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Prison Medical Articles

Dying on our dime
California's prisons are teeming with older inmates who run up staggering medical costs.
By andra Kobrin
Sandra Kobrin is a Los Angeles-based freelance writer.

June 26, 2005

The stench of manure from a nearby fertilizer factory slips past the razor wire and the sharpshooters manning the watch tower. The smell follows the inmates everywhere, from the grassy courtyard where they read or play ball to the two-woman cells decorated with family pictures to the TV rooms in each dorm. There's no escaping it. 
Older prisoners —A Los Angeles Times Magazine article Sunday about the increasing number of elderly prisoners in California prisons incorrectly stated that former Gov. Gray Davis said that murderers would leave prison during his term only "in a pine box." Although others have characterized his policy in this way, Davis did not actually make this remark. In addition, the article incorrectly stated that Gov. Arnold Schwarzenegger "is on exactly the same page" as Davis when it comes to releasing murderers. The governor, in fact, has granted parole to 84 convicted murderers whose sentences made them eligible for release, whereas Davis allowed five to be paroled. Also, the article incorrectly referred to the location of the California Institution for Women. It is in Chino, not Corona.

Yet as state prisons go, the California Institution for Women in Corona is considered a pretty place, almost as inviting as a suburban college campus. Sometimes there's a salad bar at dinner. Still, no one really wants to live here. And, more emphatically, no one wants to die here.

It's still dark when inmate No. 41465 wakes up to begin her day. The shrunken 82-year-old changes from her pajamas and pink house coat into jeans and a denim shirt labeled California Prisoner and begins her drill: breakfast at 6, sack lunch pickup at 6:30, infirmary at 7, where she acquires an ankle chain, belly chains and handcuffs. She then hobbles to a van for the 40-minute ride to Riverside Hospital for dialysis beginning at 8. Helen Loheac suffers from chronic renal failure, a condition that she figures costs the state $436,000 a year, not counting the two $24.75-an-hour armed corrections officers who guard her, all 5 feet and 90 pounds, for up to eight hours a day three times a week.

The financial toll of incarcerating senior citizens nationwide is staggering. Eyeglasses, hearing aids, medications and therapies, often for chronic or terminal conditions, compound the $30,929 annual average tab for housing a young, robust prisoner.

Penitentiary conditions accelerate aging, adding physiological years to the lives of men and women who in many cases compromised their health before getting arrested. They tend to get sicker than non-inmates with the same illnesses, in part because diagnosis and treatment arrive late. They're particularly vulnerable to diabetes, heart disease and hepatitis.

California spends two to three times more a year housing inmates over the age of 55, of which there are 6,400 currently incarcerated in state facilities, according to the Department of Corrections. A state Legislative Analysts Office study projects that the number of inmates over 60 could hit 30,200 by 2022, costing the state at least a billion dollars a year.

Sentencing reform is the primary culprit. The state's 1994 three-strikes law mandates life sentences without parole for certain repeat felons, and these recidivists—42,240 second- and third-strikers as of June 2002—will inevitably grow old and die in prison. Other than parole, the only ticket out of prison is compassionate release. Designed to liberate inmates who have six months or fewer to live and no longer pose a public threat, this legislation has emancipated an average of only 12 people a year since 1997. Inmates sentenced to life without parole or death are ineligible.

Californians overwhelmingly supported the three-strikes law 11 years ago, and so far they have deflected attempts to soften it. Without reform to reduce the number of "lifers," the best hope of containing healthcare costs lies within a recalcitrant system.

"She may have done some heinous or criminal act in her day, but at this point she's not a risk to the state any longer—other than fiscally," says state Sen. Gloria Romero (D-Los Angeles), chairwoman of a select committee overseeing the correctional system. "We are locking up the elderly at the expense of building schools for students and keeping university fees down, and we can't pretend that it's not happening."

Do Californians want to spend a billion to keep old, feeble inmates from roaming the streets, even if it's in wheelchairs? Many people say yes. They believe in throwing away the key—no matter the cost.

