As Cook County officials scramble to find ways to raise money — taxing guns, gambling machines and cigarettes — they have been unable to bring burdensome overtime costs under control.
County officials for years have promised to rein in overtime, but a Tribune analysis of payroll records shows they have largely failed, shelling out about $65.4 million in fiscal year 2011, a 1 percent drop from 2008.
The Tribune found that more than 100 county workers made at least $50,000 in overtime last year, with one hospital chef boosting his yearly paycheck to almost $118,000.
Stroger Hospital nurse Luzvilla Tortola led all county employees in overtime, making an extra $94,142 to nearly double her salary to about $190,000.
She was among 58 employees — nurses, pharmacists, a dietitian and an electrician — whose overtime made their 2011 paychecks fatter than that of Cook County President Toni Preckwinkle, who made $153,031.
Tortola said she has worked back-to-back 16-hour shifts in Stroger Hospital's neonatal intensive care unit, adding that a shortage of nurses drives up overtime costs.
"I know you want to cut overtime because there is no budget, but that is wrong," Tortola said. "You are not dealing with dummies, you are dealing with lives."
For decades, county officials have struggled to cut back on excessive extra work hours, which stress the county's resources and experts say can put workers, hospital patients and jail inmates at risk.
County lawmakers in 2005, concerned about financial and safety issues, placed a cap on the number of overtime hours employees could work in a year. But the Tribune found that hundreds of employees from 2008 through 2011 routinely exceeded that limit.
Preckwinkle, who took office in late 2010, said officials are tackling overtime among a number of workplace issues.
"We understand that we have a constellation of issues here around who shows up, whether they get overtime, how often they use family and medical leave, all that," Preckwinkle said. "It became apparent to us in the first two years that these are issues that we have to address."
Preckwinkle has cut overall county spending by about $100 million since taking office, and she eliminated the despised penny-on-the-dollar sales tax increase passed under her predecessor, Todd Stroger.
But other county fees and taxes continue to rise.
County commissioners this month approved a $2.95 billion budget for next year that places a $25 tax on new gun sales, a 1.25 percent use tax on out-of-county purchases of more than $3,500, a $1,000-a-year tax on slot machines and $200-a-year tax on video gambling terminals.
Those taxes, coupled with some fee increases, are projected to raise $41.7 million — about $24 million less than what the county spent on overtime last year.
But Preckwinkle's administration says that spending is coming under control, estimating that overtime in 2012 will drop by about $4 million.
Overtime is highest in the Cook County Health and Hospitals System. The system, which serves as a safety net for the poor and uninsured, runs Stroger and Provident hospitals, Oak Forest Health Center and 16 health care clinics.
The Health and Hospitals System accounted for about 61 percent of the total overtime paid. And in each of the last four years, the health system has exceeded its budget for overtime, running up about $40 million a year.
Dr. Ram Raju, who in fall 2011 became chief executive officer of the county's health system, said overtime is "a concern" of his and he is working to reduce it.
However, Raju said he expected that overtime levels would remain roughly the same in 2012, for a variety of reasons, including nagging nurse shortages, staffing for May's NATO summit and increased violence that led to an uptick in emergency room visits.
"It is not one thing," he said. "(There are) so many different facets to this overall issue."
Experts say excessive overtime can harm patient care.
The American Nurses Association cited a 2004 federal study that concluded that working long days increases the likelihood of medical mistakes. The study, commissioned by the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services, found that nurses who work shifts longer than 121/2 hours were three times more likely to make an error.
Working more than 40 hours in a week also "significantly increased" the risk of mistakes, according to the study. More than half of the errors involved administering medication to a patient.
In response to a 2005 Tribune story about excessive overtime, Cook County commissioners unanimously approved a policy that capped workers' overtime hours. The policy prohibits employees from working more than 624 hours of overtime per year, except in emergencies.
The Tribune's analysis of 2011 payroll records, however, found that 396 county workers — 303 of them in health care — eclipsed the 624-hour cap.
Preckwinkle and Raju said they were unaware of the overtime cap.
Commissioner Larry Suffredin, D-Evanston, said he was surprised Preckwinkle and Raju did not know of the cap and that he was disappointed that overtime hours were still an issue.
