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Article published Jan 29, 2006

The price of punishment

California's prisoners are aging and taxpayers are paying for their medical care. As costs and inmate populations rise, the debate over keeping elderly, infirm convicts locked up grows louder.

Clyde Hoffman dragged his legs over the side of his prison bed and slowly sat up.

The 81-year-old with green eyes and bushy white eyebrows looked up excitedly as a visitor stepped into his hospice room at the California Medical Facility, a Vacaville correctional hospital where terminally ill prisoners go to die.

Hoffman, who has both lung cancer and heart disease, put an inhaler to his mouth. He sucked in deeply, the inhaler's hiss filling an otherwise silent room. Outside, in other prison corridors, loud voices echoed amid the noise of clanking steel gates.

The Michigan native worked construction in Manteca for a bit in the late 1960s. Dozens of odd jobs later, police arrested him in 1990 for the fatal shooting of his girlfriend in their Merced trailer during a drunken rage. Hoffman said he remembers seeing her lying on the couch, covered with a blanket, and then nothing else until he heard police banging on the trailer door.
He's serving a 20-year sentence for second-degree murder and for the past two years he has waited for death.

"I don't read anymore," he said. "Was doing some oil painting, but don't do that no more. I can't see too good. Shaky."

Hoffman is one of a growing number of elderly inmates under the care of the California Department of Corrections and Rehabilitation.

These prisoners - men and women who often look more like frail senior citizens than heinous criminals - drive up costs and contribute to the crowding of state prisons.

Calls for change are growing louder. Critics say California is the least prepared of all the states to confront its graying inmate population.
Those critics blame prison officials for not anticipating the burgeoning elderly population. Some, like state Sen. Gloria Romero, who chairs a Senate committee on prisons, propose letting out the oldest, least risky convicts.

"Our prisons in a sense are becoming nursing homes," the Los Angeles Democrat said, adding that tax dollars now spent on elderly prisoners would be better used in other areas, such as education.

"I'm not saying open the door and let them out," she said. "Let's do the risk assessment. We can't lock them away and say everything is OK."
The growing problem
The percentage of California inmates age 60 and older has tripled in the past 25 years, according to a Record analysis of data from the Department of Corrections and Rehabilitation. These older prisoners now comprise more than 2 percent of California's total prison population. In 1981, elderly prisoners accounted for less than 1 percent of the total prison population.

The average age of inmates has risen from 28 to 37 in the past quarter-century, according to the state.

Officials attribute the growing number of elderly prisoners to the aging baby-boom generation and the 1994 passage of the three-strikes law, which was designed to keep violent repeat offenders imprisoned.

The trend is expected to continue for at least a decade - the first round of third-strike convicts won't be eligible for parole until 2014, according to the Legislative Analyst's Office.
The state isn't sure exactly how much it spends overall on housing and caring for the oldest prisoners. But state officials estimate that an average prisoner costs California about $35,000 a year and that elderly inmates, who require more care, cost an average of $70,000. Using those estimates, the state would spend 4.1 percent of its prison budget on 2.1 percent of the prisoners.

It's not only the very oldest prisoners who drive up health-care costs. Even those around age 60 can be costly because the hardness and stress of prison life tends to age them faster, causing health problems that are more common for someone 10 to 15 years older, said Jonathan Turley, a George Washington University law professor and founder of the Project for Old Prisoners. His organization advocates for the release of elderly inmates serving time for nonviolent crimes.

Turley said California prison officials have fallen far behind other states in coming up with ways to handle its aging inmate population. Alabama, for example, has a 200-bed facility for the old and sick, which Turley called a "classic geriatric" unit.

Releasing elderly, nonviolent prisoners could ease runaway costs and a bulging prisoner population, he said.
One of California's primary problems, Turley believes, is that California does not have a system of inmate geriatric centers. Instead, the oldest prisoners are spread out among the state's 33 prisons. That makes it difficult to develop targeted programs from rehabilitation efforts to geriatric health-care services. As a result, expensive California prisons often house some of the least risky elderly inmates, he said.

"It's a system that is at war with itself," Turley said.
Health-care costs
Jamie Gonzalo isn't the man he was 40 years ago.
He is withering away. Doctors amputated his legs below his knees in 2003. Diabetes had damaged his body's ability to circulate blood to his legs. His mind is feeble, and he can't recall where he lived before he was sentenced in 1965. His hospital cell is dim and smells like urine. A bundle of letters from his wife has a Modesto post office box for a return address.

A nurse outside his room whispered that Gonzalo, 60, once ruled as a prison kingpin. Today he lives at Vacaville's California Medical Facility, the same prison that holds Clyde Hoffman.

The Department of Corrections and Rehabilitation this year will spend an all-time high $1.1 billion on inmate health care, an amount that has doubled in the past seven years, according to state budgets. Next year, prison officials propose spending $1.2 billion on health care.

Gonzalo entered prison in 1964 to serve a sentence for a car theft conviction. He earned a life term after killing a fellow inmate. His prison sentence guaranteed him medical care.
This debate surfaced nationally as California prepared to execute Clarence Ray Allen, a 76-year-old murderer who had been kept alive only to die from a lethal injection Jan. 17. He had been revived after a nearly fatal heart attack in September and was also treated for diabetes, which caused partial blindness.

