned inmate population that will be spread over the rest of the institutions, and we'll be focusing on individuals that would be appropriate for the programming that we anticipate at San Quentin. Okay.

But right now, you're not prepared to say the types of - is it like a length of time people have left, or are there any targets like that that you know of?

I think a lot of those details will largely be determined by the advisory council that the Governor will be appointing to provide us input into the programs and the type of program that we will be providing at San Quentin.

The Administration is very interested in receiving input from all stakeholders, both internal in the Department and external, that will provide us some answers on how to best provide that level of programming that we anticipate at San Quentin and how to best leverage it and how to best ensure that the population that's included is the best population for the program that is envisioned.

What will the population be.

As far as the numbers?

Yeah.

I would have to look, I'm not sure I can get back to you on that.

All right. Okay. This isn't considered a pilot project, is it or?

Certainly. I think the things that we're most successful at, we would be looking to extend to other institutions. But, no, it's not anticipated this would be a pilot. We anticipate fully proposing a full programming package for San Quentin that would be part of the May revision proposal.

Okay. And. Sorry. Timeline on development of sort of the strategy.

Well, I'm sure you're aware the Governor gave us a very ambitious target of completing the building by the end of 2025. In order to make that happen, we need to really accelerate all of our efforts related to designing not only the building, but the program and beyond even the program talking about the culture of San Quentin, the adjustments that need to be made to meet the objectives that were clearly laid out by the Governor as far as changing reimagining San Quentin. So we anticipate that the timeline will be very aggressive on all of these things to meet those goals.

Great. Thank you. I guess the only comment I have is obviously, I think this is that other countries know it's always hard to compare apples to apples, because even if Norway or some other country has the same program, they might have other systems in place throughout the criminal justice system that lead to the results.

But I think if the state's going to go this route with the goal of, I assume, reducing recidivism, I'm glad there's an aggressive timeline, but also somewhat concerning because we want to get it right. I mean, if this doesn't happen right, whatever qualitative standard is put on that, or quantitative standards too, then obviously the consequences are pretty steep there. Anyways, thank you very much.

I will just reiterate my enthusiasm for the idea of this project. I was there at the press conference, was very excited to talk with many inmates at San Quentin, got up and spoke very vociferously about my absolute support for the idea of making sure that we are in a different place around reentry. This Legislature is not a group of stakeholders. We are co equal participants and partners in developing and drafting the budget associated with various efforts.

I have a deep concern with the fact that CDCR, in many hearings, and I'm just starting my endeavor of working with the CDCR in experiencing an incredible amount of lack of transparency around expenditures. And I really don't want to set us up for another replication of that kind of practice with this particular effort. So by my estimation, May seems incredibly late for such a grand endeavor with such a bold timeline for rebuilding by 2025.

And at this point, I don't know how the Committee is going to be able to fully evaluate whether we can support the funding for it, in all honesty, because we haven't been given any information. So we would love information. So thank you. With that, I appreciate you coming before us to be able to give us some information.

And just as a point of request, when we are meeting before the Subcommitee, any agency in so doing really needs to be able to provide a budget change proposal with actual information for us to be able to respond to. Thank you. We will move back to just completing the role for our previous motion that was seconded for Mr. Patterson and Mr. Jones-Sawyer. We had a motion to approve vote only issues one through five. The motion was to approve as budgeted, and we will complete the roll now.

[Roll Call].

Thank you. We will move on now to. Oh, sorry. Those items one through five have been approved and are out. Thank you. We'll move on now to issue four. Mental health, staffing, recruitment and retention update. Good.

Thank you. We have several panelists speaking on this. I'll just introduce you as you are given some opportunity to speak. I know that we have a time limit associated with your presentation. We will begin with Dr. Amar Mehta from the deputy director of mental health services with the CDCR.

Thank you very much, Madame Chair, and the rest of the committee for having us here today. As you mentioned, my name is Amar Mehta. I'm the deputy director of statewide mental health for CDCR. I've been in this position for about three years and it's been a very busy three years. A lot of things have changed over COVID and everything else. And so you obviously all know about the Coleman lawsuit and what we're here to talk about is the staffing aspect of that.

