Santa Clara County mental health doctors say they’ll strike next month unless they get a pay raise and a promise for more consistent schedules.

The April 7 walkout would mark the second doctors strike in California history, according to the Union of American Physicians and Dentists, the labor group organizing the protest. It would also temporarily cripple the only emergency room in the county dedicated to taking every single patient committed to an involuntary psychiatric hold, whether that’s for an attempted suicide, self-harm or some other reason.

“For so many doctors to decide to strike, things have to be pretty bad,” said union spokeswoman Patricia Hernandez.

Ninety-seven percent of the 60 county mental health doctors represented by the union voted to strike after several months of dead-end labor negotiations that left them without a working contract since October. In the meantime, the county has started demanding that doctors work weekends and evenings hours or risk losing their jobs.

Luke Leung, the deputy county executive in charge of labor negotiations, said the county will work on ways to prevent the strike. The county was unaware of the proposed strike until contacted by San Jose Inside. Leung said he looked up the press release online and that the union didn’t contact him directly.

“What they’re saying isn’t altogether transparent,” he said. “They said we rejected a pay increase, but certainly we would never do that. Pay is one of the central issues. It’s true that we rejected their number, but they were asking more than what we are willing to pay.”

As for the mandate that they work evenings and weekends, Leung said that’s commonly expected from many doctors.

“We have obligations, like a lot of people, that make working nights and weekends nearly impossible,” Dr. Jan Weber countered.

The county's contract with outside doctors to cover weekends and nights expired March 17. Those shifts have since been given to county physicians. In their new labor agreement, the physicians are demanding that they no longer have to work such hours, because they cut into their day shifts.

Physicians also have said they worry about understaffing because it forces them to cover work details outside their expertise, which has led to an increase in the use of seclusion and restraints to deal with patients. They want to see contract language to address the issue.

Weber, a child psychiatrist, said he’s been sent to work with adult patients dealing with psychiatric emergencies—an assignment outside his specialty. Hernandez said the county has made a habit of assigning outpatient doctors to cover psych emergencies in the inpatient facility and at the two jails.

“The county’s having trouble covering shifts, so they just decided they could use psychiatrists by assigning them wherever they need them,” she said. “But it doesn’t work that way.”

That only puts the patients and the doctors in danger, she added. “So what’s happening is that if these outpatient doctors haven’t worked in this situation for many years, they’re unprepared to handle it. That tends to increase the seclusion and use of leather restraints.”

Overcrowding in the Emergency Psychiatric Services clinic has also become an issue as the location can be understaffed, said psychiatrist Heather Colbert.

“When you have people waiting longer for treatment, they start to fight with each other or they threaten to harm themselves and it forces us to restrain them or resort to emergency medications,” said Colbert, who’s worked eight years for the county.

Leung bristles at the implication that the county would make conditions unsafe for patients.

“We would never refuse to address safety issues," he said. "We always want to work with patients to make sure they receive the proper care. Those kinds of statements are blatantly not accurate.”

Union members told San Jose Inside that the county wants to get rid of staff doctors altogether and replace them with contract physicians. Santa Clara County Medical Center spokeswoman Joy Alexiou dismissed the idea as rumor.

Hernandez doesn't seem so certain.

“They consistently underpay this group of psychiatrists to the point that they can’t find people to do the work that needs to be done,” she said, adding that the union thwarted an earlier effort to outsource a sizeable number of physician jobs to a private company.