"We believe if people commit a crime and have been tried, judged and sentenced, they need to serve the time," says J.P. Tremblay, an aide to Roderick Hickman, secretary of the state Youth and Adult Correctional Agency. "Just because we're in a budget crisis, we can't make crime-and-punishment decisions based on fiscal concerns."

Hundreds of those old inmates each cost the state $400,000 or more a year. Loheac entered the California Institution for Women 13 years ago, at age 69, upon being sentenced to 25 years to life for conspiracy to commit murder. She says she thought she was just doing her troubled son a favor in handing off a wad of cash to a man. That man was an undercover cop, as it turned out, and the money was for a hit.

In California, a life sentence almost always means just that, even if the Board of Prison Terms recommends parole. Former Gov. Gray Davis, a Democrat, stated that murderers would leave prison during his term only "in a pine box." Republican Gov. Schwarzenegger is on exactly the same page.

In the 1950s, California became the first state to operate a prison specifically for elderly inmates, but it closed in 1971 when the prison population dipped. Today, old felons are sprinkled throughout the 163,939-inmate system, though federal studies indicate that mainstreaming ultimately costs more than establishing specialized units. Once ahead of the curve, the state now lags in adjusting to demographic realities.

"Something needs to be done now or [California] will lose programs. Parks, schools and highways will suffer due to the cost of the elderly in prison," says Jonathan Turley, founder and executive director of the Project for Older Prisoners, a Washington, D.C.-based organization that develops ways for states to lower geriatric expenses. Turley studied California's elderly inmates and presented his grim findings in front of the state Senate in early 2003. In the past two years, however, there have been no serious proposals to address the issue.

Meanwhile, it took more than five years for the state corrections department to act on its own 1999 report urging the creation of an internal task force to assess elder healthcare needs and identify what training corrections officers will require to meet them. Again, no new programs are imminent.

"We need to look at different correctional strategies that have worked for other states," says John Dovey, chief deputy director of the corrections department. "We're looking at a monumental task in dealing with our elderly."

Proposition 66, an attempt to soften the three-strikes law led by Joe Klass, grandfather of the Petaluma girl whose murder by a chronic recidivist stoked the original legislation, failed at the polls last November, losing by 5.4%—634,000 votes—after Gov. Schwarzenegger rallied at the last minute for the opposition. But reform efforts are still alive. State Assemblyman Mark Leno (D-San Francisco) recently introduced a bill that would reduce the three-strikes prison population through new sentencing guidelines.

"The goal needs to be public safety, not the psychological satisfaction that someone is being punished for a crime," says Ryan King of The Sentencing Project. "If California continues to admit 1,200 three-strikes felons annually, by 2026 there will be 30,000 third-strike inmates serving sentences of 25 to life at the cost of $750 million a year."

And the state will pick up the entire tab for their healthcare, just as it does for wheelchair-bound Corona inmates Norma Jean Jackson and Carol Hargis, both of whom have served more than 25 years on their seven-to-life sentences. Both women have also lost bids for compassionate release. The 74-year-old Jackson suffers from the effects of a stroke, heart disease, diabetes and arthritis. Hargis, 64, is dying of chronic pulmonary disease.

The California Medical Facility is a prison compound off a two-lane road on the fringes of Vacaville, a quiet town 30 minutes from Sacramento. Visitors who roll down their windows might get a whiff of cow as they pass dairy barns en route to what looks more like a dilapidated office park than a place of healing. Inside, leaking pipes hang duct-taped to the ceiling and to wall after cracked wall—except in one special hallway where automatic double doors swing open. To cross the threshold from the prison into the hospice is to go from Kansas to Oz.

It's New Year's Eve, and a lighted Christmas tree stands by the visitors room, which is decorated with paintings by inmates, mostly pastorals, and drawings by schoolchildren. Metal bars are hidden behind the window shutters. More nurses than guards patrol the rooms, where occupants either watch TV or just stare the stare of the very sick.

Frank Parker wears a bright orange jacket marked Sight Impaired as he wanders behind his three-pronged cane from bed to bed, saying hello, changing the channels, delivering gossip from the units and offering comfort to the dying.