So just recently the judge passed, wrote an order about staffing up to 90%. And this wasn't the first time we've gotten a couple of these orders. It's been a long road, but right now our psychiatry staffing is at 89%, which is kind of amazing for us. It's 15 positions short of 90%. We still want to go all the way up to 100% and we want to make sure it stays there, which is the critical part.

But we've come a long way and out of the positions that are filled, two out of every three are civil service positions, not the registry or contractors that have been a concern. And out of the two out of three that we have, one is telepsych and one is onsite. So we've had a lot of telepsychiatry doctors join us recently and has just been a real boon to our system. I'm going to talk about that more in just a second.

But I just want to be clear that CDCR has absolutely no incentive in keeping any of these positions empty. We still have the same amount of work that needs to be done to take care of our patients, which is our goal. It's been really complicated. And the special master in this case commissioned an 82-page report in 2020 by a team of economists that talked about the difficulties that everyone has doing this. CDCR, obviously, but every state in the country basically is facing something similar.

It's a shortage of mental health Clinicians, a shortage of physicians, and we've all been doing our best. And that was, frankly, before COVID and burnout and retirements, the great resignation, quiet quitting, all these other things which inflation, any one of those things could be a whole nother hearing here today. So we absolutely want to acknowledge that the Department of Health and Human Services released a report that by 2025, we're going to have 10,000 fewer mental health clinicians in this country than we need.

And closer to home, the health force center at UC San Francisco projected that by 2028, we will have a severe shortage of psychiatrists specifically, which is what we're here to talk about. The court has noted that tight labor marks do not relieve defendants of their constitutional obligations to take care of the patients, and I could not agree with that more. We have patients to serve, no matter what. I mentioned telepsychiatry. That's the new world we live in. Kaiser and Sutter and everybody else is offering that.

And if we can't compete, we'll just lose every time. So we're doing our best to keep up with that. We still recruit very hard for on-site. We do our best to get as many people there in person, face to face, seeing the patients that we need to care for. We've done a lot of other things just over the last year. We released two pay differentials. One was to give additional bonuses to clinicians who had stayed on for a certain amount of time, or new clinicians that sign on. And then another was to give 15% on base pay for clinicians that are working on-site, in-person, not tela at our inpatient institutions.

With our inpatients, which is 5% of our total population, but obviously 80% of the work that we all have to do, we've created a bunch of other opportunities, such as dual appointments, which means that in CDCR you can have a schedule of four ten hours, days instead of five eight hours. And if you do that, you can actually add that fifth day back on and do 25% more work.

And we've made it easier for them to do that at their institutions so they can serve the patients and the systems that they understand and they don't have to travel as far. We've been working to make things easier for on-call, which is something we've absolutely heard from the union and really listened to. We have a night shift system which covers a lot of that system now takes a big burden off the institutions. We've made improvements to quality of care, opportunities for specialization.

There's so many things I want to give you all a chance to obviously ask our questions, but I'll just mention the last couple. We had relationships with training programs now, which has been a huge bonus both for the physicians we have who can now do more teaching and journal clubs and continuing medical education, but also for recruitment.

We've had a lot of those people come in, and two of the people I myself have hired over the last year have been from California Pacific Medical Center, which is one of our programs that we work with. So that's our rough top 10. But again, I want to give everyone a chance to speak and, of course, to answer questions. Thank you.

Thank you so much. We will move. I think we have others who are available just for question and answer, right? Yes. Okay. From the CDCR. So we'll move on to Dr. Stuart Bussey, the president of Union of American Physicians and Dentists. AFSCME Local 206.

Chairwoman and committee members.

Everyone's time limited. Go ahead.

Okay. I apologize for this late entry, but I've been sick in the hospital, and I have some handouts that I'm going to reference, if that's all right to give you guys. Okay, I can start. Good afternoon, Madam Chairwoman and committee members. My name is Dr. Stuart Bussey. I'm president of the Union of American Physicians and Dentists. Working with my doctor members at CDCR has given me the greater understanding of the phrase, the more things change, the more they stay the same.

In 1995, you know, the lawsuit was settled, and Judge White listed the six recommendations, including adequate staffing. Today I want to discuss the chronic failure to achieve that goal. I want to talk about the vacancy rate that Dr. Mehta referred to.