Joe McGrath, a chief deputy for the state Department of Corrections and Rehabilitation, said rising health-care costs affect the nation's elderly. California prison officials like him aren't the only ones having to grapple with it.

Often, however, the debate isn't over whether inmates receive too much care. A federal judge in June ordered the prison health-care system to be placed under the federal court's control, calling it "broken beyond repair." He cited the fact that an inmate needlessly dies on average every six or seven days because of the poor health-care system.

Joe Bick, chief medical officer at the California Medical Facility, said he believes $1 billion for inmate health care is reasonable, considering the poor health of inmates entering prison.
Prisoners often have been shot, stabbed, jumped from buildings or ground down their teeth from years of methamphetamine addiction. Once in prison, they receive vaccinations and treatment for chronic illnesses.

Medi-Cal or Medicare would have to pay their hospital bills if they weren't in the prison system, Bick reasoned, estimating that taxpayers spend less than $5,000 a year on most inmates' health care.

"From my point of view, its not an issue of prisoners across the country getting too much care," Bick said. "It's too many Americans who don't get any care."
Quality of life
State Sen. Jeff Denham, R-Merced, sits on the Senate prisons committee with Romero. He wants inmates to get basic medical care - no more and no less. That means no heroic lifesaving care for an elderly prisoner on death row, for example.
He worries inmates get "Cadillac medical care" while his constituents sometimes struggle to get regular checkups. Prisoners get free prescriptions, regular exams, X-rays and free operations.

Yet that doesn't mean early release is an option, Denham said.

"You can't just commute a sentence because of illness or age when their victim is still suffering or dead," Denham said.

Jane Alexander agrees.
She wants her aunt's murderer - Tom O'Donnell, 78 - to die inside the Correctional Training Facility in Soledad.

Alexander co-founded the national organization Citizens Against Homicide, whose members attend parole hearings to argue against inmates' release.

She doesn't care how much it costs to keep O'Donnell locked up.

"He should stay there until he comes out in a box, feet first," said the Marin County woman.
She also doesn't have any sympathy for the 3,400 women at the Central California Women's Facility in Chowchilla.

Colorful landscaping in front of the Central Valley prison's perimeter makes it look like a college campus. One day in October, a few female inmates with gardening tools and thick gloves tended a patch of rose bushes. Heavy gates and security checkpoints remind visitors that this is a state prison.

Joan Kathleen Starr, 75, sat in the doorway of her cell and smiled kindly. A shower cap covered a head full of curlers. She struggled to hear over the clanking background noise of a busy cellblock.

"I pray every night that my family will have forgiveness and compassion for me," she said in a high, lilting voice. After her arrest at age 59 in Los Angeles County, she was sentenced to life for the attempted murder of her husband.
Starr said she stood over her husband with a gun ready to shoot but stopped only because of her fear of God. She struggles to recall that night and won't say what drove her to threaten murder.

She doesn't often see her daughter, two sons or eight grandchildren.

"I want to see them, you know? I don't see them in here," she said. "I want to have some kind of relations before I die because I'm 75 and I'm not going to live forever."

She has been denied parole five times.
No simple answers
California's prison problems won't end soon. Legislators, nonprofit groups and prison officials each propose different ways to deal with them.

Among the most controversial is a plan to privatize the housing and care for elderly inmates. Correctional officials have spoken informally with the Houston-based Cornell Cos.

The private company can build and run prisons faster and for up to 20 percent less than the government because it has a more streamlined operation, said Paul Doucette, a Cornell spokesman.
For her part, Sen. Romero wants to change sentencing rules so that fewer nonviolent offenders - like drug abusers - are given near-life terms. And, she said, the elderly inmates who committed violent crimes should be allowed to finish their sentences outside traditional prison cells.

Yet some prison officials sound a warning about letting prisoners out just because they are elderly. Often, their families can't care for them and there aren't enough nursing homes willing to take them, said McGrath, the state prisons deputy.

There are other solutions under consideration.

At Vacaville's California Medical Facility, Warden Teresa Schwartz oversees a special pilot program for 27 elderly inmates who live in a part of the prison run like a convalescent home. It could become a model for other prisons, Schwartz said.
"We're moving slowly to make sure we're doing it right," Schwartz said.

But until lawmakers agree on a solution, people like Vacaville inmate Hoffman will continue to live out their years under taxpayers' care. The 81-year-old Hoffman claims he's no threat to society.

He'd like to spend his last days home with his family - four children, 24 grandchildren and two great-grandchildren. But he knows that's probably not going to happen. Life could be worse, said Hoffman, the oldest of seven in the hospice unit during a recent visit.

He's settled into his room deep inside the prison, a room cluttered with Styrofoam lunch boxes and tubes of medical cream. The door doesn't lock, but a prison guard hovers nearby.
"This is good, you know," Hoffman said. "For being in prison, this is terrific."

Contact reporter Scott Smith at (209) 546-8296 or  ssmith@recordnet.com