Staff shortages and management woes at Cook County hospitals are pushing overtime to extraordinary levels, imposing huge costs on taxpayers and raising concerns about patient safety.

That’s the conclusion of an investigation by Crain’s and the Better Government Assn. into the $40 million a year routinely spent on overtime pay by county hospitals and health clinics—an amount nearly equal to the cost of running the offices of county clerk and county treasurer combined.

Overtime as a share of total hours has averaged 6.3% in recent years, well above the 4.9% limit recommended by an industry research group to prevent employee fatigue. By a slightly different measure, county overtime is nearly three times the rate reported by Chicago’s private Mercy Hospital & Medical Center, which like the county serves a mostly poor, urban clientele.

Over the past four years, 1,008 health system workers have each earned at least $50,000 in overtime—this in a county that is strapped for cash and has undergone repeated layoffs and a major political brawl over raising its sales tax.

County health system CEO William Foley agrees that overtime is excessive. He blames the problem mostly on the health system’s inability to hire more nurses amid recurring staff reductions that invoke “bumping” provisions in union contracts.

Kurt Summers, chief of staff for county board President Toni Preckwinkle, calls the situation “unsustainable” and, like Mr. Foley, promises that changes are coming.

But nurses union Director Leslie Curtis says she’s heard it before and offers a stack of detailed complaints filed by her members over several years about allegedly dangerous working conditions due to staff shortages.

Indeed, the situation dates back several years. The county board in 2005 passed a resolution saying that only in “emergencies” could someone work more than 624 hours of overtime a year—an average of 12 hours a week for 52 weeks. But records obtained by the BGA under a Freedom of Information Act request show that 182 county health staffers received “emergency” waivers and worked more than 624 overtime hours in 2010.

Though officials are trying, “the hospital somehow needs to get control,” says county board Finance Committee Chairman John Daley, pointing to $157 million in health system overtime just since 2007. “It’s management. You certainly can’t blame the nurses.”

Priorities and concerns in private and public hospitals are different, says Mercy’s president and CEO, Sister Sheila Lyne. “There’s more leeway in the public world.”

Management problems like this were expected to be addressed by a new, independent board that took control of the hospital system three years ago after a revolt against former county board President Todd Stroger. But data obtained in the FOIA request indicate only a bit of improvement, with nurses, a smaller number of pharmacists and some other employees each working as many as 1,600 hours of overtime per year.

In the four years ended last December, the number of overtime hours has varied between 955,000 and, most recently, 886,000. That’s a bit better than it was. But the amount of money spent on overtime increased to $39.3 million in 2010 from $37.1 million in 2007.

Mr. Foley, who recently announced plans to step down as CEO, says the single biggest reason for the overtime is that the system has not been able to hire any new nurses since early 2009, despite 140 vacancies. Complicating matters has been a series of cuts in health staffing as the system is redesigned. Each has set off a series of union bumping actions that delay new hires, he says.

Union rules allow those whose jobs are eliminated to take the jobs of less senior workers, who in turn can “bump” more junior workers. The process can take months.

Other factors: Compensation for pharmacists (since adjusted) was well below market rates, he says. And a new payroll-tracking system that would allow supervisors to check instantly on a worker’s overtime status has been delayed, at the request of both the Stroger and Preckwinkle administrations, while a countywide system is developed. Mr. Summers says that will happen late this year.

“We know that overtime usage here continues to be high relative to the industry,” Mr. Foley says. He adds that work on holidays is included in the system’s overtime totals, so standard overtime is about 10% less than that reported in the FOIA.

Union leader Ms. Curtis, the Midwest director of the National Nurses Organizing Committee, points to what she says are the results: dozens of detailed complaints she’s filed with the county in recent years about the implications of severe staff shortages.

For instance, according to a Jan. 11 report, five registered nurses at Stroger Hospital’s maternity ward had to deal with a patient in labor with twins, a second patient recovering from a Caesarean section, and two others headed to the operating room for delivery. Meanwhile, other women in labor were admitted.

Standard practice calls for two nurses in each delivery room, according to the union.

Another instance cited by the union came last July 25, in Stroger’s burn unit. One registered nurse and one licensed professional nurse were on hand to handle seven patients with “moderate to severe injuries,” with one needing a blood transfusion and others needing dressing changes that required two nurses each.

Shortages like that, combined with the resulting overtime, boost the risk of staff burnout and mistakes, says Chrys Suby, president and CEO of Labor Management Institute, a Bloom-ington, Minn.-based health care consultancy.

Though 5.5% of hours worked in the average teaching hospital like Stroger are overtime, anything over 4.9% invites “an adverse patient outcome” because of higher medication and other errors, she says.

High-overtime nurses interviewed by BGA say they’re doing their jobs, but they’re not happy.

“We don’t have enough staff,” says Abigail Uzoaru, a nurse at Provident Hospital who has worked 4,985 overtime hours the past four years, more than any other county health staffer.

“I fight with my husband” about all the time at work, says Imelda Allen, an emergency-room supervisor at Stroger with 1,046 overtime hours last year. “Sometimes it’s five days” of overtime in a row, she says. Something like “three 16-hour (days) and two 12-hour days. . . . It’s always packed and not enough people are working.”

A county spokesman declines to comment on any specific incident but says Stroger Hospital’s patient safety report card from the state “ranks on par with other facilities in the area.”

He also says the county system will add “about 100 nurses” in June to the roster of 1,698 in non-administrative posts.

Mercy Hospital’s Sister Sheila, a former Chicago health commissioner, says the trick is tight, constant management. Mercy only clamped down on overtime after nearly going bankrupt a few years ago, she says.

Health board Chairman Warren Batts replies that Mercy has not undergone the kind of turmoil that the county system has lately, so comparing the two isn’t fair.

Meanwhile, one silver lining: Mr. Summers, the chief of staff, says that the hospital system has cut so deeply into regular hiring that, this year, it’s saving more on regular payroll than it’s spending in overtime.

But change is needed—and coming—he says. “This (amount of overtime) is not what we should expect,” he says. “The numbers should go down and, if we follow our strategic plan, it will go down.”