With a dearth of qualified psychiatrists to work with its patients, Santa Barbara County's Alcohol, Drug and Mental Health Services Department is exploring hiring contract doctors to fill the need.
However, the $6 million price tag to bring in those psychiatrists caused several members of the county Board of Supervisors to balk on Tuesday and ask that the proposal come back for more discussion next month.
ADMHS has struggled with ongoing staffing shortages for years, and recruiting psychiatrists has been difficult due to the high cost of housing and living expenses and competition from nearby correctional and government facilities that pay more, staff said.
The department has six positions it has been unable to fill permanently, which has had an impact on patient care.
To help deal with that, an agreement would be struck with a company called Traditions Behavioral Health, a staffing service that would provide contract psychiatry services at county facilities beginning this year and continuing until June 2017.
It's a $6 million contract that would fill up to five full-time vacancies.
Current ADMHS psychiatrists Dr. Mark Kofler and Dr. Charles Nicholson spoke out during public comment, expressing concern about the contract.
Kofler, speaking for the local chapter of the Union of American Physicians and Dentists, expressed concern about the permanence of contract psychiatrists, and whether that would affect continuity of care for the patients they see.
With staff psychiatrists, he said, "they are connected to the community, they live in the community."
Kofler said doctors on staff are also more likely to speak up if they see something that needs fixing within the department, which was the case in 2006, when civil service psychiatrists alerted management of "fiscal and clinical irregularities."
He asked that the county meet with the UAPD to discuss the issue.
"For years, our medical staff has been expressing concern at the failure to maintain psychiatric staff," Nicholson said, adding that staff also have suggested how to recruit qualified people for the positions. "This contract escalates the disregard for the input of it's own medical staff."
Supervisor Janet Wolf also expressed concern about the item, particularly the $18,000-a-month cost of the contract.
"It does concern me that we have not secured our own psychiatrists … but what really floors me is the amount that we're paying for these contracts," she said.
Dr. Takashi Wada, interim director of ADMHS, admitted that "it does seem like a high amount" but is consistent with the going rate for that type of position.
Right now, the department has a number of vacancies that are long-standing in spite of their best efforts to recruit, he said.
When Wolf responded that she was having a hard time justifying that amount, Wada stated that the amount goes to addressing payroll, credentialing and insurance for the employees as well.
The cost is $340,000 per position annually, an amount county staff said was extremely comparable to other positions.
Some board members balked at the amount, including Supervisor Peter Adam.
"That's a lot of dough," he said.
Because of how the contract is written, the county would be paying the same amount whether none or all five psychiatrists were hired, which raised concern on the dais.
Wolf said it's an important detail that will have to be clarified if they moved forward, and the supervisors agreed to consider the matter again at their March 4 meeting.