I have the January 2023 vacancy rate in front of you, and maybe we can get into this later, but from what I see, there are 310 positions and 185 people from our unit, which means they're not a small vacancy rate, as Dr. Mehta alluded to, but a large 40.18% vacancy rate. Now, I don't know if contractors or tele-people were included in that, but I would like to get into that. We think it's a crisis. There's murky methodologies that we can never be sure of at CDCR.

And when Governor Brown introduced the pension cap, it got even worse that it was hard to recruit people in your handout. I offered 10 recommendations 10 years ago to the Assembly committee. They could reduce psychiatric vacancies and the addiction that the state has to contractors, and none of them have been implicated. If you look in the back of the handout. Besides a difficult working environment, salary is always the top reasons for the recruitment problems.

I also remarked about the contractor salaries that are given out, and that's a lot of money out there. In 2012, it was about 25% higher than our civil servants, and now it's 100% higher. $325 an hour for the contractor and at least $65 an hour for the administrator. And that if you multiply, it times these vacancies, almost $100 million annually on these temporary workers. So some of them made 80,000 a month, and one person made $131,000 in one month. So it's kind of shocking.

Besides the financial burden of the taxpayer, poor continuity of care, and lowering morale for the civil servants, which we're going to be talking about, these are huge problems. Recruitment and retention has also been addressed by Judge Mueller and the court, the special master, as Dr. Mehta mentioned, the court employed employee stat to find out what will solve this problem. And based on the study, she ordered a 15% salary increase for all those institutions that had a 10% vacancy rate.

And if that didn't work, another 10% would be ordered. But CDCR, in the last four years, done nothing about the raises. Instead, they argued through their statistics, nontransparent, that 40 positions should be cut. That was three years ago. Fortunately, the Golding One report revealed that this was not true. There's another Golding Two report that's just come out that we're eager to look at about financial and clinical problems. Well, four years have passed since Judge Mueller's mandate, and CDCR has not raised significantly our salaries.

In fact, during this four-year period, the psychiatry wages went from 18% of the budgeted mental health expenditures to 8%. And then Judge Mueller recently ordered in January up to, it's not clear, but it looks like twice the penalty for these vacancies, twice the salary of the psychiatrist for every month, and that seems to be $46 to.

Frustrated by our 2 to 3% annual raises at our bargaining sessions, which are incredibly frustrating, we convinced CalHR to do the research paper, which I gave in front of you, the joint and executive summary of their version of it and our version of it. And we both agree that the salary, non-competitive salary, is the number one problem. Now, we tried to get it to the Legislature in February of 21, but the department sat on it until the session was over in September. So it's frustrating.

Okay, we are here today, finally, in summary, to implore your committee members to increase the civil service salaries. Bargaining has not, does not work for all the years that I've been here, and that's 20 years. Okay? It doesn't work with a party that's closed-minded, that uses deceptive statistics in front of a federal judge, that ignores her orders to increase civil servant wages while wasting tens of millions of dollars on temporary workers.

It's no way to run a business, government or not, taxpayers are hurt, civil services hurt. Inmates are hurt by less committed contractors. Please earmark some of the $14 billion that CDCR receives annually so that the mission of Coleman is honored. Thank you.

Thank you, Dr. Bussey. We will move on now to Dr. Jonathan Greenberg.

Hello, can you hear me? Okay. I'm Jonathan Greenberg. I'm psychiatrist. I'm a line staff psychiatrist working at California medical facility in Vacaville. I've been here for eight years. Since 2015, I've worked in the inpatient unit. I've worked in the extensive outpatient unit. I've worked in the crisis bed. I've been a senior psychiatrist for a year and a half, and currently I'm in the inpatient unit. I did receive that 15% bonus, but I've seen since then staffing has only gotten worse.

Actually, it's honestly an insult, that bonus. We are required to work another 52 hours a week, a month inpatient on-call, where we spend the night. Yet that 15% does not cover that. Also, it was not felt that the other staff were deserving of the 15%. So it did reduce morale overall and reduce morale in how headquarters was managing psychiatry. But to hear that the shortages and the line staff is civil services high is just not true at all.

