Tuesday, April 20, 2010
We'll explore how the state is hoping to reduce the tens of millions of dollars it spends each year on the state's sickest inmates.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. Early this year, KPBS radio, TV and KPBS.org did a series of reports about life in prison in California. The reports were focused on the increasingly long sentences being served by prisoners and how the cost of medical treatment for elderly prisoners is rising. In recent days, more evidence has come in about just how expensive it is to treat very sick California prison inmates. The head of Prison Health Care Services says 21 of the sickest inmates cost taxpayers more than $40 million in medical bills last year. Joining us with more on the new report is KPBS reporter Joanne Faryon, host of the KPBS Envision Special: Life In Prison. And, Joanne, welcome back.
JOANNE FARYON (KPBS Reporter): Thanks for having me.
CAVANAUGH: So why is it costing the state so much to care for these 21 inmates? What are they suffering from? How are they being treated?
FARYON: Well, the largest cost is the fact that these inmates, all 21 of them, are in hospitals, private hospitals outside the prison healthcare system. The prison healthcare system doesn’t have the capability to actually care for this level of illness within the system itself. So, first of all, they’re outside of the prison system. Secondly, they have to be guarded. State law says if you’re an inmate and you leave the institution, you have to be guarded. It’s two guards, 24 hours a day, 7 days a week. So that contributes to the cost as well. And these are very sick inmates, many of them dying, however, they are longer – They are going to live longer than six months because if they were to only have six months to live, they could be eligible for compassionate release. They don’t fall under this category. So they are dying but they have still more than six months to live. Some of them are on ventilators, some of them feeding tubes, some of them end stages of cancer, some have severe brain injuries. So you add all of this together and you end up with an average cost of one of these inmates at $2 million per year.
CAVANAUGH: Now let’s put it in perspective. How much does the state spend, overall, on healthcare for its prison population?
FARYON: $2 billion, and that’s a budget that’s doubled in about two years. It’s just – it’s under $2 billion, it’s $1.8-something billion. Clark Kelso is the Federal Receiver who was put in charge by a court to oversee Prison Healthcare Services about two and a half years ago. Since he’s been in this position, the prison healthcare budget has doubled, from about $1 billion to almost $2 billion, and that’s primarily because his task is to insure that inmates have access to healthcare. And getting them access to healthcare in California has proven to be very costly.
CAVANAUGH: And do we know what percentage of the prison budget goes towards healthcare?
FARYON: Yes, about 20%. So the entire Corrections budget is between $10 and $11 billion. To put that in context, that’s about 10 or 11% of our total state general fund. And some of our listeners might recall back when the governor gave his State of the State address, one of the commitments he made is that in the future, state government should not spend more on prisons than they do on higher education, and right now we spend less on higher education than we do on prisons. Because of that statement, and, in fact, he wants to introduce a Constitutional amendment that puts this in place, but because of that we are now – you now see Prison Healthcare Services scrambling to find ways to reduce its budget.
CAVANAUGH: I’m speaking with Joanne Faryon, KPBS reporter, and we’re talking about new information from Prison Healthcare Services that a small number of the sickest inmates in California prisons are costing tens of millions of dollars of California’s budget. And I’m wondering, where do these inmates who are chronically sick go if a new policy of medical parole is implemented?
FARYON: Well, what – medical parole would do this. First of all, medical parole would not apply to those who are three-strikers, and three strikers in California means you have to serve life in prison. It would not apply to those people sentenced to life without parole or those condemned to die. Medical parole, under this proposed legislation would apply to people who perhaps are serving life sentences but with – who are eligible for parole. Where would they go, that’s a great question. And under the proposed legislation, they’re saying if these people have to go to licensed nursing homes, they would send them there. The prison system would send them there. They would still – a parole officer would still be responsible for them, and they would have to wear tracking devices. How does this save money if we’re still putting them in a nursing home? Well, if you’re in a state institution, you are not eligible for federal funds. So really what this does, it shifts at least part of the cost onto the federal government. So by releasing them out of prison, first of all, you save guarding costs, which can be quite large. In fact, I read one report that says it’s about – it can be as much as 25% of that total medical bill. And also, 40% of the medical costs, about 40% could be shifted to the federal government.
CAVANAUGH: So let’s just be clear. Let me reiterate what you said. Under this proposed medical parole idea, nobody would be released if – to any kind of – on any kind of medical parole if they were sentenced under the three strikes law, if they were a condemned prisoner, if they have received the death penalty, or if they had been sentenced to life without the possibility of parole. So, basically, that means, Joanne, we would still be caring for an awful lot of very, very ill prisoners.
FARYON: We would, however, if you look at the prison healthcare budget, the $2 billion, about 25% of that goes to costs incurred at private hospitals, which this group falls under. That’s a big part of the cost. If you look at just these 21 inmates who would fall under this very special category, over 5 years the receive estimates that the state could save more than $200 million, and that’s just from 21 inmates, releasing 21 inmates under this program. The other thing to note is that under the proposed legislation, let’s say somebody very sick is released and they get better, well, then they have to go back to prison. And, in fact, the other thing that will be considered in terms of can they be released is whether or not they still pose a threat to society. But, I mean, even the Receiver, Clark Kelso, when I interviewed him earlier, said it is absurd in some cases to be guarding somebody on life support 24 hours a day, 7 days a week.
CAVANAUGH: What do other states do in terms of providing healthcare for their longterm prisoners?
