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March 29, 2010

Is "medical parole" the best way to deal with California's high prison costs?

The question in the title of this post is inspired by this notable new article in the Sacramento Bee, which is headlined "Watchdog proposes medical parole to cut California prison costs."   Here are highlights from the interesting article:

The man in charge of upgrading the quality of health care in California's overcrowded prisons has an idea for taxpayers: medical parole. J. Clark Kelso, the federal court-appointed prison health receiver, suggests that California could stop spending millions of dollars a year if officials could grant parole to a handful of inmates who are comatose or otherwise severely incapacitated.

"I am keenly aware, as are the courts," Kelso said, "that a dollar that we can save in the prison health care program is a dollar that can be spent on other important priorities for the state, such as education, money for children, the elderly, other health care programs."

An aide in Kelso's office said that, conservatively, the prison system could save $213 million over five years by paroling just 32 inmates identified as severely incapacitated.  Twenty-one of those 32 inmates are in nursing facilities or hospitals outside prisons, which requires spending for expensive guard time – including overtime – as well as huge health care costs.

These 21 inmates' average annual health care and guard costs total more than $1.97 million apiece – a total of $41.4 million a year for 21 individuals, said Kelso aide Luis Patiño. "These people are not even capable of realizing they're being punished," Patiño said. "Society becomes the victim, because it's paying the cost."

The 11 other severely incapacitated inmates are inside prison health centers, where their annual medical bills average $114,395 each.  Kelso's office supplied these details after he and Sen. Mark Leno, D-San Francisco, announced March 17 that Leno had introduced a bill to create medical parole.

Leno said 1,300 inmates' health care costs exceed $100,000 a year, and that up to 700 prisoners could qualify for a possible medical parole under his bill.... With medical parole, Leno said, California's prison system would save by transferring medical costs to federal programs and eliminating guard costs.  Prisoners are not eligible to enroll in federally funded Medi-Cal or Medicare, but parolees are.

California legislators passed a proposal similar to Leno's in 2003. Then-Gov. Gray Davis vetoed it, instead signing a bill to allow prison officials to contract space for inmates at non-prison health facilities.  Davis called it "a safer, humanitarian and more cost-efficient alternative to parole." Spokesman Aaron McLear said Gov. Arnold Schwarzenegger had no comment on Leno's draft proposal.  The governor has backed another proposal that would give the University of California control of the prison health care system as a way to cut the costs of treating chronically ill inmates....

But some lawmakers are skeptical.  State Sen. George Runner, R-Lancaster, generally a tough law-and-order legislator, said he thinks "it's an illusion" that such large savings could be achieved with medical parole. "Part of the problem is figuring out who this group is," he said. "If someone is truly vegetative then maybe there is a reason to consider this."...

Leno said his Senate Bill 1399 would apply narrowly to certain inmates who cannot function on their own, including inmates bedridden with end-stage Alzheimer's or on ventilators or feeding tubes.  He cited the example of an inmate with dementia, paralysis and no speech or bladder control whose two years of outside care has cost $350,000 a year, not counting guards.  Another inmate on a ventilator, Leno said, has cost more than $500,000 in the past 18 months.  Medical bills for a third inmate with end-stage cardiac disease and other complications have topped more than $1 million a year, he said.

Runner noted that California already has a "compassionate release" policy for prisoners severely incapacitated or near death.  But such releases are rare....

Susan Howley, director of public policy at the National Center for Victims of Crime, said that, if California allows prison officials to grant medical parole, victims' concerns should be heard in each case.  "It is especially important when you have a situation like this," Howley said, "where budget concerns are driving proposals.  When you say it's because of budgets," she said, "that really rubs victims the wrong way – that justice is too expensive."

Leno said he doesn't want to minimize crime victims' suffering. But legislators are facing tough budget choices, he said, and must find ways to contain prison costs, which are consuming nearly 11 percent of the state general fund. "I, for one," Leno said, "would much rather save the jobs of 35 teachers, rather than continue to incarcerate 10 comatose inmates at a quarter of a million dollars a year."

He said 36 other states have a version of medical parole, including Texas, which is putting about 100 to 170 inmates a year into that status.

March 29, 2010 at 02:04 PM | Permalink


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Posted by: darcydara | Mar 30, 2010 5:41:50 AM

Texas does indeed have medical parole, as the article says, though we use it pretty sparingly. The parole board approves only a fraction of those who the state corrections agency recommends for release, sometimes even rejecting people who require hospice care, etc., which I've never understood. The state pays 100% of the cost for prisoners; about 1/3 if Medicaid pays for hospice for a parolee.

The last number I heard: Only about 10% of those recommended for medical parole are approved by the parole board. Many TX offenders recommended for medical release pass away before the parole board gets around to their case. Around 40 inmates per month die in Texas prisons, a number which has been going up along with healthcare costs as the prison population gets older.

Posted by: Gritsforbreakfast | Mar 30, 2010 7:19:48 AM

The sole mature aim of the criminal law is incapacitation. If the prisoner is incapacitated by illness, medical parole has good justification as a cost saving.

Painful but gratifying to admit.

Posted by: Supremacy Claus | Mar 30, 2010 8:06:46 AM

At some point, courts have to come to the conclusion that the 8th Amendment does not require heroic care or even care that non-prisoners get.

Posted by: federalist | Mar 30, 2010 8:10:56 AM

fyi, I posted on this at Grits and then had this update on the Texas stats in the article you quoted:

UPDATE/CLARIFICATION: I spoke this morning with Larance Coleman at the Texas Senate Criminal Justice Committee who told me that the estimate by a California legislator of 100-170 Texans receiving medical parole each year is way too high. Perhaps, he said, over the life of the program that many have been released. Coleman said he gets monthly reports that include the number of medical releases approved by the parole board, and generally they average around 2 per month. I'm guessing the 100-170 number is how many TDCJ recommends, but the board turns down [or never gets to] 90% of them.

Posted by: Gritsforbreakfast | Mar 30, 2010 8:23:38 PM

The American response is a place called Andersonville, or Fort Sumpter, Georgia, United States of Confederacy. Go to Images on Google and look at the photos. Get some context.

Posted by: mpb | Mar 31, 2010 4:29:32 AM

Your response query i.e.: Bbzcque etc is BS. or as the Three Stooges might say: BIO, BIE, BIBICKIE -I, BIO, Bickie, Bickeio, IG.

Posted by: mpb | Mar 31, 2010 4:32:41 AM

Federalist, if it makes you feel better, in most facilities prisoners in fact do not get anywhere near the healthcare that even indigent, under- or non-insured non-prisoners get. For example, there are many, many cases of prisoners contracting and dying from treatable cancers because they were diagnosed way too late - despite symptoms that should have been obvious to a physician who had (a) timely access upon the patient's initial complaints, (b) the minimal clinical time to do a proper evaluation, and (c) the minimal facilities needed to order simple tests.

Some of these prisoners were serving sentences of under 10 years and should have had a chance to reform and repay their debt to society and return to their families on the outside.

It is true that the prison systems generally will not just stand aside and let someone die who is in the end stages of some terminal disease (and that this end-of-life care is expensive). But in too many cases, the person would never have gotten to this point had he or she received minimally adequate health care. Such failures make neither moral nor economic sense.

Posted by: Anon | Mar 31, 2010 12:27:36 PM

For sure the Medical Parole is not the best way to save money, we must look for another suggestions.

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Posted by: web design | May 26, 2011 7:28:57 AM

Such failures make neither moral nor economic sense.

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