Prison Healthcare Costs Skyrocket In California

California is virtually living a hand-to-mouth existence, all the time bailed out by the federal government. But it is spending hundreds of millions of dollars a year on the healthcare of those convicted for violent crimes.

State Auditor Elain Howle notes in her report that billions of dollars are spent for those incarcerated under the “three strikes” law.

As of April 2009, 25 percent of the inmate population was incarcerated under the three strikes law, which requires longer sentences for individuals who are convicted of any felony and have been convicted previously of crimes defined in state law as serious or violent felonies, also known as strikes.

“As discussed in our prior report, we estimated that on average, these individuals' sentences are nine years longer because of the requirements of the three strikes law. In further analyzing the nature of the crimes for which striker inmates are incarcerated, we found that the current conviction for which many are imprisoned is not a strike. However, the longer sentences that striker inmates are receiving are based on their previous strikes. We also found that significant portions of the striker inmate population were convicted of committing multiple serious or violent offenses on the same day, and that some committed one or more serious or violent offenses as a juvenile,” the report said.

The report went on to point out, “A significant part of the overall cost to house inmates in Corrections' 33 institutions is inmate health care costs…. Our analysis of the specialty health care costs associated with specific inmates revealed that the majority of these costs for fiscal year 2007-08 were associated with a relatively small population of inmates. Specifically, among the inmates with specialty health care costs recorded in the CMD, 30 percent of the population cost more than $427 million, while the costs for the remaining 70 percent averaged slightly more than $1,000 per inmate. Further, just one-half of 1 percent of the inmates incarcerated during the year, or 1,175 inmates, incurred 39 percent of such costs in fiscal year 2007-08. We also found that of the nearly 15,800 inmates who incurred more than $5,000 in specialty care costs during fiscal year 2007-08, 63 percent were age 40 and older. In comparison, inmates age 40 or over represent only 41 percent of all inmates. We also found that the 72 inmates who died during the last quarter of fiscal year 2007-08 incurred, on average, $122,300 for specialty health care services for that fiscal year. Ranging from $150 for one inmate to more than $1 million for another, these 72 inmates accounted for $8.8 million in specialty health care costs during fiscal year 2007-08.”

The report urged said the state, and the federal receiver overseeing health care in California's prisons, should continue to explore cost-saving measures, including an early release program for terminally ill or incapacitated inmates.

State Sen. Mark Leno, D-San Francisco, has introduced a bill with the backing of the federal receiver that would allow inmates, who do not pose a public safety threat and are incapacitated, to be "medically" paroled. The measure, SB1399, could be taken up for a vote on the Senate floor as soon as Thursday.

Leno said the audit illustrates the need for medical parole, noting that the state now spends more than 10 percent of its general fund on state prisons - a portion that has more than doubled since 2003. He also said he was struck by Howle's finding that the state spends about $132 million a year on overtime for prison guards who transport and guard ill inmates, many of whom are nonambulatory, because the state does not plan ahead for those costs.

"We can't afford to squander taxpayer dollars the way we currently are," Leno said. "There's a better way to do business - 36 other states are doing (medical parole), Texas is leading the way. ... This audit makes a strong case that our system can be run more efficiently."

Leno told Marisa Lagos of the San Francisco Chronicle that if California inmates were released, the cost of their care would largely be borne by the federal government through programs such as Medi-Cal and Social Security.

The state's prison health care system is under the control of a federal receiver and has been since 2006, when a judge ruled that substandard treatment was killing about one inmate a week and violating the constitutional ban on cruel and unusual punishment. The receiver, J. Clark Kelso, said Tuesday that the audit is "helpful" and addresses many of the issues he has attempted to tackle, including containing costs.