"He's a real sweetheart. Really helpful, really kind," says prison chaplain Keith Knauf.

Now 72, Parker is serving 15-to-life for murdering a man who he believed was having an affair with his wife. His time in prison, 20 years and counting, has not been easy on him—or on taxpayers. So far, doctors have treated Parker for three strokes and two heart attacks. His surgeries include heart bypass, knee replacement and cataract, which left him blind in one eye. Parker gulps down 15 pills a day. He has been denied both parole and compassionate release while racking up, by his count, more than $1 million in treatment.

If he were released, Parker says he would return to his home in Northern California and let the federal Veterans Administration pick up his medical bills. "I can't blame anybody but myself for being here," he says. "I don't want to be a burden to no one. Who in the world am I going to hurt, an old, crippled man like me?"

As he makes his usual rounds on this cold winter day, Parker ends up at the bedside of one of his regulars. Eighty-year-old Claude Hoffman, sits on a bed covered with a patchwork quilt handmade by the ladies of Shepherd of the Hills Lutheran Church in nearby Vacaville and watches a small TV. Though most inmates in the eight-cell unit pass away within a few months, he arrived more than a year ago ready to die of lung cancer and chronic obstructive pulmonary disease. His stay, not including medications, costs the state $1,500 a week, three times as much as a healthy prisoner.

Hoffman was sentenced to 15-to-life for killing his girlfriend about 18 years ago, an act he committed while drunk. Now a born-again Christian, he spends most of his time writing to and about Jesus:

"I used to struggle for power

An empty lonely thing

Now I am on a first-name basis

With the King of Kings."

"Every day I ask Christ our Lord to take me off the state rolls and let me go home to die," he whispers, using his inhaler to draw a breath before continuing. "I could get veterans benefits. Financially, I could take care of myself, instead of it costing the state to watch me die."

Despite the establishment of a compassionate-release program for terminally ill inmates, from 2000 to 2002, only 30% of the applicants left the penitentiary to die. And the state is even more reluctant to release "lifers."

The application process is so long that many inmates die before the decision is made. First, a prison doctor must write a recommendation stating that death is expected to occur within six months. If the applicant is a non-lifer, the paperwork then bounces from the warden to the director of the corrections department to the original sentencing judge for final approval. However, if the applicant is a lifer, as most elderly inmates are, the case also requires the approval of the Board of Prison Terms before it's sent to the original sentencing judge. In 2003, of the 48 inmates who applied, 16 received board recommendations and only 10 were released.

Last year, state legislators passed a bill to open the compassionate-release program to permanently medically incapacitated prisoners, such as a prisoner who is a quadriplegic, in hopes of saving millions of dollars. The Los Angeles County District Attorney's office backed the plan. But Gov. Schwarzenegger vetoed it, arguing that the legislation lacked "any mechanism to return these prisoners to custody" if they either recovered or posed a threat to public safety.

The veto shocked Cynthia Chandler, an attorney for and co-director of Justice Now, an Oakland-based advocate in compassionate-release cases. "Schwarzenegger says he was going to be serious about the budget crisis and move beyond partisan politics and reform corrections," Chandler says.

Other cost-saving measures used in other states have yet to gain traction in California. One involves creating minimum-security units for geriatric prisoners and staffing them with fewer, but specially trained, corrections officers. Another hinges on releasing sick inmates who have the potential to tap Medicare, Social Security or veterans benefits and tracking them via a $10-a-day bracelet system.

But Turley, of Project for Older Prisoners, believes California will get the largest return through a systematic release program like the ones he helped implement in Virginia, Maryland, Louisiana, North Carolina and Michigan. Conservatives and liberals embrace that approach, Turley says, because it's based on risk. "We can predict recidivism pretty well," he says. "If California created a Project for Older Prisoners office at a law school, like in other states, it would help remove prisoners that are low risk and high cost. They gain cell space and save dollars. A win-win situation." The state should also look into creating an alternative incarceration program, and look into working with its public health programs and its universities to supply medical care to inmates, Turley adds.