FARYON: Well, actually, that’s what the – California’s been looking at, and the Receiver’s office has been looking at. Okay, in fact, are we – how much are we spending relative to other states? And there was a recent survey done and in Corrections Compendium and that publication, surveyed all of the states and they said, okay, how much are you spending per inmate? They got information back from 38 states and of those 38 states what we learned is California, in fact, spends the most per inmate. I want to look at Texas and I’m looking at Texas because, first of all, the Receiver has been studying that state and because they have the second largest inmate population. California’s the largest with 170,000 inmates. Texas has 156,000 inmates. California spends more than $11,000 per inmate on healthcare. Texas spends $2,749 per inmate on healthcare. So how do they do it? Well, they have medical parole. They released 170 very sick inmates on medical parole last year and, secondly, they’ve partnered with their university medical schools. So a lot of the healthcare is delivered through these universities. It’s, in fact, something that California’s looking at as well. Can we do the same with the UC system here in California?
CAVANAUGH: Now I’m wondering, you know, a lot of people would say, well, you know, Texas is very strict with their prisoners and perhaps they just don’t get as good of medical care as prisoners do in California. Is there any evidence of that? Or is it really just the way you’re talking about? The medical parole plus the partnership with the state universities?
FARYON: Those are two of the things that have been touted as effective cost savers. And Texas has been doing this a while. What we do know is that despite spending more money than anyone else in California, we still have a problem with access. The courts have told California you’re not doing a good enough job, this has been – this is why we’re talking about this. In 2002, there was a lawsuit launched against California says inmates in state prison don’t have access to healthcare. Bring us all the way to 2010, they put a Receiver in charge a couple of years ago because they said, you know what, you’re – the court said, they’re still not getting access. And, in fact, when we hear stories and reports saying that our prisons are overcrowded and the state has to release people, that all comes from that original lawsuit about getting access to healthcare. So, you know, I can’t speak to whether Texas inmates get better access but we certainly know in California the courts have ruled inmates aren’t getting good enough access.
CAVANAUGH: Now when you speak about this proposed legislation, the idea of medical parole for California inmates is not exactly new.
FARYON: No, Texas has been doing this for a number of years and similar legislation actually passed in the State of California through the legislature a number of years ago but was beat out by the then governor, Gray Davis. So it was something introduced. There wasn’t the political will at the governor’s level at the time to pass it. I think from the conversations I’ve had in the past week, there seems to be a lot more will to see this proposed legislation go through. It was introduced by Senator Leno. And I believe it’s in committee right now.
CAVANAUGH: I see. So, in other – so we’re talking about medical parole for prisoners who are basically incapacitated. They are being guarded by two prison guards in private hospitals. They’re on ventilators. They cannot move. And this new legislation would put GPS monitoring on them and allow them to move into a Medicare funded facility.
FARYON: That’s right. And it’s something that Clark Kelso, again, the Receiver, has been looking at for a while. When we did our original show, we went up to Sacramento and we spoke with him and that was in January. And at the time, they were just working on these statistics so these are fairly new numbers. And obviously one of the motivations for coming up with these numbers is to show legislators, look, we could save a lot of money by introducing something like medical parole. So at the time the legislation had not yet been introduced. It was something that he was talking about, something that his department was first just looking at the calculations. And back then they thought, well, you know, I think we could save a million dollars on some of these inmates. And I don’t even know that anyone back then, just a few months ago, had any idea how expensive some of these inmates really were and how many are actually being served in hospitals outside of the prison healthcare system. And I think if anybody goes to a private hospital and is in there for a few days, you can imagine what the medical bill is. Well, picture that now with these very sick inmates who perhaps are spending the last months of their lives in these hospitals.
CAVANAUGH: And the – you say the political will may be here now and people are speculating about that because of California’s terrible financial situation?
FARYON: Yes, $18 billion deficit—it was about $20 billion—I spoke with someone in the governor’s office last week and it looks like now it’s $18 billion. There’s – Pressure has been put on the Prison Health Services Department to actually cut $800 million from their $2 billion budget. That’s what the governor’s proposing they do. It’s an interesting story in terms of how he arrived at that figure. We talked about how much other states pay – spend per inmate. Well, the governor’s office actually did its own survey, found out that the State of New York spends $5500 per inmate on healthcare and said, you know what, California, if New York can do it for $5500, you can do it for that amount, too, and cut their budget by $800 million and said find a way now to save this amount of money, which is what the Receiver is doing. There’s also the idea of Telemedicine. That’s been introduced as well by the Receiver’s office. And that’s where the doctor’s not actually in the hospital but, you know, via, I don’t want to say Skype but via some satellite service, the doctor’s able to examine or diagnose the inmate. And I believe Texas and other states do that as well. So there are other models out there in terms of ways to save money and still treat inmates. And the one thing I should let people know is what the courts ruled is that it’s unconstitutional for inmates not to have access to healthcare. So I know we – our country’s gone through that big debate in terms of is healthcare a right or isn’t it a right? If you’re in state prison, it’s your right. You have the right to healthcare. So whether we like it or we don’t like it or whatever your political views are, that’s what the law says.
CAVANAUGH: And this medical parole proposal is now, as you say, in committee in the Senate?
FARYON: It is. This – And in order to achieve that $800 million savings of the $2 billion budget, it would have to be passed fairly soon. The budget has to be passed June 30th, I believe it is. Fiscal year starts in July. They don’t know if something like this would go through before then but it’s very likely around that time that they could see something like this pass.
CAVANAUGH: Joanne, thank you so much. I appreciate it.
FARYON: Thanks for having me, Maureen.
CAVANAUGH: I’ve been speaking with KPBS reporter Joanne Faryon. And if you would like to comment on anything you’ve heard, go online, KPBS.org/thesedays. Now, coming up, a new senior center in downtown San Diego wants to redefine senior wellness. That’s as These Days continues here on KPBS.