Currently, at CMF, we have six line staff on the inpatient unit and we have 13 contractors on the non-inpatient side. We only have one line staff psychiatrist. I've seen in my eight years, people leave and leave and leave, and no recruiting at all has occurred for line staff psychiatrists. So that's the facts. That's what I've seen. Now, line staff psychiatrists on the site are we make the system go. We are the most important for patient care.

Yet I've seen us get squeezed out, squeezed out by contractors making twice as much money, squeezed out by telepsychiatrists who make the same amount of money yet get to work from home. Meanwhile, not taking on the risks of being assaulted, of being accused, of retaliated against, and also not mandated to be on call overnight or by phone. So I've seen strong efforts to continue to squeeze out line staff psychiatrists, and that's what I've seen. It's very disheartening. Contractors do not provide as good care.

They are going to have more recidivism with ongoing contractors. In order to provide good patient care, you need staff who are there for the long haul, who are invested in patient care. Line staff psychiatrists take on leader positions, chief psychiatrists, senior psychiatrists. They know the system, they know how to look up the information. You save tons of money on training, on just good patient care. Also, obviously, you don't have to pay for constantly rotating revolving door. I talk to contractors all the time.

They say, I'm here for the money and they say I would be a staff psychiatrist, but it would not make sense financially. So, you know, to work as a CDCR line staff psychiatrist, it's not an easy job. There's a mix of serious mental illness, there's exaggerating mental illness for secondary gain. There's patients are seeking drugs, there's severe personality disorders, and there's a merge of mental health and custody. I see custody offers getting injured all the time by patients being mismanaged.

In order to provide good patient care, you need to be around, you need to be invested in the system. We need to work together as a team. We need to know how to work with custody. We need to know how to look up records. We need to be able to have leadership in the system. And unfortunately, I just am not seeing that. And I haven't been seeing. I have seen it decline. It is sad to see and then to hear. It's almost like I'm hearing that I'm seeing. What I'm seeing is not what I'm seeing when I hear headquarters say what they say. Thank you. That's all I have. Thank you.

Thank you. We'll move now to Dr. Navreet Mann.

Yes, hi, good afternoon. My name is Navreet Mann. I'm a psychiatrist. I've been with CDCR for 12 years. In my time with CDCR, I've worked at many prisons, San Quentin, CSP Sacramento Folsom Stockton facility, Mule Creek, and I currently work at CDCR headquarters in Elk Grove. I've also provided patient care at many different levels. We've worked with patients who are high functioning at an outpatient level and also worked with patients who are in crisis requiring inpatient level of care within CDCR.

I'm not going to go into the details of court oversight and the recent judge's order because Dr. Mehta already talked about it. So another thing that the judge said was we have two options right now. One is either to improve staffing for CDCR, or the second thing is to reduce the patient population. So I want to talk about improved staffing.

CDCR claims that they're making robust efforts at trying to hire civil service psychiatrists, and the nationwide labor shortage is a reason for the inability to do so. But in reality, there seems to be little to no effort in recruiting or retaining existing staff. The effort focuses on getting contractors to fill in the gaps. So why is it easier to hire contractors when it really is the same labor pool? Well, it's the same people we can hire from.

And what is the first approach that is used by CDCR? It's a high hourly pay rate. My first few months in CDCR were as a contractor. The salary and benefits made the switch to civil service so much easier for me back then. 12 years later, if I were in the same position today, it would make absolutely no sense financially for me to move over from being a contractor to civil service. So what is the problem with contractors? Contractors are not the solution.

Contractors make up a transient workforce, which is made worse by the waiting hourly rates for different institutions. So when one institution pays a little bit higher, all the contractors will move to that institution, leaving behind a lot of patients who were now relying on having that one psychiatrist. This short-sighted approach has not worked for over 20 years. Over the past few decades, the workload in patient population has increased.

Without a consistent workforce dedicated to the care of inmate patients, constitutionally adequate patient care is almost impossible to achieve. Now let's talk about reducing the patient population. Where will these patients go? Will they stay in our prisons and not get mental health care, or will they be released to the streets and then without mental health care, will they be worsening our problems of homelessness and crime?