Kidney patient Helen Loheac, in Corona, sees a simple solution for her case: release. She would live out her remaining time in a small room saved for her by the nuns at Crossroads in Claremont, who often reach out to inmates. Sister Terry Dodge has said she would take her in, and Medicare would pay for dialysis.

Frank Parker would return to his family in Northern California, as would Claude Hoffman.

The release of many elderly prisoners would shift the financial burden of their health and welfare from the state to the federal government. It would free state funds to not only help balance the budget, but pay for schools, parks and highways.

As with so many matters of public policy, the obvious solution sometimes seems out of reach, bogged down in legitimate disagreements between opposing sides.

Many advocates for the elderly in prison, including state Sen. Romero and The Sentencing Project's King, believe three-strikes reform is the only long-term solution. "We need to look at our sentencing legislation and what's putting those people there to begin with," King says.

The governor's administration disagrees. "There's nothing wrong with the sentencing structure in California," says Tremblay of the state Youth and Adult Correctional Agency. "And we're certainly not emptying out our prisons to balance the budget."

So Claude Hoffman waits. The Christmas tree gives way to chicks and bunnies as he marks his second Easter at the hospice. Baseball season opens. Hoffman dreamily recalls seeing Babe Ruth and Hank Greenberg play in Detroit, his hometown. He hopes to watch a game with his family, one last time. 

U.S. prisons turning into incubators for infectious diseases 
HIV, hepatitis C, tuberculosis rampant 
Fox Butterfield, New York Times
Sunday, February 2, 2003 
©2003 San Francisco Chronicle | Feedback

URL:  http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/02/02/MN139615.DTL

Mount Pleasant, Mich. -- Marva Johnson was thrilled when her longtime boyfriend, Randy Vallad, was paroled from prison in 1999. 

They went back to living together, and once when he got a bad cut on his head, she took care of him. She was splattered with his blood, but the couple did not think anything of it at the time. 

It was not until Vallad was sent back to prison in 2001 for a parole violation that he accidentally was shown his Michigan Department of Corrections medical records. They reported that Vallad had tested positive for hepatitis C, a blood-borne virus that can cause potentially fatal liver disease, when he was first admitted to prison years before. 

"They knew and didn't tell him," Johnson, 33, said from this small city in central Michigan. "As a result, they also let him infect me." For the past 11 months, she has been taking a powerful, enervating course of drugs for hepatitis C. 

Such cases are becoming increasingly common across the United States, as jails and prisons have become giant incubators for some of the worst infectious diseases. 

According to a recent study, an estimated 1.4 million inmates released from jail or prison in 1996 were infected with hepatitis C. That was 31 percent of the 4.5 million cases of the disease nationwide. 

Similarly, newly released inmates accounted for 35 percent of the 34,000 Americans with tuberculosis in 1996, the study found. And newly released inmates also accounted for 14 to 17 percent of all Americans infected with HIV, the study estimated. 

The problem has become so acute that health care officials and prisoner rights groups are calling for widespread testing of prison populations for hepatitis C and faster treatment of prisoners. 

"This is a public health problem that has been growing and growing, but we are reluctant to do anything about it, because these are bad guys," said Dr. Robert Greifinger, a former chief medical officer for the New York State Department of Correctional Services and the author of the study, which was commissioned by Congress and prepared for the Justice Department. 

The issue has become so pressing that the federal Centers for Disease Control recently held a conference on the issue in San Antonio for prison medical officers. At the conference, the agency said public vaccination efforts against hepatitis should be extended to prisons. 

The centers also issued new guidelines urging states to test all prisoners with a history of intravenous drug use and other risky behavior for hepatitis C. Sharing of needles and unprotected sex are common ways the virus is spread. 

The problem is not that large numbers of prisoners are contracting hepatitis C while incarcerated, experts say. Most were infected years ago. The experts say the high rate of communicable diseases among inmates is a critical issue for two pressing reasons: the danger that inmates pose of infecting others when they are released, and the opportunity to treat them that is now being largely wasted. 

Greifinger noted that Americans tend to forget that most inmates eventually return home. 

In 2000, about 9 million people were released from jail and prison, according to Allen Beck of the Bureau of Justice Statistics, the statistical arm of the Justice Department. 