"The reason we passed that ordinance was because we thought it wasn't healthy for anybody to work those kind of hours," Suffredin said. "It opens us up to greater liability on a number of fronts, potential workers' compensation and potential lawsuits."
Tortola was paid last year for 1,411 hours of overtime, averaging more than 27 extra hours every week. She was one of three nurses, all at Stroger Hospital, who logged more than 1,400 extra hours.
Tortola said she often volunteers to work overtime because she is the main breadwinner in her family and also financially supports relatives in the Philippines.
"It's something that I want to do," Tortola said. "I need it financially. That is the No. 1 reason you need to do overtime."
Nurses at Stroger Hospital, the system's flagship facility, accounted for the 10 biggest overtime earners.
Although Illinois law prohibits mandatory overtime except in emergencies, the nurses union said nurses at times feel pressured to work longer hours.
"They say they're not forcing you to work overtime, but you can't walk away from your patient," said Martese Chism, chief nurse representative for the union at Stroger Hospital. "You know, you could say, 'No.' But you don't want to go home, you know, sleep with that on your conscience if something happens."
Christine Zook, the National Nurses Organizing Committee's labor representative at the health system, said that if the county wants to decrease overtime, officials need to hire more nurses.
Health and Hospitals System officials estimate there are nearly 250 nurse vacancies systemwide, which they plan to fill in the next few months.
"They are not hiring enough people to make up for attrition, and they are (making up for) it with overtime," Zook said. "A lot of nurses will work overtime, but you get burned out at some point and you just can't do all the hours. So it is a pretty dire situation."
Raju acknowledged that relying on overtime to maintain staffing levels was a "flawed strategy."
But he said overtime has not had a negative impact on patients, saying he balances patient care with nurses' fatigue.
"Sometimes I need to walk a fine line between both," Raju said. "We will make sure that we are able to provide care, at the same time ... I don't want burnout nurses."
Sheriff's OT increases
The sheriff's office, the second-largest county agency behind the hospitals system, has seen overtime increase about 25 percent in 2011 compared with 2008.
The big driver of overtime is the sprawling Cook County Jail, which houses about 9,700 inmates, a couple of thousand of whom have complex mental health issues. Of the 44 sheriff's employees who totaled more than 624 hours of overtime last year, 37 worked in the jail.
A correctional sergeant, Annette Thomas, worked more overtime hours than any other sheriff's employee — 1,445. Thomas could not be reached for comment.
Frank Bilecki, a sheriff's spokesman, said jail overtime will come down with the hiring of more than 700 correctional officers, currently under way.
The hiring of more correctional officers is the result of a 2010 agreement between the sheriff and the U.S. Department of Justice, which had found squalid and unsafe conditions at the jail. Until those hires can be fully made, correctional officers have to work overtime to make sure the jail meets federal guidelines, Bilecki said.
"For the safety of detainees, staff and visitors, a certain number of correctional officers need to be in place to secure the jail," he said.
One of the biggest overtime earners was not a jail employee but a sheriff's police radio technician, Stephen Pamon. Pamon logged 1,442 overtime hours last year, according to payroll records. He worked so much overtime that he more than doubled his salary to nearly $112,000.
Pamon said there was a good reason for that. He said his work was part of a federal grant, the Urban Area Security Initiative — a Homeland Security grant program. The program is to improve regional emergency preparedness in the wake of the 9/11 terrorist attacks.
Under the program, the county will be reimbursed for all of Pamon's overtime, said Undersheriff Zelda Whittler. "We are on top of overtime, and we're addressing it by being fiscally responsible," she said.
What's Pamon done with the extra money? "I don't have time to spend it because I'm working so much," he said.
Another energetic employee was Robert L. Scott, a chef at then-Oak Forest Hospital. Scott's regular salary in 2011 was $64,822.44, but with overtime he was paid $117,983.96 — boosting his salary by about 82 percent.
He said he resented questions about how much he earned in overtime, saying he should be congratulated for working so hard.
Scott, who has since retired, said he earned his overtime because people failed to come to work.
"When people don't show up for work, you need overtime," he said. "When you are involved in patient care, you can't just abandon these people.
"I believe in this country when a person works, you must get paid, not with some slap on the back or a pat on the butt," Scott said.Copyright © 2014, Los Angeles Times