The bottom line is that the state will have to pay for the care of these patients, either in a controlled setting within CDCR or out in the streets. And that would be in addition to continuing lawsuits and court fines and all of that. It is my understanding this is based on discussions that we've had during contract negotiations with the state, that contract to pay court fees and fines set by the court will not be coming out of CDCR budget, which drives CDCR's less than ideal efforts to hire civil servants.

If that is the case, the citizens of California will be paying out big amounts as fines and contractor pays without knowing that that money is still being used on state prisons, all in an effort to make the CDCR budget look smaller while the actual amount spent keeps increasing. Salaries for civil service psychiatrists must go up.

At a minimum, these need to be competitive with the pay rates for contract psychiatrists and other healthcare organizations. It feels like the game of passing the bug. CDCR management knows that salaries must increase to fix staffing, but claim to have no authority to make any change. As members of the Budget Committee, you are in a unique position to see the bigger picture and understand that money is being wasted by the state in order to control CDCR's budget.

Madam Chairperson and committee members, I hope you have the ability to make the change today. These patients will not receive adequate care without psychiatrists. We need a dedicated and committed workforce to help these people, to help us get out of lawsuits, and to break the cycle of lawsuit after lawsuits due to inadequate care. And I want to end with some comments that were made by the federal judge in 2019. She said that CDCR's response to this lawsuit has been defense.

She noted that CDCR has lost complete sight of the reasons that remediation was required in the first place. She reminded us that legal cases are not just words on a piece of paper. Legal cases have hearts and souls. She reminded us to keep our eyes on the souls of the mentally ill housed behind bars in this state who have the undeniable right to constitutionally adequate care. Thank you.

Thank you. I appreciate that and certainly appreciate the real life experience and being able to share what this looks like on the ground and that there is quite clearly an apparent disconnect. So let's talk a little bit about that and I'll just ask some questions and then turn it over to my colleagues.

So primarily, questions for CDCR, on average, do you have a sense of on the recruitment side of things when you list a posting for psychiatrist position about how many applications you receive to try to get at the shortage issue with apparently 40.18% vacancy rate right now?

Good afternoon, Madam Chair and committee members. Jasinda Muhammad, deputy director of human resources for CDCR, California Correctional Healthcare Services. So I take care of the HR on the healthcare side of CDCR. I don't have those figures with me today, but I'm happy to get those from my recruitment team and share some information with you as a follow-up.

Do you have any estimations for us to be able to just get some context about what is happening? And maybe, Dr. Mehta.

I can just say that it is very different for each institution. It really does depend on what population is nearby, how much population is nearby, what major cities, and that sort of thing. It also depends on whether you're talking about telepsychiatry or on-site psychiatry. We have hubs at certain locations for telepsychiatry where they go into an office and they work there. And I fully respect all of the messages that the union had today. I will say telepsychiatry are civil service.

They're all potentially union members, and every single one of them is civil service, we don't have a single registry in telepsychiatry, so we do prefer to hire into the civil service classification. We want people paying into the system, invested in the system, and our entire telepsychiatry department is part of that.

Do you have any insight into actual numbers for us? How long does it take for a posting that is listed for there to be any higher, on average?

So there's two types I want to talk about. On a regular posting, on average, it could take three to four months. But what we implemented in 2022 was an end-to-end hiring model, and that took onsite events outside, but in geographical relationship to our institutions. And we broke down all of the hiring process so a candidate could come in and get elbow-to-elbow support on how to take a state exam. And from that point, they move right into an interview process.

If they successfully complete the interview, they moved right into a tentative job offer, pre-employment, and background before they left for the day. So something that would take upwards of three to four months or more, we consolidated those efforts down into a single day, one, to help candidates with time, and two, to really try to put some focus on an expedited hiring process to get individuals in the door quicker.

Is your sense that from this report here that we've been provided that there is a 40.18% vacancy rate?

I don't know about that rate in particular. I think it also depends on the classification. So psychiatrist is currently one of the higher vacancies that we have.

There's staff psychiatrist classification.

I don't have that off hand right now.

You all knew that you were coming to this committee to speak to issues related to vacancy rates, right?

Yes, Madam Chair. I can speak a little more to that if you'd like.