But in a sign of changing attitudes, the Centers for Disease Control and Prevention recently made public Greifinger's report. It had been given to the Justice Department in March 2001, Greifinger said, but never before released to the public. 

In a separate action, the American Civil Liberties Union and two dozen other organizations interested in prison conditions recently issued a call for a congressional investigation into the state of medical care in jails and prisons. 

"Correctional systems have buried their heads in the sand because they don't want to know how many prisoners have hepatitis C," said Eric Balabin, a staff attorney with the National Prison Project of the ACLU. 

"It's simple economics," Balabin said. "Because once prisons know, they will have to treat prisoners." Under Supreme Court rulings, prisoners are entitled to reasonable health care. 

©2003 San Francisco Chronicle


March 06, 2003 

Superbug's new strain thrives outside hospitals
By Mark Henderson, Science Correspondent 

A NEW strain of the drug- resistant superbug MRSA has escaped from hospitals to infect thousands of healthy adults across the United States, hitting hardest among homosexual men. 
The bacterium, which normally affects only sick and elderly hospital in-patients, is striking fit Americans with no links to the hospitals in which it thrives, raising fears of an epidemic that could spread to Britain. The germs, which can withstand many common antibiotics, are transmitted by skin contact, with no need for an open wound. 

Outbreaks have been reported in Los Angeles, San Francisco, New York, Boston and Miami. Most of those affected are homosexual men and prison inmates, but athletes and schoolchildren involved in contact sports have also fallen ill. Precise figures for the number of infections are not available, because MRSA is not a notifiable disease in the United States, but public health officials believe cases already run into the thousands, with several deaths. 

The disease normally manifests itself as a skin condition, beginning with sores that resemble insect bites, and progressing to cause painful abscesses and boils. In rarer cases, when it reaches the lungs or the bloodstream, it can cause life-threatening pneumonia or septicaemia. 

MRSA, which stands for methicillin-resistant Staphylococcus aureus, has for years been a problem in hospitals, where it infects open wounds and bedsores, taking advantage of the weakened immune systems of seriously ill or elderly patients.It is named as a contributory cause of death in 20 per cent of death certificates issued in British hospitals where staphylococcal infection was a factor. 

The bacteria, however, have never been considered dangerous beyond the wards. The emergence of a strain that is spreading through the wider community, details of which are reported today in New Scientist magazine, has alarmed public health officials on both sides of the Atlantic. Scott Fridkin, a medical epidemiologist at the US Centres for Disease Control and Prevention (CDC) in Atlanta, said: “We are greatly concerned that MRSA has emerged in the community in people with no ties to healthcare.” 

Tyrone Pitt, deputy director of the Laboratory of Healthcare Associated Infections, said that while there was no evidence that the strain had arrived in Britain, it was a genuine threat. “It is very difficult to predict its impact. If it manifests itself just as a skin infection, that is not that threatening. If the result is pneumonia in relatively healthy people, that’s a completely different scenario,” he said. 

The Atlanta centre has yet to complete testing to confirm the strain that is spreading in the community, but health officials in Los Angeles said all the outbreaks there appeared to have been caused by a strain first isolated in New York in 1997. Most of the US cases so far have occurred in San Francisco and Los Angeles, among homosexual men who have had multiple sexual partners. The disease is not thought to be sexually transmitted, but as it is contagious through skin contact, sexual promiscuity has an indirect effect on risk. Its effects are not confined to HIV-positive men. 

Several prisons in California have reported MRSA outbreaks among inmates, and there have also been outbreaks in schools, particularly among athletes involved in contact sports. In Pasadena 50 pupils at one school were diagnosed with the condition, mostly members of the school’s football team. 

On the rise 

MRSA: Methicillin- resistant Staphylococcus aureus 

First identified: mid-eighties 

Recorded UK cases 1992: 104 2001: 4,904 

Confirmed UK deaths 1993: 13 1998: 114 

Resistant to: methicillin, oxacillin, nafcillin, cephalosporins 

Susceptible to: vancomycin 


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