Please go ahead.

Great. I think one of the differences in counting is whether we count registry psychiatrists as fill rate or not, essentially. So if we have registry psychiatrists seeing patients, we count that as full. We prefer civil service, as I mentioned, we continue to recruit for that. But a doctor seeing a patient is a doctor seeing a patient. And so in that respect, we are 89% filled. And I'm speaking directly from the court filing. Counted the way the court wants to count it. Nothing like we don't decide. That's done with the court, and they want it as direct as possible, and that's how they count it. Madam Chair used to being in court, as you can tell.

I wish. Dr. Bussey, you want to respond to that?

Yeah, no, I appreciate what Dr. Mehta says. We got this from CDCR two months ago. This is directly from CDCR. And I would accept the fact that you use contractors to fill it, but just do the math here. If anyone has a calculator, we had 185 doctors in that classification, including telepsychiatrists, which Dr. Greenberg is going to talk about in a minute. There's a real difference. And so if you add the going up to 89%, I can't do the math that quick.

But it's got to be, whatever, 70, 80 people. If you're at 90% of 310, that's about 270. So that's an extra 90 people. Multiply that times $800,000 a year. What these contractors make, that's $72 million right there. That's why we're here. The state is not using its money efficiently by paying these guys a little extra money here instead. The continuity of care is bad for the contractors, and the incarcerated inmates don't trust them. I'm going to ask Dr. Greenberg to talk. Oh, sorry.

I actually just want to make sure that my colleague has an opportunity to ask a question and then we'll move forward.

Well, I really appreciate that. Actually, I just wanted to make a comment sort of going off what you said a little earlier. And I say this respectfully, but I got a lot of places I could be right now, and I take this job very seriously. Otherwise, actually, the Budget Committee is kind of run on autopilot with the chair. But I'm here to learn on the things that we have to be voting on.

And I think the Legislature and the chair said it great earlier that the Legislature has to present a budget. But the only place we receive numbers on this entire item is on mental health staffing, recruitment, and retention. And the only place we've received information on what the staffing looks like is from the union. And we're asking these questions about some specifics and things like that so we can formulate the budget and there aren't any answers to it.

So it's a little frustrating because we want to be able to provide input and make the budget and things like that. And I can't make an educated decision based on their comments because I don't have anything to go by other than the information they provided. So I just wanted to give my little tirade right there. But thank you for listening to that.

Okay, I just have a couple more questions then. Thank you. I want to move a little bit onto the opportunity costs or the magnitude of the costs related to Coleman and kind of the court orders and let's talk about the $72 million for contractors that we are spending. Does CDCR have any strategies or understand or can they provide any information? Can you all provide any information about approximately what percentage of our prisons are out of compliance with the court order?

Yes, it depends on the classification. So we have a much greater shortage in psychologists and social workers than we do in psychiatrists. Salaries are different, so the amount that we pay for each one has to be added up that way. But if we're talking about psychiatrists here today, I wish we had given this to you. I'm so sorry about that. We will provide this information afterwards. As I mentioned, it's from our public filing. We really want that to be as transparent and open as possible.

So my apologies on that front, but it is laid out by institution and it actually also includes supervisors. So we just started counting supervisors at the court's order over the last six months or so, five months, and we're again 89% system-wide. So 90%, which is the court cut-off, we would like 100%, but the court cut-off is 90% is the majority of our institutions at this point. That's counting telepsychiatry and contractors.

Dr. Greenberg, did you have a question?

I just want to add one thing to clarify that telepsychiatrists can only work in what's called the lowest levels of care, or EOP. They do not work crisis bed, they do not work in ICF. They do not work in the PIP. They're not allowed to. They're not capable of doing it. Those are the sickest and most severe mentally ill patients. And that's where you have almost all contractors, too, because there's no recruiting going on for line staff psychiatrists.

Let's move a little bit to their recruitment because that was raised before. I think both Dr. Greenberg and Dr. Mann did offer some, I think, some opportunities for being able to move forward. And this report, I think, definitely lists some opportunities for recruitment and retention. On the recruitment side, can you share some of the strategies that you are using? You mentioned some at the outset, but have you engaged at all with UAPD on additional recruitment measures?

So I'll talk about the general recruiting first, and then Dr. Mehta may want to weigh in on the collaboration with the labor organization. So in addition to posting on the state calcareers account or system, we also have a California Correctional Healthcare Services CCHCS careers site. And so that site highlights all of the mental health classifications as well as other classifications that we're recruiting for and funnels those individuals into candidate engagement with our centralized hiring and unit, and from there they are connected with a recruiter.

They also have the ability to connect with a mental health professional. We can talk HR, salary, benefits, and all of those things related to civil service, but we want them to have a partnership and a connection to a mental health clinician that can talk to them about the experience in working with civil service. So we do a balance of that recruitment effort. Additionally, in our hiring events, we use a combination of media outreach. We use media that's radio advertisements. We do billboard marketing.

We send advertisements out to the geographic location within the surrounding our institutions to connect. We do an internal canvas because we still realize that some of our best recruiters are our state civil service employees that work for us now. And so we do a highlighted vacancy blast to say where we're going to be. We make an end in process that day. It's usually a multi-day event. We also do some candidate outreach with the colleges.

So we have between an electronic platform as well as going on site to colleges where we are doing a kind of meet the expert, lift the veil of corrections and mental health professions and career opportunities. And so we use a number of strategies between social media, healthcare network marketing, and other factors to try and attract these candidates into the system.

Are there any recruiting efforts that the folks from UAPD want to offer?

If I may, as listed in the recommendations in front of you, we spent six months after a failed bargaining session, I think it was 2020, with CalHR brainstorming ideas. Now, you see, the first executive summary is the state's idea of what recruiting is. And even they admit that. Consider adjustments to the ranges. Of course, Judge Mueller employed a firm to do that. Special master agreed to the 15% raise. It says expand practice groups, modifications to on-call.

These guys get $11 an hour to be on call a week. $11 an hour. The contractors at least 50 and maybe more dollars an hour. So we wanted to modify that and give a recruitment bonus like Kaiser does. In our executive summary, which is in the third and fourth pages, we were a little more specific.

Referral and retention bonuses, the 5% bump for the on-sites, a golden handcuff as Kaiser does, $75,000 up front, and a little more business-oriented and imaginative types of attractions to people, because they're not coming. They're just not coming here. So let's get a little creative here. And that's what the six months are for. And as I mentioned before, we wanted to give this to the Legislature in February 21. They did not let it out until Senate Pro Tem Atkins called the department at the end of the session in September.

So this is live ammunition. These are good ideas. Obviously, you know, we've got the May revives coming in this speaker. We have a letter to Governor Newsom from. I can show it to you from last time if you want to see it, but it just is a joint letter asking him to intervene with a Legislature to address this issue.

There was a $20 million ask last year for recruitment and retention bonus and actually, that's to start the ball. We realize bargaining is the way to go, but I've been here since 2000-1999, and negotiating with CDCR is like talking to a wall. I hate to say that, but they're the toughest people ever been to. We had out of desperation to go to the Legislature. We have the opportunity, I really appreciate that, to talk to you from the heart about this problem. It's not going away.

And so it's not only the patient safety and the morale-busting of working next to a guy that makes half of what I meant of what a contractor makes, but it's the taxpayers. I said 72. It's probably 100 million. It's hard to know with CDCR because we don't have any information. If you'd like to see the letter, I can give it to you, but it basically says to give these guys up front a bonus. It will help jumpstart, hopefully, the negotiations. But we need some infusion of goodwill from the department to make this problem go away.

Thank you. I appreciate that. And just my final question is around the accumulated penalties that Dr. Mann referenced a bit and the categorization of those penalties in our overall budget for the CDCR. So do you all have a sense of the costs, the accumulated costs of the penalties from the courts related to the Coleman remedial measures?

The recent court orders or a different perspective?

Let's start with the recent court orders.

Okay, got you. So it is very early days with those right now. The courts themselves have not decided how they're going to measure certain things, such as compliance with some of the suicide prevention mechanisms. Some of them are measured once a month. And the court is saying you'll be fined a certain amount every day. But we don't check every day. We've gotten no information yet on how many of those things will be measured. But the suicide prevention is one of the orders.

The second is obviously the 90% staffing rate. And the third one is the transfer timelines, patients getting into inpatient beds, which we're working on as well. DSH is our co-defendant in the case. And we're trying to get more patients out to the community and into places where they don't even have to be in prison, which, by my perspective, is great as well. I should say less than four years ago, I was seeing patients. I saw patients for six years. I was a proud union member.

I encourage all of our doctors today to join the union and advocate absolutely agree with their principles. We're working for the same goal, and the recent court orders were really kind of a bit of a slap in the face. We thought we had been working well with the court all this time and come to realize that we had very different views there. So we haven't yet been able to determine exactly how much the recent court orders are going to fall on us.

Thank you. Well, Dr. Mehta, I definitely appreciate your interest in being as transparent as possible and providing us with some sense of what is happening here over time. I saw you nodding your head a lot during the comments that were made by the other panelists, and I definitely think that your intention is, as you said, we share the common goal of making sure that our folks who are incarcerated have the kind of quality mental health services that they need.

We also recognize that we have a huge deficit in the number of staff associated with being able to do that. And it sounds like we are very challenged in terms of our retention, our recruitment efforts, and certainly there seem to be some very good offerings around how to be able to retain the staff that we need to be able to do that in our mental health providers.

Do you want to offer any promising opportunities for us to be able to actually consider the recommendations that have come through with this UAPD report or anything else that might give us a ray of hope around having something better happen?

Yeah, I do think as the market is kind of, the job market is kind of resettling after the shock of COVID and people moving and working from home and things like that. I think it's moving in a positive direction where we will be able to provide more services to the really hard-to-reach institutions that are far away, possibly by keeping all of those patients at a lower level of care and providing for them through telepsychiatry.

But a lot of the things that we're doing, the pay differential, the $5,000 bonuses, are really directed towards those on-site people. The 15% only applies to civil service, on-site psychiatrists, not telepsych, not registry. And so we're directing our attention, I think, in the right way, and we would always like to do more.

I am concerned that I think both Dr. Mann raised the issue as well as Dr. Greenberg, that it seems like the people who need the highest level of care are not going to be able to be provided care through telehealth and telepsychiatrists. So I don't know if Dr. Mann, you have a comment that you want to make about that or anything else.

I just wanted to answer your previous question about if we had any ideas. The bottom line is salary bonuses, $5,000 bonuses is not going to make people stay. People are going to come in and out of civil service or come in and out as contractors, but they're not going to stay unless our salaries are competitive. We are not competitive with the community, let alone competitive with contractors.

During contract negotiations, UAPD has tried to work with the state but nobody seems to know how these salaries can be adjusted to market value. Nobody seems to know. And I can ask CDC management right now, nobody knows who can make that change. So that's a question I keep asking whoever I can ask. Thank you.

Thank you. And just as a point of clarification from CDCR, are you all in agreement that we are able to provide the highest quality of care for people who are incarcerated, who have serious mental health issues from people who are not contractors, who are able to do things like take on the huge risks associated with providing care, be on-call, be in-person. Is that the standard of care that you are hoping that CDCR is able to provide?

Yes, we would like to provide the best possible care to our patients. Yes.

Thank you. All right. I appreciate all the panelists for coming forward. I don't have any other questions, and I don't think my fellow committee members do either. So thank you for bringing this forward.

Thank you.

Thank you.

Thank you. Thank you so much. Why don't you just go ahead and email it to us or something? Thank you. I want to thank the panelists for the robust conversation we've been able to have and for us being able to, our committee members for being able to take our first votes of the year on the budget. And with that, we will be now moving on to public comment, starting with anybody in the hearing room. Each person will have one minute for public comment.

Next, we will turn to the phone lines. The phone number to connect is on the committee website and on the screen. If you are streaming this hearing, that number is 877-692-8957 with the public access code being 1315437. I don't see anybody in the room, so we will move to the phone lines.

Ladies and gentlemen on the phones, for comment, please press one, then zero at this time. You'll be provided with a line number. When you hear your line number called, that'll be your opportunity to comment. Once again, press one zero for comment. Madam Chair, we have no callers queuing up for this item.

It with that, we will adjourn this meeting.